ABSTRACT
Objective:To evaluate antegrade interlocking intramedullary nails combined with less invasive stabilization system (LISS) in the treatment of femoral fractures (Lambiris type Ⅲ or Ⅳ).Methods:The clinical data of 27 patients were retrospectively analyzed who had been treated for femoral fractures of Lambiris type Ⅲ or Ⅳ at Department of Orthopedic Surgery, Wuhan Fourth Hospital from February 2015 to May 2019. They were 21 males and 6 females, aged from 22 to 57 years (average, 41.3 years). According to the Lambiris classification, 24 cases were classified as type Ⅲ (17 as type Ⅲa, 5 as type Ⅲb and 2 as type Ⅲc) and 3 cases as type Ⅳ. The time from injury to operation ranged from 2 to 9 days (average, 4.3 days). All the fractures were fixated with anterograde femoral interlocking nails and femoral LISS. Recorded were operation time, intra-operative blood loss, hospital stay, bone healing time, and Harris hip score, Hospital for Special Surgery (HSS) knee score and complications at the final follow-up.Results:In this cohort, operation time averaged 2.1 h (from 1.8 to 2.5 h), intraoperative blood loss 361 mL (from 310 to 480 mL), and hospital stay 15.1 d (from 11 to 18 d). All the 27 patients were followed up for 13 to 38 months (average, 25.3 months) after operation. All the fractures united well after an average duration of 29.2 weeks (from 28 to 36 weeks). By the Harris hip scores at the final follow-up, the hip function was evaluated as excellent in 18 cases, as good in 6 and as acceptable in 3, giving an excellent and good rate of 88.9%(24/27); by the HSS knee scores at the final follow-up, the knee function was excellent in 16 cases, good in 7 and acceptable in 4, giving an excellent and good rate of 85.2%(23/27). Follow-ups observed no fracture nonunion, malunion, refracture, internal fixation failure or other complications.Conclusion:In the treatment of femoral fractures of Lambiris type Ⅲ or Ⅳ, antegrade interlocking intramedullary nails combined with LISS has advantages of rigid fixation, a high rate of fracture union, limited complications, and good functional recovery.
ABSTRACT
Objective To investigate the relationship between volume of fracture fragment and surgical methods in patients with radial head fracture.Methods A retrospective study was conducted of the 60 patients with radial head fracture of Mason type Ⅲ who had been admitted to the Department of Hand Surgery,Wuhan Pu'ai Hospital from January 2013 to December 2016.They were 28 males and 32 females,aged from 26 to 71 years (average,54.5 years).Of them,41 underwent open reduction and internal fixation (incision group) and 19 radial head replacement (replacement group).The volumes of radial head and fracture fragment were measured by CT scan and three-dimensional reconstruction of the elbow joint before operation.A volume-weighted ratio R corresponding to a specific radial head fragment was calculated.Correlation between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score was calculated.At the last follow-up,the Broberg-Morrey elbow function score was used to assess the efficacy and complications were recorded in the 2 groups.Results All the 60 patients were followed up for 20 to 36 months (mean,28.6 months).At the last follow-up,the Broberg-Morrey elbow function score was 86.5 ±1.3 points (from 72 to 91 points) for the incision group and 93.6 ± 1.4 points (from 78 to 95 points) for the replacement group;the complication rate was 17.1％ (7/41) for the former and 15.8％ (3/19) for the latter.There was a linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the incision group.The linear regression equation between the two was:y=65.63+0.67x (R2=0.85,P=0.0006).There was no linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the replacement group (P =0.053).When the Broberg-Morrey elbow joint function score (93.6 points) for the replacement group was substituted into the linear regression equation y =65.63 + 0.67x (y =93.6),x =41.7.Conclusions In the patients with radial head fracture of Mason type Ⅲ,open reduction and internal fixation may lead to a better prognosis for those with a volume ratio ≥41.7 between the radial head and fracture fragment while radial head replacement may lead to a better prognosis for those with a volume ratio ＜41.7 between the radial head and fracture fragment and for those elderly ones with osteoporosis.