Less invasive fixation for the treatment of comminuted fracture of distal tibia / 中国骨伤

<p><b>OBJECTIVE</b>To study the result of less invasive fixation in treating comminuted fracture of distal tibia.</p><p><b>METHODS</b>From 2002 to 2008, 48 patients with comminuted fracture of distal tibia were treated with surgery. The closed reduction and less invasive fixation were done to stable broken fibula, and the reduction by Kirschner wire to pick was used for relatively larger debris of tibia. The Kirschner wire or screw were used to fix fracture after the restore of the ankle cavity position and the alignment of the tibia. Partial weight loading and functional exercise of ankle joint were done at 6th week after operation.</p><p><b>RESULTS</b>Forty-eight patients were followed up for 1-24 months with an average of 12 months. All the fractures were united. According to Johner-Wruhs standard to value the result by factors of pain, deformity, motion range of joint,with or without injury of nerve and blood vessel. Thirty-eight cases obtained excellent result, 8 good, fair 2. The rate of excellent and good were 95.8%.</p><p><b>CONCLUSION</b>Less invasive fixation has ascendancy such as easy operation, less injury of soft tissue, reliable fixation, which can maximally protect periosteum. It is a choice for treating comminuted fracture of distal tibia.</p>

Treatment of thoracic vertebrae tumor with posterior total vertebral resection and internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of posterior total vertebral resection in treating thoracic vertebrae tumor in order to provide a safe and effective method in rebuilding spine stability.</p><p><b>METHODS</b>From 2002.1 to 2007.12, 18 patients with thoracic spine tumor underwent posterior total vertebral resection and internal fixation. Among the patients, 10 patients were male and 8 patients were female, ranging in age from 45 to 78 years, with an average of 56 years. The course of the diseases ranged from 2 to 13 months. After the operation, the tumor reccurence was monitored by X-ray, and the tumor markers were detected.</p><p><b>RESULTS</b>All the patients were followed up for a period ranging from 12 to 60 months, averaged 29 months. All the patients showed a postoperative neurologic improvement, as well as showed radiographic evidence of solid fusion in the follow-up examinations during 3 to 9 months, with an average of (8 +/- 1.4) months.</p><p><b>CONCLUSION</b>Posterior total vertebral resection for the treatment of thoracic spine tumor is safe and effective.</p>

Different approaches of vertebroplasty for management of severe osteoporotic vertebral compression fractures / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the clinical efficacy of 3 approaches of vertebroplasty in the treatment of severe osteoporotic vertebral compression fractures.</p><p><b>METHODS</b>Twenty-five patients with severe osteoporotic vertebral compression fractures were observed, whose average age was 72 years with average disease history of 12 days and average compression of the affected vertebral bodies of 73%. The patients were divided into 3 groups for 3 different fracture types according to Rao's classification of osteoporotic vertebral structure and deformity, namely wedge type (group A, n= 12), biconcave type (group B, n= 7) and crush type (group C, n=6). Unipedicular approach was adopted in group A, far lateral bipedicular approach in group B, and posterior wall vertebroplasty and pedicle screw fixation in group C. The average follow-up time was 1 year. Visual analog scale (VAS), analgesic use and the mobility were measured in the patients preoperatively and 3 days (7 days in group C) and 6 months after the operation, respectively, and the success rates and complications were observed.</p><p><b>RESULTS</b>All the surgical procedures were successful. The average operation time was 35 min in group A, 50 min in group B, and 2 h in group C. The average volume of cement injected into each vertebral body was 2.0 ml. The average blood loss was 30 ml in groups A and B, and 600 ml in group C. The procedure increased mobility and decreased analgesic use. VAS was decreased by a mean of 4.8 in Group A, 6.2 in group B 3 days after the operation and 5.4 in group C 7 days postoperatively, and remained stable till 6 months after the operation (P<0.01). Cement extravasation occurred in 9 cases, cement in the vertebral canal in 2 cases with transient neurological symptoms, and cement extravasation in the intervertebral space and the anterior space of the vertebral bodies took place in 5 and 2 cases, respectively. No neurological complications were observed.</p><p><b>CONCLUSION</b>Different types of severe osteoporotic vertebral compression fractures require management with different approaches of vertebroplasty for adequate filling of the remaining vertebral body, which provides significant pain relief with wider indications.</p>

Treatment of distal tibiofibular fractures by indirect reduction and plate fixation through inferior fibula / 中华创伤骨科杂志

Objective To investigate the clinic results of treatment of distal tibiofibular fractures by in- direct reduction and plate fixation through inferior fibula.Methods Between 2002 and 2005,32 cases of distal tibiofibular fractures were treated with indirect reduction and plate fixation through inferior fibula.According to the AO/ASIF classification,there were 17 cases of type A,nine cases of type B,and six cases of type C.Twenty of them also received iliac autograft through a limited median incision at the lower tibia to repair their lateral tibial defects.After operation their ankle joints were fixated at 90?with piaster brace and cast for three months.The bone union,wound and the function of the ankles were observed after surgery.Results All the patients were followed up for an average of 16 months.The average bone union time was 14 weeks.No nonunion,screw loosening,broken plate,or infection of the wounds was found in this series.The excellent and good rate was 84.4% according to Mazur's ankle joint function scoring.Conclusion Indirect reduction and plate fixation through inferior fibula is a satisfactory technique in the treatment of distal tibiofibular fractures.