Objective To study the clinical outcome of comminuted factures at distal femur and proximal tibia treated with AO less invasive stabilization systems (LISS). Methods The clinical data of 14 cases of distal femoral fracture and proximal tibial fracture from September 2003 to May 2005 were analyzed retrospectively. The injury was caused by traffic accident in 9 cases, by fall in 3 cases and by slipping in 2 cases. Of 14 cases, there were 5 open fractures and 9 close fractures, including 5 cases of distal femoral comminuted fracture and 9 cases of proximal shaft comminuted fractures. According to AO/OTA classification, the fractures were classified as 33C2 in 3 cases，33C3 in 2 cases,41A2 in 2 cases，41A3 in 2 cases，41B2 in 3 cases and 41C2 in 2 cases. All patients were treated by the internal fixation with LISS-distal femur or with LISS-proximal tibia. Healing of wounds, the X-ray films before and after operations, and therecovery of joint function were observed. Results The patients were followed up from 1 month to 20 months (11 months on average). Twelve cases achieved solid osseous unions from 3 months to 5 months postoperativly; 2 cases had a good reduction and recovered smoothly 2-3 months postoperatively. The results were excellent in 10 cases, good in 3 cases and fair in 1 case according to Johner-Wruhs knee scoring. The range of knee flexion-extension was 110-130° in 11 cases, 100° in 2 cases and 80° in 1 case. Conclusion LISS is an effective method of internal fixation for treating comminntedfracture of distal femur or proximal tibia. It has the advantages of less injury, satisfied reduction and reliable fixation.
Objective To assess the curative effect of the subtalararthrodesis on the serious subtalar joint with the posterior tibial tendon dysfunction.Methods From October 2000 to February 2006, 31 patients (18 males, 13 females; age 23-62 years, averaged 36.4years) with serious subtalar joint osteoarthrisis and stage Ⅱ posterior tibial tendon dysfunction were treated by the subtalar arthrodesis. The tibial tendon dysfunction involved 15 right and 16 left lower extremities, which were caused by retrograde osteoarthritis in 14 patients,sequel of an injury in 8 patients, infection in 7 patients, and anatomic structural abnormity in 2 patients. The treatment course averaged 9.5 months (range, 6-30 months). Before the subtalar arthrodesis, the injured tendons were repaired, and then the bone grafting was performed in the tarsus sinus. All of the patients were assessed before and after operation according to the Hindfoot scores system (American Orthopedics Foot and Ankle Society, AOFAS). Results Among the patients, 28 were followed up on an average of 23.6 months (range, 8-61 months). The AOFAS scores ranged from 45.30±1.08 before operation to 79.60±2.14 afteroperation. The pain indexes ranged from 15.40±2.23 before operation to 38.50±2.61 after operation. The functional indexes of the foot and ankle joint ranged from averaged 21.60±3.01 before operation to averaged 37.40±2.83 after operation. The statistical analysis of the t-test on all the above data showed that there was a significant difference between beforeoperation and after operation (P＜0.01). The angles between the longitudinal line of the talar and the calcaneal bone were 43.70±1.06° before operation and 29.40±0.98° after operation, and the deviation angles between the calcanealline and the talus were 48.20±0.85° before operation and 39.40±1.02° after operation. There was a significant difference between before operation and after operation (P＜0.01). Conclusion The subtalar arthrodesis combined with the bone grafting in the tarsus sinus and the repair of the injured tendons can effectivelycorrect the deformity of the deformity of the metapodium, relieve the pain, retin the adjacent joint motion ability, and this method can be recommended for the adult patient who suffers from serious subtalar osteoarthritis and stage Ⅱ osterior tibial tendon dysfunction.
