Arthroscopy-assisted treatment of severe comminuted distal radial fracture using external fixators / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the outcomes of arthroscopy-assisted treatment of severe comminuted distal radial fracture with external fixators and kirschner wire fixation.</p><p><b>METHODS</b>Twenty-seven cases of severe comminuted distal radial fracture treated between March, 2010 and January, 2012 were reviewed. During the operation, the carpal joint space was expanded with the external fixator, and the fracture was fixed by Kirschner wire after open reduction. The carpal joint was observed intraoperatively with arthroscopy to ensure full reduction, and the distal posterior interosseous nerve was then severed. The results of postoperative X-ray and wrist functional status of the carpal joints were recorded. Another 27 cases of severe comminuted distal radial fracture treated by conventional surgical approach served as the control group.</p><p><b>RESULTS</b>The patients were followed up for a mean of 13.2 (5-27) months. Compared with the conventional surgical approach, arthroscopy-assisted treatment resulted in a significantly shorter operative time with better appearance of the articular surface and also better wrist function assessed using the Krimmer system (P<0.05).</p><p><b>CONCLUSION</b>Arthroscopy-assisted external fixator treatment is effective for management of severe comminuted distal radial fracture and avoids the stair-like appearance of the articular surface to achieve the maximal functional recovery of the carpal joints and reduce traumatic arthritis.</p>

Marginal compression fractures of acetabular posterior wall with posterior dislocation of hip / 中华创伤骨科杂志

Objective To explore the diagnosis and treatment of marginal compression fractures of acetabular posterior wall with posterior dislocation of hip. Methods Eleven patients with marginal compression fractures of acetabular posterior wall and posterior dislocation of hip were retrospectively reviewed. Their conditions were all confirmed by CT scan before operation. AH the patients were treated by ORIF (open reduction with internal fixation) and the compressed bones were elevated with bone grafts. All the fractures were fixed with reconstruction plating. Results The mean follow up was 32. 4 months (5 to 56 months) . The results of modified d'Aubigne and Postel score system were excellent in four patients, good in four, fair in two, and poor in one. The good to excellent rate was 72. 7%. Conclusion It is likely for patients with fractures of acetabular posterior wall and posterior dislocation of hip to have marginal compression fracture which can be definitely diagnosed by CT scan preoperatively. Good results can be obtained by elevating part of the compressed marginal bone with bone grafting, because it can improve the reduction of acetabulum and femoral head.

Treatment of intertrochanteric fractures with dynamic hip screw and cannulated screws / 中华创伤骨科杂志

Objective To discuss the application value of DHS and cannulated screws in treatment of the intertrochanteric fractures . Methods 23 cases of intertrochanteric fractures were treated with DHS and cannulated screws and 20 cases were followed up for an average period of 12 months. Results All the fractures healed . The recovery of function was excellent in 90%cases. Conclusions Using DHS and cannulated screws to treat the intertrochantenic fractures easily leads to anatomical reduction and rigid fixation, and gives large definitive rotational stability.

Application of anterior approach video-assisted thoracoscopy in thoracic and upper lumbar spine / 中国微创外科杂志

Objective To discuss the feasibility of application of anterior approach video-assisted thoracoscopic surgery (VATS) in thoracic and upper lumbar spine. Methods In the study there were: 5 patients with tuberculosis of thoracic or lumbar spine (T 6 ～ L 2) undergoing thoracoscopic cleaning of focus,with or without bone grafting; 3 patients with vertebral burst fracture ( T 10 ～ T 12 ) and 1 patient with old burst fracture (L 1) accompanied with cauda equina syndrome undergoing thoracoscopic decompression,bone grafting and plate screw internal fixation; 1 patient with intervertebral disc protrusion (T 3 ～ 4 ) accompanied with spinal compression receiving thoracoscopic decompression and spondylodesis. Results The incisions in all the patients healed by first intention.CT or MRI examinations revealed that: the foci had been cleaned thoroughly and the spinal cords had been decompressed completely; the reduction was satisfactory,except for 1 patient with slight angulation deformity; the internal fixation was stable,with proper position. Conclusions VATS focus cleaning is suitable for patients with diseases in thoracic or upper lumbar spine,regardless of whether there is compression of spinal cord or cauda equine or not,and,if necessary,spinal decompression,anterior bone grafting,or internal fixation may be conducted simultaneously.

Treatment of thoracolumbar burst fractures with video-assisted thoracoscopic surgery transdiaphragmatic approach / 中华骨科杂志

Objective To explore the feasibility and clinical effect of the video-assisted thoracoscopic surgery transdiaphragmatic approach in the management of thoracolumbar burst fractures. Methods 22 patients with thoracolumbar burst fractures were managed by the video-assisted thoracoscopic surgery transdiaphragmatic approach from September 2002 to September 2004. There were 15 males and 7 females, and the age of the patients were from 28 to 71 years with an average of 39 years. The fracture located at T11 in 2, T12 in 10 and L1 in 10. The states of preoperative neurological function were complete paraplegia in 7 cases and incomplete paraplegia in 15 cases. All cases were treated with anterior decompression, autograft and internal fixation with anterior plate fixation systems. Results The average operation time was 230 mins (180 to 320 mins). The average blood loss was 900 ml (500 to 2000 ml). An average followed up period was 19.5 months (9 to 35 months) in all patients. The fracture fragments were cleaned thoroughly and the vertebral canal were decompressed entirely showing on CT films. All patients had successful fusion with an average of 3.8 months. One fixing screw was penetrated into intervertebral space in 1 case. It had been recorrected under a fluoroscopic machine. One case was complicated leakage of cerebrospinal fluid and cured after one week in a prone position. No pleural effusion, pneumothorax and diaphragmatic herniations encountered. 4 cases with complete paraplegia didn't show any improvement, 14 cases had improved obviously in the function of the spinal cord. Conclusion The video-assisted thoracoscopic surgery transdiaphragmatic approach in the management of thoracolumbar burst fractures was feasible, for satisfactory vertebral canal decompression, graft and internal fixation. Diaphragmatic opening and repair can be accomplished safely and effectively without special endoscopic instrumentation. It also precludes the need for retropleural-retroperitoneal and open thoracoabdominal approaches and thus avoids the associated significant morbidity.