Guo-dong Liu

Complications of treating terrible triad injury of the elbow: a systematic review.

Objective Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications following surgical management of TTIE. Methods Medline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had TTIE, and were published in English. Outcomes of interest were functional outcomes and complications. Results Sixteen studies, involving 312 patients, were included in the systematic review. Mean follow up after surgery was typically 25 to 30 months. Mean Mayo elbow performance scores ranged from 78 to 95. Mean Broberg-Morrey scores ranged from 76 to 90. Mean DASH scores ranged from 9 to 31. The proportion of patients who required reoperation due to complications ranged from 0 to 54.5% (overall  = 70/312 [22.4%]). Most of these complications were related to hardware fixation problems, joint stiffness, joint instability, and ulnar neuropathy. The most common complications that did not require reoperation were heterotopic ossification (39/312 [12.5%] patients) and arthrosis (35/312 [11.2%] patients). Conclusions The results of this systematic review indicate that functional outcomes after surgery for TTIE are generally satisfactory and that complications are common. Further research is warranted to determine which surgical techniques optimize functional outcomes and reduce the risk of complications.

Clinical efficacy of simple decompression versus anterior transposition of the ulnar nerve for the treatment of cubital tunnel syndrome: A meta-analysis

OBJECTIVES The aim of this study was to evaluate the clinical efficacy of simple decompression (SD) versus anterior transposition (AT) of the ulnar nerve for the treatment of cubital tunnel syndrome. METHODS Seven public databases (PubMed, MEDLINE and EMBASE, Springer, Elsevier Science Direct, Cochrane Library and Google scholar) were searched from 1971 to December 2013. The overall odds ratios (OR) and their 95% confidence intervals (CI) were pooled to compare the clinical outcomes. Subgroup analysis was performed based on the region, study type, Jadad score, type of AT, and follow-up duration. Meta-analysis was conducted by using Rev. Man 5.1 and Stata 11.0 software. RESULTS Finally, we included 13 studies involved 1009 (500 patients receiving SD and 509 patients receiving AT) patients with cubital tunnel syndrome. The overall estimate (OR=0.91, 95% CI=0.67-1.23, P=0.536) indicated that there was no significantly statistical difference between the clinical outcomes of patients treated with SD and AT. Meanwhile, subgroup analyses by region, study type, Jadad score, type of AT and follow-up duration showed the consistent results with the overall estimate. In addition, we found that the incidence of complications in patients treated by SD was significantly lower than that in patients treated by AT (OR=0.32, 95% CI=0.17-0.60, P=0.05). CONCLUSIONS In conclusion, although SD had equivalent clinical outcomes with AT for the treatment of cubital tunnel syndrome, SD should be preferred due to having lower incidence of complications.

Meta-analysis of the outcomes of intramedullary nailing and plate fixation of humeral shaft fractures

OBJECTIVE The purpose of this study is to compare the outcomes of intramedullary nailing and plate fixation in the treatment of humeral shaft fractures using meta-analysis. METHODS PubMed, MEDLINE, EMBASE, the Cochrane Controlled Clinical Trials Register (CCTR) databases were searched for studies that investigated the efficacy of intramedullary nailing and plate fixation in the management of humeral shaft fractures. Delayed healing rate, nonunion, postoperative infection and radial nerve paralysis were key outcomes of interest. Data were searched within the time period of July 1990 through September 2012. The statistical software RevMan 5.0 was used to analyze the statistical significance of the results. RESULTS Total 459 cases of patients in 10 literature, including 231 cases of plate group and 228 cases of the intramedullary nailing groups were collected. The results of meta-analysis showed that delayed healing rate of humeral shaft fractures was lower in plate fixation compared with intramedullary nailing (RR = 2.64, 95% CI (1.08, 6.49), P < 0.05). No statistically significant difference in nonunion, postoperative infections, radial nerve paralysis and other complications was identified between nailing and plate fixation groups (P > 0.05). CONCLUSIONS In general, the effect size of intramedullary nailing may be comparable to that of plate fixation in the terms of nonunion, postoperative infections, radial nerve paralysis. The only slightly difference was identified in the event of delayed healing rate.

