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Objective To investigate the operative indications and operation techniques for augmentative plate fixation in treatment of femoral shaft atrophic nonunions subsequent to intramedullary fixation. Methods Twelve femoral nonunions after internal fixation with intramedullary nailing were treated with augmentative plate internal fixation and bone graft from June 1999 to June 2008. All femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all the patients during operation. Minimally invasive removal of the granulation tissue at fracture site and the sclerotic bone was dccorticated. The adequate lilac bone was tiled longitudinally on the nonunion gap and the cortical bone bed. The fixation involved the limited-contact dynamic titanium plate with 5-6 holes, 3.0 mm Kirschner wire and 4-6 double cortex cortical screw fixation.Protective weight-bearing was given after surgery and the tunction was evaluated at 1,3, 6 and 12 months with imaging. Results All patients were followed up for 7-26 months ( average 17.4 months), which showed radiological solid union (7-12 months, average 9.4 months) and clinical union (5-9 months, average 7.1 months ). The operation lasted for 50-120 minutes ( average 77.5 minutes), with blood volume of 150-350 ml ( average 252 ml). There were nine patients with bone pain, of whom the pain was relieved within one month in seven patients and three months in two. No infection, hardware loosening or breaking were found. Conclusion The plate augmentation and cancellous bone grafting leaving the nail in situ can be an effective solution for nonisthmal femoral nonunion, bone defect and failed exchange nailing.
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ObjectiveTo compare the outcomes and indications between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for femoral shaft hypertrophic nonunion after femoral nailing. MethodsFrom April 1998 to June 2009, 20 patients with femoral shaft hypertrophic nonunions after femoral nailing were treated with EN (11 patients) and AP (9 patients) respectively. There were no significant differences between the two groups with respect to the patient's age, gender, associated injuries, anatomical location and type of femoral fracture. Patients were evaluated by imaging and clinical function at 1, 2, 3, 4,6, and 12 months after surgery, and then every year postoperatively, to observe the callus and the recovery condition of the affected limb function. Fisher exact test and t'-test were performed to compare the outcome and complications respectively. ResultsAn unpaired t'-test showed no significant differences with respect to follow-up time, operating time, intraoperative blood loss, postoperative drainage, length of stay, time to radiographic union, time to clinical union, and AAOS score between the two groups. The cost of hospitalizations in the EN group was higher than in the AP group(t'=16.4, P=0.013). Four nonunions in the EN group failed to achieve union, which 3 patients were subsequently treated with AP and simultaneous autogenous bone grafting and 1 patient was treated with nail dynamization. All 9 hypertrophic nonunions in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP (χ2=6.01 ,P=0.008). ConclusionEN has been an excellent choice for aseptic isthmal femoral nonunion without a large bone defect subsequent to intramedullary fracture fixation, and AP can be an effective solution in cases of nonisthmal femoral nonunion and bone defect and failed exchange nailing.
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Objective To study the clinical results of early surgery for acute cervical spinal cord injury. Methods 24 cases of acute cervical spinal cord injury were treated with early surgery in our hospital from 1999 to 2002. The average interval from injury to surgery was 67 hours. The injured cervical segments were reduced, decompressed and fixed through anterior approach, posterior approach or anterior posterior approach. Results 22 cases got follow ups of 12 to 38 months (mean 18 months), but 2 cases were lost. 2 cases of the 11 patients of ASIA Grade A did not experience any restoration, but all the other patients got significant restoration and an average improvement of 1.8 ASIA grades. Conclusion Operation should be performed as soon as possible for acute cervical spinal cord injury, for good results can be achieved by early surgery.
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Objective To discuss the clinical effects of open reduction and internal fixation with locking compression plate(LCP)to treat elderly women with comminuted distal radius fracture.Methods 32 elderly women(35 sides)with comminuted distal radius fractures were treated by open reduction and internal fixation with LCP from March 2002 to October 2004 in our department.Their mean age was 65 years old.According to AO classification,11 sides were type A3,15 sides type C2 and nine sides type C3.Volar approach was used in 32 sides and dorsal approach in three sides.Bone graft was applied for five sides.Results The follow-up period was 10 to 41 months(mean 21.5 months)and the union period was three to five months.According to Dienst criteria of joint functions,the result s showed that 13 sides were excellent,19 sides good,two sides fair and one side poor.Complications included wound dehiscence and superficial infection in five sides and median nerve injury in two sides.Conclusion The LCP method in this study is one of the good options to treat elder women with comminuted distal radius fractures.
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10?) and delayed union of tibia in 4 sides. Conclusion Many factors can affect the prognosis of tibial Pilon fracture, but the key points for a successful operation are right procedure and timing of surgery.