纽扣带袢钢板内固定治疗肩锁关节脱位短期临床分析

目的分析肩锁关节脱位患者纽扣带袢钢板内固定治疗短期疗效。方法方便选取从2011年2月—2016年2月收治的60例肩锁关节脱位,随机分为对照组(30)与观察组(30),对照组采取锁骨钩钢板内固定,观察组采取纽扣带袢钢板内固定治疗,分析两组短期临床疗效。结果观察组优良率为96.67%,对照组为76.67%,观察组高于对照组(P<0.05)。并未发生喙突骨折、肩关节僵硬等并发症。结论采取纽扣带袢钢板内固定治疗肩锁关节脱位患者,短期疗效显著,该方法安全有效。

空心加压螺钉内固定与克氏针内固定治疗股骨颈骨折的疗效观察

目的：探讨空心加压螺钉内固定与克氏针内固定治疗股骨颈骨折的临床疗效.方法：随机将64例股骨颈骨折患者随机分为两组,即I组和II组,各32例,分别采用空心加压螺钉内固定和克氏针内固定方法进行治疗,比较两组的治疗效果.结果：术后64例患者均得到随访,随访时间为6个月～7年,平均为3年,均未见钉孔感染及手术死亡病例.I组32例中,优良率为87.5%,股骨头坏死率为3.1%.II组的优良率为71.9%,股骨头坏死率为9.3%,两组的优良率存在显著差别.结论：空心螺纹钉治疗股骨颈骨折具有对股骨头现有血运破坏少,利于股骨头再血管化,能够维持骨折段端足够的稳定性,其手术操作简便、时间短、手术创伤小,术后无需特殊处理等优点,值得我们股骨颈骨折临床手术治疗的首选.

微创联合经皮入路USS内固定治疗单一阶段胸腰椎骨折围手术期的临床疗效

目的探讨微创经皮入路USS内固定系统治疗单一阶段胸腰椎骨折的治疗效果。方法选取2013年3月~2014年9月间我院收治的180例胸腰椎骨折患者,随机分成两组,每组90例,其中一组经影像学检查及临床症状和外伤史确诊,采用微创经皮入路USS内固定系统治疗,另一组则采用传统开放手术进行治疗。综合观察患者围手术期参数以及Oswestry功能障碍指数（Oswestry disabil-ity index,ODI）及疼痛视觉（VAS）模拟评分,以此评价治疗效果。结果所有患者疼痛较术前明显缓解,围手术期无死亡病例,未发生伤口感染,微创组围手术期的大部分参数优于开放组（P〈0.05）,特别是微创组手术过程流血量和伤口引流量都较小于开放组,手术恢复时间及住院天数微创组也短于开放组。但由于微创组手术过程较为复杂,开放组手术时间更短;从微创组和开放组术后VAS、Oswestry评分对比中可以看出微创组显然好于开放组,差异均有统计学意义（P〈0.05）;而末次随访VAS、Oswestry评分略好于开放组,差异无统计学意义（P〉0.05）。结论采用微创经皮入路uss内固定系统治疗较传统开放式疗法对单一阶段胸腰椎骨折患者的神经系统恢复及机体恢复有着较好的作用,减轻患者痛苦,有积极的临床意义。

Multilevel cervical spondylotic myelopathy treated by anterior cervical decompression in subsection and autograft fusion

Objective：To investigate a novel surgical method for multilevel cervical spondylotic myelopathy （CSM）. Methods： Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively. All patients experienced anterior cervical decompression surgery in subsection, autograft fusion and internal fixation. Preoperative, immediate postoperative and follow-up image data, X-rays and semi-quantitative Japanese orthopaedics association （JOA） scores were used to evaluate the restoration of lordosis （Cobb＇s angle）, intervertebral heights, the stability of the cervical spine and the improvement of neurological impairment. Results： Preoperative symptoms were markedly alleviated or disappeared in most of the patients. According to the JOA scores, the ratio of improvement in neurological function was 72. 2%, including excellent in 9 cases （42.9%）, good in 7 cases （33.3%）, fair in 3 cases （14.3%） and poor in 2 cases （9.5%）. Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine （P〈0. 01）. There is no evidence of instrument failure during the mean follow-up period of 14. 2 months （9-24 months, P〉0. 01）. Conclusion：Anterior cervical decompression in subsection, autograft fusion and internal fixation is a rational effective method for the surgical treatment of multilevel CSM.

