Osteoarthritis (OA) is a chronic musculoskeletal disorder, characterized by the chronic and progressive degenerative illness of articular cartilage that leads to tenacious joint pain and inflammation as well as functional disability, impairing the life quality in elderly people. Unfortunately, there is no regenerative therapy for treating osteoarthritis. Curcumin (diferuloylmethane), a hydrophobic polyphenol compound isolated from curcuma longa rhizome, has been broadly employed as a safe supplement traditionally. Despite great beneficial impacts, achieving the desired pharmacological effects of curcumin has shown limitations because of its low systemic bioavailability. It has been found that biological activities and bioavailability of curcumin could be efficiently enhanced using nanoscale drug carriers. The current literature review aimed to discuss nanoscale delivery systems that have been constructed to improve the bioavailability and therapeutic efficacy of curcumin for treating osteoarthritis. In brief, various delivery systems composed of polymer, metal, or emulsion nanocarriers have been manufactured to improve the bioavailability and therapeutic efficacy of curcumin in the treatment of osteoarthritis. Intra-articular injection of curcumin nanoparticles could induce chondrogenesis, inhibit degradation of articular cartilage, and reverse abnormalities in joint structure and smooth surface of articular cartilage in knee osteoarthritis, thus preventing osteoarthritis development, mechanistically, through anti-inflammatory and anti-oxidative activities of curcumin. In conclusion, nano-formulations of curcumin have been found to enhance the therapeutic efficacy of curcumin for treating osteoarthritis and introduce a promising therapeutic alternative to current therapies, however, future clinical investigations are warranted to approve their application in humans.

BACKGROUND:It has been reported that Sirtuin 2 (SIRT2) prevents phosphoenolpyruvate carboxykinase 1 (PCK1) degradation, which can be involved in aging-induced osteoarthritis (OA), but the molecular mechanism of SIRT2/PCK1 in chondrocytes has not been clarified. Therefore, this study aims to explore the mechanism of SIRT2/PCK1 in chondrocyte inflammation. METHOD:To establish the OA model in vitro, chondrocytes cultured with interleukin-1β (IL-1β, 10 ng/mL) and manipulation of SIRT2 and PCK1 expression in the constructed cells to elucidate the interaction between the two genes. 1,9-Dimethyl-Methylene Blue (DMMB) was used to detect cellular glycosaminoglycan (GAG) content. Inflammatory factor levels were assessed using Enzyme-linked Immunosorbent Assay (ELISA). Apoptosis was detected by osmotic dye. The expression of B-cell lymphoma-2 (Bcl-2), Bcl-2 Associated X (Bax), Wnt Family Member 1 (Wnt1), catenin Beta 1 (β-catenin), Aggrecan, Collagen II, matrix metallopeptidase 13 (MMP-13) proteins in cells were analyzed using Western blot. RESULTS:PCK1 gained lower expressions in OA cell models. Overexpression of PCK1 or SIRT2 in the IL-1β chondrocyte model of inflammation promoted GAG content, inhibited apoptosis and Wnt/β-catenin protein expression, and lowered the levels of inflammatory factors. PCK1 silencing was proved to have the opposite effect. SIRT2 overexpression rescued the increased inflammation, MMP-13 expression, and apoptosis and the decreased Aggrecan and Collagen II expression caused by PCK1 silencing. PCK1 silencing also reversed the positive effects of SIRT2 overexpression on chondrocytes. CONCLUSION:SIRT2 inhibits articular chondrocyte extracellular matrix (ECM) degradation, inflammatory factor expression, and apoptosis via PCK1.

