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Objective: To compare the clinical efficacy of the posterior hemipelvectomy of the greater trochanter approach with the standard Kocher-Langenbeck(K-L) approach in the treatment of posterior acetabulum wall fractures and to explore a more optimal approach for the treatment of posterior acetabulum wall fractures., Methods: Total of 26 patients with posterior acetabulum wall fractures were retrospectively analysed and divided into two groups:the posterior hemipelvectomy of the greater trochanter group (test group) and the standard K-L approach group (control group). In the test group, there were 24 patients including 16 males and 8 females with an average age of (42.00±4.52) years old, the time of injury to surgery was (6.75±1.15) d. In the control group, there were 23 patients including 16 males and 7 females with an average age of (41.00±5.82) years old, the time of injury to surgery was (7.09±1.20) days. The total hospital stay, length of incision, operation time, intraoperative bleeding, postoperative drainage, discharge, fracture reduction quality (Matta criteria), hip abduction muscle strength, hip function (Merle d'Aubigne-Postel score), postoperative complications and the incidence of ectopic ossification were compared., Results: All cases were followed up for 6 months. There was no significant difference in incision length, intraoperative bleeding and postoperative drainage between two groups( P >0.05). However, the operation time of the test group was shorter than that of the control group ( P <0.05). There was no statistically significant difference in fracture reduction and hip function between two groups ( P >0.05). The hip abduction muscle strength of test group was better than that of control group( P <0.05). In addition, there was no significant difference in the incidence of postoperative complications and heterotopic ossification between two groups( P >0.05)., Conclusion: Compared with the standard K-L approach, the posterior hemipelvectomy of the greater trochanter approach can shorten the operative time, has better recovery of the postoperative hip abduction muscle strength, exposes the view of the fracture involving the more comminuted posterior acetabulum wall or the fracture of the roof of the socket, improved the rate of fracture anatomical repositioning, provides a new idea for the clinical treatment of posterior acetabulum wall fractures, and allows patients to perform functional exercises at an early stage.

BACKGROUND: Treatment methods of intertrochanteric fracture are various, which can be divided into extramedullary fixation system, intramedullary fixation system and arthroplasty. Different treatment methods have their own advantages and disadvantages. With the deepening of research, relevant controversial issues have become the hotspot of clinical research. OBJECTIVE: To review the improvement of internal fixation device for intertrochanteric fracture, the changes of operative methods and the related controversial issues, thus providing reference for further clinical research. METHODS: The first author retrieved CNKI, WanFang, PubMed, Web of Science and SpringerLink databases with the keywords of “intertrochanteric fracture, osteoporosis, hip fracture, fracture fixation, internal, arthroplasty, displacement, hip, bone plates, internal fixators, prosthesis implantation, aged” in Chinese and English, respectively. Relevant studies published from January 2008 to August 2018 were collected, and finally 56 eligible studies were included for analysis by reading the title and abstract. RESULTS AND CONCLUSION: (1) With the in-depth study on the characteristics of anatomy and biomechanics of proximal femur, the intertrochanteric fracture classification system is gradually developing and improving to correctly evaluate the severity of fracture and determine the prognosis. (2) There is no unified “gold standard” for the surgical treatment of intertrochanteric fracture. Therefore, individualized treatment plan should be selected for the patient dialectically. (3) As a “turn-of-the-century surgery” in the history of orthopedic surgery, arthroplasty is increasingly applied in elderly patients with intertrochanteric fractures, but the surgical indications should be strictly controlled. (4) There are many controversial issues in the treatment of intertrochanteric fracture, and a large number of multi-center and big data clinical studies are still needed to solve the problem. (5) The rapid development of digital medicine will change the treatment pattern of intertrochanteric fracture. [ABSTRACT FROM AUTHOR]

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Objective To detect the expression of key factors of Wnt /β-catenin and ＲANKL /LGＲ4 pathways in fracture tissues of patients with osteoporotic fracture ( OPF) ． Methods Fifty-six patients with femoral fractures from January 2016 to July 2017 in our hospital were selected． Twenty-seven cases were divided into OPF group and 29 cases were divided into control group． Surgery was performed in 3 － 7 days． Bone tissue ( more than 200 mg) from the fracture area was collected and stored in liquid nitrogen． Total ＲNA was extracted from bone tissue using liquid nitrogen grinding ＲNAiso Plus method ． The difference of mＲNA expression of each factor was compared between the two groups using ＲT-PCＲ technique． Total protein was extracted from bone tissue using liquid nitrogen grinding and pyrolysis liquid． The protein expression difference of each factor was detected and compared between the two groups using Western blotting technique． Ｒesults ＲT-PCＲ and Western blotting result showed that LＲP5，β-catenin，Ｒunx2， C-myc，and LGＲ4 decreased，but ＲANKL increased in OPF group，comparing to those in the control group ( P ＜ 0. 05 ) ． Conclusion OPF is associated with the inhibition or weakening of osteogenic factors LＲP5，β-catenin，Ｒunx2，and C-myc in Wnt /β-catenin osteogenic signaling pathway，the increase of osteoclastic factor ＲANKL in ＲANKL /LGＲ4 osteoclastic signaling pathway，and the inhibition of osteoclastic factor LGＲ4． The occurrence and treatment of OPF can be intervened by regulating the expression of various factors． [ABSTRACT FROM AUTHOR]

Objective To study to the effect of strengthen the spleen, benefiting the kidney, and strengthen the bone acupuncture method on the prevention of the femoral fracture in ovariectomized SD rats. Methods The 6-month-old SD rats were divided into 3 groups after 3-mongth ovariectomy, control group (C), alendronate group (AS), and acupuncture group (A). Rats in acupuncture group received acupuncture at Zusanli (ST36), Shenshu (BL23), and Dazhu (BL11) points once a day, 5 times a week, for 6 months. Rats in alendronate group were injected subcutaneously with alendronate sodium. Rats in control group were released and captured like the other two groups. The minimum external force, histomorphometry, bone mineral density (BMD), and bone mechanics were examined after 6-month treatment. Results The minimum external force of femur fractures in vivo in group A and group AS was significantly greater than that in group C. The fresh femoral proximal transverse diameter in group A was obviously smaller than that in group C and group AS. BMC in group A and AS group was significantly higher than that in group C. Conclusion 1. Acupuncture at ST36, BL23, and BL11 for 6 months is effective in prevention of hip fracture in postmenopausal osteoporosis model rats. Its mechanism may be closely related to promoting femoral morphological adaptation, increasing femur BMD, and increasing the ability of resistance of external force. 2. The acting mechanism of acupuncture and alendronate sodium is not identical. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the relationship between the clinical outcome and risk factors of intertrochanteric femoral fractures in patients over 65 years old. Materials and Methods: From January 2000 to March 2012, three hundred and twenty one patients older than 65 years, who underwent surgery for intertrochanteric femoral fractures, were evaluated. The following parameters were analyzed: the patient risk factors, such as age, sex, smoking, drinking history, cardiovascular disease, cerebrovascular disease and delayed days to surgery; admission day of the week; anesthetic method; operation time by perioperative care related to clinical outcome including postoperative mortality; and complications. Results: An analysis of the risk factors revealed female patients to have a 13% higher mortality (P=0.043). A duration of surgery longer than 3 hours was associated with a 29.1% and 20.8% higher mortality and complication rate, respectively (P<0.001, P=0.027). A surgical delay of four days or more after admission was associated with a 20.1% and 18.8% higher mortality risk and complication rate, respectively (P<0.001, P<0.001). Smoking, drinking history, underlying disease, anesthetic method, and operation time had no significant effect on the outcome. Conclusion: In addition to recognizing the importance of patient-related risk factors, modifying the operative factors, such as reducing surgical delays and method of anesthesia, can reduce the mortality and postoperative complications of intertrochanteric femoral fractures. [ABSTRACT FROM AUTHOR]

