Titanium and its alloys have long been used as implant materials due to their outstanding mechanical properties and apparent biocompatibility.Despite this,the search for better alloys has continued to be active by res...Titanium and its alloys have long been used as implant materials due to their outstanding mechanical properties and apparent biocompatibility.Despite this,the search for better alloys has continued to be active by researchers and industries alike,as there are still pressing issues that require attention.These include(1)a large mismatch in the elastic modulus of the implant material,which causes a stress shielding problem;(2)the release of harmful ions from Ti alloys after long-term use;(3)a low bioactivity of the Ti alloy surface,which prolongs the healing process.More research has been directed toward finding new generation Ti alloys composed of more biocompatible phases and modifying the surface of Ti alloys from naturally bio-inert to bioactive in order to circumvent the problems.This review examines recent work reported on the fabrication of Ti alloys,and based on the survey,major characteristics highlighted the importance of elastic modulus and the use of non-toxic metal elements to improve biocompatibility.In terms of surface modification of Ti alloys,numerous studies have found that a nano-scaled surface oxide layer grown on the surface is always beneficial to improving the bioactivity of Ti alloys for rapid recovery after implantation.This comprehensive review focuses on the appropriate phase and composition for new Ti alloys intended for use as biomedical implants,emphasizing both fabrication and surface modification methods.展开更多
Given the limited spontaneous repair that follows cartilage injury, demand is growing for tissue engi- neering approaches for cartilage regeneration. There are two major applications for tissue-engineered cartilage. O...Given the limited spontaneous repair that follows cartilage injury, demand is growing for tissue engi- neering approaches for cartilage regeneration. There are two major applications for tissue-engineered cartilage. One is in orthopedic surgery, in which the engineered cartilage is usually used to repair cartilage defects or loss in an articular joint or meniscus in order to restore the joint function. The other is for head and neck reconstruction, in which the engineered cartilage is usually applied to repair cartilage defects or loss in an auricle, trachea, nose, larynx, or eyelid. The challenges faced by the engineered car- tilage for one application are quite different from those faced by the engineered cartilage for the other application. As a result, the emphases of the engineering strategies to generate cartilage are usually quite different for each application. The statuses of preclinical animal investigations and of the clinical translation of engineered cartilage are also at different levels for each application. The aim of this review is to provide an opinion piece on the challenges, current developments, and future directions for cartilage engineering for both applications.展开更多
Camera calibration is the key technique in a C-arm based orthopaedic surgical navigation system. The extraction of marker location information is a necessary step in the calibration process. Ideal marker images should...Camera calibration is the key technique in a C-arm based orthopaedic surgical navigation system. The extraction of marker location information is a necessary step in the calibration process. Ideal marker images should possess uniform background and contain marker shadow only, but in fact marker images always possess nonuniform background and are contaminated by noise and unwanted anatomic information, making the extraction very difficult. A target-orientated marker shadow extraction method was proposed. With this method a proper threshold for marker image binarization can be determined.展开更多
Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the ...Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.展开更多
THERE is a 3D printing lab in the First Ward Zone of the Department of Orthopedics at Peking University Third Hospital（PUTH）.Although not big,it’s where Professor Liu Zhongjun,director of the department,spends most...THERE is a 3D printing lab in the First Ward Zone of the Department of Orthopedics at Peking University Third Hospital（PUTH）.Although not big,it’s where Professor Liu Zhongjun,director of the department,spends most of his time,when not dealing with patients and students.展开更多
