Journal Detail Information

1

Cite

Share

Anatomical reconstruction of ligaments with chronic lateral ankle instability

Chinese Journal of Orthopaedic Trauma.2010;12(9):830-835. doi:10.3760/cma.j.issn.1671-7600.2010.09.007

Objective To evaluate the clinical results of an anatomical reconstruction technique for the lateral ligaments with semitendinosus autografts in treatment of chronic lateral ankle instability.Methods From October 2008 to October 2009, 16 patients with lateral instability of the ankle underwent surgery using the proposed methods. They were 8 men and 8 women, with a mean age of 28.2 years (range,19 to 47 years) . Nine patients received only the anterior talofibular ligament reconstruction. Seven patients received both the anterior talofibular ligament and the calcaneofibular ligament reconstruction. Standard stress radiographs under anesthesia were taken to determine which ligament would be reconstructed. The semitendinosus autografts were secured to the fibular insertion site with suture anchors and to the talar or calcaneus insertion site with interference screws. The American Orthopaedic Foot and Ankle Society (AOFAS) scores and standard stress radiographs were used to assess the patients preoperation and at the last follow-up.Results We had a mean follow-up of 12. 1 months (range, 6 to 18 months). In the 16 patients, the average preoperative AOFAS score was 70. 50 ± 3.98, and the final average AOFAS score increased to 93.06 ± 4. 78 ( t = - 24. 010, P = 0. 000). Their average anterior drawer sign improved from 8. 75 ± 3.38 mm to 3.51 ±1.63 mm ( t = 7. 028, P = 0. 000). In the 7 patients who had received both lateral ligaments reconstruction,their average talar tilt improved from 16. 18° ± 7.30° to 5.57° ± 2. 99° ( t = 5. 661, P = 0. 001 ). No significant complications were found in all but one patient who had a 10° limitation of dorsal flexion of the ankle.Conclusions Our short-term results reveal that anatomical reconstruction of the ligaments with chronic lateral ankle instability using the above-mentioned methods may be effective and have the advantages of precise anatomical reconstruction, firm fixation of the grafts, mini-invasive procedure for the fibular skeletal structure and peroneal tendons, and saving the length of grafts.

2

Cite

Share

Operative treatment of calcaneal fractures

Bin CHEN ; Runguang LI ; Gang WANG

Chinese Journal of Orthopaedic Trauma.2010;12(8):746-751. doi:10.3760/cma.j.issn.1671-7600.2010.08.011

Objective To investigate the injury mechanism, clinical classification, treatment methods and clinical results of calcaneal fractures. Methods From June 2005 to May 2009, 83 feet in 70 patients with calcaneal fractures were treated. According to Sanders and Essex-Lopresti classifications, 63 feet had intra-articular fractures (30 feet of type Ⅱ, 21 type Ⅲ, and 12 type Ⅳ ) and 20 feet had extra-articular fractures (3 feet of lateral condylar fracture, 5 anterior process fracture, 9 calcaneal body fracture and 3 nodules fracture) . Reduction with a conventional lateral L-incision, mini-incision, or leverage was conducted depending on the clinical classification of the fracture involved. Fixation with a conventional plate or locking plate, simple screws and Kirschner wire was applied in all patients. Bone grafting was performed in the 20 cases whose defects were larger than 2 cm3. Functions and complications of the feet were observed at the follow-up. Results The 70 patients were followed up from 12 to 30 months (average, 18 months). The total average American Orthopaedic Foot and Ankle Society(AOFAS) score was (90.3 ± 11.0) points (48 to 100 points). The average AOFAS score for the 20 feet of extra-articular calcaneal fracture was (98.1±2.6)points (90 to 100 points), with no complications; the average AOFAS score for the other 63 feet of intra-articular calcaneal fracture was (87.8 ± 11.4) points (48 to 100 points) with such complications as necrosis at the skin edge of incision in 2 feet, sural nerve injury in 4 and traumatic subtalar arthritis in 10.Conclusions Treatment of extra-articular calcaneal fractures may have better clinical results than treatment of intra-articular calcaneal fractures. The preoperative evaluation of the fracture type and severity of soft tissue injury is especially essential to the treatment.