The article discussed the nursing experience of a male patient who experienced occupational accident, resulted in fracture in the left tibia and the right greater trochanter, complicated by acute compartment syndrome. The patient experienced several debridement surgeries and faced potential risk of posttraumatic limb amputation, causing physical and psychological double-whammy during the period of hospitalization. During the nursing process from March 22 to April 15, 2010, the author collected health-related information by observation, conversation, listening to the patient, and evaluating the patient through Gordon 11 health functional tools. Four health problems were identified, which included impaired tissue integrity, impaired physical mobility, acute pain, and anxiety. Regarding the physiology of the patient, the following nursing measures were taken: drafting a holistic wound care plan, assisting in the intake of nutrient to promote wound healing, teaching deep breathing exercise and skills to divert attention to reduce the acute pain, and introducing tension bar to encourage physical activities and improve limb movements. Psychologically, the team initiated active care, empathy, confirmed the patient's concerns, and increased the patient's participation in the treatment through detail descriptions by the doctor. As result, the patient's anxiety was successfully relieved. [ABSTRACT FROM AUTHOR]

Objective: To explore the effectiveness of arthroscopic microfracture combined with osteochondral autologous transplantation (OAT) in treatment of large area (4-6 cm 2 ) cartilage injury of the femoral condyle of knee., Methods: Between March 2016 and June 2017, 22 patients of large area cartilage injury of the femoral condyle of knee were treated with arthroscopic microfracture combined with OAT. There were 16 males and 6 females with an average age of 22-60 years (mean, 38.6 years). The cause of injury was traffic accident in 8 cases and sports injuries in 14 cases. The disease duration was 1-6 months (mean, 3.4 months). There were 15 cases of medial femoral condyle injuries and 7 cases of lateral condyle injuries. The area of cartilage defect was 4-6 cm 2 (mean, 4.98 cm 2 ). According to the International Cartilage Repair Society (ICRS) classification, 9 cases were rated as grade Ⅲ and 13 cases as grade Ⅳ. Eighteen cases were combined with meniscus injuries. Preoperative visual analogue scale (VAS) score was 6.36±1.25 and Lysholm score was 36.00±7.77., Results: All incisions healed by first intention. All patients were followed up 2-3 years with an average of 2.3 years. At 2 years after operation, the VAS score was 1.27±0.94 and the Lysholm score was 77.82±6.21, which were significantly improved when compared with those before operation ( t =16.595, P =0.000; t =21.895, P =0.000). At 2 years after operation, MRI showed that the cartilage defect was repaired well., Conclusion: Arthroscopic microfracture combined with OAT can be used to treat large area cartilage injury of the femoral condyle of knee, and the good early effectiveness can be obtained.

Objective: To evaluate the effect of demineralized cancellous bone (DCB) seeded with allogeneic chondrocytes for repairing articular osteochondral defects in rabbits., Methods: Articular chondrocytes were isolated from a 1-month-old male New Zealand rabbit for primary culture. The passage 1 chondrocytes were seeded onto prepared rabbit DCB scaffold to construct tissue-engineered cartilage and cultured in vitro for 2 weeks. Full-thickness articular osteochondral defects (3 mm both in diameter and depth) were created on both sides of the femoral medial condyles in 30 New Zealand white rabbits (age 4- 5 months). In 20 of the rabbits, the defects were filled with the tissue-engineered cartilage on the right side (group A) and with DCB only on the left side (group B); the remaining 10 rabbits did not receive any implantation in the defects to serve as the control (group C). At 1, 3, and 6 months after the implantation, tissue samples were collected from the defects for macroscopic observation and histological examination with Toluidine blue (TB) and collagen type Ⅱ staining. The effect of defect repair using the tissue-engineered cartilage was assessed at 6 months based on the histological scores., Results: The prepared DCB had a spongy 3D structure with open and interconnected micropores of various sizes and showed good plasticity and mechanical strength. DCB began to degrade within 1 month after implantation and was totally absorbed at 3 months. At 6 months after implantation, the defects filled with the chondrocyte-seeded DCB were repaired mainly by hyaline-like cartilage tissues, which were well integrated to the adjacent cartilage without clear boundaries and difficult to recognize. The chondrocytes were located in the lacunate and arranged in vertical columns in the deep repaired tissue, where matrix proteoglycans and collagen type Ⅱ were distributed homogeneously close to the normal cartilage. The subchondral bone plate was reconstructed completely. The defects implanted with DCB only were filled with fibrocartilage tissue, as compared with fibrous tissue in the control defects. The histological scores in group A were significantly superior to those in group B and C ( P &lt; 0.05), but the scores for subchondral bone plate reconstruction were comparable between groups A and B at 6 months., Conclusions: DCB is a good scaffold material for preparing tissue-engineered cartilage, and chondrocyte- seeded DCB can repair articular osteochondral defects by inducing the generation of hayline-like cartilage.

Objective: To study the effect of Jak2-STAT3 pathway on cell proliferation, migration, mineralization and bone defect healing via simulating Jak2-STAT3 pathway inhibitor AG490 to bone marrow mesenchymal stem cells (BMSC) and bone defect mice models. Methods: The effect of AG490 on BMSC proliferation was measured by MTT (methyl thiazolyl tetrazolium) assay. Regulation of AG490 on BMSC migration was tested by scratch assay and transwell assay. The BMSC migration related gene, matrix metalloproteinase (MMP)-7, MMP-9 and CXC subfamily receptor 4 (CXCR4), regulated by AG490 was studied by real-time PCR. Western blotting was adopted to analyze the regulation of Jak2-STAT3 phosphorylation through the simulation of AG490. The alizarin red staining and alkaline phosphatase (ALP) activity assay were performed to measure the effect of AG490 on BMSC mineralization and osteogenic differentiation. Mice femur bone defect models were built to analyzed the effect of AG490 on bone remodeling. Results: AG490 significantly suppressed the migration rate of BMSC at 1 d and 2 d in the experiment group [(12.42±7.50) %, (41.8±2.6)%] compared with the control group [(55.5±9.9)%, (86.9±8.7)%] in scratch assay ( P =0.000, P =0.000), the number of migrated BMSC in the experiment group (22.8± 5.9) was significantly suppressed compared with the control group (58.3±6.6) in Transwell assay ( P =0.000). The expression of MMP-7, MMP-9 and CXCR4 were significantly downregulated in experiment group [(0.5± 0.1), (0.1±0.1) and (0.35±0.07)] compared with the control group [(1.1±0.1), (1.06±0.33), (1.08±0.13)] ( P = 0.0003, P =0.000 and P =0.000). Also, the phosphorylation of Jak2-STAT3 was downregulated by AG490 in western blotting. After BMSCs were osteogenic induced for 14 days, the formation of mineralized nodule and the ALP activity of BMSC is significantly suppressed in experiment group (8.0±2.1) compared with the control group (35.7 ± 1.8) ( P =0.0005). AG490 suppressed the bone defects healing,the expression level of phosphorylated Jak2 and phosphorylated STAT3, and the number of alkaline phosphatase positive cell at defect area in vivo is lower in experiment group than the control group. AG490 suppressed the relatively bone density at the defect area significantly ( P =0.0004) at 5(th) week after the surgery. Conclusions: AG490 could suppress proliferation, migration and mineralization to of BMSCs regulate bone defect healing via inhibiting Jak2-STAT3 pathway.