Olecranon osteotomy and paratricipital approaches were widely used in the treatment of type C distal humerus fracture but some disadvantages exist, so a combined medial and lateral approach was designed. The objective of this study was to investigate and compare the clinical outcomes of combined medial and lateral approach with the paratricipital approach in open reduction and internal fixation of type C distal humerus fractures.From May 2018 to April 2020, 37 patients with type C distal humerus fracture who accepted open reduction and internal fixation in our hospital were enrolled in this study. All cases were randomly divided into two groups according to the surgical approach: combined medial and lateral approach group (19 cases), paratricipital approach group (18 cases). All of the patients received open reduction and double vertical plates fixation. The operation and follow-up indexes, including operation time, blood loss, incision length, triceps muscle strength, flexion-extension arc of elbow and forearm rotation arc, were recorded and compared. Caja score was used to assess the quality of fractures reduction. Mayo Elbow Performance Score (MEPS) was used to evaluate the elbow function in the follow-up. Complications such as incision infection, ulnar nerve injury, degenerative osteoarthritis, and heterotopic ossification were analyzed.The differences in age, gender, and AO classification of fractures between two groups were not statistically significant (p > 0.05). The sum of medial and lateral incision length of combined approach group was longer than the midline incision of paratricipital approach group (15.4 ± 0.8 vs. 14.6 ± 0.8, p < 0.05), but there was no significant difference in operation time (103.5 ± 10.2 vs. 106.0 ± 8.8, p > 0.05), blood loss (71.3 ± 24.5 vs. 72.8 ± 24.6, p > 0.05), and Caja score (16.05 ± 5.67 vs. 15.56 ± 5.66, p > 0.05). During the follow-up, the MEPS of combined approach group was higher than that of paratricipital approach group at 3 months postoperatively (80.5 ± 5.7 vs. 68.9 ± 8.1, p < 0.05), but there was no significant difference in MEPS at 6 months postoperatively (83.9 ± 6.6 vs. 79.7 ± 7.0, p > 0.05) and at the last follow-up (86.8 ± 7.1 vs. 86.9 ± 7.7, p > 0.05) between the two groups. There was no significant difference in triceps muscle strength (p > 0.05), flexion-extension arc (126.8 ± 5.3 vs. 128.9 ± 6.0, p > 0.05), and forearm rotation arc (163.2 ± 5.3 vs. 163.6 ± 4.8, p > 0.05) at the last follow-up. Although the incidence of complication of combined approach group (15.8%) was lower than that of paratricipital approach group (22.2%), the difference was not statistically significant (p > 0.05).The combined medial and lateral approach was an effective and safe way of open reduction and internal fixation for type C distal humerus fractures. Compared with the paratricipital approach, the combined medial and lateral approach could restore the elbow function more quickly postoperatively, and the long-term results were comparable.

背景:近年来,微型双固定螺钉临床应用于治疗末节指骨基底部撕脱性骨折取得一定疗效,但与传统双枚克氏治疗比较,哪种治疗方法的疗效更优,鲜见相关研究报道.目的:对比分析双枚克氏针与双固定螺钉治疗末节指骨基底部撕脱性骨折的临床疗效.方法:回顾性分析2012年1月至2020年1月到成都市双流区第一人民医院(四川大学华西空港医院)就诊,行手术治疗的末节指骨基底部撕脱性骨折患者共71例,其中双枚克氏针治疗组36例,双固定螺钉治疗组35例.记录患指的伸屈活动度、疼痛度、满意度及并发症等,采用Crawford评估患者的总体疗效,采用Buck-Gramcko评估患者治疗后主观疗效.结果 与结论:①双枚克氏针组获随访6-15个月,平均(8.89±1.75)个月;双固定螺钉组获随访6-16个月,平均(8.77±1.70)个月;②两组目测类比评分比较差异无显著性意义(P>0.05);③依据Crawford疗效评估,双枚克氏针组优良率为34/36(94％),双固定螺钉组优良率为30/35(86％),差异无显著性意义(P>0.05);③Buck-Gramcko评估主观疗效,双枚克氏针组优良率为33/36(92％),双固定螺钉组优良率为31/35(89％),差异无显著性意义(P>0.05);④双固定螺钉组术后指甲畸形发生率、锤指畸形复发发生率、切口感染发生率大于双枚克氏针组,但差异无显著性意义(P>0.05);双固定螺钉组线结外露发生率明显高于双枚克氏针组(P=0.025);双枚克氏针组术后并发症的总发生率小于双固定螺钉组(P=0.029);⑤结果表明,采用双枚克氏针与微型双固定螺钉治疗末节指骨基底部撕脱性骨折疗效相当,但微型双固定螺钉治疗存在较高并发症发生率,尤其是线结外露比例偏高.