THE TREATMENT OF LUMBOSACRAL INSTABILITY BY THE DIAPASON SYSTEM

Objective. To introduce a new internal fixation system of spine and its characteristics. Methods. To review 16 patients with lumbosacral instability who were treated by this new technique, including their clinical outcomes and radiographic evaluation. Results. Fifteen patients gained complete recovery from their preoperative symptoms. One patient who had experienced two operations before and with problems of urinary and fecal incontinence and walking difficulty still had lower limb pain, muscle weakness and urinary incontinence after operation.There is no evidence of spine glide on X-ray, implant failure, neural complication or infection during follow up. Conclusion. Diapason system can achieve good early postoperative results with few complications and ease to use for lumbosacral instability.

CHANGES IN AIRWAY SPACE FOLLOWING MANDIBULAR SETBACK USING SAGITTAL SPLIT OSTEOTOMY AND RIGID INTERNAL FIXATION

The changes in airway space following mandibular setback using sagittal split osteotomy and rigid internal fixation were studied in 28 Japanese patients with mandibular prognathism. The correlation between the amount of mandibular setback and airway space changes,as well as the correlation between the amount of airway space changes and relapse of pognion point during the following-up period were also studied. Lateral cephalometric radiographs were taken immediately before and shortly after surgery as well as 5 to 12 months postoperation. The cephalometric evaluations of airway space width and area were based on stable craniofacial landmarks. The mean setback of mandible was 8.3 mm in the right side,and 8. 2 mm in the left side. The mean amount of relapse of pogonion point during the following-up period was 0. 52 mm horizontally,and 0. 92 mm vertically. A significant decrease in airway space width and area,especially in the lower part of airway space was found following mandibular setback shortly after surgery. Although there was some increase both in airway space width and area during the following-up period,they did not increase to their original values. This suggests that the narrowing of airway space following mandibular setback using sagittal split osteotomy can be permanent. No significant correlation was found between the amount of mandibular setback and airway space changes. Since the relapse of pogonion point during the following-up period was too small,there is no significant correlation between it and the amount of airway space changes.

Transoral atlantoaxial reduction plate fixation for irreducible atlantoaxial dislocation

Objective： To design a clinically applicable transoraipharyngeai atlantoaxiai reduction plate （TARP）, introduce the operation procedure, and evaluate its preliminary clinical effects. Methods： A novel TARP system, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operational instruments was developed. This system was applied clinically on five patients with irreducible atlantoaxiai dislocation of congenital or traumatic origin. During operation, the reduction was completed by the combined action of the plate and the atlantoaxiai reductor after transoral joint release and cord decompression. Bone graft granules were implanted between the bilateral atlantoaxiai joints and TARP was used to immobilize subsequently the atlas and axis. Results： Clinical application demonstrated that TARP could induce instant reduction and that the method was operationally feasible and its postoperationai effect was satisfactory. Conclusions： The design of TARP is novel. The operational procedure is simple and easy to use. Furthermore, instant reduction can be completed during the operation and the fixation is relatively stable. TARP is an ideal alternative for irreducible atlantoaxiai dislocation and may have excellent prospects for further clinical applications.

One stage anterior-posterior approach for traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury

Objectives： To explore the clinical fea- tures of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury （CSCI）, and to analyze the feasibility, indication and therapeutic effects of anterior-posterior approach in such cases. Methods： From March 2004 to September 2009, 16 cases with this trauma were admitted and surgically treated in our department. Before surgery, skull traction was performed. Posterior atlantoaxial pedicle screw internal fixation and bone graft fusion were conducted to manage traumatic atlantoaxial instability. As for subaxial CSCI, anterior cervical corpectomy or discectomy decompression, bone grafting and internal fixation with steel plates were applied. Results： All operations were successful. The average operation time was 3 hours and operative blood loss 400 ml. Satisfactory reduction of both the upper and lower cervical spine and complete decompression were achieved. All patients were followed up for 12 to 36 months. Their clinical symptoms were improved by various levels. The Japanese Orthopaedic Association （JOA） scores ranged from 10（improvement rate=70.10%）. X-rays, spiral CT and MRI confirmed normal cervical alignments, complete decompression and fine implants＇ position. There was no breakage or loosening of screws, nor exodus of titanium mesh or implanted bone blocks. The grafted bone achieved fusion 3-6 months postoperatively and no atlantoaxial instability was observed. Conclusions： Traumatic atlantoaxial instability may combine with subaxial CSCI, misdiagnosis of which should be especially alerted and avoided. For severe cases, one stage anterior-posterior approach to decompress the upper and lower cervical spine, together with reposition, bone grafting and fusion, as well as internal fixation can immediately restore the normal alignments and stability of the cervical spine and effectively improve the spinal nervous function, thus being an ideal approach.

