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Although geriatric hip fracture is a serious public health problem in China, the result of orthogeriatric co-management (OGC) is rarely reported. This study aimed to evaluate the effect of OGC in Chinese patients aged ≥65 years.In this single-centre, pre-post intervention, retrospective study, traditional orthopaedic care (TOC) was used until OGC was implemented in May 2015, a multidisciplinary team was organized, and clinical protocol was designed. Consecutive hip fracture patients who were ≥65 years and injured within 3 weeks were included in this study. Demographic characteristics, comorbidities, fracture patterns, surgical procedure, time to surgery, length of hospital stay, inpatient complications, and in-hospital mortality were extracted and examined. At 1-year after surgery, data on patients' mobility and mortality were collected. The time to surgery, incidence of inpatient complications, mortality and functional outcomes were compared between the groups.There were no significant differences in sex, fracture type, and surgical pattern between OGC (n = 434) and TOC (n = 452) groups. Patients in OGC group were significantly older (P 0.001) and had a higher age-adjusted Charlson comorbidity index (P 0.001). However, waiting time between admission and operation was significantly lower in OGC group (P 0.001). There was no significant difference in the mortality rate at the time of the patient being in-hospital and at 1, 3, and 6 months after surgery. Although 1-year mortality was higher in OGC group (P = 0.036), Cox regression analysis showed no significant correlation of OGC with 1-year mortality. There was no significant difference in pre-injury mobility and 1-year follow-up mobility assessed by Parker score. Only approximately half of the patients in both groups completely returned to their pre-injury mobility level.OGC significantly shortens time to surgery for geriatric hip fractures compared with TOC. However, there is no significant effect on mortality rate within 1 year and functional status at 1 year of follow-up.

Hip fracture becomes a major public health issue with the growing aging population. This study evaluated a multidisciplinary co-management program for older hip fracture patients and found it significantly improved the best practice indicators. It provided preliminary evidence to support the use of such intervention in hip fracture management. Hip fracture leads to high morbidity and mortality in older people. A previous study found a significant disparity in hip fracture management in Beijing Jishuitan Hospital (JSTH) compared to best practice care in the United Kingdom (UK). Following this audit, JSTH launched a multidisciplinary co-management care plan for older hip fracture patients. This study aims to evaluate the effect of this program on the six standards recommended in the UK hip fracture best practice guidelines. In this retrospective study, electronic medical record data were collected before and after the intervention. Eligible patients were aged ≥ 65 years, had X-ray confirmed hip fracture, and were admitted to JSTH within 30 days of injury. Patient demographic information, time from emergency department presentation to admission, time from admission to surgery, pressure ulcers, osteoporosis assessment, and falls prevention were collected. Multivariable logistic and median regression models were used for binary and continuous outcomes respectively. Segment regression was also performed for time-related outcomes. A total of 3540 eligible patients were identified. After the intervention, half of the patients who received co-management received surgery within 48 h of ward admission compared to 6.4% previously, 0.3% (vs 1.4%) developed pressure ulcers, and 76% (vs 19%) received osteoporosis assessment. No significant differences were observed in fall assessment rates. However, there was a higher rate of ward admission within 4 h of arrival in emergency for patients admitted pre-intervention (61% vs 34%). The introduction of the co-management model significantly reduced the time from admission to surgery and improved other practice outcomes. A multicenter randomized controlled trial is needed to evaluate the impact of this model on patient health outcomes.

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.

Objective By analysing the injuries of the orthopaedic wounded during the 2010 Yushu earthquake, we aim to provide useful medical information for the rational application and allocation of medical resources and better implementation of medical relief in earthquake-stricken areas. Patients and methods Five hundred and eighty-two orthopaedic patients injured during the earthquake. The clinical data, injury conditions and epidemiological features (including age composition, gender ratio, distribution of injury, etc.) were collected and analysed. Results Altogether 582 orthopaedic patients were analysed. The average age for all patients was 38.8 ± 13.08 years (0–86 years). Adults accounted for 81.62%. There was no gender difference. The most common injuries included limb fractures, pelvic/acetabular fractures and spinal fractures. Fractures accompany with nerve injury were relatively low, only 17 patients account for 2.92%. Fractures complicated by crush syndrome were even lower, only 7 patients account for 1.20%. Conclusion The patients who experienced fractures in the Yushu earthquake were mostly adults. This was correlated with population composition in Yushu area. This time all the orthopaedic injuries were relative mild with less complication as nerve injury or crush syndrome mainly because of the characteristics of the house structure in Yushu area.

