BACKGROUND Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support,which are important factors that lead to internal fixation failure.The app...BACKGROUND Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support,which are important factors that lead to internal fixation failure.The appropriate treatment for proximal humerus comminuted fractures has not been established.Therefore,this study assessed the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.AIM To investigate the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.METHODS This retrospective,comparative cohort study included two groups of patients.Group 1 comprised 22 patients and group 2 comprised 25 patients with complete follow-up data.Group 1 was treated with a fibular autograft with open reduction and locking plates to enable internal fixation.Group 2 was treated with open reduction and locking plates to enable internal fixation.The intraoperative blood loss volume from the shoulder wound,operative time,shoulder wound pain,bone fracture healing time,Constant-Murley score of the shoulder joint,preoperative Holden walking function score,Mallet score of the shoulder joint,and humeral neck-shaft angle during surgery of the two groups were compared,and the differences were analysed using an independent sample t-test.RESULTS Group 1 had a shorter mean operative time than group 2(2.25±0.30 h vs 2.76±0.44 h;P=0.000).Group 1 had a lower shoulder wound pain score on the first day after surgery than group 2(7.91±1.15 points vs 8.56±1.00 points;P=0.044).Group 1 had a shorter fracture healing time than group 2(2.68±0.48 mo vs 3.64±0.64 mo;P=0.000).Group 1 had higher Constant-Murley scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(76.64±4.02 points vs 72.72±3.02 points,86.36±3.53 points vs 82.96±3.40 points,and 87.95±2.77 points vs 84.68±2.63 points,respectively;P=0.000,0.002,and 0.000,respectively).Group 1 had higher Mallet scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(10.32±0.57 points vs 9.96±0.54 points,13.36±1.00 points vs 12.60±0.87 points,and 13.91±0.75 points vs 13.36±0.70 points,respectively;P=0.032,0.007,and 0.013,respectively).CONCLUSION Using locking plates with a fibular autograft can recreate medial support,facilitate fracture healing,and improve shoulder function;therefore,this may be an effective treatment option for severe proximal humerus comminuted fractures.展开更多
BACKGROUND The morbidity and burden of knee osteoarthritis affecting millions of lives worldwide has created a constant pursuit in finding the ideal treatment for knee osteoarthritis.There has been a paradigm shift in...BACKGROUND The morbidity and burden of knee osteoarthritis affecting millions of lives worldwide has created a constant pursuit in finding the ideal treatment for knee osteoarthritis.There has been a paradigm shift in the surgical treatment of osteoarthritis ever since the initial description of Volkmann’s tibial osteotomy.This review focuses on one such recent procedure,the proximal fibular osteotomy(PFO)for medial compartment knee osteoarthritis.This review encompasses the history,evidence,risk factors,outcomes and technical considerations of PFO.AIM To understand the evidence and its techniques,and whether this could be an alternative solution to the problem of knee osteoarthritis in the developing world.METHODS The phrases“proximal fibular osteotomy”and“knee osteoarthritis”were searched(date of search December 20,2019)on PubMed to identify articles evaluating the biomechanical and clinical outcomes of PFO in patients with knee osteoarthritis.A total of 258 were retrieved.After reviewing the summary of the texts,22 articles written in English were marked for abstract review.Articles that were case studies or cadaver experiments were excluded.The abstracts of the remaining articles were read,and only those that focused on the history,outcomes of case studies and technical considerations of PFO were included in the review.A total of 12 articles were included in this review.RESULTS At least six studies reported improvement in the visual analogue scale(VAS)from the average preoperative VAS score[6.32,95%confidence interval(CI)=(4.05,8.59)]to average postoperative VAS score[1.23,95%CI:(-1.20,3.71)],which was statistically significant.Similarly,the American Knee Society Score(KSS)functional score improved from an average preoperative KSS functional score[43.11,95%CI:(37.83,48.38)]to postoperative KSS functional score[66.145,95%CI:(61.94,70.35)],which was statistically significant.The femorotibial angle improved by around 7º,and the hip knee ankle angle improved by around 6º.CONCLUSION With the existing data,it seems that PFO is a viable option for treating medial joint osteoarthritis in selected patients.Long term outcome studies and progression of disease pathology are some of the important parameters that need to be addressed by use of multicenter randomized controlled trials.展开更多
BACKGROUND In children with osteosarcoma around the knee joint without epiphysis involvement,joint-sparing surgery seems to be an ideal way to retain knee joint function.However,there are two points of debate with reg...BACKGROUND In children with osteosarcoma around the knee joint without epiphysis involvement,joint-sparing surgery seems to be an ideal way to retain knee joint function.However,there are two points of debate with regard to the technique:How to accurately achieve a safe surgical margin,and how to achieve intercalary reconstruction of the massive bone defect following resection of the tumor.CASE SUMMARY We present the case of an 8-year-old girl with osteosarcoma of the distal femur without involvement of the epiphysis.Epiphyseal distraction was applied to separate the epiphysis and metaphysis,and this provided a safe surgical margin.The massive bone defect was reconstructed with a custom-made antibioticloaded polymethyl methacrylate(PMMA)construct combined with a free nonvascularized fibular graft.Six months after surgery,bone union between the autograft and host bone was confirmed in both the proximal and distal femur by computer tomography(CT)examination.Moreover,considerable callus formation was found around the PMMA construct.After 28 mo of follow-up,there was no sign of recurrence or metastasis.The patient could walk without any aid and carry out her daily life activities satisfactorily.CONCLUSION In cases of osteosarcoma without epiphysis involvement,epiphyseal distraction can be easily applied to obtain a safe margin.Hybrid reconstruction with an antibiotic-loaded PMMA construct combined with a free non-vascularized fibular graft has the advantages of being easy to manufacture,less time-consuming to place,and less likely to get infected,while also ensuring bone union.Our case provides an alternative technique for biological reconstruction after joint-sparing surgery in patients with osteosarcoma around the knee without epiphyseal involvement.展开更多
