Objective To evaluate the mid-term effect of total hip arthroplasty (THA) after failed internal fixation of intertrochanteric fracture.Methods Twenty-one patients treated with THA due to failed internal fixation of intertrochanteric fracture from January 2007 to December 2010 were studied retrospectively.There were 10 males and 11 females,at mean age of 71.7 years (range,66-79 years).Sixteen patients were treated with dynamic hip screws/dynamic condyle screws (DHS/DCS),3 proximal femoral nails,2 hollow screws.Mean interval from internal fixation to THA was 29 months (range,10-79 months).Causes for the failed internal fixation were loosening,cutting,and breakage of screws which generated fracture displacement or nonunion in 19 patients and femoral head necrosis in 2 patients.All patients received THA with uncemented acetabulum cups and proximally long-stemmed,porous-coated titanium femoral components including AML stems for 5 patients and Solution stems for 16 patients.Moreover,greater trochanteric fracture was fixed by Luke wire.Harris hip score were measured before operation and at final follow-up.Radiographs were performed before operation,at 3,6 and 12 months after operation,and at final follow-up to assess the fracture restoration,healing,prosthesis initial fixation,and mid-term survival condition.Results One patient was died due to pulmonary infection 1.5 years after operation.Two patients were lost to follow-up and 18 patients were followed up for 3-5 years (mean,3.9 years).At final follow-up,13 patients regained the ability to walk independently,4 needed support of a cane,1 needed assistance of a walker.There were no signs of loosening,subsidence or rupture of the prosthesis.Mean Harris hip score increased from 25.3 points preoperatively to 80.6 points at final follow-up; the score was excellent in 11 patients,good in 6,good in 1,with the excellent and good rate of 94％.Conclusion THA can improve hip function,patients' quality of life and midterm outcome in salvage of failed internal fixation of intertrochanteric fractures.

BACKGROUND:Humeral supracondylar fracture is a common fracture occurred in children. The selection of internal fixation for humeral supracondylar fracture remains controversial. OBJECTIVE:To compare the biocompatibility between internal fixation with Kirschner wire and bioabsorbable implants for humeral supracondylar fractures. METHODS: From January 2007 to January 2013, 246 cases of humeral supracondylar fractures, from Affiliated Hospital of Luzhou Medical Colege, were treated by internal fixation with Kirschner wire. Meanwhile, the studies on internal fixation for treating supracondylar fracture of humerus in children were searched. Efficacy was evaluated by preoperative and postoperative elbow range of motion and the incidence of cubitus varus, and the results were statisticaly analyzed, and compared with other therapeutic methods. RESULTS AND CONCLUSION:Al cases were folowed up for 6-36 months, averagely 18 months. According to Mayo elbow performance score, function of the elbow joint was excelent in 194 cases, and good in 48 cases, with good and excelent rate being 98.4%. Four cases suffered < 5° cubitus varus, with incidence rate of 1.63%. The internal fixation with Kirschner wire provided functional recovery of elbow joint, but the second stage operation was needed to pick out the wires. And it might be perplexed by Kirschner wire loosening or needle withdrawal, resulting in instable fixation. Bioabsorbable implants were effective in the treatment of supracondylar fracture of humerus. Bioabsorbable sticks would break down over time, without harming to human body or influencing imaging examination. Elbow function development of the epiphysis would not be affected. However, due to lack of large-sample observation, long-term effects of bioabsorbable implants for treating supracondylar fracture of humerus in children deserve further studies.

BACKGROUND: Tibia open fracture is a common disease, and intramedullary fixation has become the first choice, but the high risk of postoperative infection limits its clinical application.OBJECTIVE: To investigate the early prevention effect of vancomycin-hydroxyapatite (VCM-HA) coated titanium intramedullary nail in a rabbit model of open femoral fracture combined with wound infection.METHODS: Titanium intramedullary nails coated with three different concentrations of VCM-HA were prepared using biomimetic deposition, and subsequently in vitro bacteriostasis experiment was performed. Forty healthy male New Zealand white rabbits were selected and the model of mid-femur open fracture with wound infection was prepared. The rabbit models were then divided into ordinary intramedullary nail, low-, middle- and high-concentration VCM-HA coated intramedullary nail groups (n=10 per group). The wound appearance of the animals was dynamically observed. The body mass, anal temperature, white blood cells and C-reactive protein contents in the venous blood were monitored. The pathological examination of the soft tissue around the fracture and injured limb X-ray were conducted regularly.RESULTS AND CONCLUSION: The prepared VCM-HA coated titanium intramedullary nail exerted obvious antibacterial effects in vitro. The anal temperature in the ordinary nail group was significantly higher than that in the other three groups at 3 days after modeling (P < 0.05). The white blood cells and C-reactive protein contents in the venous blood in the VCM-HA groups were significantly lower than those in the ordinary nail group at 3, 7, 14 and 28 days after modeling (P < 0.05). The hematoxylin-eosin staining of the peripheral tissues displayed the inflammatory response in the VCM-HA groups was milder than that in the ordinary nail group at each time point after modeling. The injured limb X-ray displayed that the callus grew slowly accompanied with sequestration in the ordinary nail group, while the callus growth in the VCM-HA groups was significantly better than that in the ordinary nail group. To conclude, the VCM-HA coated intramedullary nail can effectively reduce postoperative infection in an animal model of open femoral fracture combined with wound infection.

