Search

Exercise intervention (EI) is a promising and economical way for elderly patients with hip fracture, but it is unclear which type of exercise is optimal. To assess the effectiveness of different EIs and identify the optimal EI of improving the prognosis for elderly patients with hip fracture. We searched Medline (via PubMed), Web of Science, Embase, Cochrane Central Register of Controlled Trials, CINAHL, CNKI, Wan Fang, VIP and CBM from their earliest records to June 2022. The included randomized controlled trials (RCT) included at least one type of exercise for patients with hip fracture. The methodological quality of these trials was assessed using the Cochrane Collaboration Risk of Bias Tool, Stata 14.0 software was used for NMA. The primary outcome was hip function, and the secondary outcomes were activity of daily living (ADL), walking capacity and balance ability of the patients. This study included 46 RCTs involving 3,286 patients. Based on the recovery of patients' hip function, resistance exercise (RE) ([MD]: -11.07, [Crl]: -15.07 to -7.08) showed significant benefits over the control group (CG). RE ([MD]: -8.86, [Crl]: -15.01 to -2.71) ([MD]: -9.09, [Crl]: -14.20 to -3.98) showed significant benefits over the weight-bearing exercise and aerobic exercise. In addition, RE (surface under cumulative ranking curve values [SUCRA]: 94.8%) and balance exercise (BE) ([SUCRA]: 81.1%) were most likely to be the optimal exercise methods for hip function recovery. BE may be the most effective exercise in improving ADL([SUCRA]: 98.4%) and balance ability([SUCRA]: 88.4%). These results suggest that RE and BE might be the best approach to improve prognosis for elderly patients with hip fracture. More well-designed and high-quality RCTs are needed to verify the conclusions drawn from this study.

Multistage carboxyl-containing polymer latex particles were synthesized by multistep emulsion copolymerization using methyl methacrylate (MMA), butyl acrylate (BA), methacrylic acid (MAA), ethylene glycol dimethacrylate (EGDMA) and styrene (St) as raw materials, and the latex particles with diverse morphologies including multihollow, hollow and “bowl-like” were obtained by post-treating the multistage latex particles under alkali condition. The morphological evolution of the particles in the alkali post-treatment process was characterized with electron microscopy, and effects of alkali treatment conditions including treatment temperature, time as well as initial pH on particle morphology were investigated. Results indicated that the alkali treatment temperature and initial pH were the key parameters to control the morphology of the treated particles. When the alkali treatment temperature was below 60 °C or the initial pH was lower than 8.5, the particle morphology was almost unchanged no matter how long the treatment time was prolonged. The multihollow and hollow particles could be formed as alkali treatment temperature exceeded 60 °C in the range of initial pH from 8.8 to 9.5. While the latex particles with “bowl-like” morphology were observed when the multistage latex was alkali treated at 90 °C for 3 h with initial pH 9.8. Furthermore, extending alkali treatment time was beneficial to get the swelling equilibrium of the latex particles.

Background: Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy, difficult-to-access surgical sites, and the relatively low incidence of such cases. Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture. The goal of this study was to assess the use of three-dimensional (3D) printing techniques for surgical management of old pelvic fractures. Methods: First, 16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. Next, nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models. The pelvic injuries were all type C, and the average time from injury to reconstruction was 11 weeks (range: 8-17 weeks). The workflow consisted of: (1) Printing patient-specific bone models based on preoperative computed tomography (CT) scans, (2) virtual fracture reduction using the printed 3D anatomic template, (3) virtual fracture fixation using Kirschner wires, and (4) preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation. These models aided communication between surgical team members during the procedure. This technique was validated by comparing the preoperative planning to the intraoperative procedure. Results: The accuracy of the 3D printed models was within specification. Production of a model from standard CT DICOM data took 7 hours (range: 6-9 hours). Preoperative planning using the 3D printed models was feasible in all cases. Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases. The patients were followed for 3-29 months (median: 5 months). The fracture healing time was 9-17 weeks (mean: 10 weeks). No delayed incision healing, wound infection, or nonunions occurred. The results were excellent in two cases, good in five, and poor in two based on the Majeed score. Conclusions: The 3D printing planning technique for pelvic surgery was successfully integrated into a clinical workflow to improve patient-specific preoperative planning by providing a visual and haptic model of the injury and allowing patient-specific adaptation of each osteosynthesis implant to the virtually reduced pelvis.

