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OBJECTIVE@#To investigate the effectiveness of osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in the treatment of tibial plateau fractures involving posterolateral column collapse.@*METHODS@#A clinical data of 23 patients with tibial plateau fractures involving posterolateral column collapse, who had undergone osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation between January 2015 and June 2021, was retrospectively analyzed. There were 14 males and 9 females with an average age of 42.6 years ranging from 26 to 62 years. The causes of injury included traffic accident in 16 cases, falling from height in 5 cases, and other injuries in 2 cases. According to Schatzker classification, there were 15 cases of type Ⅴ and 8 cases of type Ⅵ. The time from injury to operation was 4-8 days with an average of 5.9 days. The operation time, intraoperative blood loss, fracture healing time, and complications were recorded. The depth of articular surface collapse of posterolateral column and posterior inclination angle (PSA) of the tibial plateau were compared before operation and at 2 days and 6 months after operation; fracture reduction of tibial plateau fracture was evaluated by Rasmussen anatomic score. The recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score at 2 days and 6 months after operation.@*RESULTS@#All 23 patients were completed the operation successfully. The operation time was 120-195 minutes, with an average of 152.8 minutes; the intraoperative blood loss was 50-175 mL, with an average of 109.5 mL. All patients were followed up 12-24 months, with an average of 16.7 months. One patient had superficial wound infection after operation, and the incision healed after dressing change; primary healing of incision of other patients was obtained. The fracture healing time was 12-18 weeks, with an average of 13.7 weeks. No failure of internal fixation, varus and valgus deformity of the knee joint, and instability of the knee joint was found at last follow-up. One patient developed joint stiffness and the range of motion of the knee joint was 10°-100°; the range of motion of the knee joint of other patients was 0°-125°. At 2 days and 6 months after operation, the depth of articular surface collapse of posterolateral column, PSA, and Rasmussen anatomic scores significantly improved when compared with those before operation ( P<0.05). There was no significant difference between the two postoperative time points ( P>0.05). The HSS score at 6 months after operation was significantly higher than that at 2 days after operation ( P<0.05).@*CONCLUSION@#For tibial plateau fractures involving posterolateral column collapse, reduction and internal fixation through osteotomy of non-core weight-bearing area of the lateral tibial plateau has the advantages of fully expose the posterolateral column fragment, good articular surface reduction, sufficient bone grafting, and fewer postoperative complications. It is beneficial to restore knee joint function and can be widely used in clinic.
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Male , Female , Humans , Adult , Retrospective Studies , Blood Loss, Surgical , Tibial Plateau Fractures , Treatment Outcome , Bone Plates , Tibial Fractures/surgery , Knee Joint , Fracture Fixation, Internal , Osteotomy , Weight-BearingABSTRACT
Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.
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Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.
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Objective:To investigate the clinical effect of peroneal fracture line in the treatment of posterior Pilon fracture.Methods:The data of 26 patients treated with fibular fracture line from January 2017 to July 2019 were analyzed retrospectively, including 11 males and 15 females; the age ranged from 28 to 69 years, with an average of 42.2 years. There were 10 cases of falling injury, 9 cases of falling injury and 7 cases of traffic injury; all of them were fresh closed fibular fractures;According to Yu Guangrong's classification, there were 11 cases of type I, 8 cases of type II and 7 cases of type III; AGH was divided into 10 cases of type I, 5 cases of type IIa, 2 cases of type IIb, 5 cases of type IIIa and 4 cases of type IIIb. All cases were treated by opening the fibular fracture line through the posterolateral approach, the quality of fracture reduction was evaluated by Burwell Charnley radiological evaluation standard after operation; At the last follow-up, ankle function was evaluated by American Association of Foot and Ankle surgery (AOFAS) ankle and hindfoot scores.Results:All 26 patients were followed up for 12-23 months, with an average of 14.9 months; Bone healing was achieved in all fractures. The healing time was 3-6 months, with an average of 4.0 months. The quality of fracture reduction was evaluated according to the Burwell Charnley radiology evaluation standard after operation, including anatomical reduction in 23 cases and acceptable reduction in 3 cases. The anatomical reduction rate was 88% (23/26). At the last follow-up, AOFAS ankle and hindfoot scores ranged from 80 to 100, with an average of 89.9 points, of which 17 cases were excellent and 9 cases were good, and the excellent and good rate was 100%. At the last follow-up, no patient had complications such as reduction loss, skin necrosis, infection, internal fixation loosening or ankle stiffness.Conclusion:After the treatment of Pilon fractures via peroneal fracture line, the distal tibial articular surface and posterior ankle fracture gap can be fully exposed, which can be repositioned and fixed under direct vision, with high anatomical repositioning rate and good and safe clinical results.