To investigate the safe distance from the tip of the cannulated screw to the apex of the femoral head, and to avoid cutting out of the cannulated screws from the femoral head.From November 2007 to April 2008, the placement configuration of the cannulated screws in the femoral head on the anteroposterior (AP) and lateral view was investigated. And the relation between the three-dimensional configuration and the two-dimensional perpendicular view of the femoral head to establish a solid geometry formula was analyzed. According to the configuration, the distances from the tips of different cannulated screws to the apex of the femoral head to confirm the screws placement within the femoral head was measured.The actual risk of cutting out of the cannulated screws varied according to the different placement of the cannulated screws in the femoral head, even if the screw tips were within the femoral head on the AP and lateral radiograph. The mean diameter of femoral head was 49.8 mm. If the cannulated screw is in the center of femoral head on the lateral view, the cannulated screw would not cut out as long as it was in the femoral head on the AP view. When the angle was 22.5°on the lateral view, and under 22.5°on the AP view, the distance from the screw tip to the apex of the femoral head would exceeded 2.2 mm. If the angle45°on the AP view, the distance would exceed 9.6 mm. When the angle was 45°on the lateral view, and under 22.5°on the AP view, the distance would exceed 8.2 mm. When the angle45°on the AP view, the distance would exceed 17.7 mm. When the angle was 67.5°on the lateral view, the distance would exceed 23.1 mm on AP view.If the cannulated screw is in the center of femoral head on the lateral view, the cannulated screw won't cut out as long as it is in the femoral head on the AP view. The angle is larger on the AP and lateral view (especially on the lateral view), and the distance is longer.

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 guidance of four column theory in decision making of Pilon fractures and its result.Ninety-one cases of Pilon fractures classified by four column method and treated by open reduction internal fixation (ORIF) were reviewed from March 2005 to June 2009. Four column classification:lateral column of 67 cases were involved, posterior column of 34 cases were involved, medial column of 34 cases were involved and anterior column of 34 cases were involved. Among all the 94 fractures, single column of 20 fractures were involved, 2 columns of 49 fractures were involved, 3 columns of 15 fractures were involved and all of 4 columns of 10 fractures were involved.Eighty-nine cases had been followed up. The average follow-up time was 16.2 months ranging between 6.0 and 39.0 months. The average healing time was 3.7 months ranging from 3.0 to 5.0 months. Reduction of 91% reviewed Pilon cases were good or acceptable according to Burwell and Charley's radiology evaluation system. Ankle function of 87.6% cases were excellent or good according to AOFAS evaluation system.As a simple and comprehensive classification, four column classification can contribute to reasonable operating decision making and good prognosis of Pilon fracture.

To discuss the indication and outcome of volar Barton fracture treated by nonoperative method.Twenty-three cases of volar Barton fracture treated by closed method included 8 male and 15 female with an average age of 52.2 years,ranging 16 to 84 years. Among them, 16 cases showed subluxation of the carpus (15 cases were Mehara type I ,1 case was Mehara type III) by radiographs except the other 7 cases. By the experimentation in 32 cadavers, the injury of dorsal radiocarpal ligament was supposed to be a very important cause of the subluxation of the radiocarpal joint. The criteria of Pattee and Thompson was used to evaluate the outcome of the treatment.Twenty-three patients were followed up for 7 to 70 months, 11 cases gained satisfactory outcome (1 case as excellent, 10 cases as good), 12 cases gained unsatisfactory outcome (5 cases as fair, 7 cases as poor). Five of 7 cases without the subluxation of the carpus by the radiographs gained satisfactory outcome. Six of 16 cases with the subluxation of the carpus gained satisfactory outcome.(1) The result of reduction will influence the outcome of the treatment, the step on articular surface shoud be less than 2 mm after reduction. (2) Nonoperative method is recommended if volar Barton fractures are not associated with subluxation of the carpus. (3) Nonoperative method can be tried first if the fractures associated with the subluxation of the carpus, however operation is recommended when the articular step is more than 2 mm.