To correct a lower limb deformity, orthopedic surgeons must have an exact understanding of the deformity. In general, preoperative planning is carried out using anterior-posterior (AP) and lateral radiographs. However...To correct a lower limb deformity, orthopedic surgeons must have an exact understanding of the deformity. In general, preoperative planning is carried out using anterior-posterior (AP) and lateral radiographs. However, for severe cases with a combination of angular and rotational deformities of the lower limb, obtaining true AP and lateral radiographs is difficult and accurate calculation of the rotational deformity from radiographs is impossible. In this report, we propose to focus on preoperative assessment using three-dimensional (3D) reconstruction images of computed tomography (CT) scans for severe lower limb deformity in a patient with bilateral fibular hemimelia type II according to the Achterman- Kalamchi classification. She underwent bifocal deformity corrections of the bilateral tibiae using Taylor spatial frames in combination with the Ilizarov external fixator. Complete bony union was achieved, without angular deformity or limb length discrepancy.展开更多
Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（...Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（age range 16 to 73 years）. Aesthetic and functional outcomes were evaluated by follow-up and/or telephone conversation. Results：Among the 63 fibular flaps, 29 were osteocutaneous flaps with one or two skin islands. All the flaps were surviving well and the success rate was 100%. Long term donor site disability was not recorded for any patient. Thirty-one patients responded for aesthetic and functional evaluation, 20 cases（64.5%） reported their facial appearance as excellent or good, 11 （35.48%） felt fair; 14 cases （45%） could eat unrestricted diet, 17（55%） could eat soft diet; 21 cases were（67.67%） speech normal, 10（22.33%） speech intelligible. Conclusion：Free fibular flap reflects good functional and esthetic results with a high degree of consistency, and acceptable level of complications, and we strongly believe the vascularized fibular flap is the first choice for mandibular reconstruction.展开更多
Giant cell tumour of the distal radius is the 3rd most common site after proximal tibia and distal femur. It is locally aggressive and is associated with a high rate of recurrence. Although it is usually treated with ...Giant cell tumour of the distal radius is the 3rd most common site after proximal tibia and distal femur. It is locally aggressive and is associated with a high rate of recurrence. Although it is usually treated with various modalities of treatment, wide resection and reconstruction with proximal fibular autograft is most commonly accepted in recurrent cases. The following is a case report of such a case with surgical management.展开更多
<b><span>Purpose</span></b><b><span>: </span></b><span>The purpose </span><span>of </span><span>this study was to define a treatment protoc...<b><span>Purpose</span></b><b><span>: </span></b><span>The purpose </span><span>of </span><span>this study was to define a treatment protocol in which a non-vascularized endosteal fibular strut graft, a corticocancellous grafts and a locking plate construct </span><span>are</span><span> used for stabilization of the delayed and neglected proximal humerus fractures and to report its outcome. </span><b><span>Patients & Methods</span></b><b><span>:</span></b><b><span> </span></b><span>Eleven patients (6 females and 5 males) with delayed, neglected proximal humerus fractures were included in this study,</span><span> </span><span>conducted between March 2015 </span><span>and </span><span>December 2019.</span><span> </span><span>Average age of the patients was 57 years (range: 41 to 67 yrs). All patients were treated with the debridement, decortication and shingling of the bone at the site of the fracture followed by using an endosteal fibular strut graft, corticocancellous bone grafts and stabilization with locking plate. The patients were followed</span><span> </span><span>up for a mean time of 16.3 months (range: 13 </span><span>to </span><span>40 months). The patient outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand Questionnaire, and the modified scoring system of Constant and Murley. </span><b><span>Results</span></b><b><span>:</span></b><b><span> </span></b><span>Union at the fracture site was achieved in all patients at a mean </span><span>of </span><span>8.5 months (range: 6 to 11 months). The DASH score improved from an average pre-operative score of 71.1 (range: 64 to 78) to an average post-operative score of 25.2 (range: 21 to 35) at the final follow-up. Albeit with a small sample size of n</span><span> </span><span>=</span><span> </span><span>11, this difference was found to be statistically significant (p</span><span> </span><span><</span><span> </span><span>0.05). The CM score improved from an average pre-operative score of 33.2 (range: 20 to 48) to an average post-operative score of 66.8 (range: 59 to 72) at the final follow-up. This difference was also found to be statistically significant in this patient cohort (p</span><span> </span><span><</span><span> </span><span>0.05). The results were excellent in 3 patients, good in 6 and moderate in 2. </span><b><span>Conclusions</span></b><b><span>:</span></b><b><span> </span></b><span>An endosteal fibular strut, subperiosteally placed cortico-cancellous grafts with a locking plate fixation helps in biological healing of neglected fractures of proximal humerus.</span>展开更多
