ABSTRACT
Objective To explore the effect of inadequate reduction of the medial wall on the postoperative varus deformity following calcaneal fracture surgery and other influencing factors of varus deformity.Methods A retrospective analysis was conducted of the 60 patients with calcaneal fracture involving the medial wall (60 feet) who had been treated from October 2005 to September 2015.They were 51 men and 9 women,18 to 55 years of age (average,38.4 years).According to the Sanders classification,24 patients belonged to type Ⅱ,30 to type Ⅲ,and 6 to type Ⅳ.We measured the integrity of the pre-and post-operative medial walls,the height and width of the pre-and post-operative calcanei,the pre-and post-operative B(o)hler angles and the pre-and post-operative calcaneal varus angles for statistical analysis.Results The effect of postoperative height reduction of the medial wall on the postoperative correction of varus angle was significantly larger than that of the lateral wall (P ＜ 0.05).The higher the integrity of the postoperative medial wall,the larger the correction of the postoperative varus angle.The normal rate of postoperative calcaneal varus angle significantly decreased with the increased Sanders classification severity (P =0.001).The postoperative reduction of the height and width of the calcaneus and the integrity of the preand post-operative medial walls were significantly positively correlated to the normal rate of postoperative calcaneal varus angle (P ＜ 0.05).Conclusions The medial wall has a large influence on the postoperative calcaneal varus angle.The higher integrity of the preoperative medial wall,and the more adequate reduction and fixation of the postoperative medial wall as well,the higher rate of postoperative normal calcaneal varus angle.The postoperative reduction of the calcaneal height also affects the varus angle.When the heights of the medial and lateral walls are recovered,the normal rate of varus angle is the highest;when reduction of the medial wall is inadequate but reduction of the lateral wall is fine,the normal rate of varus angle is the lowest.
ABSTRACT
Objective To explore the application and clinical effect of bipolar hemiarthroplasty with bipolar prosthesis on unstable intertrochanteric fracture in the elderly patients.Methods The study involved 53 patients aged over 75 years with intertrochanteric fracture treated with bipolar hemiarthroplasty in our hospital from April 2003 to January 2010.According to Evans-Jensen classification,there were 24 patients with type Ⅲ fractures,eight with type Ⅳ and 11 with type Ⅴ.Osteoporosis degree was at Singh degree Ⅰ in 13 patients,degreeⅡ in 18,degree Ⅲ in 12 and degree Ⅳ in 10.Most patients underwent operation within three days after injury.Results The operation duration was(75 ±10)min,with intraoperative blood loss of(350 ± 68)ml.Three patients were lost to follow-up after discharge and one patient was died of respiratory failure caused by chronic bronchitis five months after operation.Forty-nine patients were followed up for 12-93 months(mean 38 months),which showed no joint dislocation,or loosening,subsidence or rupture of the prosthesis.According to the Harris score of hip joint,the result at final follow-up was excellent in 29 patients,good in 13 and fair in seven,with excellence rate of 86％.Conclusions Bipolar hemiarthroplasty is an effective treatment for osteoporotic and unstable intertrochanteric fractures in the elderly patients.However,as the complemented therapeutic method of proximal femoral nail antirotation(PFNA),bipolar hemiarthroplasty has severe secondary trauma and its indications must be strictly mastered.