Background Various treatment options are available for displaced proximal humeral fractures. This study monitored a series of patients treated with a locking proximal humeral nail (PHN). Hypothesis Fixation with a PHN can be an effective method when treating patients with two part surgical neck fractures of proximal humerus. Materials and methods PHNs were used to surgically repair humeral neck fractures in 22 patients. Factors affecting the final function were analyzed by multiple linear regression. Results Mean patient age at the time of surgery was 56.9 years. The mean follow-up was 25.4 months, and all fractures united within 8 weeks. The average active forward flexion was 147.3°, the average external rotation was 44.1°, and the average internal rotation was T10. All patients were satisfied with their results. Two factors associated with patient American Shoulder and Elbow Surgeon scores were patient age and the strength of the supraspinatus. Discussion Details in patients choosing and surgical management were discussed. Conclusion Closed reduction and internal fixation with a PHN can be an effective method for the treatment of 2-part surgical neck fractures.

To evaluate the indications and clinical results of displaced proximal humeral fractures treated by locking proximal humeral plate (LPHP).From September 2004 to March 2006, 75 patients which were treated by open reduction and internal fixation with LPHP were available to follow-up, with an average time of 17 months (12 - 30 months). There were 60 fresh fractures and 15 delayed fractures. The range of motion, muscle strength, visual analogue scale (VAS) for pain, American shoulder and elbow surgeon (ASES) score, Constant-Murley, University of California, Los Angeles (UCLA) scoring system and simple shoulder test (SST) for function evaluation were all recorded.The average forward flexion was (147.3 +/- 17.7) degrees , external rotation was (30.5 +/- 16.2) degrees and internal rotation was to T9. The mean ASES was 86.7 +/- 12.7, Constant-Murley was 87.4 +/- 10.5, UCLA was 30.1 +/- 4.2. The total good or excellent rate was 89.3%. Compare with fresh fractures, the delayed group showed significant less forward flexion and ASES (P = 0.021 and 0.036 respectively). In 9 patients with late complications, there were significant differences regarding ASES, UCLA scoring system and Constant-Murley compared with patients without any complication.With strict indication control and appropriate surgical technique, satisfactory results can be expected for the displaced proximal humeral fractures treated with locking proximal humeral plates.

To investigate the results of two-part surgical neck fractures of proximal humerus treated with locking intramedullary nail for proximal humerus, and to discuss the indication, surgical technique and the effectiveness.The data of the 22 patients with two-part surgical neck fractures fixed with proximal humeral nail was retrospectively reviewed. The mean age was 57 years. X-ray film and visual analogue scale (VAS), American shoulder and elbow surgeon (ASES) score, Constant-Murley score, University of California, Los Angeles (UCLA) scoring system and simple shoulder test (SST) questionnaire were used to evaluate the patients' shoulder function recovery at final follow-up.All the patients were followed up with an average time of 13 months. All fractures united within 8 weeks postoperatively. No infection, avascular necrosis or complications which concerning with hardware was found during follow-up. The average active forward flexion was 147.8 degrees , the average external rotation was 45.5 degrees and the average internal rotation was T10. The mean VAS score was 1.5. The mean ASES score, Constant-Murley score, UCLA score and SST score were 81.2, 85.4, 29.9 and 9.5 respectively. Eighteen patients were rated as "excellent" or "good", while 4 others were rated "poor". All patients were satisfied with their results.With good indication control, meticulous intraoperative management and strict postoperative rehabilitation, close reduction and internal fixation with proximal humeral nail can be an effective method for the treatment of two-part surgical neck fracture.

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 diagnosis and treatment of Colles fracture with dorsally dislocated ulna.From July 2004 to November 2004, 20 cases of Colles fracture with dorsally dislocated ulna treated with supination-cast were evaluated.Fractures were healed in all cases, and no recurrent dislocation was found in duration of 6 - 10 months follow up. Evaluation with Gartland and Werley score system showed that 100% of patient restored excellent function of wrist and forearm.Supination-cast is an effective option for the acute cases. Well understanding of this injury and early diagnosis are critical.