Objective To review the progress in clinical and biomechanical study on soft tissue reconstruction of adult-acquired flatfoot deformity (AAFD). Methods The recent original articles of soft tissue repair and tendon transfer for AAFD were extensively reviewed. Results The soft tissue procedures for AAFD can be divided into two components: static restoration of medial column stability and dynamic reconstruction of the posterior tibial tendon. The most important static structure to be repaired for AAFD is the spring ligament. On the other hand, various methods can be used for dynamic reconstruction. The flexor digitorum longus transfer is widely used, but results of biomechanical studies do not support the advantage of this method. For patients having normal function of the posterior tibial muscle, the Cobb procedure may be more suitable. Conclusion The soft tissue reconstruction procedures of AAFD should be chosen individually based on the stage and type of the deformity.
Objective To summarize the current research progress on the concept, clinical presentation, diagnosis, biomechanical changes, and pathological mechanisms of the medial meniscus posterior root tear (MMPRT), and its clinical correlations with tibial rotation. MethodsThe research literature on MMPRT and its relationship with tibial rotation at home and abroad in recent years was extensively consulted and summarized. Results MMPRT is a specific and common type of medial meniscus injury of the knee joint. The occurrence of posterior medial pumping pain events following low-energy trauma in patients provides important clues for the diagnosis of this injury, with MRI being the preferred imaging modality. The biomechanical effects generated by MMPRT are similar to those caused by total removal of the medial meniscus. And this injury is usually associated with tibial rotation. MMPRT induces pathological external rotation of the tibia, which can be restored by timely medial meniscus posterior root repair. Furthermore, changes in tibial rotation are related to the healing status after medial meniscus posterior root repair. ConclusionMMPRT is closely related to tibial rotation. Understanding the biomechanics, pathological mechanisms, and clinical correlations between the two is of great significance for improving the diagnosis and treatment strategies.
Objective To determine the effect of interlocking intramedullary nail in treatment of open tibial and fibula fractures and analyze the method to promote the bone union. Methods From December 2003 to June 2006, thirtyfive patients with open tibial and fibula fracture were treated with emergency debridement, interlocked intramedullary fixation for tibia and fixed fibula at the same time. During operation, the bone marrow was collected and grafted into the fracture gaps. Among them, there were 27 males and 8 females, involving in 22 left legs and 13 right legs. Their ages ranged from 19 to 65 years, with an average of 34.7 years. The location of fracture was the middle of the tibia and fibula in 16 cases, the distal 1/3 of the tibia and fibula in 12 cases and the proximal 1/3 in 7 cases. According to the Gusitilo classification of open injuries, there were 7 cases of type I, 19 cases of type II, 8 cases of type III a and 1 case of type III b. The mean range of knee motion was 48.3° (45-70°). The mean time from injury to operation was 4.3 hours (50 minutes to 7 hours). Results The mean operation time was 94 minutes (60-132 minutes) and the mean blood loss was 122 mL (100-350 mL). The wound healed by first intention in 32 patients. Incision was sutured in 2 cases of type III a fractures after operation 4 days, gastrocnemius flap graft was performed in 1 case of type III b fracture 1 week after operation. They all achieve good heal ing. No fractures spl it off, no iatrogenic nerve and vascular injury occurred, no osteofascial compartment syndromes or deep vein thrombus happened. Tension bl isters appeared in 1 case of type II fracture after operation and subsided after 5 days. Patients were followed up for 14-43 months (mean 22 months). The X-ray films showed that fracture union was observe in 30 cases after 14 weeks of operation, in 3 cases after 18 weeks and in 1 caseafter 22 weeks of operation. The fractures union time was 15.2 weeks on average. About 2 cm nonunion in lateral tibial appeared in 1 case of type I fracture. No fracture occurred again. The mean range of knee motion was 127° (121-135°). The mean HSS score was 96.5 (87-100) at the end of the follow-up. The excellent and good rate was 100%. Conclusion The curative effect of interlocking intramedullary nail is definite in treatment of open tibial and fibula fractures and it can enhance fracture union to plant bone marrow into the fracture gaps.
