ABSTRACT
Objective To investigate the procedures and effects of surgical treatment for double disruption of the superior shoulder suspensory complex (SSSC).Methods Twenty-nine cases of double disruption of SSSC treated from January 2007 to October 2011 were enrolled in the study.There were 19 males and 10 females,at a mean age of 36 years (range,25-49 years).Injury causes included traffic injury in 25 cases and fall from height in 4.An open reduction and internal fixation was performed in 18 cases of scapular neck fracture combined with clavicular fracture,2 cases of scapular neck fracture combined with acromion fracture,2 cases of distal clavicular fracture combined with acromion and glenoid cavity fracture; hook plate fixation and ligament repair were performed in 3 cases of complete dislocation of acromioclavicular joint combined with complete disruption of coracoclavicular ligament ; open reduction and internal fixation and ligament repair were performed in 3 cases of scapular neck fracture combined with acromioclavicular joint dislocation and 1 case of clavicular fracture combined with coracoclavicular ligament disruption.Results All cases were followed up for a mean period of 11.5 months (range,6-30 months).Anatomic reduction of fractures was achieved for all cases and mean healing time was 8.4 weeks (range,7-12 weeks).Mean Constant-Murley score was 91 points (range,72-100 points),which indicated excellent results in 13 cases,good in 11,fair in 5,with excellence rate of 83％.ConclusionBased on the complex anatomic structure of the double disruption of SSSC,surgical management should focus mainly on respective fixation of the double injuries,which leads to good stability and therapeutic outcome.
ABSTRACT
Objective To evaluate the method and curative effect of reconstruction with vascularized or nonvascularized autogenous fibular transplantation of radiocarpal joint after en bloc excision of giant cell tumor of distal radius.Methods Seventeen cases with giant cell tumor of distal radius bone were treated by en bloc resection and reconstruction of wrist joint with vascularized or non-vascularized autogenous fibular transplantation.Postoperative wrist joint function and radiographic outcomes were evaluated.Results Seventeen cases were followed up from 2.0 to 5.5 years (average 3.6 years).Three cases were treated by peroneal artery anastomosis and other 3 cases by inferior lateral genicular artery anastomosis.All cases achieved primary healing of incision and the radial average length that was en bloc excised was 7.6 cm.All of the transplanted fibulas were healed well.The bone healing average time of the vascularized fibular graft was 3.7 months,while that of the non-vascularized fibular graft was 7.9 months.No tumor recurrence or lung metastases was observed during the follow-up,but 1 wrist joint was narrowed and another had degeneration of the wrist.After 2 years of surgery,the average range of motion of the wrist joint was as follows:dorsiflexion 47°,flexion 30°,ulnar deviation 23°,radial deviation 14°,pronation 55°,supination 62°.The grip force was from 40％ to 80％ of the contralateral upper limb.The MSTS score averaged 87.6 ％ with 6 excellent,eight good and 3 satisfactory results.Disabilities of the Arm,Shoulder,and Hand (DASH) questionnaire score averaged 3.48.Conclusion The method of autogenous fibular transplantation and reconstruction of radiocarpal joint after en bloc excision of giant cell tumor of distal radius can save the wrist joint function in a certain extent.It is an effective method of the wrist joint function reconstruction and beneficial to bone healing with vascularized transplantation which has less complications.
ABSTRACT
Objective To analysis the medium and long term effects of the quadratus femoris muscle pedicle bone graft with screw internal fixation for the treatment of femoral neck fractures in adults.Methods From March 2003 to December 2008,sixty-two patients with femoral neck fractures were operated.There were 50 males and 12 females,with an average age of 39 years (ranged from 16 to 62 years).Fifteen cases suffered from traffic accidents and 47 from falling injury.There were 8 cases which fracture site was infer-head in Garden type Ⅱ,twenty-nine cases in type Ⅲ and 25 cases in type Ⅳ.The average time were 12 hours (2-96 hours) from injured to hospital admission and 4 days (2-8 days) from injured to operation.Partial weight bearing started on 3 months postoperatively and full weight bearing on 6 months.The postoperative duration of follow up was 3 to 5 years in 39 cases.Healing of fractures and avascular necrosis of the femoral head were evaluated based on the X-ray results or MRI if necessary.The pain,function,deformity,range of motion were evaluated based on Harris joint function scores.Results Nonunion of fracture was noted in 2 cases during the follow-up period.The fracture healing rate was 96.8％.The avascular necrosis of the femoral head was noted in 6 cases (15.4％).There were statistical significant differences between 3 months of postoperation and 3 years of postoperation in the pain,function,deformity,range of motion.After 3 years of postoperation,there were excellent in 29 cases,good in 6 cases,general in 1 case,poor in 3 cases according to Harris joint function scores.Conclusion This technique is relatively simple and has high rate of fracture healing.The avascular necrosis of the femoral head rate is low.The medium-and long-term results are satisfactory.