Operative versus nonoperative management of Pipkin type-II fractures associated with posterior hip dislocation

Little has been written on randomized, controlled studies of operative versus nonoperative management of Pipkin type-II fractures associated with posterior dislocation of the hip. It is difficult to validate the optimal management of these fractures. The goals of this study were to (1) evaluate the results of conservative and surgical treatment for Pipkin type-II fractures associated with posterior dislocation of the hip and supply the optimal management for these fractures and (2) identify whether the Smith-Petersen approach is a safe and reliable surgical approach for Pipkin type-II fractures.Twenty-four patients were randomly divided into 2 groups: the conservative group (n=12) was treated by closed reduction, and the surgical group (n=12) was treated by primary open reduction internal fixation (ORIF) by bioabsorbable screws via a Smith-Petersen approach. Minimum follow-up was 24 months. Functional outcome was measured using the Thompson and Epstein score and the d'Aubigné-Postel score. Heterotopic ossification was classified based on the Brooker classification. The outcome of the conservative group was worse than that of the surgical group (P=.037). Two patients in the conservative group needed joint replacement for avascular necrosis of the femoral head. Heterotopic ossification was found in 6 patients (1 patient in the conservative group and 5 in the surgical group).Primary ORIF by bioabsorbable screws via a Smith-Petersen approach is an effective treatment for Pipkin type-II fractures associated with posterior dislocation.

[Treatment of Pipkin type I fracture of femoral head associated with posterior dislocation of the hip]

OBJECTIVE

To evaluate and compare the outcomes of simple closed reduction, selective fragment excision after closed reduction, and emergency fragment excision and reduction in the treatment of Pipkin type I fracture of femoral head associated with posterior dislocation of the hip.

METHODS

Between January 2002 and January 2008, 24 patients with Pipkin type I fracture of the femoral head associated with posterior dislocation of the hip were treated with simple closed reduction (closed reduction group, n=8), with selective fragment excision after closed reduction (selective operation group, n=8), and with emergency fragment excision and reduction (emergency operation group, n=8). In the closed reduction group, there were 6 males and 2 females with an average age of 37.6 years (range, 19-56 years); injuries were caused by traffic accident in 6 cases, by falling from height in 1 case, and by crushing in 1 case with a mean disease duration of 3.1 hours (range, 1.0-7.5 hours); and the interval from injury to reduction was (4.00 +/- 2.14) hours. In the selective operation group, there were 7 males and 1 female with an average age of 37.3 years (range, 21-59 years); injuries were caused by traffic accident in 7 cases and by falling from height in 1 case with a mean disease duration of 3.2 hours (range, 1.0-6.0 hours); and the interval from injury to reduction was (3.90 +/- 1.47) hours. In the emergency operation group, there were 5 males and 3 females with an average age of 35.5 years (range, 20-58 years); injuries were caused by traffic accident in 5 cases, by falling from height in 1 case, and by crushing in 2 cases with a mean disease duration of 3.3 hours (range, 1.5-6.5 hours); and the interval from injury to open reduction was (5.10 +/- 2.04) hours. There was no significant difference in the age, gender, disease duration, and interval from injury to reduction among 3 groups (P > 0.05).

RESULTS

All wounds in selective operation group and emergency operation group healed primarily. All the patients were followed up 24 to 58 months (mean, 38.7 months). According to Thompson-Epstein system, the excellent and good rates were 50.0% (4/8) in the closed reduction group, 87.5% (7/8) in the selective operation group, and 87.5% (7/8) in the emergency operation group at 24 months after operation, showing significant difference among 3 groups (chi2 = 9.803, P = 0.020). Heterotopic ossification was found in 1 case (12.5%) of the closed reduction group, in 4 cases (50.0%) of the selective operation group, and in 4 cases (50.0%) of the emergency operation group, and avascular necrosis of femoral head was found in 2 cases (25.0%) of the closed reduction group; there was no significant difference in complications among 3 groups (P > 0.05).

CONCLUSION

The treatment of Smith-Petersen approach and fragment excision by selective operation or emergency operation has similar outcome, which are better than the treatment of simple closed reduction.

