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1.
Article in Chinese | WPRIM | ID: wpr-932352

ABSTRACT

Objective:To discuss the atypical radiological features of posterior Monteggia fracture and appropriate treatment of the fracture.Methods:A retrospective study was conducted of the 12 patients who had been treated for posterior Monteggia fracture with atypical radiological features at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital from July 2019 to December 2020. They were 7 males and 5 females, aged from 18 to 65 years (mean, 46.5 years). Their elbow X-ray and CT scan features included unidentified upper ulnoradial dislocation, presence of triangular or quadrilateral butterfly fracture pieces in front of the fracture end at the level of ulnar coronal process, normal humeroradial joint or forward dislocated radial head, comminuted fracture or anterior edge fracture of the radial head, or backward angulated fracture of the radial neck. The proximal ulnar fractures were fixated with olecranon anatomical locking compression plate or with assistant kirschner wire and tension band fixation; the ulnar coronoid process fractures were fixated with kirschner wire or lag screws or a mini-plate; the radial head fractures were fixated with headless compressing screws or a mini-plate or treated with radial head replacement; the severe injury to the radial collateral ligament was repaired with a suture anchor. Fracture union time, complications and range of elbow motion at the final follow-up were recorded. Elbow function was assessed by Mayo elbow performance score (MEPS).Results:All patients were followed up for 6 to 28 months (mean, 16.4 months). All fractures achieved bony union after 12 to 19 weeks (14.6 weeks). The final follow-ups revealed the following: the range of elbow flexion and extension ranged from 75° to 145°, averaging 100.5°; the range of forearm rotation ranged from 80° to 155°, averaging 132.0°; the MEPS ranged from 50 to 100 points, averaging 86.2 points and yielding 5 excellent, 4 good, 2 fair and 1 poor cases. Elbow stiffness developed in 3 cases.Conclusion:Understanding the atypical radiological features of posterior Monteggia fracture can promote better diagnosis and treatment of the posterior Monteggia fracture in clinic.

2.
Article in Chinese | WPRIM | ID: wpr-932345

ABSTRACT

Objective:To investigate the therapeutic effects of sled board internal fixation on the treatment of olecranon fractures.Methods:The clinical data were retrospectively analyzed of the 21 patients with olecranon fracture who had been treated with sled board internal fixation at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital from May 2019 to January 2021. They were 11 males and 10 females with 14 left and 7 right sides affected, aged from 18 to 68 years (mean, 42.0 years). By the preoperative Mayo classification for olecranon fractures, one case was type ⅠA, 11 cases were type ⅡA and 9 cases type ⅡB; by the Schatzker classification, one case was type A, 4 cases were type B and 16 cases type C. The operation time and the complications were recorded; at the last follow-up, the range of motion of the elbow joint was recorded and the elbow function and pain were evaluated by the Mayo elbow performance score (MEPS) and visual analogue scale (VAS).Results:The 21 patients were followed up for 13 to 34 months (mean, 19.6 months) after operation. At the last follow-up, the flexion and extension of the affected elbow averaged 139.8° (from 125° to 160°), and the pronation-supination 177.9° (from 160° to 180°). The operation time averaged 77.8 min (from 40 to 135 min). Postoperative olecranon skin discomfort developed in 4 patients, 2 of whom underwent removal of internal fixation; no such complication as internal fixation breakage, screw loosening, incision infection or elbow stiffness was observed in the other 17 cases. At the last follow-up, the MEPS scores averaged 97.9 points (from 85 to 100 points) and the VAS scores 0.2 points (from 0 to 2 points).Conclusion:The sled board internal fixation can result in good therapeutic effects on the treatment of olecranon fractures.