Objective To compare effects, advantages and disadvantages of simple internal fixation to that of l imited internal fixation with external supporting frame fixation in the treatment of complex fractures of tibial plateau. Methods From July 2002 to August 2006, 66 cases of complex fractures of the tibial plateau were divided into the internal fixation group (n=39) and the external fixator group (n=27). The interal fixation group had 18 cases of IV, 7 cases V and 14 cases VI according to Schatzker, including 25 males and 14 females aged 18-79 years with an average of 45.4 years. The external fixator group had 13 cases of IV, 6 cases V and 8 cases VI according to Schatzker, including 18 males and 9 femles aged 18-64 years with an average of 44.2 years. No significant difference was evident between the two groups (P gt; 0.05). Patients were treated by using screws, steel plates or external supporting frame fixation strictly based on the princi ple of internalfixation. Results All patients were followed up for 1-5 years. Fracture healed with no occurrence of nonunion. Two cases inthe internal fixation group presented partial skin infection and necrosis, and were cured through the dressing change and flap displacement. Fracture heal ing time was 6-14 months with an average of 7.3 months. The time of internal fixator removal was 6-15 months with an average of 8.3 months. In the external fixation group, 11 cases had nail treated fluid 7 days to 3 months after operation, combining with red local skin; 3 cases had skin necrosis; and 3 cases had loose bolts during follow-up. Through debridement, dressing change and flap displacement, the skin wounds healed. Fracture heal ing time was 3-11 months with an average of 5.1 months. The time of external fixator removal was 5-11 months with an average of 6.4 months. At 8-14 months after operation, the knee function was assessed according to Merchant criteria. In the internal fixation group, 29 cases were excellent, 4 good, 5 fair and 1 poor, while in the external fixation group, 20 cases were excellent, 3 good, 2 fair and 2 poor. There was no significant difference between the two groups (P gt; 0.05). Conclusion The therapeutic effects of simple internal fixation and l imited internal fixation with external supporting frame fixation were similar in the treatment of complex fractures of tibial plateau. Fixation materials should be selected according to the state of injury and bone conditions for the treatment of tibial plateau fracture of type IV, V and VI based on Sehatzker classification.
ObjectiveTo explore the feasibility and effectiveness of V-Y advanced sense-remained posterior tibial artery perforator flap in repairing wound around the ankle. MethodsBetween March 2012 and January 2015, 11 patients with wounds around the ankle were treated by V-Y advanced sense-remained posterior tibial artery perforator flap. There were 6 males and 5 females with a median age of 37 years (range, 21-56 years). The causes were traffic accident injury in 3 cases, thermal injury in 2 cases, burn in 2 cases, iatrogenic wounds in 2 cases, and local contusion in 2 cases. The disease duration ranged from 1 to 3 weeks (mean, 2 weeks). Injury was located at the medial malleolus in 4 cases, at the lateral malleolus in 3 cases, and at the heel in 4 cases. All had exposure of bone, tendon, or plate. The defect area ranged from 4 cm×2 cm to 5 cm×3 cm; the area of the flap ranged from 11 cm×4 cm to 15 cm×6 cm. ResultsNecrosis of distal flap occurred in 1 case after operation; re-operation to amputate the posterior tibial artery was given and the wound was repaired by proximal skin graft. Light necrosis of distal end was observed in 2 cases, and wound healed at 3 weeks after dressing. And other flaps successfully survived, and primary healing of wounds were obtained. The patients were followed up 6-24 months (mean, 11 months). The flaps were good in color, texture, and appearance. The ankle joint had normal activity. At last follow-up, 10 cases restored fine sense, and 1 case restored protective feeling with posterior tibial artery advanced flap after amputation. ConclusionV-Y advanced sense-remained posterior tibial artery perforator flap has the advantages of reliable blood supply, simple operation, good appearance, and sensory recovery. Therefore, it is an ideal method to repair wound around the ankle.