Purposes: We would like to inform the characteristics of recurred osteo-fibrous dysplasia (OFD), and also the possible use of vascularized composite autograft and allografts (VCA) combined with live fibular graft (LFG...Purposes: We would like to inform the characteristics of recurred osteo-fibrous dysplasia (OFD), and also the possible use of vascularized composite autograft and allografts (VCA) combined with live fibular graft (LFG) for the treatment of aggressive benign bone tumor and osteogenic sarcomas in children. Materials and Methods: We reviewed one boy with recurred OFD after LFG, and other four children with osteogenic sarcoma in long bone which was treated with LFG and VCA, and followed them for average 9 years (3 - 14 years). Survival of the LFG and VCA was estimated by the ISOLS Functional Radiologic Scoring System, but not with Kaplans-Meier’s scoring system because of a small series of case reports. Results: All succeed after surgeries initially, but the cause of recurrence of OFD was still unclear, and one girl with osteogenic sarcoma on distal femur died with skip and lung metastasis, 4 years after surgeries. Conclusions: The causes of recurred OFD are not found thru pathologic studies of our patient, but we believe the multifocal origin of tumor cells even on the adjacent soft tissues in OFD is one of the causes. The excised long bone tumor is recycled by pasteurization or autoclaving, or allograft, then LFG, and neo-adjuvant chemotherapy would be one of elective surgery for the treatment of malignant long bone tumors in children. The LFG into recycled autograft or allograft bone is difficult to perform simultaneously, but very effective to increase more earlier regenerative vascularities and also the stabilities of the dead bones in children.展开更多
cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University ar...cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University are reported. All patients have ben followed up for 2 to 11 years. Excellent and good rate of operative results was 86. 6%. A long observation indicated that this procedure was superior to the other operations for the osteonecrosis of femoral head. Successful interim and final operative results can warrant its continued use in management of this kind of patients.展开更多
<span style="font-family:Verdana;">A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, ...<span style="font-family:Verdana;">A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, demonstrates an improvement in dorsifexion after an ultrasound guided infiltration of a sub-anesthetic dose of lidocaine. Less than</span><span style="font-family:""> </span><span style="font-family:Verdana;">5 cc’s of 1% or 2% lidocaine is utilized and the effect is seen within minutes after the infiltration, but usually lasts only 10 minutes. This effect may be due to the vasodilatory action of lidocaine on the microcirculation in the area of infiltration. This nerve block has significant diagnostic utility as it is highly specific in the confirmation of true focal entrapment of the CFN, has high predictive value for a patient who may undergo surgical nerve decompression if they have demonstrated a positive Phoenix Sign, and may help in the surgical decision-making process in patients who have had a drop foot for many years but still may regain some motor function after decompression. In this retrospective review, 26 patients were tested, and 25</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">of this cohort demon</span><span style="font-family:Verdana;">strated a Positive Phoenix Sign (an increase in dorsiflexion strength of the</span><span style="font-family:Verdana;"> Extensor Hallucis Longus muscle (EHL)). One patient had no response to the </span><span style="font-family:Verdana;">peripheral nerve block. Of the 25 patients who demonstrated a positive</span><span style="font-family:Verdana;"> “Phoenix Sign” and underwent nerve decompression of the CFN, and 25 (100%) showed an increase in dorsiflexion strength of the EHL after nerve decom</span><span style="font-family:Verdana;">pression surgery of the CFN. The one patient in this cohort who did not</span><span style="font-family:Verdana;"> dem</span><span style="font-family:Verdana;">onstrate any improvement in dorsiflexion of the EHL after the nerve block</span><span style="font-family:Verdana;"> did not have any improvement after surgery.展开更多
Recently we have been performing biological reconstruction for malignant bone tumors of the extremities using frozen autografts. Here we present a case treated with free vascularized fibular graft (FVFG) after this me...Recently we have been performing biological reconstruction for malignant bone tumors of the extremities using frozen autografts. Here we present a case treated with free vascularized fibular graft (FVFG) after this method. A 23-year-old man developed osteosarcoma in his left distal tibia. There was nonunion after frozen autograft reconstruction, which we treated with FVFG. Twenty-four months later, bridging between the host bone and the frozen autograft was achieved. Our department has achieved bone union in almost all cases, but we sometimes encounter cases of nonunion after this method because of delayed blood supply. In these instances, reconstruction using FVFG may represent an attractive choice for salvage treatment.展开更多
Purpose: The aim of the present study was to use finite elemental analysis (FEA) to evaluate bone stress near an implant placed at the border between the mandible and fibular graft in mandibular reconstruction. Materi...Purpose: The aim of the present study was to use finite elemental analysis (FEA) to evaluate bone stress near an implant placed at the border between the mandible and fibular graft in mandibular reconstruction. Materials and Methods: A fibular model (FM) and transplantation model (TM) were constructed for FEA. In TM, mandible was on the mesial side and the fibular graft was on the distal side. The implant was positioned at the center of both bone models. In TM, it was placed on the border between the mandible and fibular graft. A 10-mm implant was used in the monocortical model and a 15-mm implant was used in the bicortical model. The loading force was set at 100 N, the angle was set at 90°, and the loading position was set as center, mesial, or distal on the upper surface of the prosthesis. Von Mises equivalent stress values of the bone near the implant collar and apex at the middle line between buccal and lingual side were measured. Results: In all models, stress values were significantly lower with center loading than with distal loading and mesial loading. In center loading, the stress values were significantly lower in the bicortical model than in the monocortical model. There were no significant differences in stress values between FM and TM in all conditions. Conclusions: Bone stress was least with the center loading position, which was further decreased by bicortical fixation. There was no increase in mechanical stress associated with placing an implant at the border between the mandible and the fibular graft.展开更多