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

Objective： To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods： We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing （n=23）, followed by fall from height （n=20）, road traffic accidents （n-5） and fall from standing height （n=2）. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn＇s criteria. Results： Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn＇s criteria, 90.4% patients showed satisfactory results. Conclusion： Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.

Comparative study on treatment of midshaft tibial fracture with expandable and interlocking intramedullary nails

Objective ： To evaluate the clinical results of treatment of midshaft tibial fracture with expandable intramedullary nails compared with interlocking intramednilary nails. Methods： From June 2003 to August 2005, 46 patients （27 males and 19 females, aged 20-74 years, mean =38.4 years ） with midshaft tibial fracture were treated surgically in our department. The causes of fractures were traffic injury in 21 patients, fall injury in 6, tumbling injury in 11 and crushing injury in 8. According to AO/ ASIF classification, Type A fracture was found in 16 patients, Type B in 11, Type C1 in 5, and Type C2 in 2. Open fractures were found in 12 patients, according to Gustilo classification, Type Ⅰ in 9 patients and Type Ⅱin 3 patients. Based on the patients＇consent, 24 patients were treated with expandable intramedullary nails （Group A ） and 22 with interlocking intramedullary nails （Group B ）. The operation time, blood loss during operation, X-ray fluoroscopic times, hospitalization time, weight bearing time after operation, healing time of fracture and complications of all the patients were recorded. The clinical effects of all the cases were evaluated according to the criteria of Johner-Wruhs. Results： All the patients were followed up for 12,34 months （ mean = 16.2 months）. The time of operation, the blood loss, X-ray fluoroscopic times, hospitalization time and healing time of fracture of Group A significantly decreased （P 〈 0.05 ） compared with those of Group B, but the time for weight bearing after operation, the Johner- Wruhs degree of clinical effects and complications had no significant difference between Group A and Group B （P〉0.05）. Conclusions： Expandable intramedullary nail can shorten operation time, decrease blood loss and reduce invasion, which is a safe and effective treatment method for tibial midshaft fracture.

Treatment of Gustilo grade Ⅲ leg fractures by external fixation associated with limited internal fixation

Objective： To explore the clinical effects of external fixation associated with limited internal fixation on treatment of Gustilo grade Ⅲ leg fractures. Methods： From July 2006 to December 2008, 40 cases of Gustilo grade Ⅲ leg fractures were emergently treated in our unit with external fixation frames. Soft tissue injuries were grouped according to the Gustilo classification as ⅢA in 17 cases, ⅢB in 13 cases, and ⅢC in 10 cases. All the patients were debrided within 8 hours, and then fracture reposition was preformed to reestablish the leg alignment. Limited internal fixation with plates and screws were performed on all the Gustilo IliA cases and 10 Gustilo ⅢB cases at the first operation. But all the Gustilo ⅢC cases and 3 Gustilo ⅢB cases who had severe soft tissue injuries and bone loss only received Vacuum-sealing drainage （VSD）. Broad-spectrum antibiotics were regularly used and VSD must be especially maintained easy and smooth for one week or more after operation. Limited internal fixation and transplanted free skin flaps or adjacent musculocutaneous flaps were not used to close wounds until the conditions of the wounds had been improved. Results： The first operations were completed within 90-210 minutes （170 minutes on average）. The blood trans- fusions were from 400 ml to 1500 ml （those used for antishock preoperatively not included）. All the 40 patients in this study were followed up for 6-28 months, 20.5 months on average. The lower limb function was evaluated according to the comprehensive evaluation standards of leg function one year after operation and the results of 28 cases were excellent, 9 were good and 3 were poor. Conclusion： External fixation associated with limited internal fixation to treat Gustilo grade Ⅲ leg fractures can get satisfactory early clinical therapeutic effects.

Twenty-seven-year nonunion of a Hoffa fracture in a 46-year-old patient

A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion ofa Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion ofa Hoffa fracture have been documented in the literature to date, including two children and one adult. This article presents a case of an adult who had nonunion of a Hoffa fracture for 27 years and was treated by open reduction and internal fixation, and the varus deformity corrected with xenogenous bone graft. An excellent result has been achieved to date. This unusual case reminds us that we cannot neglect the possibility of nonunion of a cancellous hone fracture, especially the Hoffa fractures of the medial femoral condyle if they are treated nonoperatively. It also demonstrates that internal fixation with bone graft is effective, even for the 27-year Hoffa fracture.

