【Abstract】 Objective To review the progress in pathoanatomy, diagnosis, and treatment of posterolateral rotatory instability (PLRI) of the elbow. Methods Related literature concerning PLRI of the elbow was extensively reviewed, comprehensive analysis was done. Results The lateral collateral ligament complex (LCLC), radial head, capitellum, and coronoid process are important constraints to PLRI. Muscle groups that cross the lateral elbow are secondary constraints to PLRI. Clinical examination includes lateral pivot-shift test, lateral pivot-shift apprehension test, chair sign, active floor push-up sign, tabletop relocation test, and posterolateral rotatory drawer test. Radiology, arthroscopy, and ultrasound can help diagnosis of PLRI. Reconstruction of bony fixation or soft tissue fixation can be used for treatment of injured LCLC. Conclusion The primary constraints to PLRI is LCLC. Ultrasound imaging is accurate for identification and measurement of normal LCLC. Therefore, ultrasound may prove valuable in assessment of abnormal lateral ulnar collateral ligaments. Reconstruction of soft tissue fixation, which can avoid iatrogenic fracture, is a selective treatment method.
Objective To review the progress in the cl inical treatment of Kienbouml;ck’s disease. Methods Related l iterature concerning the treatment of Kienbouml;ck’s disease was reviewed, and comprehensive analysis was done. Results The treatment methods of Kienbouml;ck’s disease include non-surgical treatment and surgical treatment, which are primarily guided bythe anatomic factor and Lichtman stage. Non-surgical treatment methods should be selected in patients of children and at stage I. Surgical treatment methods include vascularized bone graft transfer into the cored-out lunate, radial shortening osteotomy, radial lateral wedge osteotomy, etc. All surgical treatment methods have advantages and disadvantages. Conclusion For the treatment of Kienbouml;ck’s disease, none of procedure is superior to another. In short, choosing different treatment strategies based on different patients can achieve the desired outcome.
ObjectiveTo summarize the research progress on the application of tranexamic acid (TXA) in traumatic orthopedic surgery in recent years.MethodsThe domestic and foreign literature in recent years was reviewed, and the efficacy and safety of TXA in traumatic orthopedic surgeries with different regimen, dose and route of administration were comprehensively summarized and compared.ResultsThe application of TXA in traumatic orthopedic surgeries increased gradually in recent years. Intravenous or topical administration of TXA efficaciously reduced blood loss and transfusion requirements during hip fracture surgery without significantly increasing the risk of thromboembolic events. However, the efficacy was not clear in other traumatic orthopedic surgeries such as pelvic and acetabular fractures.ConclusionMore studies are needed to confirm the efficacy and safety of TXA in traumatic orthopedic surgeries.
目的 分析下肢慢性创伤性骨髓炎患者创面细菌培养分布情况，为临床用药提供依据。 方法 对2006年1月－2010年12月收治的91例慢性骨髓炎患者创面分泌物细菌培养标本结果进行回顾性调查分析。其中男78例，女13例；年龄5～78岁，平均41.3岁。病程47 d～7个月，平均68.6 d。使用抗生素总疗程均＞7 d。 结果 65例创面细菌培养阳性患者共分离出113株病原菌，其中G?菌72株，占63.71%；G+菌41株，占36.28%。药敏结果显示，G+菌对常规青霉素类基本耐药，碳青霉烯类耐药菌株少见，对万古霉素耐药菌株尚未出现。G?菌对青霉素类及头孢菌素类耐药较高，对头孢哌酮－舒巴坦无耐药。 结论 加强对慢性创伤性骨髓炎患者创面病原菌监测极为必要,对临床抗生素的合理使用具有一定的指导意义。Objective To analyze the distribution of cultured bacteria from chronic osteomyelitis patients, and provide a basis for clinical medicine. Methods We retrospectively analyzed the bacterial culture results of the secretions from 91 patients with chronic osteomyelitis treated in our hospital from January 2006 to December 2010. Among them, there were 78 males and 13 females aged from 5 to 78 years averaging at (41.3 ± 8.35) years. The duration of the disease ranged from 47 days to more than 7 months, averaging (68.6 ± 14.57) days. The total course of antibiotic-taking was longer than 7 days for all the patients. Results A total of 113 pathogen strains were isolated from 65 secretion samples, including 72 Gram-negative bacteria accounting for 63.71% and 41 gram-positive bacteria accounting for 36.28%. Drug susceptibility results showed basic resistance of Gram-positive bacteria to conventional penicillin, rare resistance to carbapenem, and no resistance to vancomycin. Gram-negative bacteria were basically resistant to penicillin and cephalosporins, but not resistant to cefoperazone-sulbactam. Conclusion Enhancing the monitoring of pathogens for patients with chronic osteomyelitis is extremely necessary for the rational clinical use of antibiotics.
