The use of autogenous bone in treating bone defects has not met clinical demands, leading to increased attention on beta-tricalcium phosphate (β-TCP) as a bone graft substitute due to its effective repair capabilities and inherent osteoinductive properties. Upon implantation, biodegradable β-TCP can effectively modulate inflammation, promote vascular regeneration, and facilitate new bone formation through intramembranous ossification, thereby achieving bone defect healing. Continuous research has sought to understand the mechanisms underlying β-TCP's ability to induce mesenchymal stem cell differentiation into osteoblasts, initially attributed to the release of calcium and phosphorus ions and the adsorption of proteins. Current research emphasizes the impact of the material's surface structure on cellular interactions, particularly focusing on changes in cell-integrin and cytoskeleton dynamics, which regulate signal transduction pathways such as the mitogen-activated protein kinase/extracellular signal-regulated kinases (MAPK/ERK) pathway, the Wnt pathway, and the Yes-associated protein/transcriptional coactivator with PDZ-binding motif (Yap/Taz) pathway. Presently, the fundamental structure of β-TCP products has matured, with continuous innovations in macro and micro design. These bone graft substitutes are widely used in clinical settings, demonstrating long-term safety and efficacy.

The elbow is more susceptible to motion loss than other joints after trauma,and elbow stiffness leads to functional impairment in the upper limb and interferes with daily activities.Open arthrolysis is the most common and classical treatment for post-traumatic elbow stiffness.In this paper,we review the treatment protocols like preoperative clinical evaluation,arthrolysis strategies and postoperative rehabilitation program for post-traumatic elbow stiffness,discuss relevant issues and assess their prospects.

Currently clinical scoring systems are the most popular functional measurements for orthopedic patients.However,unfortunately,the scoring systems so far for the elbow are not capable enough of fully assessing the joint motion capacities,symptoms and quality of life for the patients with elbow dysfunction.In this paper,we review the elbow scoring systems most commonly used for the patients with elbow dysfunction,analyze their insufficiency in evaluation of elbow dysfunction,and discuss how to develop a new scoring system specially for elbow dysfunction.

Objective To reports to anatomy and clinical application of the medialis pedis perforator flap. Methods The origin, course, distribution and out diameter of medial plantar perforators, which were located at the septums between the abductor hallucis muscle and the flexor digitorum brevis, and between the abductor hallucis muscle and the skeleton, were observed on 10 sides adult feet specimens perfused with red latex. 11 free medialis pedis perforator flaps were transferred for soft-tissue defect in hand. The areas of tissue defect ranged from 2 cm x 2 cm - 9 cmx 4 cm. Results The medial plantar artery sends 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and the flexor digitomm bre-vis, and 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and nav-icluar bone and the medial cuneiform bone. These perforators supply the medial plantar flap and medialis pedis flap respectively. All of the 11 cases of free medialis pedis perforator flap survived uneventfully. The flap areas ranged from 2 cm × 3 cm - 11 cm× 5 cm. The appearance and functional results were satisfactory with following up for 6 to 24 months. Conclusion The free medialis pedis perforator flap is a good method in repairing soft-tissue defect in hand.

Objective To evaluate the hinged external flxator in combination with internal fixation for treatment of old type B fractures of the distal humerus.Methods Eleven cases of old type B fractures of distal humerus treated in our department were studied retrospectively.They were treated with hinged external fixators in combination with internal fixation and evaluated according to Mayo elbow performance scores.Results All the patients were followed up for 10 to 18(mean, 12.5)months.The mean union time was 4.6(range, 3.5 to 6.0)months.The final range of flexion to extension of the elbow was 19.4°±6.5° to 124.2°±11.3°.The final ranges of pronation and supination were 72.8°±5.4° and 67.6°± 7.3°.By Mayo elbow performance scores, the post-operative functional outcome of the elbow was excellent in 5 patients, good in 4, and fair in 2.Conclusion The old type B fractures of distal humerus can be effectively treated with hinged external fixators in combination with internal fixation, for early rehabilitation and restoration of the elbow function can be facilitated.

Objective To explore the possibility and effectiveness of minimally invasive osteotomy and cable osteosynthesis for the treatment of adolescent eubitus varus. Methods Eleven cases of adolescent cubitus varns(2 cases complicated with internal rotation of 10°)were treated with minimally invasive supracondylar wedged osteotomy to preserve the integrity of the contralateral codex and periosteum.Two screws were inserted above and below the fracture line.They were fixed with cable after the greenstick fracture and internal rotation were adjusted.Plastic bandage was applied for 1 week postoperatively before rehabilitation. Results Bone fractures healed in the 11 cases in 36.3 days averagely,without infection or nerve palsy.Before operation,the mean angles of varus,flexion and extension were 35°±5°,125°±10°and 10°±5°respectively.After a mean follow-up of 33.5 months,the mean valgus angle of the elbow was improved to 8°±2°(t=16.632,P<0.05),flexion to 130°±8°and extension to 8°±3°(P>0.05).Internal rotation deformity was also ameliorated in the 2 cases. Conclusion It is practical and effective to treat adolescent eubitus varus with minimally invasive osteotomy and cable osteosynthesis,for it can lead to stable fixation,short healing time,and does not affect the flexion and extension of the elbow joint.

