Complications of surgical treatment for femoral intertrochanteric fractures using dynamic hip screw / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the complications of surgical treatments for femoral intertrochateric fractures using dynamic hip screw (DHS).</p><p><b>METHODS</b>From Jan. 2002 to Dec. 2007, sixty-nine patients with intertrochanteric fractures were treated by dynamic hip screw fixation included 27 males and 42 females,with an average age of 72.9 years ranging from 53 to 96 years. According to Evans classification there were 10 cases in type I ,21 in type II, 22 in type III, and 16 in type IV, of which 51 patients (73.9%) suffered from systematic diseases preoperatively.</p><p><b>RESULTS</b>Fifty-seven patients were followed up for 8 to 70 months (41 months on average). Four patients died, 17 cases occurrenced systematic complications postoperatively. Internal fixation related complications occurred in 12 patients. There were 8 cases with mechanical failure of DHS including 4 of screw loosen,3 of cutting-out of device through femoral head and neck and 1 of plate breakage. Five patients had a coxa vara, and delayed union occurred in 4 patients.</p><p><b>CONCLUSION</b>Unstable fracture pattern produced high percentage of mechanical failure. In such cases DHS should not be the first choice for treatment. The appropriate treatment should be in relation to pre-operative fracture stability and osteoporosis.</p>

Clinical application of hook plate for the treatment of distal clavicular trauma and analysis on its complications / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the clinical results of hook plate internal fixation for the treatment of distal traumatic injuries of clavicle,and to analysis the mechanism of the complications.</p><p><b>METHODS</b>From 2001.9 to 2008.2, 36 patients with fresh distal clavicle fractures of Neer type II and 14 patients with dislocation of Acromioclavicular joint of Tossy type III were treated with hook plate internal fixations. Among the patients, 36 patients were male and 14 patients were female, ranging in age from 19 to 77 years, with an average of 43 years. After the operation, the range of motion of shoulder joint was measured and the complications were studied. The Karlsson and Constant-Murley criteria were used to evaluate the therapeutic effects.</p><p><b>RESULTS</b>All the patients were followed up with a mean duration of 12 months (7 to 18 months). All the patients could move shoulder joint actively 1 week after operation, and recover to the normal ROM at the 6th week after operation. According to Karlsson criteria, 44 patients got an excellent result, 6 good. According to Constant-Murley criteria, the average score of wound shoulder was (73.8 +/- 8.3) before operation, and (59.6 +/- 6.7) after operation, and the postoperative score was higher than preoperative score. No incision infections were found and 5 patients with complications were cured. No re-dislocation of acromioclavicular joint occurred.</p><p><b>CONCLUSION</b>It is advocated that hook plate for the treatment of distal clavicular fractures of Neer type II and acromioclavicular dislocation of Tossy type III could provide sufficient stability to allow early functional rehabilitation, and to decrease the rate of complications.</p>

Analysis of fracture conditions and therapeutic experiences of earthquake casualties / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the fracture conditions of earthquake casualties, summarize the therapeutic experiences and explore the frontier treatment model.</p><p><b>METHODS</b>The clinical data of spot treatment of fracture patients in Wenchun earthquake were collected and analyzed to observe the therapeutic effects of operative patients and to verify the rationality of the cooperated remedy model of unified military and civilian hospitals.</p><p><b>RESULTS</b>Among 236 fracture patients admitted in hospital, there were patients with extremities fractures in 81.3%, multiple fractures in 11.4% and open fractures in 10.6%. In all 55 patients underwent surgical treatment,the functional improvement rate was 65.5% and no infection or amputation happened. Supported by psychological aids, all patients were coordinated with treatment and the short-term outcome was parallel with that of ordinary fracture cases.</p><p><b>CONCLUSION</b>The general conditions of patients should be paid more attention to during the treatment procedure of fractures because of the great quantity of casualties and severe traumatic conditions in Wenchun earthquake. The cooperated remedy model of unified military and civilian hospitals should be regarded as a new sanitation service practice with certain advantages. Psychological aids can provide strong support for the patients' postoperative rehabilitation.</p>