ABSTRACT
Objective:To investigate the application of combined distractor in the treatment of refractory distal radius fractures.Methods:From March 2018 to February 2020, the data of 32 patients with refractory distal radius fractures treated with combined distractor-assisted reduction were retrospectively analyzed. The propensity score matching method was used to establish a non-distractor group according to 1∶1 matching, with a total of 32 patients. In the distractor group, there were 15 males and 17 females, age 54.9 ±15.8 years (range, 18-77). According to AO classification, 3 cases were A3, 3 cases were B3, 16 cases were C2, 10 cases were C3. In the non-distractor group, there were 12 males and 20 females, age 59.7±14.8 years, 4 cases were A3, 5 cases were B3, 12 cases were C2 and 11 cases were C3. Main measures: surgical time, radial height, palm inclination, ulnar deviation, range of motion of the wrist, visual analogue scale (VAS), and functional assessment using disability of arm, shoulder and hand (DASH) and modified Mayo wrist score (MMWS).Results:A total of 64 patients were included in this study, and all patients successfully completed the operation and were followed up for 12-54 months, with an average of 17.8 months. The operative time of the distractor group was 91.2±14.6 min, which was significantly lower than that of the non-distractor group 137.6±27.3 min, and the difference was statistically significant ( t=8.48, P<0.001); the radial height in the distractor group 11.5±1.4 mm was significantly higher than that in the non-distractor group 10.6±1.3 mm, and the difference was statistically significant ( t=2.59, P=0.012). At the last follow-up, there were no statistically significant differences in the palm inclination 7.9°±4.4° vs. 7.5°±3.5°, ulnar deviation 23.3°±5.7° vs. 22.3°±4.5°, wrist flexion 63.2°±15.3° vs. 62.6°±11.1°, dorsiflexion 63.5°±10.7° vs. 62.4°±15.2°, pronation 69.2°±11.8° vs. 67.0°±11.0°, supination 73.1°±10.4° vs. 72.0°±8.7°, VAS 0.8±0.5 points vs. 0.9±0.7 points, DASH score 12.9±6.6 points vs. 13.4±7.0 points amd MMWS 84.1±5.8 points vs. 83.5±6.2 points ( P>0.05). One patient in the distractor group had symptoms of extensor muscle irritation, and the symptoms disappeared after the internal fixation was removed; 2 patients in the non-spreader group developed carpal tunnel syndrome, which improved after incision and decompression treatment. Conclusion:For refractory distal radius fractures, the use of combined distractor can achieve better radius height recovery and shorten the operation time, and has a satisfactory postoperative effect.
ABSTRACT
Objective To explore the clinical efficacy of plate fixation via the lateral transverse incisions and double-window approaches for the treatment of intra-articular calcaneal fractures.Methods A retrospective analysis was performed on the data of 21 intra-articular calcaneal fractures (22 feet) which had been treated at Department of Orthopaedics,The Second Affiliated Hospital to Anhui Medical University from May 2014 to April 2016.There were 19 males and 2 females,aged from 20 to 60 years (average,38.3 years).The fracture affected 13 left feet and 9 right feet.According to the Sanders classification,10 feet were type Ⅱ,11 type Ⅲ and one type Ⅳ.They were treated by plate fixation via the lateral transverse incisions and double-window approaches.Early complications within 3 months after operation,the length,width,height,B(o)hler angle and Gissane angle of the calcaneus one year after operation,functional recovery of the affected feet at the last follow-up,and complications were recorded.Results The 21 patients were followed up for 21 to 44 months (mean,36.7 months).Incisions were all healed at the first postoperative stage with no serious skin or sofi tissue complications like superficial infection,deep infection or wound dehiscence.At the early stage,one patient suffered epidermal necrosis at the margin of incision,which was cured after dressing change.None of the patients developed subtalar arthritis by the last follow-up.The preoperative length,width,height,B(o)hler angle and Gissane angle of the calcaneus (respectively,68.6 ± 1.2 mm,46.7 ± 0.8 mm,39.1 ± 2.0 mm,5.4° ± 12.1° and 104.3°± 10.2°) were significantly improved to 71.7 ± 1.6 mm,48.8 ±2.0 mm,32.8 ± 1.3 mm,29.2° ± 6.8°,and 120.8° ± 6.2° one year after operation(P ＜ 0.05).At the last follow-up,their AOFAS ankle-hind foot scores averaged 92.7 points (from 73 to 98 points);17 feet were rated as excellent,3 as good and 2 as moderate,giving an excellent and good rate of 90.1％.Conclusion Plate fixation via the lateral transverse incisions and double-window approaches can reduce incidences of postoperative soft tissue complications and subtalar arthritis,leading to good clinical results in the treatment of intra-articular calcaneal fractures.
