ABSTRACT
[Objective]To evaluate surgical treatment and curative effect of intercondylar humeral comminuted fractures.[Method]Twenty-one cases of intercondylar humeral comminuted fractures were collected from February 2001 to December 2005. The fractures were classified to 5 cases of C1,9 cases of C2 and 7 cases of C3 according to the AO classification.Seventeen fractures were internal fixed by open-reduction, and 4 fractures were treated by total elbow replacement. After olecranon osteotomy, capitate eminence and trochlea humerus were reducted and fixed with bone screw,while shaft of humerus and the distal end of humerus were fixed with AO double plate or Y-shaped plate in internal fixed group. Early physiotherapy were started as soon as possible. The elbow replacement group were replaced by semi-restriction elbow prosthesis and fixed with cemente following physiotherapy after 4 to 7 days.[Result]forteen of 17 cases were postoperatively followed-up in internal fixed group from 12 to 44 months, and all cases had been visited for 14 to 36 months in elbow replacement group. According to modified Cassebaum scoring system, 71.4% were good in internal fixed group and 100% in elbow replacement group.[Conclusion]It has good curative effect in intercondylar humeral comminuted fractures with olecranon osteotomy, the AO double plate or Y-shaped plate internal fixation and early physiotherapy. With severe injury of the distal end of humerus, obviously osteoporosis and older than 50 years, the total elbow arthroplasty and replacement are preferred.
ABSTRACT
[Objective]To study the diagnosis and treatment of sacral fracture accompanied by neurological damage.[Method]Twelve patients with sacral fracture accompanied by nerve injuries were treated and analyzed during 1999 to 2004,including 9 males and 3 females. Final diagnosis was given according to the evaluation of physical examination,X-ray,CT and MRI examinations. Dennis classification found 2 cases of I type,6 cases of Ⅱ type and 4 cases of Ⅲ types.The surgical approach of these patients were selected according to the Dennis classification,Type Ⅰ and type Ⅱ were treated with conservative methods,and operations were taken if little symptom was no or a little improved. Posterior approach enlargement for sacral nerve canal,exploration and endoneurolysis on sacral nerve were performed on type Ⅲ as early as possible.Old fracture of type Ⅱ and type Ⅲ with neurologic signs had to be operated early.Conservative and operative treatments were taken 7 and 5 respectively.[Result]After six months to three years following up,two cases of Denis type Ⅰ,six cases of Denis type Ⅱ and one in four Denis type Ⅲ cases were recovered completely.Two cases of Denis Ⅲ were improved significantly while one case was improved a little.[Conclusion]The anatomical position of sacrum is not conspicuous and the symptom caused by neurological damage is too tiny to detect.Carefully physical examination combined with image analysis is necessary to elevate the rate of final diagnosis.Different surgical treatments were used to different type of sacral fracture. Posterior approach enlargement for sacral nerve canal and exploration and endoneurolysis on sacral nerve may be an ideal choice to treat sacral fracture accompanied by neurological damage.Nerves injuries is an critical operation indication for delayed sacral fracture.