Objective To investigate the factors, surgical treatment methods and clinical effect of internal fixation failure of intertrochanteric and subtrochanteric fractures. Methods From June 2015 to May 2019, arthroplasty and internal fixation revision were used to treat 18 cases of internal fixation failure of intertrochanteric and subtrochanteric fractures. There were 10 males and eight females, with an average age of 67.3 years (38–92 years). The 16 cases of initial intertrochanteric fractures were classified according to AO/OTA:13 cases of A2 and 3 cases of A3, the other 2 cases were subtrochanteric fractures (Seinsheimer type IV). The internal fixation failure was treated with total hip arthroplasty (6 cases), bipolar hemiarthroplasty (4 cases), revision with proximal femoral lockingplate (4 cases) and extend intramedullary nail (4 cases). Results All patients were followed up for an average of 24.7 months (range, 12 to 36 months). The average operative time was 111.4 min (range, 72 to 146 min) and the average intraoperative blood loss was 403.6 mL (range, 200 to 650 mL). The average time of fracture union was 6.9 months (range, 5 to 9 months) for cases of internal fixation revision. The operative time of the arthroplasty group was shorter than the revision group (P < 0.001), and the intraoperative blood loss of the arthroplasty group was less than the revision group (P = 0.001). The affected limb shortening of postoperative (0.21 ± 0.19 cm) was better than preoperative (2.01 ± 0.60 cm) (P < 0.001), while the limb shortening of the arthroplasty group (0.11 ± 0.21 cm) was less than the revision group (0.33 ± 0.09 cm) (P = 0.015). At the last follow‐up, all injured limbs regained walking function, and the Harris hip score was 81.3 ± 9.4 points. The Harris score of postoperative was better than preoperative (33.4 ± 5.9 points) (P < 0.001), while there were no significant differences between the arthroplasty group and the revision group at 3 months (76.5 ± 8.5 vs 71.1 ± 10.6, P = 0.249), 6 months (80.9 ± 7.9 vs 78.9 ± 12.9,P = 0.687) postoperative and the last follow‐up (80.5 ± 8.3 vs 82.3 ± 11.7, P = 0.716) respectively. Conclusion For internal fixation failure of peritrochanteric fractures, young patients could accept internal fixation revision to restore normal anatomical structure, correct varus deformity and autograft; while elderly patients and patients with damaged femoral head could be treated with arthroplasty to restore walking function.

OBJECTIVE:To investigate the occurrence, treatment, and effectiveness of peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures.METHODS:The clinical data of 16 patients with peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures who met the inclusion criteria between April 2014 and November 2019 were retrospectively analyzed. There were 7 males and 9 females with an average age of 78.4 years (range, 65-93 years). The 14 cases of initial intertrochanteric fractures were classified according to the classification of AO/Orthopaedic Trauma Association (AO/OTA): 5 cases of type A1, 7 cases of type A2, and 2 cases of type A3; the other 2 cases were intertrochanteric combined with subtrochanteric fractures (Seinsheimer type Ⅴ). According to the classification of peri-implant refracture which was proposed by Chan et al., there were 10 cases of type 1 (6 cases of type 1A, 3 cases of type 1B, 1 case of type 1C) and 6 cases of type 2 (4 cases of type 2A and 2 cases of type 2B). The average interval between refracture and initial surgery was 14.6 months (range, 1-52 months). The incidence of peri-implant refracture in short nail group (the length of intramedullary nail used in initial surgery≤240 mm) was 1.92% (11/573), while the incidence of long nail group (the length of intramedullary nail used in initial surgery≥340 mm) was 1.66% (5/301), showing no significant difference between the two groups ( χ 2=0.073, P=0.786). The peri-implant refractures were revised with extended intramedullary nail (5 cases) or fixed with additional limited invasive stabilization system (11 cases).RESULTS:The average operation time was 115.8 minutes (range, 78-168 minutes) and the average intraoperative blood loss was 283.1 mL (range, 120-500 mL). One patient died of myocardial infarction at 3 months after operation, and the other 15 patients were followed up 9-46 months (mean, 16.8 months). The peri-implant refractures healed at 14-20 weeks (mean, 16.4 weeks) after operation. There was no complications such as incision infection, nonunion, internal fixator loosening and rupture, screw cutting-out, and the second refracture during the follow-up. At last follow-up, all injured limbs regained walking function, and the Hospital for Special Surgery (HSS) score was 56-92 (mean, 80.2). The results were classified as excellent in 2 cases, good in 10, fair in 2, and poor in 1, with the excellent and good rate of 80%.CONCLUSION:Stress concentration at the tip of initial intramedullary nail and distal interlocking screw aera is the main cause of peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures. Revision with extended intramedullary nail or fixation with limited invasive stabilization system according to the length of initial intramedullary nail and the type of refracture can get satisfactory effectiveness.

