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Objective: To explore clinical effect of lateral locking compression plate combined with medial buttress plate in treating osteoporotic comminuted fractures of proximal humerus., Methods: From May 2017 to December 2021, 12 patients with osteoporotic comminution of proximal humerus were treated by lateral locking compression plates combined with medial buttress plates, including 5 males and 7 females, aged from 55 to 78 years old, bone mineral density(BMD) less than -2.5 g/cm3, the time from injury to operation was from 2 to 6 days. According to Neer classification, 7 patients were type Ⅲ, 4 patients were type Ⅳ and 1 patient was type Ⅵ. Postoperative complications, fracture healing and internal fixation were observed and Constant-Murley score of shoulder joint was used to evaluate clinical effects at 6 months after operation., Results: Postoperative wound healed well at stage I. All patients were followed up from 6 to 18 months. Humeral head collapse and necrosis occurred in 1 patient and humeral head varus in 1 patient. No impact of shoulder joint, internal fixation loosening occurred. Constant-Murley score at 6 months ranged from 45 to 90 points, and 6 patients got excellent result, 3 good, and 3 poor., Conclusion: Locking compression plate combined with medial buttress plate could effectively reconstruct medial humeral column support and enhance fracture stability, and receive satisfactory clinical results. However, no control group was established in this study, and function of shoulder joint has not been evaluated many times after operation, so it cannot dynamically reflect changes of shoulder joint function.

Objective: To explore clinical effect of three-dimensional(3D) printing combined with distal humerus osteotomy for children with cubital varus deformity., Methods: From January 2017 to January 2020, 17 cubital varus deformity children treated with distal humerus osteotomy were retrospective analysis, included 11 boys and 6 girls, aged from 5 to 11 years old with an average of (7.8±1.7) years old. A model of affected side elbow joint was made by 3D printing technique before operation, pre-operation was performed on the model. Three-dimensional model was successfully used for distal humeral osteotomy during operation. Carrying angle, flexion and extension angle of elbow joint were compared before and six months after operation, and Flynn scoring criteria was used to evaluate clinical effect., Results: All children were followed up for 6 to 12 months with an avergae of (9.6±1.7) months. One child occurred wound infection and healed completely after dressing change. No complications such as nonunion, internal fixation and nerve injury occurred. Carrying angle of affected limb was improved from (-20.8±2.4)°before operation to (7.2±2.3)°at 6 months after operation ( P <0.01). Angle of affected elbow joint extension improved from (-5.6±3.9)° before opeation to(-2.6±2.1)°at 6 months after operation ( P <0.01). There was no significant difference in extension angle of elbow joint between preopertaion and postopertaion at 6 months ( P >0.05). While there was no difference in elbow joint function on the healthy side and affected side at 6 months after opertaion ( P >0.05). According to Flynn scoring criteria, 13 patients got excllent results and 4 moderate., Conclusion: Three-dimensional printing combined with distal humerus osteotomy in treating elbow varus deformity could receive satisfactory clinical effect, which could accurately assist correction of cubital varus deformity, restore physiological structure and function of elbow joint.

Objective: To design and produce a lesser trochanteric reduction fixation system and verify its value and effectiveness., Methods: A lesser trochanteric reduction fixation system was designed and produced according to the anatomical features of the lesser trochanteric fractures. Sixty-six patients with intertrochanteric fractures of Evans type III were included between January 2010 and July 2012. Of 66 patients, 32 were treated with dynamic hip screw (DHS) assisted with the lesser trochanteric reduction fixation system (study group), and 34 cases were treated with DHS only (control group). The 2 groups were comparable with no significant difference in gender, age, the reasons, and the types of the fractures (P > 0.05). The operation time, intraoperative blood loss, neck-shaft angle, bone healing time, ratio of successful fixations, and the functional evaluation of the hip joint after operation were compared between 2 groups., Results: The study group had shorter operation time [(58.4 ± 5.3) minutes] and less intraoperative blood loss [(186.3 ± 6.6) mL than the control group [(78.5 ± 6.2)minutes and (246.2 ± 8.7) mL], showing significant differences (t = -14.040, P = 0.000; t = -31.145, P = 0.000). There was no significant difference in neck-shaft angle between study group [(138.6 ± 3.0)] and control group [(139.4 ± 2.9) degrees] (t = -1.044, P = 0.301). The wounds healed by first intention in both groups. The 30 and 31 patients were followed up 12 to 24 months (mean, 15 months) in the study group, and 13 to 25 months (mean, 16 months) in the control group, respectively. All fractures healed well in 2 groups. The study group had significantly shorter healing time [(8.8 ± 2.0) weeks] than the control group [(10.7 ± 3.4) weeks] (t = -2.871, P = 0.006). At 12 months after operation, coxa vara happened in 2 cases of the study group with a successful fixation ratio of 93.3% and in 10 cases of the control group with a successful fixation ratio of 67.7%, showing significant difference (Χ2 = 6.319, P = 0.022). According to Harris hip score, the excellent and good rate was 83.3% in the study group (25/30) and was 58.1% in the control group (18/31), showing significant difference (Χ2 = 4.680, P = 0.049)., Conclusion: The application of the lesser trochanteric reduction fixation system can reduce stripping of the soft tissue around the fracture fragments, shorten the operation time and the healing time, and preserve the function of the hip joint maximumly.

