ABSTRACT
Objective To evaluate the effect of double-plate treatment on grade Ⅱsupination adduction ankle frac? tures with impaction of tibial plafond. Methods A total of 17 patients of gradeⅡsupination adduction ankle fractures with impaction of tibial plafond were treated surgically in our hospital. Anteromedial approach to the medial malleolus was taken to expose the tibial plafond and the vertical medial malleolus fractures. One distal radius plate was placed on the anteromei?dal tibial plafond, and another buttress plate was placed on the medial malleolus. Bone grafting was used to restore the height of the collapsed tibia. Lateral malleolus fractures were treated with reconstruction plate. The fracture union after operation was detected by X-ray examination. American Orthopedic Foot and Ankle Society (AOFAS) ankle hind foot score was used to assess the ankle function. Results Sixteen of 17 patients were followed up postoperatively for a mean period of 2.6 ± 0.9 years. CT cross-sectional study found that the collapsed articular surface of 12 (70.6%) patients was mainly located in the an?teromedial one-fourth area, with the worst at anterior margin. Bony fusion was achieved in all patients after an average peri?od of 2.9±0.5 months. No internal fixation loosening or fracture redisplacement was found by X-ray. The average range of an?kle joint activity was 16.4°±2.8° for dorsiflexion, and was 39.2°±5.3° for plantarflexion. According to AOFAS ankle hindfoot scale, ankle function was excellent in 14 patients and good in 2, with excellence rate of 100%. Conclusion The application of double-plate fixation to treat gradeⅡsupination adduction ankle fractures with impaction of tibial plafond can play a key role in reducing fracture redisplacement and osteoarthritis.
ABSTRACT
Objective To evaluate the effectiveness and safety of rivaroxaban or enoxaparin in preventing deep vein thrombosis(DVT) and pulmonary embolism (PE) after major orthopedic surgery. Methods A total of 278 patients underwent major orthopedic surgery, from September 2009 to May 2012, were included in this study. One hundred and forty patients (the average age was 72.7 years, 42.8% were male) were treated with oral rivaroxaban, 10 mg/d. One hundred and thirty-eight patients (the average age was 69.9 years, 39.1%were male) were treated with subcutaneous enoxaparin,40 mg/d. Data were compared between two groups. The ending events included venous thrombosis VTE(DVT and PE), wound complica-tions, re-admission,need for blood transfusion,big and minor bleeding events and death. Results There were no signifi-cant differences in the incidence of VTE, blood transfusions and re- admission rates between two groups. The incidence rates of minor bleeding were 2.1%and 5.8%in two groups. There were no pulmonary embolism, severe bleeding or death in two groups of patients.Conclusion There were no significant differences in the incidence rates of VTE or major bleeding areas in patients with oral treatment of rivaroxaban and enoxaparin.Rivaroxaban was safer with a slightly decrease in minor bleeding and wound complications.
ABSTRACT
[Objective]To discuss the experience with locking compression plates fixation combining with autoallergic cancellous bone and Illizarov technique in the management of chronic fracture nonunion,and to further investigate the reason of fracture nonunion and assess the safety and the efficacy of this procedure.[Method]A retrospective analysis was made including 87 consecutive patients with fracture nonunion treated at our hospital with locking compression plates fixation combining with autoallergic cancellous bone(80 cases) and Illizarov technique(7 cases) from January 2002 to July 2007.Patients were evaluated for radiographic bony fusion,complications and clinical outcome.[Result]Mean follow-up period was 14.7 months.Bony union was achieved in all cases after a mean time of 6.8 months after operation.Joint function was improved after operation in 70 patients.No major complications related to the procedure or hardware failure occurred.[Conclusion]Medical factors are main etiopathogenisis of chronic fracture nonunion after operation.Locking compression plates combining with autoallergic cancellous bone and Illizarov technique are safe and effective procedure for the treatment of fracture nonunion.