3.
Article in Chinese | WPRIM | ID: wpr-932304

ABSTRACT

Objective:To characterize the humeral head necrosis after open reduction and anatomic locking plate fixation of complex proximal humeral fractures.Methods:A retrospective study was conducted of the 20 patients who had been treated for humeral head necrosis after surgery of complex proximal humeral fracture at Department of Traumatic Orthopaedics, Beijing Jishuitan Hospital from September 2012 to June 2020. They were 7 males and 13 females with an average age of 57.4 years (from 35 to 84 years). Analyzed were their fracture types, time for diagnosis of humeral head necrosis, length of the medial residual bone, thickness of the humeral head and shoulder function.Results:The 20 patients were followed up for 8 to 104 months (average, 48.3 months). According to the Neer classification, there were 8 three-part fractures and 12 four-part fractures; shoulder dislocation was complicated in 10 cases. According to the AO-OTA classification, there were 16 type C fractures and 4 type B fractures. The length of the medial residual bone averaged 4.8 mm (from 0 to 10.7 mm); the medial soft tissue hinge was damaged in 18 cases and the thickness of the humeral head averaged 20.6 mm (from 13.6 to 33.0 mm). All fractures got united at the first stage after an average time of 8.4 weeks (from 5 to 12 weeks). The time for diagnosis of humeral head necrosis averaged 16.5 months (from 8 to 24 months). At the final follow-up, the Constant-Murley score of the affected side averaged 53.4 (from 22 to 74) while that of the healthy side 85.5 (from 53 to 98), with a ratio of affected side to healthy side of 62.43% (from 27.95 to 82.70%).Conclusions:Necrosis of the humeral head was common after surgery for complex proximal humerus fractures, most of which were three- or four-part ones or combined with shoulder dislocation. In most of the patients, the medial soft tissue hinge was damaged and the length of the residual medial bone usually shorter than 8 mm. Necrosis of the humeral head happened late after surgery. The function of the affected shoulder was significantly lower than that of the healthy side.

4.
Article in Chinese | WPRIM | ID: wpr-932300

ABSTRACT

Objective:To explore the surgical treatment of isolated traumatic radial head dislocation (ITRHD) after failed close reduction.Methods:A retrospective study was conducted of the 8 patients with ITRHD who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for operation after failed close reduction from January 2011 to December 2020. They were 2 males and 6 females, aged from 15 to 41 years (average, 27 years). The left elbow was injured in 3 patients and the right elbow in 5. At the last follow-up, elbow flexion-extension and forearm pronation-supination were recorded and Mayo Elbow Performance Score (MEPS) was used to evaluate functional recovery.Results:The 8 patients were followed up for 2 to 13 months (mean, 4.5 months). At the last follow-up, elbow flexion-extension averaged 136.9° and forearm pronation-supination 143.8°. None of the 8 patients had significant pain or joint instability. Of them, 7 had good motor function but one reported significant limitation of forearm rotation. All the 8 patients scored a full MEPS mark.Conclusions:If close reduction failed, ITRHD should be treated in time by operative treatment the efficacy of which is reliable. Fixation of the proximal radial-ulnar joint with Kirschner wire should be avoided. Early exercise for full range of elbow motion is necessary.

5.
Article in Chinese | WPRIM | ID: wpr-932298

ABSTRACT

Objective:To investigate the efficacy of TiRobot navigation for hinged external fixation in elbow arthrolysis.Methods:The 11 patients were retrospectively analyzed who had been treated by elbow arthrolysis at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital using TiRobot navigation for hinged external fixation. There were 9 males and 2 females with a mean age of 39.3 years (from 21 to 66 years). Their elbow range of motion (ROM) was compared between preoperation and the final follow-up. Their visual analogue scale (VAS) and Mayo elbow performance score (MEPS) and complications were documented at the final follow-up.Results:The rotation axis of the elbow joint was positioned with the aid of intraoperative robot navigation in 11 patients.The deviation of entry point averaged 0.21 mm (from 0.05 to 0.41 mm) and the deviation of exit point 0.23 mm (from 0.06 to 0.38 mm). The follow-up time for the 11 patients averaged 25.8 months (from 16 to 32 months). Their elbow flexion and extension was 133.0° (134.9°, 138.7°) and rotation 164.6° ±17.5° at the final follow-up, significantly improved compared with their preoperative values [0.8°(0°, 33.7°) and 122.9°±49.0°] ( P<0.05). Their VAS averaged 0.2 (from 0 to 1) and MEPS 96.8 (from 85 to 100) at the final follow-up, giving 9 excellent and 2 good cases. There was no case of radial nerve injury, pin instability, pin breakage, pin infection or peri-pin fracture. Conclusion:When TiRobot navigation is used for hinged external fixation in elbow arthrolysis, the axis of rotation can be accurately located, leading to satisfactory functional outcomes for the patients.

