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Objective To explore the cross classification of tibial plateau fractures combined with avulsion fracture of medial femoral condyle.Methods The 16 patients were retrospectively analysed as an observation group who had been treated at Department of Lower Limbs,Sichuan Orthopaedic Hospital for tibial plateau fracture and avulsion fracture of the medial condyle of the same femur from January 2015 to December 2018.They were 9 males and 7 females,aged from 27 to 78 years (average,51.5 years).By the Schatzker classification,there were 2 cases of type Ⅰ,8 cases of type Ⅱ,3 cases of type Ⅲ and one case of type Ⅳ;by the cross classification,there were 10 cases of type Ⅰe,one case of type Ⅱe and 2 cases of type Ⅲ e and 3 cases of type Ⅰv.The 332 patients were included as a control group who had been treated at the same department for simple tibial plateau fracture from January 2010 to December 2015.The imaging data of the 2 groups were compared to find out the charateristics of cross type distribution;the widened distance of the lateral tibial plateau,collapse depth of the tibial plateau,separation of avulsion fracture of medial femoral condyle,maximum clearance of the medial knee and eversion angle of the tibial plateau were investigated in the patients with cross types e and Ⅰv in the observation group.Results In the observation group,the widened distance of the lateral tibial plateau averaged 7.18 mm,the collapse depth of the tibial plateau 8.74 mm,the separation of avulsion fracture of medial femoral condyle 3.44 mm,the maximum clearance of the medial knee 7.77 mm,and the eversion angle of the tibia1 plateau 87.03°.There was a significant difference in the cross type distribution of tibial plateau fractures between the 2 groups (P =0.002).In the observation group,the average widened distance of the lateral tibial platea for the 13 type e patients (8.49 ± 4.26 mm)was significantly larger than that for the 3 type Ⅰv patients (1.51 ± 2.11 mm) (t =2.706,P =0.017) Conclusion The cross classification of tibial plateau fractures with avulsion fracture of mediall condyle of the same femur may result mainly in types e and type Ⅰv.The widened distance of lateral tibial plateau helps distinction between types e and type Ⅰv.
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Objective@#To explore the cross classification of tibial plateau fractures combined with avulsion fracture of medial femoral condyle.@*Methods@#The 16 patients were retrospectively analysed as an observation group who had been treated at Department of Lower Limbs, Sichuan Orthopaedic Hospital for tibial plateau fracture and avulsion fracture of the medial condyle of the same femur from January 2015 to December 2018. They were 9 males and 7 females, aged from 27 to 78 years (average, 51.5 years). By the Schatzker classification, there were 2 cases of type Ⅰ, 8 cases of type Ⅱ, 3 cases of type Ⅲ and one case of type Ⅳ; by the cross classification, there were 10 cases of type Ⅰe, one case of type Ⅱe and 2 cases of type Ⅲe and 3 cases of type Ⅰv. The 332 patients were included as a control group who had been treated at the same department for simple tibial plateau fracture from January 2010 to December 2015. The imaging data of the 2 groups were compared to find out the charateristics of cross type distribution; the widened distance of the lateral tibial plateau, collapse depth of the tibial plateau, separation of avulsion fracture of medial femoral condyle, maximum clearance of the medial knee and eversion angle of the tibial plateau were investigated in the patients with cross types e and Ⅰv in the observation group.@*Results@#In the observation group, the widened distance of the lateral tibial plateau averaged 7.18 mm, the collapse depth of the tibial plateau 8.74 mm, the separation of avulsion fracture of medial femoral condyle 3.44 mm, the maximum clearance of the medial knee 7.77 mm, and the eversion angle of the tibial plateau 87.03°. There was a significant difference in the cross type distribution of tibial plateau fractures between the 2 groups (P=0.002). In the observation group, the average widened distance of the lateral tibial platea for the 13 type e patients (8.49±4.26 mm)was significantly larger than that for the 3 type Ⅰv patients (1.51±2.11 mm) (t=2.706, P=0.017).@*Conclusion@#The cross classification of tibial plateau fractures with avulsion fracture of mediall condyle of the same femur may result mainly in types e and type Ⅰv. The widened distance of lateral tibial plateau helps distinction between types e and type Ⅰv.