Objective: To investigate midterm follow-up results on Asian femoral intramedullary nail in treating segmental and comminuted femoral fractures., Methods: Between June 2011 and October 2012,16 patients with segmental and comminuted femoral fractures were treated with minimally invasive reset and Asian femoral intramedullary nail under extension table. Among them, there were 10 males and 6 females aged from 21 to 49 years old with an average of 34.5 years old; the time from injury to operation ranged from 3 to 24 d with an average of 9.1 d. There were 6 cases were type C1,2 cases were type C2 and 8 cases were type C3 according to AO classification. X-ray of femoral segment at 3,6 and 12 months after operation were applied for evaluating fracture healing. Harris score of hip joint and HSS score of knee joint were used to evaluate postoperative function., Results: All patients were followed up from 24 to 36 months with an average of 28.4 months. Operative time was from 88 to 112 min with an average of 90.7 min; blood loss ranged from 150 to 200 ml with an average of 188.75 ml; the time of fracture healing was from 5 to 9 months with an average of 5.4 months. All incision were healed at stage I. No loosening, breakage of internal fixation and displacement of fracture were occurred. There were no significant differences in Harris score of hip joint at 3, 6 and 12 months after operation (F = 0.07, P = 0.893 > 0.05), 10 cases obtained excellent results, 5 good and 1 moderate. There was no obvious meaning in HSS score of knee joint (F = 0.08,P = 0.876 > 0.05), 9 cases obtained excellent results, 6 good and 1 poor., Conclusion: Asian femoral intramedullary nail could treat segmental and comminuted femoral fractures by using variety of less invasive ways,which has advantages of less trauma, quick recovery of function and satisfied midterm following-up results. But long term following-up effects remains to be seen.

Objective: To evaluate clinical results of early total care (ETC) treatment for elderly patients with intertrochanteric femur fractures., Methods: Clinical data of 106 elderly patients with intertrochanteric fracture treated from January 2012 and February 2015 were retrospectively studied. According to whether receiving the early total care mode, the patients were divided into 2 groups, 34 cases were diagnosed and treated with early total care pattern (ETC group), including 14 males and 20 females with an average age of (74.88 ± 4.38) years old ranging from 70 to 86. According to Evans types, 4 cases were type I, 5 cases were type II, 13 cases were type III, 11 cases were type IV, 1 case was type V. Seventy-two patients were treated with conventional trauma method (conventional group), including 35 males and 37 females with an average age of (74.46 ± 3.63) years old ranging from 70 to 85. According to Evans type, 8 cases were type I ,13 cases were type II, 25 cases were type III, 25 cases were type IV, and 1 case was type V. All fractures were treated with proximal femoral nails anti-rotation (PFNA). Operative time, hospital stays, leaving bed time, complications, cases of death at 1 year after operation, postoperative Harris score at 12 months were observed and compared., Results: All patients were followed up, the time of ETC group ranged from 9 to 18 months with an average of 13.29 ± 1.51, and the time in conventional group ranged from 12 to 16 months with an average 12.93 ± 1.15, while there was no significant difference between two groups in time of following-up (t = 1.368, P = 0.174). There was no significant meaning in cases of death between ETC group (2 cases) and conventional group (8 cases). Three cases occurred complications in ETC group, and 20 cases in conventional group,there was obvious meaning between two groups (χ² = 0.739, P = 0.318). Operative time,hospital stays,leaving bed time in ETC group respectively was (2.03 ± 0.67) d, (15.41 ± 2.87) d and (3.62 ± 0.74) d; while in conventional group respectively was (4.17 ± 1.59) d, (20.11 ± 4.24) d and (5.35 ± 1.22) d; there were significant differences between two groups in operative time, hospital stays, leaving bed time. Postoperative Harris scores at 12 months in ETC group was (82.32 ± 4.56), and (79.24 ± 5.52) in conventional group, there was obvious meaning between two groups (t = 2.833, P = 0.006)., Conclusion: ETC pattern is a novel method for diagnosis and treatment of intertrochanteric femur fractures in elderly, it could shorten operative time, hospital stays, leaving bed time, decrease complications and promote recovery of function.

Objective: To discuss the clinical effects of external fixator combined with limited internal fixation in the treatment of pediatric distal femur fractures., Methods: From January 2008 to June 2014, 17 children of distal femur fractures were treated by external fixator combined with limited internal fixation. There were 12 males and 5 females, aged from 6 to 13 years old with an average of 10.2 years, ranged in the course of disease from 1 h to 2 d. Preoperative diagnoses were confirmed by X-ray films in all children. There were 11 patients with supracondylar fracture , and 6 patients with intercondylar comminuted fracture. According to AO/ASIF classification, 9 fractures were type A1, 5 cases were type A2,and 3 cases were type C1. The intraoperative and postoperative complications, postoperative radiological examination, lower limbs length and motion of knee joints were observed. Knee joint function was assessed by KSS score., Results: All the patients were followed up from 6 to 38 months with an average of 24.4 months. No nerve or blood vessel injury was found. One case complicated with the external fixation loosening, 2 cases with the infection of pin hole and 3 cases with the leg length discrepancy. Knee joint mobility and length measurement (compared with the contralateral), the average limited inflexion was 10 degrees (0 degrees to 20 degrees), the average limited straight was 4 degrees (0 degrees to 10), the average varus or valgus angle was 3 degrees (0 degrees to 5 degrees). KSS of the injured side was (96.4 +/- 5.0) points at final follow-up, 16 cases got excellent results and 1 good. All fractures obtained healing and no epiphyseal closed early was found., Conclusion: External fixator combined with limited internal fixation has advantages of simple operation, reliable fixation, early functional exercise in treating pediatric distal femurs fractures.

Objective: To explore the clinical effects of internal fixation with lag screws plus an anti-sliding plate for the treatment of Hoffa fractures of the lateral femoral condyle., Methods: From May 2006 to May 2014, 17 patients with Hoffa fractures of the lateral femoral condyle were treated with lag screws plus an anti-sliding plate. There were 13 males and 4 females, ranging in age from 27 to 59 years, with a mean of 32.5 years. All the fractures were fresh and closed fractures. According to the Letenneur's classification, 8 cases were type I, 4 cases were type II, 5 cases were type III. All the patients had no injuries of the cruciate ligament and the another part of the knee. Operative incision and fracture healing time were observed, knee joint function was evaluated by Letenneur system and HSS standard., Results: The patients were followed up from 10 to 24 months with a mean of 14.6 months. All incisions achieved primary healing, and no internal fixation breakage, malunion, femoral candyle necrosis, deep vein thrombosis of lower extremity were found. Fracture healing time was from 4 to 9 months with an average of 4.7 months. According to Letenneur's functional assessment, 10 patients got an excellent results, 4 good, 3 fair. Total HSS score was 91.1 +/- 4.7 on average,15 cases obtained excellent results, 2 good., Conclusion: Internal fixation with lag screws and an anti-sliding plate can result in excellent effects for Hoffa fractures of the lateral femoral condyle. The key to a successful surgery is an anatomic reduction and rigid fixation of the fracture.

Objective: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) between in the supine "scissors" position and in the lithotomy position for treating femoral intertrochanteric fractures of old patients., Methods: A retrospective study was performed on 58 patients with femoral intertrochanteric fractures treated with PFNA between January 2013 and January 2015. Fracture was treated with PFNA in the lithotomy position in 28 cases (group A) and in the supine "scissors" position in 30 cases (group B). There was no significant difference in gender, age, side, cause of injury, fracture type, and interval from injury to operation between 2 groups (P>0.05). The incision length, operation time, perspective times, intraoperative blood loss, complications, and fracture healing time were recorded; Harris hip score was used to access the effectiveness., Results: The wound healed by first intention without infection, pressure sores, deep vein thrombosis of lower extremity, and other complications. There was no significant difference in incision length between 2 groups (t=1.313, P=0.212). Group B was significantly better than group A in operation time, perspective times, and intraoperative blood loss (P<0.05). All patients were followed up 10-31 months (mean, 15.3 months). Stretch injury at normal side and perineal discomfort occurred in 1 case and 5 cases of group A respectively, and no nonunion and other complications was observed in the other patients. There was no significant difference in fracture healing time and Harris hip score at last follow-up between 2 groups (P>0.05)., Conclusion: PFNA in the supine "scissors" position has exact effectiveness and advantages of shorter operation time, less intraoperative blood loss, less perspective times, and fewer complications.