3

Cite

Share

Treatment of calcaneal fractures with a super-cutaneous calcaneal locking plate

Guozhu ZHANG ; Xieyuan JIANG ; Manyi WANG

Chinese Journal of Orthopaedic Trauma.2010;12(8):741-745. doi:10.3760/cma.j.issn.1671-7600.2010.08.010

Objective To study advantages and disadvantages of the super-cutaneous calcaneal locking plate in the treatment of calcaneal fractures. Methods Between October 2007 to June 2008, 12cases of calcaneal fracture were treated with a super-cutaneous calcaneal locking plate. According to the Sanders classification system, 8 cases were of type ⅡA, one case of type ⅡB, one case of type ⅡC, one case of type Ⅲ AC, and one case of type Ⅳ. All the cases were fresh fractures. The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal. In direct observation of the posterior facet and anterior tuberosity, the articular fragments were reduced anatomically. Then the reduced calcaneus was fixed by a super-cutaneous calcaneal locking plate. After bone union was confirmed 3 months after the operation by the CT scans and X-ray films, the super-cutaneous plates and screws were removed in clinic. Results The average time of follow-up was 16 months with a span from 12 to 20 months. There were no incision or pin-hole infections. The reduction of the articular surface and bone union were good. One type ⅡA developed lateral wall exostosis which resulted in peroneal tendonitis and stenosis followed by obvious walking pain. The preoperative X-ray films of the 12 patients showed that the average B(o)hler angle was 11.9°±9.4° and the Gissane angle 86. 8°± 7. 7°. Their postoperative X-ray files demonstrated that the B(o)hler angle was improved to 29. 4°± 7.0° and the Gissane angle to 115.8°± 7.7°, with a significant difference ( P ＜ 0. 01 ). According to the Ankle Hindfoot Clinical Rating System of the American Orthopaedic Foot and Ankle Society (AOFAS),their average score was 91 points (68 to 100 points). Conclusions Using a super-cutaneous calcaneal locking plate to treat calcaneal fractures can result in limited invasion, a low rate of skin infection, satisfactory reduction of the articular surface and stable fixation. Since the fixation can be removed without re-hospitalization, it is a cheaper and less painful alternative for the treatment of displaced intra-articular calcaneal fractures.

4

Cite

Share

Evaluation of flexor hallucis longus tendon transfer as a treatment for Achilles tendon defects of more than 6 cm

Chao SUN ; Zhi WANG ; Jianzhong ZHANG

Chinese Journal of Orthopaedic Trauma.2010;12(8):732-735. doi:10.3760/cma.j.issn.1671-7600.2010.08.008

Objective To evaluate the clinical results of flexor hallucis longus (FHL) tendon transfer in treatment of patients with Achilles tendon defects of more than 6 cm. Methods Between January 2005 to February 2009, 19 patients with Achilles tendon defects, 13 males and 6 females, were treated with FHL tendon transfer. Their ages ranged from 20 to 61 years, with an average of (42. 6 ± 8.2)years. Fifteen defects were found during tendonitis debridement, and 4 were old ruptures. Time from rupture to surgery ranged from 0 to 6 months (average, 2.6 months). Defects were 6 cm to 10 cm long. Procedures were performed in a two-incision manner. The postoperative ROM of ankle joint, American Orthopaedic Foot and Ankle Society(AOFAS) and visual analogue scale(VAS) scores were recorded at 3 months, 12 months,and the last follow-up. The results were statistically analyzed to evaluate the functional recovery. Results Follow-ups lasted from 12 to 48 months (average, 22. 2 months). At the last follow-up, the average ROM of ankle joint was 17.8°± 1.9° at dorsal flexion and 39.1°±2.3° at plantar flexion, and the last average AOFAS score was up to (91.8 ± 1.7), significantly different from those at 3 months after surgery (P＜0.05), but not significantly different from those at 12 months (P＞0.05). The difference were significant between the results of 3 months and 12 months (P＜0.05). The last average VAS score was (1.0±0.7),significantly different from those at 3 months and 12 months(P＜0.05) . There was also significant differences between the VAS scores of 3 months and 12 months (P＜0.05). Patient's satisfaction was 100%.Conclusion FHL tendon transfer is an efficient procedure for long Achilles tendon ruptures associated with tendonitis in relieving pain and maintaining the function of ankle joint.

5

Cite

Share

Craig Ⅴ distal clavicle fracture treated with distal clavicle excision plus suture anchor

Shun YANG ; Ming XIANG ; Hang CHEN ; Jie XIE ; Guoyong YANG ; Jianxiong XI ; Chunyan JIANG

Chinese Journal of Orthopaedic Trauma.2011;13(1):8-11. doi:10.3760/cma.j.issn.1671-7600.2011.01.004

