ABSTRACT
Objective To report the treatment effects of open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision on closed calcaneal fractures.Methods A retrospective study was done of the 20 patients (25 feet) who had been treated at Ward One,Department of Orthopaedics,People's Hospital of Yunfu from February 2016 to February of 2019 for closed calcaneal frac-tures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision.They were 16 males and 4 females,aged from 16 to 60 years.According to the Sanders classification,there were 3 cases of type Ⅱ,15 cases of type Ⅲ and 2 cases of type Ⅳ.Their fractures were reduced by traction,extruding,prying and direct visualization through the tarsal canal window;the bone plates were inserted through a small incision at the back of the heel and fixated by screws.Postoperative observation was done to address fracture healing,and length,width,height,B(o)hler angle and Gissane angle of the affected calcaneus,as well as functional recovery of the ankle-hindfoot by the American Orthopaedic Foot and Ankle Society (AOFAS) evaluation.Results The operation time for a single foot ranged from 45 min to 70 min,averaging 64.5 min;the intraoperative fluoroscopy for a single foot ranged from 3 times to 6 times,averaging 4.5 times.Local skin necrosis of about 0.5 cm x 0.3 cm appeared in one foot after operation but responded to dressing change.No other wound complications occurred.Their follow up was carried out for 6 to 36 months (average,17.3 months).The fractures healed well with well-shaped bony callus and flat articular surface after 4 to 6 months.The length (80.5 mm ±4.2 mm),width (44.8 mm ±5.2 mm),height (44.4 mm ±3.0 mm),B(o)hler angle (25.0° ± 5.1 °) and Gissane angle (113.8 ° ± 8.6°) of the calcaneus at the last follow up were significantly improved than the preoperative values (79.4 mm ± 4.5 mm,50.5 mm ± 6.3 mm,40.0 mm ±4.4 mm,12.0°± 13.8° and 107.0°± 13.3°) (all P ＜ 0.05).By the AOFAS ankle-hindfoot scale,functional recovery of the foot was excellent in 20,good in 3 and fair in 2 cases,giving an excellent to good rate of 92％.Conclusion In the treatment of closed calcaneal fractures,open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision may lead to fine outeomes due to its advantages of small incision and fine fracture reduction.
ABSTRACT
Objective To analyze the clinical efficacy of lateral elbow approach combined with anterior median approach in the treatment of terrible triad of elbow.Methods Retrospectively analyzed 20 patients of terrible triad elbow who were admitted into our hospital from April 2012 to January 2015 and treated with lateral elbow approach combined with anterior median approach.The postoperative recovery of arthrosis,forearm rotation range,and range of motion were evaluated by Mayo score system.Results All patients wounds were with primary healing.There were 11 cases of excellent and 4 cases of good through Mayo score system,with the good rate of 75％.At the final follow-up,the range of motion was (122.06 ± 24.17) ° and the forearm rotation was (136.28 ± 8.9) °.Conclusion Lateral elbow approach combined with anterior median approach for the treatment of terrible triad of elbow has clear visual field,excellent surgical rate,without complications such as elbow instability and nerve damage.
ABSTRACT
Objective To explore the belongingness,name and clinical significance of a sort of osteal structure variation (OSV) posterior,outboard and superior to the ditch of vertebral artery of atlas.Methods 23 cases of OSV were collected among 426 patients underwent MSCT intracranial and cervical angiography with volume rendering technique (VRT)to notice the pier point,shape and direction of protuberance,and the relation and influence to the vertebral artery.Results The incidence of OSV was 5.40%(23/426) in which 31 sides were detected,and 1 5 cases in unilateral and 8 cases in bilateral.Simple type was showed at 1 9 sides,compound type at 12 sides with other ponticulus.According to the shape of the ponticulus,simple root was seen at 1 7 sides(13 inferior root and 4 lat-erial root),opposite beaked at 5 sides,complete type at 9 sides.OSV was located at posterior,outbord and superior to the ditch of vertebral artery of atlas and closed to the vertebral artery.The vertebral artery was influenced by OSV as following:in simple OSV vertebral artery stenosis was seen at 4 sides in which unite convulsion was showed at one side;in compound OSV vertebral artery ste-nosis was seen at 5 sides,in which unite convulsion was showed at 2 sides.Conclusion OSV is similar to ponticulus posticus(PP)and ponticulus lateralis(PL),and has similarly importance clinical significance,and should belong to the ponticulus of atlas,and to be named as ponticulus borderland(PB).