ABSTRACT
Objective@#To explore the clinical efficacy of plate fixation via the lateral transverse incisions and double-window approaches for the treatment of intra-articular calcaneal fractures.@*Methods@#A retrospective analysis was performed on the data of 21 intra-articular calcaneal fractures (22 feet) which had been treated at Department of Orthopaedics, The Second Affiliated Hospital to Anhui Medical University from May 2014 to April 2016. There were 19 males and 2 females, aged from 20 to 60 years (average, 38.3 years). The fracture affected 13 left feet and 9 right feet. According to the Sanders classification, 10 feet were type Ⅱ, 11 type Ⅲ and one type Ⅳ. They were treated by plate fixation via the lateral transverse incisions and double-window approaches. Early complications within 3 months after operation, the length, width, height, Böhler angle and Gissane angle of the calcaneus one year after operation, functional recovery of the affected feet at the last follow-up, and complications were recorded.@*Results@#The 21 patients were followed up for 21 to 44 months (mean, 36.7 months). Incisions were all healed at the first postoperative stage with no serious skin or soft tissue complications like superficial infection, deep infection or wound dehiscence. At the early stage, one patient suffered epidermal necrosis at the margin of incision, which was cured after dressing change. None of the patients developed subtalar arthritis by the last follow-up. The preoperative length, width, height, Böhler angle and Gissane angle of the calcaneus (respectively, 68.6±1.2 mm, 46.7±0.8 mm, 39.1±2.0 mm, 5.4°±12.1° and 104.3°±10.2°) were significantly improved to 71.7±1.6 mm, 48.8±2.0 mm, 32.8±1.3 mm, 29.2°±6.8°, and 120.8°±6.2° one year after operation(P<0.05). At the last follow-up, their AOFAS ankle-hind foot scores averaged 92.7 points (from 73 to 98 points); 17 feet were rated as excellent, 3 as good and 2 as moderate, giving an excellent and good rate of 90.1%.@*Conclusion@#Plate fixation via the lateral transverse incisions and double-window approaches can reduce incidences of postoperative soft tissue complications and subtalar arthritis, leading to good clinical results in the treatment of intra-articular calcaneal fractures.
ABSTRACT
Acute closed Achilles tendon rupture is a common sport injury.Rupture of the Achilles tendon may limit the ability of physical exercises and activities of daily life.Conservative treatment has long recovery time and high risk of re-rupture of Achilles tendon.In recent years,with the early functional rehabilitation exercise,including early weight bearing and ankle joint flexion and extension exercise under the protection of orthopaedic braces,re-rupture risk of Achilles tendon has been significantly reduced,thus conservative treatment is becoming more and more popular.The surgical treatment mainly includes traditional open surgery and minimally invasive surgery.Minimally invasive treatment has less trauma,low re-rupture rate like open surgery,low risk of wound infection and is helpful for early rehabilitation.However,the risk of the sural nerve injury is higher.Open surgery has clear operating field and low re-rupture rate and low risk of the sural nerve injury.However,it still has some problems such as superficial and deep infection of the incision,suture reaction,tissue adhesion and so on.Both of them can achieve satisfactory results in the treatment of acute closed Achilles tendon rupture.Although the mechanism of injury of acute closed rupture of the Achilles tendon and epidemic characteristics have a deeper understanding,including degenerative tendon rupture and mechanical rupture of Achilles tendon,the incidence rate showed a rising trend,and affected by the geographical,gender,age and other factors,due to the existence of a variety of patient groups,there is still controversy over the optimal treatment modalities resulting from the diversity of the patient population.According to the individual differences of different groups of patients,the combination of early rehabilitation exercise can achieve satisfactory clinical effects as long as the treatment methods are appropriate.At present,the effect of biological therapy on the healing of Achilles tendon and the prevention of deep vein thrombosis are still controversial.There is no definitive evidence for the effectiveness of biological therapy and the need for prophylactic anticoagulation.The purpose of this study is to summarize the treatment of acute closed Achilles tendon rupture,and to discuss the importance of early functional exercise for acute closed Achilles tendon rupture and its effect on prognosis.
ABSTRACT
BACKGROUND:The relationship between the occurrence time and clinical symptoms of bone marrow edema in nontraumatic femoral head necrosis is stil controversial. OBJECTIVE:To evaluate the relationship of bone marrow edema in nontraumatic femoral head necrosis with Association Research Circulation Osseous (ARCO) staging and pain grading. METHODS: Forty-eight patients with nontraumatic femoral head necrosis (58 hips) were confirmed to have bone marrow edema on MRI T1 weighted images and T2 fat suppression images. Then, the patients were graded according to the MRI Classification Method reported by Zhao Pei-rong, the ARCO Staging System and Harris hip score for pain grading. We analyzed the correlation of bone marrow edema with ARCO staging and pain grading. RESULTS AND CONCLUSION:The incidence rate of bone marrow edema in ARCO I-III was increased in sequence, and the difference was statisticaly significant (χ2=27.69,P=0.001); the average rank of bone marrow edema in ARCO I-III was increased significantly (χ2=19.947,P=0.000). The incidence rate of bone marrow edema also increased among different pain grading, and the difference was statisticaly significant (χ2=57.0, P=0.000); the average rank of bone marrow edema among different pain grading was increased significantly (χ2=174.0,P=0.000). The presence and aggravation of bone marrow edema indicate the enlargement of necrosis area and the aggravation of symptoms in patients with nontraumatic femoral head necrosis, which can be used as an auxiliary index for the appraisal of disease progression.