OBJECTIVE: To explore the effectiveness of limb shortening/re-lengthening technique combined with in situ tissue regeneration technique in limb salvage for patients with complex lower limb fractures and soft tissue defects. METHODS: Between January 2021 and December 2024, 12 patients with complex lower limb fractures and soft tissue defects caused by trauma were admitted. There were 10 males and 2 females; the age ranged from 18 to 46 years, with an average of 36 years. Among them, 1 case of open comminuted tibiofibular fracture caused bone necrosis and soft tissue infection; 4 cases of open tibiofibular fractures developed bone and soft tissue infections after being fixed with a combined external fixator, resulting in defects; 7 cases of closed tibial fractures that underwent internal fixation developed soft tissue infections, leading to bone and soft tissue necrosis. The time from injury to the formation of bone and soft tissue defects was 2-9 weeks, with an average of 6 weeks. The length of bone defects was 5.0-10.2 cm, with an average of 6.8 cm; the area of soft tissue defects was 32-54 cm ², with an average of 43.9 cm ². After admission, all patients underwent thorough debridement. The limb shortening treatment was performed after the wound had filled with fresh granulation tissue, and an Ilizarov ring-shaped external fixator was placed or replaced. The limb was shortened at a rate of 1 mm/day to reduce bone defects. At the same time, the soft tissue defects were repaired using the in situ tissue regeneration technique. After the wound healed, osteotomy was performed, and limb lengthening was carried out at a rate of 1 mm/day. The lower limb full-length X-ray films were taken, and the lengthening was stopped when the lower limb alignment was restored. The healing condition of the wound was observed and the healing time was recorded. RESULTS: One patient died due to a traffic accident during limb lengthening. The remaining 11 patients completed limb shortening and re-lengthening treatment and were followed up 18-36 months, with an average of 20 months. All 11 patients successfully preserved their limbs. The wound healing time was 4-12 weeks, with an average of 8 weeks; the limb shortening time was 4-8 weeks, with an average of 6 weeks; and the limb lengthening time was 4-12 weeks, with an average of 8 weeks. One patient experienced delayed bone mineralization during bone lengthening, and one had pin tract infection. Both were treated symptomatically. The lower limb mechanical axis of all 11 patients was restored, and they were able to walk independently. CONCLUSION The application of limb shortening/re-lengthening technique combined with in situ tissue regeneration technique in the treatment of large bone and soft tissue defects not only effectively avoids the occurrence of nonunion at the apposition ends and increases the stability of the lower limb, but also significantly shortens the wound healing time, avoids the risk of soft tissue infection and increases the limb salvage rate. It can be used as a treatment technique for patients with complex lower limb fractures combined with soft tissue defects.
Humans ; Adult ; Male ; Female ; Middle Aged ; Soft Tissue Injuries/surgery* ; Limb Salvage/methods* ; Adolescent ; Young Adult ; Bone Lengthening/methods* ; External Fixators ; Lower Extremity/surgery* ; Fracture Fixation, Internal/methods* ; Fractures, Bone/surgery* ; Tibial Fractures/surgery* ; Treatment Outcome ; Regeneration

PURPOSE: Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner. METHODS: Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated. All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software. RESULTS: Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale. Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient = -0.554). CONCLUSION A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.
Adult ; Compartment Syndromes ; prevention & control ; Connective Tissue ; physiopathology ; Female ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Fractures, Comminuted ; physiopathology ; surgery ; Humans ; Knee ; physiopathology ; Male ; Middle Aged ; Range of Motion, Articular ; Tibial Fractures ; physiopathology ; surgery ; Treatment Outcome

Non-union is one of the most devastating complications after fracture fixation. It usually results in prolonged treatment duration and unpredictable results. We reviewed the literature to identify recent information regarding the following: risk factors of nonunion; mechanical risk factors, including fracture gap width and stability, osteonecrosis and healing mechanism, osteoporotic fracture and fixation method, the characteristics of fracture, soft tissue injury, local infection, and multiple fractures; as well as the metabolic risk factors, including age, comorbidities, smoking, alcoholism, and medications. The technique and devices for fracture treatment have been developed, and treatments of nonunion are evolving according to the enhancement of our understanding of nonunion. Clinicians should refer to the risk factors and advancements while developing a treatment plan.
Alcoholism ; Comorbidity ; Fracture Fixation ; Fractures, Multiple ; Methods ; Osteonecrosis ; Osteoporotic Fractures ; Risk Factors ; Smoke ; Smoking ; Soft Tissue Injuries

