Objective To investigate the clinical efficacy of dynamic external fixator for the treatment of middle phalangeal basal fractures in elder children.Methods From November 2018 to March 2022,our hospital treated 17 elder children with middle phalangeal basal fractures.All patients were treated with closed reduction of middle segment basal fractures and continuous traction with dynamic external fixators.The preoperative X-ray diagnosis and Salter-Harris classification were performed,including 8 cases of metaphyseal fractures,7 cases of type Ⅱ fractures,and 2 cases of type Ⅳ fractures.The X-ray examination of fracture alignment was conducted within 1 week after surgery,and it of fracture healing was conducted 3 and 6 weeks after surgery.At the last follow-up,the range of motion of the interphalangeal joint was measured and compared with the healthy side.The evaluation was based on the total active range of motion(TAM)scoring system recommended by the American Association of Hand Surgeons.Results All 17 patients were follow-up for 4 to 15 months,with an average of 8.5 months.All fractures achieved bone healing,with good finger flexion and extension activity,no angular or rotational deformities,and no complications such as joint stiffness and pain.The TAM score showed that 14 fingers were excellent,2 fingers were good and 1 finger was fair.Conclusion Under the condition of mastering the indications,the application of dynamic external fixators to treat middle phalangeal basal and metaphyseal fractures in elder children can achieve satisfactory treatment results.

Objective To explore the clinical efficacy of modified dynamic external fixator traction for the treatment of intra-articular fractures of the base of the middle phalanx.Methods From March 2015 to February 2018,22 patients with fractures of the base of the middle phalanx were treated with close reduction and self-made modified dynamic external fixator traction.Among them,5 patients suffered from comminuted fracture of the base of the middle phalanx,and 17 patients suffered from palmar edge fractures.The joint mobility and hand grip were measured at the last follow-up.Results All the patients achieved bony union.The flexion and extension exercises were performed after operation,and the flexion and extension of interphalangeal joints were good.No nail infection,pain and joint stiffness occuned.All the patients were follow-up from 8 to 20 months with an average 11.5 months.According to the total active motion (TAM) score system,the results were rated as excellent in 16 cases,good in 5 cases and fair in 1 case.Conclusion The modified dynamic external fixator traction is reliable in the treatment of intra-articular fractures of the base of the middle phalanx.It does not destroy the blood supply and soft tissue at the fracture end.It is conducive to fracture healing.The external fixator has simple structure and does not need to fix joints.It can exercise flexion and extension function of interphalangeal joint in early stage,and is conducive to restoring hand function as soon as possible.

Objective To explore the anatomic basis of anterior lateral malleolar venous network graft for repair of superficial palmar arch defects and report its clinical efficacy.Methods Microsurgical anatomical study was performed in 6 specimens of fresh Chinese adult lower extremities to observe and measure the branches,distribution,vessel length,caliber and venous valve characteristics of the anterior lateral malleolar venous network.From May 2007 to February 2017,15 patients with superficial palmar arch defects were treated by anterior lateral malleolar venous network graft.Results Anatomical study results showed that there was a obviously visible venous network in the superficial fascia of the anterior lateral malleolus.The distal end was originated from the fibular side of the arcus venosus dorsalis pedis,and the proximal vessels flowed into the great saphenous vein medially and the small saphenous vein laterally.Between them,there were 4 to 6 fine veins that formed network.The length of the distal dorsal segment of small saphenous vein (BC) was (2.81±0.39) cm.The branch length of the anterior lateral malleolar venous network (CD) was (5.32±0.92) cm.The fibular side vascular diameter of arcus venosus dorsalis pedis was (2.15±0.35) mm.The proximal end of the vascular network had 4.8 branches.The diameter of the vascular branch at the tip of the lateral malleolus E line horizon averaged (1.06±0.43) mm.There are an average of 4.2 valves per anterior lateral malleolar venous network.The valves in branches are toward the proximal direction.Clinically,15 cases of superficial palmar arch defects were treated by anterior lateral malleolar venous network graft with a total of 54 anastomosis sites of distal area of recipient area and an average of 3.6 anastomosis sites per case.Postoperatively,1 case suffered partial distal thumb necrosis and the rest of the distal fingers survived uneventfully.The follow-up time ranged from 6 months to 5 years and 3 months in 12 cases.The appearance of the hand was good,and the function of holding and opposition movement was restored.The finger proprioceptive sense was recovered.The two-point discrimination was 5 to 7 mm.According to the upper extremity function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association,the results were graded as excellent in 6 cases,good in 4 cases,fair in 1 case and poor in 1 case.There was no influence on the function of donor site.Conclusiou The anatomy of anterior lateral malieolar venous network is constant.Its shape,diameter and number of branches are similar to the superficial palmar arch.The valve opening is toward the proximal end.It is an ideal method for repairing the defects of superficial palmar arch.

