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BACKGROUND: Elastic intramedullary nail and steel plate are two commonly used instruments for clavicle fracture, However, there are few comparative studies on the advantages and disadvantages of them. OBJECTIVE: To systematically evaluate the treatment effects of intramedullary fixation or plate fixation for displaced mid-shift clavicle fractures. METHODS: Articles about the treatment effects of intramedullary fixation or plate fixation for displaced mid-shift clavicle fractures were searched in PubMed, Embase, Science Direct and Cochrane Library, CNKI, WanFang and VIP databases from inception to March 2017. Two reviewers independently screened the articles, extracted data and evaluated the bias risk in the included studies according to the inclusion and exclusion criteria. Meta-analysis was performed using ReMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of 21 studies were included, with 859 patients in the intramedullary fixation group and 831 patients in the plate fixation group. (2) The result of meta-analysis showed that the operation time [MD=-18.62, 95%CI (-20.75, -16.49)], blood loss [MD=-56.23, 95%C/(-68.02, -62.44)], incision length [MJ=-5.53, 95%C/(-6.56, -4.49)], hospitalization time [MD=-1.01, 95%C/(-1.13, -0.89)], and healing time [MD=-1.39, 95%C/ (-1.98, -0.80)] in the intramedullary fixation group were better than those of the plate fixation group. (3) At 6 months after surgery, the Disabilities of the Arm, Shoulder and Hand scores in the intramedullary fixation group were better than those in the plate fixation group (F < 0.05). The scores showed no significant difference between two groups at 12 months after surgery. Major complications [OR=0.61, 95%C/ (0.39, 0.93)] in the intramedullary fixation group were less than those in the plate fixation group. Minor complications and implant removal were similar between two groups. (5) Meta-analysis results imply that elastic intramedullary nail fixation for treating displaced mid-shift clavicle fractures is superior to plate fixation in surgery-related indexes, functional recovery and fracture healing, which can provide effective evidence for its clinical application.
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Objective To evaluate the clinical outcome and discuss the method of treatment both-bone forearm fracture in children (4 to 15 years old) with elastic intramedullary nail (EIN).Methods We retrospectively analyzed the clinical result of forty-five cases to treat both-bone forearm fracture in children (4 to 15 years old) with elastic intramedullary nail from April,2008 to June,2014.Then we Discussed and analyzed the complication,surgery technique,limb function.Patients were followed up for more than 24 to 30 months after the surgery to continuously evaluate the limb function and fracture healing by physical examination and x-ray image.Results There were 38 children with excellent recovery,7 good and no fair by followed up for 24 to 30 months,9 cases with observed complication due by prominent nail ends,3 patients slightly declined after the surgery,1 patient was observed with ulna fracture delayed recovery during 3 to 8 months of fracture healing.Apposition rate in all cases was ＞50％ in anterior-posterior view and the apposition rate ＞90％ in lateral view.No fracture of ESIN,Nerve injuries,severe displacement were observed during this study.Conclusion The elastic intramedullary nail is a good method to treat children both-bone forearm fracture with lower surgery technique,minimall invasion,if less complications,does not interfere with growth,has good forearm function recovery.
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Objective To study the clinical effect of elastic intramedullary nail in the treatment of preschool children limb fractures.Methods Ninety-two 92 cases closed fracture of extremities of preschool children in Children ′s Hospital of Shenyang from July 2014 to February 2016 were selected,and randomly divided into control group and observation group,46 cases in each group.The control group were treated with open reduction and plate fixation treatment,observation group were treated with elastic intramedullary nail treatment.The surgical effect and prognosis index and the incidence of postoperative complications of two groups were compared.Results The operation time,the amount of bleeding,hospitalization time,fracture healing time and loading time of the observation group were significantly lower than the control group((63.57±3.12) min vs.(94.72±6.49) min,(52.43±11.35) ml vs.(134.26±23.50) ml,(6.10±1.44) d vs.(15.83±2.61) d,(8.34±1.13) weeks vs.(12.05±1.62) weeks,(10.85±2.71) weeks vs.(16.94±3.25) weeks,t=29.34,21.29,22.14,12.74,9.76,P<0.01).The incidence of complications in the observation group was 6.52%(3/46),significantly lower than the control group(19.54%(9/46),χ2=5.06,P=0.02).Conclusion The elastic intramedullary nail for treatment of fractures of extremities shaft closed preschool children can guarantee good clinical effect,and has little trauma high quality,healing of fracture,less postoperative complications and easy care,is a kind of efficient treatment technology,can be widely developed in clinic.
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Objective To evaluate the clinical effects of open reduction plate screw nail internal fixed and minimally invasive elastic intramedullary nail internal fixation combined with neck strap suspension for treating adult humeral shaft fracture . Methods A retrospective analysis was made on the clinical data of 65 patients with humeral shaft fracture in our hospital from March 2012 to March 2014 ,including 38 cases of open reduction plate screw internal fixation (plate screw nail fixation group) and 27 cases of limited open or closed reduction elastic intramedullary nail internal fixation combined with neck strap suspension (elastic intramedullary nail group) .The operation time ,intraoperative blood loss amount ,iatrogenic radial nerve injury ,occurrence rate of incision infection ,postoperative fracture reduction degree ,fracture recovery time and elbow joint function score were compared be‐tween the two groups .Results The operation time and intraoperative bleeding volume in the elastic intramedullary nail group were less than those in the plate screw nail fixation group ,the differences were statistically significant (P0 .05) ,the postoperative shoulder and elbow joint function scores in the plate screw nail group were significantly higher than those in the elastic intramedullary nail group ,the difference was statistically significant (P<0 .05) .No serious nerve damage ,incision infection and other postoperative complications occurred in the two groups .Conclusion Both the open reduction plate screw nail internal fixation and elastic intramedullary nail in‐ternal fixation are effective method for treating adult humeral shaft fracture ,the latter has shorter operation time ,less intraoperative bleeding ,but shoulder elbow pain and limitation of motion are more serious than the former .