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Stress changes of lateral collateral ligament at different knee flexion with or without displaced movements: a 3-dimensional finite element analysis.

Yan-Lin ZHONG ; You WANG ; Hai-Peng WANG ; Ke RONG ; Le XIE

Chinese Journal of Traumatology.2011;14(2):79-83.

OBJECTIVETo create a 3-dimensional finite element model of knee ligaments and to analyse the stress changes of lateral collateral ligament (LCL) with or without displaced movements at different knee flexion conditions.

METHODSA four-major-ligament contained knee specimen from an adult died of skull injury was prepared for CT scanning with the detectable ligament insertion footprints, locations and orientations precisely marked in advance. The CT scanning images were converted to a 3-dimensional model of the knee with the 3-dimensional reconstruction technique and transformed into finite element model by the software of ANSYS. The model was validated using experimental and numerical results obtained by other scientists. The natural stress changes of LCL at five different knee flexion angles (0 degree, 30 degree, 60 degree, 90 degree, 120 degree) and under various motions of anterior-posterior tibial translation, tibial varus rotation and internal-external tibial rotation were measured.

RESULTSThe maximum stress reached to 87%-113% versus natural stress in varus motion at early 30 degree of knee flexions. The stress values were smaller than the peak value of natural stress at 0 degree (knee full extension) when knee bending was over 60 degree of flexion in anterior-posterior tibial translation and internal-external rotation.

CONCLUSIONLCL is vulnerable to varus motion in almost all knee bending positions and susceptible to anterior-posterior tibial translation or internal-external rotation at early 30 degree of knee flexions.

Anterior Cruciate Ligament ; physiology ; Collateral Ligaments ; physiology ; Finite Element Analysis ; Humans ; Knee Joint ; physiology ; Stress, Mechanical

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Analysis on the risk factors of second fracture in osteoporosis-related fractures.

Wen-Dong RUAN ; Pei WANG ; Xin-Long MA ; Rui-Ping GE ; Xian-Hu ZHOU

Chinese Journal of Traumatology.2011;14(2):74-78.

OBJECTIVETo explore the clinical characteristics and risk factors of refracture in patients suffering from osteoporosis-related fractures as well as effective interventions.

METHODSFrom January 2006 to January 2008, both out-patients and in-patients in our hospital who were over 50 years old and suffered from osteoporosis-related fractures were selected for this research. They were divided into fracture group and refracture group. The refracture rate was followed up for 2 years, during which 11 patients developed refracture, thus were included in the refracture group. Therefore, 273 patients, 225 first-fracture cases, aged (67.7+/-8.5) years, and 48 refracture cases, aged (72.7+/-9.5) years, were included in this study. General data including age and sex, fracture types, femoral neck bone mineral density (BMD) T-scores tested by dual-energy X-rays absorptiometry (DEXA), Charlson index, time-frame between two fractures as well as mobility skill assessment were collected and analyzed by single-factor and multivariate statistical methods.

RESULTSFemales accounted for 70.2% of the fracture group and 77.1% of the refracture group. The most common refracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the follow-up. The second fracture happened 3.7 years after the first one on average. The refracture rate was 2.12% within one year, and 4.66% within two years. Risk factors for a second fracture in osteoporotic fracture patients included age (larger than 75 years, HR equal to 1.23, 95%CI 1.18-1.29; larger than 85 years, HR equal to 1.68, 95% CI 1.60-1.76), female sex (HR equal to 1.36, 95%CI 1.32-1.40), prior vertebral fractures (HR equal to 1.62, 95%CI 1.01-2.07), prior hip fractures (HR equal to 1.27, 95%CI 0.89-2.42), BMD T-score less than -3.5 (HR equal to 1.38, 95%CI 1.17-1.72) and weakened motor skills (HR equal to 1.27, 95%CI 1.09-1.40).

CONCLUSIONSThe risks of second fracture among patients with initial brittle fracture are substantial. There is adequate time between the first and second fractures for interventions to reduce the risks of refracture, especially for the old women with a vertebral or hip fracture. Medication, motor functional rehabilitation and fall-down prevention training are helpful.

Age Factors ; Aged ; Aged, 80 and over ; Bone Density ; Female ; Humans ; Male ; Middle Aged ; Motor Skills ; Multivariate Analysis ; Osteoporotic Fractures ; etiology ; Risk Factors

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Vascular trauma: selected historical reflections from the western world.

