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Objective:To report the surgical techniques and clinical outcomes of multi-dimensional fixation of patellar multi-fragmentary fractures with locking plates.Methods:A retrospective study was performed in the 26 patients with patellar multi-fragmentary fracture who had undergone open reduction and 3-D internal fixation with locking plates from November 2016 to July 2020 at Department of Orthopaedic Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University. There were 17 males and 9 females, with an average age of 62.6 years (from 31 to 90 years). The patellar fractures were exposed and reduced via the longitudinal anterior midline incision of the knee. After the reduction was initially maintained with a cerclage wire, a trimmed and pre-contoured 3.5 mm locking plate was applied onto the patellar surface. After-wards, locking screws were inserted from the lower pole to the upper pole of the patella, from the anterior to the posterior and from the lateral to the medial, respectively, to complete the multi-planar fixation. Follow-ups assessed the B?stman score, knee pain visual analogue scale (VAS), radiographic image and fracture healing, range of motion of the knee, and complications.Results:All the 26 patients were followed up for 12 to 56 months (average, 28 months). Crutches were used while walking until an average of 1.6 months (from 1 to 3 months) after operation in all patients. At the last follow-up, the B?stman score averaged 27.5 points (from 17 to 30 points), yielding 12 excellent, 13 good and 1 poor case with an excellent to good rate of 96.2% (25/26); the knee pain VAS averaged 1.2 points (from 0 to 5 points); the active knee flexion averaged 125° (from 100° to 150°). No breakage, loosening or displacement of the patellar plates or screws was observed during follow-up, but cerclage wire breakage occurred without any symptom in 11 cases. Four patients complained of hardware irritation, and 4 patients underwent hardware removal after fracture union.Conclusion:Multi-dimensional fixation with locking plates is a viable and safe surgical option for patellar multi-fragmentary fractures, due to its satisfactory therapeutic outcomes.
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Fracture mapping, also known as mapping of fracture lines, is a technique of drawing fracture lines based on 3D reconstruction of radiological images. Fracture mapping can be used to describe fracture morphology, calculate fracture line angle and fragment area, improve clinical practice, propose a new classification system, clarify a fracture mechanism, and establish a model of bone fracture. At present, fracture mapping has become a powerful tool for study of morphology and clinical decision in orthopaedics. Reviewing the development of fracture mapping techniques, this paper addresses their clinical application in knee injuries, tibial plateau fracture, distal femur fracture and patellar fracture in particular. In addition, considering the trend of fracture mapping techniques and the morphology-related studies at present, we offer suggestions concerning improvement of techniques and morphology studies in knee injuries.
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Objective To investigate the outcomes of lateral approach combined with anteromedial approach for the treatment of terrible triad of the elbow injuries.Methods Data of 23 patients with terrible triad of the elbow injuries treated at our hospital using this modified surgical technique from July 2008 to January 2011 were retrospectively analyzed.Two patients lost to follow-up leaving 21 patients (21 elbows) for evaluation.There were 17 males and 4 females with a mean age of 38.4 years (range,17-63 years).The 21 elbows were treated surgically after a mean of 4 days from the injury.According to O'Driscoll classification of coronoid fractures,there were 5 cases of type A1,12 of A2,and 4 of B2.According to Mason classification of radial head fracture,there were 2 cases of type Ⅰ,12 of Ⅱ,and 7 of Ⅲ.According to Zhong Biao classification of soft tissue injury in terrible triad of the elbow,there were 6 cases of type Ⅰ,12 of Ⅱ,and 3 of Ⅲ.Our surgical procedure included fixation or replacement of the radial head and repair of the ruptured lateral collateral ligament (LCL) through a lateral approach.Simultaneous fixation of the coronoid process and repair of the common flexor muscle and medial collateral ligament (MCL) injury were performed through an anteromedial approach.Mayo elbow performance score (MEPS) was determined for each patient at the latest clinic visit.The Broberg and Morrey classification was used for evaluating traumatic arthritis.Results The mean follow-up period was 32 months.At the latest follow-up the mean flexion-extension arc of the elbow was 126° (range,115°-135°) and the mean forearm rotation was 139°(range,125°-145°).The mean MEPS was 95 points (range,85-100 points),with 19 excellent results and 2 good results.Concentric stability was restored in all cases.Early post-operative complication occurred in one patient as a wound infection,which healed uneventfully after surgical debridement and antibiotic therapy.Late post-operative complication occurred in four patients including two cases of heterotopic ossification,1 case of radial head nonunion,and one case of ulnar nerve neuropathy,but none of them required additional surgery.Conclusion Lateral approach combined with anteromedial approach for terrible triad of the elbow provided both bony and soft-tissue stability,thereby allowing early active motion as well as functional recovery of the elbow.
