Distal tibial fracture: An ideal indication for external fixation using locking plate / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficiency of one-stage external fixation by using locking plate in distal tibial fractures.</p><p><b>METHODS</b>In this non-control prospective study, 28 patients with distal tibial fractures were included and underwent one-stage external fixation by using locking plate. There were 21 males and 7 females, with a mean age of 43 years (19-63). According to AO/OTA fracture classification, there were 9 cases of Type A1, 9 of Type A2, 10 of Type A3 fractures. There were 21 close and 7 open fractures. The locking plate was placed on the anteromedial aspect of the tibia with 4-5 bicortical screws inserted in both distal met- aphysis and diaphysis. The radiographic and clinic results were evaluated.</p><p><b>RESULTS</b>All patients were followed up for the average of 16 months (ranging from 12 to 21 months). The average surgery duration was 38 (25-60) minutes. The mean time to fracture healing were 14.6 ± 2.67, 17.5 ± 3.66, and 18.4 ± 3.37 (p < 0.05) weeks in type A1, A2, and A3 fractures respectively. By the end of the follow-ups, the mean AOFAS score were 96.11 ± 2.32, 92.67 ± 1.80 and 92.00 ± 2.06 (p > 0.05) in type A1, A2, and A3 fractures respectively. None of nonunion, deep infection, or breakage of screw or plate were observed.</p><p><b>CONCLUSIONS</b>Distal tibial fracture was the ideal indication for external fixation using locking plate. The external plating is characterized by ease of performance, less invasive, fewer soft tissue impingement, improved cosmesis, and convenient for removal.</p>

Operative treatment of acromioclavicular joint dislocation: a new technique with suture anchors / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation.</p><p><b>METHODS</b>Twenty-eight patients with acute traumatic Rockwood III, IV and V dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited.All patients underwent open reduction combined with suture anchors. Function was evaluated using the Constant- Murley shoulder score. Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3, 6 and 12 months.</p><p><b>RESULTS</b>Two cases with fixation loosening were not included in final statistical analysis. Other patients obtained full joint reposition on immediate postoperative radiographs. Follow-up was performed with an average of 15.6 months (range, 12-19). After early range of motion exercises, 96.2% of the patients (25/26) could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months. There was no infection. Average Constant-Murley score was 96.3 points (range, 94-100) and mean Taft shoulder rating was 10.7 points (range, 8-12) at 12 months.</p><p><b>CONCLUSION</b>The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation.</p>

Study on clinical anatomy of calcaneal fractures and its applications / 中国骨伤

<p><b>OBJECTIVE</b>To observe and analyze the intraoperative state of calcaneal fractures, and summarize the law of displacement after calcaneal fractures, so as to guide fracture reduction and fixation.</p><p><b>METHODS</b>From March 2002 to March 2009, among 572 patients with calcaneal fractures, 427 patients were male and 145 patients were female, ranging in age from 17 to 73 years, averaged 37 years. The patients were injured from falling or road accidents, and all the patients were closed fracture. The 189 patients with complete clinical data were treated with reduction and fixation through the lateral approach after observation of displacement type of the fractures.</p><p><b>RESULTS</b>Among 189 patients,the fractures were found at the lower part of the articular surface in all patients, which was hillock point of calcaneus; the fractures were found at the Gissans Corner in 134 patients, and the type include cross-sectional fracture or oblique fracture; the fractures were found at calcaneal tubercle in 118 patients, and the fractures were divided into two parts from top to bottom; the fractures were found at the distal part of calcaneus only in 67 patients.</p><p><b>CONCLUSION</b>Calcaneal fractures show clear law of dislocation. Preoperative and intra-operative detailed analysis and evaluation, as well as reduction and fixation according to certain sequences can insure to get better operative effects.</p>

Problems and solutions of plate internal fixation for the treatment of calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To retrospective analysis operating procedures and results of calcaneal fractures treated with plate fixation, identify problems and propose measures to reduce surgical complications.</p><p><b>METHODS</b>From June 2008 to April 2009, 156 patients were reviewed, including 121 males and 35 females, ranging in age from 18 to 59 years, with an average of 41 years. Thirty-two patients had bilateral calcaneal fractures. Twenty-three patients were surgically treated on both calcaneus at the same time. Total 179 calcaneus were treated with operation. The operation records of all patients were analyzed in order to find the problems and deficiencies.</p><p><b>RESULTS</b>Among 179 calcaneal fractures, 31 feet (17.3%) had postoperative wound problems: wound infection and non-healing were found in 26 feet (14.5%), skin flap necrosis in 5 feet (2.8%). There were a lot of problems of plate internal fixation for the treatment of calcaneal fractures, including operation design, operative technique, as well as fracture reduction and fixation.</p><p><b>CONCLUSION</b>The following methods are the only way to avoid operative complications for the treatment of calcaneal fractures: improved surgical technique, minimally invasive operation, simple and effective internal fixation.</p>