Proximal tibiofibular instability is a rare condition for which treatment is poorly codified.A 21-year-old patient,a leisure sportswoman,presented a post-traumatic anterolateral instability of the proximal tibiofibula...Proximal tibiofibular instability is a rare condition for which treatment is poorly codified.A 21-year-old patient,a leisure sportswoman,presented a post-traumatic anterolateral instability of the proximal tibiofibular articulation without cartilage lesion.We propose an original surgical technique based on a review of the literature that combines an anatomical ligamentoplasty of the proximal tibiofibular joint and a proximal fibular diaphyseal osteotomy to reduce the distal tibiofibular mechanical stresses.This original technique allows a favorable evolution with recovery of professional and sports activities at 6 months.展开更多
Background The pelvis often needs to be reconstructed after bone tumor resection. A major challenge here for the orthopedic surgeons is to choose a method that gives the best performance which depends upon its biomech...Background The pelvis often needs to be reconstructed after bone tumor resection. A major challenge here for the orthopedic surgeons is to choose a method that gives the best performance which depends upon its biomechanical properties. In this study, a 3-dimensional finite element analysis （FEA） was used to analyze the biomechanical properties of reconstructed pelvis using fibula transplant fixed by four commonly used rod-screw systems. Methods A total pelvic finite-element model including the lumbar-sacral spine and proximal femur was constructed based on the geometry of CT image from a healthy volunteer. Three-dimensional finite element models of different implants including fibula, rod and screw were simulated using ways of solid modeling. Then various reconstructed finite element models were assembled with different finite element implant model and type Ⅰ resected pelvic finite element model. The load of 500 N was imposed vertically onto the superior surface of L3 vertebral body, and the pelvis was fixed in bilateral leg standing positions. FEA was performed to account for the stress distribution on the bones and implants. The pelvis displacement of the different rod-screw fixation methods and the maximum equivalent stress （max EQV） on all nodes and element were figured out to evaluate the advantages and disadvantages of different reconstructive methods.Results Stress concentration in the fibula transplant was extremely high in the reconstructed pelvis, but could be substantially decreased by internal fixation, which partially transferred the stress from the fibula to the rod-screw systems. High stress concentration was also found in the implants, especially in the connection sites between screw arid rod. Among the four methods of fixation, a double rod system with L5-S1 pedicle and ilium screws （L5-S1 HR） produced the best performance： least stress concentrations and least total displacement.Conclusion According to the stability and stress concentration, the method of L5-S1 HR fixation combined with fibula transplantation is better than other fixation methods in pelvic reconstruction after type Ⅰ resection.展开更多
The internal fixation failure for treatment of femoral neck fracture is mainly due to improper fixation, loss of fixation stability and premature ambulation. Bone nonunion and avascular osteonecrosis of the femoral he...The internal fixation failure for treatment of femoral neck fracture is mainly due to improper fixation, loss of fixation stability and premature ambulation. Bone nonunion and avascular osteonecrosis of the femoral head caused by the internal fixation failure for femoral neck fracture are always the complex topics in orthopedics. With regard to patients who sustain these complications, total hip arthroplasty is a proper choice for elderly patients, but is not acceptable by young patients. We report nine patients with the failure of internal fixation for femoral neck fracture who were treated with free vascularized fibular grafting and internal fixation with cannulated screw from November 2001 to October 2003. All of them achieved good results.展开更多
The presence of large segmental defects of the diaphyseal bone is challenging for orthopedic surgeons. Free vascularized fibular grafting （FVFG） is considered to be a reliable reconstructive procedure. Stress fractu...The presence of large segmental defects of the diaphyseal bone is challenging for orthopedic surgeons. Free vascularized fibular grafting （FVFG） is considered to be a reliable reconstructive procedure. Stress fractures are a common complication following this surgery, and hypertrophy is the main physiological change of the grafted fibula. The exact mechanism of hypertrophy is not completely known. To the best of our knowledge, no studies have examined the possible relationship between stress fractures and hypertrophy. We herein report three cases of patients underwent FVFG. Two of them developed stress fractures and significant hypertrophy, while the remaining patient developed neither stress fractures nor significant hypertrophy. This phenomenon indicates that a relationship may exist between stress frac~ tures and hypertrophy of the grafted fibula, specifically, that the presence of a stress fracture may initiate the process of hypertrophy,展开更多
