Reconstruction of talus model with Mimics software for treatment of talar posterior process fracture through posteromedial malleolar approach / 中华创伤骨科杂志

Objective To evaluate the advantages of reconstructing by mimics software before operation a three-dimensional model of talar posterior process fracture which is to be used in the treatment of talar posterior process fracture through the posteromedial malleolar approach.Methods From May 2015 to February 2019,7 patients with talar posterior process fracture were treated at Department of Orthopaedic Trauma,Jishuitan Hospital.They were 5 men and 2 women,aged from 20 to 70 years (mean,39 years).They underwent routine CT examination preoperatively.Their posterior process of talus was reconstructed by Mimics software based on their CT scanning data before operation to determine the size,number and displacement of fracture fragments.Their fractures of posterior process of talus were treated by open reduction and screw fixation in prone position through the posterior ankle approach.The American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scoring system was used to evaluate functional recovery.Results The operation time for this group ranged from 70 min to 105 min,averaging 87.1 min.Early after operation,the wounds healed well with no injury to nerves or tendons.All patients were followed up for 4 to 24 months (average,12 months).Follow-up by X-ray examination after 10 to 16 weeks revealed fracture union with no complications like screw breakage,nonunion,malunion or traumatic arthritis.Their AOFAS ankle-hindfoot scores at the final follow-up ranged from 80 to 98 points.Conclusion Preoperative three-dimensional reconstruction of talar posterior process fracture based on CT images using Mimics software can accurately determine the entry point and direction of screw insertion,yielding advantages of clear exposure,easy reduction and convenient screwing in the treatment of talar posterior process fracture through the posteromedial malleolar approach.

Treatment of distal radius fractures with dorsal dislocation of Fernandez type Ⅳ by open reduction and internal fixation / 中华创伤骨科杂志

Objective To report the treatment of distal radius fractures with dorsal dislocation of Fernandez type Ⅳ by open reduction and internal fixation via a combined dorsal and volar approach.Methods A retrospective analysis was conducted of the 14 cases of fresh distal radius fracture with dorsal dislocation of Fernandez type Ⅳ which had been treated by open reduction and internal fixation via a combined dorsal and volar approach at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from July 2010 to June 2016.All the patients were male,with an average age of 38.4 years (from 27 to 52 years).The time from injury to surgery averaged 6.9 days (from 4 to 10 days).Their injury involved 5 left and 9 right wrists.Follow-up was performed at 1,2,3,6 and 12 months after operation when anteroposterior and lateral X-ray films were taken and functional exercise guidance was provided.At 6 and 12 months after operation,all the patients were evaluated using modified Garland-Werley scoring and Patient Rated Wrist Evaluation (PRWE).Results The patients were followed up for an average of 19.4 months (from 15 to 26 months).Their fractures healed well.Their fracture healing time averaged 3.1 months (from 2 to 4 months).Their modified Garland-Werley scores at 6and 12 months after surgery were 8.9 points (from 6 to 13 points) and 7.3 points (from 4 to 11 points),respectively;their PRWE scores were 17.9 points (from 12 to 25 points) and 16.5 points (from 11 to 23 points),respectively.None of the patients was inflicted by infection,vascular injury or internal fixation failure.Conclusion The open reduction and internal fixation via a combined dorsal and volar approach can restore the stability of both the dorsal osseous structure of the distal radius and the volar ligament structure of the wrist,facilitating postoperative maintenance of the radiocarpal joint stability,improving the wrist function and leading to satisfactory outcomes.

Treatment of complicated intra-articular distal radius fractures with extended flexor carpi radialis approach / 北京大学学报(医学版)

Objective:To discuss the effect of treatment of complicated intra-articular distal radius fractures with extended flexor carpi radialis approach.Methods: A retrospective analysis of 38 cases with fresh complicated intra-articular distal radius fractures treated by using extended flexor carpi radialis approach in our hospital from October 2012 to March 2015,with 25 males and 13 females.The average age was (52.76±8.62) years (32-64 years).The average time to surgery was (5.42±1.91) d (3-10 d),with left wrist 17 cases and right wrist 21 cases.All the patients were with C3 distal radius fractures according to Association for the Study of Internal Fixation (AO/ASIF) classification.The follow-up was conducted 1,2,3,6,and 12 months after operation,including AP and lateral X-ray,wrist extension and flexion,radial deviation and ulnar deviation,forearm pronation and supination,and grip strength.At the end of 6 and 12 months after operation,all the patients were evaluated by using the mo-dified Garland-Werley score and patient rated wrist evaluation (PRWE).Results: All the patients got good bone union,and their follow-up time was more than 12 months.The average follow-up time was (16.37±2.85) months (12-22 months).The score of modified Garland-Werley evaluation 6 months post-operation was 5.37±2.82,excellent and good rate was 84.21％,the score of modified Garland-Werley evaluation 12 months post-operation was 5.03±2.60,excellent and good rate was 86.84％.The score of PRWE 6 months post-operation was 15.82±8.38,the score of PRWE 12 months post-operation was 12.17±7.58.Conclusion: The extended flexor carpi radialis approach is effective for the treatment of complicated intra-articular distal radius fractures and can avoid the complications of volar and dorsal combination approach.

