OBJECTIVE: To compare the clinical outcomes of microfracture and autogenous osteochondral mosaic transplantation in the treatment of knee joint cartilage injury. METHODS: A retrospective analysis of 71 patients with articular cartilage defects on the femoral condyles who were by autogenous osteochondral mosaic transplantation or microfracture from February 2011 to February 2016, and these patients were followed up for at least 2 years. According to the sugical procedures, the patients were divided into two groups. In the microfracture group, there were 33 patients, 20 males and 13 females, with a mean age of(28.1±4.2) years old; in the mosaicplasty group, there were 38 patients, 26 males and 12 females, with a mean age of(27.8±3.5) years old. The Lysholm knee score, Hospital for Special Surgery (HSS) knee score and the Ahlbäck classification grade were recorded to evaluate the clinical efficacy. Complications were also recorded. RESULTS: The mean Lysholm scores of the microfracture group and the mosaicplasty group improved from 62.9±6.8 and 60.3±7.5 preoperatively to 77.0±5.4 and 85.8±5.6 post-operatively, respectively(<0.05). Mean HSS scores of the microfracture group and the mosaicplasty group improved from 81.5±7.6 and 79.6±8.6 preoperatively to 88.0±4.7 and 91.9±4.7 post-operatively, respectively(<0.05). The mean Lysholm score and HSS score were significantly higher in the mosaicplasty group than those in the microfracture group at the latest follow-up. One patient in the mosaicplasty group suffered superficial wound infection. During the follow-up, no knee osteoarthritis was observed in two groups. CONCLUSIONS Autogenous osteochondral mosaicplasty and microfracture are proved to be safe and effective procedures for knee articular cartilage defects. However, the mosaicplasty has better clinical outcome than the microfracture.
Adult ; Cartilage, Articular ; Female ; Follow-Up Studies ; Fractures, Stress ; Humans ; Knee Joint ; Male ; Retrospective Studies ; Transplantation, Autologous ; Treatment Outcome ; Young Adult

Emergency physicians in the field are sometimes confronted with cases wherein patients cannot be intubated and ventilated. In some cases, cricothyrotomy, the method of choice for securing an emergency airway, may not have a successful outcome. We report a rare case of a 35-year-old male patient with avulsion of the larynx and a comminuted fracture of the jawbone, due to entrapment in a dung excavator. Prehospital tracheotomy was successfully performed. In cases with crush injuries to the larynx, anatomic structures, including the ligamentum conicum, are destroyed. In addition, massive subcutaneous emphysema blurs the anatomical key structures; hence, only a tracheotomy can prevent a lethal outcome.
Adult ; Emergencies ; Emergency Medical Services ; Fractures, Cartilage ; Fractures, Comminuted ; Humans ; Larynx ; Male ; Methods ; Subcutaneous Emphysema ; Tracheotomy

Most capitate fractures occur in association with additional carpal injuries, particularly scaphoid fractures. Isolated fractures of the capitate account for only 0.3% of carpal injuries, and stress fractures are one form of this fracture. We report the case of a 20-year-old male who had a stress fracture of the capitate after serving as an honor guard in the military. Conventional radiographs and computed tomography of the right wrist revealed a minimally displaced fracture line located at the midcarpal aspect of the right capitate. A magnetic resonance imaging scan demonstrates a subarticular capitate fracture with diffuse bone marrow edema, small osteophytes, and irregularity of the midcarpal articular cartilage. We also review the carpal kinematics which possibly caused the stress fracture. Although stress fractures of the capitate are rare, they should also be accounted for with patients who perform repetitive motions of the wrist to a considerable extent.
Biomechanical Phenomena ; Bone Marrow ; Capitate Bone ; Carpal Bones ; Cartilage, Articular ; Edema ; Fractures, Stress ; Humans ; Magnetic Resonance Imaging ; Male ; Military Personnel ; Multidetector Computed Tomography ; Osteophyte ; Wrist ; Young Adult

