ObjectiveTo review the research progress of the surgical treatment for lateral malleolus defect.MethodsThe related literature about surgical treatment and effectiveness of lateral malleolus defect at home and abroad was reviewed, summarized, and analysed.ResultsLateral malleolus defects are often caused by severe trauma or wide resection of fibular neoplasms. Although the incidence is not high, the defects are difficult to handle. These bony defects should be reconstructed to prevent an abnormal gait induced by ankle instability and avoid the occurrence of traumatic arthritis. Various repair methods have been developed, including bone transplantation, fibula lengthening, and ankle arthrodesis.ConclusionThere are various surgical methods to repair the defect of lateral malleolus, but each has its own advantages and disadvantages. In order to achieve the best results, the surgeon should choose the appropriate operation according to his own level, the patient’s specific injury, and age.
OBJECTIVE: To study the results of humeral fracture and non-union repaired by vascularized periosteal flap transfer. METHODS: The clinical data of humeral fracture and non-union in 23 cases were analysized retrospectively since 1995. Among them, minuted or several segmental fracture in 12 cases, non-union in 11 cases, and following injury of radial nerve in 7 cases. The operative method was open reduction, inner or external fixation with vascularized periosteal flap transfer. RESULTS: The period of follow-up was 6 months to 2 years. The repair result of all patients was excellent and good, but elbow joint motion in 2 cases of non-union was not satisfactory. The periosteal flap had good osteogenic ability. The period of bone union was 2 to 5 months in humeral fracture and non-union. And function of radial nerve was recovery. CONCLUSION: Transfer of distal humeral periosteal flap pedicled with radial collateral vessels is a better method for humeral fracture and non-union.
ObjectiveTo systematically review the efficacy of percutaneous cannulated screw (PCS) versus plate fixation (PF) in the treatment of ankle fractures. MethodsThe Cochrane Library (Issue 5, 2014), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched up to May 28th 2014, for studies concerning the efficacy of percutaneous cannulated screw versus plate fixation for ankle fractures. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using RevMan 5.1 software. Result A total of 10 studies (3 RCTs and 7 CCTs) involving 627 patients were included. The results of meta-analysis showed that:compared with the PF group, the PCS group was superior in time of the operation (RCT:MD=-6.78, 95%CI -11.95 to -1.60, P=0.01; CCT:MD=-9.76, 95%CI -13.68 to -5.84, P<0.000 01), blood loss during the operation (RCT:MD=-36.14, 95%CI -40.02 to -32.17, P<0.000 01; CCT:MD=-34.80, 95%CI -37.78 to -31.81, P<0.000 01) and the time of the fracture healing (RCT:MD=-1.16, 95%CI -1.51 to -0.81, P<0.000 01; CCT:MD=-1.55, 95%CI -2.97 to -0.13, P=0.03); However, there were no statistical differences between the two groups in complication rate (CCT:OR=0.48, 95%CI 0.08 to 2.81, P=0.41), AOFAS score excellent rate (RCT:OR=2.11, 95%CI 0.81 to 5.49, P=0.12; CCT:OR=1.58, 95%CI 0.75 to 3.30, P=0.23), and postoperative malleolus pain rate (CCT:OR=0.68, 95%CI 0.00 to 148.82, P=0.89). ConclusionCurrent evidence shows that PCS is superior to PF in shorting time of the operation, reducing blood loss during the operation, and shorting time of the fracture healing. However, the complication rate, AOFAS score excellent rate, and postoperative malleolus pain rate are similar for each operation. Due to the quality limitation of the CCTs, the conclusion are needed to be verified by more high quality RCTs in future.