Norman-M RICH ; Patricia-L MCKAY ; David-R WELLING ; Todd-E RASMUSSEN

Chinese Journal of Traumatology.2011;14(2):67-73.

In the spirit of international exchanges of knowledge with colleagues from all over the world, who are interested in the care and treatment of vascular trauma, we offer selected historical reflections from the western world on vascular trauma. Whereas there are a number of key individuals and a variety of events that are important to us in our writing, we know essentially nothing about what is written by other cultures and, particularly, the Chinese. It is well recognized around the world that Chinese surgeons are among the first to be highly successful in re-plantation of severed extremities, repairing both injured arteries and veins. Also, we recognize that there are contributions in other parts of the world, which are not well known to us collectively. Contributions from the Arabic speaking part of the world come to mind because there is periodic brief reference. We offer our perspective hoping that there will be one or more Chinese surgeons who will offer us the benefit of sharing their perspective on important historical contributions to the managing of vascular trauma outside of the western world, and, particularly, the English speaking literature. Once again, we encourage our colleagues in the Arabic speaking world to provide us with their perspective of the development and management of vascular trauma.
History, 15th Century ; History, 16th Century ; History, 17th Century ; History, 18th Century ; History, 19th Century ; History, 20th Century ; History, 21st Century ; History, Medieval ; Humans ; Vascular Surgical Procedures ; instrumentation ; methods ; Vascular System Injuries ; history ; surgery

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Management of duodenal trauma.

Guo-qing CHEN ; Hua YANG

Chinese Journal of Traumatology.2011;14(1):61-64.

Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature in PubMed by the keywords of duodenal trauma, therapy, diagnosis and abdomen. It shows that because the diagnosis and management are complicated and the mortality is high, duodenal trauma should be treated in time and tactfully. And application of new technology can help improve the management. In this review, we discussed the incidence, diagnosis, management, and complications as well as mortality of duodenal trauma.
Duodenum ; injuries ; surgery ; Humans ; Incidence ; Postoperative Complications ; epidemiology

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Coupled external fixator and skin flap transposition for treatment of exposed and nonunion bone.

Yong-gang ZHAO ; Jing DING ; Neng WANG

Chinese Journal of Traumatology.2011;14(1):58-60.

OBJECTIVETo discuss the effect of coupled external fixator and skin flap transposition on exposed and nonunion bones.

METHODSThe data of 12 cases of infected nonunion and exposed bone following open fracture treated in our hospital during the period of March 1998 to June 2008 were analysed. There were 10 male patients, 2 female patients, whose age were between 19-52 years and averaged 28 years. There were 10 tibial fractures and 2 femoral fractures. The course of diseases lasted for 12-39 months with the mean period of 19 months. All the cases were treated by the coupled external fixator and skin flap transposition.

RESULTSPrimary healing were achieved in 10 cases and delayed healing in 2 cases in whom the tibia was exposed due to soft tissue defect and hence local flap transposition was performed. All the 12 cases had bony union within 6-12 months after operation with the average time of 8 months. They were followed up for 1-3 years and all fractures healed up with good function and no infection recurrence.

CONCLUSIONThe coupled external fixator and skin flap transposition therapy have shown optimal effects on treating infected, exposed and nonunion bones.

Adult ; External Fixators ; Female ; Fractures, Ununited ; surgery ; Humans ; Male ; Middle Aged ; Surgical Flaps

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K-wire and tension band wire fixation in treating sternoclavicular joint dislocation.

Qing-yu CHEN ; Shao-wen CHENG ; Wei WANG ; Zhong-qin LIN ; Wei ZHANG ; Dong-quan KOU ; Yue SHEN ; Xiao-zhou YING ; Xiao-jie CHENG ; Chuan-zhu LV ; Lei PENG

Chinese Journal of Traumatology.2011;14(1):53-57.

OBJECTIVETo evaluate the feasibility and therapeutic effect of treating sternoclavicular joint dislocation by K-wire and tension band wire fixation, and to improve the safety and stability of this technique.

METHODSThis study consisted of 9 cases, 6 males and 3 females with the mean age of 25 years (range, 9-62 years). The causes were traffic accident in 7 cases, falling in 1 case and fight in 1 case. The duration from injury to operation was 2 hours to 7 days. There were 5 left dislocations and 4 right dislocations; 8 anterior dislocations and 1 posterior dislocation, including one combined with left scapular fracture and one with left olecranon fracture. Open reduction and internal fixation using K-wires and tension band wires were performed to treat dislocations.

