Less invasive fixation for the treatment of comminuted fracture of distal tibia / 中国骨伤

<p><b>OBJECTIVE</b>To study the result of less invasive fixation in treating comminuted fracture of distal tibia.</p><p><b>METHODS</b>From 2002 to 2008, 48 patients with comminuted fracture of distal tibia were treated with surgery. The closed reduction and less invasive fixation were done to stable broken fibula, and the reduction by Kirschner wire to pick was used for relatively larger debris of tibia. The Kirschner wire or screw were used to fix fracture after the restore of the ankle cavity position and the alignment of the tibia. Partial weight loading and functional exercise of ankle joint were done at 6th week after operation.</p><p><b>RESULTS</b>Forty-eight patients were followed up for 1-24 months with an average of 12 months. All the fractures were united. According to Johner-Wruhs standard to value the result by factors of pain, deformity, motion range of joint,with or without injury of nerve and blood vessel. Thirty-eight cases obtained excellent result, 8 good, fair 2. The rate of excellent and good were 95.8%.</p><p><b>CONCLUSION</b>Less invasive fixation has ascendancy such as easy operation, less injury of soft tissue, reliable fixation, which can maximally protect periosteum. It is a choice for treating comminuted fracture of distal tibia.</p>

Treatment of floating knee injuries with interlocked intramedullary nailing through a single incision / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the technique and clinical effect of interlocked intramedullary nailing through a single incision on the treatment of floating knee injuries.</p><p><b>METHODS</b>Thirty-eight patients of floating knee injuries included 25 male and 13 female with an average age of 35.6 years ranging from 17 to 52 years. All patients were treated by interlocked intramedullary nailing through a single incision. The clinical effect was evaluated postoperatively.</p><p><b>RESULTS</b>Thirty-eight cases were followed-up for 8.6 to 15.4 months with an average of 12.0 months. Thirty-seven cases gained bone healing and the time of fracture healing was from 2.7 to 6.9 months, with an average of 4.8 months. The nonunion of the distal femoral fracture was observed in 1 case with retrograde nailing, the revision operation was performed by plate and bone graft, and bony union was obtained. The results were excellent in 22 cases, good in 13 cases, fair in 2 cases, and poor in 1 case.</p><p><b>CONCLUSION</b>The treatment of floating knee injuries with interlocked intramedullary nailing through a single incision brings less damage, low infection rate, good fracture healing. It is an effective method for treating floating knee injuries.</p>

Different approaches of vertebroplasty for management of severe osteoporotic vertebral compression fractures / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the clinical efficacy of 3 approaches of vertebroplasty in the treatment of severe osteoporotic vertebral compression fractures.</p><p><b>METHODS</b>Twenty-five patients with severe osteoporotic vertebral compression fractures were observed, whose average age was 72 years with average disease history of 12 days and average compression of the affected vertebral bodies of 73%. The patients were divided into 3 groups for 3 different fracture types according to Rao's classification of osteoporotic vertebral structure and deformity, namely wedge type (group A, n= 12), biconcave type (group B, n= 7) and crush type (group C, n=6). Unipedicular approach was adopted in group A, far lateral bipedicular approach in group B, and posterior wall vertebroplasty and pedicle screw fixation in group C. The average follow-up time was 1 year. Visual analog scale (VAS), analgesic use and the mobility were measured in the patients preoperatively and 3 days (7 days in group C) and 6 months after the operation, respectively, and the success rates and complications were observed.</p><p><b>RESULTS</b>All the surgical procedures were successful. The average operation time was 35 min in group A, 50 min in group B, and 2 h in group C. The average volume of cement injected into each vertebral body was 2.0 ml. The average blood loss was 30 ml in groups A and B, and 600 ml in group C. The procedure increased mobility and decreased analgesic use. VAS was decreased by a mean of 4.8 in Group A, 6.2 in group B 3 days after the operation and 5.4 in group C 7 days postoperatively, and remained stable till 6 months after the operation (P<0.01). Cement extravasation occurred in 9 cases, cement in the vertebral canal in 2 cases with transient neurological symptoms, and cement extravasation in the intervertebral space and the anterior space of the vertebral bodies took place in 5 and 2 cases, respectively. No neurological complications were observed.</p><p><b>CONCLUSION</b>Different types of severe osteoporotic vertebral compression fractures require management with different approaches of vertebroplasty for adequate filling of the remaining vertebral body, which provides significant pain relief with wider indications.</p>