Open reduction and internal fixation of posterolateral tibial plateau fractures through fibula osteotomy-free posterolateral approach.

Objective: To evaluate the outcome of patients with posterolateral tibial plateau fractures after open reduction and internal fixation with a fibula osteotomy–free posterolateral approach. Design: Retrospective chart and operation note review. Setting: A medical college-affiliated tertiary hospital. Materials and Methods: A retrospective chart and radiographic review of posterolateral tibial plateau fractures treated with a posterolateral approach between January 2006 and July 2010 was performed. The primary (ie, the total Rasmussen function score) and secondary (ie, the postoperative infection, knee deformity, and complications) outcomes were analyzed. Results: A total of 32 patients were identified for this study. Patients were followed for an average of 18.2 months (range, 12–36 months); the total Rasmussen function score was 24.8 ± 2.9 points. The results were rated as excellent (≥27 points) in 19 patients, good (20–26 points) in 11, and fair (10–19 points) in 2 patients. No wound infections, screw loosening or implant fracture, and nonunion, deformity, or fracture redisplacement were seen. Stretch injury of the common peroneal nerve was found in 1 patient, who obtained recovery 2 months after additional conservative management. Conclusions: Adequate open reduction and internal fixation with a fibula osteotomy–free posterolateral approach can attain a satisfactory clinical outcome for patients with posterolateral tibial plateau fractures. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Operative Treatment of Terrible Triad of the Elbow via Posterolateral and Anteromedial Approaches

The aim of the study was to explore the clinical outcome of posterolateral and anteromedial approaches in treatment of terrible triad of the elbow. The study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. The mechanism of injury included fall from height in 9 patients and traffic accident in 3. According to O’Driscoll classification for fractures of the ulnar coronoid, there were 11 patients with type Ⅰ and 1 with type Ⅱ fractures. According to Mason classification for fractures of the radial head, there were 3 patients with type Ⅰ, 7 with type Ⅱ and 2 with type Ⅲ fractures. All patients were followed up for 12-27 months (average 15.5 months), which showed no pain or severe pain in all patients except for 2 patients with mild pain. At the last follow-up, the mean flexion was for 125°(range, 90°-140°), the mean extension loss for 20°(range, 0°-70°), the mean pronation for 66°(range, 20°-85°) and the mean supination for 60°(range, 30°-85°). The bony union time was 8-14 weeks (average 11 weeks) and the elbows were stable in flexion-extension and varus-valgus in all patients. The elbows maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation. Mild heterotopic ossification of the elbow occurred in 3 patients at 6 months after operation and mild degenerative change in 1 patient at 18 months after operation. The Broberg and Morrey elbow performance score was 82 points (range, 58-98 points). The results were excellent in 6 patients, good in 4, fair in 1 and poor in 1, with excellence rate of 83.3%. The results showed that the combined posterolateral and anteromedial approaches can facilitate the reduction and fixation of terrible triad of the elbow. Repair of radial head, coronoid, medial and lateral collateral ligaments can sufficiently restore the elbow stability, allow early postoperative motion and enhance the functional recovery.

Cystic Adventitial Disease of Popliteal Artery in a Boy Younger than 6 Years Old.

1Department II of Orthopedics, Childrens Hospital of Chongqing Medical University; Stem Cell Biology and Therapy Laboratory & Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China 2Department 8, Institute of Research Surgery, Daping Hospital, Third Military Medical University, Chongqing, China 3Department of Anesthesiology, General Hospital of Chengdu Military Command, Chengdu, China 4Traumatic Center, Institute of Research Surgery, Daping Hospital, Third Military Medical University, Chongqing, China These authors contributed equally to this study

A time course study about gene expression of post-thermal injury with DNA microarray.

