Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 20...Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.展开更多
Post-traumatic lower extremity bone loss in the setting of high-energy trauma can occur acutely as a result of an open fracture and surgical debridement,or secondarily as a result of nonunion or infection.Several tech...Post-traumatic lower extremity bone loss in the setting of high-energy trauma can occur acutely as a result of an open fracture and surgical debridement,or secondarily as a result of nonunion or infection.Several techniques have been described in the literature for the management of these bony defects,including non-vascularized bone grafts,vascularized bone grafts and distraction osteogenesis.Herein,the authors review the role of vascularized bone grafts in the management of post-traumatic bone loss in the lower extremity.展开更多
Objective： To assess the value of ankle fusion with a retrograde locked intramedullary nail in the treatment of sequela of lower extremity compartment syndrome. Methods： Thirty-five cases ofequinus deformity follow...Objective： To assess the value of ankle fusion with a retrograde locked intramedullary nail in the treatment of sequela of lower extremity compartment syndrome. Methods： Thirty-five cases ofequinus deformity follow- ing tibiofibular compartment syndrome treated by means of ankle fusion with a retrograde locked intramedullary nail from January 2001 to December 2010 were retrospectively reviewed. The complications, the time needed for bony fu- sion of the ankle joint assessed by anteroposterior and lateral X-ray photographs as well as patients＇ subjective evalua- tion were recorded and analysed. Results： Among the 35 patients, 15 had previously undergone surgical treatment twice on the same limb, 13 had thrice and 7 had to be operated on four times before ankle fusion. An anterior midpoint approach to the ankle joint was adopted in 29 cases, while anterior midpoint ap- proach plus a small incision on the posterior ankle joint was made in 17 cases, whereas lateral approach in 6 cases. Tar- sus joint fusion was performed on 4 cases. The follow-up period ranged 6-124 months, averaged 40.6 months. Bone grafting was not performed in this series. Preoperative tibial shaft fracture occurred in one patient and was healed after conservative treatment. Incision dehiscence located at pre- vious Achilles tendon incision was found in two patients. As a result, one received an intramedullary nail emplace- ment at calcaneoplantar part while the wound at anterosuperior part of the other one was healed by dressing change. Two patients failed to bony union 5 months postoperatively, in which one healed 10 weeks after retrieval of proximal tibial nail and another by iliac grafting. Terminal necrosis of the toe due to blood supply dysfunction was not found in this series. All the patients were satisfied with the ankle joint function postoperatively. The time for bony union on X-rays was 9.8 weeks on average. Except for one patient who demanded removal of intramedullary nail, all the intramedullary nails were not retrieved at the end of follow-up. Nail breakage happened in one patient and no other breakage or backing out of the nail was found. Conclusions： Lower extremity compartment syndrome and residual ankle deformity often extremely impact ambulation and are hard to deal with because several patho- logic phenomena might exist in these patients, for instance, poor skin conditions due to repeated preexisting surgery; poor perfusion in distal limbs following blood vascular injury; reflux limitation and long-term limb swelling due to muscle strength disturbance; osteoporosis as a result of long-term immobilization or limb disuse. Ankle fusion with a retro- grade locked intramedullary nail is an optimal protocol to solve these clinical symptoms and rather ensures a definite fusion and firm fixation to these patients with simple ma- nipulation and few complications.展开更多
Unlike other non-gynecologic solid tumors, such as breast cancer, lung cancer, metastasis to bone from endometrial carcinoma is rare, metastasis to extremity is extremely rare. We report a 51-year-old multiparous woma...Unlike other non-gynecologic solid tumors, such as breast cancer, lung cancer, metastasis to bone from endometrial carcinoma is rare, metastasis to extremity is extremely rare. We report a 51-year-old multiparous woman with FIGO Stage IVb Grade 2 endometrial adenocarcinoma which metastasized to left lower extremity bone. She received an amputation of left lower extremity below the knees, and a total abdominal hysterectomy and bilateral salpingo-oophorectomy, and followed by systemic chemotherapy, radiation therapy to the pelvis and progestational agent. She had a complete response to above treatments, and disease-free survival for 10 months. After recurrence, she received chemotherapy, radiotherapy and progestational agent once again. She had lived 56 months and is still alive by the time of report. Metastasis of endometrial carcinoma to extremity bone can rarely occur and should be considered when the patient with endometrial carcinoma complained of unexplained pain and swelling associated with extremity bone.展开更多