Purpose:To assess the effectiveness of two-stage treatment with the fibular sliding technique in chronic infected nonunion of the tibia.Methods:The study included patients who were diagnosed with long-term chronic inf...Purpose:To assess the effectiveness of two-stage treatment with the fibular sliding technique in chronic infected nonunion of the tibia.Methods:The study included patients who were diagnosed with long-term chronic infected tibial nonunion following trauma and treated with the two-stage technique between January 2010 and November 2017.Patients with(1)intra-articular fractures of the distal third of the tibia and fibula,(2)pathological fracture resulting in bone loss or(3)neurological and vascular pathologies of the limbs were excluded.The operation consisted of two stages and the main goal in the first stage was to control the infection and in the second stage to control the healing of the bone.Functional&radiographic results and complications were evaluated according to Paley's criteria.Results:The patients comprised 14 males and 5 females with a mean age of 37.4 years(range,21-52 years).Patients were followed up for an average of 27 months(range,15-38 months).The microorganisms produced from these patients were Staphylococcus aureus in 13 patients,Pseudomonas aeruginosa in 4 patients and no bacteria in 2 patients.After the first stage operation,superficial skin necrosis developed in 1 patient.In another patient,there was a persistent infection,although union was achieved.For the entire patient group,union was observed at the end of 7.44 months(range,7-11 months).Based on Paley's criteria,there were 16(84.2%)patients with excellent scores,2(10.5%)good scores and 1(5.3%)fair scores radiologically;while regarding the tibial function,15(78.9%)patients had excellent scores,3(15.8%)good scores,and 1(5.3%)fair scores.No patients had poor radiological or functional score.Conclusion:Two-stage treatment can be considered as an alternative for fractures in regions that are susceptible to many and persistent complications,such as the tibia.This technique has the advantages of short operation time,minimal blood loss,no excessive tissue damage and not very technique-demanding(a short learning curve with no requirement for an experienced team).展开更多
文摘BACKGROUND Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support,which are important factors that lead to internal fixation failure.The appropriate treatment for proximal humerus comminuted fractures has not been established.Therefore,this study assessed the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.AIM To investigate the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.METHODS This retrospective,comparative cohort study included two groups of patients.Group 1 comprised 22 patients and group 2 comprised 25 patients with complete follow-up data.Group 1 was treated with a fibular autograft with open reduction and locking plates to enable internal fixation.Group 2 was treated with open reduction and locking plates to enable internal fixation.The intraoperative blood loss volume from the shoulder wound,operative time,shoulder wound pain,bone fracture healing time,Constant-Murley score of the shoulder joint,preoperative Holden walking function score,Mallet score of the shoulder joint,and humeral neck-shaft angle during surgery of the two groups were compared,and the differences were analysed using an independent sample t-test.RESULTS Group 1 had a shorter mean operative time than group 2(2.25±0.30 h vs 2.76±0.44 h;P=0.000).Group 1 had a lower shoulder wound pain score on the first day after surgery than group 2(7.91±1.15 points vs 8.56±1.00 points;P=0.044).Group 1 had a shorter fracture healing time than group 2(2.68±0.48 mo vs 3.64±0.64 mo;P=0.000).Group 1 had higher Constant-Murley scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(76.64±4.02 points vs 72.72±3.02 points,86.36±3.53 points vs 82.96±3.40 points,and 87.95±2.77 points vs 84.68±2.63 points,respectively;P=0.000,0.002,and 0.000,respectively).Group 1 had higher Mallet scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(10.32±0.57 points vs 9.96±0.54 points,13.36±1.00 points vs 12.60±0.87 points,and 13.91±0.75 points vs 13.36±0.70 points,respectively;P=0.032,0.007,and 0.013,respectively).CONCLUSION Using locking plates with a fibular autograft can recreate medial support,facilitate fracture healing,and improve shoulder function;therefore,this may be an effective treatment option for severe proximal humerus comminuted fractures.
文摘BACKGROUND The morbidity and burden of knee osteoarthritis affecting millions of lives worldwide has created a constant pursuit in finding the ideal treatment for knee osteoarthritis.There has been a paradigm shift in the surgical treatment of osteoarthritis ever since the initial description of Volkmann’s tibial osteotomy.This review focuses on one such recent procedure,the proximal fibular osteotomy(PFO)for medial compartment knee osteoarthritis.This review encompasses the history,evidence,risk factors,outcomes and technical considerations of PFO.AIM To understand the evidence and its techniques,and whether this could be an alternative solution to the problem of knee osteoarthritis in the developing world.METHODS The phrases“proximal fibular osteotomy”and“knee osteoarthritis”were searched(date of search December 20,2019)on PubMed to identify articles evaluating the biomechanical and clinical outcomes of PFO in patients with knee osteoarthritis.A total of 258 were retrieved.After reviewing the summary of the texts,22 articles written in English were marked for abstract review.Articles that were case studies or cadaver experiments were excluded.The abstracts of the remaining articles were read,and only those that focused on the history,outcomes of case studies and technical considerations of PFO were included in the review.A total of 12 articles were included in this review.RESULTS At least six studies reported improvement in the visual analogue scale(VAS)from the average preoperative VAS score[6.32,95%confidence interval(CI)=(4.05,8.59)]to average postoperative VAS score[1.23,95%CI:(-1.20,3.71)],which was statistically significant.Similarly,the American Knee Society Score(KSS)functional score improved from an average preoperative KSS functional score[43.11,95%CI:(37.83,48.38)]to postoperative KSS functional score[66.145,95%CI:(61.94,70.35)],which was statistically significant.The femorotibial angle improved by around 7º,and the hip knee ankle angle improved by around 6º.CONCLUSION With the existing data,it seems that PFO is a viable option for treating medial joint osteoarthritis in selected patients.Long term outcome studies and progression of disease pathology are some of the important parameters that need to be addressed by use of multicenter randomized controlled trials.
