Research on posterior iliac crescent fracture / 中华创伤骨科杂志

The posterior iliac crescent fracture is a typical manifestation of injury to the posterior ring in the lateral extrusion type Ⅱ of the Young-Burgess classification for pelvic fractures. In recent years, scholars have put forward new ideas about injury mechanisms, imaging features, classification, pelvic stability and surgical procedures of this type of fractures. Minimally invasive reduction and internal fixation with percutaneous screws has been used more and more widely in the treatment of posterior iliac crescent fractures. This article reviews the clinical features, classification, treatment, problems and prospects of these fractures.

Computer-aided design of digital plating for acetabular fracture of posterior wall associated with hip dislocation / 中华创伤骨科杂志

Objective To evaluate the computer-aided design of digital plating for acetabular fracture of posterior wall associated with hip dislocation.Methods A retrospective study was conducted to analyze the 32 patients who had been admitted for acetabular fracture of posterior wall associated with hip dislocation between June 2012 and August 2016.They were 22 men and 10 women with a mean age of 42.1 years (from 21 to 57 years).They were divided according to the treatment methods into 2 groups:an observational group (n =15) subjected to digital plating and a control group (n =17) subjected to conventional plating.All the patients were treated through the Kocher-Langenbeck approach.For the patients in the observational group,patient-specific digital steel plates were manufactured after simulation of fracture reduction,design of individualized steel plate and simulation of steel plating in the computer software before operation.The 2 groups were compared in terms of operation time,intraoperative bleeding,intraoperative fluoroscopy,hospital stay,fracture reduction and hip joint function at the last follow-up and postoperative complications as well.Results For the observational group,the operation time (73.3 ± 15.2 min) was significantly shorter than that for the control group (93.2 ± 14.7 min),the intraoperative bleeding (254.3 ±63.lmL) and the intraoperative fluoroscopy (2.4 ± 0.7 times) were significantly less than those for the control group (334.6 ±70.3 mL;3.2 ±0.8 times) (P ＜ 0.05).There were no significant difference between the 2 groups in the good to excellent rate of reduction [93.3％ (14/15) versus 88.2％ (15/17)] (P ＞ 0.05).All the patients were followed up for an average of 28.1 months (from 8 to 48 months).There was no significant difference either between the 2 groups in the modified Merle d'Aubigné-Postel scores at the last follow-up (16.4 ± 1.8 versus 15.8 ± 1.6) (P ＞ 0.05).There was a significant difference between the observational and control groups in the incidence of heterotopic ossification [6.7％ (1/1) versus 17.6％ (3/17)] (P ＜0.05).Conclusions In the treatment ofacetabular fracture of posterior wall associated with hip dislocation,computer-aided design of digital plating may have advantages of shorter operation time,less intraoperative blood loss,less intraoperative fluoroscopy and lower incidence of heterotopic ossification.

Proximal femoral nail antirotation for salvage of failed internal fixation of intertrochanteric hip fracture / 中华创伤杂志

Objective To evaluate the effect of proximal femoral nail antirotation (PFNA) with autogenous bone grafting for salvage of failed internal fixation of intertrochanteric hip fracture.Methods Between January 2007 and June 2012,21 cases of intertrochanteric fractures who had failed internal fixation initially were treated with revision open reduction and PFNA internal fixation and autogenous bone grafting.There were 9 men and 12 women with the mean age of 54 years (range,27-76 years).In the initially failed internal fixation,dynamic hip screw (DHS) was used in 7 cases,locking proximal femoral plate (LPFP) in 8 cases,Gamma nail in 2 cases,proximal femoral nail (PFN) in 2 cases and home-made reconstruction nail in 2 cases.Results Mean operation time was 150 minutes (range,100-240 minutes) and mean blood loss was 800 ml (range,400-2,000 ml).There were no serious complications during operation.Mean follow-up was 26 months (range,6-66 months).Bone healing was achieved at mean 4 months (range,3-8 months) in all cases.Harris hip score was (42.1 ±3.2) points (range,36-48 points) before operation and (87.2 ± 3.8) points (range,62-94 points) at the final follow-up,with significant improvement in hip function (P ＜ 0.05).At the final follow-up,no avascular necrosis of the femoral head or hip degeneration occurred and mean neck-shaft angle was 130° (range,110°-142°).Conclusions Once the fracture patients with strong ability of action,massive proximal femoral residuals,and non-serious hip injury,revision PFNA internal fixation with autogenous bone grafting is effective.Complete preoperative evaluation and attention to specific technical details may improve success rate and reduce complications.

Intertrochanteric fractures treated with proximal femoral nail antirotation / 中华创伤杂志

Objective To investigate the advantages, indications, operative techniques and pre-liminary curative effect of proximal femoral nail antirotation(PFNA) in surgical treatment of intertrochan-teric fractures. Methods From March 2006 to June 2007, PFNA fixation was done on 38 patients with intertrochanteric fractures including 17 males and 21 females, at an average age of 65. 4 years(35-93 years). According to AO/ASIF classification, there were 10 patients with type 31-A1 fractures, 21 with type 31-A2 and 7 with type 31-A3. All patients were reduced through longitudinal traction on the traction table, with implantation of PFNA via a mini-incision. Results The mean operation duration was 50 minutes(35-105 minutes)and mean blood loss 100 ml(50-300 ml). All patients were successful except for 1 patient with split lateral cortical bone of distal shaft of the femur during operation. All pa-fients were followed up for average 13 months(4-19 months), which showed long-team bed stay due to severe complieations in 1 patient. Function recovery in 32 and deterioration of the injured limbs in 5. Cer-ebral infarction was found 6 months after operation in 1 patient, who was able to walk under support. Pri-mary bone union was achieved in all patients, with average healing time of 9. 5 weeks. There were no complications such as infection of incisional wound, pulmonary infection, phlebothrombosis, over incision or coxa adducta, except that 2 patients had perioperative respiratory system disease. According to Harris hip rating scale system. The result was excellent in 20 patients, good in 13, common in 4 and poor in 1, with total excellence rate of 89%. Conclusions As a new technique, PFNA has advantages of litth trauma. Early get-out-of-bed exercise, few complications, rigid fixation and high bone union rate and is suitable for all kinds of intertrochanteric fractures especially for old patients with osteoporosis.