6.
Article in Chinese | WPRIM | ID: wpr-956616

ABSTRACT

Objective:To evaluate the surgical treatment of acute convergent dislocation of elbow after failed closed reduction.Methods:A retrospective study was conducted of the 8 patients with acute convergent dislocation of elbow who had been admitted from January 2017 to December 2020 for surgical treatment after failed closed reduction and completely followed up at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. There were 3 males and 5 females, with an average age of 30.9 years (from 15 to 51 years). Five left and 3 right elbows were injured. Combined injuries included radial head fracture in 6 cases, distal radius fracture in 2 cases, coronoid fracture in one, medial epicondyle fracture of the humerus in one, scaphoid fracture in one, and distal radioulnar dislocation in one. All patients underwent surgery after failure of closed reduction. Intraoperative exploration found in every case a longitudinal tear on the brachialis tendon. The radial head protruded from the front into the tear and twisted the tendon so that the reduction of the radial head was frustrated. At the last follow-up, the elbow flexion and extension and forearm rotation were recorded, and the Mayo elbow performance score (MEPS) was used for function assessment.Results:All the 8 patients were followed up for a mean of 6.1 months (from 2 to 12 months). At the last follow-up, the elbow flexion and extension averaged 101.9° (from 65° to 150°), the forearm rotation 132.5° (from 75° to 170°), and the MEPS 96.3 (from 90 to 100). None of the patients had significant pain or joint instability. Various degrees of joint mobility limitation existed in 7 patients, one of whom underwent elbow arthrolysis and another of whom underwent ulnar neurolysis and anterior transposition due to ulnar nerve injury.Conclusions:For treatment of acute convergent dislocation of elbow, if closed reduction fails, surgical treatment should be performed on time, because the surgical efficacy is more reliable. As the severity and combined injuries of the convergent dislocation vary from person to person, the therapy algorithm should be individualized.

7.
Article in Chinese | WPRIM | ID: wpr-956614

ABSTRACT

Objective:To compare the outcomes between hook thin plate compression technique and conventional screw-plate fixation in the treatment of adolescent tibial tubercle avulsion fractures.Methods:A retrospective analysis was performed of the 43 adolescent patients with tibial tubercle avulsion fracture who had been treated at Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital from January 2018 to October 2020. There were 42 males and one female, aged from 13 to 17 years. According to their treatment methods, they were divided into an observation group (9 cases) treated with hook thin plate compression technique and a control group (34 cases) treated with fixation with cannulated screws alone or in addition with a 1/3 tube plate. The maximum range of knee flexion, B?stman score, and cases returning to school at one month after operation, as well as fracture union time, B?stman score and cases with complications at the last follow-up were compared between the 2 groups.Results:There were no significant differences in the preoperative general data between the 2 groups, showing comparability ( P>0.05). By the postoperative one month, the maximum range of knee flexion [90.0° (85.0°, 102.5°)], B?stman score [21.0 (18.5, 21.0)] and cases returning to school (7) in the observation group were significantly better than those in the control group [22.5° (15.0°, 30.0°), 11.0 (10.0, 13.0), and 0] ( P<0.001). The last follow-up revealed no significant differences between the 2 groups in frature union time [(2.7±0.5) months versus (2.8±0.5) months], B?stman score [30.0 (30.0, 30.0) versus 30.0 (30.0, 30.0), 30.0)] or cases with complications (1 versus 2) ( P>0.05). Conclusion:In the treatment of adolescent tibial tubercle avulsion fractures, compared with conventional fixation with cannulated screws alone or in addition with a 1/3 tube plate, hook thin plate compression technique may lead to better outcomes, because it allows early rehabilitation to shorten the postoperative immobilization time and promote early functional recovery.