Multicentric epithelioid hemangioendothelioma involving the same lower extremity: a case report and review of literature

Epithelioid hemangioendothelioma (EH) is an uncommon low-grade malignant soft-tissue tumor; no case has been previously reported where multicentric epithelioid hemangioendothelioma occurred in the same lower extremity at different sites. We report a case involving the common peroneal nerve and subsequently the long bone and the short bones of the same lower extremity, and also review the literature. After establishing case of several lesions, we reviewed the histopathology properly and followed up the patient for a long time with serial whole body assessment to pick up any subsequent lesions.

[Design and biomechanical analysis of nickel-titanium open shape memory alloy artificial vertebral body]

OBJECTIVE

To design an open shape memory alloy artificial vertebral body that can be used to reconstruct the vertebral body in spine diseases, such as thoracic-lumbar spine tumors, burst fracture of the vertebrae, kyphosis and scoliosis, and to evaluate the biomechanical stability of lumbar functional segment unit after insertion with the shape memory alloy artificial vertebral body.

METHODS

The open shape memory alloy artificial vertebral body with nickel-titanium (NiTi) alloy was made. Eight fresh spine specimens (T14-L5) from normal adult porcine were used to detect the range of motion (ROM) in 4 models and were divided into 4 groups: intact vertebrae served as group A; pedicle screw fixation of T15, L1, L3, and L4 was given in group B; after total resection of L2, it was reconstructed by open shape memory alloy artificial vertebral body combined with pedicle screw fixation of T15, L1, L3, and L4 in group C; and after total resection of L2, it was reconstructed by titanium cage vertebral body combined with pedicle screw fixation of T15, L1, L3, and L4 in group D. The three-dimensional ROM of flexion, extension, left/right lateral bending, and left/right rotation in T15-L1, L1-3, and L3,4 segments were detected in turn by the spinal three-dimensional test machine MTS-858 (load 0-8 N x m).

RESULTS

Compared with group A, groups B, C, and D had good stability in flexion, extension, left/right lateral bending, and left/right rotation, showing significant differences (P < 0.05). There was no significant difference in the degree of each motion between group B and group C (P > 0.05). Group C had less degree of motion in T15-L1 and L3,4 segments than group D, showing significant differences (P < 0.05), but there was no significant difference in L1-3 segment (P > 0.05).

CONCLUSION

The open shape memory alloy artificial vertebral body has a reasonable structure and good biomechanical stability, it can be used to stabilize the spinal segment with pedicle screw fixation.

Study of development in an experimental animal model of a pediatric physeal slide-traction plate

BACKGROUND

To develop a physeal slide-traction plate for children can provide rigid internal fixation of a bone fracture without inhibiting epiphyseal growth.

METHODS

The slide-traction plates and standard plates were designed to configure to the femoral condyle. Twelve of thirty goats were used as normal controls and the rest were implanted with plates (right femurs were fixed with standard plates, and left femurs were fixed with slide-traction plates). All goats underwent X-ray examination at 1 month, 3 months and 6 months after surgery, and femoral length were measured. Histological staining and electron microscopy were performed to evaluate the development of the epiphyseal plate at 3 and 6 months after surgery.

RESULTS

Compared to the standard plate, the slide-traction plate group exhibited more normal physeal growth, histologic features, safranin O staining, and electron microscopy structural features. There were significant differences in length in the femurs of goats fixed with slide-traction plates and standard plates at 1 month, 3 months, and 6 months after surgery, respectively. There was no difference between femurs of the normal control group and the femurs fixed with the slide-traction plates. Thicker epiphyseal plates were found in the left vs. the right femurs of the group fixed with plates at 3 and 6 months after surgery. In the group fixed with plates, Safranin O staining showed that the epiphyseal plates of the left femurs had more fuscous staining than the right femurs at 3 and 6 months after surgery. Electron microscopy also showed that cells in the epiphyseal plates of the left femurs were healthier in appearance than cells from the right femurs in the group fixed with plates.

CONCLUSION

The physeal slide-traction plate can slide with the growth of the physis and is suitable for fixation of fractures in this region.

[Design and experimental study of an epiphyseal slide-traction plate]

OBJECTIVE

To develop an epiphyseal slide-traction plate in child, which can supply the fracture a sufficient internal fixation, and will not restrain the growth of epiphyses. Animal experiments were carried out with the plates to compare the slide-traction with traditional plate.

