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Objective To investigate a reasonable and effective internal fixation method for posterolateral fracture of the tibial plateau. Methods Specimens of the tibial plateau with posterolateral fracture made from 12 adult male cadavers were randomly and evenly divided into 3 groups, and fixed by anterior 6.5 mm lag screw, lateral 4.5 mm L-shape plate, posterior 3.5 mm T-shape plate, respectively. All the specimens were loaded in turn by stress of 250, 500, 750, 1 000 N, and the corresponding axial displacement and stress were measured. Results Under the same stress, the Y-axial displacement of the anterior lag screw group was the smallest, showing a significant difference with the lateral plate group and the posterior plate group, while there was no significant difference between the lateral plate group and the posterior plate group in the Y-axial displacement. The stresses on marked points in the anterior lag screw group were evenly distributed. Conclusions For fixation of isolated posterolateral fractures of the tibial plateau, the anterior 6.5 mm lag screw can effectively increase the axial stability and balance the stress distribution around the fracture block, indicating it is an effective method for mechanical fixation. The lateral plate has certain advantage in lateral stability control, while the posterior plate has certain value to reduction of the posterior tibia plateau fracture.
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<p><b>OBJECTIVE</b>To introduce the use of single arm external fixation assisted reduction and closed complex intramedullary nail fixation for the treatment of femoral shaft fracture operation method and to study its effects.</p><p><b>METHODS</b>From June 2008 to October 2012, 24 patients with femoral shaft fractures were treated with unilateral external fixation assisted by closed reduction, interlocking intramedullary nail fixation. Among the patients, 19 patients were male and 5 patients were female, ranging in aged from 20 to 68 years,with an average of 45.6 years old. The fracture was caused by traffic accidents in 14 cases, by falling in 6 cases, by heavy bruising in 4 cases. Admission diagnosis was femoral shaft fracture. Operation was performed after traction from tibial tubercle for about 1 week.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 6 to 24 months, with a mean of 16.2 months. The X-ray showed fracture healing time ranging from 11 to 17 weeks, with an average of 13.8 weeks. All fractures healed without nails broken or close joint dysfunction. According to femoral shaft efficacy evaluation standards, 23 patients got an excellent result, 1 good.</p><p><b>CONCLUSION</b>Unilateral fixator assisted closed reduction and interlocking intramedullary nail fixation for the treatment of femoral shaft fracture has following advantages: less trauma, simple operation, effective reduction, high rate of fracture healing, and low complication rate.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , External Fixators , Femoral Fractures , General Surgery , Fracture Fixation, Intramedullary , Methods , Fracture Healing , Fractures, Comminuted , General Surgery , TractionABSTRACT
<p><b>OBJECTIVE</b>To introduce the clinical method of blocking screws and rooting technique in the treatment of distal tibial fracture with interlocking intramedullary nails.</p><p><b>METHODS</b>From June 2006 to March 2011, 26 patients with distal tibial fracture were treated with interlocking intramedullary nails using blocking screws and rooting technique, included 18 males and 8 females with an average age of 46.2 years old ranging from 24 to 64 years. According to AO classification: 10 cases of type A1, 4 cases of type A2, 8 cases of type B1, 4 cases of type B2. The average distance of the fractures end to the ankle joint was 85 mm ranging from 55 to 125 mm, the mean time between injured and operation was 4.5 days. The patients were evaluated with pain, range of motion, walking.</p><p><b>RESULTS</b>All cases were followed-up for 6 to 22 months (averaged 15 months). According to Iowa ankle joint grading system,the score was improved from preoperative (66.8 +/- 8.2) to postoperative (94.6 +/- 4.8). All fractures had united, and got satisfactory reduction and stable fixation with no complications had happen such as breakage of screw.</p><p><b>CONCLUSION</b>Fixation with interlocking intramedullary nail using blocking screws and rooting technique in treating distal tibial fracture, is a safe and effective technique for the improvement of stability.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Bone Screws , Follow-Up Studies , Fracture Fixation, Intramedullary , Methods , Recovery of Function , Retrospective Studies , Tibial Fractures , Diagnostic Imaging , General Surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Objective To compare the biomechanical effect of three fixation instruments for SchatzkerⅥtibial plateau fractures.Methods Twenty four fresh knee specimens were made into models of SchatzkerⅥtibial plateau fractures.The specimens were divided randomly into three groups.Group A were fixed with a lateral periar- ticular plate and a posteromedial antiskid plate,and group B with a lateral periarticutar plate and an anteromedial lim- ited contact dynamic compression plate(LC-DCP),and group C with a lateral periarticular plate and a medical exter- nal fixator.Each model was tested for its biomechanical performance in resisting compression,bending and rotation. Results The performance of group B was higher than group A in anti-compression,anti-bending and anti-rotation, and group C was the poorest,there was no significant difference between group A and group B,and there was signifi- cant difference between group B and group C.Conclusion The biomechanical performance of group B was good. The method might have clinical applications in the treatment of SchatzkerⅥtibial plateau fractures.
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Objective To compare the functional and radiographic outcomes of modified dual plating and less invasive stabilization system(LISS)in treatment of patients with complex tibial plateau fractures.Methods From November 2003 to November 2004,84 patients with complex tibial plateau fracture were treated with modified dual plating or LISS fixation.Their functional and radiographic outcomes were reviewed to compare the differences in bone union time,full weight-bearing time,knee joint's HSS(The Hospital for Special Surgery)scores,complications, tibia plateau angle(TPA)and posterior slope angle(PA).Results The 84 cases had complete follow-up records and a mean tollow-up of 16.2 months(range,12 to 23 months).Nine complications occurred in the modified dual plating group.The mean full weight-bearing time and radiographic bone union time were 16.8 and 15.1 weeks respectively for this group which had a mean HSS score of 87.4 points.Six complications were found in the LISS group.The mean full weight-bearing time and radiographic bone union time were 14.1 and 13.8 weeks respectively for this group which had a mean HSS score of 89.6 points.There were no significant differences between the two groups in changes of TPA and PA.Conclusion LISS can provide as good fixation as modified dual plating can for most complex tibial plateau fractures,but additional medial plate fixation may be necessary for some special cases.
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Complications are always likely to occur in the treatment of fractures. Once fracture-related complications occur,their management will be difficuh,resulting in a long handling process that increases physical and financial pain on the patients.Fea- turing“management of fracture-related complications”,this issue intends to draw attention from orthopaedists to the challenging task of prophylaxis and treatment of such problems in clinic.Not only non-union,malunion,heterotopic ossification,bone necrosis but also such systemic complications as deep vain thrombosis,soft tissue infection and necrosis are discussed.They involve long tubular bones,pelvic,proximal femur,tibial plateau and calcaneum.Authors introduce their experience from their clinical practice which can benefit readers a lot.It is well known that an effective prevention is the best treatment.In treatment of fractures,principles must be strictly followed and preventive measures taken throughout the whole process.Once a complication has been detected,therapy should be individualized 1o gain the best outcome.