Objective To evaluate the clinical effects of open reduction plate screw nail internal fixed and minimally invasive elastic intramedullary nail internal fixation combined with neck strap suspension for treating adult humeral shaft fracture . Methods A retrospective analysis was made on the clinical data of 65 patients with humeral shaft fracture in our hospital from March 2012 to March 2014 ,including 38 cases of open reduction plate screw internal fixation (plate screw nail fixation group) and 27 cases of limited open or closed reduction elastic intramedullary nail internal fixation combined with neck strap suspension (elastic intramedullary nail group) .The operation time ,intraoperative blood loss amount ,iatrogenic radial nerve injury ,occurrence rate of incision infection ,postoperative fracture reduction degree ,fracture recovery time and elbow joint function score were compared be‐tween the two groups .Results The operation time and intraoperative bleeding volume in the elastic intramedullary nail group were less than those in the plate screw nail fixation group ,the differences were statistically significant (P<0 .05);the postoperative frac‐ture healing rate had no statistically significant difference between the two groups (P>0 .05) ,the postoperative shoulder and elbow joint function scores in the plate screw nail group were significantly higher than those in the elastic intramedullary nail group ,the difference was statistically significant (P<0 .05) .No serious nerve damage ,incision infection and other postoperative complications occurred in the two groups .Conclusion Both the open reduction plate screw nail internal fixation and elastic intramedullary nail in‐ternal fixation are effective method for treating adult humeral shaft fracture ,the latter has shorter operation time ,less intraoperative bleeding ,but shoulder elbow pain and limitation of motion are more serious than the former .

BACKGROUND:Acupuncture has been found to be effective for alleviating low back pain and acute pain due to knee arthritis, but its effect on chronic pain is under discussion. OBJECTIVE:To investigate the mechanism underlying electroacupuncture (EA) alleviating chronic pain in a New Zealand rabbit model of knee arthritis. METHODS:(1) Thirty-two New Zealand rabbits were selected, and the knee osteoarthritis model was established by injecting 4% papain into the knee articular cavity of rabbit's bilateral hind limbs. The model rabbits were randomly divided into four groups (n=8 per group): normal saline plus EA, normal saline plus sham EA, nor-Binaltorphimine (nor-BNI) plus EA, and nor-BNI plus sham EA groups. The dosage of nor-BNI was 1 mg/kg, once daily, for consecutive 3 days. 30-minute EA was given at 2 hours after administration, once daily, until the day the rabbits were killed. Sham EA indicated no given electric current. The behaviors of the lower limbs were evaluated by Basso, Beattie, Bresnahan scores. The rabbits were respectively killed at 1, 3, 5 and 7 days after administration, the spinal cord was separated, and then fixed with formaldehyde. The expression levels of interleukin-17, interleukin-17 receptor A and NR1 in the spinal cord tissues were detected by immunofluorescence. (2) The other 24 New Zealand rabbits were randomly divided into model and control groups (n=12 per group), and the knee osteoarthritis model was established in the former group. Afterwards, the two groups were randomized into two subgroups, followed by given the intrathecal administration of normal saline, or 2 μg interleukin-17 antibody serum dissolvedin 10 μL normal saline, once daily, for consecutive 3 days. The behaviors of the lower limbs were evaluated by Basso, Beattie, Bresnahan scores, and the expression levels of p-NR1 and interleukin-17 receptor were detected by western blot assy. RESULTS AND CONCLUSION:The Basso, Beattie, Bresnahan scores in the nor-BNI plus EA group were significantly increased, while the expression levels of interleukin-17, interleukin-17 receptor A and NR1 in the spinal cord tissues were significantly decreased (P< 0.05). The expression level of NRI did not differ significantly between nor-BNI plus EA and nor-BNI plus sham EA groups (P> 0.05). After administration of interleukin-17 antibody serum, the Basso, Beattie, Bresnahan scores in the model group was significantly increased, and the expression levels of interleukin-17 and NR1 in the spinal cord tissues were significantly decreased, but still significantly higher than those in the control subgroups (P< 0.05). These results suggest that chronic pain in knee arthritis is the result of an increase in the expression level of NRI induced by interleukin-17. EA can remarkably improve the pain in the model rabbits of knee arthritis by downregulating interleukin-17 in the spinal cord tissues, rather than interleukin-17 receptor.