BACKGROUND:Unstable intertrochanteric fracture is often treated with proximal femoral nail anti-rotation (PFNA), which has good repair effect, but there is the risk of varus deformity. Reverse less invasive stabilization system (LISS) is a new treatment, which can avoid varus deformity. However, little evidence has focused on the comparison of PFNA and LISS. OBJECTIVE:To compare the clinical efficacy, complications and joint function of reverse LISS and PFNA in treatment of unstable intertrochanteric fractures in the elderly patients. METHODS:A retrospective analysis was performed among 64 elderly patients with unstable intertrochanteric fractures. Among them, 28 cases were treated with reverse LISS and 36 cases were treated with PFNA. The healing time, loading time, complications and Harris score of hip joint function after internal fixation were compared in the two groups. RESULTS AND CONCLUSION:The loading time in the LISS group was earlier than the PFNA group. The healing time, incidence of complications and Harris score of hip joint function showed no significant differences between the two groups (P>0.05). Reverse LISS internal fixation has similar efficacy and complication with PFNA for the treatment of senile unstable intertrochanteric fractures, and it is a reliable method for internal fixation with few complications.Subject headings:Femoral Fractures;Clinical Healing;Internal Fixators;Bone Nails;Fol ow-Up Studies

Objective To explore the possibility of anterior open reduction and internal fixation to treat the lower cervical irreducible dislocation. Methods 15 cases of lower cervical irreducible dislocation were treated by the anterior open reduction and internal fixation, 11 cases were male and 4 cases were female, 10 cases were unilateral facet locked and 5 eases were bilateral facet locked which were confirmed by the MRI and CT scan. All the cases were failed to the skull traction before operation and received anterior open reduction and plate fixation, and interver-tebral fusion. All the cases were followed up, the recovery of neurological function and the fusion rate were evaluated. Results 15 cases were completely reduction and none of them got a worse neurological function. Conclusion The treatment effect of anterior open reduction and fixation for the lower cervical irreducible dislocation were good.

Objective To evaluate the clinical efficacy and its complications in patients with avaseular necrosis of femoral head (AVNFH) by modified free vascularized fibular grafting. Methods 50 patients(75 hips) with AVNFH ，the disease was caused by trauma in 20 cases(30 hips)，use of steroids in 15cases (23 hips)，consumption of alcohol in 11 cases (16 hips) and especially condition in 4eases (6 hips).Of 75 hips，27 were classified as stage Ⅱ;38 as stageⅢ，10 as stageⅣaccording to Steinberg system; the Harris hip scores were 78.5，65.4 and 57.4 before treatment respectively. Results The duration of the fibular osteotomy was 10 to 35 min( 18 min on average).The duration of the total operation was 80 to 130 min(95 min on average).After operation，Harris hip scores in most cases were improved. According to postoperative X-ray，60 hips ( 80.0% ) were improved to different extents and 13 hips ( 17.3% ) had no significant changes. Deterioration occurred in 2 hips(2.7% ).ConclusionThe modified free vascularized fibular grafting is an effective methods for the treatment in patients with avascular necrosis of femoral head