Objective: To investigate the value of transplantation of vascularized fibula in treating non-union femoral neck fractures and preventing ischemic necrosis of the femoral head. Methods : Vascularized heterotopic fibul...Objective: To investigate the value of transplantation of vascularized fibula in treating non-union femoral neck fractures and preventing ischemic necrosis of the femoral head. Methods : Vascularized heterotopic fibula was transplanted to the anterior-lateral part of the femoral neck. The fibula artery and vein were anastomosised with lateral circumflex artery and vein. Results : One hundred and twenty-nine cases of non-union femoral neck fracture were treated with vascularized fibula graft in our hospital from 1982 to 2002. Eighty-seven cases of them were followed up for 3 to 19 years with functional and X-ray examination. The percentage of fracture healing and effect were 94. 3 and 81. 6, respectively. Conclusion:The fibula with blood supply has a synergistic fixation impact on the non-union femoral neck fractures. The fibula is solid enough for supporting the femoral head and preventing it from collapse. The vascularized fibula grafting, by providing blood supply to the affected femoral head and neck, could promote the femoral head restoration and reconstruction. In addition, the periosteum of fibula plays a role in fracture healing.展开更多
Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current ev...Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current evidence on diagnostic protocols and management strategies,highlighting optimal approaches and emerging trends.Initial care emphasizes soft tissue assessment,often guided by the Tscherne classification,and fracture classification systems.External fixation may be required in open injuries,while early open reduction and internal fixation within six days is linked to improved outcomes.Minimally invasive techniques for the lateral malleolus,including intramedullary nailing and locking plates,are effective,while medial malleolus fractures are commonly managed with screw fixation or tension-band wiring.Posterior malleolus fragments involving more than 25%of the articular surface usually warrant fixation.Alternatives to syndesmotic screws,such as cortical buttons or high-strength sutures,reduce the need for secondary procedures.Arthroscopic-assisted open reduction and internal fixation benefits younger,active patients by enabling concurrent management of intra-articular and ligamentous injuries.Postoperative care prioritizes early weight-bearing and validated functional scores.Despite advances,complications remain common,and further research is needed to refine surgical strategies and improve outcomes.展开更多
Isolated distal fibula fractures represent the majority of ankle fractures.These fractures are often the result of a low-energy trauma with external rotation and supination mechanism.Diagnosis is based on clinical sig...Isolated distal fibula fractures represent the majority of ankle fractures.These fractures are often the result of a low-energy trauma with external rotation and supination mechanism.Diagnosis is based on clinical signs and radiographic exam.Stress X-rays have a role in detecting associated mortise instability.Management depends on fracture type,displacement and associated ankle instability.For simple,minimally displaced fractures without ankle instability,conservative treatment leads to excellent results.Conservative treatment must also be considered in overaged unhealthy patients,even in unstable fractures.Surgical treatment is indicated when fracture or ankle instability are present,with several techniques described.Outcome is excellent in most cases.Complications regarding wound healing are frequent,especially with plate fixation,whereas other complications are uncommon.展开更多
The Objective is to evaluate Elastic Stable Intrame-dullary Nailing (ESIN) fixation through the treat-ment of children’s shaft fracture of tibia and fibula. From January 2007 to January 2009, 16 cases of children’s ...The Objective is to evaluate Elastic Stable Intrame-dullary Nailing (ESIN) fixation through the treat-ment of children’s shaft fracture of tibia and fibula. From January 2007 to January 2009, 16 cases of children’s shaft fracture of tibia and fibula had been treated by ESIN. 15 cases were followed up after the surgery and the follow-up time was 4 - 12 months (4.5 in average). The results turn out that all the patients’ fractures have got healed by Phase I and the healing time is 10 weeks in average. The near joints’ activity and affected extremity completely return to normal. This group of cases doesn’t show any sign of infection, bone nonunion, malunion or epiphysis injury. And six patients have had their intramedullary nails taken out after six months. It can be concluded that ESIN is good for treating children’s long diaphysis fracture which has difficulty in closed diaplasis and is suitable for children aged 6 - 13. ESIN has the advantages of small incision, slight injury of soft tissue, short sur-gery time, rapid recovery and few complications.展开更多