Objective: To observe the efficacy of He-wei Jie-gu (Chinese characters) decoction on femoral intertrochanteric fractures after internal fixation in elderly., Methods: From January 2010 to January 2012, 90 elderly patients with osteoporotic intertrochanteric fracture were randomly divided into two groups. The patients in experimental group were treated with open reduction and internal fixation, He-wei Jie-gu decoction and Caltrate D in oral, including 18 males and 27 females with an average age of (77.8±11.3) years old ranging from 65 to 89 years old;the time from injured to operation was 2 to 9 days with an average of (6.6±2.1) days; according to Evans-Jensen classification, 17 cases were in type I, 8 in type II, 15 in type III, 3 in type IV, 2 in type V. Meanwhile, the patients in control group were treated with open reduction and internal fixation, Caltrate D in oral, including 16 males and 29 females with an average age of (81.2±9.6) years old ranging from 67 to 91 years old; the time from injury to operation was 2 to 10 days with an average of (6.8±2.6) days; according to Evans-Jensen classification, 15 cases were in type I, 10 in type II, 14 in type III, 4 in type W, 2 in type V. The VAS score, hip BMD value before and after treatment, fracture healing and the Harris function score after operation were recorded and compared., Results: All patients were followed up from 3 to 9 months with an average of (5.6±2.8) months. Compared with the control group, the VAS score of the experimental group had an obviously reduction (F=98.138, P<0.01) after treatment; the hip BMD value at 3 months after treatment in the experimental group was higher than that of the control group (P<0.05); the fracture healing rate of the experimental group was higher than that of the control group (P<0.05); Harris score in 3 months of follow-up in the experimental group was higher than that of the control group (t=2.542, P<0.05); all the differences between two groups were statistically significant (P<0.05)., Conclusion: He-wei Jie-gu decoction can reduce postoperative pain and increase bone mineral density after internal fixation of femoral intertrochanteric fracture in elderly, promote the fracture healing and functional recovery in the hip joint.

Objective: To compare the effectiveness of the proximal femoral nail anti-rotation (PFNA) and locking compression plate (LCP) in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in elderly patients., Methods: Between May 2009 and August 2012, 69 elderly patients with intertrochanteric fractures with the lateral unsubstantial femoral wall were treated. Fractures were fixed with PFNA in 36 patients (PFNA group), and with LCP in 33 patients (LCP group). There was no significant difference in gender, age, injury cause, side of fracture, and fracture AO type between 2 groups (P > 0.05). The incision length, operation time, intraoperative blood loss, total blood loss, fluoroscopy frequency, time for ambulation, and early (within 3 months) and late (more than 12 months) complications were compared. Fracture healing was assessed according to X-ray reexamination, the function of the hip joint was assessed according to the Harris hip scoring system., Results: The incision length, operation time, intraoperative blood loss, and time for ambulation of PFNA group were significantly less than those of LCP group (P < 0.05), but the fluoroscopy frequency of PFNA group was significantly more than that of LCP group (P < 0.05). There was no significant difference in total blood loss between 2 groups (t = -1.686, P = 0.096). The patients were followed up 12-24 months in PFNA group and 15-30 months in LCP group. The X-ray reexamination revealed fracture healing at (12.667 ± 2.527) weeks in patients of PFNA group, and at (13.364 ± 1.194) weeks in the others of LCP group except 1 case of nonunion, showing no significant difference (t = -1.443, P = 0.154). There was no significant difference in Harris hip score between PFNA group (84.611 ± 7.076) and LCP group (81.785 ± 7.500) at 12 months after operation (t = 1.626, P = 0.109). The early complication rate and late complication rate were 16.7% (6/36) and 5.6% (2/36) in PFNA group and were 9.1% (3/33) and 9.1% (3/33) in LCP group, all showing no significant difference between 2 groups (χ2 = 0.871, P = 0.481; χ2 = 0.320, P = 0.665)., Conclusion: Both PFNA and LCP have good effectiveness in the,treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in the elderly patients. Each has its own advantages and disadvantages.

Objective: To study the effectiveness of anterolateral C-shaped approach in the treatment of intertrochanteric fracture of the femur in elderly patient by comparing with traditional anterolateral approach., Methods: Between April 2010 and November 2011, 66 patients with intertrochanteric fracture of the femur were analyzed retrospectively. Of 66 patients, 37 underwent improved anterolateral C-shaped approach combined with fixation of dynamic hip screw (DHS) (improved group), and 29 underwent traditional anterolateral approach combined with fixation of DHS (conventional group). There was no significant difference in gender, age, injury cause, side, disease duration, fracture type, and complication between 2 groups (P > 0.05). The operation time, intraoperative blood loss, postoperative drainage volume, and hospitalization time were recorded; and X-ray films were taken to observe the fracture healing. The hip function was evaluated according to self-established criterion., Results: The operation was successfully completed in all patients, and primary healing of incision was achieved. All patients were followed up 12-24 months (mean, 17.8 months). Bone union was achieved in both groups; the fracture healing time was 3-6 months (mean, 4.8 months). No loosening or breaking of internal fixation was observed during follow-up period. The operation time and postoperative drainage volume of improved group were significantly less than those of conventional group (P < 0.05); no significant difference was found in intraoperative blood loss and hospitalization days between 2 groups (P > 0.05). According to self-established criterion, improved group was significantly better than conventional group in recovery of hip joint motion and function at 6 and 12 months after operation (P < 0.05)., Conclusion: Anterolateral C-shaped approach combined with DHS could minimize muscle injury and scar formation, which is beneficial to surgical exposure and early postoperative rehabilitation.

Objective: To investigate the influence of the integration of fracture treatment and exercise rehabilitation on the effectiveness in the patients with intertrochanteric fracture of femur., Methods: Between January 2007 and December 2009, 3 873 patients with intertrochanteric fracture of femur were surgically treated in 56 hospitals. Of them, 1 970 cases were treated with rehabilitation training according to scale of safety assessment of early exercise rehabilitation of patients with fractures (trial group), 1 903 cases were treated with traditional rehabilitation training methods (control group). There was no significant difference in age, gender, fracture type, internal fixation type, or postoperative safety score between 2 groups (P > 0.05)., Results: All the patients were followed up 13-49 months (mean, 30.5 months). There was no significant difference in the incidences of bone nonunion, delayed union, and systemic complication between 2 groups (P > 0.05); significant differences were found in the incidences of incision complication, deep vein thrombosis of the lower extremity, and the overall complication between 2 groups (P < 0.05). At 6 and 12 months after operation, the trial group was significantly better than the control group in the recovery of hip motion, curative effectiveness classification, and the excellent and good rate (P < 0.05)., Conclusion: The treatment of intertrochanteric fracture of the femur guided by the integration of fracture treatment and exercise rehabilitation can apparently improve the prognosis and reduce the incidence of complications.