Surgical treatment of acetabular fracture has long been a challenging area in the field of orthopedic trauma. The aim of this research was to investigate the operative methods for delayed acetabular fractures and to assess the operation results.The operative approaches, procedures, results, and complications of the delayed acetabular fractures between 1995 and 2005 were retrospectively evaluated at Beijing Jishuitan Hospital. Quality of life was assessed for each patient with the Merle d'Aubingne and Postel fracture function rating scale and the radiological result was assessed using the Matta radiological score.Sixty-eight cases (70 hips) were followed up with a minimal duration of five years (average of 5.8 years). Excellent functional results were observed in 10 hip joints, good results in 40, fair results in 11, and poor results in nine. The risks of poor prognosis include impact fracture or osteochondral fracture of femoral head, a time beyond 42 days from injury to operative management, and dislocation of femoral head during the injury. Some of the problems, which were observed included postoperative infection in two hips, iatrogenic sciatic nerve injury in eight hips, traumatic arthritis in 15 hips, heterotopic ossification in 17 hips, and necrosis of the femoral head in six hips.A careful selection of operative indications for delayed acetabular fractures in combination with a proper operative approach and appropriate reduction and fixation could guarantee relatively good results.

Currently, there are no uniform standards and methods for perioperative glycemic control in bone fracture patients with Type 2 diabetes mellitus (T2DM). We retrospectively analyzed the efficacy and safety of two intensive insulin therapy regimens administered to bone fracture patients with T2DM in the perioperative period, to explore the best method of achieving perioperative glycemic control.A number of 159 bone fracture patients with T2DM were divided into two groups. One group (n = 81) received multiple subcutaneous insulin injections (MSII group) and the other (n = 78) received continuous subcutaneous insulin infusion (CSII group). Blood glucose (BG) levels, time to achieve glycemic target, insulin dosage, and the incidence of hypoglycemia and complications were compared between groups.Both regimens reduced BG to desired levels before surgery. The time to reach glycemic target in CSII group (2.5 days) was significantly shorter than that in the MSII group (7.3 days; P0.001). Mean insulin dosage in the CSII group (0.66 IU×kg(-1)×d(-1)) was significantly lower than that in the MSII group (0.74 IU×kg(-1)×d(-1); P = 0.005), as were the incidences of hypoglycemia (15.4% vs 32.1%) and infection (6.4% vs. 23.5%). Multiple regression analysis showed that the time to reach glycemia target was associated with the insulin therapy regimen and dosage. The insulin dosage on reaching glycemia target was positively associated with body mass index (BMI), diabetes mellitus course, glycated hemoglobin A1c (HbA1c), and β-hydroxybutyric acid, and was negatively associated with age.The efficacy and safety of CSII was superior to that achieved with MSII, suggesting that CSII should be considered as initial therapy to control perioperative BG in bone fracture patients with T2DM.

