简介：AbstractPurpose:Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner.Methods:Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated.1 All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software.Results:Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale.2 Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient =-0.554).Conclusion:A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.

简介：AbstractPurpose:The treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture.Methods:Patients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results:Twelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up.Conclusion:Stress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.

简介：胫骨的高原不属于工会的Intraarticular是稀罕的。在文学，仅仅9个病人被发现为不属于工会的胫骨的高原和他们得到了改变结果的intraarticular被对待。与骨头grafting一起的内部固定在所有情况中作为标准治疗被做。我们对待intraarticular的4个不同侧面案例在我们由4个不同方法的机构不属于工会的胫骨的高原。我们与骨头接枝，有K钉子的arthrodesis和全部的膝代替一起与巴黎扔的、内部固定的灰浆对待这些案例。大小写1与当病人拒绝了外科，扔的巴黎(流行音乐)的灰浆被对待。破裂被统一，尽管有外翻足malalignment，病人充分对运动的完整的范围满意。大小写2与开的减小被管理与骨头grafting一起的内部固定。病人有一个好工会并且在膝关节得到了运动的完整的范围。大小写3由于她的老年与全部的膝关节造形术被对待并且得到了令人满意的结果。大小写4是一感染不属于工会。Arthrodesis被做，病人能与忍受independently.We的完整的重量走断定与骨头grafting一起的那内部固定不能在胫骨的高原不属于工会的intraarticular的所有情况中是合适的。不属于工会的、现在的状况的原因和膝关节的运动的范围都应该被考虑，治疗应该根据每种patient’s状况是individualised。

简介：AbstractSchatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane, consequent to valgus impaction caused by low velocity of trauma. However, a deep understanding of the different columns of the tibial plateau and patho-mechanisms of the injury led to the unmasking of atypical fractures around the tibial plateau. We have encountered 2 cases with unusual fracture pattern of the lateral tibial condyle caused by road traffic accidents. The fracture pattern and severity of injury deviate from the original description of Schatzker type 1; in view of dual plane split, there is rotation of the posterolateral column fragment along its sagittal plane plus grade-III medial collateral ligament injury. The patients were initially treated with knee spanning external fixator and after a latency of 5 days, definitive fracture specific fixation was done, combined with repair of grade-III medial collateral ligament injury. At the 6 months follow-up both the patients achieved satisfactory knee functions (knee society score case 1:100 and case 2: 92) and returned to their jobs. The severity of fracture pattern and displacement as described should prompt for examination of associated ligament injury. Because of timely diagnosis, early and appropriate care promised an excellent function outcome even in such a severe nature of knee injury. To prompt the description of injury pattern we coined the name "dual split and dislocation" of lateral tibial plateau, as a complex injury variant of split fracture of lateral tibial plateau fracture.

简介：WeusedBastianimonoarmexternalframefixatortofixopentibialfracture,acompositeflaptransfertocoverandrepairthedefectsoftheskinandanirrigationdevicetodrainthewoundareainpatientswithinfectedopentibialfracturesinducedbyinternalfixation.Satisfactoryfunctionwasobtainedandthecosmeticresultsofboththedonerandthereceptorsiteswerealsosatisfactoryafteroperation.

简介：HistoricalperspectiveItwaswellknownthatin1918Takagiperformedthefirstarthroscopicinspectionofacadaver'skneeinJapan.1Hisinterestinthisarealaidthefoundationforarthroscopyandfacilitatedthedevelopmentofarthroscope.In1931,Burmanreportedanexperimentalstudyonthearthroscopicexplorationofc

简介：平坦破裂是的王牌的解剖结构复杂、起作用的暴露和固定是极其困难的。因为那些显然代替了王牌平坦破裂，更靠近的引出被注定引起致丑陋的愈合。有内部固定(ORIF)的开的减小不仅导致解剖减小，而且带复杂并发症。不管哪个方法将被采用，创伤的关节炎或大腿骨的头的脉管的坏死可能发生。以便treatacetabular更有效地断裂，矫形外科医生应该被要求充分为复杂并发症预防掌握theacetabular解剖，简历力学，分类和必要知识。

简介：AbstractFractures of the acetabulum in elderly patients were often caused by low energy trauma. Fractures involving anterior column are more common and often associated with impaction and comminution. Osteoporosis further complicates the management. Percutaneous fracture fixation has low morbidity but it is a technically demanding procedure. Open reduction and fracture fixation is done with or without simultaneous total hip replacement. Delayed total hip replacement is considered in posttraumatic arthritis patients. Patients with minimal displaced fractures, associated both-column fractures with secondary congruence of joint and patients who are medically unfit for surgery can be managed non-operatively. Whatever be the method of management, these elderly patients should be mobilised as early as possible.

