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Objective:To investigate the clinical efficacy of ultrasound-guided closed reduction and percutaneous Kirschner wire fixation in the treatment of supracondylar fractures of the humerus in children.Methods:The clinical data of 78 children with Gartland type II and type III straight-type supracondylar fractures of the humerus who received treatment in The First Affiliated Hospital of Anhui Medical University from October 2019 to October 2022 were retrospectively analyzed. These children were divided into an observation group ( n = 38) and a control group ( n = 40) according to different treatment methods. The observation group was subjected to ultrasound-guided closed reduction and percutaneous Kirschner wire fixation. The control group was given C-arm fluoroscopy-guided closed reduction and percutaneous Kirschner wire fixation. Mayo elbow performance score (MEPS), clinical healing time, operative time, and the incidence of intraoperative complications such as vascular and nerve injury were compared between the two groups. Results:Both groups of children achieved closed reduction without open reduction. The operative time in the observation group was (30.68 ± 5.45) minutes, which was significantly shorter than (40.54 ± 5.78) minutes in the control group ( t = 2.30, P < 0.05). The healing time of the fracture in the observation and control groups was (32.73 ± 4.56) days and (36.47 ± 6.24) days, respectively, and there was no significant difference between the two groups ( P > 0.05). The range of joint motion and elbow hyperextension angle range in the observation group were (148.78 ± 3.81)° and (8.72 ± 8.92)°, respectively, and they were (147.24 ± 4.36)° and (7.98 ± 8.86)°, respectively in the control group. There were no significant differences in the range of joint motion and elbow hyperextension angle range between the two groups (both P > 0.05). The excellent and good rate of joint function in the control and observation groups was 92.5% (37/40) and 92.1% (35/38), respectively. There was no significant difference in excellent and good rate of joint function between the two groups ( P > 0.05). There were three cases of postoperative nerve damage in the control group and no vascular or nerve damage was observed in the observation group. There were significant differences in the number of cases of vascular or nerve injury between the two groups ( χ2 = 3.97, both P < 0.05). Conclusion:Ultrasound-guided closed reduction and percutaneous Kirschner wire fixation for the treatment of supracondylar fractures of the humerus can shorten the operative time, decrease the incidence of intraoperative nerve injury, and reduce the X-ray exposure time of doctors and patients.
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ABSTRACT Introduction We compared the mechanical properties of two fixation techniques for the treatment of extra-articular distal third humeral fractures. Materials and Methods Two groups were created from twenty-four humeri. Group 1 was instrumented using a new, precontoured, 8-hole (3.5-mm-diameter) locking compression plate (LCP) placed anterolaterally. Group 2 was instrumented using an 8-hole (3.5-mm-diameter) precontoured posterolateral LCP plate placed on the distal humerus. Four-point bending tests and torsion tests were performed until the specimens broke. Results The four-point bending stiffness test showed that the stiffness of anterolaterally fixed humeri was significantly higher than that of posterolaterally fixed humeri (p<0.05). Torsion testing revealed that posterolateral fixation was associated with better yield strength (p<0.05), but the torsional stiffness did not differ significantly between the two plates (p> 0.05). Conclusions The anterolateral plate exhibited higher bending stiffness and torsional yield strength than the posterolateral plate. Anterolateral plate fixation can thus be used to manage extra-articular distal humeral fractures. Multiaxial locking screws ensure rigid fixation, allow early elbow motion without olecranon fossa impingement, and prevent iatrogenic injury of the triceps muscle. Level of Evidence I, Therapeutic Studies Investigating the Results of Treatment.