Objective To investigate the surgical approach, fixation, and clinical effect of comminuted coronal shear fracture of distal humerus. Methods From March 2017 to February 2019, we had used open reduction and internal fixation to treat 19 cases of comminuted distal humeral coronal shear fracture. There were 8 males and 11 females, with an average age of 44.6 years (19–72 years). There were 10 cases on left side and 9 cases on right side. All cases were closed fractures. According to Dubberley's classification, there were six cases of type 1, six cases of type 2, and seven cases of type 3. The lateral Kocher approach, extended Kocher approach, extended Kocher approach combined with a medial incision and the olecranon osteotomy approach were used for exposure. Headless screw, Kirschner wire, and suture were used to fix the fractures. Two cases were fixed with hinged elbow fixators additionally. The follow‐up was evaluated by Mayo Elbow Performance Score (MEPS). Results All patients were followed up for an average of 17.1 months (range, 12 to 30 months). The average time of fracture union was 8.8 ± 1.9 weeks. There were three cases of degenerative osteoarthritis of elbow and one case of heterotopic ossification after operation. A total of 10 patients underwent removal of implants. At the last follow‐up, the elbow flexion‐extension arc was 130.5° ± 10.5°. The forearm rotation arc was 167.4° ± 6.1°. The MEPS was 85.8 ± 8.5, the results were classified as excellent in nine cases, good in eight, and fair in two. The excellent and good rate was 89.5%. The time of fracture union of type 1 was shorter than type 3 ( P = 0.024), the elbow flexion‐ extension arc of type 1 fracture was better than type 2 ( P = 0.043) and type 3 ( P = 0.012), the forearm rotation arc of type 1 fracture was better than type 3 ( P = 0.006), the MEPS of type 1 fracture was better than type 2 ( P = 0.009) and type 3 ( P = 0.002). Conclusion Open reduction and internal fixation with headless screw, Kirschner wire, and suture can be used for the treatment of comminuted distal humeral coronal shear fractures. The elbow joint function can be restored satisfactorily.

病例介绍患者,男,39岁,因“车祸伤致右髋部疼痛伴功能障碍2h”于2018年10月23日急诊入院.入院时体格检查(查体):体温36.6℃,脉搏90次/min,血压130/74 mm Hg(1 mm Hg=0.133 kPa);神志清楚,精神差,急性痛苦病容,头部及胸腹部未见明显异常.专科查体:右髋部肿胀,可见大片瘀斑,右下肢外旋畸形;右髋关节压痛,轴向叩击痛阳性,可扪及骨擦感,右髋关节屈伸活动受限,右下肢长度短缩2 cm,右下肢肢端感觉及血供正常;余肢体检查未见明显异常.患者完善骨盆及右髋关节X线片及三维CT,提示右侧股骨颈头下骨折,GardenⅢ型,Pauwels角80°,合并同侧股骨转子间逆转子骨折.诊断:右侧股骨颈头下骨折(PauwelsⅢ型);右侧股骨转子间骨折(AO A3型).

