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Objective:To investigate the efficacy of single locked-plate internal fixation combined with autologous iliac bone graft in the treatment of Rorabeck type II periprosthetic distal femural fracture (PDFF) after total knee arthroplasty (TKA).Methods:A retrospective case series study was made on 13 patients suffering from Rorabeck type II PDFF after primary TKA together with severe osteoporosis (T value≤ -2.5 SD) admitted to 940th Hospital of Joint Logistics Support Force of PLA from January 2016 to December 2020, including 4 males and 9 females, aged 65-85 years [(75.2±6.5)years]. All patients were treated with single locked-plate internal fixation combined with autologous iliac bone graft. Anti-osteoporosis and early standardized joint function rehabilitation were undertaken postoperatively. The operation time and intraoperative blood loss were recorded. The range of motion of knee joint was compared before operation, at postoperative 3, 6 and 12 months and at the last follow-up. The Hospital for Special Surgery (HSS) knee score was assessed at postoperative 3, 6 and 12 months and at the last follow-up to evaluate the recovery of knee joint function. The bone mineral density was reexamined at postoperative 6 months and 12 months to evaluate the therapeutic effect of anti-osteoporosis. Complications were detected as well.Results:All patients were followed up for 12-72 months [(43.2±19.9)months]. The operation time was 90-135 minutes [(103.8±12.6)minutes], with the intraoperative blood loss of 100-250 ml [(150.0±45.6)ml]. The range of motion of knee joint was (114.6±7.8)°, (90.4±8.0)°, (97.3±4.8)° and (98.1±6.3)° before operation and at postoperative 3, 6 and 12 months (all P<0.05). The HSS knee score was (80.2±2.2)points, (84.6±2.9)points and (87.3±3.3)points at postoperative 3, 6 and 12 months (all P<0.05). The knee joint function was excellent in 10 patients and good in 3 at postoperative12 months, and the excellent and good rate was 100%. The T value of bone mineral density was (-3.8±0.6)SD, (-3.4±0.6)SD and (-2.9±0.6)SD preoperatively and at postoperative 6 months and 12 months (all P<0.05). One patient experienced nonunion and was cured after secondary autologous iliac bone grafting combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) bone grafting. Three patients developed venous thrombosis of lower limbs and were cured with oral administration of rivaroxaban. One patient had mild knee flexion and extension limitation and was improved after manual release under femoral nerve block anesthesia and subsequent functional rehabilitation. Conclusion:For patients with Rorabeck type II PDFF after TKA, single locked-plate internal fixation combined with autologous iliac bone graft has advantages of short operation time, few intraoperative bleeding, satisfactory knee range of motion and functional recovery as well as significant improvement of bone mineral density.
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OBJECTIVE: To evaluate the efficacy of internal fixation of lateral and medial borders for displaced scapular body fractures via the minimally invasive approach. METHODS: The internal fixation of lateral and medial borders via minimally invasive approach was applied in surgical treatment of 23 patients with scapular body comminuted fractures from January 2014 to June 2018. The lateral approach was made straightly orienting over the lateral border of scapula. The dissection was taken down to the deltoid fascia. The deltoid was retracted cephalically, revealing the external rotators. Blunt dissection was used down to the lateral border between infraspinatus and teres minor, exposing the fracture site. The medial incision was done along the medial border of the scapula over site of the fracture. Dissections were taken down to the fascia and the periosteum. A subperiosteal dissection was then performed to elevate the infraspinatus to the degree necessary to visualize the fracture. The medial and lateral borders of scapula body were fixed with plates and screws in a frame-like way. RESULTS One patient developed the delayed healing of the incisions due to liquefactive fat necrosis. The other 22 patients showed no complications of the incisions. The glenopolar angle (GPA) of fractured scapula was increased from preoperative (25±12) degrees to postoperative (41±5) degrees (P<0.01). The healing time of fractures healed was 3-8 months, with an average time of (4.4±1.3) months. CONCLUSIONS The lateral-medial combined fixation through minimally invasive surgical approach for the scapula body fractures allows visualization of fracture reduction without extensive muscular or subcutaneous flaps, and is associated with successful fracture healing and high functional scores of the shoulder.