Objective: To compare the effectiveness between minimally invasive cannulated screw and open reduction and plate fixation in treatment of humeral greater tuberosity fracture by a prospective case-control study., Methods: Between January 2008 and January 2011, 49 cases of humeral greater tuberosity fractures were treated with minimally invasive cannulated screw in 25 cases (trial group), and with open reduction and plate fixation in 24 cases (control group). There was no significant difference in gender, age, injury cause, disease duration, fracture displacement, injury side, and complications between 2 groups (P > 0.05). The length of incision, operation time, intraoperative blood loss, and hospitalization days were recorded. According to Neer grading system, the effectiveness was evaluated; fracture healing was observed by X-ray films., Results: The trial group had smaller incision, shorter operation time, less blood loss, and shorter hospitalization days than the control group, showing significant differences (P < 0.01). Superficial infection occurred in 2 cases of the control group, and were cured after symptomatic treatment; primary healing of incision was obtained in the others of 2 groups. All patients were followed up 1-4 years (mean, 2.3 years). The fracture healing time was (7.0 + 2.3) weeks in the trial group, and was (7.8 +/- 2.1) weeks in the control group, showing no significant difference (t=1.24, P=0.22). No heterotopic ossification or loosening and breakage of internal fixation occurred during follow-up. The shoulder function Neer score of the trial group (86.3 +/- 2.8) was significantly higher than that of the control group (80.1 +/- 2.1) (t=6.37, P=0.00). The results were excellent in 14 cases, good in 8 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 88.0% in the trial group; the results were excellent in 12 cases, good in 7 cases, fair in 2 cases, and poor in 3 cases with an excellent and good rate of 79.2% in the control group; and difference had no statistical significance (Z=0.83, P=0.41)., Conclusion: Compared with open reduction and plate fixation, minimally invasive cannulated screw for greater tuberosity fracture has the advantages of simple operation, less trauma, less intraoperative blood loss, and good shoulder function recovery.

Objective: To investigate the effectiveness of lateral closing wedge osteotomy for treatment of traumatic cubitus varus deformity in children., Methods: Between July 1996 and June 2010, 20 cases of traumatic cubitus varus deformity after humeral supracondylar fracture were treated by lateral closing wedge osteotomy. There were 13 boys and 7 girls, aged from 7 to 14 years (mean, 10.6 years). The left elbow was involved in 12 cases and right elbow in 8 cases. Thirteen cases had received closed reduction, percutaneous Kirschner wire fixation, and external fixation in other hospital, and 7 cases misdiagnosed as elbow luxation and soft tissue injury had given external fixation. Cubitus varus deformity occurred at 2-12 years after injury. Preoperatively, the elbow range of motion (ROM) in flexion and extension was 100-150 degrees (mean, 133.0 degrees) and 0-24 degrees (mean, 11.7 degrees), respectively. The angle of cubitus varus deformity was 20-50 degrees (mean, 32.1 degrees)., Results: All incisions healed by first intention, and no related complication occurred. A total of 17 patients were followed up 1-14 years (mean, 5 years). X-ray films revealed that bone union was achieved in all cases within 5-8 weeks after operation (mean, 6 weeks). The deformity of cubitus varus was corrected in all cases. At last follow-up, the elbow ROM in flexion and extension was 110-150 degrees (mean, 135.9 degrees) and 0-27 degrees (mean, 12.9 degrees), respectively. According to Jupiter et al. elbow score system, the results were excellent in 14 cases, good in 2 cases, and fair in 1 case; the excellent and good rate was 94.1%. One patient underwent recurrence at 1 month after removal of the Kirschner wire, and lateral closing wedge osteotomy was performed again after 1 year., Conclusion: Lateral closing wedge osteotomy is a safe and effective surgical procedure in correcting traumatic cubitus varus deformity in children, which is easy to operate and can be effective in reducing the complications.