To analyze various clinical parameters of elderly hip fractures so as to improve the management of elder hip fractures in China.The data of elder patients with hip fracture (primary diagnosis was fracture of femoral neck or intertrochanter) admitted into our department between 2002 to 2010 were collected. And the relevant clinical parameters included case number, age, ratio of concurrent chronic disease and duration and cost of hospitalization. The software of SAS was used for statistical analysis.A total of 1626 patients (M/F = 547/1079) ≥ 65 yr old with femoral neck fracture were admitted. Average age was 74.7 ± 6.4 yr (65 - 99) and annual average increasing rate 0.5% (-0.1% - 1.8%). The ratio of concurrent chronic disease was 53.3%. Average duration of hospitalization was 18.3 ± 10.9 days (1 - 114) and annual average increasing rate was -6.3% (-19.2% - 8.4%). Average cost of hospitalization was 38 758.04 ± 24 558.15 yuan (76.8 - 339 987.49) and annual average increasing rate 6.4% (-8.7% - 40.0%). A total of 892 patients (M/F = 362/530) ≥ 65 yr with femoral intertrochanteric fracture were admitted. Average age was 76.7 ± 6.8 yr (65 - 105) and annual average increasing rate 1.3% (-1.8% - 4.3%). The ratio of concurrent chronic disease was 55.8%. Average duration of hospitalization was 15.7 ± 8.7 days (1 - 78) and annual average increasing rate -4.5% (-22.1% - 8.0%). Average cost of hospitalization was 35 183.45 ± 21 427.47 yuan (75.3 - 148 150.41) and annual average increasing rate 18.3% (-3.7% - 79.9%).The number, age and therapeutic cost of elder patients with hip fracture are increasing continuously. Elderly hip fracture is becoming a serious problem of public health.

Operative decision-making of Pilon fractures are of great challenges until now. The aim of this study was to investigate the guidance of the four-column theory in decision-making therapeutic strategies for Pilon fractures and its result.One hundred and ten cases (107 patients) of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. Among all the 110 cases, single column of 14 cases, two columns of 46 cases, three columns of 17 cases, and all of four columns of 33 cases are involved.One hundred and eight cases have been followed up. The average follow up time is 14.7 months, varying between 7 and 52 months. The average healing time is 3.6 months, ranging from 2.5 to 8.0 months. Reduction of 86.1% reviewed Pilon cases are good or acceptable according to Burwell and Charley's Radiology Evaluation System. Ankle function of 87.1% cases are excellent or good according to the AOFAS evaluation system.As a simple and comprehensive classification, the four-column classification can contribute to reasonable operation decision-making and good prognosis of Pilon fracture.

Computer-assisted procedures have recently been introduced for navigated femoral neck screw placement. Currently there is little information available regarding accuracy and efficiency of the different navigated procedures. The aim of this study was to compare two fluoroscopic navigation tracking technologies, a novel bi-planar robot navigation and standardized optoelectronic navigation, versus standard freehand fluoroscopic insertion in a Synbone hip model.Eighteen fixed Synbone hip models were divided into 3 groups. C-arm navigated cannulated screws (AO-ASIF, diameter 7.3 mm) were inserted using freehand targeting (control group). A novel bi-planar robot system (TINAV, GD2000) and an optoelectronic system (Stryker OTS Navigation System) were used for the navigated procedures (robot group and optoelectronic group). Accuracy was measured using radiographic evaluation including the measurement of screw parallelism and decentralization, and joint penetration. To evaluate the efficiency, the number of guidewire passes, operative time and fluoroscopic images taken were noted.The two computer-assisted systems provided significantly improved accuracy compared to the freehand technique. Each of the parameters, including guidewire passes and number of fluoroscopy images, was significantly lower when using the computer-assisted systems than for freehand-unguided insertion (P0.05), but operative time was significantly shorter when using freehand-unguided insertion than for the computer-assisted systems (P0.05). Accuracy, operative time and number of fluoroscopy images taken were similar among the two navigated groups (P0.05), but guidewire passes in the robot group were significantly less than in the optoelectronic group (P0.05).Both bi-planar robot navigation and optoelectronic navigation were similarly accurate and have the potential to improve accuracy and reduce radiation for freehand fluoroscopic targeting for insertion of cannulated screws in femoral neck fractures. Guidewire passes in the robot group were significantly less than in the optoelectronic group. However, both navigated procedures were associated with time-consuming registration and high rates of failed matching procedures.