METHODS

Develop a slide-traction plate for the configuration of the femur condylus of children. Thirty adolescent goats in the experiment were divided into control group (12 goats) and plate group (18 goats). In plate group, right femurs of goats were fixed with common plates and the left femurs with slide-traction plates. All the goats were given X-ray examination at different time after surgery. And the goats were sacrificed at 3 and 6 month, histological method and electron microscopy were performed to evaluate the development of epiphyseal plate.

RESULTS

The both femurs of the goats in control group have no difference in evidence in length at all time we examined. And the both femurs of the goats fixed with plates have no difference in evidence in length at 1 day after surgery. However, the both femurs of the goats fixed with plates have difference in evidence in length at 1 month, 2 month, 3 month, 6 month after surgery. The increased length of the femurs at I month, 2 month, 3 month, 6 month after surgery was also compared with the length at 1 day after surgery, there was difference in evidence between the right femurs of the control group and the femurs were fixed with common plates, but no difference in evidence between the left femurs of the normal control group and the femurs were fixed with slide-traction plate (P > 0.05). More thicker epiphyseal plate were found in the left femurs than the right femurs of the group fixed with plates at 3 and 6 month after surgery (P < 0.01). In the plate group, safranine O staining showed epiphyseal plates at the left femurs had more fuscous staining than the right femurs at 3 and 6 month after surgery and electron microscopy also found that the cells of the epiphyseal plates of left femurs were more eugenic than the right femurs at 3 and 6 month after surgery.

CONCLUSION

The epiphyseal slide-traction plate can slide with the growth of epiphyses, which is suitable for fixation of the fracture in this part.

Bone splint technique and plating application in adolescent high-energy comminuted fracture of distal femur with bone defects

Comminuted fracture of distal femur is a common lower limb injury from traffic accidents, especially from motor accidents. Routine dynamic condylar screw (DCS) or 95-degree condylar plate (CP) sometimes cannot solve the bone defect in the center of alignment and contralateral diaphysis for the reason of absent screw anchor point, especially for AO C2.2-2.3 types. Many authors recommended open reduction and fixation with less invasive stabilization system (LISS) as the treatment of choice, but there are still problems in fusion and alignment. In this study, we reported our experiences with the use of bone splint technique in the high-energy commimuted fracture of distal femur with central and medial bone defect in adolescents.

[Intracystic allograft in management of long bone cyst merging pathologic fracture]

OBJECTIVE

To investigate the efficiency of intracystic allograft fixed with bone plate and steel plate in management of long bone cyst merging pathologic fracture.

METHODS

Twelve cases of long bone cysts with pathologic fractures were treated from January 1996 to April 2002. The median dimension of the cyst on the radiograph was 3. 6 cm x 8.1 cm. We regularly revealed the sites of cysts, cut the anterior wall, got cystic membrane away, implanted allo-bone fibula, ulna or radius shafts which were defatted and deproteined. The auto-bone and the allo-bone of all cases were fixed with bone plate and steel plate; external fixation was managed for 3 weeks after operation.

RESULTS

All incisions achieved primary healing. All cases were followed up 2. 7 years on average. According to Capanna's standard, 9 cases completely healed, 3 cases basically healed, no cases recurred. The function in shoulder joint was slightly limited in 2 cases that cysts were located on the upper humerus, while that of the other 10 cases were recovered completely.

CONCLUSION

Intracystic allograft fixed with bone plate and steel plate is safe and effective in management of long bone cyst merging pathologic fracture.

[Salvage of lower limb with long-time injury of popliteal artery]

OBJECTIVE

To evaluate the rate of salvage of lower limb with long-time injury of popliteal artery.

METHODS

Twenty-one patients with injury of popliteal artery were treated. The interval between injury and repair of artery ranged from 12 hrs to 48 hrs. The essences of operation were thorough debridement of the ischemic and necrotic muscles, primary suture of wound, and repair of popliteal artery on the basis of reduction and fixation of fracture.

RESULTS

The limb salvage were achieved in 19 cases. The saved limbs could fulfill the basic function of walk.

CONCLUSION

Thorough debridement of ischemic and necrotic muscle and primary suture of wound were reasonable methods which could treat long-time injury of popliteal artery without amputation.