Objective To derive regression formulae for stature estimation using forensic radiography from the tibia and fibula of Chinese Han teenagers in Sichuan Province. Methods To construct equations, measurements were condu...Objective To derive regression formulae for stature estimation using forensic radiography from the tibia and fibula of Chinese Han teenagers in Sichuan Province. Methods To construct equations, measurements were conducted on the training sample (412 adults, 201 males and 211 females). The whole length of the fibula and four measurements of tibia were determined using CR radiography, rectified through theoretical magnification. The regression formulae were relatively constructed to the real stature measured in an erect position. Through using the testing sample (40 adults) for the regression formulae, the reliability of the regression formulae was assessed. Results The range of correlation coefficients of four measurements for tibia was 0.880-0.895 in the sex-unknown group, 0.869-0.893 in the male, and 0.8450.855 in the female. The five measurements were found to be better correlated with stature in the male than in the female. Conclusion The digital X-ray of the tibia and fibula for stature estimation is proved to be effective in forensic individual identification; therefore, these equations can be of great assistance to the stature estimation of the contemporary Chinese Han teenagers.展开更多
BACKGROUND Ankle fractures are common injuries in the young and elderly populations.To prevent post-traumatic arthritis,an anatomic reconstruction of the ankle structure is mandatory.Open reduction and internal fixati...BACKGROUND Ankle fractures are common injuries in the young and elderly populations.To prevent post-traumatic arthritis,an anatomic reconstruction of the ankle structure is mandatory.Open reduction and internal fixation is the treatment of choice among orthopaedics.Conventional plates allow stability of the fracture if bone quality is present.Locking plates might offer an advantage for the treatment of lateral malleolar fracture in patients with comminution,severe instability,distal fractures,or osteoporotic bone.Our hospital introduced a new locking plate for fracture of the distal fibula.AIM To evaluate locking plates in terms of outcomes and complications in young and elderly patients.METHODS We retrospectively reviewed a total of 67 patients treated for displaced distal fibula fractures.Demographic data,number of comorbidities,use of inter fragmentary screw,complication,time of fracture healing,partial or full weight bearing,and reoperation were recorded for all patients.Clinical outcome was assessed by the American Orthopedic Foot and Ankle Society clinical scoring system.Radiographs were obtained at 4,8,12,16,20,and 24 wk until radiographic union was obtained.RESULTS All patients displayed complete bony union on radiographic assessment,and no patients developed any serious complications.We observed two superficial infections,one delayed wound healing,and two plate intolerances.Significant differences were observed between the two age groups in terms of radiographic healing(11.9 wk in younger patients vs 13.7 wk in older patients;P=0.011)and in the American Orthopedic Foot and Ankle Society score at 6 mo after surgery(88.2 in younger patients vs 86.0 in older patients;P=0.001)and at 12 mo after surgery(92.6 in younger patients vs 90.0 in older patients;P=0.000).CONCLUSION Locking plates provide a stable and rigid fixation in multifragmentary and comminuted fractures or in the presence of poor bone quality.展开更多
Introduction Mandibular segmental defects result in significant cosmetic and functional deficiencies.Meanwhile,the reconstruction of both the contour and function of the mandible is a challenging task.At present,autol...Introduction Mandibular segmental defects result in significant cosmetic and functional deficiencies.Meanwhile,the reconstruction of both the contour and function of the mandible is a challenging task.At present,autologous vascularized fibula transplantation is the most common method to reconstruct a mandible with long-span defects[1].展开更多
laterals or femoral head and neck of 18 mature healthy male domestic dogs were divided into two groups by the principle or auto-control.Avascular osteonecrosis of femoral head(ONFH)and old femoral neck fracture(FNF)w...laterals or femoral head and neck of 18 mature healthy male domestic dogs were divided into two groups by the principle or auto-control.Avascular osteonecrosis of femoral head(ONFH)and old femoral neck fracture(FNF)were made respectively.Free vascularized fibula grafting was performed 2 weeks later.Arter operation, X-ray,histopathological,electron microscopic,tetracycline fluorescence labelling and99mTc-methylene diphosphorate scanning were carried out respectively.The result indicated that free vascularized fibula grarting could provide new blood supply system to injured femoral head and participate in the repairing process of avascular uecrosis of femoral head.展开更多