8.
Article in Chinese | WPRIM | ID: wpr-956609

ABSTRACT

Objective:To study the locational distribution characteristics of the heterotopic ossification (HO) following traumatic elbow stiffness and the risk factors for HO development at different locations.Methods:Consecutively included according to our inclusion criteria in the present study were the patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from January 2018 to December 2018 for elbow release due to traumatic elbow stiffness but developed postoperative HO. Their baseline data and CT data were collected and processed using Mimics 20.0. The HO distribution for each patient was characterized at the anteromedial, anterolateral, posteromedial, posterolateral, posterior, medial, lateral, and proximal radioulnar locations. The patient's original injury was categorized into 5 types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. After the univariate analysis with the HO occurrence at a specific location as the dependent variable and the original injury and baseline data as the independent variables, the factors with P value less than 0.1 were included in the logistic regression analysis to determine the risk factors for HO at each location.Results:A total of 91 patients were included in this study. Of them, 88 had posteromedial HO (96.7%, 88/91), 62 posterior HO (68.1%, 62/91), 60 posterolateral HO (65.9%, 60/91), 41 anteromedial HO (45.1%, 41/91), 26 anterolateral HO (28.6%, 26/91), 13 proximal radioulnar HO (14.3%, 13/91), 8 lateral HO (8.8%, 8/91), and 7 medial HO (7.7%, 7/91). Logistic regression analysis showed that presence of ulnar nerve symptoms ( OR=4.354, P=0.017) and presence of original elbow dislocation ( OR=2.927, P=0.042) were the independent risk factors for the anteromedial HO development and that presence of original olecranon fracture ( OR=0.277, P=0.023) was the protective factor for the anteromedial HO development. Presence of original radial head fracture was the independent risk factor for the anterolateral HO development ( OR=2.891, P=0.033) and the posterolateral HO development ( OR=3.123, P=0.043). Conclusions:HO development in patients with post-traumatic elbow stiffness is closely related to their original injury. Posteromedial HO may develop in almost all the patients. Patients with ulnar nerve symptoms and original elbow dislocation are more prone to anteromedial HO development, but patients with original olecranon fracture are less likely to develop anteromedial HO. Patients with original radial head fracture are more likely to develop anterolateral and posterolateral HO.

9.
Article in Chinese | WPRIM | ID: wpr-956581

ABSTRACT

Objective:To investigate the efficacy of fixation with cannulated screws alone via the Kocher approach in the treatment of adult humeral capitulum fractures.Methods:From August 2016 to August 2020, 16 patients with humeral capitulum fracture were treated at Department of Upper Limb Orthopedics, Zhengzhou Orthopaedic Hospital. They were 10 males and 6 females, aged from 36 to 62 years (average, 45 years). The left side was affected in 10 cases and the right side in 6. According to the Ring classification, 3 cases were type Ⅰ, 3 cases type Ⅱ, 6 cases type Ⅲ, and 4 cases type Ⅳ. All patients were treated with the Kocher approach on the lateral side of the elbow. After reduction under direct vision, the fractures were fixated temporarily with Kirschner wires and finally with cannulated screws. On the second postoperative day, the patients started active flexion and extension of the elbow joint and took indomethacin orally to prevent heterotopic ossification. At the last follow-up, the curative efficacy was evaluated according to the Mayo elbow performance score (MEPS). The flexion and extension of the elbow joint and the rotation of the forearm were also recorded.Results:All patients were followed up for 10 to 19 months (mean, 14.3 months) after surgery. Bony union was achieved after 7 to 12 monthes (average, 11.3 monthes) in all the 16 patients, 2 of whom developed heterotopic ossification. By the MEPS evaluation at the last follow-up, 8 cases were excellent, 6 good and 2 fair, scoring an average of 89.5 points (from 73 to 95 points). At the last follow-up, the elbow flexion ranged from 80° to 130° (averaging 113°), extension from 5° to 30° (averaging 15°), forearm pronation from 62° to 75° (averaging 67°), and forearm supination from 50° to 90° (averaging 75°).Conclusion:When the fracture ends are exposed through the lateral Kocher approach, the fracture fragments fixated with cannulated screws only, and the patients encouraged to start elbow joint exercises in the early stage, the treatment of adult humeral capitulum fractures can result in satisfactory curative effects.

