交锁髓内钉治疗胫骨干长节段粉碎性骨折

目的：阐明交锁髓内钉内固定治疗胫骨干多节段粉碎性骨折的优越性和手术要点。方法：分析2000年6月-2004年12月26例胫骨干长节段粉碎性骨折使用交锁髓内钉固定的疗效和手术注意事项。手术采用闭合穿钉。有限切开复位．部分钢丝捆绑复位碎骨块．再用瞄准器镇定骨折远、近端。结果：26例均获得随访，随访平均时间16．5个月（6-60个月）。远期疗效按马元璋评定标准：优13例．良10例．可3例．优良率88．5％（23／26）．平均骨临床愈合时间5．5月．一期骨折愈合率达到80．8％（21／26）。仅1例髓内钉发生锁钉断裂。无深部感染、骨髓炎、畸形愈合、骨不连的发生。结论：交锁髓内钉治疗胫骨干长节段粉碎性骨折较钢板有着微刨和更符合胫骨生物力学等优越性。本组骨折愈合率高．并发症少。认为是目前治疗胫骨干长节段粉碎性骨折的首选方法。     

交锁髓内钉治疗股骨胫骨骨折骨不连原因探讨

目的探讨股骨、胫骨骨折交锁髓内钉内固定后发生骨不连的原因及防治方法。方法对235例使用交锁髓内钉的股骨胫骨骨折病例进行回顾性分析,手术采用闭合、小切口或有限切开复位,用三维瞄准器锁定骨折远近端。结果235例随访189例196肢,平均随访15.2个月,股骨87例发生骨不连5例;胫骨109例发生骨不连8例。骨不连与骨折部位、手术方式、解锁时间有明显关系。结论应力遮挡和局部血供障碍是静力型交锁髓内钉所致骨不连的主要原因,术中尽量闭合复位和有限切开复位内固定及适时解锁可降低骨不连的发生。     

Irritant nail dermatitis of chemical depilatory product presenting with koilonychia

Chemical hair removal products are available as creams, gels, powders, aerosols and roll-ons and all of these forms work in the same way by breaking chemical bonds between sulfur atoms in the protein. Currently, the common active ingredients of these products are calcium thioglycolate, potassium thioglycolate, arsenic and sulfur minerals. Sulfur and arsenic containing products are important toxic chemicals which are mainly used for removing hair in developing countries. Irritant contact dermatitis accounts for 80% of all contact dermatitis reactions which are often occupation-related. Toluene sulfonamide, formaldehyde resin, acrylates and ethylcyanoacrylate are the most common irritants. Irritant nail dermatitis with plants has been well defined with Lobelia richardii flower, Compositae family and garlic. Although allergic dermatitis, irritant dermatitis and irritant nail dermatitis have been well demonstrated with chemicals, koilonychia is unusual presentation of irritant dermatitis. Here we describe a case of nail irritant dermatitis due to application of chemical depilatory product for hair removal presented with koilonychias. To our knowledge this is the first case of such presentation with koilonychia in the English literature.     

High incidence of screw penetration in the proximal and distal tibiofibular joints after intramedullary nailing of tibial fractures—A prospective cohort and mapping study

BackgroundIntramedullary-nails (IMN) are the treatment of choice for most tibial shaft fractures due to their minimally-invasive nature and non-demanding surgical technique. However, a potential iatrogenic pitfall is intra-articular interlocking screw positioning within the proximal (PTFJ) and distal (DTFJ) tibiofibular joints that may go unrecognized.ObjectiveTo evaluate the incidence of intra-articular screw penetration of the PTFJ and DTFJs after interlocking of IMN for tibial fractures.InterventionReamed IMN using modern techniques, including proximal interlocking via standard aiming jig and distal interlocking either freehand or using SureShot^®.MethodsProspective series of 165 consecutive patients with a tibial shaft fracture managed with an IMN. Diagnosis and incidence of penetration of the PTFJ and DTFJ was assessed on protocolled low-dose postoperative CT-scans (standardized clinical practice for assessing rotational alignment). The degree of penetration of the TFJ’s was graded as: Grade 1–slight breach of the tibial cortex; Grade 2–clear penetration of the tibial cortex with intra-articular screw tip; and Grade 3–penetration of both tibial- and fibular cortices with screw tip in fibula.ResultsOf the 165 tibial shaft fractures, using the AO/OTA classification, 69% were simple, 16% wedge and 15% complex fractures. Following IMN 42% of patients had intra-articular screw penetration of their PTFJ whilst 39% had penetration of their DTFJ. 66% of patients had penetration of either one- or both of their TFJs. The grading of PTFJ violation was distributed as follows: Grade 1 in 24 patients; Grade 2 in 26 patients and Grade 3 in 19 patients. DTFJ violation was graded as: Grade 1 in 21 patients; 40 patients had Grade 2 violation; and four patients had a Grade 3 penetration.ConclusionsThis diagnostic imaging study reports a high rate of intra-articular screw penetration of the PTFJ and DTFJ after interlocking of IMN for tibia shaft fractures. A prospective cohort study is underway to evaluate its clinical significance.Changes to enable alteration in forced angle of interlocking screw trajectory and avoidance of the anteromedial to posterolateral locking screw may reduce the incidence of TJF violation.Level of evidenceLevel II – Diagnostic Imaging Study     

Does an additional antirotation U-Blade (RC) lag screw improve treatment of AO/OTA 31 A1-3 fractures with gamma 3 nail?

