The differentiation of pluripotent mesenchymal stem cells to mature osteoblasts is crucial for the maintenance of the adult skeleton. In rheumatic arthritis, osteoblast differentiation is impaired by the overproduction of cytokine tumor necrosis factor (TNF)-α. It has been demonstrated that TNF-α is able to inhibit osteoblast differentiation through the activation of nuclear factor (NF)-κB signaling. As a result of the critical role of TNF-α and NF-κB in the pathogenesis of bone-loss associated diseases, these factors are regarded as key targets for the development of therapeutic agents. In the current study, the role of the NF-κB inhibitor gliotoxin (GTX) in the regulation of osteoblast differentiation was evaluated. The non-toxic GTX doses were determined to be ≤3 μg/ml. It was revealed that GTX was able to block TNF-α-induced inhibition of osteoblast differentiation, as indicated by alkaline phosphatase (ALP) activity and ALP staining assays, as well as the expression levels of osteoblast-associated genes Col I, Ocn, Bsp, Runx2, Osx and ATF4. Additionally, it was identified that gliotoxin directly promoted bone morphoge-netic protein-2-induced osteoblast differentiation. GTX was found to inhibit the accumulation of NF-κB protein p65 in the nucleus and reduce NF-κB transcriptional activity, suggesting that GTX potentiated osteoblast differentiation via the suppression of NF-κB signaling.

膝关节周围骨折患者以往由于创伤后组织粘连、制动时间过久等影响，膝关节僵直发生率较高［1，2］。连续被动活动机（Continuous passive motion，CPM）可帮助患者术后下肢迅速恢复关节活动功能，使得恢复后的膝关节、髋关节活动自如。骨折是重大的创伤，造成形体的变化，功能的障碍，多数人会有严重的思想负担，造成心理种种变异［3］。治疗的好坏和患者的心理状况相互作用。为了解CPM机对膝关节周围骨折后患者辅助治疗的效果对其康复心理的影响，分别对骨折患者入院后24h内和出院6个月随访时进行焦虑心理评价和CPM效果评价，现报告如下。

Vasculogenic mimicry (VM), a formation of nonendothelial microvascular channels, has been generally recognized as a new pattern of neovascularization in aggressive malignancies. However, whether VM is present and clinically significant in osteosarcoma remains unknown. We identified VM by CD34/periodic acid–Schiff double staining of osteosarcoma specimens before chemotherapy and investigated its prognostic implications. Tumors were also immunohistochemically stained for focal adhesion kinase (FAK) and migration inducing gene 7 (Mig-7) to determine whether these markers are associated with the occurrence of VM. VM was found in 15 of 66 osteoblastic-type osteosarcoma samples (22.7%), and the incidence of VM did not differ with respect to patient sex, age, tumor size, tumor site, surgical type, or histologic response to preoperative chemotherapy. However, Kaplan-Meier survival analysis determined that the presence of VM and the tumor necrosis rate after preoperative chemotherapy are associated with both the overall survival (P = .011 and P = .040, respectively) and metastasis-free survival (P = .002 and P = .045, respectively). Furthermore, Cox proportional hazards analysis showed that the presence of VM and the histologic response to preoperative chemotherapy were independent indicators for both poor overall survival (P = .007 and P = .024, respectively) and poor metastasis-free survival (P = .002 and P = .027, respectively). The expression level of FAK and Mig-7 were higher in the VM group than the non-VM group (P = .017 and P = .021, respectively). These results demonstrate the presence of VM in osteoblastic osteosarcoma and suggest that VM is an unfavorable prognostic factor with FAK and Mig-7 expressions as a potential mechanism of VM formation in osteosarcoma.

Hemangiopericytoma (HPC) is a rare tumor of the central nervous system, most commonly found in the cranial cavity. HPCs in the spine are rare, and very few of them are primary osseous HPC. The aims of this study were to describe a rare case of primary osseous HPC in the thoracic spine and review the literature. A 54-year-old man presented with a 3-month history of back pain. Aneuro logical examination revealed no motor or sensory deficits. Magnetic resonance imaging (MRI) and computed tomography (CT) scan showed a tumor originating from the bone structure of the T10 vertebra with paravertebral extension, and chest CT revealed pulmonary metastases. A laminectomy, face-totomy,and subtotal resection of the tumor was performed with posterior pedicle screw system fixation followed by radiotherapy. The post-operative course was uneventful. His back pain was resolved completely after surgery. The patient survived with tumor during the 18-month follow-up period. Histopathology and immunohistologic findings were consistent with HPC. On immunohistochemistry, the tumor was positive for vimentin and CD34, partially positive for S-100, but negative for EMA, desmin, CD117, and CD1a. A literature review identified eight such cases reported between 1942 and 2013. As a conclusion, clinical manifestations of primary osseous spinal HPCs are different from intraspinal meningeal HPCs. Although showing certain variability, histopathology and immunohistochemical examinations are essential to establish the diagnosis. Surgical resection and radiotherapy are the treatment of choice. *These authors contributed equally to this work.

