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Treatment of Sanders' type Ⅲ intra-articular fracture of the calcaneus using a small dorsolateral incision

Chinese Journal of Orthopaedic Trauma.2014;16(12):1043-1048. doi:10.3760/cma.j.issn.1671-7600.2014.12.007

Objective To investigate the operative treatment of Sanders' type Ⅲ displaced intra-articular fractures of the calcaneus using a small dorsolateral incision.Methods From October 2006 to April 2012,90 patients with displaced intra-articular calcaneal fracture of sanders' type Ⅲ were treated by open reduction and internal fixation through a small dorsolateral incision at our department.The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal.They were 69 men and 21 women,aged from 17 to 61 years (average,39 years).On the right side were 49 cases and on the left side 41 cases.According to Sander's classification,26 fractures were of type Ⅲ AB,36 of type Ⅲ AC and 28 type Ⅲ BC.The displacements of articular facet were all larger than 1 mm.The foot functions were evaluated before and after operation by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system.Results For each patient,4 to 6 calcaneal cannulated screws of 4.0 mm and 2 full threaded screws of 6.5 mm were used.No incision infection,skin necrosis or injury to the posterior tibial nerve or vessels occurred after surgery.Seventy-six patients were followed up for 10 to 56 months (average,20.5 months).Clinical union was achieved after 8 to 12 weeks (average,9.5 weeks).The lateral and axial X-ray films of the calcaneus at the last follow-up showed fine reduction and fixation of the fracture fragments and significant improvements in the length,width,height,and B(o)hler and Gissane angles of the calcaneus compared with the preoperation (P ＜ O.05).The ankle and hindfoot scored 70 to 100 AOFAS points at the last follow-up.Forty-five cases were excellent,24 good,5 fair and 2 poor (excellent to good rate of 90.8％).Follow-up observed no infection,nonunion or osteomyelitis.Conclusion Open reduction and internal fixation through a small dorsolateral incision is a good option for Sanders' type Ⅲ calcaneus fractures with a displacement of more than 1 mm,because it leads to minimal soft tissue damage,excellent exposure and convenience for later removal of internal fixators and subtalar arthrodesis.

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Targeted migration of glycosylated bone marrow mesenchymal stem cells in bone defect models

Xin OU ; Xiaobin TIAN

Chinese Journal of Orthopaedic Trauma.2015;17(1):75-81. doi:10.3760/cma.j.issn.1671-7600.2015.01.018

Objective To observe the targeted migration of glycosylated bone marrow mesenchymal stem cells (BMSCs) in rabbit bone defect models.Methods A New Zealand rabbit of 2 months old and 1.5 kg in weight was used to separate,extract and amplify BMSCs.α-1,3 fucosyltransferase Ⅵ (FUT-6) gene was transfected to the BMSCs by liposome method to screen the positive clone cell lines.ELISA was used to detect FUT-6 expression and Sialyl Lewis X (sLeX) of FUT-6/BMSCs and BMSCs.Flow cytometry was used to detect the binding force of FUT-6/BMSCs and BMSCs with E/P selectin.FUT-6/BMSCs and BMSCs were labeled with eGFP in vitro and then intravenously re-infused respectively to 2 equal groups of bone defect models made of 12 New Zealand rabbits.Fluorescence microscopy was used at 6,12 and 24 hours postoperation to observe the number of labeled cells in the medullary cavity tissue at the bone defect sites to evaluate the targeted migration.Results BMSCs were amplified by in vitro culture.Transfected BMSCs expressed a significantly higher level of FUT-6,and increased significantly generation of sLeX (P ＜ 0.05).Compared with BMSCs,FUT-6/BMSCs had an obviously higher binding force with E/P selectin (15.0％ and 12.7％ versus 68.9％ and 59.7％).Fluorescence microscopy at 6,12 and 24 hours showed that there were significantly more FUT-6/BMSCs than BMSCs in the medullary cavity tissue at the bone defect sites (P ＜ 0.05).Conclusion Glycosylated BMSCs possess an obvious ability to migrate to the sites of lesion.