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BACKGROUND:Studies on tibial plateau fractures had gradualy focused on “360° stereochemical structure” from medial and lateral “double track structure” nowadays. Scholars pay great attention on the stability and reposition of posterior plateau and functional recovery after reduction. The choice of fixation material of posterior plateau was controversial. OBJECTIVE:To discuss the biomechanical characteristics of posterolateral fracture of tibial plateau using three types of internal fixation. METHODS:Using three-dimensional finite element analysis, we simulated 1/2 and 1/4 posterolateral tibial plateau fractures. Three types of internal fixation were used: two anterior 6.5 mm lag screws, lateral 4.5 mm L-shape plate, and posterior 3.5 mm T-shape plate. 500 N was loaded at the center of the tibial plateau verticaly, and biomechanical status of three types of fixation was compared. RESULTS AND CONCLUSION: In 1/2 fracture model, anterior lag screw group and posterior plate group gained least displacement in al directions, as lateral plate group gained more. In 1/4 model, the advantage in displacement of anterior lag screw group was more apparent, the second was posterior plate group, and the last was lateral plate group. In 1/2 fracture model, the maximum stress of anterior lag screw was 36.523 MPa, which of lateral plate group was 153.372 MPa and posterior plate group was 115.922 MPa. The maximum stress left in the separate bone of lag screw group was 4.309 MPa, which of lateral plate group was 4.37 MPa and posterior plate group was 3.124 MPa. In 1/4 fracture model, the maximum stress of anterior lag screw was 36.803 MPa, which of lateral plate group was 153.336 MPa and posterior plate group was 104.234 MPa. The maximum stress left in the separate bone of lag screw group was 1.195 MPa, which of lateral plate group was 0.827 MPa and posterior plate group was 1.196 MPa. Results indicated that anterior lag screw could bear more stress and gained least displacement after loading, and the fixation was more stable. Posterior plate can give more stabilization when the separate bone was bigger (1/2), similar to anterior lag screw. When the separate bone was smaler (1/4), posterior plate model was less stable than anterior lag screw. Lateral plate model, with poor stabilization, was the worst choice in three types of fixation.
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BACKGROUND:Ankle fracture combined with deltoid ligament injury can disorders the anatomical structure of ankle joint. Improper treatment can cause more serious complication, such as walking disorders. OBJECTIVE:To evaluate the clinical effect of anchor repair plus open reduction internal fixation in the treatment of ankle fracture combined with deltoid ligament injury. METHODS:Thirty-five patients with ankle fracture combined with deltoid ligament injury were selected from the Department of Orthopedics, the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University between May 2009 and January 2011, including 24 males and 11 females, and al the patients were treated with anchor repair plus open reduction internal fixation. The age of the patients was 22-61 years, averaged 35.7 years, and al the patients were closed injury without other fractures. The treatment time was 2-10 days, average 4.6 days. According to Lauge-Hansen classification, 26 patients had supination-eversion ankle fracture and nine patients had pronation-eversion. According to Danis-Weber classification, 26 patients were C type and nine patients were B type. After al the three patients were treated with anchor repair, the treatment effect of anchor repair was evaluated through assessing the improvement of clinical symptoms and signs, as wel as the imaging examination of repair and healing. RESULTS AND CONCLUSION:Al the 35 patients were fol owed-up for 9-26 months, average 13.8 months. Al the patients got Ⅰ stage healing without complications of infection and screw loosening. Fol ow-up X-ray film showed al the 35 patients with ankle fracture achieved bone union, the healing time was 10-21 weeks, average 13.6 weeks. Modified Baird-Jackson score system showed excel ent in 11 cases, good in nine cases, average in four cases, poor in one case, and the excel ent and good rate was 85.7%. At 6 months after internal fixation, the stress X-ray film examination showed the mal eolus gap of the affect side was (3.49±0.36) mm, the mal eolus gap of the healthy side was (3.37±0.41) mm, and there was no significant difference (P>0.05). The results indicate anchor in the repair of deltoid ligament injury during the treatment of ankle fracture with open reduction internal fixation can achieve satisfactory therapeutic effect.
