Objective To compare the therapeutic effect of cannulated screws fixation at different time points through different reduction methods on the heal ing of displaced femoral neck fractures. Methods From January 1997 to September 2007, 240 patients with displaced femoral neck fracture were treated, including 121 males and 119 females aged 22-79 years old (average 56 years old). All cases were fresh and close fractures. According to the fractured part, there were 133cases of subcapital fracture, 64 of transcervical fracture and 43 of basal fracture. According to Garden classification, there were 105 cases of type III and 135 of type IV. Cannulated screws fixation was performed on all the patients, and the time from injury to operation was 6 hours to 7 days. Fifty-five cases received closed reduction and 59 cases received l imited open reduction as emergency treatment, while 65 cases received closed reduction and 61 cases received l imited open reduction as selective operation. Different groups were compared in terms of the heal ing rate of fracture, the excellent and good rate of reduction as well as the excellent and good rate of fixation. Results There was no significant difference between the closed reduction and the l imited open reduction in terms of operation time and bleeding volume (P gt; 0.05). Postoperatively, all wounds healed by first intention, no infection was observed, avascular necrosis of femoral head occurred in 44 cases, and the rate of avascular necrosis of femoral head in the l imited open reduction at emergency group was less than that of other 3 groups (P lt; 0.01). All the patients were followed up for 12-72 months (average 38 months), 193 cases got fracture heal ing at 10-23 months after operation (average 14 months). For the closed reduction as emergency operation group, the l imited open reduction as emergency operation group, the closed reduction as selective operation group, and the l imited open reduction as selective operation group, the heal ing rate of fracture was 74.55%, 91.53%, 69.23% and 86.89%, respectively; the excellent and good rate of reduction was 73.73%, 94.92%,70.77% and 91.80%, respectively; the excellent and good rate of fixation was 76.36%, 93.22%, 73.85% and 88.52%, respectively. The heal ing rate of fracture, the excellent and good rate of reduction as well as the excellent and good rate of fixation in the l imited open groups were higher than that of the closed reduction groups (Plt; 0.01), and there was no significant difference between the emergency operation groups and the selective operational groups (Pgt; 0.05). Conclusion The reduction methods have significant influences on the heal ing of fractures after cannulated screws fixation of the displaced femoral neck fracture, and the operation time has no obvious effect on fracture heal ing.
To summarize the results of the free transplantation of anti-valve-inflow and pro-valveoutflow arterial ized venous flap in repairing soft tissue defect of fingers in emergency treatment. Methods From October 2002 to March 2007, 7 cases of soft tissue defects of fingers were repaired with arterial ized venous flaps. There were 6 males and 1 female, aged 17-46 years. Defect was caused by crush injury in 6 cases and by stab injury in 1 case. The interval between injuryand operation was 2-7 hours and the size of defects ranged from 3.0 cm × 2.0 cm to 6.0 cm × 3.5 cm. All defects were repaired by arterial ized free venous flap from the ipsilateral forearm, in which the proximal ends of veins were anastomosed to artery and vein of the finger. The donor site was directly sutured. Results Six cases of arterial ized venous flap survived completely and 1 case had partial superficial necrosis and healed with conservative management. The donor site healed by first intention. Postoperative follow-up ranged from 3 months to 4 years, the texture and the thickness of the flaps were satisfactory, only one presented partial pigment deposits because of superficial necrosis. No sclerosis, contracture and l imited range of motion occurred in all flaps. According to the evaluation criteria for upper l imb function issued by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 3 cases and good in 4 cases. Conclusion It is an ideal method to repair soft tissue defect of fingers by using anti-valve-inflow and pro-valve-outflow arterial ized venous flap.
Objective To compare the anesthetic effects of traditional digital block with single-injection digital block in digital injury patients for subcutaneous digital blocks. Methods Patients with one or two digits injured were randomized to the traditional digital block group and single-injection digital block group. All of the blocks were conducted by one investigator. The patients and outcome assessor were blinded to the treatment allocation. Both of the per-protocol-population (PP) analysis and the intention-to-treatment (ITT) analysis were performed to compare the two block techniques in terms of the pain during infiltration, the onset time of anesthesia and the failure rate of anesthesia. Results A total of 93 patients (109 digits) were included with 51 (61 digits) in the traditional block group and 42 (48 digits) in the single-injection block group.Two patients (3 digits) dropped out. Both of the PP analysis and ITT analysis showed that no significant difference between the two groups were detected in terms of the pain during infiltration, the onset time of anesthesia and the failure rate of anesthesia (P﹥0.05). Conclusions The subcutaneous single-injection digital block is as effective as the traditional digital block, but is much easier to perform. This technique is indicated for the digital anesthesia of palmar aspect distal to the proximal digital crease and dorsal aspect of the distal and middle phalanxes.
Objective To compare the effectiveness and complications of various surgical techniques in the treatment of the osteoarthritis of the trapeziometacarpal joint. Methods We searched MEDLINE (1966 to 2005), Cochrane Controlled Trials Register (Issue 3, 2005) and CBM (1978 to 2005), and handsearched the references of relevant studies. Only randomized controlled trials were included. We assessed the methodological quality of the included studies, extracted data, and performed quantitative and qualitative analyses. Results Seven studies were included, and all had some methodological shortcomings. There was b evidence that in the short term, ligamentous reconstruction, tendon interposition (LRTI) and trapeziectomy alone provide similar results with regard to pain relief, grip and pinch strength, range of thumb motion, hand function and overall satisfaction of patients, but more complications occur with LRTI than with trapeziectomy alone. Conflicting evidence was found about whether LRTI resulted in less subsidence of the first metacarpal bone than trapeziectomy alone. There was moderate evidence that LRTI and ligament reconstruction without tendon interposition (LR) did not have significant differences in thumb strength, patient satisfaction and subsidence of the first metacarpal bone. Limited evidence showed that LR produced better functional scores than LRTI and similar results in pain relief to LRTI. Conflicting evidence supported that LR resulted in greater motion range of thumb than LRTI. Only limited evidence showed that effectiveness was similar between LRTI and Swanson implant. We did not find randomized controlled trials about other surgical techniques. Conclusion Not enough evidence supports superiority of one technique over another. More high quality randomized controlled trials and long term follow-up are necessary.
ObjectiveTo summarize the latest research progress of early postoperative rehabilitation for acute Achilles tendon rupture after surgical repair.MethodsThe high-quality randomized controlled trials and systematic reviews/meta-analyses regarding early postoperative rehabilitation for acute Achilles tendon rupture in recent years were reviewed.ResultsThere are three functional rehabilitations after acute Achilles tendon rupture surgery, including early postoperative mobilization, early weight-bearing with immobilization, and early weight-bearing combined with mobilization. The results of randomized controlled trials show that the effectiveness of early postoperative rehabilitation is similar or better than the early postoperative immobilization. The results of systematic reviews/meta-analyses show that the early postoperative rehabilitation is beneficial to the early function recovery of the Achilles tendon, can reduce the time for functional recovery, and do not adversely affect the outcomes.ConclusionEarly postoperative rehabilitation is beneficial to the functional recovery, and do not increase postoperative complications. There is still no uniform protocol of early postoperative rehabilitation and the timing of weight-bearing, and further studies are needed in the future.