ObjectiveTo summarize the evolving concept in treatment of intertrochanteric fractures and the development of internal fixation devices. MethodsRelated literature concerning the implant devices to treat intertrochanteric fractures was reviewed and analyzed in terms of the biomechanical characteristics, clinical application, and complications. ResultsThe treatment of intertrochanteric fractures has undergone an evolving concept from conservative treatment to surgical treatment. Surgery strategies include extramedullary fixation and intramedullary fixation. Intramedullary fixation has gradually become the main treatment of intertrochanteric fractures due to its minimally invasive and biomechanical advantages. However, the current intramedullary fixation system still can not reconstruct the medial cortical support of the proximal femur, which leads to some failures in the treatment of unstable fractures. ConclusionThe development of internal fixation of intertrochanteric fractures is based on the deep understanding and biomechanical theory of intertrochanteric fractures in clinical practice. In the future, the updated design of internal fixation devices will depend on the treatment principle of reconstruction of medial support and secondary stabilization of intertrochanteric fractures, and finally the purpose of improving success rate and reducing postoperative complications of intertrochanteric fracture will achieved.
Objective To obtain the anatomical data of the insertions of the lateral collateral l igament (LCL), popl iteus tendon (PT), and popl iteofibular l igament (PFL) for the posterolateral corner of the knee (PLC) reconstruction. Methods Thirty human cadaveric knees were chosen to observe the structure of PLC, including 14 males and 16 females with an averageage of 55 years (range, 45-71 years ). The insertions of LCL, PT, and PFL were identified, then the distances from the centers of the insertions to specific bony landmarks were measured, which were lateral epicondyle, the most proximal point on the styloid process and the most anterior point on the anterior surface of the fibular head. Normal ization processing of the actual numerical values from each knee was performed. Results The center of the LCL insertion was at the site of (1.27 ± 3.10) mm proximal and (2.99 ± 1.29) mm posterior to the lateral epicondyle of the femur respectively, and the center of the PT insertion was at the site of (8.85 ± 3.38) mm distal and (3.83 ± 1.95) mm posterior to the lateral epicondyle of the femur respectively. The center of the LCL insertion was at the site of (10.56 ± 2.17) mm distal and (7.51 ± 1.81) mm anterior to the nearest point of the fibular styloid respectively, and the center of the PFL insertion was at the sites of (1.31 ± 0.55) mm distal and (0.49 ± 1.36) mm anterior to the nearest point of the fibular styloid respectively. The cross-sectional area of the insertions of femur was (44.96 ± 13.29) mm2 for the LCL and (52.52 ± 11.93) mm2 for the PT, respectively; the cross-sectional area of the insertions of fibula was (35.93 ± 11.21) mm2 for the LCL and (14.71 ± 6.91) mm2 for the PFL, respectively. Conclusion The LCL, PT, and PFL have a consistent pattern of insertion.
Objective To evaluate the effectiveness of the AO anatomical locking compression plate in treating type C distal humeral fracture. Methods Between July 2008 and April 2009, 13 cases of type C distal humeral fracture were treated with the AO anatomical locking compression plates. There were 5 males and 8 females with an average age of 52.1 years (range, 24-80 years). Fractures were caused by tumbl ing in 7 cases, by traffic accident in 4 cases, and by fall ing from height in2 cases. According to Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification, there were 3 cases of type C1, 6 cases of type C2, and 4 cases of type C3. Two cases compl icated by ulnar nerve injuries, 1 by radial nerve injury, 2 by fractures of ulnar olecranon, 3 by fractures of other parts of extremities, and 6 by osteoporosis. The time from injury to hospital ization ranged from 3 hours to 4 days (0.9 day on average). Results All the incisions achieved heal ing by first intention. Thirteen cases were followed up 12 to 21 months with an average of 15.9 months. According to the X-ray films, unions were achieved both at fracture site and the olecranon osteotomy site with a heal ing time of 8 to 13 weeks (10 weeks on average). The function of elbows recovered from 3 to 32 weeks (10 weeks on average). No fixation failure, myositis ossifican, delayed union, or malunion occurred during the follow-up. The Mayo Elbow Performance score ranged from 75 to 100 with an average score of 95.8; the results were excellent in 9 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 92.3%. Conclusion The AO anatomical locking compression plate has a good fixation in treating type C distal humeral fracture. Through the approach of olecranon osteotomy, it is easy to get anatomical reduction, stable fixation, and early exercise.