Objective： To probe the feasibility and efficacy of damage control orthopedics （DCO） in treating severe multiple injuries. Methods： A retrospective analysis was made on the clinical data of 41 patients （31 males...Objective： To probe the feasibility and efficacy of damage control orthopedics （DCO） in treating severe multiple injuries. Methods： A retrospective analysis was made on the clinical data of 41 patients （31 males and 10 females, aged 18-71 years, mean： 36.4） with multiple injuries admitted to our department and treated by DCO from January 1995 to December 2005. Results： As a first-stage therapy, devascularization of internal iliac arteries was performed in 29 patients with pelvic fractures combined with massive bleeding, including ligation of bilateral internal iliac arteries in 21 patients and embolization of bilateral internal iliac arteries in 8. And early external fixation of pelvis was performed in 10 patients. Ten patients with severe multiple injuries combined with femoral fractures were managed with primary debridement and temporal external fixation and 2 patients with spinal fractures combined with spinal cord compression received simple laminectomy. Thirty-one patients received definite internal fixation after resuscitation in intensive care unit. The overall mortality rate was 12.1% （5/41） with an average injury severity score of 41.4. The main causes of death were hemorrhagic shock and associated injuries. Complications occurred in 7 patients including acute respiratory distress syndrome in 3 cases, thrombosis of right common iliac artery in 1, subphernic abscess in 2 and infection of deep wound in lower extremity in 1. After treatment, all the patients got cured. Conclusions： Prompt diagnosis and integrated treatment are keys to higher survival rate in patients with severe multiple injuries. In this condition, DCO is an effective and safe option.展开更多
Objective： To observe and measure morphological parameters of the Chinese atlanto-odontoid joint anatomically in order to provide an anatomic data for designing artificial atlanto-odontoid joint used for substituting...Objective： To observe and measure morphological parameters of the Chinese atlanto-odontoid joint anatomically in order to provide an anatomic data for designing artificial atlanto-odontoid joint used for substituting the destroyed atlanto-odontoid joint in the orthopedic clinic. Methods： The relative anatomic parameters of 32 sets of fresh Chinese adults ＇atlanto-odontoid joint specimens were measured with a digital caliper and a goulometer, including the width of anterior arch of atlas （ AW）, the thickness of atlas at the junction of anterior arch and lateral mass （ AD）, the thickness and height of anterior tubercle of atlas （ AT and AH ）, the middle height, length and width of the lateral mass （MHL, L and LW ）, the height, transverse and anteroposterior distance of odontoid process （DH, DW and DD）, the retroversion angle of odontoid process （ β° ）, the facial angle of odontoid process （ θ° ） and so on. The data were statistically analyzed in order to ascertain the morphological parameter ranges of artificial atlanto-odontoid joint. An artificial atlanto-odontoid joint was designed according to these data. The operations of anlanto-odontoid joint arthroplasty were conducted in 3 cases of adult cadaver specimens. Resnits： The width of AW was （ 20.45 ± 1.5 3 ） nun, AD （3.91 ±1.32） nun, AT and AH （9.43± 1.93） nun and （ 10.23± 1.32 ） mm, respectively, MHL and LW （ 13.68 ± 1.38 ） mm and （ 12.98 ±1.52 ） mm, respectively, DH （15.25±2.11）mm, DW and DD （9.69±1.38）mm and （ 11.26 ± 1.02 ） ram, respectively, β° （ 12.23 ± 4.27 ） degree, θ° （ 65.48 ±2.17 ） degree. The prosthesis was composed of atlas part, axis part and accessories. Neither the vertebral artery nor the medulla oblongata was injured. Conclusions： The design of artificial atlantoodontoid joint is feasible according to these parameters. The artificial joint can not only rebuild the stability of atlanto-axial joint, but also reserve the rotation function between atlas and axis. Every part of the joint has their own parameter ranges in purpose to firm fixation, convenient operation and good motion without further injury. The prosthesis can be used for patients suffering from compression of medulla oblongata and resection of dens when it is required.展开更多
The most commonly accepted system of classification for tibia plateau fractures is that of Schatzker. Increasingly, both high energy injuries and atypical osteoporotic fragility failures have led to more complex, unus...The most commonly accepted system of classification for tibia plateau fractures is that of Schatzker. Increasingly, both high energy injuries and atypical osteoporotic fragility failures have led to more complex, unusual and previously undescribed fracture patterns being recognized. We present a case of a patient with a previously unreported pattern of tibia plateau fracture and knee dislocation. We highlight the challenges confronted and present the management and the outcomes of his injury. A 28-year old male motorcyclist was involved in a head on collision with a truck and was transferred by helicopter to our level I major trauma centre emergency department. His injuries were a circumferential degloving injury to his left leg and a right lateral tibial plateau fracture/knee dislocation. The pattern of the lateral tibial plateau fracture was unique and did not fit any recognised classification system. The patient received a spanning external fixator initially and after latency of 12 days for soft tissue resuscitation he underwent