ABSTRACT
Objective To investigate the clinical outcomes of hemiarthroplasty with Wagner SL prosthesis in treating failed internal fixation of intertrochanteric fractures of elderly patients.Methods Aretrospective case series study was conducted on the clinical data of 14 patients with failed internal fixation of intertrochanteric fractures admitted between March 2015 to April 2018.There were seven males and seven females with a mean age of 82.2 years (range,75-94 years).The primary internal fixators were proximal femoral nail anti rotation in nine patients,dynamic hip screw in three patients,and proximal femoral locking plate in two patients.The main causes of internal fixation failure were screw loosening in six patients,cutting out of screws in five patients,nonunion in two patients,and plate breakage with nonunion in one patient.Affected limb shortening and coxa varus deformity to various degrees were seen in all the patients before operation.The mean interval from internal fixation to hemiarthroplasty was 6.6 months (range,2-12 months).All patients received hemiarthroplasty using Wagner SL prosthesis,of which nine patients had additional trochanter claw plate with titanium cable fixation and two patients had tension band wire fixation.The operation time,intraoperative,and postoperative complications were recorded.Harris hip scores were measured before operation and at the last follow up to evaluate hip function.Radiographs were performed to assess the fracture healing,prosthesis position,and biological fixation.Results All patients were followed up for 6-30 months (mean,14.5 months).The mean operation time was (108.0 ± 12.4) minutes (range,88-130 minutes).No iatrogenic fracture occurred during the operation.One patient was seen contralateral intertrochanteric fracture during follow-up,and no complications such as periprosthetic fracture,prosthetic sinking,and infection occurred in the 13 patients.The Harris score increased from (26.1-±7.5)points before operation to (83.1 ±4.1)points after operation (P ＜ 0.01).All patients were able to stand and walk,of which four needed crutch assistance.At the last follow-up,X-ray film showed that the prosthesis was well positioned and that all of them reached bony fixation.Fourteen cases of greater trochanteric fracture were healed,with two cases of slight displacement.Conclusions Hemiarthroplasty is an effective remedial treatment for failed internal fixation of intertrochanteric fractures in the elderly,which can improve hip function and enhance the life quality of patients.Wagner SL prosthesis can obtain stable fixation.
ABSTRACT
Objective To observe the therapeutic effect of titanium plate and Kirschner wire system for treatment of calcaneal fracture.Methods The data of 189 patients with calcaneal fracture treated with operation were retrospectively studied,of which 102 patients of calcaneal fracture were treated with titanium plate fixation (titanium plate group),87 patients were treated with Kirschner wire system (Kirschner wire group).The operative time,blood loss,postoperative complication,healing time,before and after treatment Bohler angle,Gissane angle and middle calcaneal width,and Maryland foot function score were observed.Results The patients of the 2 groups were observed with 12-36 (24.0 ± 9.5) months follow-up.The operative time and blood loss in Kirschner wire group were significantly lower than those in titanium plate group [(42.3 ± 12.5) min vs.(67.5 ± 23.1) min and (137.7 ± 42.8) ml vs.(245.0 ± 55.6) ml],there were statistical differences (P ＜ 0.05).The Bohler angle,Gissane angle and middle calcaneal width in the 2 groups after treatment were significantly better than those before treatment [titanium plate group:(32.80 ± 6.35)° vs.(7.81 ± 8.75)°,(130.42 ±6.93)° vs.(175.80 ± 6.05)°,(30.77 ± 3.56) mm vs.(42.60 ±5.24) mm; Kirschner wire group:(30.11 ±4.91)° vs.(9.54 ±8.90)°,(132.89 ±9.54)° vs.(173.11 ±9.05)°,(32.00 ± 4.18) mm vs.(42.78 ± 4.96) mm],there were statistical differences (P＜ 0.05).The excellent rate of Maryland foot function score after treatment in titanium plate group was significantly higher than that in Kirschner wire group [92.2％ (94/102) vs.81.6％ (71/87)],there was statistical difference (P ＜ 0.05).Therewere 6 cases appeared infection of incisional wound in titanium plate group,there was no complication in Kirschner wire group,there was statistical difference (P ＜ 0.05).Conclusions Titanium plate and Kirschner wire system are the commonly used methods in treatment of calcaneal fractures,each has its advantages and disadvantages,titanium plate has long time operation,much blood loss and prone to infection,but the excellent rate is higher.Also note that the incision location,restoration and reconstruction of calcaneal anatomy subtalar joint.
ABSTRACT
Objective To investigate the short-term effects of intra-articular injection of hyaluronan on proprioception of the knee in gerontal patients with osteoarthritis (OA). Methods The 53 gerontal patients were included in this study. The study included treatment group (n=35) and the placebo group (n=18). Hyaluronan was intra-articularly injected into both knees of the subjects in treatment group, whereas physiological saline was intra-articularly injected in the placebo group. Proprioception test was performed, and Western Ontario and McMaster Universities(WOMAC) scales were used to evaluate pain and physical function. Results Statistical analysis was performed on 100 knees of 50 patients who completed the trial. Compared with the placebo group,the average absolute angular error (AAAE) value in the treatment group was detected to be statistically lower one week after the 4th injection (1.8±0.9 vs.2.9±1.1,t=2.42,P=0.02),and WOMAC was lower in the treatment group after one week (8.7±3.1 vs.11.5±4.0, t=0.73,P＜0.05). Conclusions Intra-articular injection of hyaluronan in gerontal patients with knee OA leads to a short-term increase in proprioception, and significant improvement in the functional conditions of patients.