Objective: To investigate the in vivo degradable properties of new calcium phosphate cement (CPC) containing poly lactic-co-glycolic acid (PLGA) so as to lay a foundation for the future clinical application., Methods: A novel CPC containing PLGA (CPC/PLGA) was prepared according to a ratio of 45% dicalcium phosphate anhydrous: 45% partially crystallized calcium phosphates: 10% PLGA. Thirty-two adult New Zealand rabbits (weighing 2.2-3.0 kg, male or female in half) were divided into the experimental group (n = 17) and the control group (n = 15). The bone defect models of the bilateral femoral condyles (4.5 mm in diameter and 1.5 cm in depth) were made by drilling hole. Defect at the right side was repaired with CPC/PLGA in the experimental group and with CPC in the control group, while defect at the left side was not treated as blank control. The general condition of rabbits was observed after operation; the histological observation and bone histomorphometric analysis were performed at 2, 4, 8, 16, and 24 weeks; and scanning electronic microscope (SEM) observation was performed at 8 and 16 weeks after operation., Results: All rabbits survived to the end of experiment. The histological observation showed: CPC/PLGA degraded gradually, and the new-born bone trabecula ingrew; bone trabeculae became rough and strong; and CPC/ PLGA almost biodegraded at 24 weeks in the experimental group. The CPC degradation was much slower in the control group than in the experimental group. The total bone tissue percentage was 44.9% +/- 23.7% in the experimental group, and 25.7% +/- 10.9% in the control group, showing significant difference between 2 groups (t = 3.302, P = 0.001); and the bone tissue percentage showed significant difference between 2 groups at 8, 16, and 24 weeks (P < 0.05). The results of SEM observation showed that the pore size was 100-300 microm at 8 weeks after operation, new-born bone trabecula grew into the pores and combined strongly with residual cement in the experimental group., Conclusion: Novel CPC/PLGA has good in vivo degradable properties, and it can be an ideal bone substitute in future clinical application.

Bone maintenance theory considers that the external load is the direct stimulating source of the bone remodeling. In this article, the method of experimental observation of self-repairing process of the bone defect and related results are introduced. Firstly, a hole was drilled in the rabbit thighbone so that the continuity of the bone was changed. Then bone defect model was established, and the thighbone data were obtained by using CT scanning, and the self-repairing process of bone defects caused by growth factor were observed and analyzed by MIMICS software. Finally, the relationship between volume changes of sclerotin was established, and scientific bases were provided for introducing the bionic topology optimization method to the remodeling process. The experimental results showed that the self-repairing of the each layer sclerotin of the young rabbits was faster than that of the adult ones under the same condition. In addition, the volume always changes contrarily between the spongy bone and enamel bone during the self-repairing process of bone defect.

Serious femoral damages are a common human bone disease. Rebuilding the femur and studying its mechanical properties are a continuous medical research topic, but traditional femoral prosthesis often cause some problems such as prosthesis loosening. In this work, we selected a healthy male, took his femur scanning by CT, and rebuilt high-precision femur prototypes by Mimics10.0 software, then chose the material having good biocompatibility and biodegradable, utilizing low-temperature deposition manufacturing (LDM) technology for the femoral manufacturing. This approach, fabricating the femur via LDM technology, laid a foundation for the later research on the femoral implantation in the human body.

Objective: To compare the effectiveness of the proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in the treatment of elderly patients with intertrochanteric fractures., Methods: Between May 2007 and May 2010, 63 elderly patients with intertrochanteric fractures were treated, and fractures were fixed with PFNA in 31 patients (PFNA group) and with DHS in 32 patients (DHS group). There was no significant difference in gender, age, injury cause, disease duration, and fracture type between 2 groups (P > 0.05)., Results: All incisions healed by first intention. The incision length, operation time, and blood loss in PFNA group were significantly less than those in DHS group (P < 0.05). The average follow-up time was 13.6 months in PFNA group and was 13.8 months in DHS group. The fracture healing time was (11.80 +/- 1.32) weeks in PFNA group and was (12.21 +/- 1.26) weeks in DHS group, showing no significant difference (t=1.23, P=0.29). The complication rate was 0 in PFNA group and was 12.5% (4/32) in DHS group, showing no significant difference (P=0.06). After 1 year, Harris hip score of PFNA group (86.55 +/- 10.32) was higher than that of DHS group (80.36 +/- 11.18) (t=2.28, P=0.03)., Conclusion: There are two surgical methods to treat intertrochanteric fractures in the elderly patient: PFNA and DHS, and each has advantages; for unstable intertrochanteric fractures, PFNA treatment is the first choice.

Objective: To establish a porcine model of articular full-thickness cartilage defect characterized by remaining cartilage calcified zone on femoral trochlea, so as to provide a considerable and comparative control group for investigating repair effects of tissue engineered scaffolds in articular cartilage defects with cartilage calcified zone remaining., Methods: The full-thickness cartilage column defects (6 mm in diameter, 0.2-0.5 mm in depth) without damage on calcified cartilage zone were made on the femoral trochlea in 9 clean-grade 6-month-old Guizhou minipigs by standard cartilage-defect-making suites. Microscopical observation was performed after modeling. Scanning were made by 3.0T MRI at 4 weeks. Then general observation, stereomicroscope, and histological staining were used to observe cartilage repair., Results: All animals were alive. No infection of incisions or patellar dislocations occurred; they were able to walk with partial weight-bearing immediately after surgery and could move freely without limp at 1 week. Obvious signal discontinuity in trochlea and subchondral bone could be observed in MRI, without deep signal change in defects surrounding. Microscopical observation showed a few repair tissue and petechia at base of the defect with clear boundary. Nearly intact calcified zone of cartilage and zonal collapse of subchondral bone in defects could be observed with stereomicroscope. Under common microscope, no chondrocytes was found in defects, as well as negative staining of fast green-safranin O and alcian blue. Under polarized microscope, the bottom of defects were filled with a little of fibrous tissue presenting continuous and strong light-refraction by sirius red staining., Conclusion: The animal model of articular full-thickness cartilage defect on femoral trochlea by standard cartilage-defect-making suites can be applied for the research of cartilage disease in early human osteoarthritis and function of calcified cartilage zone in pig.

Objective: To compare the clinic outcomes of dynamic hip screw (DHS), intramedullary fixation (IF) and proximal femur locking plate (PF-LCP) in the treatment of intertrochanteric fractures in the elderly patients., Methods: From July 2000 to August 2009, 165 old patients with intertrochanteric fractures were treated respectively by DHS, IF, PF-LCP. Fifty-eight patients were in DHS group including 30 males and 28 females with an average age of 71 years old; there were 30 cases of type II fracture of Jensen, 28 cases of type III fracture. Sixty-five patients were in IF group including 35 males and 30 females with an average age of 73 years old; there were 37 cases of type II fracture of Jensen, 28 cases of type III fracture. Forty-two patients were in PF-LCP group including 23 males and 19 females with an average age of 74 years old; there were 22 cases of type II fracture of Jensen,20 cases of type III fracture. The operative procedures,complications and therapeutic effects were compared among 3 groups., Results: All patients were followed up from 15 to 21 months (averaged 18.3 months). The incision length and the operation time of IF group were shorter than that of DHS and PF-LCP, but there were no significant difference between DHS group and PF-LCP group. The intraoperattive blood loss, rehabilitation and healing time of IF and PF-LCP were less or shorter than that of DHS group, but there were no significant difference between IF group and PF-LCP group. The functional recovery of IF group and PF-LCP were better than that of DHS group, there were significant difference among 3 groups. The complications of PF-LCP group was fewer than that of IF group and DHS group., Conclusion: PF-LCP is the credible method for intertrochanteric fractures in the elderly patients, especially for severe comminuted fracture and osteoporosis, for it can reduce operation complications and benefit for fracture healing and hip functional recovery.

