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Objective To compare the clinical curative effect of bridge combined internal fixation system (BCFS) and digital customized steel plate(DCSP) for treating complex extremity fracture.Methods Fortyseven cases of complex extremity fracture in this hospital from October 2012 to October 2015 were treated by BCFS and DCSP,among them,26 cases adopted BCFS(BCFS group) and 21 cases were treated by DCSP(DCSP group).Then the operation time,intraoperative blood loss volume,hospitalization time,healing time of fracture,postoperative complications and function evaluation of limbs were compared between the two groups.Results The two group were followed up for 6-15 months with an average of(13.57±1.37)months.The DCSP group was better than the BCFS group in the aspects of operation time and intraoperative blood loss volume,the difference was statistically significant(P＜0.05).The fracture healing time in the BCFS group was significantly shorter than that in the DCSP group,the difference was statistically significant(P＜0.05).The hospitalization time,postoperative complications and function evaluation of limbs had no statistical differences between the two groups(P＞0.05).Conclusion Both BCFS and DCSP can acquire good clinical curative effect in the treatment of complex extremity fracture,however BCFS has a shorter healing time of fracture.
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Objective To investigate the clinical effect of coracoclavicular ligament reconstruction by getting tendon palmaris longus for treating acromioclavicular joint dislocation under arthroscopically assisted Endobutton steel plate fixation.Methods Eighteen patients with acute closed acromioclavicular joint dislocation treated in this hospital from January 2013 to March 2015 were selected and treated by coracoclavicular ligament reconstruction by getting tendon palmaris longus and double Endobutton steel plate fixation under arthroscopy.The visual analogue scale(VAS) was adopted before and after operation.The Karlsson treatment effect score was adopted at the end of follow up period.The patients satisfaction was investigated.Results The wounds in 18 cases were stage Ⅰ first grade healing and the reduction of acromioclavicular joint dislocation was good.The postoperative VAS score was(0.56±0.62) points,which was significantly decreased compared with(2.44± 1.20) points before operation(t=5.945,P＜0.01).During the follow-up visit,1 case appeared dislocation recurrence and treated by adopting clavicle hook plate fixation;average follow up time was 17.72 months,the Karlsson score at the end stage was excellent in 12 cases,good in 5 cases and poor in 1 case,the excellent and good rate was 94.44 ％,the patient satisfaction degree was 88.89 ％.Conclusion Arthroscopically assisted Endobutton steel plate fixation combined with ligament reconstruction by tendon palmaris longus for treating acromioclavicular joint dislocation has small trauma and reliable fixation,and promotes the joint function recovery.
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BACKGROUND: Tibia open fracture is a common disease, and intramedullary fixation has become the first choice, but the high risk of postoperative infection limits its clinical application.OBJECTIVE: To investigate the early prevention effect of vancomycin-hydroxyapatite (VCM-HA) coated titanium intramedullary nail in a rabbit model of open femoral fracture combined with wound infection.METHODS: Titanium intramedullary nails coated with three different concentrations of VCM-HA were prepared using biomimetic deposition, and subsequently in vitro bacteriostasis experiment was performed. Forty healthy male New Zealand white rabbits were selected and the model of mid-femur open fracture with wound infection was prepared. The rabbit models were then divided into ordinary intramedullary nail, low-, middle- and high-concentration VCM-HA coated intramedullary nail groups (n=10 per group). The wound appearance of the animals was dynamically observed. The body mass, anal temperature, white blood cells and C-reactive protein contents in the venous blood were monitored. The pathological examination of the soft tissue around the fracture and injured limb X-ray were conducted regularly.RESULTS AND CONCLUSION: The prepared VCM-HA coated titanium intramedullary nail exerted obvious antibacterial effects in vitro. The anal temperature in the ordinary nail group was significantly higher than that in the other three groups at 3 days after modeling (P < 0.05). The white blood cells and C-reactive protein contents in the venous blood in the VCM-HA groups were significantly lower than those in the ordinary nail group at 3, 7, 14 and 28 days after modeling (P < 0.05). The hematoxylin-eosin staining of the peripheral tissues displayed the inflammatory response in the VCM-HA groups was milder than that in the ordinary nail group at each time point after modeling. The injured limb X-ray displayed that the callus grew slowly accompanied with sequestration in the ordinary nail group, while the callus growth in the VCM-HA groups was significantly better than that in the ordinary nail group. To conclude, the VCM-HA coated intramedullary nail can effectively reduce postoperative infection in an animal model of open femoral fracture combined with wound infection.