Objective To investigate the clinical efficacy between suture button plate and cortical screw in the treatment of distal tibiofibular syndesmosis seperation.Methods The clinical data and follow-up data 1 week and 2,4,6 weeks and 3,6,12 months after operation of patients with distal tibiofibular syndesmosis seperation combined with or without ankle fracture who were admitted to hospital from March 2011 to May 2014 were retrospectively collected.According to the fixation ways of distal tibiofibular syndesmosis,the patients were divided into the suture button plate group and the cortical screw group.The operation time,amount of blood loss,combined ankle fracture healing time,American Orthopaedic Foot and Ankle Society (AOFAS) scores at the last follow-up and complications were compared between the two groups.Results A total of 52 patients were enrolled,including 28 cases of suture button plate group and 24 cases of cortical screw group.There were no significant difference in operation time or amount of blood loss between the two groups (P＞0.05).All patients were followed up for 12-30 months averaged 14.5 months.All incisions healed by the first intention.The combined ankle fracture healing time in the suture button plate group was (11.2±2.0) weeks,while that was (11.0±2.1) weeks in the cortical screw group,with no significant difference between the two groups (P＞0.05).In the suture button plate group,there was no loosening or rupture of internal fixation,while distal tibiofibular syndesmosis seperation was found again in one case 3 weeks after operation,and cured by reoperation at last.In the cortical screw group,rupture of screws was found in 2 cases,which occurred 9 and 11 weeks after operation respectively,and the broken screws were taken out when the fractures were healed and the internal fixation was removed;distal fibiofibular syndesmosis seperation was found again in one case 6 weeks after operation,and no treatment was given due to old age and low demand.At the last follow-up,the AOFAS score in the suture button plate group was 84.6±10.2,while the score in the cortical screw group was 83.7± 12.5,with no significant difference between the two groups (P＞0.05).Conclusions Suture button plate and cortical screw can effectively treat distal fibiofibular syndesmosis separation.The risk of suture button plate loosening or rupture is poor.Suture button plate fixation can meet the need of early functional exercises,and avoid the routine removal by reoperation.

目的:探讨使用经皮椎弓根螺钉技术治疗单节段不稳定胸腰椎骨折的临床疗效.方法:2011-11～2013-07采用经皮椎弓根螺钉技术治疗无神经症状的单节段不稳定胸腰椎骨折24例,男14例,女10例;年龄21～56岁,平均42.3岁.致伤原因:车祸伤8例,高坠伤12例,重物砸伤4例.损伤部位:Tu2例,T127例,L1 10例,L24例,L31例.骨折按照AO分型,AO A1型16例,AO A3型8例;其中17例伤椎椎体高度丢失1/3～1/2,7例伤椎高度丢失＞1/2;A3型患者伤椎椎管内占位＜1/4且均不合并神经症状.患者受伤至手术时间为3～12 d,平均(5.4±2.5)d.结果:24例患者均获得随访,随访时间为10～24个月,平均14.6个月.手术平均时间(56.8±12.0)min;术中平均失血量(62.8±10.7)ml,X线透视平均(11.6±2.6)次,患者首次下床时间为术后(7.2±1.6)d.末次随访时,所有患者伤椎前缘高度百分比、伤椎后凸Cobb角及矢状位指数均较术前有明显改善,差异有统计学意义(P＜0.01).结论:经皮椎弓根螺钉技术治疗无神经症状的单节段不稳定胸腰椎骨折,可明显恢复伤椎椎体高度及纠正后凸畸形,维持脊柱序列的稳定,创伤小康复快,可达到满意的临床疗效.

Objective: To compare the clinical efficacy of percutaneous minimally invasive surgery and traditional open surgery on the treatment of thoracolumbar fractures. Methods: Among 38 cases of fresh thoracolumbar fractures from September 2011 to September 2013, 18 cases underwent percutaneous minimally invasive surgery, and 20 cases traditional open surgery. The perioperative parameters, radiographic index, postoperative half-year back pain score (VAS) , and functional disability index back (ODI) were all compared. Results: The perioperative parameters, postoperative pain score (VAS), and low back disability function index (ODI) in the percutaneous minimally invasive group were significantly lower than that of the open surgery group(P< 0.05). There were significant differences between the radiographic indicators pre and post operative such as anterior vertebral height, kyphosis Cobb's angle, inervertebral height, and spinal blockage index contrast (P <0.05), but the postoperative radiographic index and the time of fracture healing had no significant differences(P>0.05). Conclusion: Percutaneous minimally invasive surgery can achieve the effect of the traditional open operation with shorter operative time, less trauma, less damage to the paraspinal muscles, faster recovery and milder postoperative pain. Therefore, it is well worth applicating in the treatment of thoracolumbar fractures.