RESUMO Introdução Comparamos as propriedades mecânicas de duas técnicas de fixação para o tratamento de fraturas extra-articulares do terço distal do úmero. Materiais e Métodos Dois grupos foram criados a partir de vinte e quatro úmeros. O Grupo 1 foi instrumentado com uma nova placa de compressão com travamento (LCP) pré-contornada e com oito orifícios (3,5 mm de diâmetro) posicionados anterolateralmente. O Grupo 2 foi instrumentado com uma placa LCP pré-contornada posterolateral com oito orifícios (3,5 mm de diâmetro) colocada na parte distal do úmero. Testes de flexão e testes de torção a quatro pontos foram realizados até que os corpos de prova quebrassem. Resultados O teste de rigidez à flexão de quatro pontos mostrou que a rigidez dos úmeros fixados anterolateralmente foi significativamente maior do que os úmeros fixados posterolateralmente (p <0,05). O teste de torção revelou que a fixação posterolateral foi associada a melhor força de rendimento (p <0,05), mas a rigidez à torção não diferiu significativamente entre as duas placas (p > 0,05). Conclusões A placa anterolateral apresentou maior rigidez à flexão e resistência à tração do que a placa posterolateral. A fixação anterolateral da placa pode, portanto, ser usada para tratar fraturas extra-articulares da parte distal do úmero. Os parafusos de travamento multiaxiais garantem uma fixação rígida, permitem o movimento precoce do cotovelo sem causar impacto à fossa do olécrano e previnem lesão iatrogênica do músculo tríceps. Nível de evidência I, Estudos terapêuticos - Investigação dos resultados do tratamento.
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Objective:To compare the clinical effect of buttress plate fixation and cannulated screw fixation of Regan-Morrey type II ulnar coronoid fractures.Methods:A retrospective case control study was made on 53 patients with Regan-Morrey type II ulnar coronoid fractures admitted to Wuxi No.9 People 's Hospital from April 2015 to January 2018，including 36 males and 17 females，aged from 21 to 63 years［（36.3±7.1）years］. Among them，24 patients were treated using buttress plates（plate group），and 29 patients using cannulated screws（screw group）. The operation time and fracture healing time were documented. The visual analogue score（VAS），range of motion of elbow flexion and extension and forearm rotation and Mayo elbow performance score（MEPS）were assessed at postoperative 1，3，6 months and at the last follow-up. The incidence of complications was observed as well. Results:All patients were followed up for 15-18 months［（15.9±1.3）months］. The operation time in plate group［（150.6±24.2）minutes］was longer than that in screw group［（126.8±18.3）minutes］（ P<0.05）. There was no significant difference in fracture healing time or VAS between the two groups（ P>0.05）. After 1，3，6 months and during the last follow-up，the range of motion of elbow joint flexion and extension in plate group［（87.2±5.8）°，（109.2±7.1）°，（121.3±6.2）°，（127.3±5.4）°］was higher than that in screw group［（70.5±9.1）°，（90.2±4.5）°，（108.3±5.1）°，（116.2±4.6）°］，the range of motion of forearm rotation in plate group［（78.3±9.1）°，（98.7±8.6）°，（130.2±7.1）°，（139.2±6.7）°］was higher than that in screw group［（60.1±5.1）°，（80.6±8.7）°，（116.1±5.5）°，（127.3±4.1）°］，and the MEPS in plate group［（30.6±7.6）points，（68.1±6.1）points，（90.2±4.3）points，（95.2±2.1）points］was higher than that in screw group［（27.2±8.1）points，（54.1±7.1）points，（82.1±5.3）points，（88.2±5.2）points］（all P<0.05）. In plate group，one patient sustained superficial wound infection at postoperative 1 week，which was healed uneventfully after surgical debridement and antibiotic therapy；two patients had heterotopic ossification without addition surgery. In screw group，three patients presented screw loosening and fracture redisplacement during early movement，which was healed by reducing the intensity of elbow functional exercise and prolonging the protection time of brace；four patients had heterotopic ossification，among which one combined with elbow stiffness showed improved range of motion of the elbow after elbow release at postoperative 12 months. The incidence of complications in plate group［13%（3/24）］was lower than that in screw group［26%（7/29）］（ P<0.05）. Conclusion:For Regan-Morrey type II ulnar coronoid fractures，the buttress plate fixation is superior to the cannulated screw fixation in fixation strength，recovery of elbow function and incidence of complications in regardless of longer operation time.
