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BACKGROUND: Wound infections after posterior spinal surgery are a troublesome complication; patients are occasionally forced to remove the internal fixation device, which can lead to instability of the spine and injury to the spinal cord. The purpose of this study was to evaluate the efficacy of modified vacuum-assisted closure (VAC) for treating an early postoperative spinal wound infection. METHODS: We conducted a retrospective study of 18 patients with wound infections after posterior spinal surgery from 2014 to 2017 at a single tertiary center. All patients included in the study received modified VAC treatment (VAC combined with a closed suction irrigation system, CSIS) until the wound satisfied the secondary closure conditions. Detailed information was obtained from the medical records. RESULTS: Wound size decreased significantly after 1 week of the modified VAC treatment. Three patients were treated with VAC three times and one patient received the VAC treatment four times; the remaining patients received the VAC treatment twice. The patients had excellent wound beds after an average of 8 days. The wound healed completely after an average of 17 days, and the average hospital stay was 33 days. There was no recurrence of infection at the 1-year follow-up. CONCLUSIONS: This study demonstrates that VAC combined with a CSIS is a safe, reliable, and effective method to treat a wound infection after spinal surgery. This improved VAC procedure provides an excellent wound bed to facilitate wound healing and shorten the hospital stay.

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OBJECTIVE: To study on the reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in total knee arthroplasty (TKA) the rotational alignment reference bony landmarks of the proximal tibial component on magnetic resonance image (MRI) were measured. METHODS: From January 2010 to December 2013, 80 normal knees of Chinese volunteers including 35 males and 45 females with an average age of (35.4±6.1) years were reviewed. The images of the knees were obtained by MRI. The surgical epicondylar axis (STEA) was identified in the femoral transverse sections and then was projected to the side of tibia, forming the SETA'. A line connecting the medial border of the patellar tendon and the middle of the posterior cruciate ligament insertion (Akagi line) and its vertical line (AK), as well as a line connecting the medial 1/3 of the patellar tendon and the middle of the posterior cruciate ligament insertion and its vertical line (AP), were identified in the tibial transverse sections. The angles were measured between the AK, AP and STEA'. RESULTS: The angle between AK and STEA' was (0.59±2.07)°, and there was no significant difference between the two lines (t=-2.54, P=0.13). The mean angle between AP and STEA' was (3.21±2.04)°, and there was a significant difference between the two lines (t=14.05, P<0.05). There was a significant difference between the AK and AP (t=-11.68, P<0.05). CONCLUSION: The reliability of the Akagi line as a reference axis to guide for rotational alignment of the proximal tibial component in TKA is good.

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OBJECTIVE: To study the morbidity factors of bilateral intertrochanteric fractures by analyzing medical records, so as to provide evidences for preventing the multiple intertrochanteric fractures. METHODS: From Janurary 2000 to June 2009, 68 patients with bilateral intertrochanteric fractures were studied, including 31 males and 37 females, ranging in age from 42 to 95 years with an average age of 75 years. There were type A1 in 24 hips, type A2 in 96 hips, and type B3 in 16 hips. One hundred and twenty-eight hips had received surgical treatment, 8 hips were treated with conservative method. On the first injury, 67 patients discharged after treatment, 1 patients discharged after treatment in other department. On the second injury, 58 patients discharged after treatment, 2 patients died of complications, 8 patients dischagred after treatment in other department. The risk factors including age, cause of injury, fractures type, complications, osteoporosis and treatment were analyzed. RESULTS: The average age of two fractures were (73.6 +/- 9.25) and (76.7 +/- 6.74) years; the major injury cause was fall; the A2-type fractures went up to 80.88% on the secondary injury;and the proportion of complications was high, mainly geriatric cognitive disorders, hemiplegic paralysis, and dysopia. Bone mineral density measurement of 16 cases showed marked osteoporosis. CONCLUSION: Osteoporosis and fall injury contribute mostly to the multiple intertrochanteric fractures. Complication was the dominating risk factor. Treatment of osteoporosis, intensive care, postoperative rehabilitation and effective initial surgery are the key to prevent the secondary intertrochanteric fractures in old people.

