ABSTRACT
Objective:To investigate the efficacy of Masquelet induced membrane technique combined with an external locking plate in the treatment of infectious bone defects of the tibia.Methods:A retrospective study was conducted to analyze the data of 32 patients with infectious bone defects of the tibia who had been treated by Masquelet induced membrane technique combined with an external locking plate at Department of Orthopaedic Surgery, The Fourth Hospital of Wuhan from January 2011 to January 2021. There were 22 males and 10 females, with an age of (43.2±13.1) years. The length of bone defects was (5.1±1.3) cm. By the Cierny-Mader classification, there were 12 cases of type Ⅲ and 20 cases of type Ⅳ. The defects were located at the proximal tibia in 11 cases, at the middle tibia in 12, and at the distal tibia in 9. At the last follow-up, the lower limb function was evaluated by the Paley scale, and the quality of life by the 36-Item Short Form Health Survey (SF-36).Results:All the 32 patients were followed up for (21.2±5.7) months. Normal healing was achieved in 30 cases but delayed healing occurred in 2 cases. The external plate and screws were removed at (23.1±4.6) weeks after operation. There was no infection in the original surgical incision or no injury to the nerve, blood vessel or tendon after operation, but nail tract infection occurred more or less in 3 cases. According to the Paley scale at the last follow-up, the lower limb function was evaluated as excellent in 22 cases, as good in 8, and as fair in 2, giving an excellent and good rate of 93.75% (30/32). The SF-36 quality of life score was (88.9±3.8) points.Conclusion:In the treatment of infectious bone defects of the tibia, Masquelet induced membrane technique combined with an external locking plate can achieve satisfactory clinical outcomes due to its effective control of infection, reduction in delayed healing, good stability and good patient tolerance.
ABSTRACT
Objective:To investigate the clinical efficacy of 3D printed osteotomy guide plate combined with "Jail" screw technique in the treatment of tibial plateau fractures involving external posterior condylar collapse.Methods:From January 2016 to January 2021, 41 patients (22 males and 19 females) with tibial plateau fractures involving external posterior condylar collapse were treated with 3D printed osteotomy guide plate combined with "Jail" screw technique and followed up. The age was 47.4±11.5 years (range, 22-69 years). According to Schatzker fracture type, 18 cases were type IV, 14 cases were type V and 9 cases were type VI. All fractures were closed, and 12 of them were complicated with lateral meniscus injury, but none of them were complicated with nerve and vascular injury. The time from injury to operation was 7.2±3.4 d (range, 4-17 d). All patients underwent 3D CT scanning and digital modeling before operation. According to the modeling results, a 1∶1 solid size fracture model was made by 3D printing, and the osteotomy guide plate and the "Jail" screw preset guide plate were designed. During the operation, the tibial lateral condyle osteotomy was performed with customized osteotomy guide plate. After reduction, the fixation of the fracture was performed with the preset guide plate using "Jail" screw. Postoperative fracture reduction was evaluated according to Rasmussen score, and knee function was evaluated by Hospital for Special Surgery (HSS) score.Results:All the 41 patients were followed up for 15.2±5.8 months (range, 6-26 months). Immediate postoperative radiographs showed good fracture reduction, and the average healing time was 14.1±1.2 weeks (range, 12-17 weeks). One year after operation, the Rasmussen score of knee joint was 17.4±1.6 points (range, 13-19 points), of which 31 cases were excellent, 8 cases were good, and 2 cases were fair, with an excellent/good rate of 95% (39/41). HSS scores was 87.3±5.6 points (range, 68-95 points), including 30 excellent cases, 10 good cases and 1 fair case, with an excellent/good rate of 98% (40/41). The range of motion of knee joint was 126.8°±3.8°. At the last follow-up, no serious complications such as common peroneal nerve injury, popliteal vascular injury, postoperative infection, or internal fixation failure occurred.Conclusion:3D printed osteotomy guide plate combined with "Jail" nail placement technique is an effective method for tibial plateau fractures involving external posterior condylar collapse, and the postoperative treatment results are satisfactory. The use of customized osteotomy guide plate is more accurate and less damaging. The use of "Jail" screw preset guide plate can ensure more accurate screw placement.