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Objective To explore the efficacy and complication prevention of operative fixation of coronoid fractures via neurovascular interval of anterior elbow approach.Methods From March 2006 to September 2009,data of 21 patients with coronoid process fractures associated with complex elbow dislocation who were treated via neurovascular interval of anterior elbow approach in my ward were retrospectively analyzed.There were 14 males and 7 females.The mean age of the patients was 31.6 years (range,18-52 years).Injury was caused by walk falling in 10 cases,falling from standing-height in 3 cases and sports events in 8 cases;7 patients were left side and 14 patients were right side,including 16 prominent sides and 5 non-prominent sides.There were 3 type Ⅰa,3 type Ⅱa,8 type Ⅱb,4 type Ⅱc,3 type Ⅲa coronoid process fractures according to the O'Driscoll's classification.Pre-operative 3D-CT scans were conducted to clarify if there were subluxations or sign of instabilities in elbows.Operative fixation of coronoid process fractures with cannulated screws and/or mini plates and/or suture anchors were carried out via the anterior interval between humeral vessels and median nerve,and then lateral collateral ligaments were repaired if instability still existed.Results The average operation time was 72 min,and the follow-up time was 52-74 months.Only 1 case of type Ⅰa fracture got nonunion because of early postoperative activities from the first day after the operation and the elbow was fixed at 0 degree of extension with brace.At the latest follow-up,in suture anchor fixation group (3 cases),the average VAS was 1.8±0.5,Broberg-Morrey score 90.2±6.6,extension deficiency 11.2°±3.6°,flexion 133.4°±8.8°,and the excellent-good-rate was 66.7％ (2 cases excellent and 1 fair).In the screw-fixation group (10 cases),the average VAS was 1.6±0.8,Broberg-Morrey score 89.2±6.6,extension deficiency 15.2°±4.6°,flexion 130.8°±10.8°,and the excellent-good-rate was 90％ (6 cases excellent,3 good,and 1 fair).In the mini plate fixation group (8 cases),the average VAS score was 1.6±0.7,Broberg-Morrey score 88.6±6.7,extension deficiency 11.8°±5.6°,flexion 134.2°±8.6°,and the excellent-good-rate was 87.5％ (4 cases excellent,3 good,and 1 fair).In the lateral ligament repaired group (14 cases),the average VAS was 1.3±0.9,Broberg-Morrey score 91.5±6.3,extension deficiency 10.2°±3.4°,flexion 135.2°±4.2°,and the excellent-good-rate was 100％ (8 cases excellent,6 good).In the lateral ligament non-repaired group (7 cases),the average VAS was 2.2± 1.6,Broberg-Morrey score 80.2± 13.8,extension deficiency 13.6°±4.4°,flexion 126.6°±4.0°,and the excellent-good-rate was 71.4％ (3 cases excellent,2 good,1 fair).There were 5 cases which had early osteoarthritis changes in the elbow joint in 3 years' follow-up,with the incidence rate 23.8％ (5/21),and the incidence of mid-term osteoarthritis in the 5 and 7 years after operation was 4.8％ (1/21).Conclusion Operative fixation of coronoid fractures with suture anchor and/or cannulated screw and/or mini plate via neurovascular interval of anterior elbow approach was confirmed to be efficient and safe.Lateral collateral ligaments should be repaired if the elbow is unstable.