PURPOSE: This study is performed to evaluate the usefulness of arthroscopic surgery prior to open reduction and fixation surgery to treat acetabular fractures and hip fractures-dislocation. MATERIALS AND METHODS: From January 2010 to March 2014, a total of 54 patients with acetabular fractures or hip fractures with dislocation were treated arthroscopically via fracture surface before open reduction and fixation (group 1, n=11), and without hip arthroscopy prior to open reduction and fixation (group 2; n=43). Clinical results were evaluated using Harris hip score (HHS) and visual analogue scale (VAS) pain scores. RESULTS: The mean age of patients is 43.2 years and there are 10 males and 1 females in group 1. The mean follow-up period is 15 months. The acetabular status of each case was assessed arthroscopically. Bone fragment was performed in 6 cases, and ligamentum teres shrinkage in 1 case. At the final follow up, the mean HHS and VAS pain scores were 78.6 and 2.18, respectively. During follow up, one case of osteoarthritis and one case of heterotopic ossification were identified. At the final follow up, the mean HHS and VAS pain scores were 77.5 and 2.23, respectively. In group 2, oteoarthritis and ectopic ossification were observed in 4 and 1 cases, respectively. CONCLUSION: No differences were observed in the clinical outcomes of patients with acetabular fracture or hip fracture-dislocation when treated with or without arthroscopic surgery before open reduction and fixation. However, arthroscopy is thought to be useful for evaluating the joint cartilage surface and fracture fragments more accurately.
Acetabulum ; Arthroscopy ; Cartilage ; Dislocations ; Female ; Follow-Up Studies ; Hip Dislocation ; Hip Fractures ; Hip ; Humans ; Joints ; Male ; Ossification, Heterotopic ; Osteoarthritis ; Round Ligaments

OBJECTIVE: To explore the clinical curative effect of soft tissue wire rivet for the treatment of fracture of patella cartilage. METHODS: A retrospective study was conducted in 25 patients(25 knees) from June 2015 to February 2017 in patients with patellar cartilage fractures. Among them, 19 were male, 6 were female, 11 were left knee, 14 were right knee. The accident occurred in 2 cases, 23 cases of sprained athletes; the average age was(25.12±6.02) years old, the average weight was (62.48±7.91) kg, and the average body mass index was(23.25±1.51) kg/m². The average time from injury to admission was (1.96±1.51) d. The clinical manifestations were swelling of knee joint, positive floating patella sign, severe pain, occasional joint strangulation, limited flexion and extension, obvious tenderness of lateral patella, positive patellar extrapolation test and positive extrapolation fear test. X-ray and CT examination were performed before operation. X-ray showed the continuity of patellar bone and a loose body in the joint cavity. CT and 3D reconstruction showed patellar cartilage and facial defects. All 25 patients were fixed with soft tissue wire rivet. The clinical efficacy included preoperative Lysholm score and Insall evaluation. RESULTS: All the patients were followed up, and the duration ranged from 3 to 15 months, with an average of(9.72±4.07) months. The preoperative Lysholm score was 60.32±5.08, and the final follow-up was 88.24±4.37. The postoperative score was better than that before operation(-22.926, <0.05). According to Insall criteria, 21 cases were excellent, 4 cases were good, no fracture fragments were found and knee joint adhesion was found. Six weeks after operation, X-ray and CT showed that the fracture was well positioned, the cartilage surface was smooth without obvious steps, and the patella was in good shape. MRI showed the smooth articular surface of patellar cartilage at the 6th month after operation. CONCLUSIONS Soft tissue wire rivet for the treatment of massive patellar cartilage fracture has the advantages of simple operation, rapid postoperative recovery, no need for secondary operation pain, fewer complications, and definite effect, which is worthy of clinical promotion.
Adult ; Bone Wires ; Cartilage ; Female ; Fractures, Cartilage ; Humans ; Male ; Patella ; Retrospective Studies ; Treatment Outcome ; Young Adult

Laryngeal trauma is rare compared to other head and neck traumas, but it occurs, it can be life threatening. As for treatment, a laryngeal fracture that involves displacement of cartilage or extensive injury requires appropriate surgical treatments. For severe laryngeal fractures, conservative management is usually preferred with placing a stent to prevent laryngeal stenosis. But the downside of placing stents in the larynx includes the risk of granulation and infection. In this report, the authors describe a 35-year-old patient, who was diagnosed with blunt laryngeal trauma and treated by Horizontal partial laryngectomy. The patient's post-operative breathing and voice were fair, and airway stenosis did not occur afterwards.
Adult ; Cartilage ; Constriction, Pathologic ; Fractures, Cartilage ; Head ; Humans ; Laryngeal Cartilages ; Laryngectomy* ; Laryngostenosis ; Larynx ; Neck ; Respiration ; Stents ; Voice

OBJECTIVETo evaluate clinical effects of fixation of chronic large osteochondral fragment in the weight-bearing area of femoral condyle using absorbable pins under arthroscopy.

METHODSFrom March 2007 to December 2011, 6 patients with chronic large osteochondral fractures of femoral condyle were treated with absorbable pins under arthroscopy. Among the patients, there were 4 males and 2 females, ranging in age from 14 to 48 years old, and the courses of disease ranged from 4 to 26 weeks. After injury, patients suffered from pain and swelling on the knee. The locations of injury were at the weight-bearing areas of femoral condyle. The depth of injury was degree IV according to ICRS classification. The area of injury was more than 4 cm2. The healing of osteochondral fracture was assessed by X-ray. Lysholm score, IKDC score and Tegner activity score were used to assess outcomes.

