Ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint dislocation

We report the case of a 20-year-old man with an ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint (ACJ) dislocation. The combination of these two injuries is rare. A literature search produced various treatment algorithms. In this case, the patient was successfully treated with a Bosworth screw.This work was carried out in the Department of Orthopaedics, William Harvey Hospital, Ashford, Kent, UK     

AO跟骨板在Ⅲ、Ⅳ型跟骨骨折的临床应用

目的 评价AO跟骨板治疗Ⅲ、Ⅳ型跟骨骨折的疗效。方法 21例29足严重跟骨骨折按Sanders分型：Ⅲ型18足；Ⅳ型11足，采用AO跟骨板及髂骨(或人工骨)植骨进行有限坚强内固定。对年老、骨质疏松严重的Ⅲ型和Ⅳ型跟骨骨折后距下关节不能达到解剖复位，整复跟骨外形后，AO跟骨板固定，同时一期行距下关节融合术。结果 按Maryland足部评分系统评价术后功能，本组29足Ⅲ、Ⅳ型跟骨骨折行AO跟骨板固定总体优良率为82．8％。结论 AO跟骨板治疗Ⅲ、Ⅳ型跟骨骨折疗效肯定，术后早期功能练习．减少骨折并发症，是一种治疗Ⅲ、Ⅳ型跟骨骨折的理想方法。     

股骨干骨折--扩髓和不扩髓髓内钉比较

治疗股骨干骨折，采用不扩髓髓内钉比扩髓髓内钉手术时间明显缩短，而且失血也少。但是，扩髓钉的骨愈合更快，延迟愈合更少。两者都没有显著增加包括肺损害等其它并发症的风险。功能结果不能确定。     

Biology and Biomechanics in Osteosynthesis of Proximal Humerus Fractures

Abstract Surgical treatment of proximal humeral fractures still remains a challenge. This is primarily due to the fact that sufficient implant fixation in humeral head fractures is often not achieved due to substantial bone tissue loss with increasing age. In the last few years the locking plates and locking nails have been introduced into clinical practice with varying results. The biomechanical studies have focused on locking plate osteosynthesis as well. The following paper focuses on bone quality, biomechanical studies and biology of proper osteosynthesis and reviews the most recent literature.     

可吸收螺钉与克氏针张力带治疗髌骨骨折应用选择比较

[目的]比较可吸收螺钉与传统克氏针张力带钢丝治疗髌骨骨折的有关问题,探讨可吸收螺钉在髌骨骨折治疗中的价值。[方法]采用聚-DL-乳酸(poly-DL-lacticacid,PDLLA)自膨胀可吸收螺钉治疗髌骨骨折组94例,男53例,女41例;平均40.5岁,平均随访时间32周。传统克氏针张力带钢丝组90例,男47例,女43例;平均38.5岁,平均随访时间30周。2组比较采用成组设计t检验。比较术后2组骨折临床愈合时间,8周时膝关节屈曲角度、与健侧相比关节活动丧失角度,2组手术时间,一次性住院费用和并发症等问题。[结果]通过随访,可吸收螺钉组临床愈合时间平均(10±2.0)周,术后8周膝关节屈曲角度平均为115°±10°、与健侧相比关节活动丧失10°±6.8°,手术时间平均60 min,无1例并发症;传统克氏针张力带钢丝组临床愈合时间(12±2.0)周,术后8周膝关节屈曲角度平均105°±8°、与健侧相比关节活动丧失15°±6°,手术时间平均55 min、一次住院费用平均9 430±1 000元,其中6例克氏针滑出并针眼感染、2例克氏针钢丝断裂、3例再次手术见张力带钢丝松动骨折移位愈合、1例髌骨骨质受损行石膏托固定。[结论]PDLLA自膨胀可吸收螺钉治疗髌骨骨折相比克氏针张力带钢丝法,具有髌骨周围软组织刺激症状少、内固定更稳定的优点。临床愈合时间相对较短,关节功能恢复更理想,病程中住院费用低,无并发症,且无需2次取出内固定,是一种值得推广和进一步探讨的方法。     

美国头颈癌患者生存资料分析

为使国内头颈癌生存分析的基本方法与国际一致，规范生存率分析的基本方法，以利于相互比较．本文以文字及表格方式，简述生存分析基本术语的概念、意义和应用，并介绍2002年第6版《美国头颈部肿瘤TNM分期》的1-5年观察生存率、相对生存率。     