Objective: To compare the therapeutic effectiveness of inverted less invasive stabilization system (LISS) and proximal femoral nail anlirotafion (PFNA) in treatment of complex unstable intertrochanteric fracture in aged, and to investigate the selective strategy of the internal fixation., Methods: From February 2007 to June 2009, 47 senior patients with complex and unstable intertrochanteric fractures (Evans IV, V, R-type) were treated. Among them 23 patients were treated by inverted LISS, including 7 males and 16 females, aged from 76 to 97 years; 24 patients were treated by PFNA, including 9 males and 15 females, aged from 73 to 90 years old. The mean operating time,blood loss, intraoperative photographs frequency, incision length, length of stay, bone healing,hip function were analyzed and compared., Results: All patients were followed up for 8 to 18 months (averaged 13.1 months). All fractures got bone healing. No complications such as wound infection, varus and internal fixation cut out occurred. The operative time, incision length, in PFNA group had a slight ascendant than that in LISS inversion group, but there were no significant differences. According to postoperative Harris hip score outcome of LISS inversion group compared with the PFNA group, there was no significant difference., Conclusion: Both of PFNA and LISS have ideal effect in treatment of complex unstable intertrochanteric fracture in aged, and are good internal fixations.

Objective: To evaluate the curative effect and surgical skills of reconstruction intramedullary nailing for ipsilateral fractures of shaft of femur and hip., Methods: Fifteen patients with ipsilateral femoral shaft and hip fractures from June 2002 to June 2008 were treated with reconstruction intramedullary nails. All of them were male with an average age of 45 years (range,34-85 years). According to the Winquist-Hansen classification, there were 2 type I, 6 type II, 2 type III, and 2 type IV shaft fractures. Hip fractures consisted of 7 intertrochanteric and 8 (53.3%) neck fractures. According to Garden's classification, 1 femoral neck fracture was type I, 3 were type II, 2 were type III and 2 were type IV., Results: All of the patients were followed up for an average of 30.9 months (range, 12 to 55 months). Due to other combined severe injuries, operations were delayed for 1-14 days (average is 5 days). Delayed union of femoral shaft occurred in 1 case; nonunion of femoral shaft occurred in 2 cases. Nonunion of femoral neck occurred in 1 and coxa vara occurred in 1. Hip fractures healed in 14 (93.3%) patients, and shaft fractures healed in 13 (86.7%)patients. The average union time was 4 months (range, 2-6 months) for the hip fractures and 5.5 months (range, 4-9 months) for the shaft fractures. No femoral head osteonecrosis, wound infection or shortening more than 2 cm occurred. Functional results using Friedman-Wyman criteria were good in 13 cases, fair in 1 case, and poor in 1 case., Conclusion: Reconstruction intramedullary nails can provide biological fixation of both fractures with fewer complications, and is an effective device to treat this kind of combined fractures.

Objective: To investigate the therapeutic effect and operating technique on the treatment of osteoporotic intertrochanteric fracture of femur with the locking compression plate (LCP)., Methods: From Feb. 2006 to Oct. 2009, 49 patients with osteoporotic intertrochanteric fracture of femur were treaded with different internal fixation methods, concluded 22 males and 27 females with an average age of (74.68 +/- 5.94) years old ranging from 63 to 90 years. Among them, 29 patients were treaded with LCP, and the other 22 cases with DHS. According to X-ray and Ultrasound bone mineral desity, all cases were diagnosed in osteoporosis. The operative time, blood loss, fluoroscopy exposure frequency, bone healing time and the time of first away from bed., Results: All patients were followed up from 6 to 35 months. The operative time, fluoroscopy exposure frequency, the bone healing time and the time of being away from bed were compared between two groups, there were no statistical differences (t=1.347, 1.603, 1.973, 1.032, P>0.05). As compared with DHS group, the intraoperative blood loss in LCP group was less than that of DHS group, there were statistical differences (t=2.14, P<0.05)., Conclusion: The LCP is an effective method in the treatment of intertrochanteric fracture of femur. The method has the advantages such as small wound and early recovery, especially appropriate for older patients. But the procedure as well should be demanded strictly.

Objective: Based on establishment three-dimensional finite element models with the different defects of proximal femur, analysis of the local stress and strain changes under normal walking condition, speculate the probable rang of fracture and provide a theoretical basis for clinical work., Methods: By CT scanning the whole femur, establish Three-dimensional finite element models were established with analogous to the loaded lower extremity under normal walking condition. The stress distribution of the zone of lesser trochanter, intertrochanter and femur neck were analyzed., Results: (1) To the defects of lateral cortex of proximal femur at lesser trochanter level, defect of 5%-25%, the local maximum stress were up to 96.74-179.10 MPa. When the defect was greater than 10%, the local maximum was greater than the ultimate stress 141 MPa. While, the stresses of medial femur were 46.15-62.13 MPa, which was much lower than that of yielding stress. (2) At the level of intertrochanter with 5%-25% defect, the stresses were 45.70-127.11 MPa, all of them were lower than that of the ultimate stress. Whereas the changes of stress of medial femur were as the same as the stress at lesser trochanter level. (3) When the intramedullary defect of femur neck not involving inner cortex was less 40%, the local stress was lower than yielding stress 93 MPa. When the defects were 45% and 50%, the local maximum stress were up to 100.20 MPa and 119.40 MPa. (4) While intramedullary defects of femur neck involving half of medial cortex were 15%-50%, the stress were 87.79-1207.40 MPa. When the defects were above the level of 45%, the local maximum is greater than 141 MPa., Conclusion: The defects in lateral cortex of proximal femur has little influence on the medial cortex at the same level. And have little influence on the strength of femur; If defects located in the lateral cortex of lesser trochanter, 5% was relative safe, 5%-10% was at the risk of fracture, and defects larger than 10% would result in fracture. When defects located in the lateral femur at the level of intertrochanter area, 20% was relative safe, but defects larger than 25% would have the risk of fracture. If intramedullary defects in femur neck was smaller than 45% and not involved inner cortex, it was believed safe. When intramedullary defects in femur neck involved half of cortex, it was relatively safe below 20%, 20%-40% was at the risk of fracture, and larger than 40% resulted in fracture.

Objective: To compare clinical effects between bridge wire splint fixation and traditional Bryant traction for the treatment of femoral shaft fractures in children., Methods: From June 2006 to June 2009,38 children with femoral shaft fractures were treated with bridge wire splint fixation and Bryant traction. In bridge wire splint group, there were 15 males and 6 females, ranging in age from 8 months to 5.3 years, with an average of (2.3 +/- 0.6) years. According to fracture site classification, 5 patients were upper 1/3 femoral fractures, 9 patients were middle 1/3 femoral fractures,and 7 patients were lower 1/3 femoral fractures. In Bryant traction group,there were 10 males and 7 females, ranging in age from 10 months to 3.2 years, with an average of (2.2 +/- 0.4) years. According to fracture site classification, 4 cases were upper 1/3 femoral fractures, 10 patients were middle 1/3 femoral fractures, 3 patients were lower 1/3 femoral fractures. The clinical features, X-ray healing time,weight-bearing time and complications of the two groups were compared., Results: Comparison of fracture healing time: bridge wire splint group was (6.0 +/- 0.3) weeks and Bryant traction group was (6.2 +/- 0.4) weeks; the time of weight-bearing in bridge wire splint group was (6.1 +/- 1.0) weeks and in Bryant traction group was (6.4 +/- 1.2) weeks; there was no significant difference between two groups. There was a significant difference in soft tissue complication between bridge wire splint group occurred in 3 cases and 13 cases in Bryant traction group. According to the criteria of clinical efficacy,in Bryant traction group, 12 patients got an excellent result, 4 good and 1 fair; in bridge wire splint group, the data were 17, 3 and 1 respectively,and there was no significant difference between the two groups., Conclusion: Both of bridge wire splint fixation and traditional Bryant traction for the treatment of femoral shaft fractures in children have good efficacy. Compared with Bryant traction,bridge wire splint fixation is simple, safe and has reliable effect.