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Objective:To compare the clinical effect of miniplates plus reconstruction plate fixation assisted by preoperative digital design and conventional miniplates plus reconstruction plate fixation in the treatment of comminuted posterior acetabular wall fracture.Methods:A retrospective cohort study was used to analyze the clinical data of 35 patients with comminuted posterior acetabular wall fracture admitted to General Hospital of Central Theater Command of PLA from January 2012 to June 2019, including 26 males and 9 females, aged 25-63 years [(45.5±9.8)years]. A total of 16 patients received miniplates plus reconstruction plate fixation assisted by preoperative digital design (digital design group) and 19 patients received conventional miniplates plus reconstruction plate fixation (conventional group). The operation time, intraoperative blood loss, hospitalization time and fracture healing time were compared in the two groups. Matta radiological standard score was performed to assess the quality of fracture reduction at postoperative 2 days. Modified Merle d′Aubign-Postel score was used to evaluate hip function at postoperative 3 months, 6 months and final follow-up. Postoperative complications were observed.Results:All patients were followed up for 12-48 months [(30.1±8.9)months]. The operation time and intraoperative blood loss were (114.7±16.1)minutes and (323.4±26.1)ml in digital design group, significantly less than (179.8±67.3)minutes and (392.6±87.8)ml in conventional group (all P<0.01). There were no significant differences in hospitalization time, fracture healing time, excellent and good rate of quality of fracture reduction between the two groups (all P>0.05). The modified Merle d′Aubign-Postel score was higher in digital design group [(14.1±2.3)points, (15.4±2.3)points and (17.1±1.8)points] than those in conventional group [(13.7±2.2)points, (15.0±2.5)points and (16.8±2.1)points] at 3 months, 6 months and last follow-up, but there were no significant differences (all P>0.05). The modified Merle d′Aubign-Postel score showed significant differences within each group at each time point (all P<0.01). In digital design group, one patient was found with heterotopic ossification and one with traumatic arthritis. In conventional group, two patients were found with heterotopic ossification, one with traumatic arthritis and one with avascular necrosis of the femoral head. The rate of postoperative complications was 12.5% (2/16) in digital design group and was 21.1% (4/19) in conventional group ( P>0.05). Neither of the two groups had complications such as penetration of screws into the articular cavity, failure of internal fixation or iatrogenic sciatic nerve injury. Conclusion:Both miniplates plus reconstruction plate fixation assisted by preoperative digital design and conventional miniplates plus reconstruction plate fixation can achieve satisfactory clinical efficacy in the treatment of comminuted posterior acetabular wall fracture, but the former can significantly reduce operation time and intraoperative blood loss.
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Objective:To compare the clinical outcome of navigation-assisted percutaneous cannulated screw fixation and posterior percutaneous plate fixation for Day type II crescent fracture dislocation of pelvis (CFDP).Methods:A retrospective cohort analysis was performed on clinical data of 40 patients with Day type II CFDP treated in General Hospital of Central Theater Command of PLA from January 2012 to June 2021. There were 23 males and 17 females, with age range of 42-73 years [(54.2±7.8)years]. A total of 19 patients were treated with navigation-assisted percutaneous cannulated screw fixation (navigation group) and 21 with posterior percutaneous plate fixation (plate group). The incision length, operation time, intraoperative blood loss and in-hospital time were compared between the two groups. The reduction quality was evaluated by Matta radiographic standard at day 2 after surgery. The functional recovery was assessed by Majeed functional score at 3 and 6 months after surgery. The postoperative complications were observed.Results:All patients were followed up for 10-24 months [(13.6±2.9)months]. The incision length, operation time, intraoperative blood loss and in-hospital time was (2.4±0.3)cm, (43.1±5.2)minutes, (48.4±18.4)ml and (14.4±1.9)days in navigation group, showing significant difference compared with plate group [(8.8±0.4)cm, (132.2±19.4)minutes, (302.9±57.5)ml, (18.9±3.7)days] (all P<0.01). According to Matta radiographic standard at day 2 after surgery, the excellent and good rate was 89% in navigation group (excellent in 13 patients, satisfactory in 4 and poor in 2) and 95% in plate group (excellent in 15 patients, satisfactory in 5 and poor in 1) ( P>0.05). According to Majeed criteria at 3 months after surgery, the excellent and good rate was 89% in navigation group (excellent in 12 patients, good in 5 and poor in 2) and 95% in plate group (excellent in 15 patients, good in 5 and poor in 1) ( P>0.05). According to Majeed criteria at 6 months after surgery, the excellent and good rate was 95% in navigation group (excellent in 14 patients, good in 4 and poor in 1) and 95% in plate group (excellent in 17 patients, good in 3 and poor in 1) ( P>0.05). There was no iatrogenic neurovascular injury. The incidence of complications was 11% (2/19) in navigation group, including one patients with sacroiliac screw loosening and one with posterior iliac screw penetrating the medial cortex of the bone, while that was 29% (6/21) in plate group, including two patients with skin tenderness, two with deep vein thrombosis in the lower extremity and two with incision infection ( P<0.05). Conclusions:For Day type II CFDP, both navigation-assisted percutaneous cannulated screw fixation and posterior percutaneous plate fixation can attain satisfactory efficacy, but the former has advantages of shorter operation time, less surgical trauma, less bleeding, shorter in-hospital time and lower incidence of complications.