To evaluate the operative outcome of associated acetabular fractures through single Kocher-Langenbeck (K-L) approach and investigate the relationship between the quality of fracture reduction and long-term joint function.A total of 116 associated acetabular fractures were treated through single K-L approach at our department from October 1993 to December 2004. All cases were evaluated retrospectively. And 80 cases (81 hips) were followed up, including 5 hips of T-shaped fractures, 53 hips of associated transverse and posterior wall fractures, 18 hips of associated posterior column and posterior wall fractures, 4 hips of both column fractures and 1 hip of the associated anterior and posterior hemitransverse fractures. The quality of fracture reduction was evaluated. And the functional results and complications were tracked.The average duration of follow-up was 51.7 months. Anatomical reduction was achieved in 39, satisfactory in 31 and unsatisfactory reduction in 11 hips. The clinical outcome was excellent and good in 62 (76.5%) hips. All fractures were healed without infection. And 24 hips showed post-operative heterotopic ossification. The incidence of post-traumatic osteoarthritis was 22.5% (18 hips). There were 5 hips with the palsies of sciatic nerve. And the avascular necrosis of femoral head was found in 6 hips.Associated posterior column and posterior wall fractures, most transverse and posterior wall fractures, certain T shape fractures and both column fractures may be treated through a single K-L approach. Excellent reductions and satisfactory functional outcome can be achieved. The satisfactory joint function is based on a perfect fracture reduction.

Although the locking plate has become popular for treating displaced proximal humeral fractures in recent years, the complications of this method are still underestimated. We tried to evaluate the factors that have an influence on the complications experienced after proximal humeral fractures fixed by locking plates and compare the results from patients having complications with those having no complications.From September 2004 to September 2007, 92 out of 111 displaced proximal humeral fractures treated by open reduction and internal fixation with a locking plate were available for follow-up, with an average time of 15.2 months (12 - 36 months). The range of motion, Visual Analog Score (VAS) for pain, American Shoulder and Elbow Surgeons' Form (ASES), Constant-Murley, University of California-Los Angles scoring system (UCLA) score, and Simple Shoulder Test (SST) for function evaluation was all recorded at the latest follow-up. The results from patients with complications were evaluated according to the indices listed above and compared with those patients without any complications.There were 17 patients with complications, an 18.5% complication rate. Among them, the forward flexion, external rotation and internal rotation were 139.1° ± 24.3°, 24.1° ± 19.6°, and up to T10 level on average. The mean VAS score was 1.0 ± 1.1, the ASES score was 82.9 ± 13.8, the Constant 82.1 ± 11.8, the UCLA 28.5 ± 4.1 and the mean SST 9.5 on average. There was no significant difference of complication rate among different age, sex, and injured side, fresh or delayed fracture, combined with other injury or not groups. Compared with the group without complications, patients with complications showed significantly less external rotation and lower Constant-Murley and UCLA functional scores (P0.05). A significant difference in results was seen between patients with complications and those without complications.The indication control and appropriate surgical technique were important while performing the locking plate fixation for proximal humeral fractures.

To study the correlation of intermittent low-dose administration of recombinant human parathyroid hormone (1-34) [rhPTH (1-34)] and the expression of Runx2 during early stage of fracture healing.Sixty 2-month old male Sprague-Dawley rats underwent close unilateral femoral fracture and intramedullary nail fixation, and then were randomly divided into 2 equal groups: treatment group undergoing subcutaneous injection of rhPTH (1-34) 10 microgxkg(-1)xd(-1) immediately after the operation, and control group undergoing subcutaneous injection of normal saline of the same dose. Six rats from each group were killed with their bilateral femurs taken out on days 2, 4, 7, 14, and 21 after the operation to undergo X-ray photography Tissue RNA and protein were extracted from the bone tissues and the levels of Runx2 mRNA and protein expression were evaluated through real time quantitative PCR and Western-blotting. Blood samples were collected from the abdominal aorta before the rats were killed to undergo detection of serum calcium, phosphorus, and alkaline phosphatase (AKP).The Runx2 mRNA levels in the fractured femurs of the rhPTH (1-34) group on days 14 and 21 after the operation were 2.6 and 3.8 times as those of the control group respectively (both P0.05). The Runx2 protein levels in the fractured femurs of the rhPTH (1-34) group on days 14 and 21 after the operation were significantly higher than those of the control group respectively too. Since day 14 fracture healing was seen, and the status of fracture healing was better in the rhPTH (1-34) group than in the control group on days 14 and 21. The levels of serum calcium ion on days 14 and 21 of the rhPTH (1-34) group were both significantly higher than those of the control group (both P0.05). There were not significant differences in the serum levels of AKP, osteocalcin and collagen type Iat any time point between the 2 groups.Intermittent low-dose administration of rhPTH (1-34) up-regulates the levels of osteogenesis-specific Runx2 mRNA and protein expression to accelerate the early stage fracture healing during the early stage.