Burn injury is one of the most common and devastating forms of trauma in daily life. However, the exact sequence of events after burn injury remains unknown.

Isolated u-shaped sacral fracture with cauda equina injury.

A highly unstable and neurological injury, the isolated U-shaped sacral fracture without pre-pelvic ring fracture but combined with cauda equina injury is rare in clinics, and the treatment method remains unclear. It can occur when patients fall from a height, the lower extremities hit the ground in extreme flexion, and the sacrum is the direct touchdown point. The direct impact on the sacrum and the vertical extrusion energy through the spinal column may be the main mechanism of injury. The U-shaped sacral fracture is easily missed, and diagnosis is often delayed as it is difficult to detect on anteroposterior view pelvic radiograph due to angulation of the fracture and bowel shadow. When clinical signs suggested a possible U-shaped sacral fracture, a 2- to 3-mm cut computed tomography scan with coronal and sagittal reconstruction can provide optimal imaging to identify and evaluate the sacral fracture.This article describes 2 patients, a 16-year-old girl and a 40-year-old man, with U-shaped sacral fractures. The patients were treated with posterior sacral laminectomy within 1 week after injury and achieved satisfactory postoperative recovery. Follow-up showed bony union with no further displacement or internal fixation failure, wound infection, delayed healing, or compression of the skin by the plate and screws. The results show that posterior vertebral plate decompression and reconstructive plate internal fixation can obtain a satisfactory outcome with minor operation trauma and few complications.

Comparison of three fixations for tibial plateau fractures by biomechanical study and radiographic observation

AIM The aim of this study was to compare the fixation effects of three fixation devices for tibial plateau fracture (AO/OTA classification 41 A1). METHODS Sixteen human cadaver tibial specimens were randomly divided into four groups. An A1 fracture model was established. The fractures were subsequently fixed by axial controlled intramedullary nail, external fixation and steel plate fixation. Each specimen was subjected to axial compression, torsion test and three-point bending test. Then a rat model was used to evaluate the therapeutic effect of these three fixations by evaluation of callus formation time and healing time. RESULTS It was found that the axial controlled intramedullary nail group obtained superior biomechanical properties of resistance ability of bending, torsional and axial compressive, compared with external fixation and steel plate group. In animal experiments, the axial controlled intramedullary nail group had a significant shorter callus occurrence and healing time than steel plate and external fixator group. CONCLUSION The axial controlled intramedullary nail fixation has a superior biomechanical characteristic and fixation effect for tibial plateau fractures than steel plate and external fixator.

Treatment of unstable sacral fractures with percutaneous reconstruction plate internal fixation

PURPOSE To study the effects of percutaneous reconstruction plate internal fixation in the treatment of unstable sacral fractures. METHODS Percutaneous reconstruction plate internal fixation was applied on 21 cases of unstable sacral fracture (15 males and six females, at age range of 16-65 years, mean 38.3 years) including four cases of Denis Zone I, 14 cases of Zone II and three cases of Zone III. In operation, an arc incision (about 3-5 cm long) was made along the iliac crest on the outside border of posterior superior iliac spine (PSIS) on both sides, and then the plate was transported from the wounded side to the opposite one through the subcutaneous tunnel. RESULTS The mean incision length, operation time, intraoperative blood loss was 4.3 cm, 45.2 min, and 160.8 ml respectively. All these patients were followed up for 12-33 months (average 16.3 months), which showed no incision infection, intraoperative neurovascular injury, internal fixation loose or breakage, disunion, or obvious lower limb length inequality. The function result was rated as excellent in six cases, good in 12 and fair in 3, with excellence rate of 85.7%, according to the Majeed scoring system. CONCLUSION Percutaneous reconstruction plate internal fixation is an ideal surgical approach to unstable sacral fractures, as it is easy, safe, causing less trauma and fewer complications, and conducive to quicker recovery.