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Objective To investigate the clinical effects of headless double-threaded compression screws plus microplate for treatment of capitellar fracture of Ring type Ⅱ.Methods In the period from March 2015 to February 2018,12 capitellar fractures of Ring type Ⅱ were treated at Department of Upper limb Orthopedics,Zhengzhou Orthopaedics Hospital.There were 8 men and 4 women,aged from 25 to 57 years (average,35.4 years).There were 5 left and 7 right fractures.The fractures were exposed and reduced through the posterolateral elbow approach in 6 patients and through the lateral elbow approach in the other 6 ones.Fixation of all the fractures was conducted with headless double-threaded compression screws plus microplate.At the final follow-up,the elbow function was evaluated by the Mayo elbow performance score and the severity of traumatic arthritis by the Broberg & Morrey imaging criteria.Results All the patients were followed up for 9 to 36 months (average,23 months).The fracture healing time ranged from 9 to 12 weeks (average,10.6weeks).The final follow-ups revealed fine stability of the affected elbow joint in all the patients,and no loss of reduction,loosening or breakage of internal fixators or ischemic necrosis in any case.At the final follow-ups,the elbow inflection angles ranged from 90° to 130° (average,114.3°),the elbow extension angles from 0° to 20°(average,12.4°),the forearm pronation angles from 50° to 85° (average,70.5°) and the forearm supination angles from 45° to 80° (average,64.3°).The Mayo elbow performance scores at the final follow-up averaged 93.2points (from 85 to 100 points),yielding 8 excellent and 4 good cases.According to the Broberg & Morrey imaging criteria,10 patients showed no regressive change and 2 patients change by one grade.Conclusions A proper surgical approach should be chosen according to the preoperative imaging findings.The fracture of articular surface can be firmly fixated by head-less double-threaded compression screws and the integrity of the distal lateral column of the humerus can be restored with a microplate to achieve a strong biomechanical fixation.Fine clinical outcomes can be obtained by early functional exercise.
ABSTRACT
Comparar os parâmetros mecânicos entre dois métodos de estabilização por com pressão: placa de compressão axial de 1,5 mm com o parafuso cônico de compressão usado como tutor intramedular. Métodos: Foram usados modelos de poliuretano (Sawbone(r)) que simulam a fratura da falange proximal transversa, divididos em três grupos (placa lateral, parafuso cônico, sem implante). Resultados: Há necessidade de uma maior força para resultar na fadiga da síntese com para fuso intramedular. Comprova-se, assim, a supremacia mecânica desse sobre o modelo com a placa lateral. Conclusão: A estabilização com o parafuso Acutrak(r), no tratamento das fraturas no modelo adotado neste ensaio, apresenta resultados mecânicos superiores e estatisticamente sig nificativos em comparacão com a técnica de compressão axial com o uso da placa lateral (Aptus Hand (r)).
To compare the mechanical parameters between two methods for stabilization through compression: 1.5 mm axial compression plate versus conical compression screw used as an intramedullary tutor. METHODS: Polyurethane models (Sawbone(r)) that simulated transverse fractures of the proximal phalanx were used. The models were divided into three groups: lateral plate, conical screw and no implant. RESULTS: Greater force was needed to result in fatigue in the synthesis using an intramedullary plate. Thus, this model was proven to be mechanically superior to the model with the lateral plate. CONCLUSION: Stabilization using the Acutrak(r) screw for treating fractures in the model used in this trial presents mechanical results that are statistically significantly superior to those from the axial compression technique using the lateral plate (Aptus Hand(r)).
Subject(s)
Finger Injuries , Fracture Fixation , Fracture Fixation, Internal , Hand InjuriesABSTRACT
The purpose of our study was to compare the clinical results between arthroscopic bone fixation on intertubercular groove using suture anchor and soft tissue fixation at the rotaor interval for biceps tenodesis when partial tear or instability of biceps tendon accompanied with rotator cuff tear. From January 2010 to January 2012, 34 cases who were performed biceps tenodesis for partial tear or instability were enrolled in our study. Mean follow-up period was 30.2 months. Bone fixation using suture anchor was performed in 18 cases, and soft tissue fixation was performed in 16 cases. Clinical result was evaluated by pain visual analogue scale (VAS), Speed test, Yergason test, muscle strength, and Constant score. Pain VAS of cases with soft tissue fixation was significantly higher than that of cases with bone fixation at 6 months and final follow-up. Positive results for the final follow-up Speed and Yergason test were checked in 4 cases (25%) with soft tissue fixation and 1 (5.6%) with bone fixation. The Popeye deformity was seen in 4 cases (25%) with soft tissue fixation and 2 (11%) with bone fixation. Constant score was improved 47 to 78 in cases with soft tissue fixation and 48 to 86 in cases with bone fixation. In patient with partial tear or instability of biceps tendon accompanied with rotator cuff tear, biceps tenodesis using soft tissue fixation showed worse result compared with bone fixation because of long duration of the pain. Therefore, when performing the biceps tenodesis, bone fixation will be recommended.
