ABSTRACT
Objective To determine the surgical procedures and effects of ultra-distal tibial intramedullary nails combined with blocking screws in treatment of distal tibial fractures.Methods From April 2008 to September 2012,21 cases of distal tibial fractures were treated with ultra-distal tibial intramedullary nails combined blocking screws.All fractures were statically locked and closed using undreamed technique.For relatively simple fracture,blocking screws were considered when the reduction and stability was not satisfied after the insertion of intramedullary nails; for severe comminuted fractures,blocking screws were inserted directly under C-arm fluoroscopy.Partial weight-bearing was permitted 3 weeks after surgery.Quality of reduction,fracture union,and function assessment were measured at follow-up.Results No skin necrosis and soft tissue and bone infections occurred after a mean follow-up of 17.5 months (range,12-22 months).All fractures were healed with an average healing time of 12 months (range,8-26 months).X-ray findings revealed the fracture of ＜ 5° angulation on coronal and sagittal planes.There was no deformation or breakage of blocking screws and intramedullary nails.According to the criteria of Tormetta,the results were excellent in 19 cases and good in 2.Conclusion Blocking screws assists reduction and improve the fixation stability by narrowing the canal in treatment of distal tibial fractures and expands the application of intramedullary nails.
ABSTRACT
Objective Congenital dislocation of the patella is rare and produces varying degrees of knee disability with the growth of the child. It should be managed as soon as the diagnosis is made. The purpose of this paper is to describe the procedure and to assess the results of congenital dislocation of patella treated with medial transfer of patellar tendon and lateral transfer of medial fascio muscular flap. Methods Five children with congenital dislocation of patella were treated with medial transfer of patellar tendon and lateral transfer of medial fascio muscular flap between June 1994 and June 1998. There were two boys and three girls. The age of the patients at the surgery varied from 4 to 10 years. Four of them were unilateral and one was bilateral without any other deformities. An S-shaped incision is made to expose the distended medial fascio muscular flap, dislocated patella and well developed vastus medialis. The patellar tendon is detached from its insertion and released from the surrounding retinacula. A hole corresponding to the width of the patella is made in the membrane and another one is made through the synovial membrane and the fibrous capsule. The patellar tendon was sutured into the hole in the tibial metaphysis through the two membrane holes. The iliotibial band was lengthened and the biceps tendon was turned over the abundant medial retinaculum with a part of the vastus medialis to the lateral side of the synovial membrane. The patient was kept in a long leg cast and immobilized for 6 weeks. Results The average period of follow up was three years(range, one year and six months to five years). Four cases were able to extend the knee completely and one case had minus ten degrees in extention. Knee valgus in two patients disappeared after operation and one had a lower patella, but the function of knee was normal without any symptoms and signs. There were no complications in this series. Conclusion The patients with congenital dislocation of patella which is permanent and irreducible must be interfered with operation. Five patients were successfully treated with medial transfer of patellar tendon and lateral transfer of medial fascio muscular flap with less invasive and no complications, therefor it is worthwhile to be recommended for the treatment of congenital dislocation of patella.