重建钢板内固定治疗锁骨粉碎性骨折37例临床分析

目的 比较重建钢板内固定和克氏针内固定治疗锁骨中、外段粉碎性骨折的临床效果。方法 将 72例锁骨中、外粉碎性骨折患者分别采用克氏针内固定术 (对照组 3 5例 )及重建钢板内固定术 (观察组 3 7例 )治疗 ,分析比较两组临床疗效及并发症发生率。结果 观察组的优良率 (91.89%)明显高于对照组 (62 .86%) ,χ2 =8.773 ,P <0 .0 1;其并发症发生率 (2 .70 %)比对照组 (2 8.5 7%)明显减少 ,χ2 =9.2 98,P <0 .0 1。结论 锁骨中、外段粉碎性骨折用重建钢板内固定优于克氏针内固定。

Cemented backfill technology based on phosphorous gypsum

Physical-chemical properties of phosphorous gypsum, proportion and cemented mechanism of slurry with gypsum as aggregate were studied to remove the harms of gypsum pile, combining with difficult problems of excessive mined-out gobs, enormous ore body under roadway and low recovery ratio of Yongshaba Mine, Kaiyang Phosphor Mine Group, Guizhou Province, China. An appropriate backfill system and craflwork were designed, using shattering milling method to crush gypsum, double-axles mixing and strong activation mixing way to mix slurry, cemented slurry and mullock backfill alternately process. The results show that gypsum is fit for backfilling afterwards by adding fly ash, though it is not an ideal aggregate for fine granule and coagulate retardation. The suggested dosage （the mass ratio of cement to fly ash to gypsum） is 1：1：6-1：1：8 with mass fraction of solid materials 60%-63%. Slurry is transported in suspend state with non-plastic strength, and then in concretion state after backfilling. The application to mine shows the technology is feasible, and gypsum utilization ratio is up to 100%. Transportation and backfill effect is very good for paste-like slurry and drenching cemented slurry into mullock, and the compressive strength and recovery ratio are 2.0 MPa and 82.6%, respectively, with the maximum subsidence of surface only 1.307 mm. Furthermore, the investment of system is about 7 × 10^6 yuan （RMB）, only 1/10 of that of traditional paste backfill system.

Effects of Wet Superfine Grinding on Polyphenols and Antioxidant Activities of Whole Fruit Pulp of Navel Orange

The navel orange were cleaned and pulverized by a wet superfine grinding and a broken wall cooking machine,then the navel orange whole fruit pulp were obtained by wet superfine grinding once,wet superfine grinding twice,and broken wall cooking machine processing.The particle size distribution,free polyphenols,bound polyphenols and antioxidant activity of whole fruit pulp prepared by the three kinds of pulverization methods were discussed.The results showed that the particle size distribution of the whole fruit pulp by wet superfine grinding was more concentrated compared with the broken-wall cooking machine processing,and the total phenols dissolution rate of the navel orange whole pulp was increased by 6.9%,and the total flavonoid dissolution rate was increased by 13.5%.The results also suggested that wet superfine grinding twice could improve 1,1-diphenyl-2-picrylhydrazyl(DPPH)free radical scavenging activity of polyphenols in the whole fruit pulp,wet superfine grinding once and wet superfine grinding twice also could obviously enhance the reducing power and iron reduction ability of polyphenols in the whole fruit pulp.In conclusion,wet superfine grinding could increase both the polyphenol content and antioxidant activity of navel orange whole fruit pulp,it can be used as a pretreatment processing method for preparing navel orange whole fruit pulp.

Consolidation analysis of composite foundation with partially penetrated cement fly-ash gravel(CFG) piles under changing permeable boundary conditions

Based on the double-layered foundation theory, the composite ground with partially penetrated cement fly-ash gravel(CFG) piles was regarded as a double-layered foundation including the surface reinforced area and the underlying untreated stratum. Due to the changing permeability property of CFG piles, the whole consolidation process of the composite ground with CFG piles was divided into two stages, i.e., the early stage(permeable CFG pile bodies) and the later stage(impermeable pile bodies). Then, the consolidation equation of the composite foundation with CFG piles was established by using the Terzaghi one-dimensional consolidation theory. Consequently, the unified formula to calculate the excess pore water pressure was derived with the specific solutions for the consolidation degree of composite ground, reinforced area and underlying stratum under instant load obtained respectively. Finally, combined with a numerical example, influencing rules by main factors(including the replacement rate m, the treatment depth h1, the permeability coefficient Ks1, Kv2 and compression modulus Es1, Es2 of reinforced area and underlying stratum) on the consolidation property of composite ground with CFG piles were discussed in detail. The result shows that the consolidation velocity of underlying stratum is slower than that of the reinforced area. However, the consolidation velocity of underlying stratum is slow at first then fast as a result of the transferring of effective stress to the underlying stratum during the dissipating process of excess pore water pressure.