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Objective:To investigate the related factors of vertebral body height reloss after pedicle screw fixation of thoracolumbar fracture and to determe the optimum prediction point.Methods:A retrospective case control study was made on 215 patients with thoracolumbar fracture admitted to Second Affiliated Hospital of Soochow University from January 2010 to December 2017. There were 155 males and 60 females，aged 21-80 years［（48.6±10.4）years］. According to Denis fracture classification，there were 73 patients with compression fractures（type A in 15 patients，type B in 51，type C in 7），135 burst fractures（type A in 28 patients，type B in 87，type C in 20）and flexion distraction fractures（type A in 4，type B in 2，type C in 1）. All patients were treated by pedicle screw fixation. Follow-up lasted for 12- 48 months［（23.8±8.2）months］. Vertebral body height loss occurred in 86 patients（loss group），but did not in 129 patients（non-loss group）. The two groups were compared concerning sex，age，osteoporosis self-assessment tool for Asians（OSTA），body mass index（BMI），fracture types，number of fractured vertebrae，preoperative sagittal Cobb angle，preoperative degree of vertebral compression，number of screws placed in injured vertebrae，extent of vertebral reset and other related factors. Univariate analysis was used to identify the correlation of those factors with vertebral body height reloss. Multivariate Logistic regression analysis was performed to identify the independent factors for the height reloss with the receiver operating characteristic curve（ROC）and area under the curve（AUC）calculated to evaluate the optimum point in prediction of vertebral height reloss.Results:The two groups showed no significant differences in sex，age，BMI，fracture types，number of injured vertebrae，preoperative sagittal Cobb angle and number of screws placed in injured vertebrae（ P>0.05），but the differences were statistically significant in OSTA，preoperative degree of vertebral compression and extent of vertebral reset（ P<0.05）. According to the univariate analysis，OSTA，preoperative degree of vertebral compression and extent of vertebral reset were significantly correlated with the occurrence of vertebral body height reloss（ P<0.05）. According to the multivariate Logistic regression，OSTA（ OR=1.109，95% CI 0.527-0.685， P<0.05）and preoperative degree of vertebral compression（ OR =0.038，95% CI 0.539-0.689， P<0.05）were significantly related to vertebral body height reloss. The AUC relating OSTA and preoperative degree of vertebral compression to vertebral body height reloss was 0.604 and 0.614，respectively. The optimum prediction point of OSTA and preoperative degree of vertebral compression for vertebral body height reloss was 1.9 and 31.3%，respectively. Conclusions:OSTA and the preoperative degree of vertebral compression are independent risk factors for vertebral body height reloss. OSTA≤1.9 or preoperative degree of vertebral compression ≥31.3% indicates a significantly higher risk of postoperative vertebral body height reloss.
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Objective:To investigate the effect of robot-assisted percutaneous retrograde screw fixation in the treatment of acetabular fractures involving the posterior column.Methods:A retrospective case series study was conducted to analyze the clinical data of 13 patients with acetabular fractures involving the posterior column admitted to Wuhan Fourth Hospital from January 2019 to December 2020. There were 8 males and 5 females，aged 62-78 years［（69.7±1.5）years］. According to Judet-Letournel classification，fractures involved the posterior column in 4 patients，anterior column plus posterior semi-transverse column in 3 and double column in 6. According to AO classification，type 62-A2.1 was found in 2 patients，62-A2.2 in 2，62-B3 in 3 and 62-C in 6. All patients were treated with retrograde percutaneous screws assisted by orthopaedic surgery robot. The operation time，intraoperative blood loss，length of hospital stay and time of bone healing were recorded. The incision healing and complications were detected. Matta reduction standard was used to evaluate the fracture reduction quality at 2 days after operation，and Majeed function score was used to evaluate the functional recovery preoperatively，at 3 months after operation and at 6 months after operation.Results:All patients were followed up for 6-12 months［（9.3±1.7）months］. The operation time was 1.1-1.5 hours［（1.3±0.2）hours］. The intraoperative blood loss was 110-200 ml［（161.3±21.1）ml］. The length of hospital stay was 8-13 days［（10.7±1.3）days］. The time of bone healing was 14-18 weeks［（15.4±1.1）weeks］. All incisions were healed by first intention. One patient with sciatic nerve injury was treated with mecobalamin and recovered 3 months later. One patient with advanced heterotopic ossification had no obvious clinical symptoms. All patients had no complications such as incision infection，deep venous thrombosis of lower limbs，fat embolism，screw penetration into hip joint，fracture displacement after failure of internal fixation，traumatic arthritis，or necrosis of femoral head，etc. According to Matta reduction standard，there were 10 patients with anatomical reduction and 3 with satisfactory reduction. Majeed function score was（15.0±1.3）points before operation，（76.5±2.0）points at 3 months after operation and（85.1±1.9）points at 6 months after operation（ P<0.01），and there were 9 patients with excellent results，2 with good results and 2 with fair results，showing the excellent and good rate of 85%. Conclusion:For acetabular fractures involving the posterior column，robot-assisted percutaneous retrograde screw fixation has advantages of less surgical trauma，higher fracture healing rate，fewer complications，satisfactory anatomical reduction and good functional recovery.
