ABSTRACT
PURPOSE@#Treatment of irreducible femoral intertrochanteric fractures often requires open reduction. However, the technique unavoidably causes patients to suffer greater trauma. As such, minimally invasive techniques should be employed to reduce the surgical-related trauma on these patients and maintain a stable reduction of the fractures. Herein, a minimally invasive wire introducer was designed and used for the treatment of femoral intertrochanteric fractures. The effectiveness of using a wire-guided device to treat irreducible femoral intertrochanteric fractures was evaluated.@*METHODS@#Between 2013 and 2018, patients with femoral intertrochanteric fractures who were initially treated by intramedullary nail fixation but had difficult reduction using the traction beds were retrospectively reviewed. Decision for an additional surgery was based on the displacement of the fracture. The patients were then divided into two groups: those in the control group received an open reduction surgery while those in the observation group received a closed reduction surgery using a minimally invasive wire introducer to guide the wire that could assist in fracture reduction. The operation time, blood loss, visual analogue scale scores, angulation, reduction, neck-shaft angle, re-displacement, limb length discrepancy, and union time were then recorded and analyzed to determine the efficiency of the wire introducer technique. Categorical variables were analyzed by using Chi-square test, while continuous variables by independent t-test and the Mann-Whitney test accordingly.@*RESULTS@#There were 92 patients included in this study: 61 in the control group and 31 in the observation group. There were no significant differences in baseline demographic factors between the two groups. All surgeries were successful with no deaths within the perioperative period. The average follow-up time for the patients was 23.8 months. However, the observation group had a significantly shorter operation time, lower visual analogue scale score, less intraoperative bleeding, and shorter fracture healing time. There were no significant differences in the angulation, reduction, neck-shaft angle, and limb length discrepancy between the two groups.@*CONCLUSION@#The minimally invasive wire guide achieved a similar effect to that of open reduction in the treatment of intertrochanteric fractures with difficult reduction. Moreover, the minimally invasive wire introducer is a good technology that accurately guides the wire during reduction. Indeed, it is an effective technique and achieves good clinical outcomes in restoration of irreducible femoral intertrochanteric fractures.
ABSTRACT
<p><b>OBJECTIVE</b>To explore clinical effects of suturing-assisted locking plate in treating elderly proximal humeral fractures.</p><p><b>METHODS</b>From January 2005 to January 2013, 55 elderly patients with three- and four-part fractures of proximal humeral fractures were divided into treatment group and control group. In treatment group, there were 31 patients including 12 males, and 19 females aged from 65 to 85 with an average of (74.00±5.42) years old, and treated with suturing-assisted locking plates; 19 patients were Neer 3-part fractures, and 12 patients were Neer 4-part fractures of proximal humerus; 23 patients were suffered from low-energy injuries and 8 patients were caused by high-energy injuries. In control group, there were 24 patients including 7 males, and 17 females aged from 65 to 85 with an average of (72.79±5.34) years old, and treated with locking plates; 16 patients were Neer 3-part fractures, and 8 patients were Neer 4-part fractures of proximal humerus; 17 patients were suffered from low-energy injuries and 7 patients were caused by high-energy injuries. Operative time, blood loss during operation, and bone healing time between two groups were observed and compared. Postoperative Neer scoring were used to evaluate recovery of shoulder joint function.</p><p><b>RESULTS</b>All patients were followed up from 6 to 24 months with an average of 16.1 months. In treatment group, blood loss was (495.806±143.150) ml, function of Neer scoring was 22.645±2.443, range of action was 18.194±2.613, anatomy was 7.935±1.504 and total score of Neer scoring was 77.161±8.335; while in control group, blood loss was (641.667±169.851) ml, function of Neer scoring was 13.958±1.989, range of action was 13.083±2.165, anatomy was 5.500±1.978 and total score of Neer scoring was 58.792±7.313. There were sigificant difference between two groups in these indexes.</p><p><b>CONCLUSION</b>Suturing-assisted locking plate for the treatment of proximal humerus fractures in elderly, has advantages of less blood loss, simple fracture reduction and rapid recovery of shoulder joint, and is a effective method.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Bone Plates , Case-Control Studies , Recovery of Function , Shoulder Fractures , General Surgery , Shoulder Joint , SuturesABSTRACT
<p><b>OBJECTIVE</b>To explore the choice of operative approach for old inferior-cervical fracture-dislocation and analyze the clinical effects of anterior operative approach.</p><p><b>METHODS</b>From January 2003 to May 2010, 17 patients with inferior-cervical fracture-dislocation delayed for more than 4 weeks were treated with continued closed skull traction and anterior decompression, bone graft and internal fixation with steel plate. Among the patients, 11 patients were male and 6 patients were female with an average age of 41 years (ranged from 24 to 56 years). The time between injury and operation was from 4 weeks to 3 months. According to Frankel grade, grade A was in 7 cases, B in 4, C in 2, D in 2, E in 2. Neurological function, bone fusion height of vertebral body and cervical sequence and curvature were observed.</p><p><b>RESULTS</b>The incision of 17 cases obtained primary healing. There was 1 case with hoarseness, and symptoms disappeared after 1 month. The mean time of follow-up was 23 months (ranged from 4 to 47 months). The X-ray films showed satisfactory reduction and good alignment and lordosis. The Frankel grade improved obviously at final follow-up, grade A was in 5 cases, B in 5, C in 1 , D in 3, E in 3.</p><p><b>CONCLUSION</b>Single anterior operative approach can successfully reduce old inferior-cervical fracture-dislocation of DF stage I , II and some stage III; anterior decompression, bone graft and internal fixation with steel plate is a safe, effective method for old inferior-cervical fracture-dislocation.</p>