Subject(s)
Humans , Congenital Abnormalities , Follow-Up Studies , Muscle Strength , Rotator Cuff , Shoulder , Suture Anchors , Tendons , Tenodesis , Tissue FixationABSTRACT
La mayoría de los sistemas de fijación ósea no están diseñados para pacientes de baja estatura con huesos de pequeño diámetro y longitud, como los que se presentan en osteogénesis imperfecta, raquitismo y displasias óseas con afectación de las fisis. En niños con defectos del metabolismo óseo, los clavos telescópicos que se fijan en las fisis, suelen ser los más indicados. El Clavo de Fassier-Duval tiene excelentes reportes, pero no controla la rotación y funciona solo en personas con placas de crecimiento abiertas. Para adultos y adolescentes con huesos pequeños y débiles, no existía un clavo intramedular ajustado a sus tamaños. Esta carencia llevó al autor a involucrarse en el diseño del CLAVO GAP. Tiene diámetros desde 4,8 mm y longitudes hasta 320 mm, canulado, capacidad de bloqueo proximal y distal, se puede utilizar en fémur, tibia y húmero. Es común que estos pacientes presenten debilidad de la cortical lateral del tercio proximal del fémur, por lo que se diseñó para agregarle una fijación al cuello femoral y el trocánter. Presentamos 5 casos realizados por los autores con este sistema de fijación ósea en pacientes con osteogénesis imperfecta. En todos los casos se logró el objetivo de estabilizar los segmentos óseos extremadamente débiles, con diámetros por debajo de los parámetros convencionales, sin requerir uso de férulas post-quirúrgicas(AU)
Most of the systems for bone fixation are not designed for patients of short stature with small bones, like in the patients with osteogénesis imperfecta, rickets and bone dysplasia with affectation of the fisis. In children with defects of the bone metabolism, the nails that telescope and hold in the physes, usually are indicated. Fassier-Duval Nails has excellent reports, but it does not have control of the rotation and it works only in patients with physes open. For adults and adolescents with small and weak bones, did not exist an endomedular nail that fit its sizes. This deficiency was an incentive to the author to become involved in the design of the GAP NAIL. It has diameters from 4.8 mm and lengths to 320 mm. It is canulated. It has capacity of being locked proximal and distally. It can be used in femur, tibia and humerus. It is common that these patients present weakness of the lateral cortex of the proximal third of the femur, reason why was designed to have the possibility to fix the femoral neck and trochanter. We present 5 cases were this system was used in patients with OI. In all the cases the objective was reached, that was to stabilized bones extremely fragile, with diameters below the conventional parameters, without requiring use of braces in the postop(AU)
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Humans , Male , Female , Orthopedic Fixation Devices , Osteogenesis Imperfecta/diagnosis , Bone Diseases, Developmental , Bone Nails , Patients , Rotation , Body SizeABSTRACT
PURPOSE: In the present study, the usefulness of single bone flexible intramedullary nail fixation in pediatric displaced both forearm bone shaft fractures was evaluated. MATERIALS AND METHODS: From 2006, we treated 14 consecutive pediatric both forearm bone shaft fractures using a single bone flexible intramedullary fixation. The average age of patients was 8.6 years (range, 3-12 years). We nailed the one bone of the two that showed either greater deformity in the initial radiographs, or difficulty in maintaining reduction, which in our cases was usually the radius. The operation time, duration of cast removal, functional recovery and complications were evaluated. The bony alignment, maintained until bony union, was analyzed by radiographic assessment. These data were compared with 27 cases of both bone nailing, which was the standard treatment in our institution prior to 2006. RESULTS: All cases in both groups healed without secondary intervention. All cases recovered to a normal functional status after postoperative average 12 weeks. In regards to their clinical and radiographic results, there was no significant difference between the single bone fixation group and the both bone fixation group, except that there was a shorter operation time, and longer period of cast immobilization, for the single bone fixation group. CONCLUSION: Single bone flexible intramedullary fixation is a useful method for the treatment of displaced forearm bone shaft fractures in children. The strategy of fixating the bone that exhibits greater deformity or difficulty in maintaining reduction, which was usually the radius, was found to be effective in our cases.
Subject(s)
Child , Humans , Bone Nails , Congenital Abnormalities , Forearm , Immobilization , Nails , RadiusABSTRACT
Objective To investigate the choice of methods and time on the treatment of Gustilo type Ⅲ B and type ⅢC open tibia fractures by bone fixation and tissue flap repairing.Methods The clinic data of 136 cases of Gustilo Ⅲ B and Ⅲ C open tibia fractures were retrospectively studied.There were 102 males and 34 females,with average age of 34 years(range 14 to 68 years).Ninety-eight cases were classified as Gustilo type Ⅲ B and 38 cases were type Ⅲ C in degree.In all cases,one hundred and thirteen were treated with onestage external fixation,ninteen cases were treated with secondary bone fixation.Sixty-seven cases of all wounds were repaired by one-stage vascular pedicle skin flap.Seven wounds were repaired by one-stage free flaps with vascular anastomosis.Sixty-two cases were secondary repaired by different flaps after defect tissue under VSD (vacuum-sealing-drainage) treatment by 1 to several weeks,which contains 9 free skin graft,eleven muscle flaps based on posterior tibial artery perforator,thirteen flaps based on fibial artery perforator,fourteen gastrocnemius falps and 15 cross-leg flaps.Results Wound of all cases were healed wholly.Primary union occurred in 121 cases,twelve,cases healed after bone grafting for segmental bone defect.Three cases with delayed union healed after reoperation for infection that caused osteomyelitis and sinus tract.The period of bone healing was form 5 to 12 months.Conclusion The treatment of Gustilo Ⅲ B and Ⅲ C open tibia fractures by onestage or secondary bone fixation and tissue flap repairing get their advantages and disadvantages,but one-stage bone fixation and tissue flap repairing was better where appropriate.
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Objective To observe the therapeutic effect of general combinable external fixator for the treatment of femoral intertrochanteric fracture(FIF).Methods One hundred and seventeen FIF patients were randomized into two groups: the treatment group(N =56) received treatment with general combinable external fixator,and the control group(N =61) received bone traction.A follow-up of 6~13 months was carried out.The therapeutic effect and the incidence of complications were compared in both groups.Results The total effective rate was 96.43% in the treatment group and 50.82% in the control group,and the incidence of complications was 7.1%(4/56) in the treatment group and 45.9%(28/61)in the control group,the difference being significant(P