ABSTRACT
Objective To investigate the results and related key points in operative treatment of talar body fractures. Methods From April 2002 to July 2008, 44 patients with talar body fractures underwent the operation. There were 3 females and 41 males. The mean age of the patients was 31.7 years. The fractures occurred on the left side in 26 patients and on the right side in 18 patients. According to Sneppen classification, 24 type Ⅱ, 20 type V. Eleave cases were open fractures, according to the Gustilo-Anderson classification, there were 3 cases in type Ⅰ , 7 in type Ⅱ, 1 type in Ⅲ A. The mean interval between injury and surgical treatment for open fractures and close fractures was 5.3 hours and 8.9 days. The mechanism of injury was a fall from the height in 18 patients, a traffic accident in 13 patients, a crush injury in 8 patients, a sprain injury in 4 patients and a cut injury in 1 patient. Anteromedial approach was used for 15 close fractures, anterolateral approach for 3 and combined anteromedial-anterolateral approach for 15. K-wires fixation were utilized for 3 fractures, screws and temporary K-wires fixation for 5 cases, bioabsorbable screws for 2fractures, cannulated screws for 30 fractures and cannulated screws and threaded cancellous screws for 4cases. Results Thirty-five patients were followed up 21 to 89 months (average, 44.5 months). Necrosis of incision was found in 4 cases, wound infection occurred in 1 case. All fractures had achieved bone union;the average healing time was 22 weeks. Functional results were assessed according to AOFAS score, the average score was 77.3, There were 11 patients in excellent results, 13 in good, 10 in fair and 1 in poor. The overall excellent and good rate was 68.6%. Avascular necrosis occurred in 5 cases. Traumatic arthritis occurred in 19 cases. Arthrodesis was needed in 5 cases. Conclusion The timing and approach of surgery is determined by the condition of the talar fractures and soft tissue. Anatomical reduction, preservation of the blood supply and early active pain-free mobilization are key points in the treatment of the talar body fractures.
ABSTRACT
Objective To assesses the value of the Pipkin fracture classification on the treatment and prognosis of Pipkin fracture. Methods A total of 71 patients with Pipkin fractures treated from January 2002 to January 2007 were followed up and the detailed information of 63 patients were obtained. The clinical and radiographic evaluation criteria of Thompson was employed to evaluate the outcome, analyze the results and discuss the correlation between Pipkin fracture type and prognosis and hence propose the significance of Pipkin classification on the prognosis. Results There was no statistical difference in aspect of the outcome between type Pipkin Ⅰ , Ⅱ injury and type Pipkin Ⅳ injury (types Pipkin Ⅰ and Ⅱ injury combined with minimum fracture, with fragment ＜ 1 cm,P＞0. 05). There showed statistical difference in outcome between types Pipkin Ⅰ , Ⅱ injury and type Pipkin Ⅳ injury (types Pipkin Ⅰ and Ⅱ injury combined with acetabular rim fracture, P ＜0. 05). Conclusions Pipkin fracture classification system needs a further improvement. The type Pipkin Ⅳ injury that is combined with types Pipkin Ⅰ , Ⅱ , Ⅲ injuries with minimum fracture (fragment ＜ 1 cm) of the acetabular rim should be incorporated into types Pipkin Ⅰ ,Ⅱ , Ⅲ injury. Type Pipkin Ⅳ injury refers to types Pipkin Ⅰ ,Ⅱ , Ⅲ injuries, with major fracture of the acetabular rim and the hip joint instability. In addition, the Pipkin fracture type involving the fracture line, femoral neck and intertrochanteric region is hard to treat clinically and has poor prognosis, suggesting that this type of injury should be considered as special type Pipkin Ⅲ injury.
