[Advance in management of skeletal trauma of the extremities].
OBJECTIVE
To investigate the advance in the management of skeletal trauma of the extremities.


METHODS
The literature at home and abroad was reviewed, and the research findigs with clinical experience in the therapeutic methods for fracture of the extremities were summarized.


RESULTS
The concept on fracture management was renewed, the minimally invasive surgery (MIS) was developed and popularized, the implantation was improved, the navigation technique with computer-assisted surgery was applied, and the tissue engineering was developed. The fracture management was changed from tubular bone, the boanatomical reduction with absolutely rigid fixation to the biological osteosynthesis with protection of the fracture environment. The minimally invasive surgical techniques included the minimally invasive plate osteosynthesis, intramedullary nailing, external fixation, arthroscopic surgery, and computer-assisted surgery. In concordance with the MIS principles, the new implants, such as the locking compression plate, and the less invasive stabilization system were well designed and put into clinical practice so as to provide effective therapeutic results in treating osteoporotic fractures and complicated articular and/or metaphyseal fractures. In treatment of the delayed union or non-union of fractures, more effective techniques were employed, including the application of bone substitutes, which are degradable and have properties of bone conduction and induction. In the repair of segmental defects of the long tubular bone, the bone transport and the vascularized bone grafts could work well. The investigation of the bone engineering revealed its great potentiality.


CONCLUSIONS
Fracture of the extremities is a common problem and its management should emphasize the recovery of the extremity function of the patient in addition to emphasis on the replacement and fixation of the biological structures. The combination of bone engineering and microsurgery represents the development tendency in this field.
Zeng
Bingfang
B
Department of Orthopaedic Surgery Shanhi Sixth People's Hospital, Jiaotong University, Shanhai 200233, PR China. bingfangz@yahoo.com.cn
Liu
Xudong
X