10.
Article in Chinese | WPRIM | ID: wpr-956575

ABSTRACT

Objective:To evaluate the clinical efficacy of the axillary approach in the treatment of scapular glenoid fracture.Methods:A retrospective analysis was performed of the 12 patients who had been treated for scapular glenoid fracture from November 2019 to April 2021 at Department of Upper Limb Orthopaedics, Zhengzhou Orthopaedic Hospital. They were 4 males and 8 females, aged from 30 to 75 years (mean, 53.5 years). According to the Ideberg classification, there were 2 cases of type Ⅰa, 9 cases of type Ⅱ and one case of type Ⅴa. All cases were treated through the axillary approach. Two patients complicated with anterior shoulder dislocation were treated with manual reduction under anesthesia before operation and the other 10 cases with special plate fixation through the axillary approach. The 3 patients complicated with fracture of greater tuberosity were fixated with a special plate through the lateral shoulder split deltoid approach. Constant-Murley score, visual analogue scale (VAS) and Hawkins grading were used at the last follow-up to evaluate shoulder function, pain and stability after operation.Results:All patients were followed up for 9 to 20 months (mean, 14.4 months). The operation time ranged from 55 to 110 min (mean, 76.3 min), intraoperative bleeding from 60 to 160 mL (mean, 103.8 mL), and hospital stay from 8 to 14 d (mean, 11.1 d). All incisions healed primarily and all scapular glenoid fractures got united 6 months after operation. The last follow-up showed no shoulder instability, neurovascular injury or internal fixation failure. At the last follow-up, the range of motion of the shoulder was 159.2°±26.1° in forward bending, 156.7°±29.6° in abduction, 48.3°± 15.3° in external rotation (neutral position), and 73.3°±12.3° in internal rotation (neutral position), and the Constant-Murley score was (94.0±5.3) points. The range of motion of the shoulder and Constant-Murley score were significantly improved compared with those before operation (10.8°±11.6°, 7.5°±11.4°, 5.8°±10.0°, 42.5°±16.0° and 4.9±4.0, respectively) (all P<0.05). The VAS score was 0 in 11 patients and 2 in one patient at the last follow-up. Conclusion:The axillary approach is feasible for the treatment of scapular glenoid fracture, because it is hidden and less invasive, leading to good clinical outcomes.

11.
Article in Chinese | WPRIM | ID: wpr-910021

ABSTRACT

Objective:To explore the effect of combined administration of intravenous and topical tranexamic acid on perioperative blood loss in elbow arthrolysis.Methods:A retrospective analysis was conducted of 31 patients who had undergone elbow arthrolysis due to elbow stiffness from April 2019 to November 2020 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. An observational group of 15 patients were subjected to combined administration of intravenous and topical tranexamic acid while a control group of 16 patients to no administration of tranexamic acid. In the observational group, 15 mg/kg of tranexamic acid was injected intravenously 5 to 10 minutes before surgery and 1.0 g of tranexamic acid was injected locally in the area of anterior and posterior joint capsules after incision was closed while drainage tubes were clamped for 2 hours before release. In the control group, there was no special operative procedure while drainage tubes were also clamped for 2 hours before release. The 2 groups were compared in terms of blood loss on day 1 and day 3 after operation, drainage volume on day 1 after operation, total drainage volume, time for indwelling drainage tube, complications, and Mayo elbow performance score (MEPS) at 3 months after operation.Results:There were no statistically significant difference in preoperative general data between the 2 groups, showing they were comparable ( P>0.05).On day 1 and day 3 after operation, the blood loss was respectively (533.4±318.3) mL and (792.0±375.6) mL in the observational group, and respectively (866.4±480.5) mL and (1,403.0±636.5) mL in the control group, showing significantly differences between the 2 groups ( P<0.05). The drainage volume on day 1 after operation was (151.3±90.1) mL in the observational group and (235.0±126.1) mL in the control group, showing a significant difference between the 2 groups ( P<0.05). There was no statistically significant difference in total drainage volume or time for indwelling drainage tube between the 2 groups ( P>0.05). There were no such complications as thromboembolic events in either group. There was no significant difference in MEPS between the 2 groups at 3 months after operation ( P>0.05). Conclusions:Combined administration of intravenous 15 mg/kg and topical 1.0 g tranexamic acid may reduce blood loss on day 1 and day 3 after operation and drainage volume on day 1 after operation, and may not increase the risk of thromboembolic events, but cannot reduce total drainage volume or time for indwelling drainage tube. Application of tranexamic acid may not affect early elbow joint function after operation.