ABSTRACT
Objective To introduce the treatment of intraarticular calcaneal fractures with poor soft tissue using poking reduction combined with Ilizarov methods. Methods From September 2007 to September 2009,11 patients with the intraarticular calcaneal fractures were treated with poking reduction combined with Ilizarov methods,including 10 males and 1 female at average age of 33.6 years(range,21-50 years).Four patients had the left calcaneal fractures and seven with the right ones.According to Sander classification,there were seven patients with type II fractures,three with type III fractures and one with type IV fracture.The various extents of heel soft tissue injury were emerged in all the patients.Before operation,B(o)hler angle was 0°-12°(average 8°)and Gissane angle 70°-95°(average 80°).According to AO classification of close soft tissue injury,there were three patients with type IC2,six with type IC3,one with type IC5 and one with open soft tissue injury.The collapse of the articular surface was recovered by Steinmann pin which passed through the lateral calcaneal tubercle.The medial and lateral fracture fragments were corrected by using the tensed olive wires.The heighat and width were maintained by using the Ilizarov external fixation. Results The mean duration of follow-up was 13.3 months (range,6-20 months).All fractures were healed after mean duration for 8.1 weeks(range,7-10weeks).The postoperative B(o)hler angle was 20°-45°(average 33°)and Gissane angle 100°-118°(average 107°).According to Maryland Foot Score system,the result of postoperative function was excellent in seven patients,good in three and fair in one,with excellence rate of 91%. Conclusions For the intraarticular calcaneal fractures,the poking reduction combined with Ilizarov method is able to recover and maintain the normal calcaneal height and width and reduce postoperative wound infections and many other complications.specially for Sanders II or III with severe soft tissue injury in the open or closed calcaneal fractures.Master of surgical indications and operating poims can attain satisfactory clinical efficacy.
ABSTRACT
Objective To discuss the operative methods, timing and outcomes of severe open Pilon fractures. Methods From April 2003 to July 2008, 21 patients with open Pilon fractures were admitted. All the patients were type C fracture according to AO/OTA classification, including 17 cases of type C2 and 4 cases of type C3. According to Gustilo classification, there were 18 cases of type Ⅱ, 2 cases of type ⅢA, 1 case of type ⅢB. The patients were treated in two different ways: one-stage minimally invasive osteosynthesis for reconstruction of the articular surface with transarticular external fixation of the ankle (19 cases),which included 16 cases of Gustilo Ⅱ AO/OTA C2, 2 cases of type Gustilo Ⅱ AO/OTA C3 and 1 case of type Gustilo ⅢA AO/OTA C2. Formal open reconstruction of the articular surface by plating and external fixation was performed when the condition of soft tissue had improved (2 cases), which included 1 cases of type Gustilo ⅢA AO/OTA C3 and 1 cases of type Gustilo Ⅲ B AO/OTA C3. Results All the patients were followed up from 6 to 48 months, with the mean of 24 months. The outcome of reduction was evaluated by the Burwell-Charnley score. Anatomical reduction was found in 6 cases, function reduction was in 14 cases and poor reduction was 1 case. The heal-time ranged from 2.5 to 11 months, with the mean of 4.7 months. The delayed union occurred in 2 cases. The rate of delayed union was 9.5%. Two patients experienced skin superficial necrosis. There were superficial infection in 2 cases and deep infection in 1 case. The infection rate was 14.3%. Eight cases experienced early traumatic arthritis. The incidence of this complication was 38.1%.According to American Orthopedic Foot Ankle Society (AOFAS) scale for ankle joint, the result of the treatment was 66-94, with an average of 85.2. Conclusion It is important to have the optimal timing of surgery and reliable fixation according to fracture classification, the condition of soft tissue and time after injury. It is the key to evaluate the condition of soft tissue and protect the blood supply.
ABSTRACT
Objective To analyze the effect of acromio-humeral interval on the occurrence of subacromial impingement syndrome (SIS) after the clinical application of clavicular hook plate in acromioclavicular joint dislocation (Tossy Ⅲ). Methods From July 2005 to October 2008, 63 cases of acromioclavicular joint dislocation (Tossy Ⅲ) were treated with clavicular hook plate. There were 48 males and 15 females with an average age of 33.6 years (range, 21-53 years). The relationship of the acromio-humeral interval (AHI)were analysed between the two groups by X-ray measurement. The AHI and plate-humeral interval (PHI)were measured on X-ray film to detect difference between the two groups. Results After the operation, all t he 63 cases were divided into two groups according the occurrence of SIS. There were 14 cases in the group of SIS and 49 cases in the group without SIS. The mean follow-up was 12.2 (average, 6-15) months.The average AHI of was (8.5±2.1) mm and (9.7±2.6) mm in the group of SIS and the group without SIS respectively. The difference between the two groups was statistically significant. The average PHI of the group of SIS and the group without SIS was (6.1±2.8) mm and (6.8±2.4) mm respectively. There was no difference between the two groups. After removal of the clavicular hook plate, the clinical sign disappeared in the group of SIS. According the Karlsson scoring system, the excellent and good rate of the shoulder function was 100%. Conclusion The occurrence of SIS after the clinical application of clavicular hook plate has related to the width of the subacromial interval. The syndrome could be treated by the removal of clavicular hook plate.