Objective To compare the biomechanical stability of Kirschner wire and tension band wiring, reconstruction plate combined with tension band wiring, and olecranon anatomical plate in fixing proximal ulna combined with olecranon fracture, so as to provide the theoretical evidence for clinical selection of internal fixation. Methods Eight specimens of elbow joints and ligaments were taken from eight fresh male adult cadaveric elbows (aged 26-43 years, mean 34.8 years) donated voluntarily. The model of proximal ulna combined with olecranon fracture was made by an osteotomy in each specimen. Fracture end was fixed successively by Kirschner wire and tension band wiring (group A), reconstruction plate combined with tension band wiring (group B), and olecranon anatomical plate (group C), respectively. The biomechanical test was performed for monopodium compression experiments, and load-displacement curves were obtained. The stability of the fixation was evaluated according to the load value when the compression displacement of fracture segment was 2 mm. Results No Kirschner wire withdrawal, broken plate and screw, loosening and specimens destruction were observed. The load-displacement curves of 3 groups showed that the displacement increased gradually with increasing load, while the curve slope of groups B and C was significantly higher than that of group A. When the compression displacement was 2 mm, the load values of groups A, B, and C were (218.6 ± 66.9), (560.3 ± 116.1), and (577.2 ± 137.6) N, respectively; the load values of groups B and C were significantly higher than that of group A (P lt; 0.05), but no significant difference was observed between groups B and C (t=0.305, P=0.763). Conclusion The proximal ulna combined with olecranon fracture is unstable. Reconstruction plate combined with tension band wiring and olecranon anatomical plate can meet the requirement of fracture fixation, so they are favorable options for proximal ulna combined with olecranon fracture. Kirschner wire and tension band wiring is not a stable fixation, therefore, it should not be only used for proximal ulna combined with olecranon fracture.
Objective To review the efficacy of reconstruction plate combined with tension band wiring for treating proximal ulna and olecranon fractures. Methods Between November 2004 and September 2009, 10 patients with proximal ulna and olecranon fractures were treated by reconstruction plate combined with tension band wiring. There were 6 males and4 females with an average age of 45.3 years (range, 21-75 years). Five fractures were caused by traffic accident, 2 by fall ing from height, 2 by tumbl ing, and 1 by a machine strangulation. The locations were the left side and the right side in 5 cases respectively. One case was open fracture (Gustilo II) and the other 9 were closed fractures. Olecranon fractures included 4 cases of traverse fractures and 6 cases of comminuted fractures, and proximal ulna fractures included 6 cases of comminuted fractures and 4 cases of obl ique fractures. The combined fractures included 6 radial head fractures, 4 coronoid process fractures, 2 proximal humerus fractures, and 3 scapula fractures; other injury included 1 elbow dislocation and 1 shoulder dislocation. Two patients had secondary operation; the other 8 patients received the primary operations and the time from injury to operation varied from 7 days to 20 days, with an average of 11 days. Results One case had infection at the incision 1 week after operation, and recovered after 2 months of antibiotics and debridement; incisions healed by first intention in other 9 patients. All patients were followed up 12-64 months (mean, 40.5 months). The X-ray films showed that fracture heal ing was achieved at 10-24 weeks (mean, 12 weeks). There was no ulnar nerve symptom in all cases. Heterotopic ossification occurred in 1 case at 2 months and stiffness of the elbow in 1 case at 3 months after operation; they were both cured after symptomatic treatment. Proximal migration of Kirschner wires was found in 1 case at 6 months after operation, whose implants were taken out at 9 months after the first operation because fracture had healed. At last follow-up, the flexion and extension arc of the elbow averaged 92.8°(range, 23-130°), and the arc of forearm rotation averaged 124.4° (range, 42-175°). According to the American Hospital for Special Surgery (HSS) evaluation method, the results were classified as excellent in 6 cases, good in 2, fair in 1, and poor in 1. Conclusion Treating proximal ulna and olecranon fractures by reconstruction plate combined with tension band wiring allows patients to do postoperative exercise early and could effectively avoid compl ications.
Objective To review the methods of repair and reconstruction of the large segmental bone tumor defect in distal tibia. Methods The related literature of repair and reconstruction of the large segmental bone tumor defect in disatal tibia was reviewed and analyzed in terms of the reserved ankle joint and the non-reserved ankle joint. Results For large segmental bone tumor defect in distal tibia, the conventional allograft bone transplantation, vascularized autologous fibular transplantation, vascularized fibular allograft, inactivated tumor regeneration, distraction osteogenesis, and bone transport techniques can be selected, and the membrane-induced osteogenesis, artificial tumor stem prosthesis, three-dimensional printed metal trabecular prosthesis, ankle arthrodesis, artificial tumor ankle joint placement surgery are gradually to be applied to repair the bone defect. Moreover, due to its long survival time, the function of reconstructed bone tumor defect in the distal tibia has also received increasing attention. Conclusion Although the ideal methods has not yet been developed, great progress has been achieved in repair and reconstruction of the large segmental bone tumor defect in the distal tibia. Recently, with the appearance of three-dimensional printing and various preoperative simulation techniques, personalized and precise therapy could become ture, but therapies for the large segmental bone tumor defect in the distal tibia still need to be further explored.