Objective: Supracondylar closing wedge osteotomy is a standard operation for the management of post-traumatic cubitus varus deformity. There are many fixation methods for the broken ends of bone. However, most of these fixation methods are fraught with various complications. To evaluate the methods and functional results of double volume internal fixation for correction of adult post-traumatic cubitus varus deformity., Methods: The clinical data were retrospectively reviewed, from 22 cases of adults post-traumatic cubitus varus deformity between June 2007 and December 2010. There were 16 males and 6 females, aged 18-29 years (mean, 21 years) and they all had a history of supracondylar fracture. The deformities of cubitus varus appeared at 6 months (range, 3 months to 1 year) after fracture, and the operations were carried out at 4-17 years (mean, 8 years) after deformity occurrence. The valgus angle were 16-25 degrees (mean, 20.6 degrees) and the Flynn functional scores were all poor before operation. Supracondylar closing wedge osteotomies were performed. Two reconstruction plates were moulded and placed to the media and lateral volumes of the humerus to fix the broken ends of the osteotomy surfaces. External fixation was not needed and early rehabilitation was performed postoperatively in all cases., Results: Incisions healed by first intention. All cases were followed up 6 to 24 months (mean, 13 months). At last follow-up, the valgus angle was 0-10 degrees (mean, 7.5 degrees). All cases got bone union at 8-13 weeks (mean, 10 weeks) after operation. No related complications occurred, such as infection, nervous or vein injury, and loosening or breakage of internal fixator; and no cubitus varus recurred. The Flynn scores were excellent in 17 cases, good in 3 cases, and fair in 2 cases; the excellent and good rate was 91%., Conclusion: The operation of supracondylar osteotomy with double plates internal fixation for the correction of adult post-traumatic cubitus varus deformity can rigidly stabilize distal humerus, which is helpful to functional training just after operation and satisfactory restoration of the elbow function.

Objective: To discuss the treatment methods of humeral supracondylar fracture in children with neurovascular complications., Methods: Ninety-six children (59 males, 37 females) with humeral supracondylar fractures were treated by surgery from February 2002 to November 2007, with the mean age of 6.4 years old (ranged from 4 to 16 years). Seventeen symptoms of nerve damage occurred in 16 cases, including radial nerve injury in 5 cases,median nerve injury in 7 cases,of which 1 cases with ulnar nerve injury, ulnar nerve injury in 5 cases; 13 patients had symptoms of vascular injury such as pulse weakness and hands coldness. The patients accompanied by nerve, blood vessel injury symptoms were all treated with open reduction and internal fixation., Results: Eighty-five patients were followed up with an average duration of 11 months(ranged from 6 to 18 months). Seventy-three patients had incision healing at the first stage and other 12 patients had incision healing at the second stage. All the 85 patients had no complications such as incision infection and functional disturbance of elbow joint. Among 5 patients with radial nerve injury, 3 patients had symptoms disappeared completely at 3 months after operation; one patient underwent exploration lysis at 3 months after operation and the symptoms disappeared at 5 months after operation; another 1 patient with iatrogenic injury of radial nerve had nerve function recovered at 3 months after releasing plaster compression. Among 7 patients with median nerve injury, 6 patients had nerve function recovered completely at 6 months after operation; another 1 patient combined with ulnar nerve injuries had nerve function recovered at 9 months after exploring of nerve at the second stage. Five patients with ulnar nerve injury had nerve function recovered completely at 6 months after operation. Preoperative symptoms of radial artery pulse weakness and cold hand in 13 patients disappeared after fracture reduction., Conclusion: The ulnar nerve should be explored during the operation at the first stage of supracondylar fracture. Wether the median nerve, radial nerve and blood vessel be explored or not should be decided by preoperative examination results. The preoperative EMG and Doppler ultrasound examination is not a routine examination before surgery.