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Objective:To compare the clinical effect of cannulated lag screw combined with calcaneal locking plate versus cannulated lag screw in the treatment of Letenneur type III Hoffa fracture.Methods:A retrospective cohort study was performed on clinical data of 41 patients with Letenneur type III Hoffa fracture admitted to General Hospital of Central Theater Command of PLA from January 2010 to June 2020. There were 22 males and 19 females, aged 28-78 years［(51.9±1.9)years］. A total of 18 patients were treated with cannulated lag screw combined with calcaneal locking plate (plate-screw group) and 23 patients were treated with cannulated lag screw (screw group). The bed rest time, hospital time and bone healing time were compared between the two groups. Range of motion (ROM) of the knee at 3 and 6 months postoperatively, knee society score (KSS) at 3 and 6 months postoperatively and incidence of long-term complications were compared between the two groups.Results:All patients were followed up for 10-24 months［(14.5±2.1)months］. The bed rest time was (37.6±2.4)days in plate-screw group, lower than (45.2±1.6)days in screw group ( P<0.05). The hospital time was (16.7±3.7)days in plate-screw group, and (15.8±3.7)days in screw group ( P>0.05). The bone healing time was (12.2±0.9)weeks in plate-screw group and (12.7±0.7) weeks in screw group ( P>0.05). ROM of the knee at 3 and 6 months after operation was (119.9±2.9)° and (125.4±4.5)° in plate-screw group, greater than (116.6±4.5)°and (122.1±3.9)° in screw group (both P<0.05). KSS at 3 and 6 months after operation was (83.4±3.1)points and (86.2±2.5)points in plate-screw group, greater than (79.5±2.1)points and (82.2±2.2)points in screw group (both P<0.05). ROM of the knee and KSS in two groups increased significantly over time (both P<0.01). The long-term complications in plate-screw group included delayed fracture healing in 1 patient, traumatic arthritis in 1 and stiff joint in 1, showing the complication rate of 17% (3/18). The long-terem complications in screw group included internal fixation failure in 1 patient, delayed fracture healing in 2, nonunion in 1, traumatic arthritis in 2 and stiff joint in 2, showing the complication rate of 35% (8/23). The two groups had no significant difference in the complication rate ( P>0.05) .Conclusion:For Letenneur type III Hoffa fracture, cannulated lag screw fixation combined with calcaneal locking plate is superior to seperate cannulated lag screw fixation in aspects of short bed-term bed rest, early functional exercise, improved ROM and good function recovery.
