Objective To pay attention to the diagnosis and treatment of the complications associated with closed multifractures in metacarpals. Methods From 1997 to 2000, out of 382 patients with closed multi-fractures in metacarpals, 12 had complications. In 7 cases of fractures at the second , third , fourth and fifth metacarpal shaft, complicated by acute compartment syndrome in hand, compartmental fascia were incised for decompress; open reduction and internal fixation were performed. In 4 cases of fractures at the metacarpal base, complicated by acute carpal tunnel syndrome, the fracture was reduced and fixed without transection of the transverse carpal ligament. In 1 case of fracture at metacarpalbase, complicated by direct contusion of the median nerve, the fracture was reduced without treatment of the median nerve. Results All patients were followed up for 3 months. Fracture healed 46 weeks postoperatively. No claw deformity anddysfunction of the median nerve occurred. The arc of motion of the proximal interphalangeal and distal interphalangeal joints were normal.Conclusion During fracture reduction, we should pay attention to the complications associated with closed multi-fractures at metacarpal to decrease hand malfunction.
Objective To explore a suitable repairing method for skin defects of the foot and ankle, and to evaluate the therapeutic effects of the different repairing methods. Methods From January 2000 to October 2005, 36 patients with skin defects of the foot and ankle underwentthe repairing treatment, of whom 35 were males and 1 was female, aged 5-62 years, averaged 38 years. Of the 36 patients, 12 had an injury by a machine, 22 had a traffic accident, 1 had an infection, and 1 had a cold injury. And the injuries involved the dorsum of the foot, heel, forefoot, and medial or lateral malleolus. The injuries were respectively treated by 2 different repairing methods, the repair with the coverage by the lateral supramalleolar flaps and the repair with the coverage by the reverse sural neurocutaneous flaps. The skin defectsranged in area from 5 cm×4 cm to 20 cm×10 cm. The lateral supramalleolar flapwas used in 15 patients (15 flaps) with a flap area of 5 cm×4 cm-15 cm×8 cm,and the reverse sural neurocutaneous flap was used in 21 patients (22 flaps) with a flap area of 6 cm×4 cm20 cm×10 cm. We retrospectively observed the therapeutic results and compared the success rates of the two methods. Results Of the 36 patients, 15 underwent the repair with the coverage by 15 lateral supramalleolar flaps; 10 achieved a complete survival of the flaps, 2 developed an epidermal necrosis over the distal part, and 3 developed a complete necrosis.The other 21 patients underwent the repair with the coverage by 22 reverse sural neurocutaneous flaps. Of the 22 flaps, 21 had a complete survival, and only 1 failed to survive. The comparison revealed that there was no difference in the color, texture, and contour of the flaps between the 2 repaired groups. And the patients in the 2 groups were equally satisfied with the repairing treatments. The sensation of the flaps recovered to S0-S1. Conclusion The repairing of the foot and ankle skin defects with the coverage by the lateral supramalleolar flaps or by the reverse sural neurocutaneous flaps can achieve a similar good therapeutic result. However, the repair with the lateral supramalleolarflaps is more suitable for the skin defect of a smaller area over the medial orlateral malleolus, or the proximal dorsum of the foot; the repair with the reverse sural neurocutaneous flaps is more suitable for the skin defect of a larger area over the foot and ankle without serious destruction of the malleolar arterial rete.