definite fixation through an antero-lateral approach to the proximal tibia with two cannulated 6.5 mm partially threaded screws and an additional lateral proximal tibia plate in buttress mode. A hinged knee brace was applied with unrestricted range of motion post-operatively and free weight bearing were permitted post operatively. At the 6 months follow up, the patient walks without aids and with no limp. Examination revealed a stable joint and full range of motion. Plain radiographs revealed that the fracture healed with good alignment and the fixation remained stable. High energy injuries can lead to more complicated fracture patterns, which challenge the orthopaedic surgeons in their management. It is crucial to understand the individual fracture pattern and the possible challenges that may occur. This study reports a lateral tibia plateau fracture/dislocation which perhaps is best described as a reverse Schatzker IV type fracture.展开更多
The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debrideme...The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement ＆ lavage of the open wound with combined bony and soft tissue reconstruction. Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. While all elements of the surgical principles are very important and depend on each other for overall success the most critical element appears to be achieving very early healthy soft tissue cover. As the injuries become more complex this involves progressively more complex soft tissue reconstruction and may even requiring urgent free tissue transfer requiring close co-operative care between orthopaedic and plastic surgeons. Data suggests that the best results are obtained when the whole surgical reconstruction is completed within 48-72 h.展开更多
Objective: To observe the effect of warm needling therapy plus acupuncture on third lumbar vertebra transverse process syndrome. Methods: Sixty cases of third lumbar vertebra transverse process syndrome were randomly ...Objective: To observe the effect of warm needling therapy plus acupuncture on third lumbar vertebra transverse process syndrome. Methods: Sixty cases of third lumbar vertebra transverse process syndrome were randomly divided into a warm needling group or an acupuncture group, 30 cases in each group. Cases in the acupuncture group were treated by routine points and needle sticking manipulation, while those in the warm needling group were treated by moxibustion plus needling as same as the acupuncture group. Japanese orthopedic association scores(JOA) in the two groups were observed and compared after 2 treatment courses. Results: After treatment, the JOA score in the warm needling group was higher than that in the acupuncture group(P<0.01); subjective symptom, clinical syndromes, activity of daily living(ADL) in the warm needling group were all higher than those in the acupuncture group(all P<0.05); the score of pain in the warm needling group was significantly lower than that in the acupuncture group(P<0.01); the total effective rate in the warm needling group was 76.7%, versus 70.0% in the acupuncture group, showing a statistically significant difference(P<0.05). Conclusion: Warm needling therapy is more effective than normal acupuncture in treating third lumbar vertebra transverse process syndrome.展开更多
Objective: To evaluate the effect of local application of vascular endothelial growth factor ( VEGF ) via adenovirus-mediated gene transfer on survival of full thickness flaps selected randomly in rats.Methods: Thirty...Objective: To evaluate the effect of local application of vascular endothelial growth factor ( VEGF ) via adenovirus-mediated gene transfer on survival of full thickness flaps selected randomly in rats.Methods: Thirty Sprague-Dawley rats weighing 480-520 g were used in this study. A dorsal flap (8 cm × 2 cm) in full thickness with the pedicle located at the level of the iliac crest was designed. Then the rats received 1 012 pfu replication-deficient recombinant adenovirus carrying VEGF ( AdCMV-VEGF group, n = 10 ), 1012 pfu recombinant β-galactosidase adenovirus ( AdCMV-Gal group, n = 10) and 1 ml saline (saline group, n = 10), respectively, in the distal two thirds of the proposed flap by means of subdermal injection at 8 different locations. Three days after treatment, the flaps were elevated as originally designed and sutured back in situ. The survival rate of the flaps was evaluated on day 7 after operation.Results: The survival rate of the flaps in the AdCMV-VEGF group increased significantly as compared with those of the AdCMV-Gal group (P < 0.01) and the saline group ( P < 0.01). Immunohistochemical staining showed that VEGF was expressed in the survival flaps injected with AdCMV-VEGF. Histological analysis showed that more granulation tissues and angiogenesis were observed in the AdCMV-VEGF group than those in the AdCMV-Gal and the saline groups.Conclusions: Local application of adenovims-mediated VEGF165 cDNA may efficiently improve the survival of ischemic skin flaps.展开更多
