ObjectiveTo review the research progress of the biomechanics of proximal row carpal instability (IPRC). MethodsThe related literature concerning IPRC was extensively reviewed. The biomechanical mechanism of the surrounding soft tissue in maintaining the stability of the proximal row carpal (PRC) was analyzed, and the methods to repair or reconstruct the stability and function of the PRC were summarized from two aspects including basic biomechanics and clinical biomechanics. ResultsThe muscles and ligaments of the PRC are critical to its stability. Most scholars have reached a consensus about biomechanical mechanism of the PRC, but there are still controversial conclusions on the biomechanics mechanism of the surrounding soft tissue to stability of distal radioulnar joint when the triangular fibrocartilage complex are damaged and the biomechanics mechanism of the scapholunate ligament. At present, there is no unified standard about the methods to repair or reconstruct the stability and function of the PRC. So, it is difficult for clinical practice. ConclusionSome strides have been made in the basic biomechanical study on muscle and ligament and clinical biomechanical study on the methods to repair or reconstruct the stability and function of PRC, but it will be needed to further study the morphology of carpal articular surface and the adjacent articular surface, the pressure of distal carpals to proximal carpal and so on.
ObjectiveTo summarize the research progress of heterotopic ossification of the elbow joint after trauma. MethodsThe recent domestic and foreign literature concerning heterotopic ossification of the elbow joint after trauma was analysed and summarized. ResultsThe mechanism of heterotopic ossification of the elbow joint after trauma is mainly related to bone morphogenetic protein signal transduction disorder. Now there are many treatments of heterotopic ossification, including non-surgical treatment, prevention, and surgical treatment. Non-surgical treatment and prevention mainly aim at patients who have no elbow heterotopic ossification or who have mild limited elbow motion because of elbow heterotopic ossification after trauma, including drug therapy, radiation therapy, Chinese medicine therapy, and rehabilitation treatment. For patients with invalid non-surgical treatment, choosing surgical treatment is a must. Surgical treatment includes surgical resection, arthroscopic resection, and joint replacement, priority should be given first to surgical resection. ConclusionHeterotopic ossification of the elbow joint is common and there is not a recognized standard treatment, comprehensive use of non-surgical treatment and surgical treatment is the future direction.
Objective To investigate the effect of anteromedial coronoid facet fracture and lateral collateral ligament complex (LCLC) injury on the posteromedial rotational stability of the elbow joint. Methods The double elbows were obtained from 4 fresh adult male cadaveric specimens. Complete elbow joint (group A,n=8), simple LCLC injury (group B,n=4), simple anteromedial coronoid facet fracture (group C,n=4), and LCLC injury combined with anteromedial coronoid facet fracture (group D,n=8). The torque value was calculated according to the load-displacement curve. Results There was no complete dislocation of the elbow during the experiment. The torque values of groups A, B, C, and D were (10.286±0.166), (5.775±0.124), (6.566±0.139), and (3.004±0.063) N·m respectively, showing significant differences between groups (P<0.05). Conclusion Simple LCLC injury, simple anteromedial coronoid facet fracture, and combined both injury will affect the posteromedial rotational stability of the elbow.