Background:Spinal cord injury(SCI)remains a high rate of disability.In order to improve the quality of their lives,the application of robots in rehabilitation is increasing.However,few studies have assessed the applic...Background:Spinal cord injury(SCI)remains a high rate of disability.In order to improve the quality of their lives,the application of robots in rehabilitation is increasing.However,few studies have assessed the applicability and the effect of robots in patients with complete injury.Objective:The current study aims to assess the efficacy of robots training on the lower extremity physiology in complete SCI patients.Methods:24 patients were recruited and randomly divided into experimental and control group.The two groups spent the same amount of time on regular training.Besides,a 1-h standing training twice daily was offered to both groups five days per week,for four weeks.The experimental group used robot for standing training,while the control group used standing frame.Before and after the experiment,muscle girth and bone mineral density(BMD)were measured as lower extremity physiology.Results:The experimental group showed increased muscle girth differences(left=0.08±0.40 cm,right=0.75±0.72 cm),while the control group showed decreased girth differences(left=-0.78±0.54 cm,right=-0.56±0.54 cm).The increases in the experimental group showed significant differences compared with the control group(left,P=0.0002;right,P=0.023).Both groups showed decreased BMD.The decreases in the experimental group were significantly smaller than those in the control group.Conclusions:Training with aid of robots combined with the regular rehabilitation treatment can benefit complete SCI patients,in aspect of postponing amyotrophy of lower extremities and reducing bone loss and osteoporosis.展开更多
Reconstruction of the lower extremity is a complex task that has evolved greatly in both technique and indication over the past century.Early advances in treating traumatic lower extremity injuries focused on primary ...Reconstruction of the lower extremity is a complex task that has evolved greatly in both technique and indication over the past century.Early advances in treating traumatic lower extremity injuries focused on primary amputation to avoid the high mortality of infection.The introduction of antibiotics improved surgical debridement and local reconstructive options,enhancing the viability of lower extremities with simple and proximal defects.With the advent of microvascular surgery,free tissue transfer techniques provided a means to reconstruct more distal and complex problems.As these surgical techniques have continued to evolve,so too have indications for reconstruction,patient management and post-operative care-now with a greater emphasis on patient quality of life and limb function.The purpose of this article is to outline the evolution of lower extremity reconstruction,and how the standard of practice has changed over time.展开更多
Aim:To review the choices of soft tissue coverage in distraction osteogenesis of the extremity.Methods:A PubMed literature search yielded 14 articles included for systematic review.Data were extracted from each articl...Aim:To review the choices of soft tissue coverage in distraction osteogenesis of the extremity.Methods:A PubMed literature search yielded 14 articles included for systematic review.Data were extracted from each article if available(sample size,patient age,surgical indications,type of flap,use of additional modalities,method of bone osteogenesis,postoperative events,follow-up,satisfaction,weight-bearing status,and success rate).Unpaired t-tests were performed to compare complication rates.A retrospective review of three cases was also conducted.Results:Fourteen articles discussed 145 patients with a mean age of 33.4 years and 146 extremity injuries followed over 3.3 years on average.Indications included chronic osteomyelitis or nonunion(58.2%)and acute trauma(41.8%).Average time from injury was 1.1 years.Ilizarov frame was used in 12 articles.Free flaps(88.0%)or rotational flaps(12.0%)were used,with muscle flaps(96.7%)being most common.Most extremities received free latissimus dorsi or rectus abdominis flaps.Bone grafts and antibiotic beads were often used in conjunction.Although complications and reoperations were not uncommon(up to 30%),98.8%of patients on average were ultimately weight bearing and all articles reported>91%success rate.Additionally,the rates of any complication were not statistically different between"fix and flap"protocol and flap or frame first.Lastly,a three-patient case series is presented.Conclusion:Bone transport with soft tissue reconstruction remains an excellent choice for patients with large bony defects or who are unable to undergo autologous bone grafting.Not one surgical approach to limb salvage is superior,and decision should be made on a case by case basis between the surgeon and the patient.展开更多
文摘Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.