Comparative study on treating complete dislocation of acromioclavicular joint with three different methods

Objective:To comparatively study complete dislo cation of acromioclavicular joint treated with three different methods. Methods:A total of 96 patients (81 males and 15 females, aged 16-59 years, mean=45 years) with complete dislocation of acromioclavicular join t were treated with Dewars operation (Group A, n=32), internal fixation with K irschner tension band wires (Group B, n=44), or internal fixation with Wolter pl ates (Group C, n=20), respectively, in this study. Eighty-five patients suffere d from acute dislocations and eleven from chronic dislocations. Results:The patients were followed up for 50 months on an aver age. According to Karlssons standard, in Group A, 26 patients were assessed as good, 5 as fair and 1 as poor. In Group B, 20 patients were assessed as good, 1 3 as fair and 11 as poor. In Group C, 15 patients were assessed as good, 4 as fa ir and 1 as poor. The good and fair rates were significantly different between G roup A and Group B, and between Group C and Group B, but no statistical differen ce was found between Group A and Group C. The operating time was ( 52.36 ± 7 .24 ) minutes, ( 67.43 ± 8.11 ) minutes and ( 69.73 ± 8.04 ) minutes in Groups A, B and C, respectively. And the hospitalizing fees were ( 2 400 ± 270) yuan, ( 2 100 ±190) yuan and ( 8 450 ±360) yuan in Groups A, B and C, respectively. Conclusions:Dewars operation is a good and safe method with shorter operating time and lower hospitalizing fee for treating complete disloca tion of acromioclavicular joint. The method is simple without the need of a seco nd operation to remove the implants and with few complications.

Subciliary incision and lateral cantholysis in rigid internal fixation of zygomatic complex fractures

Objective: To introduce the technique of subciliary incision and lateral cantholysis with tri-dimension reduction and rigid internal fixation to treat zygomatic complex fractures. Methods: The subciliary incision and lateral cantholysis combined with tri-dimension reduction and rigid internal fixation of zygomatic complex fractures with titanium microplates were applied in 56 patients with zygomatic complex fractures. Another lateral eyebrow incision or sublabial incision was used to simplify the operation. Results: The postoperative follow-up period ranged from 6 months to 5 years. During the follow-up period, all the patients had satisfying postoperative results. All clinical symptoms disappeared except the numbness in the infraorbital region in 2 patients. In 94.6% patients no complications such as obvious scar, ectropion, entropion or blepharoedema were found, only 5.4% of the patients had slight ectropion 6 months after operation. Conclusions: The subciliary incision and lateral cantholysis have many advantages such as invisible scar, sufficient exposure, minimal injury, and few complications and combined with rigid internal fixation with titanium microplates this technique could be used as one of the routine operation methods to treat zygomatic complex fractures.

Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury

Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years （mean 32 years）. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents （3 cases）, fall from height （5 cases） and hit by heavy object （2 cases）. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days （average 6.6 days）. Postoperatively, the foot function was assessed using Visual Analogue Scales （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） Scales. Healing time and complications were observed. Results： All patients were followed up for 18-24 months （average 20 months）. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score （Z89 ± 0.34） and score at postoperative 8 weeks （0.67 ± 0.13）. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion： Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients＇ quality of life.

Nonunion of coronal shear fracture of femoral condyle

Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of three years. Three patients were treated conservatively and three patients had fixation failures. Delay of presentation was 2 months to one year. Treatment protocol consisted of open reduction, excision of pseudoarthrosis, bone grafting and internal fixation along with knee arthrolysis. Union wasachieved in all patients at mean 16 weeks. The treatment of nonunion of Hoffa fractures requires careful preoperative planning and meticulous surgical technique. The literature regarding the controversies in fracture management and surgical technique are reviewed.

The role of trochanteric flip osteotomy in fixation of certain acetabular fractures

Purpose： Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum, it also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetahulum fractures. Methods： From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d＇Auhigne and Postei score. The strength of the abductors was assessed according to the Medical Research Council （MRC） grading system. Results： Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period. Conclusion： Truchanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant com- plications compared with conventional way.