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Objective To evaluate the clinical and radiological results of Phlios plate and Multiloc nail in treatment of proximal humerus fractures.Methods From February 2013 to December 2015,data of 37 cases of proximal humerus fractures who were treated by reduction and fixation using Phlios plate or Multiloc nail were retrospectively analyzed.In group one (Phlios plate),there were 10 males and 8 females,with an average age of 56.3±5.8 years,including 7 cases of Neer 2-part surgical neck fracture,6 cases of Neer 3-part fracture,4 cases of Neer 4-part fracture,and 1 case of fracture-dislocation.In group two (Multiloc nail),there were 8 males and 11 females,with an average age of 57.2±7.4 years,including 8 cases of Neer 2-part surgical neck fracture,9 cases of Neer 3-part fracture,1 case of Neer 4-part fracture,and 1 case of fracture-dislocation.Operation time,range of motion of shoulder joint,visual analogue scale (VAS) pain score,American Shoulder & Elbow Surgeon (ASES) score and ConstantMurley score were collected.Results All 37 patients were followed up for an average period of 15.5 months (range,12-36 months).The average bone healing time were 2.5±0.5 months (range,2-3 months)and 2.2±0.5 months (range,1.5-3 months) in the plate and nail group respectively.At the latest follow-up,average VAS score was 0.4±0.6 (range,0-2),the ASES score aver aged 85.4±6.8 points (range,73-96),Constant-Murley score averaged 83.4±7.3 points (range,71-94),and external rotation averaged 30.8°±10.0° (range,10°-50°) in plate group,while average VAS score was 0.2±0.4 (range,0-1),ASES score averaged 89.7± 5.6 points (range,80-98),Constant-Murley score averaged 88.5±6.8 points (range,76-98),and external rotation averaged 40.3°± 7.9° (range,20°-50°) in the intramedullary nailing group.One case had partial necrosis of humeral head in the plate group,while 1 case suffered absorption of the greater tuberosity in the nail group,with the complication rate of 5.6％ (1/18) and 5.3％ (1/19) respectively,without significant difference.The internal and external rotation degrees,ASES and Constant-Murley scores were better in nail group than those in plate group for 2-part fractures,while the forward elevation and abduction degrees were similar.Conclusion Similar results were achieved for the treatment of proximal humeral fractures by Phlios plate and Multiloc nail.The Multiloc nailing group had achieved superior outcomes in Neer-2-part proximal humeral fractures.
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Objective To evaluate the short-term functional outcome of arthroscopic reduction and fixation for fractures of greater tuberosity of humerus.Methods From May 2012 to December 2016,data of 25 cases with fractures of greater tuberosity of humerus who were treated by reduction and fixation under arthroscopy were retrospectively analyzed.There were 12 males and 13 females,with an average age of 44.8 years (22-69 years),including 7 cases of left shoulder,and 18 cases of right shoulder.X-ray examinations revealed that the displacement of the greater tuberosity was 5-12 mm,with an average of 5.8 mm.There were 21 cases of fresh fractures and 4 cases of old fractures (more than 3 weeks from injury to operation).5 patients were treated only using cannulated screw fixation(Group one),while 12 patients only using suture-bridge anchor fixation(Group two) and another 8 patients were treated using combination technique with cannulated screw and suture anchor fixation(Group three).There were glenoid fractures in 11 cases before surgery,and 9 cases were found with Bankart lesion,1 case SLAP injury,8 cases rotator cuff tear found under arthroscopic examinations.At the last visit,visual analogue scale (VAS) pain score,American Shoulder & Elbow Surgeons (ASES) score and Constant-Murley score were collected to evaluate the recovery of shoulder function.Results All the incision healed primary,and no infection occurred.All 25 patients were followed up for an average period of 21.3 months (6～38 months).The X-ray showed that the fractures of the great tuberosity of humerus and the glenoid healed 2-4 months after operation,with an average time of 3.4 months.No fracture displacement and absorption were observed.At the final follow-up,the average functions of shoulder were 175.0°±6.3°,170.0°±9.5° and 160.6°±27.4° in group one,two and three respectively for forward flex-ion;57.5°±13.0°,56.1°±14.5° and 53.1°±11.2° for lateral external rotation in group one,two and three respectively;0.3±0.4,0.8± 1.1 and 1.1±1.4 points for VAS in group one,two and three respectively;98±1.6,95.6±4.0 and 93.3±7.5 points for ASES in group one,two and three respectively;and 96.5±2.3,95.0±4.3 and 92.0±9.2 points for the Constant-Murley scoring system in group one,two and three respectively.The displacement of the lateral anchor occurred in 1 patient (75 points for ASES,69 points for Constant -Murley and 3 points for VAS);and no complications such as internal fixation failure,fracture displacement and neurovascular injury occurred in the remaining patients.Conclusion It is a safe and effective method to treat the fractures of great tuberosity of humerus by reduction and fixation under the arthroscope using cannulated screws and/or suture anchors.