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Objective:To investigate the clinical efficacy of anterior approach combined with blocking plates and screws in the management of acetabular fracture involving the quadrilateral area.Methods:A retrospective case series analysis was performed for 16 patients with acetabular fracture involving the quadrilateral area admitted to First and Second Affiliated Hospital of Guangxi Medical University from January 2017 to January 2019. There were 12 males and 4 females，with the age of 21-66 years［（45.3±10.6）years］. According to Letournel-Judet classification，there were 9 patients with bi-column fracture，6 with anterior and posterior traverse fracture and 1 with anterior column fracture. A total of 9 patients were operated via the ilioinguinal approach and 7 via the lateral-rectus approach. Reduction and fixation of the pelvis and acetabulum were performed，using 3.5 mm cortical bone screws or plates to block the internal displacement of fracture in the quadrilateral body. The incision length，operation time and intraoperative blood loss were recorded. The quality of fracture reduction was assessed according to the Matta reduction criteria at postoperative 2 days and hip function by the modified Merle D'Aubigne-Postel score at postoperative 3 months and 12 months. Postoperative complications were observed.Results:All patients were followed up for 13-24 months［（16.1±2.9）months］. The ilioinguinal approach and lateral-rectus approach showed surgical incision of 12-26 cm［（18.6±4.0）cm］and 8-15 cm［（10.7±2.3）cm］，respectively. The operation time was 107-215 minutes［（159.2±27.8）minutes］and the intraoperative blood loss was 200-2，300 ml［（853.1±489.7）ml］. According to Matta reduction criteria，the results were excellent in 9 patients and good in 7. Three months after operation，the modified Merle D'Aubigne-Postel score was 11-18 points［（15.2±2.2）points］，which showed the results were excellent in 4 patients，good in 7，fair in 4 and poor in 1，with the excellent and good rate of 69%. Twelve months after operation，the modified Merle D'Aubigne-Postel score was 13-18 points［（16.9±1.4）points］，which showed the results were excellent in 7 patients，good in 8 and fair in 1，with the excellent and good rate of 94%. The liquefaction of post-surgical incision was seen in a patient，bladder injury in a patient，lateral femoral cutaneous nerve injury in a patient，and heterotopic ossification in a patient. There was no loosening or breakage of the internal fixation.Conclusion:For acetabular fracture involving the quadrilateral area，anterior approach combined with blocking plates and screws can prevent the displacement of quadrilateral fracture and attain satisfactory reductiongood hip function recovery and few complications.