IntroductionPoor bone quality and unstable fractures increase the cut-out rate in implants with gliding lag screws. The U-Blade (RC) lag screw for the Gamma3^® nail was introduced to provide monoaxial rotational stability of the femoral head and neck fragment. The purpose of this study was to evaluate whether the use of the U-Blade (RC) lag screw is associated with reduced cut-out in patients with OTA/AO 31A1-3 fractures.Material & methodsBetween 2009 and 2014, 751 patients with OTA/AO 31A1-3 fractures were treated with a Gamma3^® nail at our institution. Out of this sample 199 patients were treated with U-blade (RC) lag screws. A total of 135 patients (117 female, 18 male) with standard lag screw (treatment group A) were matched equally regarding age (±4 years) sex, fracture type and location to 135 patients with U-blade (RC) lag screw (treatment group B). Within a mean follow up of 9.2 months (range 6–18 months) we assessed the cut-out rate, the calTAD, lag screw migration, the Parker's mobility score and the Parker’s ratio at postoperatively, six and 12 months following surgery. Furthermore we recorded all complications, ASA-Score, hospital stay and duration of surgery retrospectively.ResultsThe most common fracture among group B with a cut-out of the lag screw were AO/OTA 2.3 and 3.2 fractures whereas in group A cut-out was most commonly seen in AO/OTA 2.1, 2.2 and 2.3 fractures, there was no significant reduction of the cut-out rate in group B 2.2% (n = 3) compared to group A 3.7% (n = 5). The duration of surgery was significantly shorter in group A (p < 0.05). There was no significant difference in lag screw placement, the Parker’s ratio and mobilization.ConclusionIn our study the U-Blade (RC) lag screw did not reduce the cut-out in treatment of OTA/AO 31A1-3 fractures at all. Considering the longer duration of surgery and the higher costs of the U-Blade (RC) lag screw, our results do not justify its use. However, further prospective randomized studies will be necessary.     

形状记忆合金弓齿钉治疗腕舟状骨腰部骨折

正2013年10月~2015年3月,我科采用腕掌侧切开复位形状记忆合金弓齿钉治疗17例腕舟状骨腰部骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组17例,男15例,女2例,年龄16~42岁。左侧1例,右侧16例,均为闭合骨折。新鲜骨折16例,陈旧性骨折1例,合并桡骨茎突骨折1例。1.2治疗方法臂丛麻醉下手术。取     

Serum levels of anti‐Fcγ receptor IIB/C antibodies are increased in patients with systemic sclerosis

Systemic sclerosis (SSc) is a systemic autoimmune disorder that results in fibrosis of the skin and multiple internal organs. Although the precise mechanism is unknown, it appears to result from the overproduction of extracellular matrix proteins and aberrant immune activations. Receptors for the Fc region of immunoglobulin (Ig)G (FcγR) are members of the Ig superfamily that modulate both activation and inhibition of immune responses. FcγRIIB is the sole inhibitory member, which has an intrinsic cytoplasmic immunoreceptor tyrosine‐based inhibitory motif. The present study was undertaken to investigate the circulating concentrations of anti‐FcγRIIB/C antibodies (Ab) in patients with SSc. Serum levels of anti‐FcγRIIB/C Ab were significantly increased in patients with SSc compared to those in controls and in patients with localized scleroderma. Serum levels of anti‐FcγRIIB/C Ab in patients with limited cutaneous SSc were similar to those in patients with diffuse cutaneous SSc. Among SSc patients, serum levels of anti‐FcγRIIB/C Ab were increased in those with nail‐fold bleeding and decreased in those with diffuse pigmentation and calcinosis. These findings support the notion that increased serum anti‐FcγRIIB/C Ab levels are involved in aberrant immune responses in SSc.     

Prediction of tibial nonunion at the 6-week time point

IntroductionIntramedullary (IM) nail fixation is a common operative treatment, yet concerns regarding the frequency of complications, such as nonunion, remain. Treatment of tibial shaft fractures remains a challenge, and little evidence of prognostic factors that increase risk of nonunion is available. The aim of this study was to develop a predictive model of tibial shaft fracture nonunion 6 weeks after reamed intramedullary (IM) nail fixation based on commonly collected clinical variables and the radiographic union score for tibial fractures (RUST).MethodsA retrospective case-control study was conducted. All tibial shaft fractures treated at our level I trauma center from 2007 to 2014 were retrospectively reviewed. Only patients with follow-up until fracture healing or secondary operation for nonunion were included. Fracture gaps ≥3 mm were excluded. A total of 323 patients were included for study.ResultsInfection within 6 weeks of operation, standard RUST, and the Nonunion Risk Determination (NURD) score had statistically significant associations with nonunion (odds ratio > or < 1.0; p < 0.01). The NURD score was increasingly predictive of nonunion with decreasing RUST. All patients in the high RUST group (RUST ≥ 10), achieved union regardless of NURD score. In the medium RUST group (RUST 6–9), 25% of patients with a NURD score ≥7 experienced nonunion. In the low RUST group (RUST <6 or infection within 6 weeks), 69% of patients with a NURD score ≥7 experienced nonunion.ConclusionThree variables predicted nonunion. Based on these variables, we created a clinical prediction tool of nonunion that could aid in clinical decision making and discussing prognosis with patients.