Objective To evaluate the feasibil ity of direct anastomosis in the rat model of the brachial plexus extravertebral foramen nerve root division of C5-7. Methods Forty-eight SD rats (male or female) aging 4-6 months and weighing 250-300 g were selected to make the model of extravertebral foramen nerve root division of C5-7. The left C5-7 nerve roots, as the experimental sides, were separated to the brachial plexus nerve trunk and the transected roots were sutured to theproximal stump immediately after cutting off the brachial plexus extravertebral foramen nerve root division. The right C5-7nerve roots, as the control sides, received no operation. The general condition of rats after operation was observed. The gross observation, the histological observation and BDA nerve tracing technology were adopted to observe the wet weight of musculus biceps brachii, the cross section of biceps brachii and the spinal cord and distal nerve trunk at 3 weeks, 3 months and 6 months after operation. Results All rats survived well after operation. Claudication and unfold claw reflex were observed in the experimental sides, and the unfold claw reflex disappeared 3 months later. Comparatively, the control sides were normal. Nerve adhesion aggravated gradually and the neural stems were shriveled within 6 months after operation in the experimental sides. Comparatively, the control sides were normal. The wet weight of biceps brachii in the experimental sides and the control sides at 3 weeks, 3 months and 6 months after operation was (0.28 ± 0.12), (1.37 ± 0.33), (0.58 ± 0.10), (1.36 ± 0.35), (1.39 ± 0.31), (1.37 ± 0.38) g, respectively, indicating significant differences between two sides at 3 weeks and 3 months (P lt; 0.05), but no significant difference at 6 months (P gt; 0.05). The modified Marsland and the LFB staining of spinal cord and superior trunk of brachial plexus showed that the number of neurons, cell nuclear and Nissl body decreased and cell bodies changed from swell ing to shrinkage, dyeing nerve fibers increased, neural axone was thin and myel in sheath was sl ightly stained at each time point in experimental side. The number of motor neurons in cornu anterius medullae spinal is in the experimental side was 84.5% ± 3.2%, 74.4% ± 4.5%, 73.7% ± 3.8% of that in the control side at each time point, respectively. HE staining of biceps brachii detected thatthe muscle denaturation was very serious at 3 months after operation and then recovered. Neural tracing used BDA showed that the closer to the proximal of nerve trunk, the more obviously stained it was of myel in sheath and the more massive of axon at 6 months after operation. And there was almost no myel in and axon stained in musculocutaneous nerve. Conclusion In the rat model of brachial plexus extravertebral foramen nerve root division, the motoneuron in cornu anterius medullae spinal is necrosis rate reaches 20%-30%, and most of the residual neurons are pathologic. The regenerated fibers manifest as insufficient dynamic power and incomplete development, making no sense for the recovery of end organ function. Therefore, the exact mechanism of the recovery of biceps brachial muscle demands further study.
Objective To demonstrate the anatomical and biomechanical basis of scaphoid ring sign in advanced Kienbock’s disease. Methods The study consisted of two sections. The ligaments stabilizing the proximal pole of the scaphoid were observed in 5 specimens. Under 12 kg dead weight load through the tendons of the flexion carpal radial, the flexion carpal ulnar, the extension carpal radial, and the extension carpal ulnar for 5 minutes, the stresses of the scaphoid fossa and lunate fossa were measured in the case of neutral, flexion, extension, radial deviation and ulnar deviation of the wrist joint under normal and rupture conditions respectively by FUJI prescale film and FPD-305E,306E.Results Based on anatomical study, the ligaments stabilizing the proximal pole of the scaphoid consisted of the radioscaphocapitate ligament, long radiolunate ligament and scapholunate interosseous ligament; and the latter two ligaments restricted dorsal subluxation of the proximalpole of the scaphoid. When compared rupture condition with normal condition, thescaphoid fassa stress of radial subregion was not significantly different (0.90±0.43 vs 0.85±0.15), and the ones of palmar, ulnar and dorsal subregions decreased (0.59±0.20, 0.52±0.05 and 0.58±0.23 vs 0.77±0.13, 0.75±0.08 and0.68±0.09) in the case of extension; the scaphoid fassa stresses of all subregions increased or had no difference in the case of neural, flexion, radial deviation and ulnar deviation. The lunate fossa stresses of all subregions increased in thecase of neural, and the ones of all subregions decreased or had no difference inthe case of flexion, extension, radial deviation and ulnar deviation.Conclusion Rotary scaphoid subluxation should be treated operatively at Ⅲ B stage of Kienbock’s disease to avoid traumatic arthritis of theradioscaphoid joint.