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Objective:To introduce the standard screw implantation methods and to analyze the biomechanical stability of the second-generation dynamic anterior plate-screw system for quadrilateral area (DAPSQ).Methods:Six adult formalin-preserved corpses were selected to make a complete pelvic specimen. Further, the left high double-column fracture models were made and randomly fixed with second-generation DAPSQ or anterior reconstruction titanium plate and 1/3 tube buttress-plate (ARTPB). The specimens of intact pelvis (IP) group, DAPSQ group and ARTPB group were fixed on a Zwick Z100 material machine and loaded vertically with 200 N, 300 N, 400 N, 500 N, 600 N, 700 N, and 800 N in a simulated sitting position, respectively. The axial displacement and strain changes in the anterior and posterior columns were tested in the three groups. The stiffness was calculated accordingly.Results:The axial compression displacement in the three groups showed an increase trend as well with the vertical load increased from 200 N to 800 N ( F=68.581, P<0.001; F=91.795, P<0.001; F=33.819, P=0.002). The axial displacement in ARTPB group was significantly larger than that in DAPSQ group and IP group ( P<0.05), while the difference between DAPSQ and IP groups was not significant ( P>0.05). Under the vertical load of 600 N, the pelvic axial stiffness of IP group, DAPSQ group, and ARTPB group were 220.72±70.33 N/mm, 185.68±48.49 N/mm and 135.83±60.58 N/mm, respectively. The axial stiffness of ARTPB group was significantly lower than that in DAPSQ group and IP group ( t=5.345, P=0.003; t=6.443, P=0.001), while the difference between DAPSQ and IP groups was not significant ( t=2.138, P=0.086). There were no significant differences of the strain values in anterior column among the three groups during the load increasing from 200 N to 800 N ( P>0.05). With the load increasing from 500 N to 800 N, the strain values of the posterior column in ARTPB group were significantly greater than those of IP and DAPSQ groups ( P<0.05). However, the differences between IP and DAPSQ groups were not statistically significant in strain values of the posterior column ( P>0.05). Conclusion:Compared with anterior reconstruction titanium plate and 1/3 tube buttress-plate, acetabular double-column fracture model fixed with the second-generation DAPSQ has less axial compression displacement but with greater axial stiffness. The stress change in the posterior columns of the acetabulum is like in IP. Therefore, the second-generation DAPSQ has reliable biomechanical stability.
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Objective:To compare the clinical effects between simple bone grafting and dynamization of locking compression plate (LCP) combined with autologous bone grafting in the treatment of femoral aseptic nonunion.Methods:In this retrospective study, 30 patients with femoral aseptic nonunion were included who had been treated from January 2010 to January 2020 at Department of Orthopaedics, General Hospital of Central Theater Command of Chinese People’s Liberation Army. They were 19 males and 11 females, with an age from 25 to 55 years. Of them, 12 were subjected to LCP dynamization combined with autologous bone grafting (group A) and 18 to simple bone grafting (group B). The 2 groups were compared in terms of surgical indicators, fracture healing time, Hospital for Special Surgery (HSS) knee scores at preoperation and 12 months postoperation and Lane-Sandhu radiographic scores at 1, 3, 6 and 12 months postoperation.Results:As there was no statistically significant difference in general information between the 2 groups, they were comparable ( P>0.05). The fracture healing time in group A [(8.2±1.7) months] was significantly shorter than that in group B [(9.8±2.2) months] ( P<0.05). There was no significant difference between the 2 groups in Lane-Sandhu radiographic score at 1 month postoperation ( P>0.05). The Lane-Sandhu radiological scores in group A at 3, 6, and 12 months postoperation (4.2±1.2, 8.4±0.7 and 10.8±0.9) were significantly higher than those in group B (3.3±0.9, 7.1±1.3 and 9.8±1.2) ( P<0.05). There was no statistically significant difference between the 2 groups in preoperative HSS knee score ( P>0.05). The HSS knee score at 12 months postoperation in group A (83.3±4.3) was significantly higher than that in group B (76.2±4.1) ( P<0.05). Conclusion:In the treatment of femoral aseptic nonunion, compared with simple bone grafting, LCP dynamization combined with autologous bone grafting may shorten fracture healing time, improve bone formation, and thus lead to better therapeutic efficacy.