Objective Giant cell tumor(GCT) of bone is a common bone tumor characterized by active growth,strong corrosion and fast destruction,for which there are a variety of treatment options.The purpose of this article is to evaluate the clinical results of different surgical treatments for GCT of long bones.Methods We retrospectively analyzed the clinical and follow-up data of 60 cases of GCT of long bones treated from January 2000 to November 2010.The patients,32 males and 28 females,ranged in age from 15 to 61 years(mean 35 years).According to Campanacci's staging system,6 cases were classified as gradeⅠ,31 as grade Ⅱ and 23 as grade Ⅲ.Seventeen of them were treated by thorough curettage,alcohol deactivation of the tumor and bone transplantation,and 43 by enbloc resection.Results The follow-up time was from 17 to 132 months(mean 68 months).The total rate of local recurrence was 11.7%(7 /60),17.6% in the group of curettage + bone transplantation,3.3% in the group of prosthesis replacement + tumor resection + allogeneic bone transplantation,and 40% in the group of distal radius tumor excision + fibula autografting for functional reconstruction.Conclusion Intralesional curettage with adjuvant therapies remains the first choice treatment for GCT of long bones.For extensive,biologically aggressive and / or recurrent tumors,enbloc resection is more effective,but needs to be strictly indicated.

Objective The incidence of malignant melanoma in bone is very low.This paper is to introduce the clinical manifestations,imaging and pathological features and treatments of pelvic malignant melanoma.Methods This study included 2 cases of tumor,1 involving the left acetabulum and soft tissue,and the other in the left femur,pelvis and soft tissue.We analyzed the characteristics of the 2 cases and reviewed related literature.Results Both the cases had night pain and high local skin temperature,without specific radiological features,and confirmed to be malignant melanoma by pathological examination.Conclusion Malignant melanoma is a highly malignant tumor,mostly occurs in the skin and mucosa,and easily metastasizes to the liver,lungs and other organs,but rarely involves bones and skeletal muscle.Definite diagnosis of the malignancy depends on pathological examination.Surgical excision,chemotherapy and radiotherapy are the main options for its treatment.

Objective The aim of this systematic review is to review the published papers from East Asia on the clinical,pathological,and epidemiological characteristics of primary clavicle tumor and tumorous lesions.Methods A computerized search based on keywords " clavicle,"" tumor," and " tumorous lesion "(both in Chinese and in English) was performed on papers published from1980 to 2011 in East Asian countries,including China,Japan,DPR Korea,North Korea,and Mongolia.An analysis was carried out with unified inclusion and exclusion criteria.Results Two hundred and twenty two cases were identified.The age of onset ranged from1.5to 70,with an average age of 29.4,and a male/female ratio of 1.53∶1.The percentage of different tumor sites was 28.9% of the cases were located in medial 1/3 region of the calvicle,18.8%in central 1/3 region and 33.6%in lateral 1/3 region;7.4%involved both the medial and central 1/3 region as well as the central and lateral 1/3 region;and 4.0%involved the full length.Major pathological types included 18.02%eosinophilic granuloma,9.91% plasmocytoma,8.11% osteosarcoma and osteochondrom,7.21% Ewing sarcoma,and 5.41% chondrosarcoma.The age of onset was found to be strongly correlated with the benign/malignant ratio.Clavicle malignancy was rarely found in patients younger than10 years old,while the incidence of malignancy greatly was increased among patients over 40 years old.Total or subtotal claviculectomy was the most adopted treatment in cases with available treatment information.Among them,40.8% of patients in these cases received reconstruction of allograft or autograft.Conclusion Clavicle tumors and tumorous lesions in East Asia had an inclined occurrence in respect to age and gender.The most common tumors were eosinophilic granuloma and tumors derived from the bone marrow hematopoietic system.Elder age was found to be a risk factor for malignancy.These characteristics may be related to the special tissue structure and mode of development in clavicle as well as the genetic traits of the typical Mongoloid in East Asia.