Non-union is one of the most devastating complications after fracture fixation. It usually results in prolonged treatment duration and unpredictable results. We reviewed the literature to identify recent information regarding the following: risk factors of nonunion; mechanical risk factors, including fracture gap width and stability, osteonecrosis and healing mechanism, osteoporotic fracture and fixation method, the characteristics of fracture, soft tissue injury, local infection, and multiple fractures; as well as the metabolic risk factors, including age, comorbidities, smoking, alcoholism, and medications. The technique and devices for fracture treatment have been developed, and treatments of nonunion are evolving according to the enhancement of our understanding of nonunion. Clinicians should refer to the risk factors and advancements while developing a treatment plan.
Alcoholism ; Comorbidity ; Fracture Fixation ; Fractures, Multiple ; Methods ; Osteonecrosis ; Osteoporotic Fractures ; Risk Factors ; Smoke ; Smoking ; Soft Tissue Injuries

PURPOSEThe treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi's external stabilization system (JESS) by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries.

METHODSBetween June 2008 and June 2010, 25 consecutive patients who were 17e71 years (mean, 39.7), underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries. Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up. Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries (Gustilo-Anderson grade I&II). The injury mechanisms were motor vehicle accidents (n=19), fall from a height (n=2) and assault (n=1). The fractures were classified according to Schatzker classification system.

RESULTSThere were 7 type-V, 14 type-VI and 1 type-lV Schatzker's tibial plateau fractures. The average interval between the injury and surgery was 6.8 days (range 2-13). The average hospital stay was 13 days (range, 7-22). The average interval between the surgery and full weight bearing was 13.6 weeks (range 11-20). The average range of knee flexion was 121°(range 105°-135°). The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients. The complications included superficial pin tract infections (n=4) with no knee stiffness.

CONCLUSIONJESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high- energy tibial condylar fractures associated with severe soft tissue injuries.

Adolescent ; Adult ; Aged ; Bone Screws ; External Fixators ; Female ; Fracture Fixation ; methods ; Humans ; Length of Stay ; statistics & numerical data ; Male ; Middle Aged ; Soft Tissue Injuries ; surgery ; Tibial Fractures ; surgery ; Treatment Outcome

Aluminum ; Fixatives ; Formaldehyde ; Humans ; Polymers ; Tissue Fixation ; instrumentation ; methods

OBJECTIVETo evaluated HER2 status using immunohistochemistry (IHC) assay and fluorescence in situ hybridization (FISH) at two different time points of tissue fixation after surgical resection of gastric cancer, emphasizing the importance of standard operation and quality control in HER2 testing.

METHODSForty-one resection specimens of advanced gastric cancer were collected with tissue fixation periods of < 30 min or > 30 min after surgical resection. HER2 status was evaluated by immunohistochemistry (IHC) assay and fluorescence in situ hybridization (FISH).

RESULTSThe frequency of HER2 expression by IHC in the samples with fixation time of < 30 min was higher than that in those of > 30 min (P < 0.05). However, no significant difference was observed by FISH (P > 0.05) between the two groups. Samples of < 30 min fixation time had high concordant results between IHC and FISH (100.0% for both positive and negative cases, Rho = 0.724, P < 0.05). In addition, HER2 expression by IHC was significantly correlated with Lauren classification, histologic differentiation, TNM stage and gender (P < 0.05).

CONCLUSIONThe time to tissue fixation after surgical resection of more than 30 min has deleterious effect on the detection of HER2 by IHC although FISH testing is not affected.

Aged ; Humans ; Immunohistochemistry ; In Situ Hybridization, Fluorescence ; Receptor, ErbB-2 ; analysis ; Stomach Neoplasms ; chemistry ; pathology ; surgery ; Time Factors ; Tissue Fixation ; methods

OBJECTIVETo investigate the clinical results of distal tibia fractures accompanying with anterior soft tissue injury by posteromedial approach.