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Objective To discuss the treatment strategy of medial collateral ligament and combined injury in the terrible triad of elbow.Methods The data of 21 patients with terrible triad of elbow who received treatment from February 2010 to April 2012 was retrospectively analyized.There are 17 males and 4females with12 cases left and 9 right elbows.The average age of them was 37.6 years (16-57).MRI examination was performed routinely,and used as guidance of treatment strategy of medial collateral ligament and combined injury.For the patients without or with partial damage of anterior bundle of medial collateral ligament(AMCL) injury while the continuity of ligament remains complete in MRI image,exploration and repair of the medial collateral ligament is not conventional.For the patients with MRI image showing AMCL avulsion or body disruption,we routinely used antero-medial approach to explore and repair,suture-anchors were used for suture the bony avulsion of the medial collateral ligament,body disruption of ligament and combined flexor-pronator teres complex injury were also be suture repaired.None of the patients used hinged external fixator during operation.A hinged brace was applied after operation.Results All patients were followed up for an average of 12.4 months (6-26).At the last follow-up,the average range of motion of the elbow was 135.2 ±10.2 degrees,average straight limited degrees,6.7±2.2 degrees,an average of 142±11.0 degrees of flexion.Mayo elbow performance score was 92 points (85-100).17 cases were excellent and 4 were good.Complications included:a transient ulnar nerve palsy in 3 cases,heterotopic ossification in 2 cases,tardive ulnar neuritis in 1 case,no elbow residual instability,dislocation,elbow stiffness and other complications.Conclusion Anterior bundle of medial collateral ligament avulsion or body disruption should be routinely suture repaired,which is in favor of restoring elbow immediate stability favoring restore elbow immediate stability.
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10.3969/j.issn.2095-4344.2013.26.016
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Objective To investigate the reliability of the Three-Column classification for fracture of tibial plateau and compared with the conventional Schatzker classification.Methods From December 2004 to March 2007,304 patients with tibial plateau fracture were treated in our department.The CT scans and 3D reconstruction were performed in all patients before operation.All the patients were classified by the Three-Column classification and then treated with open reduction and internal fixation via the corresponding approaches based on the Three-Column classification.To validate the Three-Column classification,four doctors classified 50 patients which were chosen randomly from 323 consecutive fracture cases.Schatzker classification was also classified at the same time.Inter-observer reliabilities of the Three-Column classification and the Schatzker classification were figured out respectively in the form of Kappa value.Results According to the Three-Column classification,there were 4 pure compression fractures (1.2％),181 one-column fractures(56.0％),108 two-column fractures(33.4％) and 30 three-column fractures (9.3％) in all 323 cases.In one-column fracture cases,the numbers of lateral,medial,and posterior column fractures were 114 (63.0％),53 (29.3％),and 14 (7.7％),respectively.Among two-column fracture cases,the lateral-medial column fractures (33.3％) were 36.While the number of medial-posterior column fractures and lateral-posterior column fractures were 34 (31.5％) and 38 (35.2％),respectively.There was a moderate inter-observer reliability when using Schatzker classification (Kappa=0.567; range,0.513-0.589).There was a substantial interobserver reliability when using the Three-Column classification (Kappa=0.766; range,0.706-0.890).Conclusion The Three-Column classification based on CT and 3D reconstruction is simple and more reliable for fracture of tibial plateau.It is suggested that the new classification system,the Three-Column classification,can be used and popularized in the orthopaedic surgery.
