ABSTRACT
Objective@#To evaluate the efficacy of articular compression molding techniques in the surgery for acetabular posterior wall fracture.@*Methods@#A retrospective study was conducted of the 28 patients (28 hips) with fracture of acetabular posterior wall plus comminuted compression of articular surface who had been treated using the articular compression molding techniques at Department of Orthopedics, The Hospital of 81 Group Army of PLA from January 2014 to January 2018. They were 25 males and 3 females, aged from 26 to 63 years (average, 49.3 years). The time from injury to surgery ranged from 4 to 12 days (average, 7.8 days). According to the Letournel-Judet classification, all were single element (simple) posterior wall fractures combined with posterior dislocation of the femoral head and articular compression of different degrees; transient sciatic nerve injury was complicated in 12 cases. The posterior hip dislocations were timely and successful reset at emergency treatment. The compression fractures of the posterior wall and hip joint were treated by open reduction and internal fixation via the acetabular posterior (K-L) approach. The articular compression was treated by 4 stabilization techniques: absorbable screwing and blocking technique in 10 cases, indwelling screwing in 12 cases, indwelling Kirschner wiring in 2 cases and die push and squeeze tamping in 4 cases. The operation time, intraoperative bleeding and complications were recorded. The therapeutic efficacy was evaluated by the modified Merle d’Aubigne & Postel scoring criteria at the final follow-up.@*Results@#The operation time lasted from 76 to 118 minutes (average, 94.2 minutes); the intraoperative bleeding ranged from 100 to 320 mL (average,220.8 mL). No incision liquefaction, infection or other complications occurred. The 28 patients were followed up for 10 to 36 months (average, 17.6 months). According to the Matta scoring criteria, 24 cases achieved anatomical reduction but 4 dissatisfactory reduction. By the modified Merle d’Aubigne & Postel scoring criteria at the final follow-up, the efficacy was evaluated as excellent in 26 cases and as good in 2. Heterotopic ossification was observed in 3 cases and microscopic free dense shadow in the joint cavity (about 2 mm in the round ligament) in 3 cases. There were no cases of obvious traumatic arthritis or osteoarthritis, femoral head necrosis, walking pain, lameness or hip abduction weakness. The 12 patients complicated with preoperative transient sciatic nerve injury recovered within 3 months after surgery.@*Conclusion@#The articular compression molding techniques can effectively treat severely comminuted articular compression in the acetabular posterior wall fracture and improve reduction of articular surface and hip joint matching, leading to stability and good joint function.
ABSTRACT
Objective To explore the clinical effect of minimally invasive treatment of C type pilon fracture with single main plate combined with multiple planar screws for supporting fixation.Methods From January 2013 to March 2017,data of 22 patients treated by minimally invasive treatment with single main plate combined with multiple planar screws for supporting fixation were retrospectively analyzed.There were 17 males and 5 females,aged from 23 to 69 years (average,51.2 years).All cases were closed fractures involving fibula including weight hitting (5 cases),traffic accident (7 cases) and fall injury (10 cases).There were 3 cases of 43-C1 type,11 cases of 43-C2 type and 8 cases of 43-C3 type according to AO/OTA classification.According to the Rtiedi-Allg(o)wer classification,there were 5 cases of type Ⅱ and 17 cases of type Ⅲ.Complications were recorded postoperatively and the articular surface reduction was evaluated using the Burwell-Charnley score.At the last follow-up,Tornetta's pilon fracture clinical treatment outcome criteria was used to evaluate ankle joint function.Results All the patients were followed up for 13 to 25 months (average,17.3 months).There were 20 cases of anatomical reduction,1 case of fair reduction and 1 case of poor reduction according to the Burwell-Charnley score.All the 22 patients were healed with healing time of 3 to 6 months (average,4.8 months).The efficacy was evaluated according to the evaluation criteria of the clinical treatment results of pilon fracture by Tornetta:excellent in 8 cases,good in 10 cases,fair in 3 cases,and poor in 1 case.The excellent and good rate was 81.8％(18/22).All patients had no complications such as wound edge blistering,skin necrosis and infection.Among them,1 case of internal fixation rejection occurred,and the incision was well healed after removal of the internal fixation after 3 months.Conclusion Minimally invasive treatment of C type pilon fracture with single main plate combined with multiple planar screws for supporting fixation not only provides a better anatomical reduction of the articular surface,but also effectively reduces or even avoids incision complications.The long-term clinical results are satisfactory.