Objective To explore the expression of focal adhesion kinase(FAK) in different migration characteristics of osteosarcoma subclone cell lines,as well as its role in the osteosarcoma cell proliferation and migration.Methods Limiting dilution was used to obtain 143B subclone cell lines(A1,A2,A3,A4,A5)with different migration capacities,and their FAK expressions were detected by Western blottting.The role of FAK in the osteosarcoma cells proliferation and migration was studied by small interfering RNA(siRNA) sequence,and the proportion of the cells with lamellipodia was counted by immunofluorescence staining method.Results The migration ability of osteosarcoma cell lines 143B subclone A2 and A3 was significantly stronger than A1,A4 and A5(P<0.05),and FAK expressions of cell lines A2 and A3 were significantly higher.The subclone cell line A3 transfected with FAK-siRNA decreased the migration ability(P<0.05),and the proportion of cells with lamellipodia decreased from 33.3% to 12.8%(P<0.05),but there was no change of the cell growth.Conclusion FAK was founded in the 143B osteosarcoma subclone cell lines with stronger migration capacities.FAK may affect the migration ability of osteosarcoma cells through lamellipodia formation,but have no effect on the proliferation of osteosarcoma cells.

PURPOSE:The aim of this study is to systematically review the published literature from East Asia on the clinical, pathological, and epidemiological characteristics of primary clavicle tumor and tumorous lesions.METHODS:A computerized search based on keywords "clavicle," "tumor," and "tumorous lesion" (both in Chinese and in English) was performed on literature published from 1980 to 2011 in East Asian countries, including China, Japan, South Korea, North Korea, and Mongolia. An analysis was carried out with unified inclusion and exclusion criteria.RESULTS:Two hundred and six cases were identified. The age of onset ranged from 1.5 to 70, with an average age of 29.4, and a male/female ratio of 1.53:1. Lesion locations included 28.9% in medial third, 18.8% in the middle third, and 33.6% in the lateral third of the clavicle. Another 7.4% involved both the medial and middle thirds, 7.4% involved both the middle and lateral thirds, and 4.0% involved the entire length of the clavicle. Major pathological types included 18.5% eosinophilic granuloma, 10.2% plasmocytoma, 7.8% Ewing sarcoma, 8.7% osteosarcoma, 8.7% osteochondroma, and 5.3% chondrosarcoma. The age of onset was found to be strongly correlated with the benign/ malignant ratio. Clavicle malignancy was rarely found in patients younger than 10 years, while the incidence of malignancy greatly increased among patients over 40 years old. Total or subtotal claviculectomy was the most common treatment in cases for which treatment information was available. Of these, 40.8% of patients received reconstruction with allograft or autograft.CONCLUSIONS:Clavicle tumors and tumorous lesions in East Asia had an inclined occurrence in respect to age and gender. The most common tumors were eosinophilic granuloma and tumors derived from the bone marrow hematopoietic system. Age of onset was found to be a risk factor for malignancy. These characteristics may be related to the special tissue structures and mode of development in the clavicle as well as to the genetic traits of the typical Mongoloids in East Asia.

Objective:To evaluate the biomechanical properties of our designed shape memory connector(SMC) in the fixation of experimental humeral fracture.Methods:Osteotomy of humeral diaphysis was performed in adult New Zealand rabbits.The humeral fracture was fixed with SMC in Study Group and with 4-hole dynamic compression plate(DCP) in Control Group.The humeri fixed with SMC or DCP were harvested after surgery.The specimens were mechanically tested under 3-point bending,external rotational torque and axial cpmpression loading to assess stiffness and failure.Results: There were no significant differences in terms of maximum torque,torsional stiffness and bending strength between the two groups(P0.05).But bending rigidity was slightly greater in Study Group compared to Control Group(P0.05).Both the axial rigidity and stress shielding rate of Study Group were significantly lower than those of Control Group(P0.01),while compressive strength was similar in the two groups.Conclusion:These findings suggest that SMC can provide sufficient stability and also an axial continuous dynamic compression on fracture gap.The special material and architectural design of SMC helps to find the right balance between reducing the risk of internal fixation failure and provides optimal interfragmentary strain for the stimulation of callus formation.

