ObjectiveTo explore the feasibility of transposition of the proximal motor branches from tibial nerve (TN) as direct donors to suture the deep peroneal nerve (DPN) so as to provide a basis for surgical treatment of high fibular nerve injury. MethodsNineteen lower limb specimens were selected from 3 donors who experienced high-level amputation (2 left limbs and 1 right limb) and 8 fresh frozen cadavers (8 left limbs and 8 right limbs). The length and diameter of the three motor branches from TN (soleus, medial gastrocnemius, and lateral gastrocnemius) and the distance from the initial points to the branch point of the common peroneal nerve (CPN), as well as the length and diameter of the noninvasive separated bundles of DPN, then the feasibility of tensionless suturing between the donor nerves and the DPN bundle was evaluated. At last, part of the nerve tissue was cut out for HE and Acetylcholine esterase staining observation and the nerve fiber count. ResultsGross anatomic observation indicated the average distance from the initial points of the three donor nerves to the branch point of the CPN was (71.44±2.76) (medial gastrocnemius), (75.66±3.20) (lateral gastrocnemius), and (67.50±3.22) mm (soleus), respectively. The three donor nerves and the DPN bundles had a mean length of (31.09±2.01), (38.44±2.38), (59.18±2.72), and (66.44±2.85) mm and a mean diameter of (1.72±0.08), (1.88±0.08), (2.10±0.10), and (2.14±0.12) mm, respectively. The histological observation showed the above-mentioned four nerve bundles respectively had motor fiber number of 2 032±58, 2 186±24, 3 102±85, and 3 512±112. Soleus nerve had similar diameter and number of motor fibers to DPN bundles (P>0.05), but the diameter and number of motor fibers of the medial and lateral gastrocnemius were significantly less than those of DPN bundles (P<0.05). ConclusionAll of the three motor branches from TN at popliteal fossa can be used as direct donors to suture the DPN for treating high CPN injuries. The nerve to the soleus muscle should be the first choice.
ObjectiveTo compare the postoperative tibial malrotation between traditional minimally invasive plate osteosynthesis (MIPO) and three-dimensional printing-assisted MIPO (3D-MIPO) for different types of tibial fractures, and explore the change of these differences.MethodsA prospective randomized controlled trial was conducted. The 120 patients with unilateral tibial fracture who met the selection criteria between January 2016 and October 2018 (40 patients in each of AO types A, B, and C) into the trial group (20 patients, 3D-MIPO) and the control group (20 patients, traditional MIPO) at ratio of 1∶1. There was no significant difference between the two groups (P>0.05) in gender, age, fracture site, and other general information. The bilateral tibial rotation angles were measured on the CT images within 1 week after operation, and the difference of tibial rotation angle between affected and unaffected sides was calculated. The tibial malrotation was defined when the difference exceeded 10°. The degree of tibial rotation and the incidence of malrotation between the two groups in different types of tibial fractures were compared. ResultsPostoperative infection occurred in 1 case, and improved after the dressing change and anti-inflammatory treatment. No complications such as loosening and displacement of internal fixation occurred. There was no significant difference in the difference of bilateral tibial rotation angles between the two groups in type A fractures after operation (t=0.559, P=0.580); while in types B and C fractures, the differences of bilateral tibial rotation angles in control group were significantly higher than those in trial group (P<0.05). There was no significant difference in distribution of internal or external rotation between the two groups in types A, B, and C fractures (P>0.05). No malrotation occurred in type A fractures, and there was no significant difference in the incidence of malrotation between the two groups in type B fractures (P=1.000). The incidence of malrotation in control group was significantly higher than that in trial group in type C fractures (P=0.044).Conclusion3D-MIPO has the same anti-malrotation effect as traditional MIPO for type A tibial fracture, but for types B and C tibial fractures, the anti-malrotation effect of 3D-MIPO is significantly better than that of traditional MIPO. The more complex the fracture type is, the more significant this advantage is.
ObjectiveTo compare the predictive value of the two concepts for complications by comparing the incidences of surgical complications associated with different tip-apex distance (TAD) and calcar referenced tip-apex distance (Cal-TAD) in the treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail (APFN) fixation. MethodsA total of 188 cases of femoral intertrochanteric fractures treated with APFN fixation between January 2014 and December 2018 were collected according to inclusion criteria. TAD and Cal-TAD were measured on the X-ray film at immediate after operation; the patients were divided into two groups according to the measurement results: <25 mm and ≥25 mm. Gender, age, and fracture side and AO type were recorded. The patients in each group were reviewed whether there was delayed fracture union or nonunion, whether the screw blade moved axially, whether the femoral neck collapsed or even screw blade cut out, whether the internal fixator became loose or broken within 12 months after operation. Then statistical analysis was performed. ResultsThere were 119 patients with TAD<25 mm and 69 patients with TAD≥25 mm, and 142 patients with Cal-TAD<25 mm and 46 patients with Cal-TAD≥25 mm. There was no significant difference in gender, age, or fracture side and AO type between groups (P>0.05). During the follow-up, 6 patients (5.04%) with TAD<25 mm, 10 patients (14.49%) with TAD≥25 mm had complications, and 1 patient (0.70%) with Cal-TAD<25 mm and 15 patients (32.61%) with Cal-TAD≥25 mm had complications. There were significant differences in the incidence of complication between the patients with different TAD, between the patients with different Cal-TAD, and between patients with TAD<25 mm and Cal-TAD<25 mm (P<0.05). ConclusionIn the operation of femoral intertrochanteric fracture with APFN fixation, surgical complications can be significantly reduced when TAD or Cal-TAD was controlled within 25 mm, Cal-TAD is more significant in the prediction of postoperative complications.