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Objective:To compare the effect of interlocking intramedullary nail and locking plate in the treatment of varus proximal humeral fractures in the elderly.Method:A retrospective case-control study was conducted to analyze the clinical data of 46 elderly patients with varus proximal humeral fractures treated in Central Theater General Hospital of PLA from June 2016 to January 2019, including 27 males and 19 females, at age of 60-84 years［（71.9±5.7）years］. All fractures were fresh. Overall 25 patients were treated with interlocking intramedullary nail（intramedullary nail group）, and 21 patients were treated with locking plate（bone plate group）. The incision length, operation time, intraoperative bleeding and fracture healing time were compared between the two groups. Visual analogue scale（VAS）was used to evaluate the degree of pain relief at 1 week and 1 month after operation, and Constant-Murley score was used to evaluate the recovery of shoulder function at 1 month, 3 months and 1 year after operation. The cervical trunk angle was recorded at 2 days and 1 year after operation to judge whether there was a loss of cervical trunk angle. Postoperative complications were observed.Results:All patients were followed up for 12-32 months［（19.7±6.6）months］. The incision length［（7.1±0.6）cm］, operation time［（60.8±5.2）minutes］, intraoperative bleeding［（64.4±8.4）ml］and fracture healing time［（10.0±1.0）weeks］in intramedullary nail group were significantly less than those in bone plate group［（13.6±0.9）cm,（80.2±8.1）minutes,（151.0±15.2）ml,（11.0±1.5）weeks］（ P<0.05）. In both groups, the VAS decreased significantly over time, and markedly increased Constant-Murley score was detected as well（ P<0.05）. The VAS in intramedullary nail group［（2.8±0.2）points,（1.1±0.2）points］was significantly lower than that in bone plate group［（4.0±0.2）points,（1.5±0.1）points］at 1 week and 1 month after operation（ P<0.05）. The Constant-Murley score in intramedullary nail group［（59.9±6.9）points,（79.1±6.8）points］was higher than that in bone plate group［（50.1±8.5）points,（73.6±8.4）points］at 1 month and 3 months after operation（ P<0.05）, but the score showed no significant difference between intramedullary nail group［（89.1±5.3）points］and bone plate group［（86.4±6.4）points］at 1 year after operation（ P>0.05）. According to Constant-Murley score, 10 patients were evaluated as excellent and 15 patients as good in intramedullary nail group at 1 year after operation, with the excellent and good rate of 100%, while 8 patients were evaluated as excellent, 11 patients as good and 2 patients as fair in bone plate group at 1 year after operation, with the excellent and good rate of 91%（ P>0.05）. The cervical trunk angle in intramedullary nail group［（140.2±2.9）°,（139.6±2.3）°］had significant difference from that in bone plate group［（139.6±3.2）°,（138.8±3.3）°］at 2 days and 1 year after operation（ P<0.05）. In both groups, the cervical trunk angle had slight lost at 1 year after operation compared with that at 2 days after operation, but the difference was not statistically significant（ P>0.05）. In intramedullary nail group, 1 patient had subacromial impact. In bone plate group, 1 patient had screw cutting, 2 patients subacromial impact, and 2 patients delayed fracture healing. The incidence of complications in intramedullary nail group was 4%（1/25）, lower than 24%（5/21）in bone plate group（ P<0.05）. Conclusion:Compared with locking nail plate, interlocking intramedullary nail in the treatment of senile varus proximal humeral fracture has the advantages of small trauma, early fracture healing, less pain, early function recovery and less complications.
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Objective:To evaluate the clinical results of miniplates combined with reconstruction plate in treating comminuted posterior wall acetabular fractures.Methods:A retrospective case series study was conducted for 27 patients with comminuted posterior wall acetabular fractures treated in General Hospital of Central Theatre Command of PLA from October 2015 to June 2019. There were 18 males and 9 females, at age of 23-61 years［（45.9±10.9）years］. All patients were treated by using miniplates combined with the reconstruction plate. The operation time, intraoperative blood loss, intraoperative blood transfusion, length of hospital stay and time of fracture healing were recorded. The reduction quality was evaluated according to Matta radiographic standard at 2 days postoperatively. The modified Merle D'Aubigné-Postel score was adopted to evaluate the hip function at 3, 6 months postoperatively and the final follow-up. Postoperative complications were observed, and heterotopic ossification was assessed by Brooker grading standard.Results:All patients were followed up for 12-48 months［36（24, 36）months］. The operation time was 123-242 minutes［（165.4±29.8）minutes］; the intraoperative blood loss was 170-550 ml［（358.3±111.3）ml］; nine patients required intraoperative blood transfusion of 300-500 ml［（377.8±66.7）ml］. The length of hospital stay was 12-29 days［（21.4±4.7）days］. The fracture healing time was 12-24 weeks［（16.3±3.0）weeks］. According to Matta radiographic standard, the reduction quality was excellent in 21 patients, good in 3 and poor in 3 at 2 days postoperatively, with the excellent rate of 89%. The modified Merle D'Aubigné-Postel score was 9-16 points［（13.1±1.9）points］at 3 months postoperatively, was 10-18 points［（15.4±2.0）points］at 6 months postoperatively, and was 12-18 points［（16.9±1.8）points］at last follow-up（ P<0.01）. The modified Merle D'Aubigné-Postel score between 3 months and 6 months was significantly different（ P<0.01）, and the difference between 6 months and the follow-up was statistically significant（ P<0.01）. The modified Merle D'Aubigné-Postel score was graded as excellent in 0 patient, good in 7, fair in 11 and poor in 9 at 3 months postoperatively, with the excellent rate of 26%; graded as excellent in 3 patients, good in 19, fair in 2 and poor in 3 at 6 months postoperatively, with the excellent rate of 81%; graded as excellent in 18 patients, good in 5, fair in 3 and poor in 1 at the last follow-up, with the excellent rate of 85%（ P<0.01）. No iatrogenic sciatic nerve injury, deep vein thrombosis or wound infection occurred after operation. No hardware loosening or loss of reduction occurred during the follow-up. The post-traumatic arthritis was identified in 2 patients. The avascular necrosis of femoral head was observed in 1 patient and thereafter underwent total hip replacement. The heterotopic ossification occurred in 3 patients, among which 2 patients were graded as Brooker class I and 1 as class II, but there was no adverse effect on hip function. Conclusions:Miniplates combined with reconstruction plate in the treatment of comminuted posterior wall acetabular fractures have reliable fixation effect and attain good reduction, high fracture healing rate, less complications and satisfactory functional recovery.
