Objective To explore the efficacy of temporary titanium plate screwing for positional maintenance in reduction and internal fixation for displaced acetabular fractures.Methods A retrospective study was conducted of the 28 patients (28 hips) with displaced acetabular fracture who had been treated by open reduction and internal fixation from October 2013 to March 2016.They were 20 males and 8 females,aged from 24 to 68 years (average,42.3 years).The time from injury to surgery ranged from 7 to 21 days(average,14.5 days).According to the Letournel-Judet classification,there were 2 posterior column fractures,4 transverse fractures,5 posterior column plus posterior wall fractures,6 transverse plus posterior wall fractures,2 T-shaped fractures,3 anterior and posterior transverse fractures and 6 double column fractures.The posterior acetabular approach or combined anterior and posterior approach was used.In all the patients temporary titanium plate screwing was conducted to fix one side of the fracture so as to facilitate accomplishment of open reduction and internal fixation without losing the indirect anatomic reduction of the intraarticular fracture.After the open reduction and internal fixation was accomplished,the temporary screw fixation was removed in 26 patients but retained in 2 patients as needed.The reduction quality,complications and outcomes at the final follow-ups were recorded.Results All the 28 patients were followed up for 10 to 36 months (mean,15.6 months).By the Matta criteria,anatomical reduction was achieved in 26 cases,unsatisfactory reduction in one and poor reduction in one,yielding an anatomic reduction rate of 92.9％.By the improved Mere d'Aubigne & Postel criteria,the clinical outcomes at the final follow-up were excellent in 27 cases and good in one,yielding a good to excellent rate of 100％.Postoperatively,heterotopic ossification of different severities occurred in 11 cases but did not affect their joint function;transient paralysis of the sciatic nerve was reported in 6 cases but recovered 3 months after surgery.No complications like avascular necrosis of the femoral head or walking pain were observed during follow-ups.Conclusion Temporary fixation with titanium plate screws during open reduction and internal fixation for displaced acetabular fractures can effectively improve the reduction and fixation of the articular surface,leading to satisfactory short-term clinical outcomes.

Objective To investigate the clinical efficacy of preoperative full reset combined with minimally invasive treatment of extreme distal pilon fractures.Methods A retrospective analysis was made on 34 patients (35 ankles) with tibial fractures extremely close to the distal articular surface treated surgically between January 2011 and January 2015.There were 21 mnales and 13 females,aged 20-71 years (mean,36.2 years).Injury resulted from traffic accidents in 32 patients and high falls in two.Using the AO/OTA fracture classification system,type 43-B3 was noted in three patients,43-C1 in five patients,43-C2 in 18 patients and 43-C3 in eight patients.Calcaneal traction combined with manipulative reduction was used to correct fracture displacement preoperatively.All fractures were stabilized by minimally invasive percutaneous plate osteosynthesis (MIPPO) through single or combined medial,anteromedial and anterolateral approaches while minimizing damage to bone attachment and continuity of soft tissue,after soft tissue swelling subsided.For the patients with articular surface collapsing with severe comminution,a series of procedures were done under direct vision including using the talus articular surface as a mold,stable fixation with fine Kirschner (1-1.5 mm) and thin screws (2.1-2.7 mm series) and impaction bone grafting below subchondral bone.Thereafter,distal tibia anatomical short multi-directional locking plate fixation,distal nail support and early ankle joint functional exercise were done.Burwell-Charnley radiological evaluation system was used for radiological assessment,and TeenyWiss scoring system for ankle clinical symptoms and function.Postoperative complications were recorded.Results Follow-up lasted for 11-38 months (mean,16.6 months).No infection,wound disunion,or plate exposure occurred.Burwell-Charnley radiological evaluation system showed anatomic reduction in 32 patients,unsatisfactory reduction in one,and poor reduction in one.According to the Teeny-Wiss scoring system,the results were excellent in 31 patients,good in two and poor in one,with the excellentgood rate of 97％.Three patients suffered traumatic arthritis after operation and alleviated after oral administration of painkiller.Conclusion With use of full reset combined with manipulative reduction to correct fracture displacement,minimally invasive locking plate,distal row of nails,impaction bone grafting and limited fixation,the patients with extremely distal tibial pilon fractures achieve satisfactory reduction,stable fixation,and early functional exercise.