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Objective To evaluate the short?term functional outcome of Multiloc Proximal Humeral Nails (PHN) in the treatment of proximal humeral fractures, by retrospectively reviewing the function and complications of our institutional experi?ence. Methods 15 patients were treated operatively for displaced proximal humeral fractures using the Multiloc PHN. Fractures were classified according to Neer's classification. Male 4 cases, female 11 cases, with a mean age 63.7 years (58-73 years), and the mean follow?up was 5.2 months (3-10 months). A number of parameters including patient demographics, mechanism of injury, operative time, time to union and complications were recorded. Functional outcome was evaluated using the rating scale of the American Shoulder and Elbow Surgeons (ASES) and Constant Score, Visual Analogue Scale (VAS) scores. Results 15 patients completed the follow?up more than 3 months, the operation time was 145.3minutes (70-200 min), the blood loss was 189.3ml (50-310 ml). The union rate was 100%(mean time to union: 2.5 months). The ASES score was 83.1 and Constant Score was 81.7 , while the VAS was 1.7. The Constant score 87 (85, 92) and ASES 90 (83.5, 100) were higher for 5 cases without calcar screw than those of the other 10 cases using the calcar screw whose Constant 83 (77, 90), ASES 85 (73, 95). The average Constant score 88 (78, 92) and ASES score 91.5 (75, 100) were higher in 7 cases with 1 screw?in?screw than those with more than 2 screw?in?screw in 8 cases whose Constant 80.5 (74, 88.5), ASES 81.8 (73, 92.5). There were no complications such as hardware failure, protruded screws, infection, nonunion, avascular necrosis of humeral head or impingement syndrome, but 1 patient suffered from elbow stiff?ness (complication rate:6.7%). Conclusion The Multiloc proximal humeral nail is an effective implant for stabilisation of dis?placed proximal humeral fracture with a good short?term functional outcome. Its advantages are short operation time, small inci?sion, less trauma, less blood supply and less complications. The shoulder pain history and or with intraoperative findings of rotator cuff injuries, may have a negative impact on the prognosis.