ObjectiveTo explore the feasibility and short-term effectiveness of ankle arthrodesis by ankle osteotomy-tool. MethodsA retrospective analysis was made on the data of 38 patients with end-stage ankle arthritis undergoing ankle arthrodesis between February 2009 and March 2012. There were 24 males and 14 females, with an average age of 67 years (range, 40-85 years). The left ankle was involved in 18 cases and the right ankle in 20 cases. There were 20 cases of post-traumatic arthritis, 7 cases of avascular necrosis of talus, 5 cases of rheumatoid arthritis, 5 cases of primary osteoarthritis, and 1 case of post infective arthritis. The disease duration ranged 3.2-6.1 years (mean, 4.7 years). The ankle osteotomy-tool was used to remove the joint surfaces, and proximal humeral locking plate combined with compression screws were used for internal fixation. ResultsThe operation time was 40-90 minutes (mean, 60 minutes). The healing of incisions by first intention was obtained in the other cases except 1 case of superficial infection, which was cured after dressing change. Thirty-eight patients were followed up 10 to 36 months (mean, 23 months). The ankles in 4 patients started to swell repeatedly when they walked early after operation and the swelling subsided at 1 year after rehabilitation therapy. The X-ray films showed that bone fusion was obtained at 12 weeks after operation on average (range, 10-19 weeks). No internal fixation failure or malunion occurred. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was improved significantly from 43.11±17.49 at preoperation to 85.03±13.17 at last follow-up (t=14.412, P=0.000). The short-form 36 health survey scale (SF-36) showed that physical component summary score was increased significantly from preoperative 54.30±12.32 to postoperative 77.95±8.21 (t=7.723, P=0.000), and mental component summary score was significantly increased from preoperative 63.16±8.30 to postoperative 77.05±10.12 (t=2.523, P=0.021). According to the patients' satisfaction, 32 patients were very satisfied, 5 patients were satisfied, and 1 patient was not satisfied. The subjective satisfaction of patients was 97.37%. ConclusionAnkle arthrodesis by lateral malleolus osteotomy with ankle osteotomy-tool and internal fixation using proximal humeral locking plate and compression screws has the advantages of simple operation, less complications, rigid fixation, and high fusion rate. It may obtain a good short-term effectiveness.
Objective To study the biomechanical differences of the first carpometacarpal joint stability by using different reconstruction methods so as to provide theoretical basis for the clinical choice of reconstruction method. Methods The upper limb specimens were selected from 12 fresh adult cadavers, which had no fracture, bone disease, dislocation of wrist joint, deformity, degeneration, or ligament injury on the anteroposterior and lateral X-ray films. The specimens were randomly divided into 5 groups: normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group. Three normal specimens were used as normal group, and then were made of the first carpometacarpal joint dislocation models (injury group); after the first carpometacarpal joint dislocation was established in the other 9 specimens; the volar ligament, dorsal ligament, and volar-dorsal ligaments were reconstructed with Eaton-Little method, Yin Weitian method, and the above two methods in 3 construction groups. The biomechanical test was done to obtain the load-displacement curve and to calculate the elastic modulus. Results During biomechanical test, ligament rupture and loosening of Kirschner wire occurred in 1 case of injury group and palmar carpometacarpal ligaments reconstruction group; no slipping was observed. The elastic modulus values were (11.61±0.20), (5.39±0.12), (6.33±0.10), (7.12±0.08), and (8.30±0.10) MPa in normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group respectively, showing significant differences among groups (P<0.05). Conclusion Volar ligament reconstruction, dorsal ligament reconstruction, and volar-dorsal ligament reconstruction all can greatly improve the stability of the first carpometacarpal joint. And the effect of volar-dorsal ligament reconstruction is the best, but the stability can not restore to normal.
ObjectiveTo evaluate the long-term effectiveness of lunate excision and vascularized capitate osteotomy transposition for advanced Kienböck's disease. MethodsBetween June 2004 and January 2008,16 patients with Kienböck disease in Lichtman stages ⅢB-IV were treated with lunate excision and vascularized capitate osteotomy transposition.There were 10 males and 6 females at the age of 27-59 years (mean,38.8 years).The disease was caused by trauma in 10 cases,and unknown reason in 6 cases.The main clinical symptoms were pain and limited activity of the wrist joint,and the disease duration was 5-32 months (mean,26.5 months).The carpal height index was 0.88±0.05; the radioscaphoid angle was (63.8±9.1)°.The visual analogue scale (VAS) score,range of motion (ROM),grip strength,Evans score,and radiographic changes were used to assess the effectiveness during follow-up. ResultsAll patients obtained healing of incision by first intention and were followed up 5 years and 4 months to 9 years (mean,5.8 years).VAS score was 2.0±1.5 at the final follow-up.The ROM of the flexion and extension of the wrist joint at the affected side were significantly less than those at the normal side (P<0.05).However,no significant difference was found in the grip strength and Evans score between the affected side and normal side (t=-0.997,P=0.327; t=-1.852,P=0.077).Postoperative radiographs showed that the carpal height index was 0.94±0.03,and the radioscaphoid angle was (48.4±4.8)°,which were improved significantly when compared with preoperative ones (t=-3.927,P=0.000; t=5.987,P=0.000).Osteophyte at the dorsal side of the radius and scaphoid rotation occurred in 6 cases and 2 cases,respectively. ConclusionLunate excision and vascularized capitate osteotomy transposition is a reliable method for advanced Kienböck's disease,with favorable improvement in wrist pain and grip strength for long-term follow-up.