Buttress plating for a rare case of comminuted medial condylar Hoffa fracture associated with patellar fracture

Hoffa fracture is an uncommon injury. In the literature, lateral condylar Hoffa fracture is mentioned as a more common injury pattern than medial condylar Hoffa fracture. The mechanism of injury and method of treatment is not very well described in the literature. We are present- ing a rare case of comrninuted medial condylar Hoffa frac- ture with ipsilateral patellar fracture. The mechanism of in-jury has not been described in the literature. Lag screw fixation, which is the most acceptable method of treatment, is not possible due to comminution. We explain the pos- sible mechanism of injury and fix the fracture with L-but- tress plate.

Monteggia fracture dislocation equivalents analysis of eighteen cases treated by open reduction and internal fixation

Objective： Monteggia fracture disloca- tion equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a re- view of the literature. Methods： A retrospective record of Monteggia frac- ture dislocation （2003-2008） was reviewed from medical record department of our institute. Classic Monteggia frac- ture dislocation, children below 12 years or adults over 50 years, as well as open grade iI ＆ Ill cases were excluded from this study. Monteggia variant inclusion criteria in- cluded fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 fe- males with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results： Follow-up ranged from 1-4 years, mean 2.6 years. Patients were assessed clinicoradiologically. MayoElbow Performance Score outcomes. At final follow-up, was employed to assess the the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions： Monteggia fracture dislocation equiva- lents are rare injuries and pre-surgery recognition by radio- graphs and 3-D CT helps make optimal plan. The poor results usually relate to intraarticular damage, coronoid fractures and comminution of the ulna and radial head fractures.

Surgical factors contributing to nonunion in femoral shaft fracture following intramedullary nailing

Purpose： To explore the possible surgical factors related with nonunion in femoral shaft fracture following intramedullary nailing. Methods： We retrospectively analyzed totally 425 patients with femoral shaft fracture in level I urban trauma center, including 254 males and 171 females, with an average age of 37.6 （ranging from 21 to 56） years old. The inclusion criteria included： （1） traumatically closed fracture of femoral shaft, with preoperative films showing non-comminuted fracture, such as transverse fracture, oblique fracture or spiral fracture; （2） closed reduction and fixation with interlocking intramedullary nail at 3-7 days after trauma; （3） complete follow-up data available. The relationship between the following factors （fracture site, reduction degree, direction of nail insertion and nail size） and nonunion was studied. Results： The incidence of femoral nonunion was 2.8%; in patients with closed simple fracture undergoing interlocking intrameduallary nailing, including 11 cases of hypertrophic nonunion. Nonunion was related significantly to distal fracture, unsatisfactory reduction and unreamed nail （p 〈 0.05）. There was no significant difference between antegrade nail and retrograde nail （p 〉 0.05）. Conclusions： Nonunion in femoral shaft facture following interlocking intramedullary nailing is related to fracture site, fracture reduction and nail diameter. The choice of reamed nails or unreamed nails depends on the fracture site and reduction degree.

Coupled exofixator for comminuted fracture of humeral shaft

Objective: To report and assess the efficacy of a coupled exofixator in the treatment of comminuted fracture of the humeral shaft.Methods: From June 1999 to September 2003, 24 patients with comminuted fracture of the humeral shaft were treated in our department, in whom 11 were involved in left humerus fractures and 13 in right humerus fractures. Closed reduction or open reduction with a small incision as well as a coupled exofixator was used to treat these patients. Results: All cases got anatomical reduction after 6-12 months follow-up. The time for fracture union averaged 5.8 months with a good functional recovery of the shoulder-elbow joints. Conclusions: The coupled exofixator is favorable to the treatment of comminuted humeral shaft fractures. It can shorten union time and avoid nonunion occurrence.

Combined index finger pollicization with an anterolateral thiqh flap for thumb reconstruction

A severe crush injury to the hand is devastating to patients. Under conditions in which the crush force is too great, the digits are not viable candidates for replantation. We present two cases in which the patients suffered from loss of the thumb ray at the first carpometacarpal joint and skin defect at the radial side. The tendons, radial nerve and metacarpal bone of the index finger were injured, and the second metacarpal head was retained. There was a comminuted fracture of the trapezium in both patients. The treatment protocols consisted of the index finger pollicization and the free anterolateral thigh flap transfer. The procedure was performed in a single operation. The new thumb is able to provide a stable post for pinch and grip after six months follow-up. Both patients were satisfied with the function and appearance of the reconstructed thumb.

