ABSTRACT
BACKGROUND:Complex scapular fractures were mainly treated by implant fixation. Standard fixation approach (Judet approach) had long incision and big trauma. With the application of spiral CT and three-dimensional reconstruction, minimal y invasive incision could be designed before implant fixation, and then fixation could be finished by physicians. Thus, trauma was reduced and repair effect was elevated. OBJECTIVE:To observe the effects of the three-dimensional reconstruction design combined with titanium plate reconstruction or lag screw for treatment of scapular fractures. METHODS:From February 2007 to January 2012, 33 cases of scapular fractures were enrol ed from Department of Orthopedics, No. 1 Hospital of Qinhuangdao in China. They were scanned by three dimensional reconstruction of CT before implant fixation to identify the regions needed to be repositioned and fixed. Thus, minimal y invasive incision of implant fixation was designed. The dissection of skin, subcutaneous tissue and muscle was reduced. Reposition was performed. Titanium plate and/or lag screw were used for fixation. RESULTS AND CONCLUSION:The operation lasted for 90-130 minutes in 33 patients, with intraoperative blood loss for 300-400 mL. Fracture was total y healed, and the healing time was 2-4 months. The fol ow up lasted for 12-24 months. According to Hardegger standard, there were excellent in 17 cases, good in 12 cases, average in 3 cases and poor in 1 case, with an excellent and good rate of 88%. These results suggested that three-dimensional reconstruction design combined with minimal y invasive incision treatment for scapular fractures showed fewer traumas, can complete the satisfactory fracture reduction and implant fixation, and obtain good repair effect.
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Objective To describe the surgical technique in reconstructing anterior cruciate ligament (ACL) with six strands harmstring tendon graft fixed by bioabsurbable rigidfix cross pins under arthroseopy and to e-valuate its efficacy. Methods From March 2005 to June 2008,39 patients with ACL injury were treated with ACL reconstruction by transplantation of six strands autogenous harmstring tendon , fixed by bioabsorbable rigidfix cross pins in femoral side. There are 22 male and 17 female,ages from 22 to 55 (the average age is 37). 19 cases were hurt in traffic accident, and another 20 cases in accidental injury. The state of illness is 7 days to 38 months. 13 cases merge the meniscus rupture, and 4 cases of meniscus suture,8 partial meniscectomy, 1 meniscectomy were performed simultaneously ;4 cases associating with the medial collateral ligaments Ⅲ degree injure underwent medial collateral ligament neo-plasty or reconstruction ;no cases merge posterior cruciate ligament injury, the patients were followed up 12 to 51 months , Pre-and post-operative knee joint function and stability were evaluated according to the Lysholm scoring scale system and the results of KT-2000 arthrometer , the clinical results and the reliability of the fixation were analyzed. Results 32 patients were followed-up and there is no limitation of the extention in the knee joints. The flexation of the knee joint is greater than 120°,and the anterior drawer test in 90° of flexation were negative in all patients. The postoperative Lachman test was strong positive in 1 case, negative in 26 cases and positive in 5 cases. The Lysholm scores was (92.6±4.2) points. The results of KT-2000 arthrometer: 31 cases 0-4.5 nun, average 3.2 mm;1 case 6. 5 mm. Conclusions It is a safe and reliable method to reconstruct ACL with six strands harmstring tendon graft fixing by bioabsorbable rigidfix cross pins under arthroscopy, and this procedure can obtain primary stabilization and long term stabilization of the autografts.
ABSTRACT
Objective To discuss the clinical technique and outcomes of the treatment with arthroscopically assisted percutaneous retrograde interlocking nailing for supracondylar femoral fractures. Methods From July 2001 to June 2003, there were 22 supracondylar femoral fractures which were 19 fresh fractures and 3 old fractures. There were 10 males and 12 females, and the average age of which was 39.5 years ranging from 22 to 65 years. 7 patients sustained falls, and the other 15 patients were caused by traffic accidents. According to the AO/ASIF classification system, 7 fractures were evaluated as type A1, 8 type A2 and 7 type A3. All the patients were treated by arthroscopically assisted percutaneous retrograde interlocking nailing. Some additional lesions were also treated under arthroscopy simultaneously, including 3 releases for the stiff knee, 2 removals of the loose bodies, 7 debridements and lavages for the osteoarthritis, and 3 bone grafts for the fracture union. Results The average operative time was 130 minutes ranging from 90 to 210 minutes, and the average blood loss was 100 ml. The reduction and fixation were proved to be satisfactory by the postoperative roentgenogram. 20 patients were available for follow-up, which ranged from 6 to 24 months with an average of 14 months. All the fractures were united on an average of 3.3 months postoperatively except one ranging from 2 to 6 months. The one with fracture union were reoperated with bone grafting and compressive plate fixation, and the fracture healed 3 months later. The range of motion was beyond 90? in all patients, no breakage of internal fixation instruments or wound infection occurred. The functional results of knee joint were assessed as excellent in 14, good in 5 and fair in 1, and the rate of excellent and good was 95%. Conclusion The percutaneous retrograde interlocking nailing for the supracondylar femoral fractures is proved to have many advantages, such as less trauma and blood loss, and accurate location, which are beneficial to both of the fracture union and functional recovery.