ObjectiveTo investigate the effectiveness of limited internal fixation combined with hinged super-articular external fixator to treat type C3 fracture of the distal humerus. MethodsBetween September 2007 and November 2012, 37 cases of type C3 fracture of the distal humerus were treated. There were 22 males and 15 females with an average age of 43.6 years (range, 22-66 years). The causes were accident injury in 24 cases, falling injury in 5 cases, falling from height in 4 cases, heavy crush injury in 2 cases, machine injury in 1 case, and other injury in 1 case. There were 22 cases of open injury and 15 cases of closed injury. The time from injury to operation was 3-46 hours (mean, 18 hours). ResultsNeedle tract reaction and incision infection occurred in 3 cases and 1 case respectively, healing of incision by first intension was obtained in the other cases. Thirty-six patients were followed up 9-48 months (mean, 25.4 months). Heterotopic ossification occurred in 3 cases after operation and no recurrence was found by release after fracture healing. Fractures healed in the other patients after 6-14 months (mean, 9 months) of operation except 1 patient who suffered chronic osteomyelitis. One patient had delayed ulnar neuritis at 12 months after operation, and the nerve function returned to normal after the ulnar nerve transposition. There was no bone ischemic necrosis, elbow joint instability, or loosening of internal fixation. At last follow-up, the average range of motion of injured elbow was 105.0° in flexion,-25.0° in extension, 69.2° in pronation, and 75.6° in supination. According to Mayo elbow joint function score (MEPS) and disability of arm shoulder and hand (DASH) score, the results were excellent in 22 cases, good in 8 cases, fair in 4 cases, and poor in 2 cases with an excellent and good rate of 83.3%; and according to Cassebaum elbow joint function score, the results were excellent in 21 cases, good in 7 cases, fair in 5 cases, and poor in 3 cases with an excellent and good rate of 77.8%. ConclusionA combination of limited internal fixation and hinged super-articular external fixator has satisfactory clinical curative effect for type C3 fractures of the distal humerus, relatively few complications.
ObjectiveTo summarize the characteristics, diagnosis, and treatment of acral glomus tumor in order to improve the level of diagnosis and treatment. MethodsThe clinical data from 70 cases of acral glomus tumor treated between June 2004 and October 2013 were analyzed retrospectively. There were 11 males and 59 females with an average age of 41 years (range, 18-67 years). The disease duration ranged from 4 months to 30 years, with a median duration of 5 years. Sixty-nine cases had solitary tumors and only 1 patient had more than 1 lesion. The tumors were located on the finger in 66 patients (67 fingers) and the toe in 4 patients (4 toes); among them, the subungual glomus tumor happened in 44 patients (44 fingers and 1 toe). All patients suffered from paroxysmal pain and pinpoint pain with positive Love's pin test, and 29 patients (28 fingers and 1 toe) had positive cold sensitivity. Fifty-two patients (48 fingers and 4 toes) were found to have glomus tumor according to the high-frequency color doppler ultrasonography. X-ray films revealed depression on the phalanx in 16 patients (14 fingers and 2 toes). ResultsNo patient suffered from delayed incision healing, and infection after surgical treatment. The follow-up time was from 1 month to 9 years and 2 months with a median follow-up time of 20 months. The clinical symptoms disappeared after surgery with no dysfunction or recurrence. ConclusionThe diagnosis of acral glomus tumor is easy because of the typical symptoms:paroxysmal pain, pinpoint pain, and cold sensitivity. High-frequency color doppler ultrasonography may play an important role in the preoperative assessment of glomus tumors with accurate localization.