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Objective:To evaluate the effectiveness of TiRobot-assisted surgery by O-arm navigation for minimally invasive treatment of type C pelvic fractures.Methods:A retrospective case control study was conducted on clinical data of 53 patients with type C pelvic ring fractures treated between January 2018 and September 2019 at Shanghai Tenth People’s Hospital. There were 29 males and 24 females，aged 20-68 years［（40.4 ± 15.5）years］. All were diagnosed with AO type C fractures. A total of 32 patients underwent minimally invasive internal fixation by TiRobot orthopedic system assisted with O-arm navigation（TiRobot group），and 21 patients were managed by minimally invasive internal fixation under the fluoroscopy guidance of the C-arm X-ray machine（control group）. The operation time，intraoperative blood loss，fluoroscopy time of screw and good and excellent rate of screw placement were recorded. One week after surgery，the pain intensity was assessed by visual analog scale（VAS），and the fracture reduction quality by Matta radiographic criteria. At the latest follow-up，the recovery of pelvic function was evaluated by Majeed criteria. Complications were recorded after operation and during the follow-up.Results:All patients were followed up for 12-15 months［（13.2 ± 0.3）months］. The operation time was（85.2 ± 6.9）minutes in TiRobot group and（101.0 ± 6.7）minutes in control group（ P < 0.05）. The intraoperative blood loss showed no significant difference between the two groups（ P > 0.05）. The fluoroscopy time of screw placement was 6（5，7）seconds in TiRobot group，compared to 10（10，15）seconds in control group（ P < 0.05）. In TiRobot group，the screw placement was excellent in 30 patients，good in 1，and fair in 1，with the excellent and good rate of 97%（31/32），while in control group，15 patients showed excellent placement of screws，2 good，and 4 fair，with the excellent and good rate of 76%（17/21）（ P < 0.05）. There was no significant difference in VAS between the two groups at postoperative one week（ P > 0.05）.At the latest follow-up，the pelvic reduction quality based on Matta radiographic criteria and pelvic function using Majeed criteria did not differ significantly between the two groups（ P > 0.05）. No complications occurred after operation and during the follow-up，such as loosening or breakage of screws，heterotopic ossification，vascular injury or nerve injury. Conclusion:For type C pelvic fractures，TiRobot-assisted minimally invasive internal fixation by O-arm navigation can shorten operation time and intraoperative fluoroscopy time，and improve the accuracy of screw placement when compared to C-arm fluoroscopy.
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Objective To compare the primary clinical results of arthroscopic figure of 8 suture and ladder mesh suture fixations in treating anterior cruciate ligament (ACL) tibial avulsion fractures.Methods From August 2013 to November 2016,a total of 37 patients with ACL tibial avulsion fracture who had closed epiphyses underwent arthroscopy.By the Meyers-McKeeverZaricznyj classification,10 cases were type Ⅱ,22 type Ⅲ and 5 type Ⅳ.There were 25 cases in the figure of 8 suture fixation group with two No.2 high-strength sutures crossed to form a 8 figure to pull out and fix the fracture through the tibial tunnels,including 17 males and 8 females with an average age of 18.91 ±9.34 years (range 14-36 years).The ladder mesh suture fixation group with three No.2 high-strength sutures woven into a mesh to pull out and fix the fracture through the tibial tunnels had 12 cases,including 8 males and 4 females with an average age of 19.63±7.85 years (range 15-33 years).At the latest follow-up,the Lysholm and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function,while the Lachman test and Pivot-shift test were used to estimate knee joint instability.The operation duration,knee range of motion (ROM) and the number of case with flexion contracture were evaluated.Results All 37 cases were followed up.The average follow-up duration was 16.35±5.27 months (range 10-22 months) in figure of 8 suture fixation group and 14.06±7.18 months (range 10-21 months) in ladder mesh suture fixation group.In figure of 8 suture fixation group,the Lysholm and IKDC average scores were 95.86±5.74 and 90.53±4.61,respectively.However,they were 96.53±3.17 and 92.15±5.54 in ladder mesh suture fixation group with no significant difference between the two groups after operation (t=0.723,P=0.462;t=l.018,P=0.279).The percentage of negative Lachman test and Pivot-shift test in the figure of 8 suture group was 92％ (23/25).There was no significant difference in the negative rate in the ladder mesh suture fixation group 100％ (12/12,x2=0.904,P=0.265).The average operation duration of ladder mesh suture fixation group was 61.8±6.3 minutes,which was longer than that of figure of 8 suture fixation group 43.5±5.9 minutes (t=2.714,P=0.025).Flexion contracture of ≥5° occurred in 4 cases in the figure of 8 suture group and 0 case in the ladder mesh suture fixation group with significant difference between the two groups (x2=0.450,P=0.032).Conclusion In treating ACL tibial avulsion fractures,arthroscopic figure of 8 suture fixation and ladder mesh suture fixation can achieve satisfied functional recovery and stability.The ladder mesh suture fixation can effectively achieve reduction of fracture fragments and knee flexion contracture.It may have more advantages in treating rotational type Ⅲ and type Ⅳ comminuted fractures.However,some disadvantages in this technique,such as high technical requirements and long operation time,have to be considered.