ABSTRACT
Objective To evaluate the efficacy of articular compression molding techniques in the surgery for acetabular posterior wall fracture.Methods A retrospective study was conducted of the 28 patients (28 hips) with fracture of acetabular posterior wall plus comminuted compression of articular surface who had been treated using the articular compression molding techniques at Department of Orthopedics,The Hospital of 81 Group Army of PLA from January 2014 to January 2018.They were 25 males and 3 females,aged from 26 to 63 years (average,49.3 years).The time from injury to surgery ranged from 4 to 12 days (average,7.8 days).According to the Letournel-Judet classification,all were single element (simple) posterior wall fractures combined with posterior dislocation of the femoral head and articular compression of different degrees;transient sciatic nerve injury was complicated in 12 cases.The posterior hip dislocations were timely and successful reset at emergency treatment.The compression fractures of the posterior wall and hip joint were treated by open reduction and internal fixation via the acetabular posterior (K-L) approach.The articular compression was treated by 4 stabilization techniques:absorbable screwing and blocking technique in 10 cases,indwelling screwing in 12 cases,indwelling Kirschner wiring in 2 cases and die push and squeeze tamping in 4 cases.The operation time,intraoperative bleeding and complications were recorded.The therapeutic efficacy was evaluated by the modified Merle d'Aubigne & Postel scoring criteria at the final follow-up.Results The operation time lasted from 76 to 118 minutes (average,94.2 minutes);the intraoperative bleeding ranged from 100 to 320 mL (average,220.8 mL).No incision liquefaction,infection or other complications occurred.The 28 patients were followed up for 10 to 36 months (average,17.6 months).According to the Matta scoring criteria,24 cases achieved anatomical reduction but 4 dissatisfactory reduction.By the modified Merle d'Aubigne & Postel scoring criteria at the final follow-up,the efficacy was evaluated as excellent in 26 cases and as good in 2.Heterotopic ossification was observed in 3 cases and microscopic free dense shadow in the joint cavity (about 2 mm in the round ligament) in 3 cases.There were no cases of obvious traumatic arthritis or osteoarthritis,femoral head necrosis,walking pain,lameness or hip abduction weakness.The 12 patients complicated with preoperative transient sciatic nerve injury recovered within 3 months after surgery.Conclusion The articular compression molding techniques can effectively treat severely comminuted articular compression in the acetabular posterior wall fracture and improve reduction of articular surface and hip joint matching,leading to stability and good joint function.
ABSTRACT
Objective@#To explore the clinical effect of minimally invasive treatment of C type pilon fracture with single main plate combined with multiple planar screws for supporting fixation.@*Methods@#From January 2013 to March 2017, data of 22 patients treated by minimally invasive treatment with single main plate combined with multiple planar screws for supporting fixa-tion were retrospectively analyzed. There were 17 males and 5 females, aged from 23 to 69 years (average, 51.2 years). All cases were closed fractures involving fibula including weight hitting (5 cases), traffic accident (7 cases) and fall injury (10 cases). There were 3 cases of 43-C1 type, 11 cases of 43-C2 type and 8 cases of 43-C3 type according to AO/OTA classification. According to the Rüedi-Allgöwer classification, there were 5 cases of type Ⅱ and 17 cases of type Ⅲ. Complications were recorded postopera-tively and the articular surface reduction was evaluated using the Burwell-Charnley score. At the last follow-up, Tornetta’s pilon fracture clinical treatment outcome criteria was used to evaluate ankle joint function.@*Results@#All the patients were followed up for 13 to 25 months (average, 17.3 months). There were 20 cases of anatomical reduction, 1 case of fair reduction and 1 case of poor reduction according to the Burwell-Charnley score. All the 22 patients were healed with healing time of 3 to 6 months (aver-age, 4.8 months). The efficacy was evaluated according to the evaluation criteria of the clinical treatment results of pilon fracture by Tornetta: excellent in 8 cases, good in 10 cases, fair in 3 cases, and poor in 1 case. The excellent and good rate was 81.8% (18/22) . All patients had no complications such as wound edge blistering, skin necrosis and infection. Among them, 1 case of internal fixa-tion rejection occurred, and the incision was well healed after removal of the internal fixation after 3 months.@*Conclusion@#Mini-mally invasive treatment of C type pilon fracture with single main plate combined with multiple planar screws for supporting fixa-tion not only provides a better anatomical reduction of the articular surface, but also effectively reduces or even avoids incision complications. The long-term clinical results are satisfactory.
ABSTRACT
Objective To study the clinical characteristic of acquired immune deficiency syndrome (AIDS) patients younger than 15 years old and to explore the influence of human immunodeficiency virus (HIV) infection on them. Methods The clinical information, including demographic profile, clinical stages of the disease, laboratory test results and developmental status were gathered from 275 antiretroviral therapy naive patients. Results Seventy eight point nine percent patients were infected by vertical transmission. Sixteen percent were infected by receiving blood products. The average age was (7.6±3. 7) years, with 5 cases younger than 1 year old, 104 cases ranging from 1 - 5 years and 166 cases elder than 6 years. Seventy point one percent patients were classified as stage 3 or 4 according to World Health Organization definitions. The average CD4 count was ( 137 ± 159 )/μL, ( 304 ± 317 ) /μL and ( 1 246 ± 776 )/μL respectively in children elder than 6 years, ranging from 1 to 5 years and younger than 1 year. One hundred and eighty one cases suffered from anemia on different severity grading. The most common HIV related symdromes included persistent fever, skin damage, persistent diarrhea, oral candidiasis and recurrent upper respiratory tract infection. Among these infected children, 49. 6% showed height lower than x - 2s and 19. 9% showed weight lower than x - 2s. Conclusions Most survival pediatric AIDS patients are elder than 6 years. HIV infection can significantly affect the children's immune system function,growth and development.