文摘Post-traumatic lower extremity bone loss in the setting of high-energy trauma can occur acutely as a result of an open fracture and surgical debridement,or secondarily as a result of nonunion or infection.Several techniques have been described in the literature for the management of these bony defects,including non-vascularized bone grafts,vascularized bone grafts and distraction osteogenesis.Herein,the authors review the role of vascularized bone grafts in the management of post-traumatic bone loss in the lower extremity.
文摘Objective： To assess the value of ankle fusion with a retrograde locked intramedullary nail in the treatment of sequela of lower extremity compartment syndrome. Methods： Thirty-five cases ofequinus deformity follow- ing tibiofibular compartment syndrome treated by means of ankle fusion with a retrograde locked intramedullary nail from January 2001 to December 2010 were retrospectively reviewed. The complications, the time needed for bony fu- sion of the ankle joint assessed by anteroposterior and lateral X-ray photographs as well as patients＇ subjective evalua- tion were recorded and analysed. Results： Among the 35 patients, 15 had previously undergone surgical treatment twice on the same limb, 13 had thrice and 7 had to be operated on four times before ankle fusion. An anterior midpoint approach to the ankle joint was adopted in 29 cases, while anterior midpoint ap- proach plus a small incision on the posterior ankle joint was made in 17 cases, whereas lateral approach in 6 cases. Tar- sus joint fusion was performed on 4 cases. The follow-up period ranged 6-124 months, averaged 40.6 months. Bone grafting was not performed in this series. Preoperative tibial shaft fracture occurred in one patient and was healed after conservative treatment. Incision dehiscence located at pre- vious Achilles tendon incision was found in two patients. As a result, one received an intramedullary nail emplace- ment at calcaneoplantar part while the wound at anterosuperior part of the other one was healed by dressing change. Two patients failed to bony union 5 months postoperatively, in which one healed 10 weeks after retrieval of proximal tibial nail and another by iliac grafting. Terminal necrosis of the toe due to blood supply dysfunction was not found in this series. All the patients were satisfied with the ankle joint function postoperatively. The time for bony union on X-rays was 9.8 weeks on average. Except for one patient who demanded removal of intramedullary nail, all the intramedullary nails were not retrieved at the end of follow-up. Nail breakage happened in one patient and no other breakage or backing out of the nail was found. Conclusions： Lower extremity compartment syndrome and residual ankle deformity often extremely impact ambulation and are hard to deal with because several patho- logic phenomena might exist in these patients, for instance, poor skin conditions due to repeated preexisting surgery; poor perfusion in distal limbs following blood vascular injury; reflux limitation and long-term limb swelling due to muscle strength disturbance; osteoporosis as a result of long-term immobilization or limb disuse. Ankle fusion with a retro- grade locked intramedullary nail is an optimal protocol to solve these clinical symptoms and rather ensures a definite fusion and firm fixation to these patients with simple ma- nipulation and few complications.
文摘Unlike other non-gynecologic solid tumors, such as breast cancer, lung cancer, metastasis to bone from endometrial carcinoma is rare, metastasis to extremity is extremely rare. We report a 51-year-old multiparous woman with FIGO Stage IVb Grade 2 endometrial adenocarcinoma which metastasized to left lower extremity bone. She received an amputation of left lower extremity below the knees, and a total abdominal hysterectomy and bilateral salpingo-oophorectomy, and followed by systemic chemotherapy, radiation therapy to the pelvis and progestational agent. She had a complete response to above treatments, and disease-free survival for 10 months. After recurrence, she received chemotherapy, radiotherapy and progestational agent once again. She had lived 56 months and is still alive by the time of report. Metastasis of endometrial carcinoma to extremity bone can rarely occur and should be considered when the patient with endometrial carcinoma complained of unexplained pain and swelling associated with extremity bone.