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Objective To explore clinical effect of double-tube continuous negative pressure drainage in the treatment of Morel-Lavallée leision.Methods We retrospectively analyzed the clinical data of 13 patients with Morel-Lavallée leision,which were diagnosed and treated in our hospital from May 2009 to July 2010.They were 11 women and 2 men,aged from 19 to 57 years (average,32.5 years).All patients underwent operations within 3 days after injury,except for 2 patients whose diagnosis was postponed.The operation was performed with small incision and double-tubes were placed for continuous negative pressure drainage.Double-tubes were not removed until effusion was less than 30 ml/24 hours.The heal was defined as no skin necrosis and subcutaneous hydrops at lesion site,no skin floating and sliding at palpation.Results Double-tubes were removed 4 to 12 days postoperatively (average,6.3 day).All of 13 patients were followed up for an average of 13.7 months (range,10 to 18 months).Skin necrosis occurred in 1 patient.Lesions were healed 4 to 10 weeks postoperatively(average,7.2 weeks).No deep infection or delayed hematogenous infection was found.There were no general systematic complications.Superficial infection at wound site occurred in one patient and healed after wound management.Conclusion Application of double-tube continuous negative pressure drainage is a safe,less invasive,low-cost and effective treatment for Morel-Lavallée leision.
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Objective To compare the clinical results of distal clavicular anatomical plates and clavicular hook plates in treatment of distal clavicular fractures.Methods Twenty-six patients with lateral 1/3 clavicular fractures of Craig Ⅱ type Ⅱ or Ⅴ treated from August 2009 to January 2011 were enrolled in the study.Eleven patients were managed by anatomic plates,including eight patients with type Ⅱ fractures and three with type Ⅴ fractures,while the rest 15 patients were treated by clavicular hook plates,including 11 patients with type Ⅱ fractures and four with type Ⅴ fractures.General information of the two groups was comparable before operation.Shoulder function after operation was evaluated by Constant-Murley score system.Postoperative radiographic findings and complications of patients in the two groups were studied comparatively.Results The distal clavicular anatomical plate group presented a lower incidence of shoulder pain and better mobility of shoulder,as compared with the clavicular hook plate group,but there were no significant differences in incision infection and implant loosening between the two groups.According to the Constant-Murley evaluation standard,excellence rates of the distal clavicular anatomical plate group and clavicular hook plate group were 91％ and 73％,respectively.Conclusion The distal clavicular anatomical plate is conducive to decrease of incidences of shoulder pain,increase of range of motion of shoulder and reduction of complications for treatment of Craig Ⅱ type Ⅱ or Ⅴ distal clavicular fractures and hence is in favor of early functional recovery of the limbs.
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Objective To summarize the clinical outcomes of reconstruction of malunited ankle fractures.Methods From January 2006 to October 2009,23 malunited ankle fractures were treated in our department.All deformities were evaluated individually based on pre-operatively X-ray and CT scan.Varying degrees of fibular shortening or rotational deformity were found in all patients,with 4 cases of varus or valgus deformity,and 5 of a widen syndesmosis.Then different reconstructive techniques were chosen according to the type of malunion:a lengthening fibular osteotomy was performed in patients with fibular shortening or rotational deformity;an opening or closing wedge osteotomy was chosen correspondingly in patients with varus or valgus deformity;functional fusion of syndesmosis was performed in cases of widen syndesmosis.The postoperative follow-up included standard radiography to evaluate bone union;relative complications were also recorded and functional outcome were assessed with American Orthopedic Foot Ankle Society (AOFAS)ankle-hindfoot scores.Results Twenty-one patients were followed up with an average period of 36 months (12-58 months).There were no complications of infection,implant failure,nonunion or malunion.Solid union with a favorable alignment was obtained at an average of 12 weeks (10-14 weeks).The mean pre-operative AOFAS ankle-hindfoot score was 28 (15-39).While the score increased to 82 (70-94) one year after operations.But 2 patients underwent ankle arthrodesis correspondingly 18 months and 24 months post-operatively due to severely post-traumatic arthritis.Conclusion An early realignment reconstruction of the length and rotation of fibula and the congruity of ankle mortise may improve the ankle function and slow down the development of post-traumatic arthritis for patients who suffered from malunited ankle fractures.