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Oblique and non-oblique cannulated screwing for senile femoral neck fractures: a comparative study

Xi XIA ; Zhi LIU

Chinese Journal of Orthopaedic Trauma.2015;17(2):108-113. doi:10.3760/cma.j.issn.1671-7600.2015.02.005

Objective To compare the clinical outcomes between oblique and non-oblique fixation with cannulated screws for femoral neck fractures in the elderly patients.Methods Totally 189 patients of over 65 years old were treated for femoral neck fracture from June 2007 to October 2013 at our department.Oblique fixation with cannulated screws was used in 130 cases.They were 43 males aud 87 females with an average age of 77.8 ± 7.5 years.According to Garden classification,40 cases were of Garden types Ⅰ and Ⅱ (undisplaced fractures),and 90 of Garden types Ⅲ and Ⅳ (displaced fractures).Of them 26 were Pauwells type Ⅲ.Non-oblique fixation with cannulated screws was conducted in 59 cases.They were 24 males and 35 females with an average age of 75.5 ± 8.2 years.According to Garden classification,12 cases were of Garden types Ⅰ and Ⅱ (undisplaced fractures),and 47 of Garden types Ⅲ and Ⅳ (displaced fractures).Of them,15 were Pauwells type Ⅲ.The fracture union,postoperative complications,rate of reoperation and Harris scores at the last follow-up were compared between the 2 groups.Results All the 189 patients were followed up for 10 to 38 months (average,17.4 months).The oblique fixation led to a union rate of 99.2％ (129/130),a fixation failure rate of 3.1％ (4/130) and a femoral head necrosis rate of 2.3％ (3/130),which were not significantly different from those resulted from the non-oblique fixation [98.3％ (58/59),10.2％ (6/59) and 5.1％ (3/59) respectively] (P ＞ 0.05).However,the rate of femoral neck shortening [35.4％ (46/130)] and the reoperation rate [3.1％ (4/130)] in the oblique fixation group were significantly lower than those in the non-oblique fixation group [50.8％ (30/59) and 15.3％ (9/59) respectively] (P ＜ 0.05).The mean Harris hip score at the last follow-up for the oblique fixation(75.7 ± 14.3) was significantly higher than that for the non-oblique fixation (70.8 ± 16.7) (P ＜ 0.05).Conclusion As oblique cannulated screwing can reduce the rates of femoral neck shortening and reoperation to some extent,it may be a better fixation choice than the non-oblique cannulated screwing for femoral neck fracture in elderly patients.

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Effect of postural reduction and balloon dilation on correction of vertebral height by percutaneous balloon kyphoplasty

Kai ZHANG ; Ou WANG ; Long JIA ; Liming CHENG

Chinese Journal of Orthopaedic Trauma.2015;17(3):209-212. doi:10.3760/cma.j.issn.1671-7600.2015.03.006

Objective To explore the effect of postural reduction and balloon dilation on the correction of vertebral height following balloon percutaneous kyphoplasty (PKP) for osteoporotic vertebral coinpressive fracture (OVCF).Methods From June 2012 to December 2013,47 OVCF patients involving 57 fractured thoracolumbar vertebrae with intact posterior wall underwent PKP.In all patients postural reduction was performed under general anesthesia.The percentages of vertebral height loss before and after balloon dilation were compared.The curative effects were evaluated by comparing preoperative and postoperative visual analogue scale(VAS) scores and cobb angles.Results Compared with preoperation,the vertebral heights of anterior and middle columns were significantly improved after postural reduction,balloon dilation and PKP (P ＜ 0.05),but there was no significant improvement before and after balloon dilation (P ＞0.05).The postoperative average cobb angle (22.8°± 8.1°) was significantly decreased compared with the preoperative one (22.8° ± 8.1°) (P ＜ 0.05).The VAS scores at preoperation,one day postoperation and the final follow-up were respectively 8.5 ± 0.4,3.4 ± 0.2 and 3.1 ± 0.3.The postoperative ones were significantly lower than the preoperative one (F =7.518,P =0.006).Conclusions In PKP,postural reduction under general anesthesia plays an important role,but balloon dilation may exert an insignificant effect on restoration of vertebral height.