Objective To study the cl inical effect of expert tibial nail (ETN) in the treatment of the complex tibial fractures of type C. Methods From May to October 2008, 10 cases of complex tibial fractures of type C were treated with unreamed ETN and closed reduction. There were 7 males and 3 females aging from 23 to 50 years with an average age of 39 years. Fracture was caused by traffic accident in 6 cases, by crush in 2 cases, and by fall ing from height in 2 cases. According to Association for the Study of Internal Fixation (AO/ASIF) classification, there were 2 cases of 42-C1 fractures, 4 cases of42-C2 fractures, and 4 cases of 42-C3 fractures; including 4 cases of closed fractures and 6 cases of open fractures (2 cases of Gustilo type I and 4 cases of Gustilo type II). Results The mean duration of surgery and blood loss were 75 minutes (range, 60-110 minutes) and 55 mL (range, 20-100 mL), respectively. All the incision healed by first intension without compl ication of infection. All cases were followed up for 12-17 months (average 14 months). X-ray films showed that no breakage of nail, iatrogenic fracture, l imb shortening, and angulation deformity occurred. All fractures healed after 3-8 months (average 4.2 months). At last follow-up according to Johner-Wruhs standard for the functional recovery, the results were excellent in 8 cases and good in 2 cases. Conclusion ETN has an angular stable locking system for intramedullary nails, which can enhance axial and transverse stabil ity for the treatment of complex tibial fractures of type C. It will provide firm fixation and minimal invasion.
In order to investigate the blood supply of osteo-periosteal flap of lateral inferior part of tibia, 40 lower limbs of adult cadavers were observed. The result showed that the superior malleolar branch was the biggest branch on the lateral inferior part of tibia and served as the main blood supply to the above area. It originated from the anterior tibial artery, 3.1 +/- 0.8 cm above the intermalleolar line. During its way to the anterior border of the tibia, it gave out the ascending and descending branches. The ascending branch was along the anterior border upward and anastomosed with the musculo-periosteol branch of the anterior tibial artery at the level of 6.3 +/- 1.3 cm above the intermalleolar line. The decending branch was anastomosed with the anterior medial malleolar artery. For the anastomosis between the superior malleolar branch with the peripheral vessels, the osteo-periosteol flap could be designed at the lateral side of the lower part of tibia in size of 8-10 cm x 4-6 cm. This was a new donor area of osteo-periosteol flap for repair of non-union of bone in lower end of tibia or arthrodesis of the ankle joint.
Objective To discuss the feasibil ity of repairing soft tissue defects of lower extremity with a distally based posterior tibial artery perforator cross-bridge flap or a distally based peroneal artery perforator cross-bridge flap. Methods Between August 2007 and February 2010, 15 patients with soft tissue defect of the legs or feet were treated. There were 14 males and 1 female with a mean age of 33.9 years (range, 25-48 years). The injury causes included traffic accident in 8 cases, crush injury by machine in 4 cases, and crush injury by heavy weights in 3 cases. There was a scar (22 cm × 8 cm atsize) left on the ankle after the skin graft in 1 patient (after 35 months of traffic accident). And in the other 14 patients, the defect locations were the ankle in 1 case, the upper part of the lower leg in 1 case, and the lower part of the lower leg in 12 cases; the defect sizes ranged from 8 cm × 6 cm to 26 cm × 15 cm; the mean interval from injury to admission was 14.8 days (range, 4-28 days). Defects were repaired with distally based posterior tibial artery perforator cross-bridge flaps in 9 cases and distally based peroneal artery perforator cross-bridge flaps in 6 cases, and the flap sizes ranged from 10 cm × 8 cm to 28 cm × 17 cm. The donor sites were sutured directly, but a spl it-thickness skin graft was used in the middle part. The pedicles of all flaps were cut at 5-6 weeks postoperatively. Results Distal mild congestion and partial necrosis at the edge of the skin flap occurred in 2 cases and were cured after dressing change, and the other flaps survived. After cutting the pedicles, all flaps survived, and wounds of recipient sites healed by first intention. Incisions of the donor sites healed by first intention, and skin graft survived. Fifteen patients were followed up 7-35 months with an average of 19.5 months. The color and texture of the flaps were similar to these of the reci pient site. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system, the mean score was 87.3 (range, 81-92). Conclusion A distally based posterior tibial artery perforator cross-bridge flap or a distally based peronealartery perforator cross-bridge flap is an optimal alternative for the reconstruction of the serious tissue defect of ontralateral leg or foot because of no microvascular anastomosis necessary, low vascular crisis risk, and high survival rate.