RESULTSAll patients were followed up for 6 to 24 months, 10 months on average. According to Rockwood's rating scale on postoperative sternoclavicular joint, 8 cases achieved excellent outcomes with an average score of 13.88, and the rest case achieved a good outcome with the score of 12. Anatomical reduction was obtained in all cases. There were no such postoperative complications as severe infection, injury to blood vessel and nerve, failure of fixation, etc. Patients were all satisfied with the anatomical reduction and functional recovery.

CONCLUSIONSThe technique of K-wire and tension band wire fixation is safe, simple, effective, less invasive and has been successfully used in orthopedic surgery. It is effective in treating sternoclavicular joint dislocation though it has some disadvantages.

Adolescent ; Adult ; Bone Wires ; Child ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Radiography ; Sternoclavicular Joint ; diagnostic imaging ; injuries ; surgery

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Functional recovery of sciatic nerve through inside-out vein graft in rats.

Rahim MOHAMMADI ; Saeed AZIZI ; Nowruz DELIREZH ; Rahim HOBBENAGHI ; Keyvan AMINI

Chinese Journal of Traumatology.2011;14(1):46-52.

OBJECTIVEPresent study aimed at further comprehensive functional, histomorphometrical and immunohistochemical assessment of peripheral nerve regeneration using rat sciatic nerve transection model.

METHODSThe 10-mm rat sciatic nerve gap was created in rats. In control group nerve stumps were sutured to adjacent muscle and in treatment group the gap was bridged using an inside-out vein graft. In sham-operated group the nerve was manipulated and left intact. All animals underwent walking track analysis test 4, 8, and 12 weeks after surgery. Subsequently, muscle mass measurement was performed to assess reenervation, histological examination to observe the sciatic nerve regeneration morphologically and immunohistochemistry to detect Schwann cells using anti S-100. Results were analyzed using a factorial ANOVA with two between-subjects factors. Bonferroni test for pairwise comparisons was used to examine the effect of treatments.

RESULTSFunctional analysis of myelinated nerve fibers showed that nerve function improved significantly in the time course in treatment group. However, quantitative morphometrical analysis of myelinated nerve fibers showed that there was no significant difference between 8 and 12 weeks in treatment group. Muscle weight ratio was bigger and weight loss of the gastrocnemius muscle was ameliorated by inside-out vein grafting. The position of positive immunohistochemical reactions further implied that regenerated axons and Schwann cell-like cells existed after vein grafting was performed, and was accompanied by the process of myelination and structural recovery of regenerated nerves.

CONCLUSIONFunctional analysis of peripheral nerve repair is far more reliable than quantitative morphometrical analysis.

Animals ; Immunohistochemistry ; Male ; Nerve Regeneration ; Rats ; Recovery of Function ; S100 Proteins ; analysis ; Sciatic Nerve ; physiology ; surgery ; Veins ; transplantation

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Surgical treatment strategy for multiple injury patients in ICU.

Lian-yang ZHANG ; Yuan-zhang YAO ; Dong-po JIANG ; Jian ZHOU ; Xian-kai HUANG ; Yue SHEN ; Jian HUANG

Chinese Journal of Traumatology.2011;14(1):42-45.

OBJECTIVETo investigate the surgical treatment for patients with multiple injuries in ICU.

METHODSClinical data of 163 multiple injury patients admitted to ICU of our hospital from January 2006 to January 2009 were retrospectively studied, including 118 males and 45 females, with the mean age of 36.2 years (range, 5-67 years). The injury regions included head and neck (29 cases), face (32 cases), chest (89 cases), abdomen (77 cases), pelvis and limbs (91 cases) and body surface (83 cases). There were 57 cases combined with shock. ISS values varied from 10 to 54, 18.42 on average. Patients received surgical treatments in ICU within respectively 24 hours (10 cases), 24-48 hours (8 cases), 3-7 days (7 cases) and 8-14 days (23 cases).

RESULTSFor the 163 patients, the duration of ICU stay ranged from 2 to 29 days, with the average value of 7.56 days. Among them, 143 were cured (87.73%), 11 died in the hospital (6.75%) due to severe hemorrhagic shock (6 cases), craniocerebral injury (3 cases) and multiple organ failure (2 cases), and 9 died after voluntarily discharging from hospital (5.52%). The total mortality rate was 12.27%.