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Objective:To compare the efficacy of 3D navigation versus C-arm fluoroscopy for placement of percutaneous double-segment long sacroiliac screws in the treatment of injury to the posterior pelvic ring.Methods:A retrospective study was conducted in the 48 patients with pelvic fracture who had been treated surgically from February 2015 to October 2020 at Department of Orthopaedics, General Hospital of Central Command of PLA. The patients were divided into a navigation group and a fluoroscopy group according to their different auxiliary ways to assist screw placement. In the navigation group of 27 patients, there were 19 males and 8 females, with an age of (45.5±7.4) years; in the fluoroscopy group of 21 patients, there were 14 males and 7 females, with an age of (44.1±10.1) years. The 2 groups were compared in terms of placement time for each screw, fluoroscopy time for each screw, adjustments of guide wire, accuracy of screw position, quality of fracture reduction, fracture union time, pelvic function, and postoperative complications.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative general data ( P>0.05). The placement time for each screw [(12.7±2.2) min], fluoroscopy time for each screw [(40.7±9.3) s] and adjustments of guide wire [1 (0,1) time] in the navigation group were significantly less than those in the fluoroscopy group [(23.7±3.6) min, (71.4±14.1)s and 5 (4,6) times] (all P<0.05); the assessment of screw placement in the former (49 excellent, 4 good and one poor cases) was significantly better than that in the latter (29 excellent, 8 good and 5 poor cases) ( P<0.05). The 48 patients were followed up for 8 to 25 months (mean, 13.1 months). There were no significant differences between the 2 groups in fracture union time, quality of fracture reduction or Majeed scores for the pelvic function (all P>0.05).Symptoms of injury to the L5 nerve root were observed in one patient in the fluoroscopy group; none of the patients reported postoperative complications like wound infection, screw loosening or breaking. Conclusions:Compared with C-arm fluoroscopy, 3D navigation may better assist placement of percutaneous double-segment long sacroiliac screws in the treatment of injury to the posterior pelvic ring, because 3D navigation can significantly shorten the time for screw placement and the fluoroscopy time for screw placement, reduce adjustments of guide wire, and improve accuracy of screw placement.
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Objective:To compare the clinical efficacy between our first generation and second generation dynamic anterior plate-screw system for quadrilateral area (DAPSQ) in the treatment of T-shaped acetabular fractures.Methods:A retrospective study was conducted of the 28 patients with T-shaped acetabular fractures who had been treated at Department of Orthopaedics, General Hospital of Central Theater Command from January 2008 to December 2019. They were divided into 2 groups according to fixation methods. Group A [15 patients, 11 males and 4 females, an age of (43.5±9.1) years] were treated with the first generation DAPSQ while Group B [13 patients, 8 males and 5 females, an age of (42.5±7.0) years] with the second generation DAPSQ. Operation time, intraoperative bleeding, fracture reduction, function of the affected hip and postoperative complications were recorded and compared between the 2 groups.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative general data ( P>0.05). The 28 patients were followed up for 12 to 60 months (average, 35.0 months). The operation time [(193.9±33.3) min] and intraoperative bleeding [(830.8±177.4) mL] for Group B were significantly less than those for Group A [(231.3±40.0) min and (1,043.3±190.7) mL] ( P<0.05). In Group A, according to the Matta scoring, the fracture reduction was rated as excellent in 8 cases, good in 5 and poor in 2; in Group B, the fracture reduction was rated as excellent in 8 cases, good in 4 and poor in one. According to the modified Merle d'Aubigné & Postel scoring at the final follow-up, the function of the affected hip was rated as excellent in 9 cases, as good in 3, as fair in 2 and as poor in one in Group A while as excellent in 9 cases, as good in 2 and as fair in 2 in Group B. There were no statistically significant differences between the 2 groups in reduction quality or in the function of the affected hip ( P>0.05). Follow-up observed hip traumatic arthritis in 2 cases in Group A and in one in Group B. Conclusion:In the treatment of T-shaped acetabular fractures, compared with the first generation DAPSQ, the second generation DAPSQ can shorten operation time and decrease intraoperative bleeding significantly, though both achieve comparable functional outcomes.