METHODSFrom August 2008 to August 2010,31 patients (21 males and 10 females, ranged in age from 24 to 68 years with an average of 46 years) with distal tibia fractures accompanying with anterior soft tissue injury were treated with open reduction and internal fixation through posteromedial approach. Of the 31 cases, 14 cases were open fractures (including 5 cases Gustilo-Anderson type I, 5 type II, 2 type III A, and 2 type III B) and 17 cases were closed fractures (including 3 cases Tcherne-Oestern type I, 12 type II, 2 type III). According to typing of AO, type 43A were in 26 cases and type 43C1 were in 5 cases. Operation time, intraoperative blood loss, fracture healing time, AOFAS ankle score, and complications were recorded to evaluate clinical effects.

RESULTSAll the patients were followed up from 12 to 36 months with an average of 21 months. The mean operation time was 70 min (ranged, 40 to 110 min) and the mean blood loss was 100 ml (ranged, 50 to 200 ml). Average healing time for closed fractures was 13 weeks (ranged, 10 to 18 weeks), while open fractures was 19 weeks (ranged, 15 to 29 weeks). Cross-foot of 40 occurred in 1 case and pes valgus of 30 in 1 case at final follow-up; and AOFAS ankle scores were from 69 to 100 with an average of 88.4 +/- 9.7. Of them, 10 cases obtained excellent results, 17 good, 4 fair.

CONCLUSIONPostermedial approach is an effective method for distal tibia fractures especially accompanying with local soft tissue injury or bad skin condition.

Adult ; Aged ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Soft Tissue Injuries ; surgery ; Tibial Fractures ; complications ; surgery

OBJECTIVETo evaluate the performance of a new highly efficient and environment-friendly tissue cell fixatives for preserving the morphologies and properties of pleural and peritoneal effusions.

METHODSFifty-six specimens of tissue cells from pleural and peritoneal effusions were preserved using the new preservative or 95% ethanol. HE staining and Western blotting were employed to detect the morphologies and protein expression levels of CK, CEA and P53 of the cells after fixation.

RESULTSThe new preservative well preserved the morphologies of the cells from the pleural and peritoneal effusions, and the nuclei and cytoplasm were intact with little debris. The conventional preservative (95% ethanol) caused noticeable structural damage of the tissue cells, especially the cytoplasm where obvious debris were seen after fixation. CK, CEA and P53 protein expression levels in the cells were 91%, 86% and 88% after fixation with the new preservative, significantly higher than those (46%, 38% and 31%, respectively) in cells fixed with 95% ethanol (P<0.05).

CONCLUSIONThe new preservative is efficient and environment-friendly for preserving the morphologies as well as the proteins of tissue cells from pleural and peritoneal effusions well, demonstrating its potential in tissue cell fixation and preservation.

Ascitic Fluid ; cytology ; Biocompatible Materials ; Cytoprotection ; Humans ; Materials Testing ; Tissue Fixation ; methods

The aim of this research was to explore the most optimal method of DNA extraction from formalin-fixed, paraffin-embedded (FFPE) tissues, and to improve the amplification of long fragments with the method. Three methods, one step method, phenol-chloroform extraction method, and genomic DNA purification kit method, were employed to extract DNA from twenty normal thyroid tissues which were fixed with formalin and embedded with paraffin. The highest proportionality of OD260/OD280 in the examples was obtained by phenol-chloroform extraction method, 1.703 +/- 0.086, compared to the results of the other two methods. As for the long DNA segments amplification, the achievement ratio of one step method, phenol-chloroform extraction method and genomic DNA purification kit method were 0%, 5% and 10%, respectively, by traditional PCR method, but 0%, 95% and 85% respectively by the nest PCR. We have found that the best process of extracting DNA from FFPE is digesting by proteinase K and purifying by phenol-chloroform, and it is effective to amplify long DNA segments from FFPE by nest PCR.
Base Sequence ; DNA ; isolation & purification ; Formaldehyde ; Humans ; Molecular Sequence Data ; Paraffin Embedding ; Pathology, Molecular ; methods ; Polymerase Chain Reaction ; methods ; Sensitivity and Specificity ; Thyroid Gland ; pathology ; Tissue Fixation