Using unstable fractures of the distal end of the radius: open reduction and internal fixation with T - type plate / 中华外科杂志

<p><b>OBJECTIVE</b>To treat unstable fractures of the distal end of the radius with open reduction and internal fixation with T-type plate.</p><p><b>METHODS</b>45 patients were treated with T-type plate. Bone graft was used in fifteen patients with severe bone defect. Clinical findings of 45 patients with fractures of the distal end of the radius (one is bilateral fractures) showed fairly good results.</p><p><b>RESULTS</b>The patients were followed up for an average period of 25.36 months. 41 patients showed excellent or good results with a rate of 91.11%.</p><p><b>CONCLUSION</b>It is difficult to reduce unstable fracture of the distal end of the radius in the way of close reduction. Re-displacement is frequent for external fixation and is not reliable in maintaining reduction. These fractures should be treated with early open reduction and internal fixation, and reasonable exercise should be taken after the operation. Good results can be predicted. The most important factors affecting final outcome include radial shortening and reduction of articular surface.</p>

A clinical analysis of 145cases of femoral intertrochanteric fracture with close reduction and in-tramedullary nail fixation / 中华创伤骨科杂志

Objective To evaluate the effect of Gamma nail,PFN(proximal femoral nail)and recon-struction nail fixation in treatmen t of intertrochanteric fractures an d problems regarding the operative t echnique.Methods This study reviews the X-ray films an d complications of one hundred forty-five cases of in-tertrochanteric fractures treated with intramedullary nail at Beijing Jishuitan Hospital from March 1998t o October2001.Results All cases healed ,one case died eight months postoperatively.The distal fragment was broken intraoperatively in two cases.Ante roposterior and lateral and rotatio n displacement occured intraoperatively in fifteen cases.Limb discrepancy over one centimeter occurred in five cases.Conclusion Intramedullary nail is a good device to treat intertrochante ric fractures with vartous coxa varu s the common complication.Skillful in-tramedullary nail technique is the k ey to decrease the complications.In cidence of coxa varus in the stable ty peⅡis less than that in the unstable typeⅠafter the treatment.[

The forearm traction instrument —a new traction device / 中华创伤骨科杂志

Traction during reduction is essent ial for internal or external fixatio n of unstable distal radial fractures.Adequate and effective t raction is the key to the restoration of articular congruence,normal joint relation and the length of distal radius.The f orearm traction instrument develop ed by the authors is a simple,versatile and reliable device,from which stable,continuous and effective traction c an be expected during the surgery.The traction instrument is connected wi th the surgery-table before the operation.According to the needs of diff erent operations,many kinds of traction could be perfo rmed to support the operation.With t he help of the device,frac-ture reduction and fixation is signi ficantly improved during the surgery without excessively violent traction.The X-ray exposure and the operation hou rs can also be decreased as well.Over-traction or long-time violent traction could be avoided during the surgery.According to the author' s experience,the forearm traction i nstrument is an effective implemental device in the treatment of the unstable fractures of distal radius.[

Unstable fractures of the distal end of the radius: management with external fixator / 中华创伤骨科杂志

Objective To evaluate the treatment of unstable fractures of the distal end of the radius with external fixator.Methods 28 patients with unstable fractures of the distal end of the radius were treated with external fixators. 19 cases of them were fixed with K wires and bone graft was used in 4 patients with severe bone defect.Results The patients were followed up for an average period of 10.11 months. According to modified Mcbride grading, 25 patients showed excellent or good results with the excellent and good rate being 89.28% . Conclusion It is difficult to reduce unstable fracture of the distal end of the radius with close reduction. Redisplacement is frequent for plaster cast and is not reliable in maintaining reduction. These fractures should be treated with early open reduction. External fixation plus reasonable exercises taken after the operation is one of the good treatments and good results can be predicted. The most important factors affecting final outcome include radial shortening and reduction of articular surface.

The clinical study for the treatment of unstable distal radius fractures via volar approach / 中华骨科杂志

Objective To summarize the outcome of volar approach for unstable distal radius fractures, as well as to explore and discuss the more prompt and efficient way with less complications. Methods Volar approach was used for unstable distal radius fractures in 129 cases (140 sides). This study involved 77 males and 52 females with an average age of 43.7 years (range, 15-76 years). According to the Coony universal classification, 36 sides were of type Ⅱ, 7 of type Ⅲ and 97 of type Ⅳ, which included 105 sides of fresh fracture and 35 old ones. Extra-articular reduction was performed under C-arm to restore the palm tilted angle and ulna deviated angle. For those with severe bone defect, artificial bone graft or auto-graft was applied. T-plates were fixed in 32 sides, T-plates with K-wires in 57, external fixators in 13, external fixators with K-wires in 38 respectively. Results The functional recovery was achieved at 3.8 months averagely after operation with a range of 2 to 6 months. The mean follow-up period was 23.6 months ( range, 12-40 months). 91 sides were rated as excellent, 38 as good, 10 fair and 1 poor. The long-term excellent-good rate was 92.1%. Conclusion The volar approach for unstable distal radius fractures has the following advantages: 1)less invasive without compromise to the bone and tendon sheath of distal radius; 2)The volar surface of radius is smooth , easier for plating; 3)no injury to the palmer ligaments and better for recovery; 4)better reduction; 5)avoidance of bone graft displacement; 6) shorten the operation time, less post-operative complication, earlier rehabilitation and faster functional recovery. The volar approach for unstable distal radius fractures is suitable either for internal or external fixation.