<正>神经纤维瘤病(Neurofibromatosis,NF)又称为Von Recklinghauson病,由德国医生Von Reckling-hauson首先提出并详细阐述的一种常染色体显性遗传病,由外胚层及中胚层发育障碍所致,主要表现为神经嵴细胞的异常增生[1],可分为NF1和NF2型[2]两种。我们收治1例I型神经纤维瘤病合并右前臂右手巨肢畸形,现报告如下。

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 < 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 make comparison of curative effects among three surgical methods on thoracolumbar unstable fracture.Methods Eighty six patients with thoracolumbar unstable fracture received posterior approach and were randomly divided into three groups.Group A received(traditional internal fixation)bone grafting via internal vertebral plates fixed by pedicle screws in the upper and lower vertebrae near the fracture region or via processus transversus;group B received internal fixation by pedicle short screw in the injured vertebrae based on the same treatment that was received by group A;group C received bone grafting via the vertebral arch pedicle of the injured vertebrae based on the same fixation that was received by group A.Results There was no significant difference in length of incision,operation time and blood loss during operation among the three groups(P>0.05).One year after the operation or after the removal of the implants,comparison was made in the ratio of centrum anteroposterior margin and Cobb angle.Those indexes of group B and C were superior to those of group A,and those of group C were superior to those of group B(P<0.05).As the comparison in failure rate of internal fixation,group B and C were better than group A(P<0.01).Conclusion After the removal of the implants,the treatment of thoracolumbar unstable fracture by bone crafting via the vertebral arch pedicle of the injured vertebrae can effectively maintain the height of centrum,rectify the kyphosis angle,prevent vertebral collapse and reduce complications such as failure of internal fixation and centrum recompression,etc.

UNLABELLED 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 and 4 females with an average age of 45.3 years (range, 21-75 years). Five fractures were caused by traffic accident, 2 by falling from height, 2 by tumbling, 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 oblique 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 healing 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 are of the elbow averaged 92.8 degrees (range, 23-130 degrees), and the arc of forearm rotation averaged 124.4 degrees (range, 42-175 degrees). 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 complications.

Objective To evaluate the long-term efficacy of vascularized pisiform transfer for patients with Kienb(o)ck's disease in Lichtman stages Ⅲ-Ⅳ. Methods Eleven patients were reviewed to analyze results after lunate resection and vascularized pisiform transfer for Lichtman stages Ⅲ and Ⅳ. There were six men and five women. Age ranged from 20 to 67 years with a average of 41.0±14.3 years. According to Lichtman stage. There were 4 cases in stage Ⅲa, 5 cases in stage Ⅲb, and 2 cases in stage Ⅳ. Assessment criteria included subjective assessment of pain, visual analogue scale (VAS), range of motion (ROM), grip power,Cooney wrist score and radiographic changes on each follow-up visit. The radiographic changes including pis iform bone location, shape, sclerosis change, osteoarthritis, carpal height ratio, Nattrass index, Radioscaphoid angle and ulnar variance were recorded. Results The follow-up periods of all of cases were 61-202 months,with an average of 104.1 months. Pain had improved in 10 patients and disappeared in 7 cases. The VAS score was 2.2±1.9 at follow-up visit. Range of motion of injured wristw as only 65.3% of opposite side. Grip power was 84.3% of the contralateral hand. According to Cooney score, the results were excellent in 1 case, good in 7cases, fair in 2 cases and poor in 1 case, with the excellent and good rate of 72.7%. Radiologically, 8 cases had normal position of the pisiform bone, 2 had volar displacement and 1 had ulnar displacement which leaded to widen scaphopisiform space. Six pisiform bones had normal trabecular structure, three had degenerative changes. Bone sclerosis was seen in 2 cases and osteoarthritis was found in 3 patients. Compared with radiographic parameter before surgery, carpal height ratio and Nattrass index significantly lowered and radioscaphoid angle significantly increased. Conclusion Lunate resection and vascularized pisiform transfer is an effective method for Kienb(o)k′s disease in stages Ⅲ-Ⅳ. Although carpal collapse appeared postoperatively,the results show high patient satisfaction and good function after vascularized bone transplantation.