To discuss and evaluate the surgical techniques of arthroscopic rotator cuff repair and its clinical results.From March 2002 to May 2005, 44 out of 68 patients treated by arthroscopic rotator cuff repair had been reviewed with a mean post-operation time of 12 months. Of the 44 patients, 40 were available for follow-up, with a mean period of 20.6 (12 - 40) months. The mean age was 56 (30 - 81) years. According to Gerber classification, there were 8 partial tears, 27 small tears and 5 massive tears. No irreparable tear was included in this series. All tears were repaired under the scope, and metal suture anchor (Super-Revo, Linvatec) had been used in all patients. ASES score (American shoulderelbow surgeons' score), Constant-Murley score and SST (simple shoulder test) questionnaire were adopted before operation and at the latest follow-up.The pre-operation and post-operation mean ASES score was 72.6 vs. 92.3 (P0.001), with the mean VAS score for pain 6.2 vs. 1.8 (P0.001), the mean forward flexion 74.5 degrees vs. 146.0 degrees (P0.001), and the mean external rotation 27.8 degrees vs. 38.3 degrees (P0.01). The excellent and good rate for post-operation ASES was 92.5%. The pre-operation and post-operation mean Constant-Murley score was 69.6 vs. 90.4 (P0.001), with an excellent and good rate of 90.0%.Arthroscopic rotator cuff repair is a successful treatment for rotator cuff tear. By the use of suture anchors, scope surgery shares the advantages of minimal morbidity, quick functional recovery and protection of deltoid muscle. With appropriate indication control, descent surgical skill and intense postoperative rehab, gratifying outcome can usually be anticipated.

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 study the characteristic, treatment and prognosis of tibial plateau fracture Schatzker type IV.According to the roentgenogram and CT scan in 51 patients, Schatzker type IV injury is divided into 3 types: split, total condylar, depression. In the treatment of split and total condylar injury, if there was no articular depression on CT scan, reduction is done through medial approach; if CT scan demonstrated articular depression, middle approach was used to reduce the depression and bone graft. In split injury, buttress plate was fix on posterior-medial side. In total condylar injury, buttress plate is fix on medial side. In depression injury, fracture was reduced through medial approach, bone graft and buttress plate was fix on medial side. Thirty-three patients were followed up in 41 months averagely. And the statistical analysis was done.The average Lysholm score of 33 patients was 83.2. Eight patients were excellent, 9 were good, 14 were fair, 2 were poor. The range of motion from 30 degrees to 147 degrees (average 110 degrees ). The factors that caused bad results were: the fracture was not anatomical reduced; tibial plateau is more than 4 mm wider than femoral condylar or lateral subluxation exceed 8 mm; varus deformity of knee. They also caused the increase of osteoarthritis.In order to get anatomical reduction and stable fixation, the approach and fix pattern should be chosen on the bases of classification and CT scan of Schatzker IV injury. The factors which influence the prognosis are: (1) tibial plateau is more than 4mm wider than femur condylar, or lateral subluxation more than 8 mm; (2) Varus deformity. Attention should be paid to avoid these during operation.

The indication, surgical techniques and results had been discussed through clinical analysis of percutaneous pinning for the treatment of proximal humerus fractures.Forty-nine patients with 49 shoulders treated with percutaneous pinning had been reviewed with a mean follow-up period of 16.9 months. All were acute fractures, with a mean age of 40.4 years. There were 39 2-part surgical neck fractures, 6 impacted 2-part greater tuberosity fractures and 4 valgus-impaction 4-part fractures. SST (Simple Shoulder Test) questionnaire, ASES (American ShoulderElbow Surgeon) score, Constant-Murley score and UCLA score had been adopted for final evaluation at the latest follow-up.The mean ASES score was 91.4, the mean VAS score was 1.7, the mean forward flexion was 146.7 degrees, external rotation 39.6 degrees, internal rotation at T(8)-T(9) level; the mean Constant-Murley score was 88.2; the mean UCLA score was 31.2; the mean number of questions for "yes" in SST questionnaire was 10.1. All fractures healed with a mean period of 8.8 weeks. No patient had been found for any evidence of humeral head necrosis at the latest follow-up The total satisfaction rate for pain relieve was 95.9% (47/49), and for functional recovery was 91.8% (45/49).Most 2-part surgical neck fractures, impacted 2-part greater tuberosity fractures and 4-part valgus-impaction fractures are good indications for percutaneous pinning. With appropriate and intense rehabilitation, satisfactory results can be expected in percutaneous pinning for the treatment of certain types of proximal humerus fractures.

