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Objective: To investigate the application and effectiveness of self-made spring plate in surgical treatment of acetabular posterior wall fracturejavascript:void(0)s. Methods: Between June 2013 and June 2017, 38 patients with acetabular posterior wall fractures were treated. There were 27 males and 11 females with an average age of 53 years (range, 28-68 years). The injury caused by traffic accident in 18 cases, falling from height in 15 cases, and tumble in 5 cases. There were 4 cases of simple posterior wall fracture, 18 cases of posterior wall fracture with posterior dislocation of hip joint, 10 cases of posterior wall fracture with posterior column fracture, and 6 cases of posterior wall fracture with transverse fracture. The time from injury to admission was 1-4 days (mean, 2.5 days). The time from injury to operation was 4-8 days (mean, 5 days). After fracture reduction via the Kocher-Langenbeck approach (35 cases) or the combined ilioinguinal approach (3 cases), the spring plate was used to press the posterior wall fracture, and then the reconstruction plate was pressed against the spring plate and fixed to the posterior column. Results: All the incisions healed by first intention. All patients were followed up 12-36 months (mean, 28 months). Five cases of post-traumatic sciatic nerve injury and 2 cases of sciatic nerve injury caused by traction during operation were fully recovered at 3 months after operation. The imaging examination showed that all the fractures healed. The fracture healing time was 10-16 weeks (mean, 12 weeks). There was no ruptures or failures of internal fixation during the follow-up period. There were 2 cases of femoral head necrosis, 1 case of traumatic arthritis, and 1 case of osteomyositis at last follow-up. The hip joint function was rated as excellent in 27 cases, good in 5 cases, fair in 2 cases, and poor in 4 cases according to the Harris scores at 12 months after operation. Conclusion: For the acetabular posterior wall fracture, it has the advantages of easy to use and reliable fixation that the posterior wall fracture is fixed with spring plate firstly, and the spring plate is pressed to fix the posterior column with the reconstruction plate finally.
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Objective To compare the clinical outcomes of palmaris longus tendon (PLT) and iliotibial tract fascia graft (ITFG) for coracoclavicular ligament (CCL) reconstruction combined with hook plate fixation in the treatment of acromioclavicular joint (ACJ) dislocation.Methods A retrospective study was conducted to evaluate the outcomes of 68 patients with ACJ dislocation of Rockwood type Ⅲ and above who had been treated in our department with CCL reconstruction using PLT or ITFG in addition to hook plate fixation from January 2008 to January 2014.They were 57 males and 11 females,with an average age of 36.1 years (range,from 19 to 55 years).The patients were divided into 2 groups according to their grafts used in CCL reconstruction:36 cases in PLT group and 32 in ITFG group.They were firstly treated with CCL reconstruction followed by hook plate fixation.The hook plates were removed at 6 months after operation.The acromioclavicular and coracoclavicular distances were measured on the postoperative anteroposterior radiographs of the injured shoulders.The outcomes were assessed at the final follow-ups according to Constant-Murley shoulder score and Karlsson criteria.The 2 groups were compatible without significant differences in preoperative general data (P ＞ 0.05).Results The 68 patients were followed up for an average of 18 months (range,from 16 to 22 months).The acromioclavicular and coracoclavicular distances measured in PLT group at 12 months after operation were significantly larger than those measured in ITFG group (P ＜ 0.05).At the final follow-ups,the Constant-Murley shoulder score (92.1 ±7.2) and Karlsson excellent to good rate (83.3％,30/36) in ITFG group were insignificantly higher than those in TIR group (88.3 ± 9.8;81.3％,26/32) (P ＞ 0.05).Conclusion In the treatment of ACJ dislocation of Rookwood type Ⅲ and above,CCL reconstruction using ITFG may lead to better radiographic outcomes than that using PLT,though the 2 grafts lead to similar functional recovery of the injured shoulders.
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Objective To investigate the long-term results of gastrocnemius fascial turn-down flaps and suture anchors in reconstruction of chronic Achilles tendon rupture.Methods From September 2007 to February 2010,20 patients with chronic Achilles tendon rupture were reconstructed with gastrocnemius fascial turn-down flaps plus suture anchors.There were 13 males and 7 females at mean age of 36 years (range,23-50 years).Unilateral tendon rupture was observed in 19 patients and bilateral in 1 patient.Tendon defect gap was 5-9 cm (mean 6.7 cm).Braces were used to immobilize the lower limber,and early exercise was encouraged.The outcomes were assessed using Arner-Lindhohm scoring system and Leppilahti scoring system.Results Postoperative recovery was uneventful.No patients experienced cut infection or other complications.After a mean 38-month follow-up (range,30-42 months),all patients could stand on the injured toes.Muscular strength of the affected lower limber was restored to 89％ of the unaffected side.According to the Arner-Lindhohm score,10 patients were rated as excellent and ten good.Mean Leppilahti score was 85 points (range,60-100 points),with excellent results in nine patients,good results in 10 and fair result in one.Conclusion For patients with chronic Achilles tendon rupture,the reconstructing using gastrocnemius fascial turn-down flaps combined with suture anchors can attain rigid fixation,early functional exercise,effective prevention of tendon adhesion,and good function recovery.