Anatomical and clinical study of a novel anterial cubital approach for ulnar coronoid fractures / 中华骨科杂志

Objective To investigate the feasibility of a noval anterior cubital approach for the coronoid via flexor?prona?tor teres interval and assess the clinical result. Methods Five formalin?fixed adult cadaver elbows were used. Through a single universal anteromedial longitudinal skin incision, the coronoid tip was exposed via pronator and flexor carpiradialis interval, and coronoid anteromedial facet and base via palm longus and flexor carpi ulnaris interval. The distances from the entry point to the muscles or branching point of the nerves to the line passing through medial and lateral epicondyles, as well as the length were mea?sured with regard to the motor nerve branches arising from median nerve to pronator teres, flexor carpiradialis, palm longus and flexor digiti superficialis, as well as the most proximal two motor branches to flexor carpi ulnaris arising from ulnar nerve. From September 2013 to August 2014, 4 male patients with ulnar coronoid fracture were treated operatively through the above anterior cubital approach in our hospital. They were all left side involved, with an average age of 32 years (range, 16-42 years). According to O’Driscoll classification, there were two cases of type Ib and two cases IIb respectively. They were all treated by open reduction and internal fixation through flexor?pronator teres interval. Results At cubital fossa, there were 2-3 branches to the pronator teres mostly, 1 branch to flexor carpiradialis and palm longus arising from median nerve. The branch to the flexor digiti superficia?lis usually was long and thick, and divided into 2-5 short twigs near muscle. The branch to palm longus had the same trunk with that to flexor digiti superficialis. The branch to flexor digiti superficialis was the most proximal among those passed through the in?terval of pronator teres and flexor carpiradialis, and its entry point to the muscle had an averaged distance of 37.22 mm to the line passing through medial and lateral humeral epicondyles. It was optimal to expose coronoid tip through the interval of pronator teres and flexor carpiradialis. It was safe to expose coronoid proximal to the branch to flexor digiti superficialis. While, it was better to expose the anteromedial facet and base of corocoid through the interval of palm longus and flexor carpiulnaris via median and ul?nar nerve interface. All of the four patients were followed up for an average period of 9 months. They all achieved bone union from 6 weeks to 3months (mean, 9 weeks). All the patients obtained excellent result according to the modified An&Morrey elbow per?formance index with scores from 94 to 100. Conclusion The novel anteromedial cubital approach via flexor?pronator teres is opti?mal for exposure of coronoid.

Clinical treatment of double or above disruptions of the superior shoulder suspensory complex / 中华骨科杂志

Objective To summarize the classification and surgical treatment of double or above disruptions of the superior shoulder suspensory complex(SSSC)retrospectively.Methods From June 2006to March 2010,26 consecutive patients with double or above disruptions of the SSSC were treated and entered in the study,including 18 males and 8 females with an average age of 42 years(range,16-80).All patients received surgical treatment,these included clavicle fracture and scapular neck fracture in 9 cases (type Ⅰ),distal clavicle fracture or dislocation and coracoclavicular ligament and acromioclavicular joint injury in 10(type Ⅱ),distal clavicle fracture and other injuries in the SSSC in 7(type Ⅲ).The duration from injury to surgery was 6.4 days(range,3-10).Scapular neck fracture and scapular area dishes fracture were fixed with reconstructive plate and canulated screws,acromial fracture was treated with reconstructive plate and canulated screws,clavicle fracture was fixed with reconstructive plate or hook plate,coracoid fracture was fixed with canulated screw.All patients were treated with primary repair for ligament injuries.The surgery effect was assessed with Rowe and Constan-Murley systems after the fractures reunion.Results All patients were successfully followed up,and the average time was 18.7 months(range,12-32).Fractures were healed with an average of 8.2 weeks(range,6-12 weeks).There was no inferior shoulder knocking syndrome after surgery.Patients all felt shoulder in a stable status.Two patients appeared deltoid muscle power decline,3 appeared shoulder fatigue and aching pain.The average score was 89.7(range,71-97)according to the Rowe system.Eighteen cases were grade as excellent,5 as good,and 3 as fair.The average score was 92.4(range,70-100)according to the Constant-Murley system.Sixteen cases were grade as excellent,6 as good,and 4 as fair.Conclusion Double or above disruptions of the SSSC can be classified into three types,and surgical treatment with constructive plate and canulated screws for them is a good option.

Operative treatment of complex posterior tibial plateau fractures via posterior approach / 中华骨科杂志

Objective To evaluate the clinical results of operative treatments for the complex posterior tibial plateau fractures via posterior approach. Methods Eleven cases with complex posterior tibial plateau fracture from June 2008 through June 2010 were reviewed retrospectively. There were 7 males and 4females, with age from 33 years to 60 years (average, 47.8 years). According to AO classification, there were 41-B2.2.4 type in 2 cases, 41-B3.1.2 type in 3, 41-B3.3.2 type in 3, 41-B3.1.2 type combined 41-B3.3.2 type in 2, 41-C3.3 type in 1. Carlson posterior lateral approach were used in 5 cases, posterior medial approach were used in 3 cases, and posterior medial and/or lateral approach combined with anterior approach were used in 3 cases. All fractures were fixed with plates. Autogenous ilium grafts were used if necessary.Results All cases were followed up. The average follow-up time was 1.6 years (range, 3-24 months). At the final follow-up visit, bone union was obtained in all cases. The mean Rasmussen score was 16.7 (range, 15-18), and the mean HSS was 86.2 (range, 75-96). The postoperative knee range of motion were 0°-135°, 0°-130° and -10°-125° in 5 cases with posterior lateral plateau fractures, 3 cases with posterior medial plateau fractures and 3 cases with anterior and posterior plateau and intercondylar fractures respectively. There was no vascular and nerve injuries. Loosing or breaking of hardware's was not found. Conclusion The Carlson posterior lateral and/or medial approach is preferred for the complex posterior plateau fractures, with the advantages of direct reduction and stabilization.

