Three nonparallel screws for the treatment of femoral neck fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical effects of three nonparallel screws in treating femoral neck fractures.</p><p><b>METHODS</b>From September 2008 and May 2009, 29 patients were treated, including 12 males and 17 females with an average age of 52 years (ranged from 27 to 62 years). Before operation, according to Garden classification system, 2 cases were Garden type II (undisplaced fracture), 18 cases were Garden type III (partial displaced fracture) and 9 cases were Garden type IV (complete displaced fracture). After fracture reduction in operation, Pauwels classification system was used to classify the type, and 12 cases were type II, 17 cases were type III Closed reduction and internal fixation with three non-parallel screws were used to treat. The surgery X-ray and follow-up X-ray were compared to observe whether femoral neck abbreviate and screw exit appeare. Harris scoring was used to evaluate function.</p><p><b>RESULTS</b>All patients were followed-up from 34 to 44 months with an average of 38 months. The mean time of bone union was 7 (ranged, 3 to 12) months. Nonunion occured in 4 cases with Garden IV, and femoral head necrosis occurred in 2 cases. For Harris scoring, two cases with nondisplaced fracture were 100. Among 27 cases with displaced fractures, 23 cases achieved bone union without femoral head necrosis, average Harris scale was 91.35 +/- 8.00, and the average Harris scale of 4 cases with bone nonunion was 61.23 +/- 5.12. For all but one, there was no femoral neck crispation after bone union.</p><p><b>CONCLUSION</b>Nonparallel screws for femoral neck fractures can effectively control abbreviation and screw tail exit after fracture healing.</p>

Is closed reduction and interlocking intramedullary nailing fit for the treatment of fractures of humeral shaft with radial nerve injury? / 中华创伤骨科杂志

Objective To study whether closed reduction and interlocking intramedullary nailing will worsen the injured radial nerve associated with the fracture of humeral shaft.Methods Of the 353 patients with fracture of humeral shaft who received operation from January 2002 to January 2005,63 ones were complicated with preoperative injury to their radial nerve.A retrospective analysis was done of their physical examination records, operative records,X-ray films and results of the treatment.Eleven cases were treated with closed reduction and interlocking intramedullary nailing,and 52 cases with open reduction and internal fixation of plates and screws fol- lowed by exploration to the radial nerve.Chisquare test of PEMS 3.1 system was adopted to analyze the clinical data. Results The radial nerve was embedded by the fracture ends in nine cases(17.3%)of the 52 cases,and con- tused in the other 43 ones.In the 63 cases,The injured nerves recovered spontaneously 2 to 12 weeks postoperatively except in twn cases.All the eases got bony union 3 to 4 months after operation.Closed reduction and interlocking intramedullary nailing has hardly more harmful effects on the injured radial nerve assoeiated with the fracture of humeral shaft than open reduction and internal fixation of plates and screws followed by neural exploration.Con- clusion Closed reduction and interlocking intramedullary nailing is fit for the freatment of fractures of humeral shaft with radial nerve injury.

Selection of dorsal or volar internal fixation for unstable distal radius fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the results of T-plate in the treatment of unstable distal radius fractures.</p><p><b>METHODS</b>Dorsal or volar T-plate fixation was used for unstable distal radius fractures according to different types of fracture. For comminuted fractures with severe cortex destruction and insufficient buttress, artificial bone graft or autograft was adopted to restore local stability.</p><p><b>RESULTS</b>Satisfactory reduction was achieved after surgery. Functional rehabilitation under surveillance began from the 2nd or 3rd post-operative day. The overall excellent or good recovery rate was 90.77% after a mean follow-up of 29.63 months. For the 55 sides of volar fixation (30 sides with a dorsal displacement fragment), excellent or good recovery rate was 92.72%. Dorsal fixation was used in delayed cases (> 6 weeks) or certain fracture patterns unsuitable for volar approach. The excellent on good recovery rate was 77.77%.</p><p><b>CONCLUSIONS</b>Volar approach is an ideal option not only for distal radius fracture with a volar displaced fragment but also for dorsal displaced fractures (Colles' fracture). The advantages of this approach include flat cortex for easy plate fixation, better tension band effect, less soft tissue destruction, leaving dorsal soft tissue hinge intact, and avoiding bone graft leakage. Satisfactory results can be obtained in those patients with unstable distal radius fracture through volar approach plate fixation, especially in those with fresh fractures. If possible, volar approach can also be used in delayed fractures within 6 weeks. The results of dorsal fixation is a little bit inferior.</p>