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Objective To evaluate the effect and potential risks of two types of materials ( taitanum versus polylevolactic acid,PLLA) screws on fixation of distal tibiofibular syndesmosis by a prospective randomized comparative clinical study.Methods From January 2007 to May 2008,48 patients with ankle fractures combined with a verified syndesmotic rupture were randomly allocated to receive either bioabsorbable PLLA (n =28 ) or titanium (n =20) screw fixation.The patients were assessed in aspects of radiography,function recovery and complication during follow-up.Results The total followup rate was 98％.The demographic information of the two groups showed no statistical difference ( P ＞0.05).After 1-2 years of follow-up,the indexes including Baird score,total score,and Baird grade were not statistically different between the two groups ( P ＞ 0.05).At the end of follow-up,there was significant difference in regard of joint motion between the injured and uninjured ankle in both groups ( P ＜0.05).Moderate rejection occurred in two patients and tibiofibular heterotopic ossification in two in PLLA group.Conclusions There is no significant difference between the bioabsorbable and metallic screws with regard to ankle function recovery,but the bioabsorbable screw fixation can avoid a second operation for taking out the screw.However,the complication risk of the bioabsorbable screws should not be ignored,such as rejection reaction,heterotopic ossification.
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ObjectiveTo evaluate the security and effectiveness of minimal invasive fixation with 3D fluoro-images navigation in the management of acetabular fractures.MethodsFrom August 2008 to December 2010,20 patients with acetabular fractures were treated with percutaneous screw fixation under the guidance of 3D fluoro-images based on navigation system after closed reduction.There were 9 males and 11 females,aged 26-54 years old(mean,37.1±1.2 years).Fractures were caused by traffic accident in 15cases,and falling from height in 5 cases.According to AO classification,there were 2 cases of A1.1 type,3 cases of A2.2 type,4 cases of A2.3 type,2 cases of A3.2 type,2 cases of A3.3 type,2 cases of B1.1 type,2 cases of B2.2 type,1 case of B3.1 type,1 case of C2.1 type,1 case of C2.3 type.The interval from injury to hospitalization was 2-46 h (mean,8.6±0.2 h).After 3-14 days of skeletal traction through tibial tubercle,the operation was performed.ResultsTotally 46 screws were fixed.The average time for surgery was(22.6 ±1.2) min per screw.Forty-five screws were placed correctly with a successful rate of 97.8％,only one screw was reinserted for deviation.All the screws were checked by the 3D fluoro-images that they were not in the joint space after fixation.The result was same with CT scan.No incision problem and implant failure occurred.All 20 patients were followed up 12 to 28 months with an average of (22.8±1.7) months.At last follow-up,fracture union was achieved in all patients with satisfactory screw fixation.ConclusionThe minimal invasive fixation with 3D fluoro-images navigation makes the surgery for the nondisplaced acetabular fracture more precise and time-saving,minimize the surgery injury,and improves clinical results without an increasing rate of complications.
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Objective To discuss the value of preoperative C-reactive protein (CRP) and eryth-rocyte sedimentation rate (ESR) in predicting postoperative infections following multiple fractures. Methods A study was conducted in 78 patients with multiple fractures (complicated with pelvic frac-ture, ISS > 18) treated in our department from December 2006 to March 2009. CRP and ESR levels be-fore second damage control operation as well as postoperative infections were recorded. Meanwhile, the optimal cut-off value was determined by receiver operating characteristic curve and analyzed. Results There were 11 patients with postoperative infection. The preoperative optimal cut-off value of CRP was 50 mg/L, with a sensitivity of 0.909 and a specificity of 0.821. The preoperative optimal cut-off value of ESR was 27.5 mm/h, with a sensitivity of 0.818 and a specificity of 0.791. The combination tests showed the sensitivity and specificity of 0.875 and 0.900 respectively. Conclusion CRP (50 mg/L) can be a sensitive predictive index for postoperative infection in the multiple fractures (complicated with pelvic fractures). Combination test of CRP and ESR can benefit diagnosis of postoperative infection.