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Objective:To evaluate the efficacy of lateral deltoid muscle approach in the treatment of valgus-impacted three- and four-part fractures of the proximal humerus.Methods:From January 2015 to December 2017, 36 patients were treated at Department of Orthopaedics, General Hospital of Central Military Theater for valgus-impacted three- and four-part fractures of the proximal humerus via the lateral deltoid muscle approach. They were 10 men and 26 women, aged from 38 to 85 years (mean, 65.6 years). The fracture had occurred at the left side in 20 cases and at the right side in 16. According to the Neer classification, 22 cases had a three-part fracture and 14 a four-part one. Their operation time and intraoperative bleeding were recorded. The efficacy was evaluated by their Constant-Murely scores and ranges of motion of the shoulder joint one year after operation.Results:This cohort was followed up for 12 to 36 months (mean, 21.7 months). Their operation time ranged from 55 to 120 min (mean, 75.9 min); their intraoperative bleeding ranged from 50 to 200 mL (mean, 109.7 mL). Their Constant-Murely scores of the affected shoulder one year after operation ranged from 79 to 90 points (mean, 84.1points). At one year after operation, their abduction ranged from 90° to 160° (mean, 120.6°), their uplift from 90° to 170° (mean, 128.1°), their backward extension from 20° to 60° (mean, 38.8°), their internal rotation from 20° to 45° (mean, 30.5°), and their external rotation from 30° to 45° (mean, 35.6°). All patients obtained bony union with no such complications as axillary nerve injury, deep infection, nonunion or ischemic necrosis of the humeral head.Conclusion:Treatment of valgus-impacted three- and four-part fractures of the proximal humerus via the lateral deltoid muscle approach is minimally invasive, simple, safe and effective.
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Objective:To investigate the effect of modified fluoroscopic monitoring in the treatment of acetabular anterior column fractures with percutaneous retrograde screw fixation under computer-assisted 3D navigation.Methods:A retrospective case series analysis was performed on the clinical data of 42 patients with acetabular anterior column fractures admitted to Central Theater Command General Hospital of PLA from December 2013 to December 2016. There were 24 males and 18 females, with the age of 20-61 years [(41.6±12.9)years]. All patients underwent percutaneous retrograde acetabular anterior column screw fixation under computer-assisted 3D navigation. A total of 61 screws were inserted. The observation indexes included the time for insertion of each screw, intraoperative bleeding volume, fluoroscopy time, coincidence rate between intraoperative fluoroscopy and postoperative imaging, and complications. The D'Aubigné-Postel system was used to evaluate the hip joint function at postoperative 6 months. Fracture healing and complications were detected at postoperative 12 months.Results:All patients were followed up for 9-18 months [(13.1±3.2)months]. Time for insertion of each screw was (18.7±4.8)min, intraoperative bleeding volume was (16.6±3.8)ml, fluoroscopy time was (25.3±10.9)s, and coincidence rate between intraoperative fluoroscopy and postoperative imaging was 100%. There were no complications such as neurovascular injury, thrombosis, wound infection, heterotopic ossification and long-term pain. Six months after operation, D'Aubigné-Postel function score was (10.7±0.9)points, significantly improved compared with preoperative (8.7±1.6)points ( P<0.05). Two patients (3 screws) had lower limb mobility and two patients (2 screws) had screw loosening. Conclusion:For acetabular anterior column fractures, percutaneous retrograde acetabular anterior column screw placement assisted by 3D navigation is helpful to improve the accuracy of screw insertion, decrease introperative fluoroscopy time, reduce operation risk, improve screw coincidence rate, and therefore improve hip function.
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TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.
