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Objective:To investigate the efficacy of elastic locking intramedullary nail (ELIN) in the treatment of mid clavicle fractures.Methods:From January 2014 to December 2020, the data of 61 patients with mid-clavicle fracture treated with ELIN were retrospectively analyzed. Among them, 38 patients were from the Fourth Central Hospital Affiliated to Nankai University and 23 were from the Second People's Hospital of Hulunbuir City. There were 36 males and 25 females, aged from 19 to 85 years (average, 54.5 years), 39 cases on the left side and 22 cases on the right side. According to Robinson's classification, there were 20 cases of type 2A2, 29 cases of type 2B1 and 12 cases of type 2B2. There was no nerve or vascular injury before operation. The postoperative evaluation measures included incision length, operation time, blood loss, fracture reduction, fracture healing time, ELIN removal time, shoulder Constant-Murley score, disabilities of the arm, shoulder, and hand (DASH) score, and related complications.Results:All patients were followed up for 13-51 weeks (average, 21.8 weeks). There were 34 cases of closed reduction and 27 cases of mini-open reduction, and the length of incision was 2.04±1.08 cm. The closed reduction operation time was 20.32±7.11 min, and the mini-open reduction operation time was 20.30±5.37 min. The intraoperative blood loss was 6.47±2.31 ml in the closed reduction group and 27.41±11.55 ml in the mini-open reduction group. Compared with the healthy side, the clavicle length of the affected side was shortened by 7.74%±3.51% of pre-operation and 0.71%±1.00% of post-operation, there was statistically significant difference in the length of clavicle shortening of pre- and post-operation ( t=3.84, P<0.001). The fracture healing time was 10.48±2.39 weeks. The removal time of ELIN was 13.39±2.69 weeks. At the last follow-up, the Constant-Murley score of shoulder joint was 98.87±1.74. The average of DASH score was 1.13 (range, 0-10). There were 18 cases of skin irritation after operation, of which 13 cases formed pressure sores at the tail end 3-6 weeks after the operation, and were treated with dressing change and keeping clean; 4 cases of skin irritation at the tail end formed bursitis, which disappeared after removal of the internal fixation. In 1 case, the tip of ELIN penetrated the anterior cortex from the proximal clavicle and stimulated the skin. Radiograms showed continuous callus at 4 weeks after operation, and there was no local tenderness on the physical examination, which reached the clinical healing standard, and the symptoms were relieved after the nail was removed. No serious complications such as neural and vascular injury, nail breaking, delayed healing, infection, numbness or discomfort in the subclavian area occurred in all cases, and all patients were satisfied or basically satisfied with the aesthetic of the skin appearance. Conclusion:Minimally invasive and microstress shielding fixation of mid-clavicle fracture with ELIN have the advantages of simple operation, minimally invasive, beautiful appearance, anti-short-shrinkage and rapid fracture healing etc. It is an effective surgical method for the treatment of mid-clavicle fractures.