简介：破坏损害被定义为avery骨头和软纸巾的严重损坏。我们在一些破裂盒子中发现了那的Butin临床的实践，软纸巾的损坏不象“destructiveinjury”一样严重显示，而弄碎破裂stillcannot表演骨头损坏的严厉。因此我们proposeda新术语“destructivefractures”在把破坏损害的定义与典型诊所盒子相结合以后。破坏破裂指谁的破裂骨状的纸巾太严重被损坏被修理，但是软纸巾，神经和静脉是严重地伤害的更少，canbe修理。从一年2001～2010，破坏破裂的75个盒子被同意进入我们的部门。根据是否与外部环境连结的破裂和破裂地点，他们被划分成6种类型：al类型，关上的骨干破坏骨折；a2类型，开的骨干破坏骨折；bl类型，关上的包含关节的破坏骨折；b2类型，开的包含关节的destructivefracture；c1类型，关上的混合破坏骨折；c2类型，开的混合破坏骨折。相应临床的治疗为破坏骨折的新分类标准是的每type.The被进行简单、实际并且thuscan被用作一个重要指南为破坏破裂做合理treatmentplans。

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简介：骨盆的破裂是严重损害。在24个小时以内的死亡最经常是尖锐的血损失的结果。这些病人的紧急情况管理挑战性、争论。在它的管理的关键问题正在识别出血的地点然后控制流血。有骨盆的骨折的血液动力学地不稳定的病人的管理要求一个多学科的队。在这个管理算法处理的问题是诊断评估，损坏控制复活，为noninvasive的指示骨盆的稳定，preperitoneal有关外科的选择和angiography的骨盆的收拾行李和批评决定。这篇评论文章在那些决心上集中于知识的最近的身体。

简介：Objective:Toinvestigatetheinfluenceofhipandpelvicfracture,especiallyacetabularfracturecomplicatedbysciaticnerveinjuryonclinicalfeaturesandprognosisofsciaticnerveinjury.Methods:FromJanuary1987toJanuary2000,17patients(14maleand3female)whohadhipandpelvicfracturescomplicatedbysciaticnerveinjuryweretreatedwithoperativereductionandinternalfixationandfollowedupfrom10monthsto5years.Theaverageagewas38years(ranging23-56years).Theleftextremitieswereinvolvedin11patientsandtherightin6.Twelvepatientsunderwentprimaryexplorationandneurolysisand5patientsunderwentsecondaryoperation.Results:Preoperatively,8patientsweretreatedwithlargedosesoforalnarcoticstocontroltheirseveresciaticpain.Threeofthe8patientsunderwentpatient-controlledanalgesiaandepiduralanalgesia.Afteroperation,excellentandgoodratesofreductionandfunctionalrecoveryofsciaticnervewere94.1%and88%respectively.Fourpatientsstillhadsciaticpainand2patientsfailedtorecover.Sciaticnervefunctionimprovedwithin3-6monthsaftersurgeryin11patients.Conclusions:Hipandpelvicfracturescanresultinsciaticnerveinjury,especiallycommonperonealnerveinjuryandprognosisispoor.Openreductionandinternalfixationcombinedwithnerveexplorationandneurolysisshouldbeusedasearlyaspossibleforseveresciaticpain.