12.
Article in Chinese | WPRIM | ID: wpr-884275

ABSTRACT

Objective:To explore the feasibility and therapeutic efficacy of using the Henry approach to expose and place a metaphyseal bone plate laterally to fixate a proximal radial shaft fracture.Methods:A retrospective analysis was done of the 5 proximal radial shaft fractures (defined as the fracture involving the extent between the radial tuberosity to the insertion of the pronator teres) which had been treated from April 2018 to June 2019 at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital through the Henry approach to place a metaphyseal plate laterally to the radius for fixation. There were 2 males and 3 females, aged from 16 to 59 years (average, 41.4 years), with 3 cases on the left side and 2 cases on the right side. The imaging data, fracture healing time, forearm pronation-supination, and visual analogue scale (VAS) of the patients were regularly followed up; the therapeutic efficacy was evaluated at the last follow-up using Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH), Anderson and Grace-Eversmann evaluations.Results:The 5 patients were followed up for 7 to 16 months (average, 10.6 months). Their fracture healing time averaged 4.6 months, elbow flexion 146°, extension -2°, pronation 77°, and supination 88°. In postoperative VAS, 4 cases scored a 0 point and one case 1 point. At the last follow-up, their Quick-DASH scores averaged 4.1 points; by the Anderson evaluation, 5 cases were excellent; by the Grace-Eversmann evaluation, 4 cases were excellent and one case was good. No postoperative complication was observed.Conclusion:It is an effective treatment of proximal radial shaft fracture to use the Henry approach to expose and place a 3.5mm metaphyseal plate laterally to the radius for fixation.

13.
Article in Chinese | WPRIM | ID: wpr-884274

ABSTRACT

Objective:To compare the clinical outcomes between OTA/AO-C open and closed fractures of the distal humerus treated by open reduction and internal fixation.Methods:The clinical data were retrospectively analyzed of the 70 patients who had been treated at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital for OTA/AO-C fractures of the distal humerus from January 2014 to June 2017. Of them, 22 suffered from open fractures (Gustilo types Ⅰ/Ⅱ) and 48 closed fractures. There were 18 males and 4 females with an age of (42.6±13.0) years in the open group and 21 males and 27 females with an age of (42.2±17.1) years in the closed group. Analyzed were interval from injury to surgery, hospitalization time, injury energy and functional outcomes which included range of motion (ROM) in elbow flexion and extension, ROM in elbow rotation, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH), complications and rate of secondary surgery.Results:There was no significant difference between the 2 groups in age, injury energy or interval from injury to surgery ( P>0.05), but there were significantly more males in the open group than in the closed group ( P=0.011). The follow-up time for all the patients averaged 34.0 months (from 25 to 54 months). There were no statistically significant differences between the 2 groups in hospitalization time [9.5(6.0, 13.0) d versus 8.5 (6.0, 11.0) d], ROM in flexion and extension [120.0° (100.0°, 137.8°) versus 128.5° (110.0°, 140.0°)], ROM in rotation [155.0° (151.3°, 155.0°) versus 155.0° (155.0°, 155.0°)], MEPS [95.0 (80.0, 100.0) versus 95.0 (80.0, 100.0)] or DASH [2.6 (0.63, 9.2) versus 1.7 (0.0, 8.5)] ( P>0.05). There were no statistically significant differences between the 2 groups either in rate of secondary surgery [36.4% (8/22) versus 33.3% (16/48)], ulnar nerve symptoms [54.5% (12/22) versus 60.4% (29/48)], local irritability in the region of internal fixation [9.1% (2/22) versus 6.3% (3/48)] or elbow stiffness [13.6% (3/22) versus 10.4% (5/48)] ( P>0.05). Conclusion:Open reduction and internal fixation can lead to similar clinical outcomes in the treatment of both open (Gustilo types Ⅰ/Ⅱ) and closed distal humeral fractures of OTA/AO-C, with no significant differences in postoperative ROM, functional scores or complications.