Objective: The main material is the absorbable shape-memory polymer invented by us with polycaprolactone,approved to use in clinic by U.S.FDA.The coupling agent that the si-or is added as the accessories.A multiple functional group is organic ester with two or three ethylenic linkages,such as pentaerythritol,triacrylate etc.Filling materials are the compounds with the active calcium ions,such as calcium hydrophosphate etc,which are quite biocompatible and absorbable.(Patent Number: 200610023175.) This thesis is aimed at evaluating the biological compatibility of the carrier of the absorbable and biodegradable shape-memory polymer by the cytological experiments in vitro.Methods: In the assay,the 3T3 cells were cultured in primary and passage cultures.Cells were inoculated to two groups of carrier that the absorbable and biodegradable memory polymer group and naked dish group,which built different 3T3 cell culture system.The activity,proliferation and DNA synthesis of in vitro culture 3T3 cells were observed to study the polymer carrier biocompatibility,when the cells were inoculated to the biodegradable shape-memory polymer carrier,by the cell growth curve,MTT,3H-TdR assay.Results: There is little difference of effect on the activity,proliferation and metabolism etc.biological characteristics of in vitro culture 3T3 cells that were cultured the absorbable and biodegradable shape-memory polymer and naked dish.Conclusions: The vitro cells assay indicates that this absorbable and biodegradable shape-memory polymer has good biocompatibility.

OBJECTIVE To investigate the clinical manifestation of thoracolumbar vertebral osteoid osteoma and to evaluate the surgical procedure and effectiveness of transpedicular tumor resection and spine reconstruction with posterior pedicle screw system and bone graft. METHODS Between January 2001 and June 2010, 8 cases of thoracolumbar vertebral osteoid osteoma underwent one-stage transpedicular intralesional excision and bone graft combined with spine reconstruction with pedicle screw system through posterior approach. There were 5 males and 3 females with a median age of 15.5 years (range, 6-27 years). Affected segments included T8 in 1 case, T10 in 1 case, L2 in 2 cases, L3 in 1 case, L4 in 1 case, and L5 in 2 cases. All of the cases had back pain, 1 had radiating pain of lower extremity, and 4 patients presented with scoliosis. The mean diameter of lesions was 1.6 cm (range, 0.9-2.0 cm). RESULTS The mean operation time was 110 minutes (range, 70-170 minutes) and the mean blood loss was 720 mL (range, 300-1 400 mL). The postoperative pathologic examination showed osteoid osteoma in all cases. All patients achieved healing of the incisions by first intention. Immediate relief of pain was observed after operation in all patients without complication. The patients were followed up 12-58 months (mean, 39 months). No local recurrence or spinal deformity was observed during the follow-up. CONCLUSION CT can show a low attenuation nidus with central mineralization and varying degrees of perinidal sclerosis, so it has great value for final diagnosis of thoracolumbar vertebral osteoid osteoma. One-stage transpedicular intralesional excision supplemented by impaction bone graft and combined posterior pedicle screw stabilization is a safe and effective treatment.

Objective To study retrospectively the efficacy and complications of complete tumor resection via a posterior midline approach used to treat primary spinal schwannomas.Methods The patients' clinical presentations,operative findings and follow-up were reviewed in 39 patients,over the period from 2001 to 2010.There were 25 males and 14 females with a mean age of 41.5 years(range 14-72 years).Affected segments included thoracic vertebral canal in 17 cases,thoracolumbar vertebral canal in 4 case,lumbar vertebral canal in 15 cases,and lumbosacral vertebral canal in 3 cases.A posterior midline incision approach with laminectomy and facetectomy for single-stage complete resection of intraspinal and paraspinal components of tumor were used.Spine reconstruction with pedicle screw system was also carried out in relevant cases.Results Total excision was achieved in all patients.The patients were followed up for a mean of 35 months(range 10-69 months).Local recurrence was observed in one case of benign schwannoma.One patient with malignant nerve sheath tumor had local recurrent and lung metastasis,who died in 17 months after operation.ASIA sensory scores increased 1.6 in average after operation in 22 patients with paresthesia and ASIA motor scores increased 2.5 in average in 7 of 10 patients with paraparesis.Segmental instability occurred in 2 of 6 cases without spinal instrumentation after surgery.Conclusion Optimizing operative exposure is an important prerequisite for a safe and complete resection of thoracic and lumbar spinal schwannoma.This surgical exposure allows for facetectomy and costotransversectomy when necessary.Leaving the affected nerve root behind can result in a potential recurrence with the attendant difficult problems of reoperation.Spinal instrumentation was required except for patinets with the tumor mass located in midthoracic region.