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Objective:To investigate the effect of different screw and screw hole combination of locking compression plates (LCP) on axial micromotion of fracture ends.Methods:Eighteen mature male New Zealand white rabbits were enrollled and divided into Groups A, B and C according to the random number table method, with six rabbits in each group. After obtaining the whole fresh right tibial specimens, the tibia was cut off transversely at the middle part and fixed with LCP. All specimens were fixed with locking screws in locking holes at the distal side of the fracture end. In Group A, locking screws were fixed in locking holes at proximal end. In Group B, common screws were fixed in locking holes at proximal end. While in Group C, common screws were fixed in compression holes at proximal end. All specimens were subjected to a dynamic axial load of 0-50 N on a universal test machine. The distance of the micromotion of the fracture site was measured and axial compression stiffness corresponding to each fixing method was calculated through the instrument's own system.Results:All specimens generated corresponding axial displacement under the axial load. Under an axial load that approximated a body weight (25 N), the axial displacement value of the fracture end was (0.101±0.017)mm in Group A, (0.164±0.007)mm in Group B, and (0.305±0.041)mm in Group C. Under the axial load of approximately two body weights (50 N), the axial displacement value of the fracture end was (0.218±0.012)mm in Group A, (0.285±0.013)mm in Group B, and (0.513±0.051)mm in Group C. Under the same load, the average axial displacement value of fracture site was Group C>Group B>Group A ( P<0.01). The axial stiffness of LCP device was (234.36±13.28)N/mm in Group A, (203.78±16.46)N/mm in Group B, and (112.62±16.23)N/mm in Group C, namely Group A>Group B>Group C ( P<0.01). Conclusion:LCP fixed with common screws or via compression holes can significantly increase axial micromotion of the fracture end. While the combined application of the two methods has better effect and can reduce the stiffness of LCP device.
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Objective:To investigate the clinical effect of treatment of valgus impacted proximal humeral fracture in elderly patients with locking plate internal fixation through deltoid approach.Methods:A retrospective case series study was carried out to analyze the clinical data of 25 elderly patients with valgus impacted proximal humeral fracture hospitalized in Central Theater General Hospital of PLA from September 2016 to March 2018, including 7 males and 18 females, aged 60-81 years [(67.9±9.1)years]. According to Neer classification, 21 patients were with three part proximal humeral fracture and 4 with four part fracture. All patients were treated by internal fixation with locking plate through deltoid approach. Rehabilitation exercise training was done after operation. Total length of incision, operation time, intraoperative bleeding volume and fracture healing were recorded. At the last follow-up, the range of motion and abductor muscle strength of the shoulder joint between the affected side and the healthy side were compared, joint function was evaluated using the Constant-Murley score, and the postoperative complications were observed.Results:All patients were followed up for 12-23 months [(14.6±3.2)months]. Total length of incision was 6.4-8.8 cm [(7.1±1.2)cm]. Operation time was 68-106 minutes[(84. 0±5.6)minutes]. Intraoperative bleeding volume was 55-95 ml [(62.5±16.4)ml]. All the fracture lines were well reduced and bony union was observed in all patients at popstoperative 6 months. At the last follow-up, there was no significant difference in flexion, abduction, pronation range and abductor muscle strength between the affected side and the healthy side ( P<0. 05). At the last follow-up, the Constant-Murley score of shoulder joint function was excellent in 9 patients, good in 13, fair in 3, with excellent and good rate of 88%. There was no subacromial impact, humeral head necrosis or other complications after operation. Conclusion:Locking plate through deltoid approach in treatment of valgus impacted proximal humeral fracture in the elderly has the advantages of less operative trauma, shorter operative time, less intraoperative bleeding, less postoperative complications, good reduction of fracture and good functional recovery of shoulder joint.
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Since December 2019, corona virus disease 2019 (COVID-19) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of COVID-19. Based on the needs of emergency surgery for orthopedic trauma patients and review of the latest diagnosis and treatment strategy of COVID-19 and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of COVID-19 and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.
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With aim to reasonably cope with the elderly patients with hip fracture during epidemic of corona virus disease 2019 (COVID-19), Professor Su Jiacan and Academician Zhang Yingze organized the "expert consensus on diagnosis and treatment of elderly patients with hip fracture under epidemic of corona virus disease 2019" that for the first time formulated the management strategies for the elderly patients with hip fracture including selection of surgical methods and protective measures for medical staff from perspective of orthopedic surgeons. The authors interpret the clinical guiding value and key points of diagnosis and treatment of the consensus to help clinicians better understand the consensus and strengthen its practical application.