BACKGROUND Aggressive giant cell tumor of the distal fibula is so rare that no consensus on a surgical strategy has been reached.Thus,an appropriate treatment strategy is still important to discuss.CASE SUMMARY A 61-y...BACKGROUND Aggressive giant cell tumor of the distal fibula is so rare that no consensus on a surgical strategy has been reached.Thus,an appropriate treatment strategy is still important to discuss.CASE SUMMARY A 61-year-old man who had been experiencing progressive swelling of the left lateral malleolus accompanied by pain for half a year was presented at our hospital.He had never been treated prior to coming to our hospital.Preoperative imaging revealed a 10 cm×6 cm mass located in the body of the distal fibula.Pathological biopsies confirmed it was a giant cell tumor.Preoperative examination revealed he had dilated cardiomyopathy with class 3 cardiac function.The cardiologist and anesthesiologist determined that he could tolerate the operation,but the operation should be as short and minimally invasive as possible.With the patient’s consent,we performed a tibiotalar fusion and followed up with him for 2years,finding no recurrence and a satisfactory recovery.CONCLUSION Tibial talus fusion is an effective method for the treatment of distal fibula tumors.展开更多
Chronic osteomyelitis in children is frequent in the developing countries. Their complications and morbidity burden the functional prognosis. The reconstruction of diaphyseal bone loss after sequestrectomy in young ch...Chronic osteomyelitis in children is frequent in the developing countries. Their complications and morbidity burden the functional prognosis. The reconstruction of diaphyseal bone loss after sequestrectomy in young children remains a difficult and expensive challenge in our context. The delay in care and the lack of social security for all, are risk factors for morbidity. The induced membrane technique described by Masquelet starts to be applied and showed satisfactory results. We report the results of a case of reconstruction of the proximal humerus by using a non-vascularized fibula and supplemental bone substitute in a boy of 2 years with sickle cell. No scarring occurred at the sampling site. The process of bone consolidation is underway.展开更多
<p style="text-align:justify;"> <span style="font-family:Verdana;">Chronic osteomyelitis is serious because of the orthopedic sequels that they could cause. Extended diaphyseal sequestr...<p style="text-align:justify;"> <span style="font-family:Verdana;">Chronic osteomyelitis is serious because of the orthopedic sequels that they could cause. Extended diaphyseal sequestrations could cause bone loss and their management is delicate. Here we report a case of right ulnar diaphyseal reconstruction by non-vascularized fibula transfer. This was a three-year-old girl, non-sickle cell, who had chronic osteomyelitis of the right ulna. The evolution was towards an almost total ulnar diaphyseal sequestration with externalization of the distal extremity. The removal of this large sequestrum occurred almost spontaneously, leaving a significant bone loss over a length of about 6 cm. Secondarily, we reconstructed the right ulnar diaphysis by transfer of a free non-vascularized graft of the left fibula, maintained by a pin. </span><span style="font-family:Verdana;">The follow up was favorable with almost complete recovery of pro</span><span style="font-family:Verdana;">no-supination. Fibular ossification has evolved as well and we did not notice any complications at the graft collection site. Non-vascularized fibula graft transfer is a useful therapeutic option in the management of significant bone defect</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> secondary to chronic osteomyelitis of one of the two forearm bones.</span> </p>展开更多
BACKGROUND Fibrous dysplasia is a congenital disorder in which normal bone is replaced by fibro-osseous tissue or irregular trabeculae of woven bone intermixed with mature collagenous tissue.A single or multiple bones...BACKGROUND Fibrous dysplasia is a congenital disorder in which normal bone is replaced by fibro-osseous tissue or irregular trabeculae of woven bone intermixed with mature collagenous tissue.A single or multiple bones are affected.This rare bone disorder has three clinical patterns including monostotic,polyostotic,and that associated with McCune-Albright syndrome.Most studies report primary fibrous dysplasia.However,a few cases of recurrent monostotic fibular fibrous dysplasia have been reported.Here,we report a therapeutic strategy for recurrent fibular fibrous dysplasia.CASE SUMMARY A 4-year-old boy was admitted for persistent pain in the left