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It has become a research hotspot in the field of trauma orthopedics how to fix intertrochanteric fractures effectively,especially the head-neck fragment,so that the osteoporotic fracture ends can be stabilized.In order to reduce fixation failure,application of bio-reinforced materials is another promising mothod in addition to improving the design of internal fixation.This paper reviews the research history,characteristics,current research into the biomechanics and clinical application of bone reinforced cement materials,intending to help surgeons understand the principles,surgical techniques and application scope of bone bio-reinforced materials for internal fixation.
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Objective To explore the significance of proximal femoral medial wall plating by finite element analysis of the stability after medial wall fixation of the proximal femur in all types of 6-part classification of femoral intertrochanteric fractures.Methods Finite element method was used to establish models of 7 types of 6-part classification of femoral intertrochanteric fractures which were fixated with proximal femoral nail anti-rotation (PFNA),medial wall plating (bi-cortex),PFNA + medial wall plating (uni-cortex).The boundary conditions and material properties were defined according to the data published in literature.A load of the peak hip stress was applied in simulation of a normal adult of 70 kg in weight walking.The conditions above produced the Von Mises stress diagrams and Min Principal stress distributions of the normal femur for 21 groups of internal fixation models.The stability of the model was assessed by analyzing the peak stress value of the key part and fragmental displacements in each group.Results In 7 types of fractures fixated with PFNA,the changes in stress and fragmental displacement were small for all major femoral parts while the fragmental displacement increased in the greater trochanter.In the medial wall plating,the stress increased obviously with the increase in bone fragments,especially the lateral ones,for the significant femoral parts and internal fixation,and the fragmental displacements increased greatly but the displacement was always limited for the medial fragments.In the fixation with PFNA + medial wall plating,the stress changes and fragmental displacements for significant femoral parts were the smallest of the 3 fixation methods.Conclusions Proximal femoral plating can effectively reduce stress concentration at the proximal femur and provide better support for the medial wall of the proximal femur.For unstable fractures,PFNA plus medial plating may provide rigid fixation because it better reduces stress on the femur than simple PFNA,does not increase fragmental displacements and leads to no significant abnormal changes in internal fixation structure.
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Objective To explore the surgical efficacy of trans-syndesmotic ankle fracture dislocation (the "Logsplitter" injury) plus the Tillaux-Chaput fracture / the Wagstaffe-Lefort fracture and the Volkmann fracture without tibiofibular joint screwing.Methods Between January 2015 and December 2018,16 adult patients with the "Logsplitter" injury plus avulsion fractures were treated by open reduction and internal fixation at Department of Orthopaedics,The Sixth Affiliated Hospital,Xinjiang Medical University.They were 11 males and 5 females with an average age of 36.4 years (range,from 27 to 56 years).There were 2 open fractures (one type Ⅱ and one type ⅢA by the Anderson-Gustilo classification) and 14 closed ones;all fractures were type 44-C by the AO/OTA classification;according to the Lauge-Hansen classification,there were 9 cases of pronation-abduction rotation,3 cases of pronation-external rotation and 4 cases of supination-external rotation.The fibular fractures were treated through a single lateral approach followed by plate fixation.The Volkmann fractures were fixed with screws and the Tillaux-Chaput fractures / the Wagstaffe-Lefort fractures with screws or Kirschner wires.The ankle functions were assessed postoperatively using the ankle-hindfoot rating system of the American Orthopaedic Foot and Ankle Society (AOFAS),and the dysfunction index and bother index of Short Musculoskeletal Function Assessment (SMFA).Results All the patients were followed up for 8 to 27 months (average,21.3 months).X-ray films showed complete fracture healing in all cases after 12 to 18 weeks postoperatively (mean,14.8 weeks).At the last follow up,13 patients walked normally and 2 with mild discomfort.Their AOFAS scores averaged 96.3 (range,from 86 to 100),giving 12 excellent,3 good and one poor cases;their SMFA dysfunction index was 15.9 (range,from 8 to 17)and SMFA bother index 6.5 (range,from 3 to 9)at the last follow-up.Conclusions In the treatment of trans-syndesmotic ankle fracture dislocation — the "Logsplitter" injury,open reduction and internal fixation of the Tillaux-Chaput fracture / the Wagstaffe-Lefort fracture and the Volkmann fracture to reconstruct the lower tibiofibular horizontal stable "ring",without tibiofibular joint screwing,can obtain satisfactory clinical results.