ObjectivesTo analyze the epidemiological characteristics of inpatients with skin cancer in China.MethodsThe medical records of all inpatients with skin cancer in second-level and above hospitals in China from 2015 to 2017 were collected, and the demographic characteristics and regional distribution of inpatients were retrospectively analyzed.ResultsFrom 2015 to 2017, the quantity of inpatients with skin cancer in China increased annually. The ratio of male to female was 1.09 to 1, individuals aged 60 to 70 were high incidence age group, and the occupation was primarily farmers. Guangdong province had the largest quantity of inpatients. Among geographic regions, the proportion of inpatients in East China was the largest (34.20%). Among economic regions, the proportion of inpatients in the east was the largest (45.86%).ConclusionsThe quantity of inpatients with skin cancer in China is on the rise, and there are obvious spatial differences. Therefore, more attention should be paid to the prevention and treatment of skin cancer.
ObjectiveTo review the research progress of different surgical approaches in the treatment of acetabular both-column fractures.MethodsThe domestic and foreign related research literature on surgical approaches for acetabular both-column fractures was extensively consulted. The anatomical characteristics, exposure ranges, advantages, disadvantages, and indications of various common surgical approaches for both-column fractures were mainly summarized.ResultsThe ilioinguinal approach is more suitable for both-column fractures if the anterior column fracture is complicated or combined with the anterior wall fracture while the posterior column fracture is simple and stable. The modified Stoppa approach or the lateral (para) rectus abdominal approach is the preferred choice when both-column fractures are combined with a quadrilateral fracture or femoral head dislocation. What’s more, the Kocher-Langenbeck approach is required when the posterior column fractures are complicated or combined with posterior wall fractures. In addition, the simultaneous ilioinguinal and Kocher-Langenbeck approaches are the first choices when the both-column fractures possessing extremely severe and obvious displacement.ConclusionThe reasonable choice of surgical approach is extremely important for acetabular both-column fractures. Each surgical approach has its advantages and limitations. It is necessary to take the precise reposition of the acetabular joint surface as the principle, and comprehensively judge the fracture types and severity of anterior column, posterior column, and square area, and then select the optimal surgical approach for surgical treatment.
ObjectiveTo explore the effectiveness of triangular stabilization system in the treatment of postoperative nonunion of femoral neck fracture.MethodsThe clinical data of 30 patients with postoperative nonunion of femoral neck fracture who met the selection criteria between December 2014 and December 2019 were retrospectively analyzed. There were 21 males and 9 females with an average age of 40.7 years (range, 15-65 years). The Pauwels angle at the time of injury was 51°-79°, with an average of 63.6°. According to the Pauwels classification, they were all type Ⅲ. The time from the first operation to this revision operation was 5-24 months, with an average of 9.7 months. The preoperative visual analogue scale (VAS) score was 4.2±1.3, the Harris score was 31.2±5.3, the neck-shaft angle was (116.3±7.9)°, and the lower limb shortening length was (1.73±0.53) cm. Triangular stabilization system, which was made of dynamic condylar screw and medial anatomical buttress plate, combined with the window bone grafting at the fracture site was used for bone nonunion revision. The postoperative lower limb shortening length, neck-shaft angle, fracture healing time, and complications were recorded; the Harris score was used to evaluate the hip joint function, and the VAS score was used to evaluate the pain improvement before and after operation.ResultsAll patients were followed up 12-60 months, with an average of 27.7 months. There was no clear sign of femoral head necrosis and collapse after operation; 1 patient developed infection at 4 months after operation, and the incision healed after debridement and removal of internal fixator. All patients achieved bone healing, and the healing time was 2.8-6.0 months, with an average of 3.9 months. At last follow-up, the lower limb shortening length was (0.30±0.53) cm, which was significantly corrected when compared with preoperative one (t=16.721, P=0.000); the neck-shaft angle was (133.9±5.7)°, which was significantly recovered when compared with preoperative one (t=−11.239, P=0.000). The VAS score was 0.7±0.9, the Harris score was 88.3±5.9, both of which were significantly improved when compared with preoperative scores (t=16.705, P=0.000; t=−40.138, P=0.000).ConclusionTriangular stabilization system combined with window bone grafting can provide a stable and balanced mechanical environment, promote fracture healing, and achieve satisfactory effectiveness in the treatment of postoperative nonunion of femoral neck fracture.