ABSTRACT
[Objective]To explore the operative techniques of open reduction and internal fixation of displaced radial head fractures in adults. [Methods]Twenty-six cases of radial head fractures had been treated with open reduction and internal fixation. According to Mason classification, 16 fractures were type II, 6 were type III and 4 were type IV. Operative exposures of radial head were performed through the Kocher approach in 22 cases, and through a midline posterior skin incision in 4 cases in order to repair concomitant fracture of proximal ulna. After being reduced, fractures of radial head were fixed with mini-fragment plate and screw which were placed in "safe zone" not to impinge on the proximal radioulnar joint with forearm rotation.[Results]At a mean follow-up of 32 months, all fractures had united. There was no patient who suffered from wound infection or injury to posterior interosseous nerve. According to the Broberg and Morrey functional elbow index, the outcome were excellent in 17 patients, good in 9.[Conclusion]Open reduction and internal fixation of displaced radial head fractures may get satisfying outcomes, with successful performing of the requirements below: (1) sustaining lateral ulnar collateral ligament; (2) avoiding injury to posterior inerosseous nerve; (3) getting anatomic reduction; (4) stably fixing fractures without impinging on joint.
ABSTRACT
[Objective]To explore the methods and effects of closed reduction and percutaneous internal fixation to treat intercondylar fractures of humerus.[Method]From 2001,3 to 2004,9 we selectively treated 6 cases(group A) of Rise-Borough Ⅱ,Ⅲ type of humeral intercondylar fractures with closed reduction and percutaneous internal fixation with hollow screw and Kirschner's wire.Others(group B) treated with opened reduction and internal fixation with plates and screws.[Result]Following up 6～12 months,the outcome were evaluated with Aitken and Rorabeek rating system.Group A:5 patients were graded as excellent,1 as good.Group B:7 patients were graded as excellent,7 as good,1 as fair,1 as poor.[Conclusion]To treat Rise-Borough Ⅱ,Ⅲ type of humeral intercondylar fractures with closed reduction and percutaneous internal fixation with hollow screw and Kirschner's wire,can decrease iatrogenic impairment,receive reliable fixation and early functional exercise.The fracture union quickly,and the patient has excellent joint function and less postoperative complication.
ABSTRACT
[Objective]To evaluate and compare the effects of fibial-tibial fracture(FTF) treated by interlocking intramedullary nail (I I N group A) and intramedullary expand expanded self-lock nail (IESN group B).[Method]From June 2000 to September 2003,one hundred sixteen cases of FTF were treated by I I N(N=60)or IESN (N=56) and followed-up for 12~24 months (average 17.9 months).Results were compared between group A and group B.[Result]In group A,the satisfactory rate,union rate,close reduction rate,medullary expanding rate,complication rate and antirotation ability were 89.5%, 96.7%, 71.6%, 51.6%,21.6% and +++ respectively.In group B,that were correspondently 91.0%,98.5%,89.3%,5.3%,3% and +.[Conclusion]Adopting the biological osteosynthesis either the I I N or IESN for treatment of FTF could get a result of more satisfactory rate and higer union rate.Applying a stable fixation,the IESN is more suitable for instable FTF.Such as multisegmental or comminuted targe oblique FTF,while of fering a flexible fixation,IESN is preferable for transverse fractures of middle and lower third tibia and fibula.
ABSTRACT
[Objective]To analize the complications in the treatment of the fractures around the knee joint with less invasive stabilization system(LISS).[Method]From July 2005 to October 2007,89 patients with 91 fractures around knee joint were treated with the LISS,including 45 fractures of distal femur and 46 fractures of proximal tibia.[Result]All patients were followed up for 13 to 29 months.The average time to union was 16 weeks(ranged,11-25 weeks).The functional outcome: 45 had an excellent result,35 had a good result and 11 had a fair result,with 87.9% excellent to good results.There were 10 patients(11%) with symptomatic hardware irritation,2 of them had soft-tissue disruption.Seven cases(8%) had malalignment,2(2%) loss of reduction,1(1%) delayed union,1(1%) failed fixation,1 superficial peroneal nerve injury and 1 profound peroneal nerve injury.Cold-welding occurred in 9 cases(10%) which resulted in difficult removal.[Conclusion]LISS is one of the reliable and effective methods in fixation of the fractures around the knee joint.However,its operation indications and operating instructions should be strictly followed.