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Objective To observe the clinical efficacy of internal fixation through a modified posterolateral approach in the treatment of lateral and posterior malleolar fractures.Methods From January 2015 to January 2018,25 patients with fracture involving the lateral and posterior malleolus were treated at Department of Orthopedics,The Second Affiliated Hospital to Wenzhou Medical University.They were 13 males and 12 females,aged from 18 to 70 years (mean,43.1 years).By the Lauge-Hansen classification for ankle injury,9 cases belonged to supination-supination type of degree Ⅲ,11 to supination-supination type of degree Ⅳ,and 5 to pronation-supination type of degree Ⅳ.By the Haraguchi classification,all the posterior malleolar fractures in this series belonged to type Ⅰ.Internal fixation through a modified posterolateral approach was performed for all the lateral and posterior malleolar fractures.Their operation time,fracture healing time and postoperative complications were observed.At the last follow-up,ankle joint function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results In the 25 patients,the operation time ranged from 50 to 100 min (mean,70 min).Of this group,21 patients were followed up for 12 to 18 months (mean,14 months).Bony union was achieved after 3 to 5 months after operation.Superficial wound infection was observed in 3 cases.No such complications occurred like postoperative adhesion,deep infection,contracture of flexor hallucis longus tendon,or loosening or breakage of implants.By the AOFAS ankle-hindfoot scale at the last follow-up,the ankle function was excellent in 13 cases,good in 6 and fair in 2.Conclusion The modified posterolateral approach is worth popularizing in clinic because it provides possibilities of fixating the lateral and posterior malleolar fractures by the same incision,not stripping the muscular origins of the flexor hallucis longus and reducing postoperative adhesion of the flexor hallucis longus.
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Objective To report the treatment effects of open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision on closed calcaneal fractures.Methods A retrospective study was done of the 20 patients (25 feet) who had been treated at Ward One,Department of Orthopaedics,People's Hospital of Yunfu from February 2016 to February of 2019 for closed calcaneal frac-tures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision.They were 16 males and 4 females,aged from 16 to 60 years.According to the Sanders classification,there were 3 cases of type Ⅱ,15 cases of type Ⅲ and 2 cases of type Ⅳ.Their fractures were reduced by traction,extruding,prying and direct visualization through the tarsal canal window;the bone plates were inserted through a small incision at the back of the heel and fixated by screws.Postoperative observation was done to address fracture healing,and length,width,height,B(o)hler angle and Gissane angle of the affected calcaneus,as well as functional recovery of the ankle-hindfoot by the American Orthopaedic Foot and Ankle Society (AOFAS) evaluation.Results The operation time for a single foot ranged from 45 min to 70 min,averaging 64.5 min;the intraoperative fluoroscopy for a single foot ranged from 3 times to 6 times,averaging 4.5 times.Local skin necrosis of about 0.5 cm x 0.3 cm appeared in one foot after operation but responded to dressing change.No other wound complications occurred.Their follow up was carried out for 6 to 36 months (average,17.3 months).The fractures healed well with well-shaped bony callus and flat articular surface after 4 to 6 months.The length (80.5 mm ±4.2 mm),width (44.8 mm ±5.2 mm),height (44.4 mm ±3.0 mm),B(o)hler angle (25.0° ± 5.1 °) and Gissane angle (113.8 ° ± 8.6°) of the calcaneus at the last follow up were significantly improved than the preoperative values (79.4 mm ± 4.5 mm,50.5 mm ± 6.3 mm,40.0 mm ±4.4 mm,12.0°± 13.8° and 107.0°± 13.3°) (all P ＜ 0.05).By the AOFAS ankle-hindfoot scale,functional recovery of the foot was excellent in 20,good in 3 and fair in 2 cases,giving an excellent to good rate of 92％.Conclusion In the treatment of closed calcaneal fractures,open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision may lead to fine outeomes due to its advantages of small incision and fine fracture reduction.