简介：Objective:Toevaluatetheefficacyandsignificanceofposterolateralfusioninpreventingfailureofshort-segmentstabilizationforthetreatmentofthoracolumbarburstfractures.Methods:Sixtypatientswiththoracolumbarburstfractureswereincludedinthestudy.Thepatientswereclassifiedintotwogroups(n=30ineachgroup).InGroupA,patientsweretreatedinourhospitalwithshort-segmentinstrumentationviaposterolateralfusionwithiliacbone.InGroupB,patientsweretreatedinotherhospitalwithshort-segmentfixationwithoutfusion.Allcasescametoourhospitalforreexamination.Therewere18malesand12femalesinGroupAwithameanageof42.3years(range,24to52years)and16malesand14femalesinGroupBwithameanageof41.5years(range,19to54years).Radiographic(Cobbangle,kyphosisofthevertebralbody,andsagittalindex)andclinicaloutcomes(LowBackOutcomeScore)wereanalyzedafteranaveragefollow-upof16months.Results:Afteroperation,Cobbanglewasreducedfrom19.3°to3.1°inGroupAandfrom19.1°to3.3°inGroupB(P>0.05).Itwas5.9°inGroupAand11.9°inGroupBatthefinalfollow-up(P<0.01).Itsaveragelossofcorrectionwas2.8°inGroupAand8.6°inGroupB.Averagekyphosisofthevertebralbodywasreducedfrom21.3°to6.2°inGroupAandfrom21.7°to7.4°inGroupB(P>0.05).Itwasdecreasedto7.9°inGroupAand13.5°inGroupBatthefinalfollow-up(P<0.01).Itsaveragelossofcorrectionwas1.7°inGroupAand6.1°inGroupB.Sagittalindexwasreducedfrom21.3°to3.6°inGroupAandfrom20.5°to3.8°inGroupB(P<0.05).Itwasdecreasedto5.1°inGroupAand9.8°inGroupBatthefinalfollow-up(P<0.01).Itsaveragelosswas1.5°inGroupAand6.0°inGroupB.InGroupA,73.3%ofpatientshadanexcellentresultbasedonLowBackOutcomeScoresystem,whilethatinGroupBwasonly43.3%.Conclusions:Posterolateralfusionisaneffectivemeasuretopreventimplantfailure,anddecreaselo

简介：Objective:Toobservetheeffectofoctyl-a-cyanoacrylateuponbonehealinganditsdegradationinvitroaftermiddletibialtransversefractureinrabbits,andtoestablishtreatmentofhigherefficacywiththeapplicationofoctyl-a-cyanoacrylate.Methods:MiddletibialtransversefracturemodelofNewZealandrabbitswasestablished.Intheexperimentalgroup,internalfixationwith2mmKirschnerwireswasperformedandthebrokenendswerefixedwithoctyl-a-cyanoacrylate.Inthecontrolgroup,onlyinternalfixationwith2mmKirschnerwireswasconducted.Animalswerekilledatpresettimeintervalsof2,4,6,8,10and12weekspostoperativelyandsampleswereharvested.Results:Twoweeksafteroperation,clearfracturelineswereobservedinboththeexperimentalandthecontrolgroups.Fibroussofttissueconnectionwasnotedbetweenthebrokenendsandtherewassofttissueadhesionaroundthefracturesite.Therewasnocallusformationandthebrokenendsweresurroundedbyadhesivesofttissues.Obviousexternalcallusformationwasconfirmedat8weeksafteroperationinbothgroupswithpartialdisappearanceoffracturelines.Tenandtwelveweeksaftertheoperation,fracturelinesdisappearedcompletelyandtherewasobviousexternalcallusformationandboneunion.Inthefourthweek,fibrouscellsandchondrocyteswerefoundtogrowintothecolloidandsurrounditatthe6thweek.Theadhesivematerialwasdegradedandgraduallyabsorbedatthe8thweek.Chondrificationwasobserved.Conclusions:Twoweeksafterfixationfortibialfractureinrabbits,octyl-a-cyanoacrylatebeginsinvivodegradation.Chondrocytesandfibrocytesgraduallygrowintothedegradationareaandsurroundtheadhesivematerial,whichbrokeintopiecesat8weeks.Completedegradationanddisappearanceoftheadhesivematerialispresentbetween10and12weeks.Nobarriereffecthamperingfracturehealingisnoted.

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简介：HowSpringFestivaliscelebratedAlthoughthedateoftheSpringFestivalwasswitchedfromthebeginningofspringtothefirstdayofthefirstlunarmonth,themainwaysofcelebratingit,frombygonedays,remainpopular.

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