CONCLUSIONSThe damage control principle should be followed when multiple injury patients are resuscitated in ICU. Surgical treatment strategies include actively controlling hemorrhage, treating the previously missed injuries and related wounds or surgical complications and performing planned staging operations.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Postoperative Complications ; surgery

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Influence of hinge position on the effectiveness of open-door expansive laminoplasty for cervical spondylotic myelopathy.

Jun WAN ; Tian-tong XU ; Qing-feng SHEN ; Hui-nan LI ; Ying-peng XIA

Chinese Journal of Traumatology.2011;14(1):36-41.

OBJECTIVETo assess the influence of different hinge positions on clinical results of expansive open-door laminoplasty (EOLP) for cervical spondylotic myelopathy (CSM).

METHODSA total of 102 CSM patients who underwent EOLP from February 2006 to February 2007 were enrolled in this randomized controlled trial. Using a random digits table, 57 patients with the hinge located at the inner margin of the lateral mass were classified as wide-open group, while 45 patients with the hinge positioned at the lamina margin served as narrow-open group. All patients were observed over 24 months, and the clinical and radiological results were analyzed statistically.

RESULTSThere were no significant differences in operation duration, intraoperative bleeding volume, Japanese Orthopaedic Association (JOA) scores, cervical curvature index, range of motion and neural function recovery rate. The neural functions were satisfactorily improved after surgery in both groups, while the severity of axial symptoms was significantly lower in the narrow-open group than in the wide-open group (P equal to 0.003). The incidence of C(5) palsy in the wide-open group was higher than that in the narrow-open group (5.3% vs 0), even though the difference did not reach statistical significance (one tailed Fisher's exact test, P equal to 0.17).

CONCLUSIONSProper inward shift of the hinge can ensure effectiveness of surgical decompression, avoid an excessive backward shift of the spinal cord, decrease the incidence of C(5) palsy and alleviate the severity of axial symptoms.

Aged ; Female ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Spondylosis ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

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Anatomical and biomechanical analysis of sacral pedicle and lateral mass.

Meng-jun LI ; Guo-qiang DAI ; Dong WANG ; Jin-wu WANG ; Hai-tao JIANG

Chinese Journal of Traumatology.2011;14(1):29-35.

OBJECTIVETo study the anatomical and biomechanical features of sacral pedicle and lateral mass so as to provide reference for clinical screw fixation technology of sacral pedicle and lateral mass.

METHODSA total of 60 adult patients'spiral CT images of the sacrum and coccyx were selected randomly. The entry points of sacral pedicle and lateral mass screws were determined, and the screw trajectory was measured using the three dimensional reconstruction method. Meanwhile, the gross anatomy was scrutinized in 15 adult cadaver specimens to determine the sacral pedicle and lateral mass screw entry points. The length, width and angle of sacral pedicle and lateral mass screw trajectory were measured. Eight of 15 cadaver specimens were selected to test the maximal extraction force of sacral pedicle and lateral mass screws. The clinical data of 15 cases treated by pedicle and lateral mass screw technology were collected and analyzed.

RESULTSThe diameter and length of S(1)-S(5) sacral pedicle and lateral mass screw trajectory were regular, with about 20 degree inclination angle. The S(1) pedicle screw entry point was located at the intersection point of the basal lateral part of articular process and median line of transverse process, and no significant difference was found for the maximal extraction force between pedicle and lateral mass screws (P larger than 0.05). The entry points of S(2)-S(5) pedicle screws were located at the intersection point of the line connecting adjacent posterior sacral foramina and median line of the transverse process. The lateral mass screw entry point of S(2)-S(5) was on the median side of intersection point between median line of the transverse process and lateral sacral crest. The maximal extraction force of pedicle screws was significantly greater than that of lateral mass screws (P less than 0.05).

CONCLUSIONBoth the sacral pedicle and the lateral mass screw fixation techniques can offer effective fixation and reconstruction for fracture of the sacrum and coccyx, but pedicle screw fixation may be more convenient, safe and reliable than lateral mass screw fixation.

Adult ; Biomechanical Phenomena ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Imaging, Three-Dimensional ; Male ; Sacrum ; anatomy & histology ; physiology ; surgery ; Tomography, X-Ray Computed

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