ABSTRACT
The incidence of open femoral fractures is relatively low, primarily caused by high-energy trauma and often associated with multiple injuries. The management of open femoral fractures is considered one of the most challenging lower limb injuries due to their serious nature, multiple traumas, high disability rate, high infection rate, and high amputation rate. Most scholars currently recommend that open grade I and grade II fractures of the femur be treated with thorough debridement and open reduction, and internal fixation at the initial stage when the patients are in good condition. However, for open grade III femur fractures, many studies still show that staged treatment strategies are preferred, but the fixation method at the initial stage is still controversial. For patients with severe open femoral fractures, the medical team should create an individualized treatment plan, taking into account the patient's and family's preferences, the medical team's experience, and available resources, rather than simply relying on the salvage or amputation scoring system to make the final decision. This review discusses the epidemiology, classification, surgical management options, and strategies for limb salvage and amputation in the treatment of open femur fractures, providing practical guidance for healthcare professionals who manage these patients.
ABSTRACT
[Objective]To explore the surgical management and its results of intercondylar fracture of humerus through approach of osteotomy of olecranon(AOO) with dual anatomical steel plate DASP.[Method]From July 2002 to March 2006,26 patients of intercondylar fracture of humerus were treated surgically through AOO,and the fracture was reduced and fixed with DASP.The patients were 19 males and 7 females with a mean age of 35 years (range 15～46 years),According to Riseborough and Radin classification,type Ⅱ fracture was found in 6 cases,type Ⅲ in 18,type Ⅳ in 2.Early rehabilitation exercises was taken.[Result]Twenty-five fractures were satisfactory reduced but one not too good,none had incision infection,injuries of the ulnar nerve.Twenty-two patients were followed up from 6 months to 19 months(average 13.5 months),of these 22 patients,all the osteotomies healed in 17 weeks averagely(range 14～24 weeks) and the injuried ulnar nerve recovered completely.The function of the elbow(according to Cassbaum scale) showed excellent in 5 cases,good in 13,fair in 3 and poor in 1.the good-excellent rate was 81.8%.[Conclusion]The technique of DASP for the treatment intercondylar fracture of humerus through transolecranon approach offers many advantages,such as sufficient exposure easy to get anatomical reduction,stable fixation and earlier exercise.
ABSTRACT
Objective To discuss difficulties and techniques of standard video-assisted thoracoscopic or laparoscopic surgery(SVATS or SVALS) for spine internal fixation.Methods Between July 2004 and September 2005,6 cases of vertebral lesions located in the T_5～L_1 segment(including 2 cases of vertebral tuberculosis) were given SVATS under single-lung ventilation for resection of diseased vertebral body,reconstruction with autograft or titanium mesh cage,and fixation with the Z-plate system or the CD-Horizon system.Other 2 cases of vertebral tuberculosis located in the L_2～L_3 segment underwent retroperitoneal gasless SVALS for lesion debridement,reconstruction with autograft,and fixation with the Z-plate system.For cases of vertebral tuberculosis,(anti-tuberculosis) drugs were administrated preoperatively for 3 weeks and postoperatively for 6 months.Results The lesion debridement and anterior decompression was completed in all the 8 cases,including internal fixation with the Z-Plate system in 7 cases and with the CD-Horizon system in 1 case.There were 5 cases of iliac autografting and 3 cases of titanium mesh cage reconstruction.The operative time was 6.5~12.6 h(mean,8.7 h) and the blood loss during surgery was 250~1 800 ml(mean,950 ml).The correction of the Cobb angle was 5?~18?(mean,12?).During a follow-up period for 2~13 months(mean,7.4 months) in the 8 cases,nerve functions recovered by 1~2 Frankel grade in 5 cases,and the Cobb angle lost by 4? at 6 months postoperatively in 1 case of metastatic adenocarcinoma at the T_7 segment.Conclusions Spine internal fixation of T_5～L_3 segment can be conducted successfully with SVATS or SVALS.The key to the question is accurate orientation of the port site,proper hemostasis of the segment blood vessel,and careful resection of the anterior wall of the vertebral canal.