Treatment of comminuted trochanteric fractures and non-union of trochanteric osteotomy in revision total hip arthroplasty

Objective: To explore the clinical efficacy of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non union in revision total hip arthroplasty with tension band fixation. Methods: A retrospective review of 295 revision total hip operations performed between 1992 and 1998 was undertaken. Twenty hips of 19 patients with comminuted fractures or nonunion of the greater trochanter were stabilized with tension band technique. Multiple 2.0 mm k wires and tension band wires were placed through the intact cortex distally and the abductor tendon proximally in the pattern "8". Results: The average follow up was 30 months. The Harris Hip Score improved on average from 45 preoperatively to 89 at follow up. Sixteen hips with intra operative trochanteric fracture through osteolytic bone and four hips with symptomatic trochanteric nonunion were approached with tension band fixation. Perioperative loss of fixation in one patient required a repeated surgery. The same fixation at the second operation achieved an uneventful healing. Two patients had a 2 cm proximal migration of one K wire without loss of bony fixation. The trochanteric fractures healed with no further proximal wire migration. One patient had loss of fixation with trochanteric escape at 6 weeks post operatively. The patient has abductor weakness with Trendleburg limp but without pain. On average, radiographic examination showed that healing occurred at 16.6 weeks postoperatively. Six patients developed grade 1 heterotopic ossification and two patients grade 3. All were asymptomatic. None of the 19 patients experienced a dislocation during the follow up. Conclusions: Tension band fixation for greater trochanter can enhance the success rate of revision total hip arthroplasty without a deficient abductor mechanism.

External fixation and bone grafting for collapsed and comminuted distal radius fracture

Objective: To study the therapeutic effect of collapsed and comminuted distal radius fracture. Methods: Twenty-six patients with collapsed and comminuted distal radius fracture were hospitalized from July 1998 to June 2003. All fractures were treated by the methods of open reduction, sustained bone grafting and passing joint external fixator to restore the anatomic shape of distal radius. Results: All 26 cases were followed up, and the results showed that the fractures have been united radiographically. The joint surfaces were intact and there was no length discrepancy occurred in patient’s radius. The average volar tilt was 6° to 15° and the average ulnar tilt was 18° to 25°. According to the Dieust criterion, 19 cases were rated as excellent and 7 as good. Conclusions: The method that applying passing joint external fixator and bone grafting for the treatment of collapsed and comminuted distal radius fracture could maintain the stability of fracture and restore the length of radius and the intact of joint surface.

Uncontacted tire explosion causing trauma to bilateral lower extremities： A case report

It is uncommon for tire explosion related injuries on the lower extremity. The bilateral lower extremities were injured by tire explosion when the patient was seated in a bus. She sustained an open fracture with partial bone loss in the right calcaneus （a comminuted fracture in the right ankle joint） and a closed comminuted fracture in the left tibia and fibula. This damage was caused by uncontacted tire explosion, thanks to a thick floor between the exploded tire and the patient＇s feet. This type of injury on lower extremity caused by uncontacted tire explosion was uncommon.

Definition, classification and treatment of destructive fractures

Destructive injury is defined as a very serious damage both to the bone and the soft tissues. But in clinical practice we found that in some fracture cases, the damage to soft tissues is not as severe as ＂destructive injury＂ indicates, whereas comminuted fractures still cannot show the severity of bone damage. Therefore we proposed a new term ＂destructive fractures＂ after combining the definition of destructive injury with typical clinic cases. Destructive fractures refer to the fractures whose osseous tissues are damaged too seriously to be repaired, but soft tissues, nerves and veins are less severely injured and can be repaired. From the year 2001 to 2010, 75 cases of destructive fractures were admitted in our department. According to whether the fractures interlinked with the external environment, together with the fracture sites, they were divided into 6 types： al type, closed diaphysis destructive fracture; a2 type, open diaphysis destructive fracture; b1 type, closed joint-involved destructive fracture; b2 type,open joint-involved destructive fracture; cl type, closed mixed destructive fracture; c2 type, open mixed destructive fracture. Corresponding clinical treatments were conducted for each type.The new classification criterion of destructivefracture is simple and practical and thus can be used as an important guide to make reasonable treatment plans for destructive fractures.

Ligamentotaxis for comminuted fracture of capitate： a case report

We present the technical report for treat- ment of comminuted fracture of the capitate with ligamentotaxis. The base of third metacarpal was found to be fractured with comminution of the capitate. The decrease in carpal height index and comminution of the third metacar- pal base lead to dilemma between conservative treatment and surgical management of this particular injury. The sur- gical management was chosen to maintain the carpal height index of the wrist to prevent the late degenerative changes.The patient was applied with external fixator in distraction mode expanning the wrist joint for six weeks, and the wrist was mobilised after removal of the fixator. It is shown that the external fixator in distraction mode expanning the wrist joint is a good alternative method for treatment of capitate fracture.

Comminuted fractures of ipsilateral radial head and distal radius： A rare injury pattern

A new injury pattern of comminuted fractures of ipsilateral radial head and distal radius of forearm in an adult was described. To the best of our knowledge, this type of injury pattern had not been previously reported in the English literature. The possible mechanisms of injury were that the rebound forces were volar to the distal radius as the fracture was dorsally angulated, with a continuation of the radial head fracture due to the longitudinal impaction of the radius against the capitellum. Open reduction and internal fixation can obtain excellent results within 7 12 days after injury. We hope that our experience will increase the awareness of the occurrence of a double injury of the forearm.