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Objective:To compare the clinical outcomes between replacement with a composite press-fit radial head prosthesis versus open reduction and plate-screw internal fixation in the treatment of adult Mason Ⅲ radial head fractures.Methods:The clinical data of 64 adult patients with Mason Ⅲ radial head fracture were retrospectively analyzed who had been admitted to Department of Orthopedics, Beijing Friendship Hospital from January 2012 to December 2019. They were 18 males and 46 females, aged from 32 to 58 years (average, 45.7 years). They were divided into 2 groups: 32 cases received mini-plate-screw internal fixation (internal fixation group) and 32 cases replacement with a composite press-fit radial head prosthesis (replacement group). At the last follow-up, elbow valgus angle, range of elbow motion, Mayo score of elbow function and visual analogue scale (VAS) pain score were recorded and compared to evaluate the postoperative clinical outcomes.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). All patients were followed up for 8 to 48 months (average, 18.7 months). The operation time was, respectively, (81.4±8.2) min and (68.9±7.3) min for the internal fixation group and the replacement group, showing a statistically significant difference ( P< 0.05). For the internal fixation group and the replacement group at the last follow-up, the flexion and extension angles were 95° to 125° and 100° to 140°, the rotation angles 135.3°±11.2° and 143.5°±12.8°, and the Mayo scores 79.2±3.8 and 83.4±3.9, all significantly favoring the replacement group ( P<0.05). The VAS pain scores before operation and at the last follow-up were 7.6±0.7 and 0.9±0.7 for the internal fixation group, and 7.9±0.8 and 0.7±0.6 for the replacement group, showing significant differences between preoperation and the last follow-up in both groups ( P<0.05). All the incisions healed by the first intention, with no postoperative infection. Internal fixation loosening with ulnar neuritis was reported in one case in the internal fixation group; peri-prosthesis absorption with no prosthesis loosening was observed in one case in the replacements group. Conclusion:In the treatment of adult Mason Ⅲ radial head fractures, although both replacements with a composite press-fit radial head prosthesis and open reduction and plate-screw internal fixation can lead to satisfactory results, the former may be more effective.
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Objective To quantitatively analyze the operation risks for femoral intertrochanteric frac-tures under the guidance of Acute Physiology and Chronic Health EvaluationⅡ( APACHEⅡ) . Methods A retrospective analysis was performed among the 226 patients with femoral intertrochanteric fracture who had re-ceived surgery between January 2013 and January 2016. They were 59 men and 167 women, aged from 69 to 106 years ( average, 75. 4 ± 6. 1 years ) . Their average APACHEⅡscore was 18. 3 ± 6. 3 ( from 5 to 34 ) . They were divided into 3 groups according to their APACHEⅡscores: 127 cases in the low risk group (≤ 15 ) , 68 cases in the medium risk group ( from 16 to 24 ) and 31 cases in the high risk group ( ≥25 ) . The mortality was compared between the 3 groups. The deaths and survivals were compared in each group in terms of age, oper-ation time, intraoperative blood loss, postoperative blood transfusion and combined internal diseases. Results Thirteen patients died during hospitalization, giving a mortality of 5. 7％ ( 13/226 ) . The causes for death were heart attack in 6 cases, respiratory failure in 4, toxic shock in 2 and renal failure in one. The mortality in the high risk group ( 22. 6％, 7/31 ) was significantly higher than in the low risk group ( 1. 6％, 2/125 ) and in the medium risk group ( 5. 9％, 4/68 ) ( P <0. 05 ) . In the low risk group, the intraoperative blood loss was sta-tistically different between deaths and survivals ( P <0. 05 ); in the medium risk group, the intraoperative blood loss and postoperative blood transfusion volume were statistically different between deaths and survivals ( P <0. 05 ); in the high risk group, the age and intraoperative blood loss were statistically different between deaths and survivals ( P <0. 05 ) . Conclusions APACHEⅡcan be used to quantitatively evaluate the patients with femoral intertrochanteric fracture who usually suffer from intraoperative complications and concomitant in-ternal diseases. The most significant risk factor may be intraoperative blood loss.