Purpose： Bear maul injuries are the most common wild animal inflicted injuries in India. More than 300 bear maul injuries report to our hospital per year. Methods： Twenty-one consecutive patients over a period of 1 ...Purpose： Bear maul injuries are the most common wild animal inflicted injuries in India. More than 300 bear maul injuries report to our hospital per year. Methods： Twenty-one consecutive patients over a period of 1 year reported to our department for orthopaedic management of bear maul injuries. All the patients were referred either from peripheral hospitals or from other surgical departments of our hospital. Results： All the patients had facial[scalp injuries of variable severity. In all the patients the severity of limb and facial trauma was inversely proportional to each other. Pattern of upper limb trauma in most of the patients was similar. Fifteen patients had either fractures of distal humerus or mid shaft/proximal forearm bone fracture. Two had distal forearm bone fracture, 2 had carpal/metacarpal fractures and I had clavicle fracture. Only I had lower limb fracture. Thirteen out of 21 patients had associated neurovascular injury of the involved limb. The characteristic feature was extensive soft tissue involvement of the affected limb. Conclusion： Upper limb injuries in bear maul patients usually have similar pattern. The severity of upper limb and facial/scalp trauma is inversely proportional to each other. Multistage orthopaedic surgeries are needed for such comolex limb injuries.展开更多
Purpose： Maxillofacial injuries are commonly encountered in the practice of emergency medicine. More than 50% of patients with these injuries have multisystem trauma that requires coordinated manage- ment between eme...Purpose： Maxillofacial injuries are commonly encountered in the practice of emergency medicine. More than 50% of patients with these injuries have multisystem trauma that requires coordinated manage- ment between emergency physicians and surgical specialists in oral and maxillofacial surgery, otolar- yngology, plastic surgery, ophthalmology, and trauma surgery. The aim of this study is to identify the patterns of brain injuries associated with maxillofacial trauma and its outcome. Methods： This descriptive study （cross-sectional） was carried out among 90 polytrauma patients with maxillofacial fractures attending the Emergency Department at Suez Canal university Hospital and fulfilling our inclusion and exclusion criteria. Results： This study demonstrates the relation between type of maxillofacial fracture and type of trau- matic brain injuries in which the majority of patients with epidural hemorrhage presented with mid face fractures （60%）, while the minority of them presented with upper and lower face fractures （20% for each of them）. The majority of patients with subdural hemorrhage were associated with mid face fractures （75%）, the majority of patients with brain contusions associated with mid face fractures （75%）, and all of the patients presented by pneumocephalus were associated with mid face fractures （100%）. Conclusion： The results of this study confirm the value of quick diagnosis and early intervention, which is fundamental to prevent morbidity as well as mortality especially with regards to prevention of traumatic brain injury as even a short duration of hvpoxia and edema will lead to significant permanent neurological deficits.展开更多
基金funded by the Malaysian Ministry of Higher Education under the Fundamental Research Grant Scheme(Project Code FRGS/1/2018/TK05/USM/01/5)the first author is supported financially by a scholarship from Universiti Sains Malaysia(USM Fellowship)。
文摘Titanium and its alloys have long been used as implant materials due to their outstanding mechanical properties and apparent biocompatibility.Despite this,the search for better alloys has continued to be active by researchers and industries alike,as there are still pressing issues that require attention.These include(1)a large mismatch in the elastic modulus of the implant material,which causes a stress shielding problem;(2)the release of harmful ions from Ti alloys after long-term use;(3)a low bioactivity of the Ti alloy surface,which prolongs the healing process.More research has been directed toward finding new generation Ti alloys composed of more biocompatible phases and modifying the surface of Ti alloys from naturally bio-inert to bioactive in order to circumvent the problems.This review examines recent work reported on the fabrication of Ti alloys,and based on the survey,major characteristics highlighted the importance of elastic modulus and the use of non-toxic metal elements to improve biocompatibility.In terms of surface modification of Ti alloys,numerous studies have found that a nano-scaled surface oxide layer grown on the surface is always beneficial to improving the bioactivity of Ti alloys for rapid recovery after implantation.This comprehensive review focuses on the appropriate phase and composition for new Ti alloys intended for use as biomedical implants,emphasizing both fabrication and surface modification methods.