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A finite element analysis of six-segment classification of femur intertrochanteric fracture

Zhenyuan CHEN ; Kainan LI ; Zhixi ZHANG

Chinese Journal of Orthopaedic Trauma.2015;17(5):433-437. doi:10.3760/cma.j.issn.1671-7600.2015.05.014

Objective To explore the mechanism of six-segment classification of femur intertrochanteric fracture in a three-dimensional finite element model of upper thigh-bone and its clinical relevance.Methods The left upper thigh-bone of a normal male volunteer of 60 years old was scanned using 64-slice CT.After the images were stored in the format of JPG,they were input into photoshop 7.0 for three-dimensional creation.The three-dimensional images were used to make a three-dimensional finite element model of upper thigh-bone using software Super 93.The model consisted of 764 nodes and 531 units (including 306 compact bone units and 225 cancellous bone units).In this model,the stress distribution at the trochanter during human tumbling was analyzed by imitating adduction,abduction,adduction-intemal rotation and abduction-external rotation of the hip,as well as intense muscular contraction of gluteus medius,piriformis and iliopsoas during adduction-internal rotation of the hip.Results Analysis of stress nephogram showed that the stress was distributed mainly at the exterior cortical bone and spread to the inter-trochanteric part in simple hip adduction (two-part fracture) and distributed mainly at the interior cortical bone and spread to the inter-trochanteric part in simple hip abduction (two-part fracture).In adduction-internal rotation or abduction-external rotation of the hip,the stress was focused on the anterior and posterior walls of the greater trochanter and trochanteric part and spread to the exterior and interior cortical bone and the inter-trochanteric part (three-or four-part fracture).During intense muscular contraction of gluteus medius,piriformis and iliopsoas during adduction-internal rotation of the hip,the stress was focused on the anterior and posterior walls of the greater trochanter,lesser trochanter and trochanteric part and spread to the exterior and interior cortical bone and the inter-trochanteric part (five-or six-part fracture).Conclusions The six-segment classification of femur intertrochanteric fracture explains complex stress distributions after human falling.When combined with three-dimensional CT reconstruction,it is more intuitive than other classifications so that it can provide more definite surgical advice for different types of fracture.

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Impact of ruptured tibiofibular syndesmosis on biomechanics of the ankle joint

Weiqiang DONG ; Bin YU ; Bo BAI

Chinese Journal of Orthopaedic Trauma.2015;17(6):532-535. doi:10.3760/cma.j.issn.1671-7600.2015.06.016

Objective To explore the impact of partial or complete rupture of the tibiofibular syndesmosis on the biomechanical properties of the ankle joint.Methods Six fresh cadaveric specimens of adult ankle were used for creation of 3 models of tibiofibular syndesmosis.In model A,the medial and lateral ligaments of the ankle joint and the tibiofihular syndesmosis were intact.In model B,only the anterior lower tibiofibular ligament was broken.In model C,all inferior tibiofibular ligaments were broken.The 3 models were tested with an electronic pressure sensor in a BOSE material testing machine respectively at 5 positions:10° dorsal extension,20° inversion,20° eversion,20° plantar flexion,and neutral position.The peak values and locations of the compressive stresses of the 3 models at 5 positions were recorded.All the data were collected and analyzed using IBM SPSS 22.0 statistical software.Results Model A exhibited the smallest average stress at all the 5 positions,followed by model B and model C,with significant differences between groups (P ＜ 0.05).The locations of main compressive stress at the neutral position,10° dorsal extension,and 20° plantar flexion in model B and model C tended to expand outwards compared with model A,especially in model C.Conclusions Rupture of the anterior lower tibiofibular ligament and inferior tibiofibular ligaments may increase the compressive stress on the ankle joint,especially rupture of the inferior tibiofibular ligaments.The location of main compressive stress tends to expand outwards when the anterior lower tibiofibular ligament and inferior tibiofihular ligaments are broken,especially the inferior tibiofibular ligaments.