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Objective To evaluate the mid-term effect of total hip arthroplasty (THA) after failed internal fixation of intertrochanteric fracture.Methods Twenty-one patients treated with THA due to failed internal fixation of intertrochanteric fracture from January 2007 to December 2010 were studied retrospectively.There were 10 males and 11 females,at mean age of 71.7 years (range,66-79 years).Sixteen patients were treated with dynamic hip screws/dynamic condyle screws (DHS/DCS),3 proximal femoral nails,2 hollow screws.Mean interval from internal fixation to THA was 29 months (range,10-79 months).Causes for the failed internal fixation were loosening,cutting,and breakage of screws which generated fracture displacement or nonunion in 19 patients and femoral head necrosis in 2 patients.All patients received THA with uncemented acetabulum cups and proximally long-stemmed,porous-coated titanium femoral components including AML stems for 5 patients and Solution stems for 16 patients.Moreover,greater trochanteric fracture was fixed by Luke wire.Harris hip score were measured before operation and at final follow-up.Radiographs were performed before operation,at 3,6 and 12 months after operation,and at final follow-up to assess the fracture restoration,healing,prosthesis initial fixation,and mid-term survival condition.Results One patient was died due to pulmonary infection 1.5 years after operation.Two patients were lost to follow-up and 18 patients were followed up for 3-5 years (mean,3.9 years).At final follow-up,13 patients regained the ability to walk independently,4 needed support of a cane,1 needed assistance of a walker.There were no signs of loosening,subsidence or rupture of the prosthesis.Mean Harris hip score increased from 25.3 points preoperatively to 80.6 points at final follow-up; the score was excellent in 11 patients,good in 6,good in 1,with the excellent and good rate of 94％.Conclusion THA can improve hip function,patients' quality of life and midterm outcome in salvage of failed internal fixation of intertrochanteric fractures.
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BACKGROUND: Autologous bone marrow is the only tissue that contains abundant osteoinductive osteogenitor cells and is the first-choice transplantation materials for treatment of bone nonunion. Artificial bone with osteoinductive capacity can provide a supporting effect for the in-growth of osteocytes. Iliac periosteum can be used for treatment of bone nonunion due to the advantages including abundant blood circulation, easy harvesting, and able to improve local arterial blood supply. BJECTIVE: To treat refractory bone nonunion in limbs using artificial bone with autologous bone marrow combined with iliac periosteum transplantation, and to compare the therapeutic efficacy to artificial bone with autologous bone marrow transplantation and simple iliac periosterum transplantation. METHOD: Thirty-nine refractory bone nonunion limbs from 36 patients were assigned to three groups: artificial bone with autologous bone marrow combined with iliac periosteum transplantation (combination group, n = 19), artificial bone with autologous bone marrow (bone marrow group, n = 9), and autologous iliac periosteum (iliac periosteum group, n = 11). The time for bone healing, limb function score 1 month after fixture removal, and postoperative X-ray score were evaluated. RESULTS AND CONCLUSION: All initial 39 limbs acquired bone union and were followed up for an average period of 18.5 months. The combination group yielded better therapeutic effects than the bone marrow group and the iliac periosteum group in terms of the time for bone healing, limb function score 1 month after fixture removal, and postoperative X-ray score (P < 0.05). These findings indicate that artificial bone with autologous bone marrow combined with iliac periosteum transplantation exhibits better clinical therapeutic effects in treatment of refractory bone nonunion in limbs.
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Objective To compare the efficacies and indications of locking compression plate (LCP) and external fixator plus Kirschner wires in treatment of complex intra-articular fracture of the dis-tal radius. Methods Ninety-eight patients with complex intra-articular fractures of the distal radius were treated with volar LCP or external fixator plus Kirschner wires, the efficacies of which were evaluated by comparing the grasping force and wrist function of the patients. Results All the patients were fol-lowed up for an average of 12.4 months, which showed fracture healing in all the patients. According to the wrist function assessment system of New York Orthopedic Hospital (1990), there was no statistical difference in the efficacy of LCP and external f'lxator plus Kirschner wires in treatment of types C1 or C2 fractures (P > 0.05), while the efficacy of external fixator plus Kirschner wires was significantly superior to that of LCP in treating type C3 fracture (P < 0.05). Conclusions For types C1 or C2 intra-articu-lar fractures of the distal radius, the efficacies of LCP and external fixator plus Kirschner wires are simi-lar, while the efficacy of external fixator plus Kirschner wires is superior to that of LCP in treating type C3 intra-articular fracture of the distal radius.
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Objective To evaluate the primary result of proximal femoral nail anti-rotation(PF-NA)in treating osteoporotic intertrochanterie fractures. Methods Between March 2006 and August 2007.PFNA or Gamma nail intemal fixation were performed in 31 patients with osteoporotic intertrochan-tefie fractures.of whom were 19 males and 12 females at a mean age of 75.6 years(45-89 years).Ac-cording to AO classification,there were 8 type A1 fractures,16 type A2 fractures and 7 type A3 fractures.Aeearding to Evans-Jensen classification.18 cases were rated as Evans Ⅱ and 13 as Evans II.AIl frac-tares were closed ones and 6 patients were combined with internal diseases.PFNA was implanted throush a mini-incision without exposure of the fracture section during operation in 12 patients. Results Of all.6 patients received emergency operation,19 did operation within 3 days and 6 waited for selective op-eration(5-7 days)after controlling internal diseases.PFNA had shorter operation time,less hlool loss and shorter union time compared with Gamma nail(P＜0.05).No complications such as infection,non-union or loosening of nails were found.According to HarriS hip rate scale system,the excellence rate of PFNA was 83.4%and that of Gamma nail 73.7%. Conclusion PFNA is a good choice to treat osteo-perotie intertrochanteric fractures.owing to its advantages of stable fixation,minor trauma,eaSy opera-tion.short operation time,little bleeding,minor lOSS of selerotin and early exercise.