Internal fixation with headless compression screws and back buttress plate for treatment of old Hoffa fracture

Objective： To analyze the early clinical and radiographic outcomes of Hoffa fractures treated by a standard protocol of open reduction and internal fixation using headless compression screws combined with back buttress plate in a consecutive series of 8 Chinese patients. Methods： Open reduction and internal fixation was performed on all patients. The fractures were anatomical- ly reduced and held temporarily by K-wire. If the ends of fractures were atrophic, autologous bone graft from the ipsilateral iliac crest was packed between the ends. Then the fracture fragments were fixed with AO 6.5 mm headless compression cannulated screws. At least two screws were used to provide rotational stability. One pre-contoured reconstruction plate was placed on the nonarticular surface posteromedially or posterolaterally as back buttress plate. Results： All the patients were followed up for at least 12 months （range 12-25 months）. All fractures achieved anatomical reduction and healed clinically and radiographically. At recent follow-up, the mean flexion degree was 120.6° （range 110°-135°） and the mean extension degree was 2.5° （range 0°-5°）. The average visual analogue scale score was 1.6 points （range 0-3）. Six patients were assessed as excellent and 2 as good according to the hospital for special surgery knee score system. There were no superficial or deep infections, or hardware breakages. No patient had giving way or locking of the knee, though some had intermittent pain and swelling after strenuous exercise. Injury mechanism had significant influence on the functional outcome （P=0.046）. Conclusion： Headless compression screws combined with back buttress plate and/or autologous bone grafting to treat old Hoffa fracture is one of effective measures. It would be conducive to not only fracture healing but also early exercise and functional recovery.

Timing of internal fixation and effect on Schatzker IV-VI tibial plateau fractures

Objective： To study the effect of internal fixation performed at different times on therapeutic outcomes of Schatzker IV-VI tibial plateau fractureS. Methods： The clinical data of 42 cases ofSehatzker IV- VI tibial plateau fractures treated in our department were analyzed retrospectively. Among these 42 patients, 21 re- ceived surgical treatment within 12 h after injury, （Group I）, the other 2 [ were first treated by traction or piaster fixation followed by a delayed internal fixation after soft tissue swell- i ing subsided （Group II）. The surgical time, comPlications, length of hospital stay, cost of hospitalization, and time for i fracture union, as well as functional recovery were analyzed and compared between the two groups. Results： After 10-28 months follow-up （mean 16.5 months）, except 5 cases who lost to follow-upl no differ-ences were found between the two groups regarding surgi- cal time, preoperative and postoperative complications, heal- ing time or the Hospital for Special Surgery （HSS） score at the end of follow-up, but significant differences were found in the length of hospital stay, cost of hospitalization and HSS score at 3 months after operation （P〈0.05）. Conclusion： Under certain conditions, early internal fixation for Schatzker IV-VI tibial plateau fracture is feasible, which can shorten the length of hospital stay, decrease the cost of hospitalization and promote early functional rehabilitation.

Use of gentamicin-loaded collagen sponge in internal fixation of open fractures

Objective： To assess the outcome of immediate plate osteosynthesis via application of antibiotic impregnated collagen fleeces （gentamicin-collagen and an- tibiotic sponge） which gradually release antibiotic locally in the surgical treatment of open fractures presented to us 6 hours after injury. Methods： All cases were treated in our tertiary level trauma center and teaching hospital including 35 patients with open fractures who were treated by immediate open reduction and plate fixation from January 2008 to August 2010. Among them, 31 patients were available for adequate follow-up and assessment. All fractures were treated by irri- gation and debridement, immediate open reduction and plate fixation along with placement of antibiotic-releasing collagen fleeces around the plate just before closure of wound. Pa- tients were assessed to determine postoperative infection, delayed union or nonunion and development of other post- operative complications. It was hypothesized that immedi- ate plate osteosynthesis after thorough debridement and local antibiotics would give safe and acceptable clinical results in treatment of open fractures. Results： The 31 patients with adequate final follow-up were assessed at a mean time of 40 weeks （15-160 weeks）.Most fractures united primarily in an acceptable time period according to area of involvement. Local wound complica- tions （superficial infection and skin loss） were found in 3 patients （9.67%）. Deep infection was noted in 2 patients （6.45%）. None of these patients needed implant removal and both fractures united in due time. Delayed union was noted in 5 patients （16.13%）. No patient progressed to non- union or implant failure in long term follow-up. Excessive scarring was developed in 2 patients （6.45%）. Conclusions： Immediate plate osteosynthesis after adequate debridement and placement of collagen film eluting antibiotics locally produces excellent results regarding bone union and absence of deep infections and is a safe technique in the management of open bone injuries. These sponges can be used easily with any form of internal fixa- tion and there is no need of second surgery for the removal of these antibiotic carriers since they are bioabsorbable. Local antibiotic-impregnated collagen sponges along with systemic antibiotics for 3 to 5 days offer promising results in open fracture management.