BACKGROUND:Although a variety of mechanics study on the mechanical characteristics of the pelvis has been performed,but the exact stress distribution in the region remains unclear.ONJECTIVE:To observe the gross distribution of bone trabecula around acetabulum and compare with existing biomechanical research results.METHODS:Four dry pelvic specimens were cut in accordance with the plane which composed of acetabular edge and the plane of obturator in order to observe the distribution patterns of trabecular bone on the cross-section,and to observe the gross distribution of trabecula around acetabulum.RESULTS AND CONCLUSION:The trabeculae of hip bone were divided into three groups.①Sacropubic bundle:It ran from the auricular surface,posterior superior iliac spine and posterior inferior iliac spine to pubic symphsis along the iliopectinal line,and part of the trabecula terminated in the posterior superior acetabular.②Iliocotyloid bundle:It ran from the greater sciatic notch of the auricular surface to the superior posterior acetabular,and located in the shallow layer of the sacropubic bundle.③Ilioischial bundle:From the region of the iliac crest to the ischial tuberosity,part of the trabecula terminated in the anterior superior acetabular.High-density trabecular net transversely located at the level of the sciatic notch,defined by a distinct saltire-shaped crossing over the acetabulum between the sacropubic and the ilioischial bundles.The human hip acetabulum was constituted by iliocotyloid bundle,sacropubic bundle and ilioischial bundle.High-density trabeculum net transversely located at the level of the sciatic notch,iliopubic eminence and the cross-section of sacropubic and the ilioischial bundles.This is consistent with the stress distribution and loading of the acetabular region in the current research.

Objective Essex-Lopresti injury,which involves disruption of the distal radioulnar joint rupture of the interosseous membrane and fracture of the radius head,is particularly difficult to be diagnosed and treated.This study aims to explore the effects of surgical methods for the treatment of Essex-Lopresti injury with ipsilateral fracture of the forearm,a problem rarely seen clinically.Methods Twenty patients with Essex-Lopresti injury with ipsilateral fracture of the forearm underwent anatomic reduction fracture of the forearm,reconstruction of the length of the radius,and reduction and stabilization of the distal radio-ulnar joint.All were followed up for 12-24 months,averaging 18 months.Results According to the Morrey and Broberg scoring system,the mean elbow joint score was 74(60-95) points,with an excellence rate of 65%;based on the Mcbride scoring system,the mean wrist joint score was 88.5(75-98) points,with an excellence rate of 83%.Conclusion For Essex-Lopresti injury with ipsilateral fracture of the forearm,initial anatomical reduction of the ulna fracture conduces to reconstruction or restoration of the radial length,and radial head fracture and interosseous membrane lesion are usually mild.

BACKGROUND:Preliminary studies have established the method to research the spatial distribution of cortical bone thickness through the three-dimensional model based on the CT data of the normal body.OBJECTIVE:To make division of the thickness of cortical bone around the acetabulum according to the three-dimensional thickness distribution of the hip cortical bone.METHODS:The cortical bone was extracted and the geometric model was established through the segmentation of eight healthy volunteers CT image by Mimics.The new algorithm of cortical thickness measurement was determined by Patran Command Language provided by PATRAN platform.After the thickness data were obtained,we made a division of the thickness area by cluster analysis method according to the distribution size of the cortical bone.RESULTS AND CONCLUSION:The cortical thickness of acetabulum was between 0.44 mm and 4.00 mm.Cluster analysis showed that it could be divided into 0.44-1.133 mm group,1.133-1.826 mm group and 1.826-4.00 mm group.According to the thickness of the three groups,the model was rendered,and then we found that the thicker parts of the cortical bone could be divided into three cortical bone beams.The first group was extended from the arcuate line to the pubic symphysis.The second group was extended from the acetabular roof to iliac nodules.The third group was around the ischium notch.There were three thickest positions throughout the thicker parts of the cortical bone around acetabulum.The positions were consistent with the high stress points.

Objective Osteosarcoma is a malignant tumor which frequently occurs in adolescents.It has a poor prognosis,and chemotherapy cannot improve the five-year survival of the patients.This study was to evaluate the short-term efficacy and safety of rh-endostatin(endostar) in the treatment of osteosarcoma.Methods We assigned 17 patients with confirmed osteosarcoma to an experimental group(n=10) and a control group(n=7),the former treated with endostar in combination with chemotherapy,and the latter by chemotherapy only.We observed and compared the clinical benefit response(CBR),quality of life scores and adverse reactions in the two groups.Results The CBR rates were 100% and 71.4% in the experimental and the control group,respectively.There were no statistically significant differences in adverse effects between the two groups(P0.05),nor were there any unexpected adverse events.Conclusion Endostar exhibited anti-tumor activity with high clinical benefit response for osteosarcoma patients.