ObjectiveTo investigate the application of lateral malleolus hook-plate for the treatment of stageⅡsupination-adduction type medial malleolus fractures. MethodsBetween January 2011 and June 2013, 21 patients with stageⅡsupination-adduction type ankle fractures were treated with lateral malleolus hook-plate, including 12 males and 9 females with an average age of 55.5 years (range, 27-65 years). The injury causes were sprain in 17 cases and traffic accident in 4 cases. The mean time between injury and admission was 12.4 hours (range, 2-72 hours). The tibial distal medial articular surface collapse was found in 7 cases by CT examination and in 3 cases by X-ray film. Of 21 cases, there were 12 cases of low transverse fractures of lateral malleolus, 7 cases of short oblique fractures of lateral malleolus, and 2 cases of ankle joint lateral collateral ligament injury without fractures of lateral malleolus. After operation, the clinical outcome was evaluated according to the talus-leg angle, the recovery of Coin-sign continuity, inside-outside and top ankle gap, talus slope, American Orthopedic Foot and Ankle Society (AOFAS) score, Olerud-Molander score, Kofoed evaluation standards, and patient satisfaction. ResultsSeventeen cases were followed up 18.7 months on average (range, 12-25 months). Primary healing was obtained in 16 cases except 1 case of delayed healing. Fracture healed at an average of 14.6 weeks (range, 12-16 weeks). All cases achieved anatomical reduction, the continuity of Coin-sign, and consistency of inside and outside joint gap; no talus tilt occurred. There was no complication of reduction loss, loosening or breakage of internal fixation, or osteoarthritis during follow-up. The talus-leg angle of the affected side was significantly improved to (83.4±1.8)° at 1 week after operation from preoperative (74.8±7.1)° (t=5.370, P=0.000), but no significant difference was found when compared with normal side (83.8±2.3)° (t=0.676, P=0.509). The AOFAS score, Olerud-Molander score, and range of motion at 1 week, 3 months, and 1 year after operation were significantly improved when compared with preoperative ones (P < 0.05). According to Kofoed evaluation standard, the outcome was excellent in 15 cases and good in 2 cases; the excellent and good rate was 100%. According to patient satisfaction, the outcome was excellent in 13 cases, good in 3 cases, and poor in 1 case; the excellent and good rate was 94.1%. ConclusionThe use of lateral malleolus hook-plate for fixation of stageⅡsupination-adduction type medial malleolus fracture not only can effectively maintain anatomical reduction and supporting function, but also can prevent re-collapsing of the reset joint surface. The surgical method can not increase soft tissue complication, so it is a safe and effective method.
ObjectiveTo analyze the methods of offside reconstruction in total hip arthroplasty (THA) for severe osteoarthritis. MethodsBetween July 2009 and June 2011,18 cases (18 hips) of severe osteoarthritis of the hip were treated by THA,including 14 males and 4 females with a mean age of 55.4 years (range,47-72 years).The disease duration was 11-74 months (mean,33.6 months).The left hip was involved in 11 cases and the right hip in 7 cases.The hip Harris score was 34.6±5.3.The lower limb discrepency was observed in 15 cases.Thomas sign,Patrick sign,and Trendelenburg sign were positive in all cases.All patients received THA; during operation,standard femoral neck osteotomy was performed and the correct rotation center was chosen to reconstruct offside. ResultsAll the incisions healed primarily.Common peroneal nerve injury occurred in 1 case and was cured after symptomatic treatment for 3 months,and the other patients had no complication.The mean follow-up period was 43.5 months (range,30-53 months).All patients achieved pain relief,and returned to normal gait.The X-ray films showed no dislocation of the hip or prosthetic loosening.Lower limb discrepency was observed in 6 cases.The mean offside difference between normal and ipsilateral side was 0.4 mm (range,0.1-0.7 mm).At last follow-up,the hip Harris score was 83.0±7.1,showing significant difference when compared with preoperative score (t=-22.96,P=0.01); the hip range of motion was significantly increased when compared with preoperative one (P<0.05). ConclusionThe offside reconstruction can accurately be carried out by making precise template and vernier caliper measurement,selecting suitable prosthesis preoperatively,maintaining the proper femoral calcar length,adjusting the length of the neck and neck-shaft angle,releasing the soft tissue reasonably during THA for severe osteoarthritis,and the short-term effectiveness is satisfactory.