To establish a new imaging protocol to acquire the most appropriate fluoro-images for fluoro-navigated percutaneous fixation of acetabular fracture and to evaluate the safety and efficiency of the procedures.Guide needles were inserted into the bilateral anterior and posterior columns of the acetabula of 4 dry human cadaver pelvic skeletons and 4 plastic pelvic models. Then the pelvis skeletons were fixed to imaging guided surgery mimic operation modules. Dynamic fluoroscopy was conducted with C-arm X-ray machine vertically on the 4 virtual planes of the acetabulum, inner, outer, anterior, and posterior from multiple angles. The fluoroscopic images clearly showing the guide needles, anterior and posterior columns, and acetabulum were selected as registration images, and the relative space positions between the C-arm X-ray fluoroscope and pelvis and operation table. Guided by the navigation system, totally 16 titanium hollow screws were inserted into bilateral anterior and posterior columns of acetabula of the 4 pelvis skeletons. The screw positions were estimated by visual method. The time needed to position the C-arm so as to obtain the standard registration image, time needed for fluoroscopy, and operation time, including establishment of navigation system, software interface operation, and screw insertion, were recorded.All the screws were inserted to the satisfying positions: placed within the desired bony corridor of the column and none of then were inserted into the joint. While inserting the screw into the anterior column fluoroscopy should be conducted with obturated oblique view, obturated inlet view, obturated oblique outlet view, or pelvic AP view. While inserting the screw into the posterior column fluoroscopy should be conducted with iliac-oblique view, obturated oblique view, pelvic inlet view, or obturated oblique outlet view. The total surgical time required for screw insertion was 11.7 min for anterior column, and was 9.2 min for posterior column. 9.5 and 7.3 minutes were needed to position the C-arm X-ray machine so as to obtain the images of the anterior and posterior columns respectively. 2.9 and 1.7 seconds were needed for the actual fluoroscopy during insertion of the screws into the anterior and posterior columns respectively.The standard registered fluoro-images are different from the conventional standard Judet-Letournel oblique views. How to get appropriate fluoro-images is the key point for fluoro-navigated percutaneous fixation of acetabular fractures.

To evaluate the effect of treatment of calcaneal malunion fracture with isolated subtalar arthrodesis.Twenty-one patients with calcaneal malunion fracture, with 21 diseases feet, all males, underwent tenolysis of peroneal tendon, lateral exostectomy, and isolated arthrodesis of subtalar joint and were followed up for 16 months (8-47 months). American Orthopedic Foot and Ankle Society and pain score systems were used to evaluate the changes of symptoms. X-ray films were taken to observe the changes of the bones.The calcaneal deformity was greatly improved in all the patients and the symptom of pain disappeared or was alleviated. The mean post-operational AOFAS score was 71.3 (44-85) points, higher than that before the operation [36.7 (18-56) points]. The pain mean post-operational score was 2.0 (0-4) points, much lower than that before the operation [8.2 (7-10) points].Surgical treatment including tenolysis of peroneal tendon, lateral exostectomy, and isolated arthrodesis of subtalar joint is effective on calcaneal malunion fracture.