Objective: To investigate the causes and the measures for prevention and management of complications of supracondylar fracture of the humerus., Methods: In 203 cases of supracondylar fracture of the humerus treated from July 2002 to July 2008, 49 cases had complication, whose data were retrospectively analyzed. There were 32 males and 17 females with an average age of 9 years (range 2-14 years). Fracture was caused by tumble in 38 cases, by falling from height in 4 cases, and by traffic accident in 7 cases. All cases were closed fractures. According to Gartland typing for supracondylar fracture of the humerus, there were 10 cases of type II and 39 cases of type III. Complications included 21 cases of vascular injuries, 10 cases of neural injuries, and 3 cases of osteofascial compartment syndrome. The time from injury to operation was 1-25 days. Closed reduction was given in 13 cases, closed reduction plus percutaneous K-wire fixation in 21 cases, and open reduction plus K-wire fixation in 15 cases. After reduction, plaster external fixation was performed. The cases of manipulation which blood circulation could not improve underwent incision to exploration of blood vessel. Two cases of neural injuries were treated with incision decompression of epineurium. Three cases of osteofascial compartment syndrome were treated with incision decompression, and the incision was sutured after 7-10 days., Results: All incisions healed by first intention. The duration of follow-up was 1-5 years with an average of 3.4 years. Fracture healing was achieved within 4-8 weeks. All vascular injuries and 9 cases of neural injures recovered thoroughly. Poor function occurred in 1 case of median nerve injury and Volkmann ischemic contracture in 1 case of osteofascial compartment syndrome. Cubitus varus deformity was found in 11 cases and myositis ossificans in 4 cases within 3 months to 1 year. According to Flynn standard of the function of elbow, the results were excellent in 21 cases, good in 7 cases, fair in 3 cases, poor in 18 cases., Conclusion: Early reduction is the key for prevention of further vascular injury, nerve injury and osteofascial compartment syndrome. Operation is essential when expectant treatment invalid. Satisfactory reduction, good fixation and functional rehabilitation are key points for preventing cubitus varus deformity.

Objective: To analyse short-term clinical effect of total elbow arthroplasty in treatment of distal comminuted humeral fracture with serious osteoporosis in geratic patients., Methods: From April 2006 to October 2007, five cases of distal comminuted humeral fractures were treated by total elbow arthroplasty with bone cement. Of them, there were 2 males and 3 females, aging 50-76 years old (mean 67.6 years old), including 4 cases of closed fracture and 1 case of open fracture (II type Gustilo-Anderson). All fractures were caused by tumbling. According to classification of AO, there were 2 cases of type C1, 2 cases of type C2 and 1 case of type C3. The Barnett index of osteoporosis was 0.40-0.45. The time from injury to operation was 4 to 18 days (mean 7.2 days). The rehabilitation exercise of function was done after 2 days of operation., Results: The operative time was from 120 to 180 minutes (mean 150 minutes), the bleeding amount was from 150 to 250 mL (mean 200 mL). All incision achieved primary healing. No complication occurred. Five cases were followed up for 19 to 36 months (mean 24.5 months). The mean motion range of elbow joint include 141.6 degrees for flection, 6.5 degrees for extention, 10.2 degrees for the degree of ectropion, 81.7 degrees for revolve forward, and 73.8 degrees for revolve behind respectively after 4 months of operation. The length discrepancy of upper limb was less than 1.5 cm, the muscle force for flexion and extention of finger and wrist was normal. The X-ray films showed that the position of artificial joint was satisfactory without prosthesis dislocation or loosening. According to Mayo elbow performance score, the excellent and good rate was 80% (excellent in 1 case, good in 3 cases, and fair in 1 case)., Conclusion: Total elbow arthroplasty with bone cement is an effective method in treatment of distal comminuted humeral fracture with serious osteoporosis obviously in the geratic patients, but indication and technique of operation should be mastered strictly.

Objective: To explore the improvement of the method for the treatment of supracondylar fractures of humerus in order to prevent and decrease the occurrence of cubitus varus., Methods: One hundred and ninety-seven patients with supracondylar fractures of humerus included 167 males and 30 females with an average age of 8.7 years old ranging from 3 to 12 years. There were 179 cases of extention and 18 cases of flexion. Six cases were open fractures. Thirty-four patients of fractures underwent fixation by only plaster slab, 53 underwent manipulative reduction and fixation by plaster slab, 23 underwent traction reduction and fixation by plaster slab, 87 underwent surgical operation. Among the cases of operation, 29 cases adopted anterior-lateral incision of elbow and 85 adopted posterior-interior incision of elbow., Results: Among the 197 cases, 191 cases were followed up for 1 to 5 years with an average of 3.7 years. According to the correlated curative effect evaluation of supracondylar fractures of humerus, the results were excellent in 142 cases, good in 27, fair in 13, poor in 9. Cubitus varus occurred in 8 cases., Conclusion: The objective factors for the occurrence of elbow varus do exist. However, during the treatment of these fracture, if strict correction of the ulnar deviation and stability are maintained during the reduction, the rate of occurrence of elbow varus could made to decreased a minimum.