lower limb and abnormal gait over the previous 9 mo.He had no history of present or past illness.Preoperative imaging data showed erosion-like changes with bone expansion of the left middle and lower fibular segment.Tumor tissue in the fibular bone marrow cavity was removed by curettage,and rapid intraoperative pathological examination suggested fibular fibrous dysplasia.An allograft was implanted into the fibular medullary cavity.However,he was readmitted with clinical symptoms including persistent pain,abnormal gait,and local swelling at the age of 6 years.He was diagnosed with recurrent fibular fibrous dysplasia based on the second medical examination.He underwent fibular bone tumor radical resection and longus fibular allograft transplantation combined with fibular bone locking plate and screws.Good host bone to allogenic bone graft fusion was observed by the physician on postoperative regular follow-up.CONCLUSION Radical resection of fibrous dysplasia and longus fibula allograft combined with internal fixation for reconstruction are suitable for the treatment of recurrent monostotic fibular fibrous dysplasia.展开更多
Reconstructions of the sternum remain a formidable challenge for the operating team. Reconstruction of the sternumdefect, regardless of the reason, should ensure the stability of the anterior chest wall, the return of...Reconstructions of the sternum remain a formidable challenge for the operating team. Reconstruction of the sternumdefect, regardless of the reason, should ensure the stability of the anterior chest wall, the return of acceptable respiratory parameters and the control of wounds. Stability of the chest wall can be provided by autogenous tissues or prosthetic materials. In our experience, the fibula free osteocutaneous flaps are harvested for reconstruction of the bone defect in two patients after full-thickness defect of the sternum and anterior chest wall.展开更多
Gap bone defect is a major challenge. Its treatment has evolved over the years from amputation to limb reconstruction through vascularised graft, distraction osteogenesis and use of customised implants. Availability a...Gap bone defect is a major challenge. Its treatment has evolved over the years from amputation to limb reconstruction through vascularised graft, distraction osteogenesis and use of customised implants. Availability and affordability of these innovative techniques have always been an additional challenge in the developing resource poor countries. We report the use of Tibialization of Ipsilateral fibula first suggested by Hahns in 1884 to bridge a gap of 12 cm in an 8 year old male, with segmental tibia loss from chronic osteomyelitis. We did an end to end transposition of the ipsilateral fibular into the tibia gap defect in a one stage procedure. This was after eradication of the infective process of osteomyelitis. He commenced partial weight bearing ambulation in cast at 3 months and out of cast ambulation at 18 months post surgery. The transposed fibula was 75% tibialized at 18 months post surgery. Conclusion: Fibular is a useful armamentarium in filling segmental bone defect.展开更多
Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, whi...Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.展开更多
Objective:To investigate the relationship between serum adhesion molecules, trace elements and delayed union of tibial and fibula fractures.Methods:A total of 46 patients with delayed union of tibial and fibula fractu...Objective:To investigate the relationship between serum adhesion molecules, trace elements and delayed union of tibial and fibula fractures.Methods:A total of 46 patients with delayed union of tibial and fibula fractures in our hospital from May 2014 to June 2016 were selected as the observation group, 46 patients with normal healing of tibial and fibula fractures were selected as the control group, then the serum adhesion molecules and trace elements levels of two groups at forth, eighth and sixteenth week after the surgery were compared.Results:The serum dhesion molecules levels of observation group at forth, eighth and sixteenth week after the surgery were all higher than those of control group, the serum trace elements levels were all lower than those of control group, and the serum adhesion molecules levels of two groups at eighth week after the surgery were all higher than those at other time, the trace elements levels were all lower than those at other time (allP<0.05).Conclusions:The serum adhesion molecules and trace elements of patients with delayed union of tibial and fibula fractures show obviously abnormal state, so those indexes of those patients should be paid to more monitoring and improvement.展开更多