RESULTSThe osteochondral fractures healed in all patients, and the cartilage became degenerative to some extent when performing a secondary exploration. The postoperative Lysholm score, IKDC score and Tegner activity score increased compared with those before operation.

CONCLUSIONUsing absorbable pins under arthroscopy for the treatment of chronic large osteochondral fracture of femoral condyle is effective to regain the flat structure of articular cartilage and promote the healing of osteochondral fracture.

Adolescent ; Adult ; Arthroscopy ; methods ; Bone Nails ; Cartilage, Articular ; injuries ; surgery ; Chronic Disease ; Female ; Femoral Fractures ; surgery ; Fracture Healing ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore the operative method and effect of fracture of orbital floor defects repaired with tragus cartilage through Cald-well-Luc approach under nasal endoscope. METHOD: Fifteen cases suffered fracture of orbital floor defects(blow out fracture) were analyzed retrospectively. Oral vestibular incision were done directly to tip teeth kennel, maxillary sinus anterior forewall was chiseled with 2 cm x 2 cm size, orbital floor fracture defect size was probed under nasal endoscope, and the fracture of orbital floor defects was repaired with tragus cartilage. RESULT: Fifteen cases were successfully operated and no cases showed vision loss,diplopia, enophthalmos obviously after operation,while 3 case were a little eyeball limitation of activity and restored basically after one month. With two years of follow up, there were no spurious eyelid drooping, up-eyelid lacuna deepen, eyelid diameter shorten and facial deformity were found. Both eye-balls were basical symmetry and no complications were happened. CONCLUSION It is a satisfactory, effective and aminimally invasive surgical method without facial scars and eyelid ectropion for fracture of orbital floor defects repaired with tragus cartilage through Cald-well-Luc approach under nasal endoscope.
Adult ; Blindness ; Cartilage ; transplantation ; Diplopia ; Ear Auricle ; Endoscopes ; Endoscopy ; methods ; Enophthalmos ; Female ; Humans ; Male ; Maxillary Sinus ; surgery ; Middle Aged ; Nose ; Orbital Fractures ; surgery ; Retrospective Studies

Histologically, Schmorl's nodes are defined as the loss of nuclear material through the cartilage plate, growth plate, and end plate into the vertebral body. Most Schmorl's nodes are asymptomatic, although there are some reports of symptomatic Schmorl's nodes, which should be treated similarly to vertebral compression fractures, with conservative treatment as the first choice. We report the case that we reduced the pain by blocking the ramus communicans nerve in a patient with Schmorl's node.
Cartilage ; Fractures, Compression ; Growth Plate ; Humans ; Nerve Block

BACKGROUND: Rib fractures are the most common injuries that are caused by blunt chest trauma. However, fractures of the costal cartilage generally go unnoticed on chest X-rays unless they involve a calcified cartilage. For this reason, the sensitivity of conventional radiography for detecting rib fractures is low, and especially those involving the cartilaginous part of the rib. Thus, we have evaluated the usefulness of ultrasonography for detecting fractures of the costal cartilage that were overlooked on the conventional radiographs of patients who suffered minor blunt chest traumas. MATERIAL AND METHOD: A total of 45 patients who suffered minor blunt chest trauma and who had no evidence of rib fractures or other major fractures on conventional radiographs were admitted for ultrasonography between April 2008 and March 2009. There were 24 women and 21 men, and the mean age of the patients was 50.4+/-15.91 years (range: 17~76 years). They were examined for the detection of fractures of the costal cartilage by performing ultrasonography with a 7.5-MHz linear transducer. RESULT: A total of 30 patients (67%) had fractures of the costal cartilage, whereas 15 patients (33%) had no evidence of chondral rib fractures. The mean number of fracture sites of the fractured costal cartilage was 1.6+/-0.81 (range: 1~4 sites) in 30 patients. Periosteal hematoma was the most common finding associated with fractures of the costal cartilage (n=7, 17%), followed by sternum fracture (n=5, 12%). However, periosteal hematoma was noticed in 1 patient (2%) who was without fracture of the costal cartilage, and sternum fracture was noticed in 1 patient (2%) who was without fractures of the costal cartilage. CONCLUSION: The results of this study suggest that ultrasonography may be a useful imaging modality for detecting fractures of the costal cartilage that are overlooked on the conventional radiographs of patients who suffer minor blunt chest trauma.
Cartilage ; Female ; Hematoma ; Humans ; Male ; Rib Fractures ; Ribs ; Sternum ; Thoracic Wall ; Thorax ; Transducers