BACKGROUND:Finite element technology is a digital simulation of the real stress situation;however,photoelastic technology can truly display the overall stress distribution of the test model.OBJECTIVE:To make the pelvis photoelastic model by laser rapid prototyping technology,and then to investigate the stress distributions of the pelvis under normal gait loading conditions by three-dimensional photoelastic analysis and to compare the result with that gained by the finite element method.METHODS:The pelvic potoelastic model was made by laser rapid prototyping technology,including the fifth lumbar vertebrae and bilateral proximal femur.Mass loading was imposed on the femur.Four groups of muscles forces were imposed through steel wire fixed on iliac wing,anterior superior iliac spine,posterior superior iliac spine and inferior ramus of pubis.The femur was assumed to adduct for 15° and moved from flexed 22° to extend 12° during four gait phases.After stress froze,slices were cut along the arcuate line.Isochromatic lines and isoclinic lines were observed in the field of polarized light.RESULTS AND CONCLUSION:①Stress was concentrated on the center of ilium posterior superior roof of acetabulum,iliopubic eminence and cacroiliac joint,and the maximum stress was on the posterior superior roof of acetabulum.② The main stress was transferred from posterior superior roof of acetabular to the cacroiliac joint and superior ramus of pubis partly.The area from roof to tubercle of the iliac crest loaded more stress with the femur extending.③The stress on the acetabular area was mainly from the acetabular contact forces produced by mass loading,and the role of the muscle contraction force was limited.The three-dimensional photoelastic analysis could reflect distribution of stress on acetabulum.The result was in accordance with the data of finite element method.

目的分析成骨肉瘤发生肺转移患者的临床特点,为了解肺转移发生的高危因素、早期给予干预性治疗、寻找多中心研究的方向和新的药物及治疗方案提供临床依据。方法 2001年1月-2010年10月间在我院经规范治疗并获得随访的成骨肉瘤患者共158例,对其中41例发生肺转移患者的一般情况、肿瘤发生部位、Enneking分期、化疗方案、手术方法、局部复发情况、肺转移特点和生存情况进行回顾性分析。结果肺转移发生率25.9%。158例患者中局部复发16例,复发率10.1%;复发患者中出现肺转移12例,占局部复发的75%。41例肺转移患者中存活11例,存活率26.8%,平均存活时间47.6个月(9～114个月)。12例单发肺转移患者中5例存活,存活率41.7%;29例多发肺转移患者中6例存活,存活率20.7%。8例行肺清扫术患者中5例存活,存活率62.5%。行保肢术25例,存活8例,存活率32%;行截肢术12例,存活3例,存活率25%。结论尽管采取多药方案的新辅助化疗手段及根治性外科手术,但仍有近30%的成骨肉瘤患者发生肺转移。肺转移患者生存率明显降低,其局部复发与肺转移关系密切;肺转移类型、出现时间以及手术方式等对生存率具有重要影响。采取相应措施有望提高肺转移患者的生存率。

OBJECTIVE:To investigate the effects of the ventralateral approach in treating severe Pilon fracture.METHODS:From February 2002 to March 2008, 63 patients with Ruedi II-III Pilon fractures were treated with the ventralateral approach, including 36 males and 27 females with an average age of 37 years ranging from 19 to 71 years. The mean time from injury to operation was 8 days (ranged for 2 h-19 d). According to the Ruedi classification system, type II was 32 cases (6 cases of them combined with soft tissue lesion, 4 with open fracture) and type III was 31 cases (9 cases of them combined with soft tissue lesion, 8 with open fracture). The clinical effects were evaluated according to Helfet criteria and the complications were observed including condition of wound healing, infection, bone union, deformity union, motion of the ankle, the degree of the pain and so on.RESULTS:The first intention achieved in 59 cases, the delayed healing in 4 cases. Stiffness of the ankle was found in 5 cases because of bone disunion. All patients were followed up from 8 to 31 months with an average of 15.3 months. The ranging in bone healing time was from 8 to14 weeks with an average of 10 weeks. According to the Helfet criteria, 28 cases obtained excellent results, 30 good, 5 poor.CONCLUSION:The operative treatment of Ruedi I-III Pilon fractures with the ventralateral approach can obtain satisfactory results and avoid complications effectively.