To introduce a new way of treatment for elbow stiffness and instability.30 cases of elbow trauma were treated with mobile hinged Orthofix elbow fixator, 26 of them were followed up. There are 15 male patients and 11 female patients. The average age is 32.6 years old. The 26 injured elbows involved 12 cases on left side and 14 cases on right side; Sixteen cases on the dominant side and 10 cases on the non-dominant side. Sixteen cases had elbow stiffness, 5 cases had acute radial head fracture and posterior dislocation of the elbow, 3 of cases had Monteggia's fracture dislocation, and 2 cases had neglected posterior dislocation of the elbow.The average follow up time was 6 months (3 - 12 month). The mean time of fixation with fixator was 8.5 weeks (6 - 11 weeks). The mean ROM of the 16 cases of elbow stiffness was (37.5 +/- 0.8) degrees before operation, and (96.5 +/- 0.6) degrees operation, with a significant difference (P0.05). The mean Mayo elbow score was (69.5 +/- 1.7) before operation, compared with (82.8 +/- 1.6) after operation, with a significant difference (0.05). For the other 10 cases (5 cases with acute radial head fracture and posterior dislocation of the elbow, 3 cases with Monteggia's fracture dislocation, 2 cases with neglected posterior dislocation of the elbow), the average ROM of the elbow flexion-extension was 95 degrees (65 degrees - 150 degrees ); The average range of flexion was 117 degrees; the average loss of extension was 22 degrees; the average pronation was 76 degrees (20 degrees - 90 degrees ), the average supination was 75 degrees (15 degrees - 90 degrees ). Nine of the cases achieved anatomic reduction and proved by X-ray. The mean Mayo elbow score was 84 (49 - 96). Three cases were rated excellent, 4 good, 2 fair and 1 poor. The rate of excellent and good was 70% (7/10). Nine cases had no pain or mild pain, and did not need analgesic. Eight cases returned to their former work, 5 of the cases had complications.The mobile hinged elbow external fixator have following advantages: (1) distraction of the articular space and enhance fracture healing; (2) allow early movement of the elbow during healing; (3) provide stable environment for the healing after arthrolysis and reconstruction. Mobile hinged elbow external fixator can achieve successful result in the treatment of elbow stiffness or unstable fracture dislocation of elbow.

To study the characters of the treatment of perioperative period in fractures with diabetes mellitus (DM) and the effect of diabetes on the treatment of them.To retrospectively analyze the clinical data of 97 fracture patients with DM (DM group) who accepted operation. Compare the difference of the average hospitalized length, medical cost and the incidence of postoperative complications with the controls.(1) Insulin dosage was less in postoperative period (0.5 +/- 0.2) U.d(-1).kg(-1) than steady period (0.7 +/- 0.2) U.d(-1).kg(-1) and operative period (0.7 +/- 0.3) U.d(-1).kg(-1), the difference is significant (P0.05); (2) There were more complications in DM group than that in the control group before operation. The fractured patients with DM could receive operation after preoperative treatment and improving micro-circulation; (3) Compared with control group, DM group had longer preoperative preparation period of in-hospital duration, and higher in-hospital medical costs; (4) There were no significant difference between DM group and control group (P0.05) in postoperative complications and wound healing.Fractured patients with DM should take effective methods to treat complications of DM and do adequate preparation for the operation. Rational treatment of preoperative complications is very important for preventing postoperative one and guarantee operation successful. But the longer of hospitalized length is, the higher of in-hospital medical costs are.