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Objective@#To compare the curative effect between Elastic Locking Intramedullary Nail (ELIN) and Anatomic Locking Plate (ALP) for the treatment of fracture in the mid-shaft of clavicle (Classification AO/OTA:2A/2B).@*Methods@#Data of 47 cases of 2A/2B clavicular fractures who were treated with operation from January 2014 to December 2016 were retrospectively analyzed. The patients were divided into ELIN group and ALP group according to different fixation methods. There were 23 cases in ELIN group, 14 male and 9 female, aged from 19 to 85 years (average, 55.26 years). 14 cases on the left side and 9 cases on the right side. There were 6 cases of type 2A and 17 cases of type 2B. There were 24 cases in the ALP group, 18 male and 6 female, aged from 15 to 71 years (average, 51.25 years). 16 cases on the left side and 8 cases on the right side. There were 9 cases of type 2A and 15 cases of type 2B. The operation time, intraoperative blood loss, length of skin incision, fracture healing time, extraction time of internal fixation, Constant-Murley score of shoulder joint, disabilities of the arm, shoulder, and hand (DASH) score, and complication incidence were compared between the two groups.@*Results@#All the operations were successfully performed. The mean follow-up for the patients in the ELIN group was 19.35 weeks (range, 14-23 weeks). The mean follow-up for the patients in the ALP group was 53.13 weeks (range, 28-76 weeks). In the ELIN group, the operative time was 20.78 ± 7.71 min, the intraoperative blood loss was 13.26±9.72 ml, the length of incision was 1.57±1.24 cm, the fracture healing time was 10.39±2.39 weeks, the extraction time of internal fixation was 13.17±2.37 weeks, the Constant-Murley score of shoulder joint was 99.09±1.86, and the DASH score was 1.20±2.47. In the ALP group, the operative time was 57.79±11.56 min, the intraoperative blood loss was 69.17±46.24 ml, the length of incision was 9.67±2.90 cm, the fracture healing time was 14.21±4.05 weeks, the extraction time of internal fixation was 47.38±10.46 weeks, the Constant-Murley score of shoulder joint was 98.00±2.17, and the DASH score was 0.89±1.65. The operation time (t=12.856, P=0.000), intraoperative blood loss (t=5.791, P=0.000) in the ELIN group were less than that of ALP group. The length of incision was significantly smaller in ELIN group than that of ALP group (t=12.549, P=0.000). The fracture healing time was earlier in ELIN group than that of ALP group (t=3.566, P=0.002). The extraction time of internal fixation was obviously earlier in ELIN group than that of ALP group (t=15.603, P=0.000). Constant-Murley score of shoulder joint and DASH score showed no significant difference. No delayed healing, no infection was found in the ELIN group, however skin irritation and tail bursitis were found in 6 cases, 3-6 weeks after the operation. The dressing was changed, kept clean. Skin irritation and tail bursitis disappeared, after the extraction of the internal fixation. There were 2 cases of delayed healing in the ALP group. After prolonged observation, the 2 cases healed. The healing time was extended to 24 and 27 weeks, respectively. There was 1 case of infection, 1 case of poor skin healing in the ALP group. The infected patient was treated with debridement and sensitive antibiotics, and the patient with poor skin healing was treated with dressing change. All the patients had wound healing about 4 weeks after surgery. 2 cases of skin irritation in the ALP group disappeared, after the extraction of the internal fixation.@*Conclusion@#Both ALP and ELIN are effective methods for the treatment of mid-shaft clavicular fracture. ELIN group has the advantages of more minimally invasive, faster union, shorter internal fixation time, better appearance, and lower medical cost. However, the ELIN group also had skin irritation and temporary bursitis.
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Objective To compare the curative effect between Elastic Locking Intramedullary Nail (ELIN) and Anatomic Locking Plate (ALP) for the treatment of fracture in the mid?shaft of clavicle (Classification AO/OTA:2A/2B). Methods Data of 47 cases of 2A/2B clavicular fractures who were treated with operation from January 2014 to December 2016 were retrospectively analyzed. The patients were divided into ELIN group and ALP group according to different fixation methods. There were 23 cases in ELIN group, 14 male and 9 female, aged from 19 to 85 years (average, 55.26 years).14 cases on the left side and 9 cases on the right side. There were 6 cases of type 2A and 17 cases of type 2B. There were 24 cases in the ALP group, 18 male and 6 fe?male, aged from 15 to 71 years (average, 51.25 years). 