Objective To introduce distal clavicle excision plus suture anchor to treat Craig Ⅴ distal clavicle fracture.Methods From November, 2005 to August, 2007, 25 patients with Craig Ⅴ distal clavicle fracture were treated with distal clavicle excision plus suture anchor.They were 18 men and 7 women,with a median age of 42.6 years.They were followed up periodically by radiological examination.At the final follow-up, their shoulder functions were evaluated by University of California-Los Angeles (UCLA) scoring system and Constant scoring system, and the pain was evaluated according to visual analog scale (VAS).Results All the patients obtained a median follow-up of 13.6 months (8 to 24) .The height of distal clavicle in all patients reached anatomical reduction.Their average UCLA score was 33.5 (28 to 35), and average Constant score was 90.6 (79 to 100) .Their mean VAS score was 1.2 (0 to 4) .Their average forward flexion and elevation was 156.4° ( 145° to 170°), and external rotation was 45.6° (40° to 60°) .The rate of top quality was 88.0% (22/25).Conclusion Distal clavicle excision plus suture anchor is an effective method to treat Craig Ⅴ distal clavicle fracture which results from serious trauma.

6

Cite

Share

Analysis of close reduction under the C-arm X-ray perspective for femoral neck fractures

Xin LI ; Zhong CHEN ; Hongchang YANG

Chinese Journal of Orthopaedic Trauma.2011;13(1):25-28. doi:10.3760/cma.j.issn.1671-7600.2011.01.008

Objective To evaluate the actual displacement of a femoral neck fracture following close reduction under the C-arm X-ray perspective.Methods From June, 2006 to June, 2009, we managed 12 patients with femoral neck fracture by open reduction and internal fixation.They were 8 males and 4 females, aged from 23 to 65 (average, 42.3) years old.We tried close reduction of their fractures under the C-arm X-ray perspective before a temporary fixation.Next we performed open reduction, readjusted the fracture ends, and placed internal fixation.The actual displacement of the fracture measured after open reduction was carefully compared with the close reduction under the X-ray perspective.Results A substantial displacement was found after open reduction in 7 patients who had achieved anatomic reduction under the X-ray perspective.In the other 5 patients who presented with a slight displacement after close reduction under X-ray perspective, the actual displacements were larger than the X-ray observations but completely reduced after open reduction.The actual measurements after open reduction were significantly larger (3.21 ± 0.96 mm on average) in the anteroposterior displacement ( t = 11.540, P = 0.000), but insignificantly larger (0.58 ±0.93 mm on average) in the superior-inferior displacement ( t = 2.184, P = 0.346) than those after close reduction.Conclusions In general, anatomic reduction can not be achieved for a femoral neck fracture under the C-arm X-ray perspective.Consequently, open reduction may be better than close reduction in the treatment of femoral neck fracture in that improper reduction can block blood supply to the femoral neck and dissection of the capsula articularis coxae can improve blood supply as well as help decompression.

7

Cite

Share

The risk of chondral injury during the Rigidfix femoral fixation via the anteromedial portal to reconstruct the anterior cruciate ligament

Huaqiang FAN ; Changming HUANG ; Huixiang DONG

Chinese Journal of Orthopaedic Trauma.2010;12(12):1156-1159. doi:10.3760/cma.j.issn.1671-7600.2010.12.015

Objective To evaluate the risk of chondral injury during anterior cruciate ligament (ACL) reconstruction using a double cross-pin femoral fixation device via the anteromedial portal in Chinese cadavers. Methods Nine specimens of the knee (6 left ones and 3 right ones) were taken from 5 male and 4 female conservative cadavers of Chinese adult. The average age of the cadavers were 34.8 (26 to 45)years old. Femoral tunnel drilling and cross-pin guide insertion were performed using the Rigidfix Cross Pin device through the anteromedial portal. The ACL reconstructions were simulated at 3 entrance points of the cross-pin (0°, 45° and 90° relative to the horizontal plane) . The risks of chondral injury were statistically analyzed when the cross-pin entrance point was at the 3 different positions relative to the femoral chondral surface. Results The incidence of chondral injury was 100% when the Rigidfix cross-pin guide was at 90° relative to the horizontal plane. When the Rigidfix cross-pin guide was at 45° and 0° the incidences of chondral injury were 66. 7% and 22. 2% respectively. Conclusion Since there is always a risk of chondral injury when the Rigidfix cross-pin device is used to reconstruct ACL via the anteromedial portal, the anteromedial portal is not recommended for the ACL reconstruction using Rigidfix femoral fixation.

