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Some advances in management of peripheral nerve injury

Chinese Journal of Orthopaedic Trauma.2002;0(01):-.

The reports on the peripheral nerve injury in the internati onal journals in 2003 included the anatomical study on surface landmarks to loca te the thenar branch of the median nerve (Wilhelmi etc.) and management of iatro genic injury to the spinal accessory nerve (Chandawarkar etc.). Gu, Kim, and Tun g, etc. reported the nerve transfers, which were effective in repairing the uppe r brachial plexus injury. The partial bundles transfer of ulnar nerve (Oberlin s method) was one of the nerve transfer operations. The functions of both biceps and brachial muscles were reported to be repaired simultaneously for elbow flex ion reconstruction in the management of brachial plexus injury. Bertellis, etc. reported that the brachial plexus avulsion injury was repaired with nerve transf ers and nerve grafts which were directly implanted into the spinal cord and part ial recovery of shoulder and elbow movements were achieved. The incidence rate o f birth-related brachial plexus injury was 0.06% to 0.26%. 85% to 90% of the patients could spontaneously restore their function (Richter etc.), but a f ew patients who could not should be evaluated 6 months after the birth to decide whether they needed microsurgical nerve repair or not. The suitable time for op eration was reported to be 6 months to 9 months after birth. The patients must b e examined thoroughly and their follow-up information must be recorded, and the y could accept the hyperbaric oxygen therapy.

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Biomechanic studies of Nitinol orthopedic instruments and their clini cal applications in hand surgery

Liming QIN ; Yongqing XU

Chinese Journal of Orthopaedic Trauma.2004;0(11):-.

There has been great interest in NiTi alloy in medical domain si nc e Buehler found its memory effect in 1963. In the recent 30 years, a lot of basi c and clinical researches of the alloy have been reported in the world. From the biomechanical viewpoint, the ossification and resorption of bone are related to the stress. Different stresses are required in the different kinds of fracture healing. Many measurements have been used to test the biomechanical properties o f the Nitinol orthopedic instruments. The clinical applications of the instrumen ts in hand surgery started in China in 1980's and resulted in satisfactory outco mes. This article summarizes the progress made in the basic researches of the ni tinol orthopedic instruments and their clinical applications in hand surgery.

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Diagnosis and treatment of elbow instability

Mingkui DU ; Qiugen WANG

Chinese Journal of Orthopaedic Trauma.2004;0(11):-.

The instability of elbow is common among patients who suffered f ro m acute fracture or dislocation or from chronic strain. It is crucial to correct ly deal with the acute injury of the elbow, otherwise it would become chronic in stability of the elbow which is difficult to treat. This paper reviews the liter ature about the clinical representation, diagnosis and treatment of elbow instab ility. The surgical principle is to convert a complex fracture-dislocation patt ern into a simple dislocation pattern. Surgery should try to restore the anatomi c structure of the elbow, including articular surfaces and soft tissues. In inju ries to the ulnohumeral joint, reconstruction of the lateral tissues is the key to restoring joint stability. The premier treatment of recurrent instability of elbow is surgical treatment.

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Application of three-dimensional CT for posterior pelvic ring fractures

Hongsheng DANG ; Jindong XIA ; Fuxing PEI

Chinese Journal of Orthopaedic Trauma.2004;0(11):-.

Objective To investigate the clinical significance of three-dim en sional CT in diagnosis and treatment of posterior pelvic ring fractures. Methods A retrospective analysis was done for 19 cases of posterior pelvic ring fractur es who were treated from March 2002 to August 2003 and had plain and three-dime nsional CT films. Their radiological characteristics and results were compared b etween the 2 kinds of film. Results 3-D CT corrected the misdiagnosis or uncert ainty of 9 cases who had plain radio-graphs. The 3-D CT showed obvious advanta ges over plain radio-graphs in detecting sacroiliac diastasis, sacroiliac joint fragments, fractures involving iliac and sacral lips abutting the sacroiliac jo int, sacral fracture and complicated comminuted fracture, because it clearly del ineated fractures of posterior pelvic ring and manifested the severity of commin ution and separation. Conclusion The 3-D CT scan provides valuable information for precise diagnosis and treatment plan for the complex posterior pelvic ring f ractures.