文摘Given the limited spontaneous repair that follows cartilage injury, demand is growing for tissue engi- neering approaches for cartilage regeneration. There are two major applications for tissue-engineered cartilage. One is in orthopedic surgery, in which the engineered cartilage is usually used to repair cartilage defects or loss in an articular joint or meniscus in order to restore the joint function. The other is for head and neck reconstruction, in which the engineered cartilage is usually applied to repair cartilage defects or loss in an auricle, trachea, nose, larynx, or eyelid. The challenges faced by the engineered car- tilage for one application are quite different from those faced by the engineered cartilage for the other application. As a result, the emphases of the engineering strategies to generate cartilage are usually quite different for each application. The statuses of preclinical animal investigations and of the clinical translation of engineered cartilage are also at different levels for each application. The aim of this review is to provide an opinion piece on the challenges, current developments, and future directions for cartilage engineering for both applications.
基金Project of Science and Technology Committee of Shanghai Municipality (No.2528(3))
文摘Camera calibration is the key technique in a C-arm based orthopaedic surgical navigation system. The extraction of marker location information is a necessary step in the calibration process. Ideal marker images should possess uniform background and contain marker shadow only, but in fact marker images always possess nonuniform background and are contaminated by noise and unwanted anatomic information, making the extraction very difficult. A target-orientated marker shadow extraction method was proposed. With this method a proper threshold for marker image binarization can be determined.
文摘Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.
文摘THERE is a 3D printing lab in the First Ward Zone of the Department of Orthopedics at Peking University Third Hospital（PUTH）.Although not big,it’s where Professor Liu Zhongjun,director of the department,spends most of his time,when not dealing with patients and students.
文摘Objective： To probe the feasibility and efficacy of damage control orthopedics （DCO） in treating severe multiple injuries. Methods： A retrospective analysis was made on the clinical data of 41 patients （31 males and 10 females, aged 18-71 years, mean： 36.4） with multiple injuries admitted to our department and treated by DCO from January 1995 to December 2005. Results： As a first-stage therapy, devascularization of internal iliac arteries was performed in 29 patients with pelvic fractures combined with massive bleeding, including ligation of bilateral internal iliac arteries in 21 patients and embolization of bilateral internal iliac arteries in 8. And early external fixation of pelvis was performed in 10 patients. Ten patients with severe multiple injuries combined with femoral fractures were managed with primary debridement and temporal external fixation and 2 patients with spinal fractures combined with spinal cord compression received simple laminectomy. Thirty-one patients received definite internal fixation after resuscitation in intensive care unit. The overall mortality rate was 12.1% （5/41） with an average injury severity score of 41.4. The main causes of death were hemorrhagic shock and associated injuries. Complications occurred in 7 patients including acute respiratory distress syndrome in 3 cases, thrombosis of right common iliac artery in 1, subphernic abscess in 2 and infection of deep wound in lower extremity in 1. After treatment, all the patients got cured. Conclusions： Prompt diagnosis and integrated treatment are keys to higher survival rate in patients with severe multiple injuries. In this condition, DCO is an effective and safe option.