8

Cite

Share

Gene function assembly analysis to screen key genes associated with deep vein thrombosis after trauma

Hailan HU ; Jianwen MO ; Bo BAI

Chinese Journal of Orthopaedic Trauma.2010;12(12):1139-1141. doi:10.3760/cma.j.issn.1671-7600.2010.12.011

Objective To screen key genes related to deep vein thrombosis (TDVT) after trauma using gene function assembly analysis. Methods Thirty Sprague Dawley rats were randomized into control, thrombosis and non-thrombosis groups. Traumatic limb DVT models were established in rats through quantitative beating on the bilateral posterior limbs. The Genechip Rat genome 430 2. 0 genechips were applied to detect changes in genes expressions on difference phases of DVT. On the basis of the differential gene expressions in the thrombosis and non-thrombosis groups, the gene function assembly analysis was conducted to define the most significant and concentrated gene functions leading to the biological characters of DVT.Results B factor (bf), complement 4 binding protein α (C4bpα), plasminogen activator inhibitor 1 (serpinel), urokinase-type plasminogen activator receptor (plaur) were screened to be the key genes related to DVT, because they were found to be involved in the functions like complement activation, development,growth, morphogenesis, primary metabolism, cell motility, protein metabolism, localization of cell, locomotion and localization. The abundance values of the genes expressed were 1.6, -0. 2, 2. 1, 5. 1 in the thrombosis group, and -0. 5, - 1.4, 2. 7, 3. 3 in the non-thrombosis group. Conclusion Bf, C4bpα,serpinel, plaur may be the key genes that play a role in the process of DVT.

9

Cite

Share

A binary logistic regression analysis of deep venous thrombosis after hip fracture surgery

Kai WU ; Qiugen WANG

Chinese Journal of Orthopaedic Trauma.2010;12(12):1104-1107. doi:10.3760/cma.j.issn.1671-7600.2010.12.002

Objective To explore the incidence, etiological and protective factors, and preventive countermeasures of deep venous thrombosis (DVT) in patients undergoing hip surgery. Methods Four hundred and forty-one patients who had hip fracture surgery in our department from January, 2005 to May, 2010were analyzed retrospectively. They were 223 males and 218 females, aged 65.7 years. (range, 22 to 87). A binary logistic regression was performed, using gender, age, duration of surgery, surgery type, anesthesia type, blood transfusion, physical therapy, thrombo-prophylaxis and complication as covariates, taking DVT incidence as the dependant variable. Results The patients obtained a median follow-up of 17.2 months (range, 3 months to 4 years and 7 months). Sixty-nine patients developed DVT (incidence, 15.6%).Analysis of multiple variables showed that duration of surgery, anesthesia type, blood transfusion, hypertension and diabetes were risk factors to DVT. Physical therapy and thrombo-prophylaxis were protective factors.Age, gender and surgery type had no statistically significant influence on DVT (P ＞ 0.05). Conclusions The DVT incidence after hip fracture surgery is high. In order to decrease the DVT incidence, surgeons should try their best to estimate risk factors for every patient perioperatively, avoid general anesthesia or blood transfusion, shorten operating duration, effectively control complications, actively perform physical therapy or thrombo-prophylaxis, and prolong the anticoagulant therapy for patients with higher risk factors.

10

Cite

Share

Low modulus titanium alloy plating for femoral shaft fractures: A finite element analysis

Xiaokang LI ; Zheng GUO ; Jipeng LIU

Chinese Journal of Orthopaedic Trauma.2010;12(12):1164-1168. doi:10.3760/cma.j.issn.1671-7600.2010.12.017

Objective To investigate the effects of internal plating with high and low moduli of elasticity on the stress and its distribution on the femoral shaft fracture. Methods A femur from a normal Chinese adult male was scanned by 64-detector row helical CT at 0. 5 mm interval. The CT images were used to establish a finite element model of the femur by software. The mid-femoral fracture was simulated in the model and fixated by eight-hole plates of Ti-6Al-4V (high modulus group, E = 110 GPa) and of Ti2448 (low modulus group, E = 30 GPa). When the femur was in axial compression, flexion and torsion loads, the stress and its distribution on the bone fracture site were analyzed to compare the biomechanics of the plates with high and low moduli. Results Under axial compression load, the contact stress between fracture ends in the low modulus group was larger than that in the high modulus group, while the max stress at the hole (11.47MPa) was smaller than that in the high modulus group (13.89 MPa) . Under four-point bending load, the contact stress in the low modulus group was still larger, while the bending movement was smaller. Under the torsion load, stress on the femur was well-distributed in both groups, but the max stress at the hole in the low modulus group (11.47 MPa) was smaller than that in the high modulus group (31.24 MPa). Conclusions Under internal fixation by plates of low modulus, the stress stimulus at the fracture site may be increased,while the stress concentrated at the hole may be decreased. The stress shielding of the low modulus plate may also be modified.

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share