ABSTRACT
Objective:To evaluate biplane osteotomy and bone transport combined external locking plating for sequential treatment of massive tibial bone defects.Methods:Twenty-eight patients with massive tibial bone defects were reviewed who had been treated at Department of Repair and Reconstruction, Wuhan Puai Hospital from October 2013 to October 2019. They were divided into a bone transport group and a combined bone transport group (bone transport combined external locking plating) according to their surgical methods. In the bone transport group of 14 cases, there were 10 males and 4 females with an age of (38.6±3.2) years and a bone defect of (8.0±0.5) cm; in the combined bone transport group of 14 cases, there were 9 males and 5 females with an age of (39.1±3.9) years and a bone defect of (8.3±0.3) cm. The time for wearing external fixator, fracture healing time, dock-in-site healing time, postoperative function assessment and complications were observed and compared between the 2 groups.Results:There was no significant difference between the 2 groups in their preoperative general data, showing they were comparable ( P>0.05). The bone transport group were followed up for 12 to 28 months (average, 18.4 months) and the combined bone transport group for 12 to 26 months (average, 16.8 months). The time for wearing external fixator in the combined bone transport group [(8.4±0.7) months] was significantly shorter than that [(13.3±1.4) months] in the bone transport group ( P<0.05). No significant difference was observed between the 2 groups in either the fracture healing time [(8.4±1.3) months versus (7.4±1.2) months] or the dock-in-site healing time [(210.2±9.1) months versus (206.2±9.8) months] ( P>0.05). By the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring, the bone healing was excellent in 6, good in 5 and fair in 3 cases in the bone transport group while excellent in 8, good in 4 and fair in 2 cases in the combined bone transport group, showing no significant difference between the 2 groups in the excellent to good rate ( P>0.05). By the postoperative functional assessment of the lower extremity, there were 7 excellent, 3 good, 3 fair and one poor cases in the bone transport group while 8 excellent, 5 good and one poor cases in the combined bone transport group, showing no significant difference between the 2 groups in the excellent to good rate ( P>0.05). In the bone transport group, there were 3 cases of pin track infection, one case of dock-in-site nonunion, 2 cases of poor alignment of lower extremities, 2 cases of skin depression, one case of nail loosening, 5 cases of joint stiffness and 3 cases of delayed union of the distracted bone; in the combined bone transport group, there were one case of pin track infection, 2 cases of poor alignment of lower extremities, 3 cases of skin depression, 3 cases of joint stiffness, 2 cases of delayed union of the distracted bone and one case of refracture. Conclusion:In the sequential treatment of massive tibial bone defects, biplane osteotomy and bone transport combined external locking plating can reduce the time for wearing external fixator and increase the satisfaction of patients.
ABSTRACT
BACKGROUND:Femoral neck fracture is mainly fixed by three inverted triangle cannulated screws. Scholars have proposed to add a cannulated screw to enhance the fixation strength of femoral neck fracture of Pauwels III type based on three cannulated screw fixation, but the stability is not verified. OBJECTIVE:To analyze the biomechanical stability and stress of the three and four cannulated screws for the treatment of the Pauwels III femoral neck fractures. METHODS:The CT imaging results of the fourth generation of artificial bone sawbones were imported into the Mimics software wherein a three-dimensional finite element model of the proximal femur was prepared and introduced in the 3-matic software. Models of middlesegment of femoral neck with Pauwels III fractures were established. Cannulated screw models were established with UG 8.0 software and introduced in the fractures models. Finally, finite element models of Pauwels III femoral neck fractures fixed with three and four screws were established. In the same condition, an axial load of 411 N was applied on the femoral head with Abaqus software. The displacement of two markers of the broken ends and internal fixation system Von Mises stress distribution were compared between the two models. RESULTS AND CONCLUSION:(1) The displacement was 0.42 mm in three screws model, and 0.17 mm in the four screws model. (2) Von Mises stress peak was 547 MPa and 27.8 MPa in both models. The peak value was lower in models of fourscrews than that of three screws. Stress concentration position was at the fracture site in both models. The stress range of models of four screws was more extensive and scattered. (3) Finite element analysis results demonstrated that four-screw implantation for Pauwels III femoral neck fractures had strong anti-shearing force and biomechanical stability. Clinical advantages need further clinical comparative study.
ABSTRACT
Objective To compare diabetes(pre-diabetes) prevalence and awareness between Province Shanxi and Fujian .Meth-ods Study data was from China National Diabetes and Metabolic Disorders Study 2007-2008 .5 926 individuals(Shanxi 3 254 ,Fu-jian 2 672) were included as study participants .Standardized questionnaire was used to obtain demographic and lifestyle data .All participants were administered a glucose tolerance test .Results Overall diabetes prevalence was 9 .6% .The diabetes prevalence in Shanxi was lower compared with Fujian(8 .2% vs .11 .3% ,P<0 .001) .Overall pre-diabetes was 15 .4% and no significant differ-ence was found between the two provinces .The awareness of diabetes and pre-diabetes in Shanxi was lower compared with Fujian , although both provinces were not satisfactory .Conclusion Regional differences were showed in diabetes (pre-diabetes) prevalence and awareness between Province Shanxi and Fujian .