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An anatomical study of the medial femoral circumflex artery based on three-dimensional computerized tomographic angiography

Guohua XU ; Gang WANG

Chinese Journal of Orthopaedic Trauma.2015;17(2):165-169. doi:10.3760/cma.j.issn.1671-7600.2015.02.017

Objective To characterize the medial femoral circumflex artery based on three-dimensional computed tomographic angiography (3DCTA) so as to provide anatomical aids for diagnosis and treatment of hip injuries.Methods To do this research the 3DCTA data of 103 patients (206 hips) were collected who underwent 3DCTA from March 2012 to June 2014 for examination of the pelvis and lower extremities.They were 55 men (mean age,54.7 ± 15.9 years) and 48 women (50.0 ± 16.1 years).① The origin and course of the medial femoral circumflex artery was observed.② The length of the artery trunk was measured.The distances between the origin(A) of the artery to the main anatomical marks [the peak of greater trochanter (B),the inward peak of lesser trochanter (C),and the crosspoint (D) of the femoral artery and the pubic edge or the acetabulum inlet edge] were measured.Comparisons of the measurements were conducted between genders.③ The distance between point A and point E,the starting point of the femoral profound artery,was measured.Comparisons of the measurements were conducted between genders.Results 2.9％ (3/103) of the subjects had their bilateral medial femoral circumflex arteries originate from the femoral artery,94.2％ (97/103) had their bilateral medial femoral circumflex arteries originate from the femoral profound artery,and 2.9％ (3/103) had one medial femoral circumflex artery originate from the femoral artery and the other from the femoral profound artery.1.9％ (4/206),76.7％ (158/206) and 21.3％ (44/206) of the subjects had the artery of screw type,of circuitous type and of straight type,respectively.The artery trunk goes posteriorly and medially after it is issued,divides into branches along the course,continues to go around the back of the femoral neck,and finally goes to the outward and upper direction.There were no statistical differences between males and females regarding length of the artery trunk,or distances between points AB,AC,AD or AE (P ＞ 0.05).Conclusion Since 3DCTA can clearly demonstrate the origin,course and anatomical morphology of the medial femoral circumflex artery,it can be used to provide anatomical aids for clinical evaluation and treatment of hip injury.

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Factors influencing the indication for tracheostomy following cervical spinal cord injury

Ruiduan LIU ; Anmin JIN

Chinese Journal of Orthopaedic Trauma.2015;17(3):213-216. doi:10.3760/cma.j.issn.1671-7600.2015.03.007

Objective To determine the factors influencing the indication for tracheostomy following cervical spinal cord injury.Methods A retrospective study was performed to analyze the 118 patients who had been treated for cervical fracture/dislocation along with cervical spinal cord injury from July 2004 to June 2014 and whose abbreviated injury scale score (AISS) was lower than 3.They were 96 men and 22 women,19 to 68 years of age (average,45.2 years).The patients were divided into a tracheostomy group (n ＝ 28) and a non-tracheostomy group (n =90).The 2 groups were compared in terms of gender,age,presence or absence of complete spinal cord injury at admission,injured segment,injury mechanism,smoking history,injury severity score (ISS),motor AISS,systolic pressure at admission,hospital stay,and ICU stay to determine the factors influencing allocation of tracheostomy.Results Compared with the non-tracheostomy group,the tracheostomy group had a higher rate of complete spinal cord injury at admission,a higher rate of smoking,a higher ISS at admission,a lower motor AISS,and longer hospital and ICU stay,with statistically significant differences (P ＜ 0.05).There were no significant differences between the 2 groups in gender,age,injured segment,injury mechanism,or systolic pressure at admission (P ＞ 0.05).Increased severity of cervical spinal cord injury was associated with significantly decreased motor AISA,increased rate of tracheostomy and increased ISS (P ＜ 0.05).Conclusion The influencing factors for indication of tracheostomy after cervical spinal cord injury are complete cervical spinal cord injury irrespective of the level of injury,ISS,motor AISS,and history of smoking.