ABSTRACT
[Objective]To discuss the treatment effect of locking compression plate(LCP)for proximal humeral complicated fractures.[Method]A retrospective study was done on 21 cases of proximal humeral fractures treated with LCP from April 2005 to June 2006.There were 13 male and 8 female,with age of 26-71 year(mean 42.3 year).According to Neer classification,15 cases were three-part fractures including 5 cases with anterior dislocation and 6 cases with primary osteoporosis;6 cases were four-part fractures including 3 cases with anterior dislocation and 2 cases with posterior dislocation.Reduction and fixation were done by deltopectoral-gap approach,the operator put the locking plate on 10mm positerior to the intergroove of tuberosity,5mm away from the tip of humeral greater tuberosity.If there were bone defects in the fracture site after reduction,they were treated with allografts,locking screws and unlocking screws were drilled into proximal and distal part of the fracture.Shoulder exercise should be performed passively three days after operation.One week after operation,active shoulder exercise was done,which was gradually intensified two weeks after operation.[Result]Twenty-one cases were followed up for 10-14 months,average 12.5 months,all fractures were union in 12 month.According to Neer shoulder score,the result was excellent in 11 cases,good in 7 and fair in 3,with excellent and good rate of 85%.[Conclusion]The screw of LCP can lock the plate so that the plate can firmly fixate the proximal humeral comminution fractures and osteoporosis bone,so simultaneously reach fracture union and function exercise,but attentions should be paid to the suitable procedure of LCP to avoid a series of problem of locking plate.
ABSTRACT
Objective To evaluate fixation of anatomic plate by comparing ou tc omes of surgery and conservative therapy for proximal humeral fractures. Methods 24 cases of proximal humeral fractures were fixed with anatomic plate, lag scre ws and kirschner wire. 19 cases were managed with conservative therapy of manual reduction and external wood splint fixation. The results were evaluated by Neer classification and Constant-murley scoring system. Results All the case were f ollowed up 10 to 19 months(averaging 11.5 months). In the 24 operated cases, 11 patients were graded as excellent, 8 as good, 4 as fair, 1 as poor. In the 19 ca ses of conservative therapy, 6 patients were graded as excellent, 7 as good, 6 a s fair, most of which were Neer types Ⅲand Ⅳ. The operative treatment produced better outcome than the censervative treatment ,far the difference was statisti cally significant(P
ABSTRACT
Objective To explore the efficacy of closed reduction and inter na l fixation of cannulated screws by minimally invasive procedure in management of tibial plateau fractures. Methods From October 1999 to January 2002, 42 patient s with tibial plateau fractures, which were 29 males and 13 females with an aver age age of 41 years ranging from 26 to 67 years, were treated surgically in our hospital. According to Schatzker system, the fractures were diagnosed as type Ⅰ in 9, type Ⅱ in 5, type Ⅲ in 13, type Ⅳ in 3, type Ⅴ in 6 and type Ⅵ in 6. There was open fracture in 5, and closed fracture in 37. The fracture fragments of tibial plateau were reduced with closed manipulation or reduced assisted by minimally invasive procedure. The later by minimally invasive procedure included two kinds of reductions, one of which was reduction assisted by Kirschner pin t hat was introduced percutaneously into the larger fragment; the other was reduct ion assisted by a bone tamper that was introduced through a small incision into the cortical window beneath the depressed articular surface. Fixation was achiev ed using percutaneous 6.5 mm cannulated screws or combination of the cannulated screws and Bastiani external frame in unstable fractures. Results Of 42 patients , 37 were followed up from 6 to 30 months (average, 15 months). All 37 fractures were united within 12 weeks postoperatively. The mechanical axis of affected li mb and the stability of affected knee joint were restored in the patients. Accor ding to Sanders score for functional results of knee joint, 13 patients were rat ed as excellent, 20 good, and 4 fair. Anatomical reduction was identified while the stepping of articular surface after reduction was less than 2 mm. In 21 pati ents with anatomical reduction, the functional results were excellent in 8, good in 11, and fair in 2. However, in 16 patients without anatomical reduction, the functional results were excellent in 5, good in 9, and fair in 2. There was sig nificant difference between the two groups on functional results. There were no postoperative complications such as infections and neurovascular bundle. Conclus ion Closed reduction and fixation through minimally invasive procedure has provi ded satisfied results in tibial plateau fractures such as less complications, ex cellent mechanical axis restoration, and ideal functional recovery.