基金Supported by National Natural Science Foundation of China,No.81301671
文摘BACKGROUND In children with osteosarcoma around the knee joint without epiphysis involvement,joint-sparing surgery seems to be an ideal way to retain knee joint function.However,there are two points of debate with regard to the technique:How to accurately achieve a safe surgical margin,and how to achieve intercalary reconstruction of the massive bone defect following resection of the tumor.CASE SUMMARY We present the case of an 8-year-old girl with osteosarcoma of the distal femur without involvement of the epiphysis.Epiphyseal distraction was applied to separate the epiphysis and metaphysis,and this provided a safe surgical margin.The massive bone defect was reconstructed with a custom-made antibioticloaded polymethyl methacrylate(PMMA)construct combined with a free nonvascularized fibular graft.Six months after surgery,bone union between the autograft and host bone was confirmed in both the proximal and distal femur by computer tomography(CT)examination.Moreover,considerable callus formation was found around the PMMA construct.After 28 mo of follow-up,there was no sign of recurrence or metastasis.The patient could walk without any aid and carry out her daily life activities satisfactorily.CONCLUSION In cases of osteosarcoma without epiphysis involvement,epiphyseal distraction can be easily applied to obtain a safe margin.Hybrid reconstruction with an antibiotic-loaded PMMA construct combined with a free non-vascularized fibular graft has the advantages of being easy to manufacture,less time-consuming to place,and less likely to get infected,while also ensuring bone union.Our case provides an alternative technique for biological reconstruction after joint-sparing surgery in patients with osteosarcoma around the knee without epiphyseal involvement.
文摘To correct a lower limb deformity, orthopedic surgeons must have an exact understanding of the deformity. In general, preoperative planning is carried out using anterior-posterior (AP) and lateral radiographs. However, for severe cases with a combination of angular and rotational deformities of the lower limb, obtaining true AP and lateral radiographs is difficult and accurate calculation of the rotational deformity from radiographs is impossible. In this report, we propose to focus on preoperative assessment using three-dimensional (3D) reconstruction images of computed tomography (CT) scans for severe lower limb deformity in a patient with bilateral fibular hemimelia type II according to the Achterman- Kalamchi classification. She underwent bifocal deformity corrections of the bilateral tibiae using Taylor spatial frames in combination with the Ilizarov external fixator. Complete bony union was achieved, without angular deformity or limb length discrepancy.
基金Science Fund of Department of Public Health of Jiangsu Province(ZK200209)
文摘Objective： To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods：The clinical data of 63 patients were reviewed, 35 male and 28 female（age range 16 to 73 years）. Aesthetic and functional outcomes were evaluated by follow-up and/or telephone conversation. Results：Among the 63 fibular flaps, 29 were osteocutaneous flaps with one or two skin islands. All the flaps were surviving well and the success rate was 100%. Long term donor site disability was not recorded for any patient. Thirty-one patients responded for aesthetic and functional evaluation, 20 cases（64.5%） reported their facial appearance as excellent or good, 11 （35.48%） felt fair; 14 cases （45%） could eat unrestricted diet, 17（55%） could eat soft diet; 21 cases were（67.67%） speech normal, 10（22.33%） speech intelligible. Conclusion：Free fibular flap reflects good functional and esthetic results with a high degree of consistency, and acceptable level of complications, and we strongly believe the vascularized fibular flap is the first choice for mandibular reconstruction.
文摘Giant cell tumour of the distal radius is the 3rd most common site after proximal tibia and distal femur. It is locally aggressive and is associated with a high rate of recurrence. Although it is usually treated with various modalities of treatment, wide resection and reconstruction with proximal fibular autograft is most commonly accepted in recurrent cases. The following is a case report of such a case with surgical management.
文摘<b><span>Purpose</span></b><b><span>: </span></b><span>The purpose </span><span>of </span><span>this study was to define a treatment protocol in which a non-vascularized endosteal fibular strut graft, a corticocancellous grafts and a locking plate construct </span><span>are</span><span> used for stabilization of the delayed and neglected proximal humerus fractures and to report its outcome. </span><b><span>Patients & Methods</span></b><b><span>:</span></b><b><span> </span></b><span>Eleven patients (6 females and 5 males) with delayed, neglected proximal humerus fractures were included in this study,</span><span> </span><span>conducted between March 2015 </span><span>and </span><span>December 2019.</span><span> </span><span>Average age of the patients was 57 years (range: 41 to 67 yrs). All patients were treated with the debridement, decortication and shingling of the bone at the site of the fracture followed by using an endosteal fibular strut graft, corticocancellous bone grafts and stabilization with locking plate. The patients were followed</span><span> </span><span>up for a mean time of 16.3 months (range: 13 </span><span>to </span><span>40 months). The patient outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand Questionnaire, and the modified scoring system of Constant and Murley. </span><b><span>Results</span></b><b><span>:</span></b><b><span> </span></b><span>Union at the fracture site was achieved in all patients at a mean </span><span>of </span><span>8.5 months (range: 6 to 11 months). The DASH score improved from an average pre-operative score of 71.1 (range: 64 to 78) to an average post-operative score of 25.2 (range: 21 to 35) at the final follow-up. Albeit with a small sample size of n</span><span> </span><span>=</span><span> </span><span>11, this difference was found to be statistically significant (p</span><span> </span><span><</span><span> </span><span>0.05). The CM score improved from an average pre-operative score of 33.2 (range: 20 to 48) to an average post-operative score of 66.8 (range: 59 to 72) at the final follow-up. This difference was also found to be statistically significant in this patient cohort (p</span><span> </span><span><</span><span> </span><span>0.05). The results were excellent in 3 patients, good in 6 and moderate in 2. </span><b><span>Conclusions</span></b><b><span>:</span></b><b><span> </span></b><span>An endosteal fibular strut, subperiosteally placed cortico-cancellous grafts with a locking plate fixation helps in biological healing of neglected fractures of proximal humerus.</span>
文摘Purposes: We would like to inform the characteristics of recurred osteo-fibrous dysplasia (OFD), and also the possible use of vascularized composite autograft and allografts (VCA) combined with live fibular graft (LFG) for the treatment of aggressive benign bone tumor and osteogenic sarcomas in children. Materials and Methods: We reviewed one boy with recurred OFD after LFG, and other four children with osteogenic sarcoma in long bone which was treated with LFG and VCA, and followed them for average 9 years (3 - 14 years). Survival of the LFG and VCA was estimated by the ISOLS Functional Radiologic Scoring System, but not with Kaplans-Meier’s scoring system because of a small series of case reports. Results: All succeed after surgeries initially, but the cause of recurrence of OFD was still unclear, and one girl with osteogenic sarcoma on distal femur died with skip and lung metastasis, 4 years after surgeries. Conclusions: The causes of recurred OFD are not found thru pathologic studies of our patient, but we believe the multifocal origin of tumor cells even on the adjacent soft tissues in OFD is one of the causes. The excised long bone tumor is recycled by pasteurization or autoclaving, or allograft, then LFG, and neo-adjuvant chemotherapy would be one of elective surgery for the treatment of malignant long bone tumors in children. The LFG into recycled autograft or allograft bone is difficult to perform simultaneously, but very effective to increase more earlier regenerative vascularities and also the stabilities of the dead bones in children.