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Effects of different intensities of treadmill running on bone composition in rats

Zhe LI ; Shengyao LIU ; Guoxin NI

Chinese Journal of Orthopaedic Trauma.2015;17(4):322-325. doi:10.3760/cma.j.issn.1671-7600.2015.04.010

Objective To evaluate the effects of different intensities of treadmill running on changes in tibial bone composition in a rat model.Methods A total of 24 female Wistar rats were randomly assigned into 4 even groups (n =6) of free movement (FM),low-intensity running (LR),medium-intensity running (MR),and high-intensity running (HR).Rats in LR,MR,and HR groups underwent treadmill running with respective intensities (15 m/min and a 0° gradient,20 m/min and a 5° gradient,25 m/min and a 10° gradient) for 8 weeks (1 h/d and 5 d/week).FM group were taken as controls.The cortical and trabecular bone at the left tibial metaphysis was harvested after 8 weeks in each group for Raman spectroscopy to analyze mineral-matrix ratio,carbonate-phosphate ratio and crystallinity.Results In MR group,the mean mineral-matrix ratio was 4.883 ± 0.128 for cortical bone and 4.216 ±0.213 for trabecular bone,both significantly higher than those in FM group (4.113 ±0.132 and 3.773 ±0.122) (P ＜ 0.05).The mean mineral-matrix ratio was 3.222 ± 0.329 for trabecular bone in HR group,significantly lower than that in FM group (P ＜ 0.05).In MR group,the mean carbonate-phosphate ratio was 0.166 ± 0.013 for trabecular bone,significantly lower than that in FM group (0.177 ± 0.011) (P ＜ 0.05).In HR group,the mean carbonate-phosphate ratio was 0.195 ± 0.012 for cortical bone and 0.187 ± 0.010 for trabecular bone,both significantly higher than those in FM group (0.183 ± 0.014 and 0.177 ± 0.011) (P ＜ 0.05).In HR group,the mean crystallinity was 0.0521 ± 0.0012 for cortical bone and 0.0522 ± 0.0017 for trabecular bone,both significantly higher than those in the other 3 groups (P ＜ 0.05).Conclusions Running with medium intensity may increase bone mineralization and turnover,thus enhancing bone quality.However,running with high intensity may decrease bone mineralization and thus bone quality.

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A comparison of suture bridge and single row techniques in repair of full-thickness rotator cuff tears in a rabbit model

Wenyong FEI ; Weichun GUO ; Wen ZHANG

Chinese Journal of Orthopaedic Trauma.2015;17(4):331-336. doi:10.3760/cma.j.issn.1671-7600.2015.04.012

Objective To compare suture bridge and single row techniques in repair of rotator cuff tears in a rabbit model.Methods Seventy-six mature male New Zealand white rabbits were used in this study.The 12-month old rabbits,weighing from 2.5 to 3.0 kg (average,2.8 kg),were made models of full-thickness rotator cuff tear by cutting off at the foot print the supraspinatus tendon.The models were randomly divided into 2 even groups (n =38 each).Their right shoulders were repaired by suture bridge and single row techniques respectively in the 2 groups,with their left shoulders untreated as controls.The rabbits were then sacrificed at the 2nd,4th and 8th weeks after surgery for histological comparisons of healing under microscopy.Biomechanical comparisons were made at the 8th week to analyze advantages and disadvantages of the two methods.Results At 2,4 and 8 weeks postoperatively,there were no significant differences between the anterior and middle 1/3 zones of bone-tendon junction regarding cartilage growth or collagen fiber morphology in the suture bridge group,while the cartilage growth and collagen fiber morphology in the middle 1/3 zone of bone-tendon junction were significantly more mature than in the anterior 1/3 zone in the single row group.At the 8th postoperative week,the load to failure in the suture bridge group (134.59 ± 17.69 N) was significantly higher than that in the single row group (72.23 ± 12.08 N) (P ＜ 0.05),but remained significantly lower than that in the control group (192.61 ± 9.42 N) (P ＜ 0.05).Conclusion The suture bridge technique is a feasible and reliable method for repair of rotator cuff tear and has a better healing effect than the single row technique.

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