Modulation of prostacyclin and thromboxane secretion by cytotrophoblasts from normal and pre-eclamptic human pregnancies

We and others have previously observed an imbalance in cytotrophoblast secretion of the vasoactive prostanoids prostacyclin and thromboxane A(2) in pre-eclampsia. To examine the effects of potential modulators of this imbalance, cytotrophoblasts isolated from normal and pre-eclamptic pregnancies were incubated in the presence of lipopolysaccharide, the calcium ionophore A23187, tumour necrosis factor alpha, or interleukin 1beta, with or without the cyclo-oxygenase inhibitor, indomethacin. Further incubations included the drugs tranylcypromine, a prostacyclin synthetase inhibitor (0.1, 10 microM ), or the thromboxane synthetase inhibitor, pirmagrel (0.001, 1 microM ). Results showed that cytotrophoblasts from pre-eclamptic pregnancies had increased thromboxane production and significant stimulation of prostacyclin production by lipopolysaccharide and calcium ionophore. Lipopolysaccharide stimulated thromboxane production in normal cytotrophoblasts, while indomethacin almost completely inhibited production of both prostanoids. Tranylcypromine mildly inhibited prostacyclin production in normal cytotrophoblasts only, whereas pirmagrel strongly inhibited thromboxane production in a dose-related manner, with reciprocal increase in prostacyclin production occurring in cytotrophoblasts from pre-eclamptic pregnancies. This study confirmed that cytotrophoblasts from pre-eclamptic women had increased thromboxane production and showed that pirmagrel, at the relatively low dose of 0.001 microM, was able to normalize the imbalance of thromboxane and prostacylin production and may therefore warrant further investigation as a treatment for pre-eclampsia.

[Local plantar rotatory flap for repairing of soft tissue defect of heel]

OBJECTIVE

Soft tissue defect of heel is not uncommon. Transplantation of free cutaneous flap and transfer of axial cutaneous flap have been used in treating such defect successfully, but both of them are somewhat complicated. Local plantar rotatory flap might show great importance in this field.

METHODS

Since March 1993 to March 1998, 9 cases with soft tissue defect of heel were repaired by local plantar rotation flaps. The size of defect ranged from 2 cm x 4 cm to 6 cm x 8 cm, and it was designed superficial to plantar fascia. The flap was medially based, and nutrilized by proximal plantar subcutaneous plexus of blood supply as well as lateral and medial plantar nerve.

RESULTS

Followed up 4 months to 2 years, all the flaps were survived. Sensation of the flap was preserved in 7 patients, who had normal sensation of the donated area preoperatively. The transferred flap was endurable to body bearing.

CONCLUSIONS

The flap is easily prepared with reliable blood supply and sensation of the flap preserved. The method is worthy to be recommended for widely use because of its advantages over other methods.

[Measurement of the three dimensional shape about crown with the digital speckle correlation method]

It is the first step that the data about relative teeth's shape are catched for CAD/CAM system in dental rehabilitation.That is how to measure the teeth's shape.The digtal speckle correlation method are introduced to measure the teeth's shape in the article.For one posterior tooth,we measured the five surfaces that the occlusal surface and the four axial surfaces.According to some special marks,we changed the five group's local data into one coordinate and reconstructed the three dimensional shape of the tooth.At last we drew the graph with the computer.In this paper the author also discussed some factors about the measure system's sensitive and precise and the extent scale.etc.

In-vitro secretion of prostanoids by placental villous cytotrophoblasts in pre-eclampsia

Villous trophoblasts isolated from term placentae of normal pregnancies, and pregnancies complicated by chronic hypertension or pre-eclampsia, were examined over 7 days in primary culture. Low levels of prostaglandin E2 and prostacyclin (measured as 6-keto prostaglandin Fl alpha) were secreted by trophoblast cells from all three clinical groups. Secretion was maximal at day 1 and decreased exponentially thereafter. Thromboxane secretion also fell sequentially from day 1. Thromboxane secretion by pre-eclamptic trophoblasts was three to four times that of cells from normal or chronically hypertensive subjects. Prostanoid secretion by isolated cultured cytotrophoblasts was not dependent on aggregation or morphological alteration, nor related to changes in progesterone or human chorionic gonadotrophin production. Because the local maternal circulation is exposed to substances secreted by this cell population, thromboxane could be the trigger for vasoconstriction and coagulation found within the maternal uteroplacental circulation in pre-eclampsia.