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Conservative and operative therapies in treatment of proximal humeral fractures

Yafei ZHANG ; Guigen PANG ; Tao ZHANG

Chinese Journal of Orthopaedic Trauma.2004;0(11):-.

Objective To evaluate fixation of anatomic plate by comparing ou tc omes of surgery and conservative therapy for proximal humeral fractures. Methods 24 cases of proximal humeral fractures were fixed with anatomic plate, lag scre ws and kirschner wire. 19 cases were managed with conservative therapy of manual reduction and external wood splint fixation. The results were evaluated by Neer classification and Constant-murley scoring system. Results All the case were f ollowed up 10 to 19 months(averaging 11.5 months). In the 24 operated cases, 11 patients were graded as excellent, 8 as good, 4 as fair, 1 as poor. In the 19 ca ses of conservative therapy, 6 patients were graded as excellent, 7 as good, 6 a s fair, most of which were Neer types Ⅲand Ⅳ. The operative treatment produced better outcome than the censervative treatment ,far the difference was statisti cally significant(P

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Arthroscopic treatment of discoid meniscus injury

Ying LU ; Qiang LI ; Gang REN

Chinese Journal of Orthopaedic Trauma.2004;0(11):-.

Objective To observe the effect of arthroscopic meniscectomy to tr eat discoid lateral meniscus tear. Methods From July 1999 to June 2003, arthrosc opic meniscectomy was conducted for 49 menisci of 45 patients with discoid later al meniscus tear. 41 patients had unilateral injury, and 4 bilateral. 32 knees w ere complete injury and 17 incomplete. The discoid lateral meniscus tear account ed for nearly one third of the patients with meniscus tear who received arthrosc opic meniscectomy at the same time. Arthroscopic partial meniscectomy was done f or 44 knees, total meniscectomy for 5 knees and meniscus suture for 3 knees. Aft er operation the rehabilitation training programs, including straight-leg-rais ing exercise and range-of-motion exercise, were carried out. Results The opera tions for the 45 cases were successful and there was no complication. 40 patient s were followed up. Before operation, the mean Lysholm -Ⅱscore was 55 points ( 40 to 71 points). After a mean follow-up period of 39 months, the mean Lysholm -Ⅱscore was 88 points (60 to 100 points). The excellent and good results were obtained in 85.3%of the patients. Conclusions Arthroscopic meniscectomy should be a preferred method for discoid lateral menisci tear, due to its minimal invas ion, possibility of early mobilization, a lower complication rate, and preservat ion of more meniscus structure and function. If the operation is combined with s tandard rehabilitation training, the effects can be enhanced.

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Osteotomy and secondary fixation to treat malunion after the distal femoral fracture

Ming XIE ; Guilin ZHANG ; Nan LI ; Manyi WANG ; Bo ZHANG

Chinese Journal of Orthopaedic Trauma.2004;0(11):-.

Objective To introduce a two-stage operative method to treat ma lu nion after the distal femoral fracture. Methods From Aug. 1992 to Aug. 2000, 12 patients underwent osteotomy and secondary fixation due to malunion after the di stal femoral fracture. There were 10 closed fractures and 2 open ones. The prima ry treatment was conservative for 2 patients, and operative for 10. We first per formed the osteotomy along the primary fracture line where the deformity was the most severe. When the roentgenogram confirmed that the deformity had been corre cted satisfactorily, a secondary operation of ORIF (open reduction with internal fixation) was performed. Results On average, all the 12 patients gained bone un ion 5.1 months postoperatively. The mean follow-up duration was 7.2 years (rang e: 3.5 to 11.5 years). None of the patients was afflicted by infection or loosen ing of the internal fixator. According to the Schatzker scoring scale system, al l the patients were evaluated as poor preoperatively, but as excellent in 7, goo d in 4 and fair in 1 at the last follow-up. Conclusion Osteotomy and secondary fixation is not only simple and accessible but also can lead to confirmed clinic al results. However, it is still very important to reduce and fix the acute frac tures stably to avoid malunion.