Objective To investigate the surgical treatment effectiveness of acetabular transverse and posterior wall fractures by Kocher-Langenbeck approach. Methods Between January 2002 and February 2009, 17 patients with acetabulartransverse and posterior wall fractures were treated with Kocher-Langenbeck approach and fracture reduction and fixation. There were 12 males and 5 females with an average age of 33.4 years (range, 20-65 years). The disease causes were traffic accident in 16 cases and fall ing from height in 1 case. The disease duration was 6 hours to 11 days. According to Letournel classification, all fractures were rated as acetabular transverse and posterior wall fractures. Concomitant injuries included posterior hi p dislocation in 3 cases, fracture of extremities in 8 cases, injury of sciatic nerve in 3 cases, craniocerebral injury in 1 case, and l ienal rupture in 1 case. Results The incisions healed primarily and no compl ication of infection and deep venous thrombosis occurred after operation. All patients were followed up 12 to 36 months with an average of 19 months. The X-ray films showed that fracture healed 3 to 5 months after operation. After operation, anatomic reduction was found in 9 cases, satisfactory reduction in 5 cases, and unsatisfactory reduction in 3 cases according to Matta et al criterion. According to modified grading system of Merle D’Aubigne and Postel, the results were excellent in 4 cases, good in 9, fair in 3, and poor in 1 at last follow-up with an excellent and good rate of 76.5%. The nerve function was recovered in patients with sciatic nerve injury at 12 months after symptomatic treatment. Traumatic arthritis occurred in 5 cases, avascular necrosis of the femoral head in 1, and heterotopic ossification in 5 between 9 weeks and 12 months after operation. Conclusion For acetabular transverse and posterior wall fractures, it is important to make adequate preoperative preparation, to get the imaging data, and to perform open reduction andinternal fixation with Kocher-Langenbeck approach as early as possible.
To investigate the anatomic feature of the posterior hip joint capsule and its distributional difference of collagen fibers and to probe the optimization of the capsulotomy which can reserve the best strength part. Methods Ten adult cadaver pelvises (6 males and 4 females, aged 28-64 years) fixed with formal in were used. Ten right hips were used for anatomical experiment of hip joint capsule. The posterior hip joint capsules were divided into 3 sectors(I-III sectors ) and 9 parts (IA-C, IID-F, IIIG-I). The average thickness of each part was measured and the ischiofemorale l igaments were observed. Five capsules selected from ten left hips were used for histological experiment. The content of collagen fibers in sector I and sector II was analyzed by Masson’s staining. Two fresh frozen specimens which were voluntary contributions were contrasted with the fixed specimens. The optimal incision l ine of the posterior capsule was designed and used. Results The thickness in the posterior hip joint capsule [IA (2.30 ± 0.40), IB (4.68 ± 0.81), IC (2.83 ± 0.69), IID (2.80 ± 0.79), IIE (4.22 ± 1.33), IIF (2.50 ± 0.54), IIIG (1.57 ± 0.40), IIIH (2.60 ± 0.63), IIII (1.31 ± 0.28) mm] had no uniformity (P lt; 0.01). The IIIG part and the IIII part were thinner than the IB part and the IIE part (P lt; 0.01). Two weaker parts located at obturator externus sector (sector III), the ischiofemorale l igament trunk went through two thicker parts (IB and IIE). The distribution of the collagen fibers in sector I and sector II(IA 20.34% ± 5.14%, IB 48.79% ± 12.67%, IC 19.87% ± 5.21%, IID 17.57% ± 3.56%, IIE 46.76% ± 11.47%, IIF 28.65% ± 15.79%) had no uniformity (P lt; 0.01). The content of collagen fibers in IB part and IIE part were more than that of other parts (P lt; 0.01). There were no statistically significant difference in the distribution feature of the thickness and the ischiofemorale l igaments between the fresh frozen specimens and the fixed specimens. The optimal incision l ine C-A-B-D-E of the posterior capsule was designed and put into cl inical appl ication. The remaining capsular flap comprise the most of the ischiofemorale l igament trunk and the part of gluteus minimus. Conclusion Although enhanced posterior soft tissue repairin total hip arthroplasty was investigated deeply and obtained great development, but the postoperative dislocation rate was not el iminated. It is significant for optimizing the capsulotomy to reserve the best strength part of the posterior capsule and to bring into full play the function of the ischiofemorale l igaments.