文摘Objective： To observe and measure morphological parameters of the Chinese atlanto-odontoid joint anatomically in order to provide an anatomic data for designing artificial atlanto-odontoid joint used for substituting the destroyed atlanto-odontoid joint in the orthopedic clinic. Methods： The relative anatomic parameters of 32 sets of fresh Chinese adults ＇atlanto-odontoid joint specimens were measured with a digital caliper and a goulometer, including the width of anterior arch of atlas （ AW）, the thickness of atlas at the junction of anterior arch and lateral mass （ AD）, the thickness and height of anterior tubercle of atlas （ AT and AH ）, the middle height, length and width of the lateral mass （MHL, L and LW ）, the height, transverse and anteroposterior distance of odontoid process （DH, DW and DD）, the retroversion angle of odontoid process （ β° ）, the facial angle of odontoid process （ θ° ） and so on. The data were statistically analyzed in order to ascertain the morphological parameter ranges of artificial atlanto-odontoid joint. An artificial atlanto-odontoid joint was designed according to these data. The operations of anlanto-odontoid joint arthroplasty were conducted in 3 cases of adult cadaver specimens. Resnits： The width of AW was （ 20.45 ± 1.5 3 ） nun, AD （3.91 ±1.32） nun, AT and AH （9.43± 1.93） nun and （ 10.23± 1.32 ） mm, respectively, MHL and LW （ 13.68 ± 1.38 ） mm and （ 12.98 ±1.52 ） mm, respectively, DH （15.25±2.11）mm, DW and DD （9.69±1.38）mm and （ 11.26 ± 1.02 ） ram, respectively, β° （ 12.23 ± 4.27 ） degree, θ° （ 65.48 ±2.17 ） degree. The prosthesis was composed of atlas part, axis part and accessories. Neither the vertebral artery nor the medulla oblongata was injured. Conclusions： The design of artificial atlantoodontoid joint is feasible according to these parameters. The artificial joint can not only rebuild the stability of atlanto-axial joint, but also reserve the rotation function between atlas and axis. Every part of the joint has their own parameter ranges in purpose to firm fixation, convenient operation and good motion without further injury. The prosthesis can be used for patients suffering from compression of medulla oblongata and resection of dens when it is required.
文摘The most commonly accepted system of classification for tibia plateau fractures is that of Schatzker. Increasingly, both high energy injuries and atypical osteoporotic fragility failures have led to more complex, unusual and previously undescribed fracture patterns being recognized. We present a case of a patient with a previously unreported pattern of tibia plateau fracture and knee dislocation. We highlight the challenges confronted and present the management and the outcomes of his injury. A 28-year old male motorcyclist was involved in a head on collision with a truck and was transferred by helicopter to our level I major trauma centre emergency department. His injuries were a circumferential degloving injury to his left leg and a right lateral tibial plateau fracture/knee dislocation. The pattern of the lateral tibial plateau fracture was unique and did not fit any recognised classification system. The patient received a spanning external fixator initially and after latency of 12 days for soft tissue resuscitation he underwent definite fixation through an antero-lateral approach to the proximal tibia with two cannulated 6.5 mm partially threaded screws and an additional lateral proximal tibia plate in buttress mode. A hinged knee brace was applied with unrestricted range of motion post-operatively and free weight bearing were permitted post operatively. At the 6 months follow up, the patient walks without aids and with no limp. Examination revealed a stable joint and full range of motion. Plain radiographs revealed that the fracture healed with good alignment and the fixation remained stable. High energy injuries can lead to more complicated fracture patterns, which challenge the orthopaedic surgeons in their management. It is crucial to understand the individual fracture pattern and the possible challenges that may occur. This study reports a lateral tibia plateau fracture/dislocation which perhaps is best described as a reverse Schatzker IV type fracture.
文摘The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement ＆ lavage of the open wound with combined bony and soft tissue reconstruction. Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. While all elements of the surgical principles are very important and depend on each other for overall success the most critical element appears to be achieving very early healthy soft tissue cover. As the injuries become more complex this involves progressively more complex soft tissue reconstruction and may even requiring urgent free tissue transfer requiring close co-operative care between orthopaedic and plastic surgeons. Data suggests that the best results are obtained when the whole surgical reconstruction is completed within 48-72 h.
基金supported by the Community Health Service Centre, Sandun Town, Xihu District, Hangzhou
文摘Objective: To observe the effect of warm needling therapy plus acupuncture on third lumbar vertebra transverse process syndrome. Methods: Sixty cases of third lumbar vertebra transverse process syndrome were randomly divided into a warm needling group or an acupuncture group, 30 cases in each group. Cases in the acupuncture group were treated by routine points and needle sticking manipulation, while those in the warm needling group were treated by moxibustion plus needling as same as the acupuncture group. Japanese orthopedic association scores(JOA) in the two groups were observed and compared after 2 treatment courses. Results: After treatment, the JOA score in the warm needling group was higher than that in the acupuncture group(P<0.01); subjective symptom, clinical syndromes, activity of daily living(ADL) in the warm needling group were all higher than those in the acupuncture group(all P<0.05); the score of pain in the warm needling group was significantly lower than that in the acupuncture group(P<0.01); the total effective rate in the warm needling group was 76.7%, versus 70.0% in the acupuncture group, showing a statistically significant difference(P<0.05). Conclusion: Warm needling therapy is more effective than normal acupuncture in treating third lumbar vertebra transverse process syndrome.