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Objective To explore the feasibility and therapeutic effects of total hip replacement (THR) for intertrochanteric fractures combined with late necrosis of the femoral head.Methods From June 2010 to October 2015,8 patients underwent THR for intertrochanteric fractures combined with necrosis of the femoral head.They were 6 males and 2 females,with an average age of 53.5 years(from 45 to 67 years).According to the Evans-Jensen classification,2 fractures were type ⅠB,5 type ⅡA and one type ⅡB.All the 8 fractures were complicated with late femoral head necrosis,5 cases of which were ischemic.According to the Ficat classification,the ischemic necrosis was type Ⅲ in one and type Ⅳ in 5 cases.In the other 3 cases,the necrosis secondary to the hip osteoarthrosis was type Ⅲ according to the Tonnis classification.The necrotic femoral head was removed after osteotomy of the femoral neck via the posterolateral approach;after reduction of the femoral calcar,the intertrochanteric fracture was reduced and fixated in a press-fit manner through antegrade implantation of a biological stem prosthesis.Functional assessment of the affected hip was carried out at the final follow-up using Harris scoring.Results The 8 patients were followed up for an average of 25.5 months (from 12 to 45 months).After operation,biological press-fit and initial stability of the femoral stem were achieved in all the patients.The X-ray films showed bone ingrowth fixation in all the 8 hips at 3 months postoperatively.The Harris hip scores at the final follow-up averaged 92.3(from 89 to 98).The patients showed fine subjective satisfaction.Follow-ups revealed no infection,prosthetic failure,osteolysis,dislocation or articular instability.Conclusion In treatment of intertrochanteric fractures combined with necrosis of the femoral head,THR can lead to fixation and reduction of the intertrochanteric fracture and replacement of the necrotic femoral head at one stage,promoting functional recovery of the affected hip.
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Objective To investigate the technique and clinical results of total hip arthroplasty in treating post-traumatic hip fusion ankylosis secondary to operation in acetabular combined with femoral head fracture.Methods From October 2009 to January 2015,7 patients (7 hips) with post-traumatic hip fusion ankylosis underwent total hip arthroplasty.There were 6 males and 1 female with an average age of 38 years (range,25-51 years).There were 4 hips on the left side,3 hips on the right side.Open reduction and internal fixation were performed on all patients.One patient had a postoperative deep infection and 6 patients underwent implant removal.The hip bony fusion ankylosis was developed secondary to post-traumatic arthritis after the surgery of ipsilateral acetabular combined with femoral head facture.The interval between internal fixation and total hip arthroplasty was 37.6 months on average (range,21-67 months).The hip bony fusion ankylosis was relieved by wedge shape osteotomy at femoral neck level.The cemenfless prostheses were implanted in suitable places based on the accuracy position of acetabular center.One infection case was treated via surgical debridement,removal of all the screws,and antibiotic-loaded cement spacer implantation in the first stage.The cementless prostheses were implanted in the second stage.Results The average operation time and blood loss was 108 min (90-150 min) and 320 ml (280-450 ml) respectively.The internal fixation devices were explanted completely,including plate and screw in 5 cases,only screw in 1 case,intramedullary nail and screw in 1 case.The mean fallow-up period was 32.5 months (range,15-48 months).The average Harris hip score improved from 48.8±6.5 points preoperatively to 92.6±5.1 points post-operatively (t=22.82,P=0.001).Osseointegration was developed in all of the acetabular and femoral components at 3 months post-operatively.Radiograph analysis showed satisfied position of acetabular cup and no evidence of implant migration or center of rotation change.Stem subsidence (＜1.0 mm) occurred in 2 cases and heterotopic ossification in 2 cases (Brooker type Ⅰ and type Ⅱ in 1 case,respectively) at one year postoperatively.No complication occurred,such as damages of vessels and nerve,dislocation,component loosening or infection.Conclusion The wedge shape osteotomy of femoral neck is a safe and reliable method in treating hip fusion ankylosis.Total hip arthroplasty can be achieved by reconstruction of acetabular center,suitable components implanted in anatomical position and ideal reconstruction of soft tissue around hip.
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Objective To discussion the feasibility and effect of total hip arthroplasty (THA) of postoperative ankylosis in patients with hip peripheral fracture.Methods From January 2008 to October2013,cementless THA was performed in 23 patients with ankylosis after internal fixation of hip peripheral fracture.There were 16 males and 7 females,aged 23 to 67 years (mean,43 years).Interval between internal fixation and THA was 12 to 73 months (mean,38 months).Results Mean follow-up was 28 months (range,3 to 60 months).All patients presented good press-fit prostheses with mean acetabular valgus of 43.3°,mean acetabular anteversion of 22.5°,and mean femoral anteversion of 16.4°.Primary wound healing was detected with no occurrence of infection,prosthetic loosening or dislocation,and periprosthetic fracture.Femoral vein incomplete embolism was diagnosed in one patient with limb swelling 2 months after operation,but swelling subsided after 3 months of bed rest,elevation of the affected limb and anticoagulant therapy.Length of the bilateral limbs was almost equal in 19 patients with the difference within 0.5 cm,but the affected limb was 0.8-1.4 cm shorter in 3 patients and was 0.8 cm longer in 1 patient.Harris hip score improved from (42.16 ± 3.03)points before operation to (93.08 ± 5.23) points at the last follow-up (P ＜ 0.05).Conclusion THA is associated with good hip function recovery and improved quality of life during the treatment of postoperative ankylosis in patients with hip peripheral fracture.