Classification and surgical treatment of scapular neck fractures / 中华创伤杂志

Objective To explore the classification and surgical treatment of scapular neck frac-tures. Methods A retrospective analysis was done based on the clinical data of 18 patients (including 12 males and 6 females) who accepted operation in Tianjin Hospital from January 2000 to December 2007. The average age of the patients was 41 years (17-62 years). All patients accepted CT examina-tion. According to Hardegger classification, there were 10 patients with anatomical neck fractures and eight with surgical neck fractures. According to Miller system, there were five patients with type II A fractures, six with type II B fractures, six with type II C fractures and one with type II B + IIC fracture. Of all, 15 patients had associated injury. The operative approach included posterolateral approach in nine patients, modified Judet approach in six and anteroposterior conjoint approach in three. Reconstruction plates and lag screws were applied to fix the fractures. Results All patients were followed up consecu-tively with an average period of 25. 5 months (6-70 months). The mean Constant-Murley score was 73 points (35-95 points, meadian 75.5 points) after treatment. There were two patients with malreduction,one with shoulder instability and three with traumatic arthritis postoperatively. Conclusions The indi-cations for early operation include: (1) angular deformity in horizontal or coronal planes of fractures, ie,glenopolar angle (GPA) <20°(2) fracture displacement =10 mm;(3) associated with floating shoul-der injury or superior suspensory shoulder complex injury. The major factors influencing prognosis are as-sociated injuries, quality of fractures reduction, fixation stability, injury of rotator cuff and postoperative rehabilitation.

Correction of deformity with major bone defect by lengthening with different external fixators / 中国矫形外科杂志

[Objective]To study the correction of deformity with major bone defect by lengthening with different external fixators and to evaluate the results.[Method]From August 2000 to March 2004,7 patients suffering from deformity with major bone defect were treated by external fixators including Ilizarov, Orthofix LRS,and Hybrid external fixators combined with Orthofix LRS.Linar or wedged osteostomy was carried out at the deformity site.Wedged osteotomy and callus distraction were used for the cases of deformity with limb shortening,and compression of dock site combined with bone transport was used for those of deformity with bone defect and shortening.[Result]The cases corrected were: 1 femur with anterior angular deformity and 7cm shortening,and 6 tibiae including 2 varus deformities,2 posterior angular deformities,and 2 complex deformities.The average length was 5.3cm(4.5～7 cm),with an average distraction time of 3.5 months and followed by an average time of external fixation of 7 months.There were no obvious complications,such as vascular and nerve injuries.The function of the adjacent knee and ankle was not affected.[Conclusion]External fixators including Ilizarov,Orthofix LRS and Hybrid external fixators may provide one of good alternatives for correction of deformity with major bone defect.Compared with Ilizarov,Orthofix LRS and Hybrid external fixators are more conventional,more advantaged,and preferred,especially for its distinct clamp which can provide multi-plane fixation and correct the deformity simultaneously with limb lengthening.

Effect on surgical treatment of comminuted humeral intercondylar fracture / 中国矫形外科杂志

[Objective]To conclude the result of comminnted fractures of humeral intercondyle treated by operation with variable approaches and variable fixations.[Method]Six-three cases with comminuted fractures of humeral intercondyle treated by operation with variable approaches and variable fixations were followed by averaged 44.0 months(14～84 months),functional result were evaluated with three rating systems.[Result]The function resume after trans-olecranon approach and AO plate fixation technique were satisfactiary with broad indications.[Conclusion]Trans-olecranon approach with AO plate fixation is recommended to be the best choice to treat comminuted fractures of humeral intercondyle.The severity of the initial trauma,operative scheme,postoperative functional training and patients' cooperation are the most important elements for postoperative functional recover.

Analysis of related factors in the treatment of distal femoral and proximal tibial fractures by LISS / 中华骨科杂志

Objective To explore the clinical result of fixation on the distal femur and/or proximal tibia with LISS(Less Invasive Stabilization System), and to analyze the related factors during the operation. Methods From July 2003 to March 2005, 16 patients(17 fractures) were treated with LISS (Mathys, Swiss). There were 11 males and 5 females, with an average age of 39 years (mean, 19-58 years), including 9 distal femoral fractures and 8 proximal tibial fractures, while 1 patient sustaining distal femoral and proximal tibial fracture on the ipsilateral side. The LISS plates were inserted beneath the periosteum through a small incision after closed reduction(except the intraarticular fractures). The locking screws were inserted through stab incisions, and by monocortical fixation. Only 1 patient underwent the bone graft who accepted the open reduction 21 days after injury. Results All the patients achieved bone union during the follow up from 5 to 25 months ( mean, 15 months ). 3 patients had their implants removed. The function of the knee was evaluated according to Karlstr?觟m score system based on both the subjective feeling and objective PE, and there were 10 excellent and 3 good, and 3 fair, the good-excellent rate was 81%. Secondary reduction loss occurred in one patient, but bone union and the function of the knee were not compromised. There was also neither infection nor implant pull-out and breakage. Conclusion The unique designed LISS has the advantages of protecting the blood supply of bone fragments and the periosteum, optimizing bone union and function recovery. LISS provides an alternative for treatment of distal femoral or proximal tibial fractures. However, as a new designed system, not only conception but the procedure as well should be demanded strictly.