Objective To investigate the clinincal curative effects of superficial palmar branch of radial artery (SPBRA) flaps with anastomosed accompanying vein repairing soft tissues defects in fingers.Methods From January,2016 to June,2017,10 cases with soft tissues defects received the operation of superficial palmar branch of radial artery flaps transplantation.In the process of operation,the superficial palmar branch of radial artery (SPBRA) was carefully separated,accompanying vein and superficial vein.The SPBRA was anastomosed with the proper digital artery,while the accompanying vein of superficial palmar branch and superficial vein were anastomosed with the palm vein.The nerve supplied this flap was anastomosed with the proper digital nerve.Mesured the range of motion and two-points discrimination of fingers with following-up.Regular followed-up was performed after operation.Results All patients were followed-up ranged from 6 to 24 months,averaged of 13.8 months.All flaps survived.The shape of flaps was plump and the two-points discriminations ranged from 8 to 12mm.Conclusion Using SPBRA flaps with anastomosed accompanying vein to repair soft tissues defects in fingers,there were minor damage to donor and recipient sites,and the shape and sense of recipient site was perfect.It is a promising treatment choice for patients with soft tissues defects in fingers.

OBJECTIVE We conducted this study to define and measure the dorsal radial tilt, and to guide the reduction of distal radius fractures and the pre-bending of steel plates used in surgery. METHODS The dorsal radial tilt was measured using both computed tomography (CT) and x-ray from both left and right side. The differences and correlations of the data measured by those two methods and from two sides were analyzed. RESULTS The tilts measured by x-ray were significantly bigger than those measured by CT from the left side (t=55.51, p < 0.01) and from the right side (t=49.81, p < 0.01). The tilts measured by those two methods from the left and right sides were correlated (r=0.85, p < 0.01; r=0.81, p < 0.01). The dorsal radial tilts measured from the left side were not significantly different from those measured from the right side by CT (t=1.49, p > 0.05) and by x-ray (t=1.51, p > 0.05). The dorsal radial tilts measured from the left side by CT were significantly different from those measured from the right side by x-ray (t=43.07, p < 0.01), and these two sets of data were correlated (r=0.71, p < 0.01). The dorsal radial tilts measured from the left side by x-ray was significantly different from that measured from right side by CT (t=40.43, p < 0.01), and those two sets of data were also correlated (r=0.75, p < 0.01). CONCLUSIONS The dorsal radial tilts measured from one side by one method can be used to estimate the tilts measured from the other side / the same side by the same method / the other method.