Objective To explore the role of compound nerve conduit, made of nerve growth factors (NGF) encapsuled by biodegradable core-shell nanofibers through coaxial electrospinning, in regeneration of injured sciatic nerves in rats. Methods The compound nerve conduits were developed from the core-shell structured biodegradable nanofibers with P(LLA-CL) as a shell and BSA/NGF or BSA as a core through coaxial electrospinning. Seventy-two Sprague-Dawley rats were randomly divided into 4 even groups. The middle segments (10 mm) of the sciatic nerve were excised and the defects were repaired with sciatic nerve autograft (group A), with P(LLA-CL) conduit (group B), with PLLA-CL conduit and one injection of NGF (group C), and with P(LLA-CL)/NGF controlled-release conduit (group D), respectively. Morphologic and functional evaluations of nerve regeneration were done by gross observation, sciatic function index, neural electrophysiological examination, resumption rates of triceps weight, histological and ultrastructural observa-tion respectively in 1, 2, 3 months after the operation. Results Three months after the operation, although partial biodegradation and small cracks could be observed, conduits remained intact in outline. Based on the functional and histological observations, nerve regeneration, nerve fibers arrangement, myelination and nerve function reconstruction in the P(LLA-CL)/NGF controlled-release conduit (group D) were similar to those in nerve autograft (group A) and significantly superior to those in groups B and C (P<0.05). Conclusion As the P(LLA-CL)/NGF-controlled release conduit has favorable mechanical properties and biocompatibility, it can effectively promote regeneration of the sciatic nerve in rats.

Objective To study the clinical effect of cohesive elastic bandage (CEB) after operative treatment of ankle fractures. Methods After surgery, 60 patients with ankle fracture were randomly as-signed to 2 even groups: CEB dressing group and common dressing group. Functional exercise started the next day after operation. Comparison was made between the 2 groups in drainage, displacement and swelling. Results In CEB dressing group, the volume of drainage was (34.6±18.1) mL, the rate of displacement 6.7%, and the swelling was slight in 21 patients, moderate in 5 and severe in 4. In common dressing group, the volume of drainage was (85.1±17.1) mL, the rate of displacement was 63.3%, and the swelling was slight in 7 patients, moderate in 12 and severe in 11. The differences were significance(P<0.05) . Conclusion Use of CEB after surgery for ankle fractures may alleviate swelling, reduce bleeding effectively, and benefit early functional exercise.

Objective To report the technique and effect of distally based, cross-leg, anterolateral thigh flap for reconstructing the soft tissue defects in middle and distal thirds of the contralateral leg. Methods Five patients of soft tissue defects in lower legs associated with injuries to the eontralateral legs were treated with distally based, cross-leg, anterolateral thigh flaps of the contralateral limbs. Results After the pedicle division at 6 weeks postoperatively, the 5 flaps all survived. And the blood supply of flaps remained steady when followed up for 12 to 15 months. The flaps possessed favorable contours, and allowed successful secondary repair of injured bones or tendons. The donor sites healed primarily, and no influence was observed to the donor limbs. Conclusion For the soft tissue defects in middle and distal thirds of leg associated with damage to the surrounding tissues and arterial injury of the contralateral leg, cross-leg transplantation of the contralateral distally based anterolateral thigh flap is a good option of reconstruction.

BACKGROUND: Basic flbroblast growth factor (bFGF) can promote tendon proliferation, collagen secretion,and out-sheathed tendon healing; however, effects on in-sheathed tendon are still unknown.OBJECTIVE: To explore the effects of exogenous bFGF on in-sheathed tendon healing and adhesion formation. DESIGN,TIME AND SETTING: A randomized controlled animal study, which was carried out in Experimental Animal Center, Shanghai Sixth People's Hospital from May 2004 to February 2005.MATERIALS: Ninety Leghorn chickens were randomly divided into 3 groups with 30 animals for each, and the right third digitorum longns tendon of the chicken was transected. METHODS: In the control group, the tendon was sutured in situ after transection. In the fibrin group,the tendon was sutured after 0.6 μL fibrin sealant (FS) was applied at repair site. In the bFGF group,the tendon was sutured after 0.6 μL FS mixed with 500 ng bFGF was applied at repair site. MAIN OUTCOME MEASURES: At 1,2,4 and 8 weeks postoperatively, the tendons of 6 chickens in each group were harvested for morphological and histological evaluation.Another six specimens of each group was obtained for biomechanical test at 8 weeks.RESULTS: There were no significant differences between control group and fibrin group. In bFGF group compared with control and fibrin groups, appearance of the angiogenesis,fibroblast proliferation and collagen production in the sheath, epitenon and parenchyrna at repair site occurred earlier and were more in quantity,the gliding excursion of the tendon was shorter, and the work of flexion and the ultimate tensile strength of the tendon were greater. CONCLUSION: The exogenous bFGF at tendon repair site can facilitate in-sheathed tendon healing, but also increase the tendon adhesion.