Objective: to observe the short-term therapeutic effects of single condylar replacement and fibular osteotomy combined with arthroscopic debridement in patients with knee osteoarthritis. Methods: 30 patients with knee...Objective: to observe the short-term therapeutic effects of single condylar replacement and fibular osteotomy combined with arthroscopic debridement in patients with knee osteoarthritis. Methods: 30 patients with knee osteoarthritis (all moderate) who underwent surgery in our hospital were included in the study. These patients used two different surgical schemes, of which 15 cases were used as the cleaning group, the surgical scheme was fibular osteotomy + arthroscopic cleaning, and another 15 patients underwent single ankle replacement as the single condyle replacement group. The clinical indexes of the two groups were compared before operation, 3 months and 6 months after operation to evaluate the short-term curative effect. Results: the VAS score of the two groups 6 months after operation was significantly lower than that of the other two observation points. The data were processed, indicating that P < 0.05. In terms of HSS score, the statistical results showed that the score level 6 months after operation was in a higher state, indicating that the knee condition of patients at this time point was better (P < 0.05). Compared with the preoperative femoral tibial angle, the level of this index was lower in both groups 6 months after operation (P < 0.05). The femoral tibial angle in fibular osteotomy group was greater than that in single condyle replacement group, and the difference was statistically significant (P < 0.05). Conclusion: fibular osteotomy combined with arthroscopic debridement has the advantages of minimally invasive, definite curative effect, rapid recovery, less complications, less cost and high satisfaction.展开更多
文摘Objective: To investigate the value of transplantation of vascularized fibula in treating non-union femoral neck fractures and preventing ischemic necrosis of the femoral head. Methods : Vascularized heterotopic fibula was transplanted to the anterior-lateral part of the femoral neck. The fibula artery and vein were anastomosised with lateral circumflex artery and vein. Results : One hundred and twenty-nine cases of non-union femoral neck fracture were treated with vascularized fibula graft in our hospital from 1982 to 2002. Eighty-seven cases of them were followed up for 3 to 19 years with functional and X-ray examination. The percentage of fracture healing and effect were 94. 3 and 81. 6, respectively. Conclusion:The fibula with blood supply has a synergistic fixation impact on the non-union femoral neck fractures. The fibula is solid enough for supporting the femoral head and preventing it from collapse. The vascularized fibula grafting, by providing blood supply to the affected femoral head and neck, could promote the femoral head restoration and reconstruction. In addition, the periosteum of fibula plays a role in fracture healing.
文摘Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current evidence on diagnostic protocols and management strategies,highlighting optimal approaches and emerging trends.Initial care emphasizes soft tissue assessment,often guided by the Tscherne classification,and fracture classification systems.External fixation may be required in open injuries,while early open reduction and internal fixation within six days is linked to improved outcomes.Minimally invasive techniques for the lateral malleolus,including intramedullary nailing and locking plates,are effective,while medial malleolus fractures are commonly managed with screw fixation or tension-band wiring.Posterior malleolus fragments involving more than 25%of the articular surface usually warrant fixation.Alternatives to syndesmotic screws,such as cortical buttons or high-strength sutures,reduce the need for secondary procedures.Arthroscopic-assisted open reduction and internal fixation benefits younger,active patients by enabling concurrent management of intra-articular and ligamentous injuries.Postoperative care prioritizes early weight-bearing and validated functional scores.Despite advances,complications remain common,and further research is needed to refine surgical strategies and improve outcomes.
文摘Isolated distal fibula fractures represent the majority of ankle fractures.These fractures are often the result of a low-energy trauma with external rotation and supination mechanism.Diagnosis is based on clinical signs and radiographic exam.Stress X-rays have a role in detecting associated mortise instability.Management depends on fracture type,displacement and associated ankle instability.For simple,minimally displaced fractures without ankle instability,conservative treatment leads to excellent results.Conservative treatment must also be considered in overaged unhealthy patients,even in unstable fractures.Surgical treatment is indicated when fracture or ankle instability are present,with several techniques described.Outcome is excellent in most cases.Complications regarding wound healing are frequent,especially with plate fixation,whereas other complications are uncommon.