Femoral attachment of the anterior cruciate ligament

Endoscopic anterior cruciate ligament (ACL) reconstruction is one of the most popular orthopaedic procedures. Correct tunnel positioning is a prerequisite to success. Current surgical techniques are unable to duplicate the complex anatomy and function of the native ACL. Surgery mainly aims at restoring anteroposterior laxity. The ACL is not isometric and only a few fibers are nearly isometric over the full range of motion. However, a nearly isometric behaviour of the ACL graft is desirable. Isometry is mainly influenced by femoral attachment; thus the femoral tunnel position has a greater effect than the tibial on graft length changes. The purpose of this article is to describe the anatomy of the femoral ACL insertion and to discuss the surgical techniques used to replicate it.     

Postmenopausal Women With Colles'' Fracture Have Lower Values of Bone Mineral Density Than Controls as Measured by Quantitative Ultrasound and Densitometry

Measurement of ultrasonographic parameters provides information concerning not only bone density but also bone architecture. We investigated the usefulness of ultrasonographic parameters and bone mineral density (BMD) to evaluate the probability of Colles' fracture. Two-hundred eighty-nine postmenopausal women (62.3 +/- 8.7 yr) with (n = 76) and without (n = 213) Colles' fracture were studied. BMD of lumbar spine and proximal femur was evaluated in all women by dual-energy X-ray absorptiometry (DXA) and speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness in the calcaneus were measured by a Sahara ultrasonometer (Hologic). Patients suffering from Colles' fracture had lower values of BMD adjusted by height at the lumbar spine, L2-L4 (0.797 g/cm2 vs 0.860 g/cm2), femoral neck (0.685 g/cm2 vs 0.712 g/cm2 ), SOS (1518 m/sg vs 1525 m/sg), and stiffness (74.6 vs 77.7) (p < 0.05). Nevertheless, BUA values were similar in both groups. After stepwise logistic regression analysis, the area found under receiver operating characteristic (ROC) curves was 0.60 for L2L4 and 0.63 for a formula combining L2L4 and height. Our data suggest that patients suffering from Colles' fracture have lower values of BMD by DXA, SOS, and stiffness. However, the ability of these techniques to discriminate is low because the values for the area under ROC curve are 0.60 for L2-L4 and 0.63 for a formula derived of the combination of L2-L4 and height.     

Improved Performance of Hip DXA Using a Novel Region of Interest in the Upper Part of the Femoral Neck: In Vitro Study Using Bone Strength as a Standard of Reference

We tested the hypothesis that bone mineral density (BMD) and bone mineral content (BMC) in proximal human femur specimens in the upper neck region of interest (ROI) and femoral neck axis length (FNAL) provide a significantly better prediction of femoral bone strength than standard ROIs in vitro. BMD and BMC were measured in 110 proximal femur specimens using a standard dual-energy X-ray absorptiometry (DXA) scanner. The analysis included a new ROI in the upper neck as well as the standard ROIs. FNAL was obtained from the scan images. The specimens' failure-load was measured in a mechanical loading device, simulating a fall on the greater trochanter. For the standard ROIs, correlations between failure-load and BMD ranged from R2 = 0.64 (shaft ROI) to R2 = 0.70, p < 0.001 (femoral neck). Prediction of strength by BMD did not significantly differ from those of BMC (R2 ranging from 0.65 to 0.75, p < 0.001). In the upper neck ROI, for both BMD and BMC correlations with failure-load were higher (R2 = 0.76 and 0.81, respectively; p < 0.001). A lower, yet still significant, correlation was found between FNAL and bone strength (R2 = 0.23, p < 0.001). Normalization of failure-load with respect to FNAL did not significantly increase the correlations with densitometric measures. This study provides in vitro evidence indicating that among the ROIs of the proximal femur the newly defined upper neck ROI provides the best prediction of bone strength. Only a weak association was observed between failure load and FNAL.     

改良术式综合治疗陈旧性髌骨骨折

目的探讨陈旧性髌骨骨折的治疗方法。方法对11例陈旧性髌骨骨折进行回顾性总结,采用保留髌骨,切开复位,松解粘连,改良张力带钢丝或/和聚髌器坚强的内固定,术后配合CPM机康复锻炼。结果11例全部随访,随访0.5～4.5年,根据胥少汀等制定的评定标准,优4例,良5例,优良率81.8%。结论不做髌骨切除,松解粘连、良好的对位,坚强的内固定,早期配合应用CPM机进行功能锻炼,可取得满意的疗效。