14.
Article in Chinese | WPRIM | ID: wpr-867899

ABSTRACT

Objective:To summarize our experience in prevention of COVID-19 infection in emergency and confined operations during the first 3 weeks after Spring Festival in 2020.Methods:From February 3rd to 23rd, 2020, 151 patients were admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for emergency and confined operations. In this cohort, 125 patients were admitted to ordinary wards. They were 70 males and 55 females with an age of 51.1 years ± 14.9 years. Of them, 2 were subjected to emergency operation and 123 to confined operation. The mean time from injury to operation was 9.9 days ± 6.1 days. There were 26 cases in the senile wards, 7 males and 19 females with an age of 80.8 years ± 7.0 years all of whom underwent confined operations. The mean time from injury to operation was 8.4 days ± 6.3 days. The protocols for emergency diagnosis, admission, emergency and confined operations, postoperative rehabilitation and management of suspects with COVID-19 during the epidemic of COVID-19 were optimized according to Diagnosis and Treatment Protocols for Novel Coronavirus Pneumonia (Trial version 5), emergency responding pre-plans of our hospital, and our experience in Enhanced Recovery After Surgery (ERAS) as well.Results:The patients in the ordinary wards had a hospital stay of 6.8 days ± 4.6 days while those in the senile wards 5.1 days ± 2.0 days. Abnormal temperature (≥37.3 ℃) was observed perioperatively in 17 cases in the ordinary wards. It was absorption fever in all and appeared in 4 cases upon admission. Fever appeared in 11 patients in the senile wards and upon admission in 3 of them. One senile patient who had been diagnosed of normal pneumonia returned to normal temperature and remained stable conditions after antibiotic therapy. The other patients were free of complications related to COVID-19 during their hospital stay.Conclusion:The first-line medical staff working at emergency department, wards and surgical theaters must heighten their vigilance against COVID-19 infection and rigorously follow protocols for prevention of COVID-19 infection in their daily clinical practice.

15.
Chinese Journal of Trauma ; (12): 791-796, 2020.
Article in Chinese | WPRIM | ID: wpr-867795

ABSTRACT

Total elbow arthroplasty (TEA) is an effective surgical method for treatment of end-stage elbow arthritis. However, compared with hip and knee arthroplasties, the implant survival rate of TEA remains low, with a high postoperative complications rate and a high revision rate. The main reasons for revision include aseptic loosening, periprosthetic infection, periprosthetic fracture, component failure, and postoperative instability, of which the most common cause is aseptic loosening. Unlike the initial TEA, revision surgery usually needs to deal with complicated conditions such as infection, scars, bone defects, prosthetic stem extraction and cement removal, making the operation more difficult. There are few clinical studies related to TEA revision in China. Therefore, the authors review the reasons for postoperative revision, the management of key intraoperative issues, and the outcomes of treatment to provide the basis for future clinical application and academic research of TEA revision surgery in China.

16.
Chinese Journal of Trauma ; (12): 831-836, 2020.
Article in Chinese | WPRIM | ID: wpr-867787

ABSTRACT

The most common indications for total elbow arthroplasty (TEA) are rheumatoid arthritis, osteoarthritis, and post-traumatic arthritis. However, with the rapid development of the prosthesis and surgical techniques, the indications of TEA have been expanded to post-traumatic instability, failure of internal fixation, and acute comminuted distal humeral fractures in elderly patients. The most common complications of the classic Bryan-Morrey approach are postoperative ulnar nerve symptoms and weakness of the triceps muscle. Although the triceps-sparing approach enters the elbow joint through both sides of the triceps and retains the triceps brachii, it adds the operation difficulty and there still exist problems regarding postoperative ulnar nerve symptoms, extensive subcutaneous dissection, and large amount of drainage. In September 2018, Professor O'Driscoll introduced his modified small tongue-shaped flap approach, named as Diamond-Pop approach, but it has not been reported yet in recent literatures. The authors conducted a retrospective case series study to evaluate the clinical outcomes of 20 patients with elbow trauma or arthritis treated by TEA using this approach in Beijing Jishuitan Hospital from September 2018 to September 2019.