文摘The Objective is to evaluate Elastic Stable Intrame-dullary Nailing (ESIN) fixation through the treat-ment of children’s shaft fracture of tibia and fibula. From January 2007 to January 2009, 16 cases of children’s shaft fracture of tibia and fibula had been treated by ESIN. 15 cases were followed up after the surgery and the follow-up time was 4 - 12 months (4.5 in average). The results turn out that all the patients’ fractures have got healed by Phase I and the healing time is 10 weeks in average. The near joints’ activity and affected extremity completely return to normal. This group of cases doesn’t show any sign of infection, bone nonunion, malunion or epiphysis injury. And six patients have had their intramedullary nails taken out after six months. It can be concluded that ESIN is good for treating children’s long diaphysis fracture which has difficulty in closed diaplasis and is suitable for children aged 6 - 13. ESIN has the advantages of small incision, slight injury of soft tissue, short sur-gery time, rapid recovery and few complications.
文摘Objective To derive regression formulae for stature estimation using forensic radiography from the tibia and fibula of Chinese Han teenagers in Sichuan Province. Methods To construct equations, measurements were conducted on the training sample (412 adults, 201 males and 211 females). The whole length of the fibula and four measurements of tibia were determined using CR radiography, rectified through theoretical magnification. The regression formulae were relatively constructed to the real stature measured in an erect position. Through using the testing sample (40 adults) for the regression formulae, the reliability of the regression formulae was assessed. Results The range of correlation coefficients of four measurements for tibia was 0.880-0.895 in the sex-unknown group, 0.869-0.893 in the male, and 0.8450.855 in the female. The five measurements were found to be better correlated with stature in the male than in the female. Conclusion The digital X-ray of the tibia and fibula for stature estimation is proved to be effective in forensic individual identification; therefore, these equations can be of great assistance to the stature estimation of the contemporary Chinese Han teenagers.
文摘BACKGROUND Ankle fractures are common injuries in the young and elderly populations.To prevent post-traumatic arthritis,an anatomic reconstruction of the ankle structure is mandatory.Open reduction and internal fixation is the treatment of choice among orthopaedics.Conventional plates allow stability of the fracture if bone quality is present.Locking plates might offer an advantage for the treatment of lateral malleolar fracture in patients with comminution,severe instability,distal fractures,or osteoporotic bone.Our hospital introduced a new locking plate for fracture of the distal fibula.AIM To evaluate locking plates in terms of outcomes and complications in young and elderly patients.METHODS We retrospectively reviewed a total of 67 patients treated for displaced distal fibula fractures.Demographic data,number of comorbidities,use of inter fragmentary screw,complication,time of fracture healing,partial or full weight bearing,and reoperation were recorded for all patients.Clinical outcome was assessed by the American Orthopedic Foot and Ankle Society clinical scoring system.Radiographs were obtained at 4,8,12,16,20,and 24 wk until radiographic union was obtained.RESULTS All patients displayed complete bony union on radiographic assessment,and no patients developed any serious complications.We observed two superficial infections,one delayed wound healing,and two plate intolerances.Significant differences were observed between the two age groups in terms of radiographic healing(11.9 wk in younger patients vs 13.7 wk in older patients;P=0.011)and in the American Orthopedic Foot and Ankle Society score at 6 mo after surgery(88.2 in younger patients vs 86.0 in older patients;P=0.001)and at 12 mo after surgery(92.6 in younger patients vs 90.0 in older patients;P=0.000).CONCLUSION Locking plates provide a stable and rigid fixation in multifragmentary and comminuted fractures or in the presence of poor bone quality.
基金supported in part by grants from the Clinical Research for Crossing Item of Shandong University(No.2020SDUCRCB001)the Shandong Provincial Natural Science Foundation(No.ZR2020MH180)+1 种基金the Rongxiang Regeneration Medicine Fund of Shandong University(No.2019SDRX-11)the Science and Technology Development Plan of Jinan City(No.201805041)。
文摘Introduction Mandibular segmental defects result in significant cosmetic and functional deficiencies.Meanwhile,the reconstruction of both the contour and function of the mandible is a challenging task.At present,autologous vascularized fibula transplantation is the most common method to reconstruct a mandible with long-span defects[1].