Objective: To compare clinical outcomes of elastic intramedullary nail fixation and external fixator for the treatment of pediatric femoral shaft fractures., Methods: From Sep. 2002 to Aug. 2008, 67 pediatric patients with femoral shaft fractures were treated. Among them, 36 pediatric patients with femoral shaft fractures were treated with closed reduction and elastic intramedullary nail fixation including 23 males and 13 females with an average age of (7.1 +/- 1.6) years ranging from 5 to 11 years; while 31 patients were treated with closed reduction and external fixation including 19 males and 12 females with an average age of (6.5 +/- 2.3) years ranging from 3 to 12 years. All patients obtained closed reduction. The fracture healing time and postoperative complications were compared between these two groups., Results: All patients were followed up for 9 to 24 months, in averaged (12 +/- 3) months. The time of fracture healing and bone union in elasitic intramedullary nail group was shorter than that of external fixation group (P<0.05). There were 5 cases of infection,3 of delayed healing, 2 of refracture, and 1 of fixation failure in external fixation group, and there were 3 of soft tissue irritation in elastic intramedullary nail group., Conclusion: Elastic intramedullary nail has some advantages for the treatment of pediatric femoral shaft fracture, while external fixation has some advantage in patients with multiple injury and open injury. The proximal and distal femoral fractures are not suitable for elastic intramedullary nail fixation.

Objective: To compare the clinical effects of different fixing methods for intertrochanteric fractures and make theoretical analysis., Methods: From June 2003 to June 2007, 321 patients with intertrochanteric fractures, male 132 and female 189, ranging in age from 20 to 93 years with an average of 56.8 years, were treated with different fixation including Richard nail (142 cases), proximal femora nail (PFN, 94 cases) and external fixator (85 cases). The clinical data of all the patients were retrospectively analyzed, including the incidence of complications, joint function of hip (according Kudema modified Merli D'Aubigne criteria)., Results: All patients were followed up from 10 months to 4 years with an average of 14 months. About the incidence of complications, there was significant difference between the external fixator group and the others two groups (P < 0.05); there was no significant difference between the Richard nail group and the PFN group (P > 0.05). There was significant difference in joint function of hip among three methods. PEN group was best than others two groups., Conclusion: There is the best clinical effects and lowest incidence of complications with PFN method, which is the better choice in treating intertrochanteric fractures.

Objective: The injury instruments were identified and studied according to the cleaver traces on bone., Methods: The bone and fresh shrub branches were cut with the same part of the same cleaver respectively. To visualize the traces on the bone by histological processing and to match the traces on bone and branch by the comparison microscope. Then to analyze the character of traces on the bone., Results: Cutting-line traces made by cleaver on the bone can be fully matched with those in the shrub branch sample., Conclusion: Cleaver traces on the bone can be displayed clearly and shown at micro level. It will provide a new method for the identification of suspected weapon.

Objective: To evaluate the clinical effect of minimally invasive Trochanteric Antegrade Nail (TAN) for the treatment of intertrochanteric fractures of femur in elder., Methods: From January 2005 to June 2008, 80 patients with intertrochanteric fractures of femur were treated with minimally invasive fixation of Trochanteric Antegrade Nail. There were 16 males and 64 females with an average age of 75 years ranging from 65 to 93 years. According to Evans classification, there were 8 cases of type I, 32 of type II, 30 of type III, 6 of type IV and 4 of type V. After the operation of minimally invasive Trochanteric Antegrade Nail fixation,patients begun to do the continuous passive motion (CPM) and active motion of the injured hip joint and knee joint., Results: All patients were followed from 5 to 18 months with an average of 10 months. All factures were healing in time from 10 to 14 weeks with none screw breakage. Proximal screw exiting out about 0.5 cm occurred in 3 patients without obvert symptom. Three patients appeared lower limb deep venous thrombosis and were cured with medicine. According to the scales of Sanders, pain score was 9.08 +/- 1.19, ambulation score 8.85l +/- 1.09, function score 9.10 +/- 1.27, muscle strength score 9.13 +/- 1.18, daily life score 8.91 +/- l.07, X-ray evaluation score 9.34 +/- 1.09, so as the results were excellent in 56 cases, good in 20, poor in 4., Conclusion: With the advantage of mini-invasion, operative convenience and stable fixation, minimally invasive TAN fixation is an effective method for intertrochanteric fractures in elder.

Objective: To compare the radiographic and functional outcomes of nonoperative and minimally invasive methods in treating femoral subtrochanteric fractures in children., Methods: Forty-five children (male 28, female 17) aging from 4- to 15-years-old with femoral subtrochanteric fracture were managed with traction and cast application (16 cases), and elastic intramedullary nailing (29 cases). Early and late radiologic outcomes were respectively evaluated by Beaty and Theologis criteria. The outcomes of clinical effect were evaluated with Sanders scoring system., Results: All patients were followed up from 26 to 62 months with an average of 39.5 months. The fractures united in 45 patients. Early (at 4th week after treatment) satisfactory radiologic outcomes were respectively 6 cases and 26 cases between two methods of nonoperative and minimally invasive. Late (at 2nd year after treatment) satisfactory radiologic outcomes were respectively 11 cases and 28 cases between two methods of nonoperative and minimally invasive. According to Sanders scoring, 12 cases were excellent, 4 good with nonoperative methods; and 28 excellent, 1 good with minimally invasive methods. There were significant differences between the two groups in aforesaid aspect., Conclusion: Minimally invasive methods provided more satisfactory alignment of fractures as well as better functional outcomes than nonoperative methods. It is the first choice to treat femoral subtrochanteric fractures in children.

Objective: To investigate bioactivity, biodegradation, bone conductive properties, and clinical maneuverability of a novel injectable chitosan microspheres/calcium phosphate cement (CPC)., Methods: The bone defect of pi x 4 mmx4 mmx6 mm was made at both thigh bones of 12 rabbits, and experimental material (chitosan microspheres/CPC) or control material (alpha-tricalcium phosphate cement, alpha-TCP) was injected into the defect respectively. The filling situation was evaluated by X-ray 3 days after operation. The rabbits were divided into three groups, four for each group. The samples with chitosan microspheres and the control with alpha-TCP were collected at 8, 16, 24 weeks after operation. Histological examination and scanning electron microscope (SEM) evaluation were performed., Results: The absorption of implants with chitosan microspheres was observed at 8 weeks, and became more apparent at 16 weeks. Different size of cavities were observed in CPC after the degradation of chitosan microspheres. The chitosan microspheres/CPC was dramatically degraded after 24 weeks with a few chitosan microspheres, and new bone replaced the degraded materials. The implants with alpha-TCP were absorbed slowly compared with the chitosan microspheres/CPC. The cavities in alpha-TCP were small., Conclusion: The chitosan microspheres/calcium phosphate cement has the characters of good biocompatible and osteocombinative ability. Compared with the control material, adding chitosan microspheres into CPC could enhance its degradability and facilitate the new bone formation.