16 cases on the left side and 8 cases on the right side. There were 9 cases of type 2A and 15 cases of type 2B. The operation time, intraoperative blood loss, length of skin incision, fracture healing time, ex?traction time of internal fixation, Constant?Murley score of shoulder joint, disabilities of the arm, shoulder, and hand (DASH) score, and complication incidence were compared between the two groups. Results All the operations were successfully performed. The mean follow?up for the patients in the ELIN group was 19.35 weeks (range, 14-23 weeks). The mean follow?up for the patients in the ALP group was 53.13 weeks (range, 28-76 weeks). In the ELIN group, the operative time was 20.78 ± 7.71 min, the intraopera? tive blood loss was 13.26±9.72 ml, the length of incision was 1.57±1.24 cm, the fracture healing time was 10.39±2.39 weeks, the extraction time of internal fixation was 13.17±2.37 weeks, the Constant?Murley score of shoulder joint was 99.09±1.86, and the DASH score was 1.20±2.47. In the ALP group, the operative time was 57.79±11.56 min, the intraoperative blood loss was 69.17± 46.24 ml, the length of incision was 9.67±2.90 cm, the fracture healing time was 14.21±4.05 weeks, the extraction time of internal fixation was 47.38±10.46 weeks, the Constant?Murley score of shoulder joint was 98.00±2.17, and the DASH score was 0.89±1.65. The operation time (t=12.856, P=0.000), intraoperative blood loss (t=5.791, P=0.000) in the ELIN group were less than that of ALP group. The length of incision was significantly smaller in ELIN group than that of ALP group (t=12.549, P=0.000). The frac?ture healing time was earlier in ELIN group than that of ALP group (t=3.566, P=0.002). The extraction time of internal fixation was obviously earlier in ELIN group than that of ALP group (t=15.603, P=0.000). Constant?Murley score of shoulder joint and DASH score showed no significant difference. No delayed healing, no infection was found in the ELIN group, however skin irritation and tail bursitis were found in 6 cases, 3-6 weeks after the operation. The dressing was changed, kept clean. Skin irritation and tail bursitis disappeared, after the extraction of the internal fixation. There were 2 cases of delayed healing in the ALP group. After pro?longed observation, the 2 cases healed. The healing time was extended to 24 and 27 weeks, respectively. There was 1 case of infec?tion, 1 case of poor skin healing in the ALP group. The infected patient was treated with debridement and sensitive antibiotics, and the patient with poor skin healing was treated with dressing change. All the patients had wound healing about 4 weeks after sur?gery. 2 cases of skin irritation in the ALP group disappeared, after the extraction of the internal fixation. Conclusion Both ALP and ELIN are effective methods for the treatment of mid?shaft clavicular fracture. ELIN group has the advantages of more minimal?ly invasive, faster union, shorter internal fixation time, better appearance, and lower medical cost. However, the ELIN group also had skin irritation and temporary bursitis.
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OBJECTIVE: To explore the clinical outcomes of open reduction and internal fixation by posterolateral and posteromedial approaches for treating posterior Pilon fractures in elderly patients. METHODS: Between August 2009 and August 2014, 20 elderly patients with posterior Pilon fractures were treated with open reduction and internal fixation by posterolateral and posteromedial approaches. There were 14 males and 6 females, aged from 66 to 83 years (mean, 72.7 years). The causes were falling injury in 11 cases and traffic accident injury in 9 cases. All the patients had lateral malleolus and medial malleolus fractures. The time from injury to operation was 7-14 days (mean, 8.6 days). The posterolateral incision was made to expose the posterolateral bone fragments of posterior malleolus and lateral malleolus fracture, and the posteromedial incision was made to expose the posteromedial fracture fragments of posterior malleolus and medial malleolus fracture. After reduction, fracture was fixed with locking plate or cannulated screw. All the patients began to functional exercise at 1 day after operation. RESULTS: The operation time was 60-110 minutes (mean, 92 minutes). The incisions healed primarily in all patients. There were no complications of incision dehiscence, infection, implant exposure, and nerve damage. No irritation sign of tendon was observed. All 20 cases were followed up for 12-18 months (mean, 13 months). The X-ray films showed that fracture healed at 3-9 months, with an average of 5.2 months. During follow-up period, no loosening or breakage of the implant was observed. The other patients could walk normally except 2 patients (over 80 years old) who could walk with crutch. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the results were excellent in 12 cases, good in 4 cases, and fair in 4 cases; the excellent and good rate was 80%. CONCLUSIONS: A combination of posterolateral approach and posteromedial approach for open reduction and fixation of posterior Pilon fractures can achieve satisfactory effect in elderly patients. It has the advantages of protecting ankle blood supply and avoiding the soft tissue necrosis and implants exposure.