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Objective To evaluate the clinical outcomes of primary repair of bony and ligamentous components in treatment of Mason-Johnston type Ⅳ radial head fractures.Methods From August 2007 to November 2011,16 cases of Mason-Johnston type Ⅳ radial head fractures were treated by open reduction and screw or plate fixation combined with simultaneous repair of ruptured capsular ligaments with suture anchors.There were 11 men and 5 women with a mean age of 31.6 years (range,18-52 years).Totally,left side was involved in seven cases and right side in nine； dominant side was involved in 13 cases and non-prominent side in three.Time from injury to operation averaged 6.2 days (range,2-11 days).Nine cases of partial articular fractures with 2 or 3 fragments were treated with 1.5 mm or 2.0 mm AO miniscrews and seven cases of complete articular fractures with 2-4 fragments were treated with 2.0 mm AO mini plastic plates and screws after reduction.Active and assisted functional exercise was instructed in the early period after surgery.Visual analogue scale (VAS) and Broberg-Morrey elbow performance were measured for function assessment at the latest follow-up.Results Follow-up averaged 22.6 months (range,12-38 months),which showed primary wound healing without infection.All fractures achieved bony union at an average of 4.8 months (range,3.3-6.2 months).Ten out of the 16 cases,four of partial articular fractures and six of complete articular fractures,had slight but asymptomatic ossification in the medial and lateral collateral ligament attachment.There were two excellent,six good and one fair results in partial articular fracture group,with excellent-good rate of 89％ as well as one excellent,four good and two fair results in complete articular fracture group,with excellent-good rate of 72％.Moreover,the total excellentgood rate reached 81％.Range of motion in extension,flexion and rotation,Broberg-Morrey score and VAS presented statistical differences between partial and complete articular fracture groups (P ＜ 0.05).Conclusion Primary management of bony and ligamentous components to treat Mason-Johnston type Ⅳ radial head fractures brings timely three-dimensional stability of the elbow joint,favors early functional exercise and further decreases incidence of postoperative complications,such as elbow stiffness,pain and heterotopic ossification.
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ObjectiveTo analyze the therapeutic effect of open reduction with internal fixation (ORIF) and anatomic reconstruction locking plate in treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus.MethodsThe study involved 30 patients with Neer 3-part and 4-part fracture dislocations treated with anatomic reconstruction locking plate from September 2004 to December 2007.Twenty patients had complete follow-up data.The treatment methods included locking proximal humeral plate (LPHP) in seven patients and proximal humeral internal locking system (PHILOS) in 13.There were 15 males and five females,at age range of 29-84 years (average 52.5 years),including nine patients younger than 65 years and 11 older than 65 years.According to Neer classification,there were 15 patients with 3-part fracture dislocations including 12 anterior and three posterior dislocations and five patients with 4-part fracture dislocations including four anterior and one posterior dislocations. VAS and Constant scoring system were adopted to evaluate the shoulder joint function postoperatively. Results All 20 patients were followed up for 36-71 months ( average 51 months),which showed avascular necrosis of humeral head in six patients (30％),plating loosening in two,screw penetration in six,nonunion in two and infection in two.The mean visual analogue score (VAS) was 2.55 poiuts and the mean Constant score for the shoulder was 80.8.According to the Neer shoulder functional evaluation standard,eight patients were graded as excellent,six as good,three as fair and three as poor,with excellence rate of 70％.ConclusionsAlthough the anatomic reconstruction locking plate and ORIF can cause a high incidence of avascular necrosis of humeral head in the treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus,especially for the patients older than 65 years.However,there is no obvious correlation between necrosis of humeral head and shoulder function.Clinically,the method could be selected on the ba-sis of individual condition of the patients.
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Objective To introduce distal clavicle excision plus suture anchor to treat Craig Ⅴ distal clavicle fracture.Methods From November, 2005 to August, 2007, 25 patients with Craig Ⅴ distal clavicle fracture were treated with distal clavicle excision plus suture anchor.They were 18 men and 7 women,with a median age of 42.6 years.They were followed up periodically by radiological examination.At the final follow-up, their shoulder functions were evaluated by University of California-Los Angeles (UCLA) scoring system and Constant scoring system, and the pain was evaluated according to visual analog scale (VAS).Results All the patients obtained a median follow-up of 13.6 months (8 to 24) .The height of distal clavicle in all patients reached anatomical reduction.Their average UCLA score was 33.5 (28 to 35), and average Constant score was 90.6 (79 to 100) .Their mean VAS score was 1.2 (0 to 4) .Their average forward flexion and elevation was 156.4° ( 145° to 170°), and external rotation was 45.6° (40° to 60°) .The rate of top quality was 88.0% (22/25).Conclusion Distal clavicle excision plus suture anchor is an effective method to treat Craig Ⅴ distal clavicle fracture which results from serious trauma.