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Objective To compare the clinical effects of the T-type volar locking compression plate and variable angle two-column locking compression plate in treatment of 118 cases with distal radial fractures.Methods Retrospectivly analyzed the clinical data of distal radius fracture cases from Dec.2011 to Nov.2015 in Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University who were respectively underwent T-type locking compression plate and variable angle two-column locking compression plate.The T-type locking compression plate group of 60 cases;according to AO/OTA classification,including 3 cases of type A3,type B2 5 cases,type B3 7 cases,type C1 10 cases,typc C2 20 cases,type C3 in 15 cases.The variable angle two-column locking compression plate variable angle two-column locking compression plate group 58 cases;according to AO/OTA classification,including 1 cases of type A3,type B2 2 cases,type B3 4 cases,type C1 15 cases,type C2 18 cases,type C3 18 cases.Comparative analysis of two groups of postoperative radiographic parameters and functional recovery.Palm angle,ulnar deviation angle,radius height,wrist joint activity and G-W function score were measured by ((x) ± s),and the comparison was performed t test.Results All patients were followed up,mean follow-up time of T-type locking compression plate group was 26.5 months,the mean follow-up time of variable angle two-column locking compression plate group was 25.6 months.The results showed that there were no significant differences between the two groups in ulnar deviation angle,radius height,radial deviation angle and Gartland-Werley function score.There was significant difference between the two groups in the angle of palm angle,wrist dorsal extension,palmar flexion,ulnar deviation,Wrist rotation,and variable angle two-column locking compression plate had advantages.Conclusion Two kinds of treatment of distal radius fractures were satisfactory clinical efficacy,and variable angle two-column locking compression plate had more advantages,doctors can choose corresponding fixation methods according to the specific situation of patients.
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Objective To compare the clinical effects of the T-type volar locking compression plate and variable angle two-column locking compression plate in treatment of 118 cases with distal radial fractures.Methods Retrospectivly analyzed the clinical data of distal radius fracture cases from Dec.2011 to Nov.2015 in Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University who were respectively underwent T-type locking compression plate and variable angle two-column locking compression plate.The T-type locking compression plate group of 60 cases;according to AO/OTA classification,including 3 cases of type A3,type B2 5 cases,type B3 7 cases,type C1 10 cases,typc C2 20 cases,type C3 in 15 cases.The variable angle two-column locking compression plate variable angle two-column locking compression plate group 58 cases;according to AO/OTA classification,including 1 cases of type A3,type B2 2 cases,type B3 4 cases,type C1 15 cases,type C2 18 cases,type C3 18 cases.Comparative analysis of two groups of postoperative radiographic parameters and functional recovery.Palm angle,ulnar deviation angle,radius height,wrist joint activity and G-W function score were measured by ((x) ± s),and the comparison was performed t test.Results All patients were followed up,mean follow-up time of T-type locking compression plate group was 26.5 months,the mean follow-up time of variable angle two-column locking compression plate group was 25.6 months.The results showed that there were no significant differences between the two groups in ulnar deviation angle,radius height,radial deviation angle and Gartland-Werley function score.There was significant difference between the two groups in the angle of palm angle,wrist dorsal extension,palmar flexion,ulnar deviation,Wrist rotation,and variable angle two-column locking compression plate had advantages.Conclusion Two kinds of treatment of distal radius fractures were satisfactory clinical efficacy,and variable angle two-column locking compression plate had more advantages,doctors can choose corresponding fixation methods according to the specific situation of patients.