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BACKGROUND:The treatment of displaced acetabular fractures consists of formal open reduction and internal fixation.However,extensile exposure can lead to a lot of complications Percutaneous screw fixation for acetabukar fractures can decrease these complications Recently developed fluoroscopic-based computerized navigation technology not only allows the surgeon to achieve maximum accuracy of screw fixation but also significantly reduce radiation exposure time.OBJECTIVE:To evaluate the clinical application of the fluoroscopic-based computerized navigation system for percutaneous screwing for acetabular fractures.METHODS:A total of 18 adult patients with 20 non-displaced and displaced acetabular fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system.All acetabular fractures were acetabular anterior column fractures and posterior column fractures,which were fixed by varied hollow screws Static muscle contraction and limited active and passive motion were performed at 2 days,and weight-bearing exercise was performed at 4 weeks after operation.The time of screw implantation,screw position deviation,screw biocompatibility,as well as adverse effect after screw implantation was observed.In addition.d'Aubigne and Postel scoring was used in follow-up.RESULTS AND CONCLUSION:A total of 30 acetabular screws were inserted.The average operation time for per screw was24.1 minutes from the image acquisition to wound closure.The average fluoroscopic time for per screw was 27.6 seconds.Compared to the final position of the screw,the average wire tip error was 1.5 mm and the average trajectory difference was2.25°.One patient sustained a transient femoral nerve palsy which was attribute to reduction clamp inserting from the use of the limited open reduction method rather than screw fixation itself and resolved 2 months after the operation.No evidence was noted of secondary displacement of the fragment or screw failure Using the rating system of d'Aubigne and Postel,13 patients had excellent results,4 patients had good results,and 1 patient had a fair result.The excellent to good rate was 94%All results demonstrated that percutaneous screw fixation of acetabular fractures with fluoroscopy-based navigation can produce excellent results in selected patients with non-displaced and displaced fracture amenable to closed or limited open reduction,which becomes a safe and effective alternative to traditional open reduction and internal fixation for the treatment of certain acetabular fractures.
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Objective To compare and analyze the biomechanical strengths of 4 different fixations for the posterolateral shearing tibial plateau fracture. Methods The posterolateral shearing fracture models were created in 40 synthetic tibia (SYNBONE, right) and randomly assigned into 4 groups. Group A was instrumented with 2 lag screws, group B with anteromedial LC-DCP, group C with lateral locking plate,and group D with posterolateral buttress plate. Vertical displacements of the posterolateral fragments and failure loads were measured under axial loads from 500 N to 1500 N. Results The vertical displacements in groups A, B, C and D were respectively(0. 459 ±0. 045) mm, (0. 365 ±0. 035) mm, (0. 264 ±0. 025)mm and (0. 128 ± 0. 018) mm under axial loads of 500 N, (1. 058 ± 0. 091 ) mm, (0. 882 ± 0. 053 ) mm,(0.551±0.053) mm and (0.440±0.068) mm under 1000 N, and (1.559±0.097) mm, (1.466±0. 079) mm, (1. 291 ±0. 077) mm and (0. 832 ±0. 130) mm under 1500 N. The differences between the 4 groups were statistically significant ( P ＜ 0. 05) . The loads to failure in groups A, B, C and D were respectively (1870 ± 156) N, (2520 ± 186) N, (2816 ± 190) N and (3465 ±210) N. The differences between the 4 groups were statistically significant ( P ＜ 0. 05 ). Conclusion The posterolateral buttress plate may be the biomechanically best fixation method for the posterolateral shearing tibial plateau fracture.