文摘cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University are reported. All patients have ben followed up for 2 to 11 years. Excellent and good rate of operative results was 86. 6%. A long observation indicated that this procedure was superior to the other operations for the osteonecrosis of femoral head. Successful interim and final operative results can warrant its continued use in management of this kind of patients.
文摘<span style="font-family:Verdana;">A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, demonstrates an improvement in dorsifexion after an ultrasound guided infiltration of a sub-anesthetic dose of lidocaine. Less than</span><span style="font-family:""> </span><span style="font-family:Verdana;">5 cc’s of 1% or 2% lidocaine is utilized and the effect is seen within minutes after the infiltration, but usually lasts only 10 minutes. This effect may be due to the vasodilatory action of lidocaine on the microcirculation in the area of infiltration. This nerve block has significant diagnostic utility as it is highly specific in the confirmation of true focal entrapment of the CFN, has high predictive value for a patient who may undergo surgical nerve decompression if they have demonstrated a positive Phoenix Sign, and may help in the surgical decision-making process in patients who have had a drop foot for many years but still may regain some motor function after decompression. In this retrospective review, 26 patients were tested, and 25</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">of this cohort demon</span><span style="font-family:Verdana;">strated a Positive Phoenix Sign (an increase in dorsiflexion strength of the</span><span style="font-family:Verdana;"> Extensor Hallucis Longus muscle (EHL)). One patient had no response to the </span><span style="font-family:Verdana;">peripheral nerve block. Of the 25 patients who demonstrated a positive</span><span style="font-family:Verdana;"> “Phoenix Sign” and underwent nerve decompression of the CFN, and 25 (100%) showed an increase in dorsiflexion strength of the EHL after nerve decom</span><span style="font-family:Verdana;">pression surgery of the CFN. The one patient in this cohort who did not</span><span style="font-family:Verdana;"> dem</span><span style="font-family:Verdana;">onstrate any improvement in dorsiflexion of the EHL after the nerve block</span><span style="font-family:Verdana;"> did not have any improvement after surgery.
文摘Recently we have been performing biological reconstruction for malignant bone tumors of the extremities using frozen autografts. Here we present a case treated with free vascularized fibular graft (FVFG) after this method. A 23-year-old man developed osteosarcoma in his left distal tibia. There was nonunion after frozen autograft reconstruction, which we treated with FVFG. Twenty-four months later, bridging between the host bone and the frozen autograft was achieved. Our department has achieved bone union in almost all cases, but we sometimes encounter cases of nonunion after this method because of delayed blood supply. In these instances, reconstruction using FVFG may represent an attractive choice for salvage treatment.
文摘Purpose: The aim of the present study was to use finite elemental analysis (FEA) to evaluate bone stress near an implant placed at the border between the mandible and fibular graft in mandibular reconstruction. Materials and Methods: A fibular model (FM) and transplantation model (TM) were constructed for FEA. In TM, mandible was on the mesial side and the fibular graft was on the distal side. The implant was positioned at the center of both bone models. In TM, it was placed on the border between the mandible and fibular graft. A 10-mm implant was used in the monocortical model and a 15-mm implant was used in the bicortical model. The loading force was set at 100 N, the angle was set at 90°, and the loading position was set as center, mesial, or distal on the upper surface of the prosthesis. Von Mises equivalent stress values of the bone near the implant collar and apex at the middle line between buccal and lingual side were measured. Results: In all models, stress values were significantly lower with center loading than with distal loading and mesial loading. In center loading, the stress values were significantly lower in the bicortical model than in the monocortical model. There were no significant differences in stress values between FM and TM in all conditions. Conclusions: Bone stress was least with the center loading position, which was further decreased by bicortical fixation. There was no increase in mechanical stress associated with placing an implant at the border between the mandible and the fibular graft.