Objective To study the techniques and outcomes of using a retrograde pedicled vascularized radius bone flap based on the 1st,2nd intercompartmental supraretinacular artery (1,2ICSRA) for scaphoid nonunion through dorsal and palmar approaches.Methods Between March 2013 and April 2015,16 patients with scaphoid nonunion were treated by surgery through palmar and dorsal approaches.There were 14 males and 2 females with an average age of 29.1 years (range,19-51 years).The location of lesion was 6 cases on the left and 10 cases on the right.5 cases were treated with plaster fixation.11 cases weren't treated after wrists injured.The preoperative time was 6-26 months,with an average of 16.5 months.The operation was completed within one incision.The bone flaps based on 1,2ICSRA were taken through dorsal approach.The broken ends of the scaphoid fracture were cleaned,and the deformity was corrected with bone grafting and internal fixation through palmar approach.Time of fracture union and wrist pain resolution was evaluated.Wrist motion and grip strength were measured and compared.The result of the latest follow-up was used as the criterion for efficacy evaluation.The wrist pain was evaluated using visual analogue scale (VAS) and the postoperative wrist function based on the modified Mayo wrist score was recorded.Results Post-operative follow up ranged from 6-19 months,with an average of 11 months.Bone union was achieved in all the cases,so the healing rate was 100％.7 cases were healed in 11 weeks.5 cases were healed in 13 weeks.3 cases were healed in 15 weeks.1 case was healed in 17 weeks.The average healing time was 12.5 weeks.The humpback deformity of Scaphoid and DISI of 7 cases were corrected.The bending of wrist could reach 60.2°±3.2°,and the elongation could reach 51.3°± 3.5°.The radial deviation of wrist could reach 13.6°±1.42°,and ulnar deviation could reach 24.4°±1.8°.The range of grip strength was 29-64 kg,with an average of 45 kg.The 16 patients returned to normal work.The pain after wrist movement of 14 cases was completely disappeared,and the VAS was 0.Two cases felt slight pain when wrist was overworked,and the VAS were 0.9 and 1.2.The wrist joint function of patients recovered well.The modified Mayo score was 69-99,with an average of 90.75.The functional results were 12 excellent,2 good,and 2 fair,and the excellent and good rate was 87.5％ (14/16).No complications such as infection,failure of screws,orthopaedic arthritis or scaphoid necrosis were found during the follow-up period.Conclusion The technique of 1,2 ICSRA pedicled bone graft and palmar bone grafting for nonunion of scaphoid can provide convenience for us to deal with the broken ends of the scaphoid fracture,correct the malformation and graft bone through dorsal and palmar approaches.This method can protect the blood supply of the scaphoid,and promote scaphoid union.

Objective To evaluate the efficacy and safety of dorsal ligament reconstruction in treatment of old dorsal dislocation of distal radioulnar joint.Methods Seven patients with old dorsal dislocation of distal radioulnar joint were treated with dorsal ligament reconstruction using the palmaris longus tendon from March 2005 to May 2012 in our institute,including 4 males and 3 females with a mean age of 37 years.All patients had a history of wrist injury for more than 3 months and were diagnosed as isolated dislocation of distal radioulnar joint without fractures.During the operation a bone tunnel was made at dorsal ulnar side of radius near the ulnar notch,which was parallelized to long axial of ulna,two holes were drilled from dorsal to palmarulnaris side through the extensor carpi ulnaris sulcus of the ulna.The palmaris longus tendon was harvested and the strip of the tendon was penetrated through the radial hole.After the tips being crossed,put them through the holes of ulna,reduct the distal radioulnar joint by supinating the forearm,the strip of the tendon was sutured after being tightened,the reversed back the free end of the tendon to reconstruct the sheath of extensor carpi ulnaris tendon.Postoperatively,the upper extremity were kept in a long arm plaster in the position of elbow flexion 90° and forearm supination for 3 weeks,then the below elbow cast was replaced for another 3 weeks.Results Patients were followed-up for 1 year and 8 months 4 years and 2 months with the average of 2 years and 9 months.The rotation of wrist was improved and the handgrip strength was increased significantly.A functional evaluation was performed using the modified Mayo wrist scoring system.All patients had better wrists scores postoperatively (mean,93) compared to preoperatively (mean,68).All patients satisfied with the final result.Conclusion Dorsal ligament reconstruction should be a promise surgical modality for the old dorsal dislocation of distal radioulnar joint.