基金supported by the National Natural Science Foundation of China(61761166002).
文摘Background:Spinal cord injury(SCI)remains a high rate of disability.In order to improve the quality of their lives,the application of robots in rehabilitation is increasing.However,few studies have assessed the applicability and the effect of robots in patients with complete injury.Objective:The current study aims to assess the efficacy of robots training on the lower extremity physiology in complete SCI patients.Methods:24 patients were recruited and randomly divided into experimental and control group.The two groups spent the same amount of time on regular training.Besides,a 1-h standing training twice daily was offered to both groups five days per week,for four weeks.The experimental group used robot for standing training,while the control group used standing frame.Before and after the experiment,muscle girth and bone mineral density(BMD)were measured as lower extremity physiology.Results:The experimental group showed increased muscle girth differences(left=0.08±0.40 cm,right=0.75±0.72 cm),while the control group showed decreased girth differences(left=-0.78±0.54 cm,right=-0.56±0.54 cm).The increases in the experimental group showed significant differences compared with the control group(left,P=0.0002;right,P=0.023).Both groups showed decreased BMD.The decreases in the experimental group were significantly smaller than those in the control group.Conclusions:Training with aid of robots combined with the regular rehabilitation treatment can benefit complete SCI patients,in aspect of postponing amyotrophy of lower extremities and reducing bone loss and osteoporosis.
文摘Reconstruction of the lower extremity is a complex task that has evolved greatly in both technique and indication over the past century.Early advances in treating traumatic lower extremity injuries focused on primary amputation to avoid the high mortality of infection.The introduction of antibiotics improved surgical debridement and local reconstructive options,enhancing the viability of lower extremities with simple and proximal defects.With the advent of microvascular surgery,free tissue transfer techniques provided a means to reconstruct more distal and complex problems.As these surgical techniques have continued to evolve,so too have indications for reconstruction,patient management and post-operative care-now with a greater emphasis on patient quality of life and limb function.The purpose of this article is to outline the evolution of lower extremity reconstruction,and how the standard of practice has changed over time.
文摘Aim:To review the choices of soft tissue coverage in distraction osteogenesis of the extremity.Methods:A PubMed literature search yielded 14 articles included for systematic review.Data were extracted from each article if available(sample size,patient age,surgical indications,type of flap,use of additional modalities,method of bone osteogenesis,postoperative events,follow-up,satisfaction,weight-bearing status,and success rate).Unpaired t-tests were performed to compare complication rates.A retrospective review of three cases was also conducted.Results:Fourteen articles discussed 145 patients with a mean age of 33.4 years and 146 extremity injuries followed over 3.3 years on average.Indications included chronic osteomyelitis or nonunion(58.2%)and acute trauma(41.8%).Average time from injury was 1.1 years.Ilizarov frame was used in 12 articles.Free flaps(88.0%)or rotational flaps(12.0%)were used,with muscle flaps(96.7%)being most common.Most extremities received free latissimus dorsi or rectus abdominis flaps.Bone grafts and antibiotic beads were often used in conjunction.Although complications and reoperations were not uncommon(up to 30%),98.8%of patients on average were ultimately weight bearing and all articles reported>91%success rate.Additionally,the rates of any complication were not statistically different between"fix and flap"protocol and flap or frame first.Lastly,a three-patient case series is presented.Conclusion:Bone transport with soft tissue reconstruction remains an excellent choice for patients with large bony defects or who are unable to undergo autologous bone grafting.Not one surgical approach to limb salvage is superior,and decision should be made on a case by case basis between the surgeon and the patient.