To investigate indication, technical key during surgery and early results of humeral head replacement for the treatment of complicated proximal humerus fractures.Sixteen patients who received humeral head replacement were reviewed with a mean follow-up period of 6.8 months. Of the 16 patients, 15 suffered acute fractures with the mean interval between injury and surgery being 8 days. 1 case was a malunion after ORIF 1 year ago. The mean age for these patients were 58.9 years. Trauma series X-rays were taken at post-operation 2-week, 6-week, 10-week, 16-week 6-month and the latest follow-up. SST (Simple Shoulder Test) questionnaire, ASES (American ShoulderElbow Surgeon) score, Constant-Murley score and UCLA score had been adopted for evaluation at the latest follow-up.The mean ASES score was 89.1 (64 - 94); the mean VAS score was 2.7 (0 - 5); the mean forward flexion was 128.1 degrees (90 degrees - 150 degrees ), external rotation 35 degrees (30 degrees - 40 degrees ), internal rotation at T8-T9 level (L1-T6); the mean Constant-Murley score was 85.7 (53 - 95); the mean UCLA score was 30.4 (21 - 33); the mean number of questions for "yes" in SST questionnaire was 9.3 (7 - 11). The total satisfaction rate for pain relief was 93.8% (15/16), and functional recovery was 87.5% (14/16).Through strict indication control, appropriate timing, meticulous surgical techniques and long intense rehabilitation, satisfactory results can be obtained in humeral head replacement for the treatment of complicated proximal humerus fractures. Our report is only a preliminary one on early results, and a long-term follow-up data is needed for further evaluation.

To study the effect of close needling in the treatment of calcifying tendonitis.Seventeen patients with calcifying tendonitis who had received close needling treatment were followed-up for 9.3 months on average. An 18-gauge or 16-gauge needle was used during needling. X-ray examination was given 4, 6, 8 and every 4 weeks after needling. SST (simple shoulder test) questionnaire, ASES (American ShoulderElbow Surgeon) score, constant-Murley score and UCLA score were adopted for evaluation before and after treatment.Calcium deposition disappeared within 4 - 20 weeks mean 9.4 weeks in 15 of the 17 patients after needling for 1 - 3 times. Average ASES score before treatment was 47.7 (34 - 59), forward elevation was 90 degrees (70 degrees - 100 degrees ), external rotation was 15 degrees (0 degrees - 30 degrees ), and internal rotation was L3-4 (L1-buttock). Average constant-Murley score before treatment was 44.6 (34 - 54), UCLA score was 11.6 (8 - 15), and numbers of questions for "yes" in SST questionnaire was 3.4 (2 - 5). After needling the average ASES score was 87.1 (72 - 91), forward elevation was 143.5 degrees (120 degrees - 160 degrees ), external rotation was 40 degrees (30 degrees - 50 degrees ), internal rotation was T(8)-T(9), constant-Murley score was 87.8 (64 - 94), UCLA score was 29.5 (19 - 33), and numbers of questions for "yes" in SST questionnaire was 9.1 (6 - 12). Significant difference was found between before and after needling (ASES: P0.01, forward elevation, external rotation and internal rotation: P0.01, constant-Murley: P0.01, UCLA: P0.01, SST: P0.01).Close needling is an effective method for the treatment of calcifying tendonitis. Symptoms and disability are greatly relieved non-surgically in most of patients. Care should be taken in differential diagnosis of degenerative calcification in chronic rotator cuff disease.

To improve the effect of operative management of acetabular fractures.One hundred and seventy eight acetabular fractures were treated operatively from August 1993 to December 2000. Their functional results and complications were analyzed.One hundred and twelve hips were followed up for an average of 45.7 months. Heterotopic ossification was noted in 26 hips, post-operative osteoarthritis in 22 hips, avascular necrosis of the femoral head in 8 hips, and sciatic nerve injury in 7 hips after operations. No death and infection were found in this series.Ectopic bone formation develops at extended ilio-femoral and Kocher-Langeneck approaches. Cartilaginous injury of the femoral head is contributable to post-operative osteoarthritis, and imperfect reduction is an important factor in the genesis of osteoarthritis.