文摘laterals or femoral head and neck of 18 mature healthy male domestic dogs were divided into two groups by the principle or auto-control.Avascular osteonecrosis of femoral head(ONFH)and old femoral neck fracture(FNF)were made respectively.Free vascularized fibula grafting was performed 2 weeks later.Arter operation, X-ray,histopathological,electron microscopic,tetracycline fluorescence labelling and99mTc-methylene diphosphorate scanning were carried out respectively.The result indicated that free vascularized fibula grarting could provide new blood supply system to injured femoral head and participate in the repairing process of avascular uecrosis of femoral head.
文摘BACKGROUND Aggressive giant cell tumor of the distal fibula is so rare that no consensus on a surgical strategy has been reached.Thus,an appropriate treatment strategy is still important to discuss.CASE SUMMARY A 61-year-old man who had been experiencing progressive swelling of the left lateral malleolus accompanied by pain for half a year was presented at our hospital.He had never been treated prior to coming to our hospital.Preoperative imaging revealed a 10 cm×6 cm mass located in the body of the distal fibula.Pathological biopsies confirmed it was a giant cell tumor.Preoperative examination revealed he had dilated cardiomyopathy with class 3 cardiac function.The cardiologist and anesthesiologist determined that he could tolerate the operation,but the operation should be as short and minimally invasive as possible.With the patient’s consent,we performed a tibiotalar fusion and followed up with him for 2years,finding no recurrence and a satisfactory recovery.CONCLUSION Tibial talus fusion is an effective method for the treatment of distal fibula tumors.
文摘Chronic osteomyelitis in children is frequent in the developing countries. Their complications and morbidity burden the functional prognosis. The reconstruction of diaphyseal bone loss after sequestrectomy in young children remains a difficult and expensive challenge in our context. The delay in care and the lack of social security for all, are risk factors for morbidity. The induced membrane technique described by Masquelet starts to be applied and showed satisfactory results. We report the results of a case of reconstruction of the proximal humerus by using a non-vascularized fibula and supplemental bone substitute in a boy of 2 years with sickle cell. No scarring occurred at the sampling site. The process of bone consolidation is underway.
文摘<p style="text-align:justify;"> <span style="font-family:Verdana;">Chronic osteomyelitis is serious because of the orthopedic sequels that they could cause. Extended diaphyseal sequestrations could cause bone loss and their management is delicate. Here we report a case of right ulnar diaphyseal reconstruction by non-vascularized fibula transfer. This was a three-year-old girl, non-sickle cell, who had chronic osteomyelitis of the right ulna. The evolution was towards an almost total ulnar diaphyseal sequestration with externalization of the distal extremity. The removal of this large sequestrum occurred almost spontaneously, leaving a significant bone loss over a length of about 6 cm. Secondarily, we reconstructed the right ulnar diaphysis by transfer of a free non-vascularized graft of the left fibula, maintained by a pin. </span><span style="font-family:Verdana;">The follow up was favorable with almost complete recovery of pro</span><span style="font-family:Verdana;">no-supination. Fibular ossification has evolved as well and we did not notice any complications at the graft collection site. Non-vascularized fibula graft transfer is a useful therapeutic option in the management of significant bone defect</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> secondary to chronic osteomyelitis of one of the two forearm bones.</span> </p>
基金The Scientific and Technological Innovation Platform of Huaihua,China,No.2022F2701The Science and Technology Planning Project of Huaihua,China,No.2021R3117.
文摘BACKGROUND Fibrous dysplasia is a congenital disorder in which normal bone is replaced by fibro-osseous tissue or irregular trabeculae of woven bone intermixed with mature collagenous tissue.A single or multiple bones are affected.This rare bone disorder has three clinical patterns including monostotic,polyostotic,and that associated with McCune-Albright syndrome.Most studies report primary fibrous dysplasia.However,a few cases of recurrent monostotic fibular fibrous dysplasia have been reported.Here,we report a therapeutic strategy for recurrent fibular fibrous dysplasia.CASE SUMMARY A 4-year-old boy was admitted for persistent pain in the left lower limb and abnormal gait over the previous 9 mo.He had no history of present or past illness.Preoperative imaging data showed erosion-like changes with bone expansion of the left middle and lower fibular segment.Tumor tissue in the fibular bone marrow cavity was removed by curettage,and rapid intraoperative pathological examination suggested fibular fibrous dysplasia.An allograft was implanted into the fibular medullary cavity.However,he was readmitted with clinical symptoms including persistent pain,abnormal gait,and local swelling at the age of 6 years.He was diagnosed with recurrent fibular fibrous dysplasia based on the second medical examination.He underwent fibular bone tumor radical resection and longus fibular allograft transplantation combined with fibular bone locking plate and screws.Good host bone to allogenic bone graft fusion was observed by the physician on postoperative regular follow-up.CONCLUSION Radical resection of fibrous dysplasia and longus fibula allograft combined with internal fixation for reconstruction are suitable for the treatment of recurrent monostotic fibular fibrous dysplasia.