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OBJECTIVE: To compare therapeutic effects between clavicular hook plate and tension band fixation for the treatment of Allman type II to III sternoclavicular joint dislocations. METHODS: A retrospective survey was analyzed from May 2000 to September 2008. A total of 31 patients with Allman type II to III sternoclavicular joint dislocations were followed up. Sixteen patients were fixed with the clavicular hook plate (Group A) including 11 males and 5 females, with a mean age of (37.4 +/- 7.3) years. Fifteen patients were treated with tension band fixation (Group B) including 9 males and 6 females, with a mean age of (35.6 +/- 5.1) years. The indexes of intra-operation and during the hospital stay, the clinical outcomes and postoperative complications were statistically compared. RESULTS: All the patients were followed up for 12 to 37 months, with an average of 20 months. There was no significant differences in data of operative time, blood loss and length of incision between the two group (P > 0.05); however, the economic cost was significantly much more in Group A (P < 0.01). Also, there was statistically difference in the incidence of complications between the two groups (P = 0.023), which were 2 patients in Group A and 8 patients in Group B. According to Rockwood evaluation criteria, in group A, 13 patients got an excellent result, 2 good and 1 poor; in group B, 10 patients got an excellent result, 3 good, 1 poor and 1 bad. There were no statistical difference in good and excellent rate. CONCLUSION: The clavicular hook plate for the treatment of Allman type II to III sternoclavicular joint dislocation is believed to be as good as tension band fixation, but there are fewer complications and in favor of early exercise.

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OBJECTIVE: To evaluate the safety and reliability of percutaneous internal fixation for pelvic ring injuries with cannulated screws. METHODS: Forty-eight patients (21 male and 27 female, aged from 17 to 61 years with an average age of 38 years) with unstable pelvic ring injuries were treated with closed reduction and percutaneous cannulated screws fixation under C-arm fluoroscopic guidance. According to Tile's classification, the patients were classified into type B1 in 4 cases, B2.1 in 8, B2.2 in 10, B3 in 4, C1 in 11, C2 in 7 and C3 in 4. Among them, 39 patients were treated with anterior and posterior fixation, 4 were treated with anterior fixation, and 5 were treated with posterior fixation alone. Anteroposterior, inlet and outlet X-ray radiographs and CT scans of the pelvis were taken preoperatively to evaluate the stability and deformities, and after surgery the plain radiographs and CT scans were taken to evaluate the reduction and the location of screws. RESULTS: The average operative time was 55 minutes (range, 15 to 95 minutes), and the average intraoperative blood loss was 60 ml (range, 15 to 150 ml), no patient accepted blood transfusion during or after operation. All 48 patients were inserted 157 cannulated screws (mean 3.3, range 2 to 8 per patient). Forty-two patients (135 screws) underwent postoperative pelvic CT scan and 91.11% (123 screws) of them was considered in optimal location; 7 screws penetrated the wall of pelvis and acetabulam because of overlength (<0.5 cm) or deviation, 5 screws interfered with the sacral canal or foramen. Fortunately, these 12 screws did not cause any symptom to the patients. The average follow-up period was 13 months (range 8 to 49 months), the displacement of injured pelvis was satisfactorily corrected in 45 patients (93.75%) and the fractures were healed at one stage. Among all patients, 40 cases (83.33%) had returned to their original works, 4 were still in the process of recovery at the last follow-up and the other 4 were unemployed as sciatic nerve injury or amputation. According to Lindahl improved standard of functional assessment of pelvic injury, the result was excellent in 35 cases, good 10 and fair 3, the average score was 78.7. CONCLUSION: With better understanding of the pelvic anatomy, and under C-arm fluoroscopic guidance, treatment of closed reduction and percutaneous cannulated screw internal fixation for unstable pelvic ring injuries is a safe, reliable and feasible method. The clinical outcome is satisfactory.

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