AIM: To explore the influence of different fixed ways on healing and curative effect of osteochondral fracture block of knee joint. METHODS: A total of 50 patients with knee joint injury combing free cartilage block of joint from the 251 Hospital of Chinese PLA between May 1999 and October 2004 were selected. They were all treated with opening internal fixed operation in joint. The osteochondral fracture blocks were fixed with thick silk suture, thin Kirschner wire, steel wire, common screw or Herbert lag bolt. After operation, the external fixation was done in the patients fixed with thin Kirschner wire at the 6th-8th weeks. Exercise of knee joint function was performed after pulling out Kirschner wire. Passive and initiative activity was conducted intermittently in the other groups in an early period. Fracture line, flat degree of articular surface and density of lower bone of cartilage were observed with X-ray at positive lateral of knee joint at the 1st, 6th weeks, 3rd, 6th and 12th months after operation. Mass, color, flat degree and adherence of cartilage were observed under arthroscope or looking steadily. Recovery of knee joint function was assessed with knee joint evaluation of Hospital for Special Surgery of America (HSS assessment) at the 6th and 12th months. RESULTS: Totally 50 patients were involved in the result analysis. ①Functional recovery of joint was good, without pain, in thirty-five patients who were fixed with common screw or Herbert lag bolt. Score of HSS knee joint was excellent. The X-ray revealed that the fracture was healing fully, and the articular surface was flat. Thirteen patients required getting the internal screw out at 6-12 months. Healing status of cartilage fracture block was good when looking steadily in opening joint, and the cartilage was near to normal or similar. ②The 15 patients fixed with thick silk suture, thin Kirschner wire or steel wire after operation for 6-12 months felt slight ache when walking, and the recovery of joint function was bad. The score of HSS knee joint was good, and the X-ray showed that fracture was healing completely, and the flat degree of articular surface was bad, showing slight hyperplastic sclerosis of local fracture. Arthroscopy was performed, and the internal material was obtained after opening joint. Healing condition of cartilage fracture was bad observed indirectly or directly. The cartilage was replaced with fibrous scar tissue, which was similar to fibrous cartilage tissue in particular, the healing of cartilage fixed with Kirschner wire was the worst. CONCLUSION: Both common screw fixation and Herbert lag bolt fixation can reach better reduction and compression, which is beneficial for healing and plerosis of cartilaginous. It is indicated that the natural healing of osteochondral fracture of knee joint is related with the reduction, securing-compression fixation and early exercise of joint function.

股骨粗隆间骨折好发于老年人,处理不当,常遗留髋内翻、下肢短缩和外旋畸形.研究表明高龄人群发生股骨粗隆部骨折的概率较股骨颈明显增高[1].目前关于股骨粗隆间骨折治疗方法很多,选择创伤小、固定坚强、早期活动更适合老年患者,经皮钢板内固定技术在四肢长骨骨折及平台骨折中的应用较为广泛,而报道股骨粗隆间骨折的文章较少.我们采用闭合复位、改良小切口、DHS微创植入方法取得良好效果,现报道如下.

<正>1病历资料患者,男性,63岁。主因双膝伸直、站立困难10 d入院。患者于酒后上楼梯时突发双膝无力、后仰,他人扶持未摔倒,当时未觉膝部有疼痛不适,受伤后第2天下地时自觉双侧膝关节伸膝困难,不能站立,双膝疼痛不适,于当地医院行MRI、X线片检查,考虑双侧股四头肌腱断裂(图1,2)。当时诊断不明确转我院治疗,入院体检：双膝无明显肿胀,髌骨上方有空虚感,局部有压痛,主动伸膝不能,进一步行B超检查,诊断：双侧股四头肌腱完全断裂。手术所见：左侧股四头肌腱于髌骨止点处断裂,右侧于肌腱、肌肉移行部分斜行断裂。双侧股四头肌腱完全断裂均行手术：左侧行髌骨止点钻孔固定,钢丝减张；右侧直接缝合(图3)。术后棉腿直夹板固定,1周后在康复师指导下功能锻炼。