To evaluate the precision in location and clinical flexibility of the newly designed full-length planning module of orthopedic robot system in treatment of fractures of long bone.Nine plastic tibia models were selected for the image mosaicing. The full length of each tibia model was measured on the constructed panorama and compared with the real model length to record the length deviation and conduct the precision analysis. Fracture of tibia and fibula with shortening and angulation deformity was caused on a cadaver specimen with two lower limbs. Full-length planning was carried out on the entire tibial panorama with the fracture. After the reduction distance was determined quantitatively, automatic close traction procedure was carried out with the tibial reduction frame to analyze the precision and effectiveness of this module. At the same time, the relative length variation between the two bone fragments was monitored utilizing video camera to ensure the safety of the reduction operation. Image mosaicing, surgical planning, and bone traction were performed on a clinical case of tibial fracture to validate the clinical feasibility of the module.An entire tibial panorama could be constructed from 7 - 10 C-arm images collected during the operation. 1.5 min was needed for image collection. The average mosaicing and planning time was 3 min. The mosaicing error was less than 1.5 mm. The average time for the traction frame installation and traction operation was 4 min. Traction resulted in accurate reposition of the fracture ends meeting the requirement of surgery in both the cadaver specimen and the clinical case.The newly designed full-length planning module of orthopedic robot system is easy to use and provides effective and accurate traction result in long bone fracture therapy. This module can not only achieve the minimally invasive surgery, but also dramatically decrease the radiation damage to the medical staff.

To compare the results of using antegrade locked intramedullary nailing and the retrograde locked intramedullary nailing in the treatment of humeral shaft fractures.From January 1999 to December 2003, 92 closed humeral shaft fractures were operated with locked intramedullary nail. There were 92 patients, 67 men, 25 women, mean age 37 years (range 18 to 72 years). There were 69 antegrade nailing and 23 retrograde nailing. The average followup of the others was 28 months (12-70 months).The difference between the two groups' operation time, union rate and Mayo elbow performance score were not statistically significant. However, there were statistic significance between the two groups' intraoperative complication rate and Constant-Murley shoulder score.There is a much higher rate of iatrogenic fracture when retrograde nailing are performed. Antegrade nailing may influence the function of shoulder, but it's easier to manipulate.

To study the clinical and molecular genetic features of 17alpha-hydroxylase deficiency and treatment of femoral neck fracture complicated therein.A patient with 17alpha-hydroxylase deficiency with femoral neck fracture, with social sex as female, aged 19, underwent thorough clinical assessment, including history collection, physical examination, and laboratory test. Hormonal replacement therapy was applied and closed replacement was performed on the fractured femoral neck. Molecular genetic method was adopted to explore the gene mutation.The patient was diagnosed as 17alpha-hydroxylase deficiency according to clinical assessment. Under spinal anesthesia, the displaced femoral neck was reduced closely and fixed using 3 cannulated screws. Ten-month follow-up showed that the function of the injured hip was recovered. Genetic examination showed homozygous mutation in the exon 6: 6436 - 6438 (TAC--AA), causing amino acid missense mutation Y329K and 418X.Femoral neck fracture in 17alpha-hydroxylase deficiency patient can be treated successfully by operative method. 6436 - 6438 (TAC--AA) mutation in CYP17A1 gene may be a prevalent mutation causing 17alpha-hydroxylase deficiency in China.

To explore the proper methodology to treat cubitus varus deformity in adults with lateral closing wedge osteotomy.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.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.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 evaluate the clinical feasibility and effect of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails.The hardware components of the system included a PC computer with a monitor, auto mechanical stereotactical localization cubic frame, foot holder and localization operative apparatus. Special navigation software can be used for registration of X-ray fluoroscopic images and real-time controlling navigation of tools. Twenty-one cases of close tibial and fibular fractures were treated with closed intramedullary nailing, 6 of which involved in middle third, 12 in middle and lower third, 3 in lower third. C-arm alignment and registration time, fluoroscopic time and drilling time involved in the locking procedure were recorded. The size of unreamed or reamed tibial nails ranged from 8/300-11/330.All distal holes except 1 were locked successfully. In 9 of 41 locked holes (21.95%), the drill bit touched the canal of locking hole without damage of the nail and clinical consequences. The fluoroscopy time per pair of screws was 2.23+/-0.31 s.The computer-assisted auto-frame navigation system for distal locking is well designed, easy to operate and do not need additional instruments during the procedure. The developed system enables the physician to precisely navigate surgical instruments throughout the anatomy using just a few computer-calibrated radiographic images. The total time of X-ray exposure per procedure can be significantly reduced.