文摘Reconstructions of the sternum remain a formidable challenge for the operating team. Reconstruction of the sternumdefect, regardless of the reason, should ensure the stability of the anterior chest wall, the return of acceptable respiratory parameters and the control of wounds. Stability of the chest wall can be provided by autogenous tissues or prosthetic materials. In our experience, the fibula free osteocutaneous flaps are harvested for reconstruction of the bone defect in two patients after full-thickness defect of the sternum and anterior chest wall.
文摘Gap bone defect is a major challenge. Its treatment has evolved over the years from amputation to limb reconstruction through vascularised graft, distraction osteogenesis and use of customised implants. Availability and affordability of these innovative techniques have always been an additional challenge in the developing resource poor countries. We report the use of Tibialization of Ipsilateral fibula first suggested by Hahns in 1884 to bridge a gap of 12 cm in an 8 year old male, with segmental tibia loss from chronic osteomyelitis. We did an end to end transposition of the ipsilateral fibular into the tibia gap defect in a one stage procedure. This was after eradication of the infective process of osteomyelitis. He commenced partial weight bearing ambulation in cast at 3 months and out of cast ambulation at 18 months post surgery. The transposed fibula was 75% tibialized at 18 months post surgery. Conclusion: Fibular is a useful armamentarium in filling segmental bone defect.
文摘Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.
文摘Objective:To investigate the relationship between serum adhesion molecules, trace elements and delayed union of tibial and fibula fractures.Methods:A total of 46 patients with delayed union of tibial and fibula fractures in our hospital from May 2014 to June 2016 were selected as the observation group, 46 patients with normal healing of tibial and fibula fractures were selected as the control group, then the serum adhesion molecules and trace elements levels of two groups at forth, eighth and sixteenth week after the surgery were compared.Results:The serum dhesion molecules levels of observation group at forth, eighth and sixteenth week after the surgery were all higher than those of control group, the serum trace elements levels were all lower than those of control group, and the serum adhesion molecules levels of two groups at eighth week after the surgery were all higher than those at other time, the trace elements levels were all lower than those at other time (allP<0.05).Conclusions:The serum adhesion molecules and trace elements of patients with delayed union of tibial and fibula fractures show obviously abnormal state, so those indexes of those patients should be paid to more monitoring and improvement.
文摘Objective: to observe the short-term therapeutic effects of single condylar replacement and fibular osteotomy combined with arthroscopic debridement in patients with knee osteoarthritis. Methods: 30 patients with knee osteoarthritis (all moderate) who underwent surgery in our hospital were included in the study. These patients used two different surgical schemes, of which 15 cases were used as the cleaning group, the surgical scheme was fibular osteotomy + arthroscopic cleaning, and another 15 patients underwent single ankle replacement as the single condyle replacement group. The clinical indexes of the two groups were compared before operation, 3 months and 6 months after operation to evaluate the short-term curative effect. Results: the VAS score of the two groups 6 months after operation was significantly lower than that of the other two observation points. The data were processed, indicating that P < 0.05. In terms of HSS score, the statistical results showed that the score level 6 months after operation was in a higher state, indicating that the knee condition of patients at this time point was better (P < 0.05). Compared with the preoperative femoral tibial angle, the level of this index was lower in both groups 6 months after operation (P < 0.05). The femoral tibial angle in fibular osteotomy group was greater than that in single condyle replacement group, and the difference was statistically significant (P < 0.05). Conclusion: fibular osteotomy combined with arthroscopic debridement has the advantages of minimally invasive, definite curative effect, rapid recovery, less complications, less cost and high satisfaction.