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Operative treatment of compound acetabular fractures through single ilioinguinal approach

Shiwen ZHU ; Manyi WANG ; Xinbao WU ; Qiyong CAO ; Honghua WU

Chinese Journal of Orthopaedic Trauma.2004;0(11):-.

Objective To evaluate the results of operative treatment of comp ou nd acetabular fractures through single ilioinguinal approach. Methods 46 cases o f compound acetabular fractures were treated through single ilioinguinal approac h from June 1994 to October 2003 in our department. Their functional recovery an d complications were followed up. Results On the average, 40 cases were followed up for 40.4 months. All the fractures healed and no infection was found. Clinic al results were excellent and good in 33 patients, and only one patient showed s light ectopic ossification after the operation. Conclusions Acetabular fractures associated with anterior and posterior hemi-transverse fractures, most both co lumn fractures and some T shape fractures can be treated through the single ilio inguinal approach which can result in good reduction, satisfactory functional re covery, less invasive incision, and low rate of postoperative complications.

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Management of acetabular comminuted fractures combined with compressive defects

Chuncai ZHANG ; Shuogui XU ; Baoqing YU ; Jialin WANG ; Jiacan SU ; Hongxing SHEN ; Qingge FU ; Yunfei NIU ; Ke REN ; Peng ZHANG ; Guangye WANG ; Wenrui LI ; Wenhu LI ; Jiarang WANG

Chinese Journal of Orthopaedic Trauma.2004;0(11):-.

Objective To discuss the therapy for acetabular comminuted fractur e combined with compressive defects. Methods From July 1997 to February 2005, 43 cases of comminuted acetabular fracture combined with compressive defect were t reated. 25 cases were obsolete, 16 fresh, and 2 malformed (90 days after injury) . 34 cases were complicated fractures with defects, and 9 simple fractures with defects. The defect volumes ranged from 3 to 9 cm3, averaging 4.5 cm3. They were treated with ATMFS (acetabular tridimensional memory fixation system) to fixate the comminuted bone fragments tridimensionally. The modified acetabular approac h, reduction of acetabular comminuted articular face, anatomical reconstruction of posterior wall of acetabulum with autogenous ilium, autogenous and artificial bone implantation and bone wax isolation were used. The follow-ups lasted from 5 to 86 months, averaging 15.7 months. Results 31 cases achieved anatomical red uction by filling up the compressive defects. 12 cases were treated by anatomica l reconstruction of posterior wall. On average, 5.3 months after operation, the injured hip joint was as good as the healthy one in 40 cases. Ischemia necrosis of femoral head occurred in 1 case, and 2 cases experienced heterotopic ossifica tion with ischemia necrosis of femoral head which led to osseous fusion of hip j oint. Conclusion The new methods for treatment of acetabular fractures with comp ressive defects elevate the reduction rate of acetabulum and femoral head, and a re effective for the functional recovery of hip joint.

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The experimental study of poly-DL-lactic acid absorbable membrane in prevention of peripheral nerve adhesion

Yan SU ; Changqing ZHANG ; Sa SONG

Chinese Journal of Orthopaedic Trauma.2004;0(12):-.

Objective To study the effect of poly- DL- lactic acid (PDLLA) absorbable membrane on preventing adhesion after repair of peripheral nerve injury. Methods 60 SD rats were divided into 2 groups randomly: the suturing+ PDLLA group (experimental group) and the purely suturing group (contrast group), with 30 rats in each group. Their sciatic nerves were cut off and then sutured microsurgically. In the experimental group, the anastomotic stoma was encapsulated with PDLLA membrane; in the contrast group, there was no such a treatment. We conducted gross observations and histological examinations at 2, 4, 8, 12, and 16 weeks after operation, neural electrophysiological examinations at 12 and 16 weeks after operation, and image analysis by computer at 16 weeks after operation. Results The scar proliferation and adhesion near the anastomotic stoma in the experimental group were less extensive than those in the contrast group; regenerative nerve fibers grew more straight and orderly manner. Electrophysiological examinations and image analyses by computer also showed that the experimental group achieved better results than the contrast group. Conclusion Poly- DL- lactic acid (PDLLA) absorbable membrane can prevent scar proliferation and adhesion after repair of peripheral nerve and promote nerve functional recovery effectively.

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