To investigate the feasibility and accuracy of the software computer-assisted robot orthopaedic trauma surgery planning system (CAOTS).The software CAOTS was developed and used on 85 cases of stereotactic operation, 24 model bones, 21 cadaveric extremity bones, and 40 patients. 307 groups of directional targets in these cases were randomly sampled. The distribution of error sources for evaluating system performance was embodied using Monte-Carlo method in order to derive the theoretic guarantees for further optimizing and enhancing the system performance, then the software SPSS 2.0 was used to analyze the errors.The statistical area of deviation number was 0.0408 +/- 0.4578 mm, corresponding to the result by Monte-Carlo method. Punching succeeded at the first run for all 307 cases without wrong locking and other clinical complications.Accurate and reliable, CAOTS improves the intra-operative navigation techniques and facilitates the orthopedists to perform operation.

To investigate the effects of medical robot-assisted surgical navigation system based on fluoroscopic images in distal locking of femoral intramedullary nails.Using a robot-assisted computer-guided system designed based on modularization and minimization that permitted C-arm alignment assistance and real-time navigation control, provided constant feedback without the need for radiologic updates, thus avoiding constant X-ray exposure. The C-arm was used to collect the orthotopic and lateral X-ray images into the computer so as to calculate the locations of the target points. Nails were locked into 5 plastic femurs (Swiss Sybone, 35 holes), 2 dry human femoral specimens (12 holes), and one leg of fresh human cadaver (6 holes). Radiographs were taken to confirm that screws were positioned correctly, and fluoroscopic time associated with the locking procedure was recorded.All distal holes were locked successfully. In 6 (11.1%) of the 53 holes the drill bit touched the canal of the locking hole, albeit with no damage to the nail. The fluoroscopy time of per screw was 1.83 +/- 0.31 seconds.The medical robot-assisted surgical navigation system enables the physicians to precisely navigate surgical instruments throughout the procedure using just a few computer-calibrated radiographic images. The total radiation time per procedure can be significantly reduced because additional X-ray exposure is not required for tool navigation. The idea of a robot-assisted surgical navigation system is practicable.

To observe the accident of avascular necrosis of the femoral head after internal fixation with cannulated screws in femoral neck fractures and analysis of the related factors.212 cases of femoral neck fracture treated with cannulated screws between Sep. 1989 and Dec. 1999 were reviewed retrospectively. The average age was 45.2 years old, ranging from 13 to 70 years. Among the fractures, 3 were Garden stage I, 32 were Garden stage II, 107 were Garden stage III, 53 were Garden stage IV, and 17 unclassified. Average duration of follow-up was 32.7 months, ranging from 12 to 101 months.Fracture healing occurred in 203 cases (95.8%). Avascular necrosis of the femoral head occurred in 70 cases (33.0%) and late collapse developed in 30 cases (14.3%). The rate of the avascular necrosis and late collapse of the femoral head according to the Garden stage was 0/0, Garden stage I; 6.3%/0, Garden stage II; 33.6%/15.9%, Garden stage III; 49.1%/20.8%, Garden stage IV. Avascular necroses of the femoral head were observed within 3 years in most cases (95.7%). Correlation analysis shows Garden stage of the fracture was the major factor contributed to the accident of avascular necrosis and late collapse of the femoral head. It also shows the low risk of avascular necrosis and late collapse of the femoral head was related to the patient's age over 60; time of surgery within 14 days and Garden's reduction index within 155-180 degrees on both AP and Lateral views.Garden stage of the fracture is the major factor contributed to the accident of avascular necrosis and late collapse of the femoral head, emergency operation and good reduction is beneficial to reduce the accident of avascular necrosis of femoral head.