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Objective To analyze the causes of complications and death of the femoral intertrochanteric fracture during perioperative period, and to assess the orthopedics surgery risk of aged. Methods 499 of 547 cases were retrospectively re?viewed (132 male, 367 female), who underwent operation from May 2007 to Jun 2014 in our hospital. Their age varied from 59 to 103 years old, with an average of 78.3 ± 7.3 years old. According to Evans classification, there were 84 cases of type I, 67 type II, 187 type III, and 161 type IV. The causes of death were analyzed and discussed. The factors including health assess?ment before operation, age, operating time and blood loss were studied statistically to find out their correlation with mortality of operation. Results There were altogether 354 complications, including pulmonary infection, urinary system infection, DVT, and cardiac events. There were 30 cases of death and the mortality was 6.0%. The major causes of death included infectious shock, pulmonary infection, cardiac events, kidney failure and hemorrhagic shock caused by hepatic rupture. Statistical results from the score of APACHEⅡshowed the factor which definitely influenced the mortality was the amount of blood loss during op?eration.APACHEⅡscoring area under the ROC curve was 0.938, and the best cutoff value was 17.5 (about an index of 0.767), with the sensitivity of 86.7%and specificity of 90%. The area of risk of death under the ROC curve by APACHE Ⅱscore was 0.817, the best cutoff value of 16.765%(about an index of 0.483), and the sensitivity and specificity of 93.3%and 55.0%. Conclu?sion There were a lot of complications and accompanied diseases when femoral intertrochanteric fractures happened in aged pa?tients. The main cause of death was septic shock. There were relationships between hemoglobin and the operating time and the de?gree of trauma. What’s more, it was confirmed that the APACHEⅡscoring system was very useful to value the condition of the patients with femoral intertrochanteric fractures, which can be recommended.
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Objective To evaluate the clinical effects in t he treatment of femoral peritrochan teric frac-tures by PFN(proximal femoral nail).Methods A retrospective analysis was done in the treatment of femoral peritrochanteric fractures(72cases).38cases were male and 44cases female.Their age ranged 64～96years old with the average age being 78years old.70cases were intertrochanteric f ractures(EvensⅠtype 16,Ⅱtype 31,ⅢA type 14,ⅢB type 6,Ⅳtype 3),and 2cases subtrochanteric fractu res.Results65patients were followed up for over 6months.All fractures healed and all patients could take care of themselves and were satisfied with t he clinical curative effect except one patient who had the lag screw pulled o ut and coxa vara because of serious os-teoporosis.Conclusion PFNis a better way to cure femoral peritrochanteric fractures because of few complications and simple surgical procedure.Bein g a micro-trauma technique,it is worthy of wide application in clinic.[
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Objective To analyze the results and complications of the treatment of intra articular calcaneal fractures with internal plate fixation. Methods From January 1998 to October 2004, 31 patients with calcaneal fracture (36 calcanea) were treated in our hospital. According to Sanders classification, there were 2 type Ⅱ,22 type Ⅲ,and 12 type Ⅳ. They were treated with reconstruction of the joint surface, internal fixation with screw and plate through the extensile lateral approach, and bone graft. The preoperative and postoperative data were statistically analyzed with SPSS 10.0. Results Follow ups lasted from 6 to 33 months with an average of 25 months. All the fractures healed 3 months after operation. On average, Bhlers angle was improved from preoperative 13.2?to postoperative 38.5?, Gissanes angle from 75?to 115.5?, and step distance from 5.0mm to 0.3mm. The differences between the preoperative and postoperative data were statistically significant(P
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Objective: In order to popularize the use of interlocking nail, the authors reviewed 81 femoral shaft fractures in 80 patients who were treated with interlocking nail from July 1988 to October 1997. Material and Method: There are 60 males and 20 females. Forty-one fractures were of left femur and 40 of right. The average age was 33 years(range 15-79 years) . Results: The results showed that 60 cases of fractures that followed up over half a year had bony union. The complications included one bone union failure due to incorrect indication. two fractures during the operation, misinserting the proximal screw in 2, and misinserting the distal screw in 3, lengthening of the extremity in 2, valgus knee in 2, deep infection in 1, delayed infection in 1, nail broken in 3, proximal screw broken in 1, distal screw broken in 1, distal screw loosening in 2. Conclusion: 1) The indication must be correctly chosen. 2) Well-trained operative technique for interlocking nail is necessary to reduce the compli cation. 3 )The patient with old or comminuted fracture fixed with G - K nail should properly delay the time to start weight bearing.