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Objective To discuss clinical outcomes of extraperitoneal pelvic packing (EPP) plus external fixation for hemodynamically unstable pelvic fractures. Methods We used EPP plus external fixation to control 15 cases of hemodynamically unstable pelvic fractures from further damage. They were 6 males and 9 females. Their average age was (44. 0 ± 1.2) (38 to 56) years old. Their injury was caused by a traffic accident (13 patients) and falling from a great height (2 patients). According to the Tile classification,there were 3 cases of type B1, 2 cases of type B2-2, 5 cases of type C1, 3 cases of type C2, and 2 cases of type C3. All the 15 patients were hemodynamically unstable and had a hypovolemic shock. Results There was a statistically significant increase in systolic blood pressure, hematocrit and hemoglobin measured immediately after EPP( P < 0. 05) . However, the units of RBC transfusion significantly decreased( P <0.05) and there were no significant difference in pulse rate( P > 0. 05) . The average operation time was (32.0 ± 2.6) min(30 to 40 min). Five patients died (72. 0 ± 4.2) h after operation ( 1 to 7 d). There was no significant difference between the survivors and the non-survivors in systolic blood pressure, pulse rate,hemoglobin, ISS score, hematocrit and blood transfusion( P > 0. 05). But there was significant difference in age and time between injury and EPP ( P < 0. 05). Conclusions In emergency treatment of patients with the hemodynamically unstable pelvic fracture, especially those combined with hypovolemic shock, EPP plus external fixation can effectively control the massive venous (presacral venous plexus) and bone hemorrhage.The blood pressure and pulse rate can be restored by fluid replacement and blood transfusion. Consequently,this method may significantly improve the hemodynamical parameters and decrease the mortality.
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A total of 12 cases with Achilles tendon rupture were repaired by modified Kessler's methods.The sutured tendons were then strengthened with Mitek anchor system with 2 anchors inserted into the calcaneus lateral and medial to insertion of Achilles tendon and the sutures passed through the repaired tendon using Bunnel methods.The healing of skin incision,time to weight bearing,range of motion of the ankles,calcaneal pain and re-ruptures were recorded.The results were evaluated according to Amer-Lindholm criteria.All the patients were followed up with mean 17 months (range from 14 to 25 months).There were no calcaneeal pain or re-rupture cases,neither deep nor superficial wound infection or skin necrosis cases.According to Arner-Lindholm criteria for curative result,the result was excellent in 4 cases and good in 8 cases.The Mitek anchor system can be used successfully to treat Achilles tendon rupture and decrease postoperative complications.Thus,the technique is an ideal option for Achilles tendon rupture repair.
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Objective To analyze the effect of meniscus tear on prognosis of tibial plateau fracture and the effect of fracture on meniscus healing by comparing the outcomes of simple tibial plateau fractures and the fractures combined with meniscus injury. Methods A retrospective analysis was conducted in 57 cases of tibial plateau fractures treated with internal fixation in our hospital from January 2004 to June 2006. Twenty-three of them were complicated with meniscus tear and received repairing. Knee joint functions were evaluated by the HSS (The Hospital for Special Surgery) score. The menisci were examined by Joint-line tenderness, McMurray, Apley and Thessaly tests. The femorotibial angle (FTA), tibial plateau angle (TPA) and posterior slop angle (PA) were measured on X-ray images. Results Fifty cases were followed up for an average Of 15 (6 to 24) months. The HSS scores for the simple tibial plateau fracture and the tibial plateau fracture combined with meniscus tear were 87.9 and 87.1, respectively. There were no statistical signifi-cances in HSS score(t=0.351, P=0.727), FTA, TPA and PA results between the 2 groups. No more positive physical signs of meniscus tear were found in the group of tibial plateau fracture combined with meniscus tear than in the other group. Conclusions Meniscus tear may not affect the postoperative re-habilitation of the knee joint with tibial plateau fracture; neither is there evidence that tibial plateau fracture may hinder meniscus healing.
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Objective To discuss the effect of damage control applied for an earthquake pelvic fracture. Methods One case of pelvic fracture in the 5.12 Wenchuan earthquake was treated by damage control in May, 2008. The patient was managed with anti-shock measures and temporal fixation of fracture in the first stage and minimally invasive surgery under fluoro-navigation system in the second stage. Results After two-stage damage control, the patient obtained stable vital signs, satisfactory reduction and internal fixation with no complications. Conclusion Damage control strategy for the earthquake pelvic fractures can improve the survival of patients and decrease their complications.