Objective To study the method and safety of coagulation factor replacement in patients having fracture with hemophilia. Methods Five male hemophilia patients with fractures were treated, and the mean follow-up period was 9 months. Under the cooperation with the hematology department. Monitored levels of factors Ⅷ and Ⅸ perioperatively, and established routine process of factor replacement, according to the China guideline of Hemophilia dialogue and tre atme nt. Results Hemophilic patients who had undergone therapy of perioperative coagulation factor replacement could suffer treatment of fractures. All patients had no complications such as hematoma, infection. But one patient firstly accepted operation, after 4months, the plate was broken, proformed conservative treatment. Conclusion Coagulation factor replacement and monitoring of coagulation factor levels are the key to the success of treament in hemophilic fracture patients.

Objective:To explore surgical techniques and summarize surgical experience of the paraumbilical flap pedicled with deep inferior epigastric vessels for the repiration of soft tissue defects in pelvic area.Methods:Between August, 2006 and August, 2018, 8 patients with soft tissue defects and bone exposure were treated with paraumbilical flap pedicled with deep inferior epigastric vessels. There were 6 males and 2 females with the average age of 35.3 (range, 12-47) years. The defects were caused by car accident in 5 cases, by high falling injury in 1 case, by soft tissue necrosis after malignant schwannoma resection in 1 case, and by soft tissue necrosis after pelvic operation of open reduction internal fixation in 1 case. The defects located at iliac spine in 5 cases, at tuber ischii in 1 case, and at buttock and perineal region in 1 case. The size of the wounds ranged from 11.0 cm×6.0 cm to 22.0 cm×8.0 cm. The size of the flaps ranged from 13.0 cm×7.0 cm to 29.0 cm×12.0 cm. The followed-up was made by outpatinet service, telephone or WeChat.Results:All flaps survived, and the wound infection was controlled. The followed-up time ranged from 12 to 46 (mean 26) months. All flaps survived uneventfully, and the texture and elasticity of the flaps were good. There were no recurrence of infection, and no ventral hernias occurred in donor sites.Conclusion:The transfer of paraumbilical flap pedicled with deep inferior epigastric vessels is a reliable method to repair large soft tissue defects in iliac spine, perineal region, buttock and tuber ischii.

Objective: To compare pedicle screw internal fixation (PSIF) and subcutaneous anterior pelvic internal fixation (APIF) in the treatment of pelvic anterior ring fractures. Methods: A retrospective study was conducted of a consecutive series of 46 patients who had undergone surgery for anterior ring pelvic fractures at Department of Orthopaedic Surgery, The People’s Hospital of Henan Province from January 2014 to September 2018. Of them, 20 were treated by PSIF and 26 by APIF. In the PSIF group, there were 12 males and 8 females with an age of 47.8±2.4 years, and 6 cases of B1, 9 cases of type B2, 4 cases of type B3 and one case of type C1 by the Tile’s classification; in the APIF group, there were 16 males and 10 females with an age of 49.6±1.2 years, and 9 cases of B1, 8 cases of type B2, 5 cases of type B3, 2 cases of type C1 and 2 cases of type C2 by the Tile’s classification. The 2 groups were compared in terms of surgical or postoperative complications (including iatrogenic nerve injury, infection, implant failure and fracture nonunion), fracture reduction and therapeutic efficacy at the final follow-up. Results: There were no significant differences between the 2 groups of patients in their preoperative general data, indicating they were compatible(P>0.05). The 46 patients were followed up for 9 to 18 months (mean, 13.5 months). In the PSIF and APIF groups, the incidences of injury to the lateral femoral cutaneous nerve were 5.0%(1/20) and 7.7%(2/26), those of infection 5.0%(1/20) and 3.8%(1/26), and those of skin discomfort 5.0% (1/20) and 7.7%(2/26), respectively. According to the Matta criteria, the fracture reduction at the last follow-up was evaluated as excellent in 7, as good in 11 and as fair in 2 in the PSIF group, giving an excellent and good rate of 90.0%, and as excellent in 9, as good in 13 and as fair in 4 in the APIF group, giving an excellent and good rate of 84.6%. According to the Majeed criteria, the pelvic function at the final follow-up was evaluated as excellent in 10, as good in 7, as fair in 2 and as poor in one in the PSIF group, giving an excellent and good rate of 85.0%, and as excellent in 13, as good in 10, and as fair in 3 in the APIF group, giving an excellent and good rate of 88.5%. There were no significant differences between the 2 groups in all the comparisons above (P>0.05). The incidence of femoral nerve parasthesia was 0(0/20) for the PSIF group, significantly lower than that for the APIF groups (3.8%, 1/26) (P<0.05). Conclusion As both PSIF and APIF lead to similar clinical efficacy in the treatment of pelvic anterior ring fracture, either of them can be selected as an appropriate surgical procedure depending on the patient’s situation and surgeon’s experience.