Endobutton and cortical screw fixation for the treatment of distal tibiofibular syndesmosis separated / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the treatment effect of Endobutton plate cable system for the treatment of the distal tibiofibular syndesmosis injury.</p><p><b>METHODS</b>Total 38 patients with tibiofibular syndesmosis separation treated by surgical operation from October 2011 to October 2013 were analyzed retrospectively. According to internal fixation, 38 cases were divided into two groups involving group A (cortical screw fixation) and group B (Endobutton plate cable system fixation). In group A, there were 26 patients including 16 males and 10 females with an average age of (37.90±4.67) years old ranging from 19 to 63 years old; 14 cases were on the left and 12 on the right;involving 8 cases of Weber-Denis type B, 18 cases of Weber-Denis type C; according to Lauge-Hanson typing, 9 cases of supination external rotation (SER), 10 cases of pronation abduction (PAB), 7 cases of pronation external rotation (PER). In group B, there were 12 cases including 7 males and 5 females, with an average age of (38.70±6.03) years old ranging from 20 to 55 years old;6 cases were on the left and 6 cases on the right;involving 4 cases of Weber-Denis type B and 8 cases of Weber-Denis; involving 7 cases of PER, 3 cases of SER, 2 cases of PAB. The operative time, intraoperative blood loss, surgery cost, hospital stay time, the wound healing, pain score at 1 month after operation, and the load time were recorded and evaluated. According to reviewing of X rays regulary, the healing of fracture were assessed, the function outcomes of ankle was evaluated according to the Ankle Hind Foot Scale of American Orthopaedic Foot and Ankle Society.</p><p><b>RESULTS</b>All patients were followed up for 8 to 18 months with an average of 13.5 months. There were no statistical significance in intraoperative blood loss, hospital stay time, average load time and postoperative pain score at 1 month after operation between two groups (>0.05). Duration of operation, the operative time were significantly shorter in cortical screw group;however, the average cost of hospitalization was significantly higher in Endobutton group. No significant differences were found between two groups in outcome of radiographic measurement. The X rays of 36 patients showed well healing of fracture, normal mortise and no distal tibiofibular syndesmosis separation. AOFAS score at the final follow up in group A was (87.50±8.67) scores, 18 cases got excellent result, 4 cases were good, and 4 cases were fair. AOFAS score at the final follow up in group B was (86.23±7.42) scores, 7 cases obtained excellent result, 4 cases were good and 1 case was fair; AOFAS score between two groups were no significant difference (>0.05).</p><p><b>CONCLUSIONS</b>Endobutton plate cable system is a dynamic capital equipment in treating the tibiofibular syndesmosis separation, it has a similar outcome compared with the screw, but without screw fractured and do not regular remove after operation. The patients could take the functional exercises earlier.</p>

Comparison of different diameter hollow screw for the treatment of femoral neck fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate and compare the outcome of two kinds of diameter hollow screws for the treatment of femoral neck fractures.</p><p><b>METHODS</b>From June 2008 to June 2013, 117 patients with femoral neck fractures were treated by closed reduction and hollow screws fixation. Among them,48 patients were fixed by 6.5 mm screw including 30 males and 18 females with an average age of (45.61 ± 11.99) years old ranging from 19 to 60 years old, involving 17 cases in Garden I/II and 31 cases in Garden III/IV; 69 patients were fixed by 8.0 mm screw including 40 males and 29 females with an average age of (45.17 ± 9.95) years old ranging from 18 to 60 years old, involving 31 cases in Garden I/II and 38 cases in Garden III/IV. The general information, operative time, hospital stay time, reduction quality, diameter of femoral head and neck, fracture healing time, the rate of fracture healing, postoperative complications were recorded and evaluated. Harris scoring was used to evaluate the hip joint function.</p><p><b>RESULTS</b>All patients were followed up for 19.6 months (18 to 24 months). The difference of operative time, duration of hospitalization, quality of reduction were not statistically significant (P > 0.05). There was no difference between two groups about the average diameter of the femoral head and neck, the fracture healing time, the rate of healing and the postoperative complications (P > 0.05). There were no difference between two groups about Harris scale. There were significant difference between Garden III/IV and I /II (P > 0.05).</p><p><b>CONCLUSION</b>Closed reduction and internal fixation with hollow screw in treating the young adult patients with femoral neck fracture is the first choice, both different diameters hollow screws could meet the requirements of fixation of femoral neck fracture, and not affect on fracture healing time and postoperative complications.</p>