Objective: To investigate the therapeutic effect on femoral intertrochanteric fracture for three kinds of treatment methods and make theoretical analysis to offer basis on choosing the proper treatment method in clinic., Methods: We retrospectively reviewed the clinical and radiological records of 198 patients with femoral intertrochanteric fracture for three kinds of different treatment: unilateral external fixation apparatus (51 cases), dynamic hip screw (57 cases), internal fixation of Gamma nail (90 cases) from January 2001 to October 2006. The union of fracture and weight loading time, the averages length of stay,the incidence of complications,the functional evaluation of hip joint (the rate of excellent and good results) were compared and the curative effects were analyzed in different methods., Results: All the patients were followed-up for 36 months in average (from 8 months to 51 months). The union of fracture time were no statistically significant among the three groups (P>0.05). The weight loading time and incidence of complications were statistical significance among the three groups (P<0.05). Among the three groups,the incision length, operation time,blood loss and drainage in dynamic hip screw group were more than other groups, the unilateral external fixation apparatus group were less, Gamma nail group were in moderate. According to the Sanders' hip functional standard score,there were significant difference between the Gamma nail group and the other two groups (compared with dynamic hip screw group, P<0.05; compared with unilateral external fixation apparatus group, P<0.01)., Conclusion: The internal fixation of Gamma nail is a good choice for treating femoral intertrochanteric fracture. The weight loading time is earlier,the recovery of hip joint function is better,the incidence of complications is less in Gamma nail group than other two groups.

Objective: To investigate the diagnosis and treatment of the coronal fracture of the femoral condyle., Methods: Seven patients with Hoffa fracture treated in our hospital in recent 7 years were enrolled in this study. Six patients were treated with surgical treatment, while one non-displaced fracture received conservative treatment. Fractures were reduced under direct vision and fixed with hollow lag screws. The knees were immobilized in extension with cast after operation, and flexion exercise was commenced 3 weeks later., Results: All the patients were followed up. According to Kumar functional assessment system,5 patients got excellent results, 1 good, and 1 fair., Conclusion: Rigid internal fixation with hollow lag screw and extension plaster fixation is the excellent way to treat the coronal fracture of the femoral condyle.

Objective: To evaluate the different effect on the expression of Calcitonin gene related peptide (CGRP)and neuropeptide Y (NPY) between tissue engineered bone with vascular bundle graft in vivo and that with sensory nerve tract graft in vivo., Method: Thirty-six healthy New Zealand rabbits were divided into 3 groups randomly and equally: vascular bundle group (A), sensory nerve tract group (B), tissue-engineering group (C). Group A segmental bone defect of 1.5 cm long was made at the right femur in each animal. After plate fixation, the defects were implanted respectively with the engineered bone prepared in the above-mentioned 3 methods. At 3, 6 and 12 months post-operatively, the distribution of CGRP and NPY in the new bone were detected by immunohistochemistry and analyzed semi-quantitatively by image analysis software., Results: CGRP and NPY immuno-histochemical results indicated their contents increased significantly in all 3 groups as time passed (P = 0.000). Compared with group B, the contents of CGRP and NPY in group A significantly increased at 3 months (P = 0.000), but there was no statistic difference between them at 6 or 12 months (P > 0.05). The expression of CGRP and NPY in both group A and B were significantly more than that in group C at 3, 6 or 12 months (P = 0.000)., Conclusion: Implantation of vascular bundle into tissue-engineered bone can significantly improve the CGRP and NPY contents at early 3 months comparing with Implantation of sensory tract into tissue-engineered bone, but the changes are not significant at 6 or 12 months post-operatively.

Objective: To sum up the experimental and clinical history as well as latest development of repair of growth plate injury., Methods: Recent articles ab safe and effective methoout repair of growth plate injury were extensively reviewed and major reparative methods were introduced, especially including tissue engineering research on growth plate., Results: Repair of growth plate injury was a great difficulty in experimental study and clinical treatment of pediatric orthopediis. Transplantation of free growth plate and cartilage were unfavorably used because of lack of blood supplement. Although circulation problem was solved by transplantation of vascularized growth plate, autografts of epiphyseal cartilage were involved in limitation of donor, and allografts of epiphyseal cartilage induced immunological reaction. Noncartilaginous tissue and material could only prevent formation of bony bridge in small defect of growth plate and lacked ability of regenerative repair. Transplantation of tissue engineered cartilage and chondrocytes might be a choice for repair of growth plate injury., Conclusion: Owing to lack of safe and effective methods of repairing growth plate injury, research on chondrocyte and tissue engineered cartilage should be further done.

Objective: To investigate the effectiveness of mosaicplasty in repair of large-sized osteochondral compound defects and the integrity of transplanted tissue with recipient sites so as to lay a foundation for clinical application., Methods: Twenty-four adult goats were divided into 3 groups randomly. The diameters of defect were 6 mm for the medium-sized defects and 9 mm for the large-sized defects, which were created by a trepan. All of the defects were repaired with osteochondral plugs in diameters of 2 mm (the medium-sized defects) or 3 mm (the large-sized defects). The osteochondral plugs were harvested around the intercondylar fossa or intertrochlea groove, and pressed into the recipient sites by specialized instruments in a mosaic mode. No internal fixation was needed and the animal were allowed to move freely after operation. From 4 to 24 weeks postoperatively, the specimens were observed in gross and under electromicroscopy. X-ray detection and glycosaminoglycan (GAG) analysis were also performed to testify the healing process and the integrity of the cartilage and subchondral bone., Results: The transplanted subchondral bone was integrated firmly with each other or with recipient sites in both mosaicplasty groups. But 24 weeks postoperatively, transplanted cartilage was not integrate with each other apparently. Obvious cleavage between cartilage plugs could be seen. But in the large-sized defect groups, some of the osteochondral plugs were relapsed into the defects leaving the recipient sites some steps, leading to some degree of abrasion in the opposing articular cartilage. There was no significant difference in the GAG content between the transplanted cartilage and normal cartilage. X-ray analysis also demonstrated the healing process between the subchondral bone., Conclusion: Mosaicplasty can repair the medium or small-sized osteochondral defects efficiently.

Objective: To study an optimal ratio of small intestinal submucosa (SIS) and (hydroxyapatite-tricalcium phosphate, HA-TCP, SIS/HA-TCP) compositions according to the effect of SIS/HA-TCP compositions with different ratios on repairing rabbit femoral condyle defect., Methods: Thirty-six rabbits were made into bone defect models of 6 mm in diameter and 10 mm in depth in both sides of femoral condyles. Three different ratios of SIS/HA-TCP compositions (w/w: 1, 0. 5, 0. 25) were implanted into rabbit femoral condyle defect. After 2, 4, 8 and 12 weeks of operation, the repair effect was observed grossly. The histological evaluations were performed by histological scoring system and computer imaging analysis system., Results: The amount of new bone formation in SIS/HA-TCP(0. 5) group was more than that in SIS/HA-TCP(1) and SIS/HA-TCP(0. 25) groups. Histological observation: In SIS/HA-TCP (1) group, few new bone formation was seen and bone defect was repaired in the 12th week. In SIS/HA-TCP (0.5) group, immature woven bone was found in the defect in the 2nd week; more immature woven bone appeared and formed trabeculae in the 4th week; the regenerated bone was vigorously growing into the interspaces of the implanted materials in the 8th week; the implanted materials was basically replaced by bony structure and the lamellar bone appeared in the 12th week. The results of SIS/HA-TCP (0. 25) group were similar to that of SIS/HA-TCP(0. 5) group. The histological scoring was higher in SIS/HA-TCP (0.5) and SIS/HA-TCP (0.25) groups than that in SIS/HA-TCP (1) group (P<0.05) in the 2nd, 4th, 8th, and 12th weeks. The scoring was higher in SIS/HA-TCP (0.5) group than that in SIS/HA-TCP (0.25) group in the 2nd and 12th weeks (P< 0.05). In new bone formation and the degradation of HA-TCP, SIS/HA-TCP (0.5) and SIS/HA-TCPC (0.25) groups were superior to SIS/HA-TCP (1) group (P<0.05), SIS/HA-TCP (0.5) group was superior to SIS/HA-TCP (0.25) group (P<0.05)., Conclusion: SIS/ HA-TCP (0.5) has better effects of repairing bone defect and it can be used as a reference ratio in constructing bone scaffolds.