文摘Objective: To evaluate the effect of local application of vascular endothelial growth factor ( VEGF ) via adenovirus-mediated gene transfer on survival of full thickness flaps selected randomly in rats.Methods: Thirty Sprague-Dawley rats weighing 480-520 g were used in this study. A dorsal flap (8 cm × 2 cm) in full thickness with the pedicle located at the level of the iliac crest was designed. Then the rats received 1 012 pfu replication-deficient recombinant adenovirus carrying VEGF ( AdCMV-VEGF group, n = 10 ), 1012 pfu recombinant β-galactosidase adenovirus ( AdCMV-Gal group, n = 10) and 1 ml saline (saline group, n = 10), respectively, in the distal two thirds of the proposed flap by means of subdermal injection at 8 different locations. Three days after treatment, the flaps were elevated as originally designed and sutured back in situ. The survival rate of the flaps was evaluated on day 7 after operation.Results: The survival rate of the flaps in the AdCMV-VEGF group increased significantly as compared with those of the AdCMV-Gal group (P < 0.01) and the saline group ( P < 0.01). Immunohistochemical staining showed that VEGF was expressed in the survival flaps injected with AdCMV-VEGF. Histological analysis showed that more granulation tissues and angiogenesis were observed in the AdCMV-VEGF group than those in the AdCMV-Gal and the saline groups.Conclusions: Local application of adenovims-mediated VEGF165 cDNA may efficiently improve the survival of ischemic skin flaps.
文摘Purpose： Bear maul injuries are the most common wild animal inflicted injuries in India. More than 300 bear maul injuries report to our hospital per year. Methods： Twenty-one consecutive patients over a period of 1 year reported to our department for orthopaedic management of bear maul injuries. All the patients were referred either from peripheral hospitals or from other surgical departments of our hospital. Results： All the patients had facial[scalp injuries of variable severity. In all the patients the severity of limb and facial trauma was inversely proportional to each other. Pattern of upper limb trauma in most of the patients was similar. Fifteen patients had either fractures of distal humerus or mid shaft/proximal forearm bone fracture. Two had distal forearm bone fracture, 2 had carpal/metacarpal fractures and I had clavicle fracture. Only I had lower limb fracture. Thirteen out of 21 patients had associated neurovascular injury of the involved limb. The characteristic feature was extensive soft tissue involvement of the affected limb. Conclusion： Upper limb injuries in bear maul patients usually have similar pattern. The severity of upper limb and facial/scalp trauma is inversely proportional to each other. Multistage orthopaedic surgeries are needed for such comolex limb injuries.
文摘Purpose： Maxillofacial injuries are commonly encountered in the practice of emergency medicine. More than 50% of patients with these injuries have multisystem trauma that requires coordinated manage- ment between emergency physicians and surgical specialists in oral and maxillofacial surgery, otolar- yngology, plastic surgery, ophthalmology, and trauma surgery. The aim of this study is to identify the patterns of brain injuries associated with maxillofacial trauma and its outcome. Methods： This descriptive study （cross-sectional） was carried out among 90 polytrauma patients with maxillofacial fractures attending the Emergency Department at Suez Canal university Hospital and fulfilling our inclusion and exclusion criteria. Results： This study demonstrates the relation between type of maxillofacial fracture and type of trau- matic brain injuries in which the majority of patients with epidural hemorrhage presented with mid face fractures （60%）, while the minority of them presented with upper and lower face fractures （20% for each of them）. The majority of patients with subdural hemorrhage were associated with mid face fractures （75%）, the majority of patients with brain contusions associated with mid face fractures （75%）, and all of the patients presented by pneumocephalus were associated with mid face fractures （100%）. Conclusion： The results of this study confirm the value of quick diagnosis and early intervention, which is fundamental to prevent morbidity as well as mortality especially with regards to prevention of traumatic brain injury as even a short duration of hvpoxia and edema will lead to significant permanent neurological deficits.