To observe the outcome of hip fractures which accepted traction treatment instead of operation considering their general condition in elderly.102 cases of hip fractures accompanied by heart disease, hypertension, diabetes etc from Nov. 2000 to Jan. 2005 were accepted traction treatment. Among them, 37 cases are femoral neck and 65 cases are femoral intertrochanteric fractures. The average age was 75.8 years old, ranging from 48 to 98 years old. All cases were treated at home.one-year mortality was 8.8% (9/102). According to the incidence, the complications include bedsore (30/102, 29.4), pulmonary infection (6/102, 5.9%), DVT (2/102), PE (1/102), Urine infection (1/102). The rate of healing in femoral neck fractures was 51.7% (15/29); in intertrochanteric fractures was 97.6% (40/41). The decrease of Harris score between pre-injury and post-injury was 23.1 in femoral neck fractures and 15.6 in intertrochanteric fractures.For non-displacement and stable femoral neck fractures and some intertrochanteric fractures, good results could be obtained by traction treatment. Considering its low cost, traction treatment had its own indications.

To explore the pathogenetic mechanism, diagnostic criteria, and treatment of Essex-Lopresti injury.The clinical data of 5 patients with Essex-Lopresti injury that were treated by reconstruction of the length of radius, reduction and stabilization of the distal radio-ulnar joint and 3 of which were followed up were analyzed.In all the five patients there were no pain in elbow or wrist, instability in elbow joints, and limitation in the territory of the elbow joints. The patients had an average elbow score of 86.8 points (75.5 to 95.5 points), one with excellent result; 4 with good result, and one with fair result, according to the Morry's elbow joint scoring system. There was a little limitation for the wrist joints. The injuries did not affect their ordinary life. Only one of the 5 patients with open injury felt being unable to do as much as he would like to, and the others were capable to go back to work as usual. The average wrist score was 87 points (80 to 90 points), 3 with excellent result, and 2 with good result, according to the Green and O'Brien's wrist clinical scoring system.Early and accurate diagnosis is critical in order to obtain a satisfactory result in Essex-Lopresti injury. The primary goal is to reestablish the normal length of radius, relocation and stabilization of the distal radioulnar joint.

To explore the approach to accurately judge the degree of rotational deformity in femur shaft fracture.110 patients with femur shaft fracture were divided into 3 groups: Group A (n = 62) with the distal end of the fractured femur at the traumatic side at neutral position so as to fix the fracture, Group B (n = 27), with both the distal and proximal ends of the fractured femur at the neutral position so as to fix the femur at an antiversion angle of 15 degrees d, and Group C (n = 21), with the degree of antiversion angle to be controlled to that on the intact side. X ray examination and CT scanning were conducted 3 days after intramedullary nailing to measure the degree of the antiversion angle on both sides. The difference between the degrees of antiversion angle at the 2 sides was considered the rotational deformity of the femur shaft after the nailing. The antiversion angles of the femurs at both sides of 11 healthy persons were measured as controls.The biggest value of antiversion angle was 26 degrees , the smallest value was 8 degrees , the average value at the left side was 12.8 degrees , and the average value at the right side was 12.45, and the biggest difference between the 2 side was 7 degrees in the control group. The average antiversion angle of the femur was 14.67 degrees , the biggest value was 51 degrees , and the smallest value was -24 degrees at the traumatic side; and the average antiversion angle of the femur was 14.27 degrees , the biggest value was 40 degrees , and the smallest value was -23 degrees at the intact side in the treatment groups. 53% and 52% of the patients in Groups A and B showed a rotational deformity10 degrees , and 9% and 11% of them showed a rotational deformity20 degrees , significantly different from those in the control group (all P0.05). The rotational deformity was10 degrees in all patients of Group C, not significantly different from that of the control group (P0.05).Clinically about half of the femur shaft fractures are fixed in the position of rotational deformity10 degrees after nailing. The rotational deformity of femur shaft fracture should be prevented by comparing the antiversion angle on the intact side so as to achieve more reliable adequate reduction.