[Endothelial adhesive molecules and vascular permeability]

Endothelial cells (EC) are the main permeable barrier of vascular wall, and play important roles in the regulation of vascular permeability. Cell adhesive molecules (CAM) participate in cell-to-cell junction organization and cell-to-matrix adhesion. CAM are closely related to endothelial integrity and permeability. Three CAM families take part in the intermediate junction of EC formation: integrin family, cadherin family and immunoglobulin family. Studies on CAM are helpful to elucidate the mechanism of EC injury and repair, new vessel formation, regulation of vascular permeability and circulation blood cell emigration.

Pentoxifylline attenuates platelet activating factor-induced permeable edema in isolated perfused guinea pig lungs

The effect of pentoxifylline (Pen) on platelet activating factor (PAF)-induced pulmonary injury was studied in isolated guinea pig lungs perfused with cell-free Tris buffered Ringer solution. PAF (1.0 nmol.L-1) increased lung weight and pulmonary filtration coefficient (Kf), which indicated the formation of high permeable pulmonary edema. Pen (0.5 and 1.0 mmol.L-1) markedly attenuated the PAF-induced increment of lung weight and vascular permeability, but not the increment of pulmonary capillary pressure and venous resistance. There was no correlation between the severity of lung edema and the number of leukocytes in the perfusates. These results suggest that Pen has direct anti-permeability effect on pulmonary microvessels.

Renal sympathetic preganglionic neurons demonstrated by herpes simplex virus transneuronal labelling in the rabbit: close apposition of neuropeptide Y-immunoreactive terminals

Renal sympathetic preganglionic neurons in the spinal cord of rabbits were transneuronally retrogradely labelled by injection of Herpes simplex virus type 1 into the renal nerve and immunohistochemical demonstration of viral antigen. The morphology of the labelled neurons was examined, particularly with respect to the shape and extent of their dendritic trees. Double-labelling immunohistochemical studies were performed to determine the relationship of neuropeptide Y-immunoreactive axons to virus-labelled perikarya and dendrites. The shape of the renal sympathetic preganglionic neurons differed according to whether the neurons were located in the intermediolateral cell column or in other sympathetic areas. The neurons in the intermediolateral cell column had very long dendrites, extending in the rostrocaudal and mediolateral directions. The medially oriented processes extended towards and beyond the central canal. The laterally oriented dendritic processes projected within the dorsolateral funiculus, towards the edge of the spinal cord. Neuropeptide Y-immunoreactive fibres were concentrated in regions containing renal sympathetic preganglionic neurons of the spinal segments examined (T7-L2). Immunoreactive varicose terminals were closely opposed to individual preganglionic neurons, especially to the dendritic processes of these neurons. Our findings indicate that neurotransmitter candidates such as neuropeptide Y are likely to influence renal preganglionic neurons by an input to dendritic processes at some distance from the perikarya. Electrophysiological and other functional studies utilizing applications of neurotransmitter candidates onto these neurons should take this into account.

Transneuronal labelling of neurons in rabbit brain after injection of herpes simplex virus type 1 into the renal nerve

We mapped the distribution of virus-labelled neurons in the brain after injection of Herpes simplex virus type 1 (HSV1) into the rabbit renal nerve. Seven days after injection, labelled neurons were observed in four brain regions, the rostral ventrolateral medulla (47 +/- 3% of neurons), the A5 area of the lower pons (38 +/- 4%), the caudal raphe nuclei and the parapyramidal area of the medulla (13 +/- 2%), and the paraventricular nucleus of the hypothalamus (1 +/- 1%). In the rostral ventrolateral medulla approximately one half of the HSV1-labelled neurons also contained tyrosine hydroxylase, characterizing them as C1 neurons. In the A5 area virtually all HSV1-labelled neurons also contained tyrosine hydroxylase. In the raphe nuclei and the parapyramidal area 47% of HSV1-positive neurons contained serotonin. The distribution of labelled neurons was similar to that observed after injection of HSV1 into the adrenal gland.

Renal and adrenal sympathetic preganglionic neurons in rabbit spinal cord: tracing with herpes simplex virus

We mapped sympathetic renal preganglionic neurons in the rabbit spinal cord using Herpes simplex virus retrograde transneuronal tracing after application of the virus to the renal nerve. Virus-positive neurons were found in the spinal cord from T7 to L2, principally in the ipsilateral intermediolateral cell column. Renal and adrenal preganglionic neurons are largely separate populations. Extensive nonspecific spread of virus from infected cells to neighboring neurons does not appear to occur.