17.
International Journal of Surgery ; (12): 721-725, 2020.
Article in Chinese | WPRIM | ID: wpr-863413

ABSTRACT

Chronic elbow dislocation has a low incidence, but high disability rate, often leads to complications such as stiffness and instability, whose management is still a huge challenge in orthopedics traumatology. The mainstream strategy now is to reduce the elbow after extensive soft tissue release, repair or reconstruct collateral ligaments, stabilize the elbow with a hinged external fixator, and start rehabilitation as soon as possible. However, as evidence supporting treatment approaches comes mostly from small case series and case reports, controversies still remain in some intraoperative issues, such as the choice of surgical approach, the indications and methods of triceps lengthening and the reconstruction of ligaments. Combining relevant literature and clinical experience, the authors discussed the research progress in diagnosis and treatment of chronic elbow dislocation, suggesting that clinical doctors should focus on prevention rather than treatment of this disease, and advocated further reducing the incidence and disability rate of chronic elbow dislocation.

18.
Article in Chinese | WPRIM | ID: wpr-797423

ABSTRACT

Objective@#To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate.@*Methods@#From January 2013 to December 2017, 54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma, Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration). According to their age, the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5±3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1±5.8 years. The 2 groups were compared in terms of perioperative data, ranges of motion (flextion, extension and rotation), numeric rating scale for pain (NRS), Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) at the last follow-up, complications and secondary surgery.@*Results@#The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy, combined injury and gender between them (P>0.05). The young group had significantly more cases of high-energy injury and combined injuries than the elderly group(P<0.05). All patients were followed up for 33.6±15.0 months (from 12 to 63 months). The total blood loss in the elderly group (643.9±298.7 mL) was significantly less than that in the young group (953.9±554.6 mL) (P<0.05). At the last follow-up, there were no significant differences between the 2 groups in ranges of motion, NRS or MEPS (P>0.05), but the elderly group had significantly higher Quick-DASH scores (13.9±14.4 points) than the young group (5.7±8.9 points) (P<0.05). There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P>0.05), but the rate of secondary surgery in the young group (37.9%, 11/29) was significantly higher than that in the elderly group (4.0%, 1/25) (P<0.05).@*Conclusions@#In the treatment of humeral intercondylar fractures, ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.

19.
Article in Chinese | WPRIM | ID: wpr-791268

ABSTRACT

Objective To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate.Methods From January 2013 to December 2017,54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma,Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration).According to their age,the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5 ± 3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1 ± 5.8 years.The 2 groups were compared in terms of perioperative data,ranges of motion (flextion,extension and rotation),numeric rating scale for pain (NRS),Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm,Shoulder and Hand (Quick-DASH) at the last follow-up,complications and secondary surgery.Results The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy,combined injury and gender between them (P > 0.05).The young group had significantly more cases of high-energy injury and combined injuries than the elderly group (P < 0.05).All patients were followed up for 33.6 ± 15.0 months (from 12 to 63 months).The total blood loss in the elderly group (643.9 ± 298.7 mL)was significantly less than that in the young group (953.9 ± 554.6 mL) (P < 0.05).At the last follow-up,there were no significant differences between the 2 groups in ranges of motion,NRS or MEPS (P > 0.05),but the elderly group had significantly higher Quick-DASH scores (13.9 ± 14.4 points) than the young group (5.7 ± 8.9 points) (P < 0.05).There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P > 0.05),but the rate of secondary surgery in the young group (37.9%,11/29) was significantly higher than that in the elderly group (4.0%,1/25)(P < 0.05).Conclusions In the treatment of humeral intercondylar fractures,ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.

20.
Article in Chinese | WPRIM | ID: wpr-824406

ABSTRACT

Objective To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus.Methods From January 2013 to May 2017,159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating.They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years).They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not.The stiffness group had extension-flexion and/or pronation-supination < 100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥ 100° and no secondary elbow arthrolysis.Age,gender,fracture side,mechanism of injury,AO fracture classification,open/close fracture,additional fracture,preoperative nerve injury,time from injury to surgery,surgical approach,configuration of plating,medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis.Results The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months).The latest follow-up showed fracture union in all the patients.The stiffness group had 38 patients and the non-stiffness group 121.Multivariate regression analysis showed that high energy trauma (OR =3.141,95% CI 1.396 ~ 7.070,P =0.006) and time from injury to surgery > one week (OR =2.596,95% CI 1.123 ~ 6.000,P =0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus.Conclusion The patients with high energy trauma and time from injury to surgery > one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.

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