Comparison of three fixation methods for the treatment of tibial fractures in adolescents / 中国骨伤

<p><b>OBJECTIVE</b>To explore the fixation methods in treatment of tibial fracture in adolescents by comparing the results and complications of three fixation methods and to determine the factors related to those complications.</p><p><b>METHODS</b>From January 2007 to January 2012, 83 diaphyseal tibial fractures in 79 adolescents were treated with elastic stable intramedullary nail fixation, plate fixation, or external fixation respectively. There were 55 males and 24 females with an average age of 13.9 years (ranging from 11 to 17.6 years). Outcomes were compared in terms of the hospital stay,time to union, complications, and reoperation rates.</p><p><b>RESULTS</b>All patients were followed up for 15.8 months in average. The time to union was significant associated with the pattern of fixation, energy of the injury, multiple and open fracture. The time of bone union of external fixation group was longer than that of elastic stable intramedullary nail fixation and plate fixation groups. But complication rates of external fixation group were higher than that of elastic stable intramedullary nail fixation and plate fixation groups. Four patients were treated with elastic nail fixation underwent a reoperation (loss of reduction in 2 cases, delayed union and nonunion in each 1 case). Six patients were treated with external fixation required a reoperation (loss of reduction in 3 cases, malunion in 2 cases, and replacement of a pin canal infection in 1 case). Two fractures were treated with plate fixation required refixation following nonunion and malunion. A multivariate analysis with adjustment for baseline differences showed external fixation to be associated with a 7.56 times (95% confidence interval=3.74 to 29.87) greater risk of loss of reduction and (or) malunion than elastic stable intramedullary nail fixation. At the final follow-up,there were agreeable results among three groups and no significant differences among them in final therapeutic effect (P>0.05).</p><p><b>CONCLUSION</b>External fixation for treatment of tibial fracture in adolescents has the highest rate of complications than the other two fixation methods. Elastic stable intramedullary nail fixation can achieve the same effect of other fixed system and avoid most of the complications. Operation method choice depends on the experience of doctors and patients' basic situation and the fracture types.</p>

Biomechanical comparison of Evans procedure and Chrisman-Snook technique for the treatment of II degree lateral collateral ligament of ankle joint / 中国骨伤

<p><b>OBJECTIVE</b>To measure the stability of Evans procedure and Chrisman-Snook technique in the treatment of II degree lateral collateral ligament of ankle joint, and provide basis for treatment and prognosis.</p><p><b>METHODS</b>From July 2008 to June 2009,18 frozen corpes were collected, including 10 males and 8 females, with an average age of fresh 39.3 +/- 11.2 years. The frozen corpes were randomly divided into three group, including normal controls(group A), Evans procedure (group B) and Chrisman-Snook technique ( group C), 6 specimens in each group. Anterior talofibular ligament and calcaneofibular ligament were cut off to cause II degree lateral collateral ligament in group B and C. Evans procedure or Chrisman-Snook technique were applied to restore lateral collateral ligament, and measure biomechnics. The displacement of tibiotalar joint and subtalar joint were observed.</p><p><b>RESULTS</b>(1) The lateral stress results of tibiotalar joint showed the displacement by Evans procedure (group B) was greater than other groups (P < 0.0001). There were no significant differences between group A and C (P > 0.05). (2) The lateral stress results of subtalar joint showed the displacement by Evans procedure (group B) was greater than other groups (P< 0.0001). There were no significant differences between group A and C (P > 0.05).</p><p><b>CONCLUSION</b>Ankle instability is caused by ankle joint lateral collateral ligament injury. Chrisman-Snook technique is better than Evans procedure in stability on the early stage of ankle joint restoration, and conform to principle of biomechanics.</p>