Objective: To expore the prevention of ulnar nerve injury during fixation of supracondylar fracture in children by a medial-lateral three-pin fixation technique., Methods: Eighty-one patients including 54 boys and 27 girls with average age of 6 years old (2.5 to 11 years)were treated by a three-pin fixation technique with insertion of two Kirscher wires from the lateral side and the third wire through the medial side. They were followed-up without any complications related to the ulnar nerve. According to Garland system, there were 25 cases of type II supracondylar fracture and 56 of type III. All patients were treated by a medial-lateral three-pin fixation technique, and external fixation with plaster for 3 weeks., Results: All cases achieved immediate stability and long-term bony fusion postoperatively and no iatrogenic ulnar nerve injury happen., Conclusion: The technique is a stable and reliable methods for unstable supracondylar fracture and the iatrogenic injury ulnar nerve can be avoided completely.

Objective: To explore the possibility of treating mid-distal humeral shaft fractures associated with radial nerve palsies with minimal invasive plating osteosynthesis (MIPO) techniques., Methods: From April 2003 to October 2006, 10 patients with mid-distal humeral shaft fractures associated with radial nerve palsies were treated. All patients were male, aged 19-58 years. According to AO/ASIF classification, there were 4 cases of B1 type, 2 cases of B3 type, 1 case of A2 type, 1 case of B2 type, 1 case of C3 type and 1 case of A3 type. A straight 4.5 mm dynamic compression plate was placed on the anterior aspect of humerus through two small incisions located on the anterior side of proximal and distal part of the arm. The radial nerve exploration was performed through a lateral small incision made on the fracture site. The fractures were then reduced by manual manipulation and the plate was fixated to the main fragments with 3 screws in each end of the plate. The postoperative complications, the bone healing time, and the recovery time of the radial nerve functions were recorded. The functions of the affected shoulder and elbow were assessed with UCLA and Mayo elbow performance score system respectively., Results: All incision healed by first intention. Ten patients were followed up 9-36 months with an average of 15.7 months. The X-ray films showed that the union of fractures was achieved 12-16 weeks (13.6 weeks on average). The function of the radial nerves recovered completely 12-36 weeks (17.8 weeks on average) in 9 patients. The abductions of the affected shoulder were 150-170 degrees (165 degrees on average). The ROM of the elbows were 130-140 degrees (135.5 degrees on average). According to the UCLA shoulder scoring system, 9 patients achieved the excellent result and 1 patient achieved the good result. All the patients had the excellent results according to Mayo elbow performance score system., Conclusion: The mid-distal humeral shaft fractures associated with radial nerve palsies can be treated with MIPO technique and the good results can be obtained.

Objective: To explore the proper methodology to treat cubitus varus deformity in adults with lateral closing wedge osteotomy., Methods: The clinical data of 20 adult patients with post-traumatic cubitus varus deformity who underwent lateral closing wedge osteotomy and were followed up for 40 months on average were analyzed., Results: twenty-seven of the 28 patients showed excellent heal, and one case of delay in healing occurred. Eighteen elbow joints were in a neutral position, 6 were slightly varus, and 4 were varus. Tardy ulnar nerve palsy occurred in 5 cases. Reduction of elbow flexion was 11 degrees, even more than 20 degrees in 5 cases. Four patients were able to flex their elbows by 120 degrees or less. The reduction of extension was 3.4 degrees on average. Two patients showed failure of internal fixation, Kirshner wires were used in both of which., Conclusion: Exact pre-operative planning of osteotomy, minimal injury to the soft tissues, proper dealing of the ulnar nerve, and stable internal fixation are the key factors that improve the function of elbow joint after the lateral closing wedge osteotomy and reduce the post-operative complications.

To find new technique for repair of peripheral nerve defect, the nerve elongation repair technique was adopted. Two cases with nerve defect were treated by this method. One was a 12 year old male, the defect length of right radial nerve was 7.2 cm at the elbow. The other one was a 28 year old male, the defect length of left ulnar nerve the was 5 cm at elbow. In this method, the nerve was elongated by slow stretch from distal and proximal end of the ruptured nerve. After a few days, the nerve was repaired by direct suture. After operation, the function of nerves were recovered in 119 days and 114 days respectively. Follow-up for 5 years, the function of the effected limbs were recovered to the normal side. It was concluded that: (1) the peripheral never can be elongated by slow stretch; (2) to stretch the nerve end in a rubber tube can prevent adhesion and connective tissue blocking; (3) strength and supporting point of stretching should be designed carefully.