文摘Proximal tibiofibular instability is a rare condition for which treatment is poorly codified.A 21-year-old patient,a leisure sportswoman,presented a post-traumatic anterolateral instability of the proximal tibiofibular articulation without cartilage lesion.We propose an original surgical technique based on a review of the literature that combines an anatomical ligamentoplasty of the proximal tibiofibular joint and a proximal fibular diaphyseal osteotomy to reduce the distal tibiofibular mechanical stresses.This original technique allows a favorable evolution with recovery of professional and sports activities at 6 months.
基金This study was supported by grants from National Natural Science Foundation of China （No. 30571895）, Program for New Century Excellent Talents in University （No. NCET-06-0375）, and Shanghai Foundation for the Development of Science and Technology （No. 044119739）.
文摘Background The pelvis often needs to be reconstructed after bone tumor resection. A major challenge here for the orthopedic surgeons is to choose a method that gives the best performance which depends upon its biomechanical properties. In this study, a 3-dimensional finite element analysis （FEA） was used to analyze the biomechanical properties of reconstructed pelvis using fibula transplant fixed by four commonly used rod-screw systems. Methods A total pelvic finite-element model including the lumbar-sacral spine and proximal femur was constructed based on the geometry of CT image from a healthy volunteer. Three-dimensional finite element models of different implants including fibula, rod and screw were simulated using ways of solid modeling. Then various reconstructed finite element models were assembled with different finite element implant model and type Ⅰ resected pelvic finite element model. The load of 500 N was imposed vertically onto the superior surface of L3 vertebral body, and the pelvis was fixed in bilateral leg standing positions. FEA was performed to account for the stress distribution on the bones and implants. The pelvis displacement of the different rod-screw fixation methods and the maximum equivalent stress （max EQV） on all nodes and element were figured out to evaluate the advantages and disadvantages of different reconstructive methods.Results Stress concentration in the fibula transplant was extremely high in the reconstructed pelvis, but could be substantially decreased by internal fixation, which partially transferred the stress from the fibula to the rod-screw systems. High stress concentration was also found in the implants, especially in the connection sites between screw arid rod. Among the four methods of fixation, a double rod system with L5-S1 pedicle and ilium screws （L5-S1 HR） produced the best performance： least stress concentrations and least total displacement.Conclusion According to the stability and stress concentration, the method of L5-S1 HR fixation combined with fibula transplantation is better than other fixation methods in pelvic reconstruction after type Ⅰ resection.
文摘The internal fixation failure for treatment of femoral neck fracture is mainly due to improper fixation, loss of fixation stability and premature ambulation. Bone nonunion and avascular osteonecrosis of the femoral head caused by the internal fixation failure for femoral neck fracture are always the complex topics in orthopedics. With regard to patients who sustain these complications, total hip arthroplasty is a proper choice for elderly patients, but is not acceptable by young patients. We report nine patients with the failure of internal fixation for femoral neck fracture who were treated with free vascularized fibular grafting and internal fixation with cannulated screw from November 2001 to October 2003. All of them achieved good results.
文摘The presence of large segmental defects of the diaphyseal bone is challenging for orthopedic surgeons. Free vascularized fibular grafting （FVFG） is considered to be a reliable reconstructive procedure. Stress fractures are a common complication following this surgery, and hypertrophy is the main physiological change of the grafted fibula. The exact mechanism of hypertrophy is not completely known. To the best of our knowledge, no studies have examined the possible relationship between stress fractures and hypertrophy. We herein report three cases of patients underwent FVFG. Two of them developed stress fractures and significant hypertrophy, while the remaining patient developed neither stress fractures nor significant hypertrophy. This phenomenon indicates that a relationship may exist between stress frac~ tures and hypertrophy of the grafted fibula, specifically, that the presence of a stress fracture may initiate the process of hypertrophy,
文摘Purpose:To assess the effectiveness of two-stage treatment with the fibular sliding technique in chronic infected nonunion of the tibia.Methods:The study included patients who were diagnosed with long-term chronic infected tibial nonunion following trauma and treated with the two-stage technique between January 2010 and November 2017.Patients with(1)intra-articular fractures of the distal third of the tibia and fibula,(2)pathological fracture resulting in bone loss or(3)neurological and vascular pathologies of the limbs were excluded.The operation consisted of two stages and the main goal in the first stage was to control the infection and in the second stage to control the healing of the bone.Functional&radiographic results and complications were evaluated according to Paley's criteria.Results:The patients comprised 14 males and 5 females with a mean age of 37.4 years(range,21-52 years).Patients were followed up for an average of 27 months(range,15-38 months).The microorganisms produced from these patients were Staphylococcus aureus in 13 patients,Pseudomonas aeruginosa in 4 patients and no bacteria in 2 patients.After the first stage operation,superficial skin necrosis developed in 1 patient.In another patient,there was a persistent infection,although union was achieved.For the entire patient group,union was observed at the end of 7.44 months(range,7-11 months).Based on Paley's criteria,there were 16(84.2%)patients with excellent scores,2(10.5%)good scores and 1(5.3%)fair scores radiologically;while regarding the tibial function,15(78.9%)patients had excellent scores,3(15.8%)good scores,and 1(5.3%)fair scores.No patients had poor radiological or functional score.Conclusion:Two-stage treatment can be considered as an alternative for fractures in regions that are susceptible to many and persistent complications,such as the tibia.This technique has the advantages of short operation time,minimal blood loss,no excessive tissue damage and not very technique-demanding(a short learning curve with no requirement for an experienced team).