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Objective To evaluate the minimally invasive treatment of calcaneal fractures of Sanders Ⅱ &Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires.Methods From June 2016 to February 2018,53 patients (60 feet) were treated at Department of Hand and Foot Surgery,Central Hospital of Linyi for closed intra-articular calcaneal fractures.Of them,24 (28 feet) received the minimally invasive treatment and 29 (32 feet) open surgery via the conventional lateral L-shaped incision.The 2 groups were compared in terms of B(o)hler angle,Gissane angle,and the width,length and height of the calcaneus before operation,one week after operation and at the final follow-up,as well as in terms of preoperative preparation time,operation time,surgical bleeding volume,incision complications,subtalar joint stiffness,and anklehindfoot score of the American Foot and Ankle Surgery Association (AOFAS).Results The 2 groups were comparable because there were no significant differences between them in the preoperative general data (P ＞ 0.05).All the patients were followed up for 10 to 22 months (average,16 months).The B(o)hler angles,Gissane angles,and the widths,lengths and heights of the calcaneus after operation and at the final follow-up were significantly better than the preoperative values in the minimally invasive group (all P ＜ 0.05).The preoperative preparation time (2.5 d ± 1.2 d) and operation time (62.6 min ± 6.3 min) in the minimally invasive group were significantly shorter than those (7.6 d ± 3.5 d and 85.9 min ± 9.7 min) in the conventional group (P ＜ 0.05),the surgical bleeding volume in the former (30.5 mL ± 3.8 mL) was significantly smaller than that in the latter (80.9 mL ± 8.3 mL) (P ＜ 0.05),and the rates of incision complications (0) and subtalar joint stiffness (10.7％) in the former were significantly lower than in the latter (9.4％ and 43.7％) (P ＜ 0.05).However,there was no significant difference between the 2 groups in the AOFAS anlle-hindfoot score (92.8 ± 5.9 versus 89.5 ± 7.5) (P ＞ 0.05).Conclusion The minimally invasive treatment of calcaneal fractures of Sanders Ⅱ & Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires can lead to satisfactory clinical results,because this method shortens significantly the time for hospitalization and leads to less invasion,fewer complications,accurate reposition and reliable fixation.
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Objective To explore the efficacy of open reduction and internal fixation in the treatment of senile osteoporotic ankle fractures.Methods A retrospective case series study was conducted to analyze the data of 26 elderly patients with osteoporotic ankle fractures which all caused by sprain from June 2012 to June 2018 in Changhai Hospital,including 10 male and 16 female patients aged from 60 to 93 years (mean,69.72 years).In these 26 patients,three had medial malleolus fractures,four had lateral malleolus fractures,six had double ankle fractures and 13 had cotton's fractures.According to the Lauge-Hansen type,all 26 patients can be classified into four types:5 with supination external rotation type,4 supination adduction type,16 with pronation-external rotation type and 1 with pronation abduction type.All the patients received open reduction and internal fixation.Plate fixation was used for lateral and posterior malleolus fractures,plate fixation and cannulated screws were applied to fix the comminuted posterior malleolus fracture while in the comminuted internal malleolus fracture,the steel plate was used only when needed.Early professional functional rehabilitation training and active antiosteoporosis treatment were applied.All the operation time and bleeding volume were recorded,and the reduction of fracture plus the healing of wounds were observed.At last follow-up,American Orthopedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale was used to evaluate the treatment effect and the Visual Analogue Scale (VAS) to evaluate the therapeutic effect and the subjective satisfaction of the patients.Complications were recorded as well.Results All patients were followed up for 12-48 months (mean,23.6 months).Operation time ranged from 30 to 95 minutes (mean,70 minutes) and bleeding volume ranged from 10 to 150 ml (mean,70 ml).All patients got satisfied reduction of fracture within 25 patients' incision healing in first intention,although one has fat liquefaction.AOFAS Ankle Hindfoot Scale improved from preoperative (84.4 ± 10.8) points to (31.9 ± 11.4) points at last follow-up (P ＜0.01),and the results were excellent in five patients,good in 17,fair in three and poor in one,with the excellent and good rate of 85％.VAS improved from preoperative (1.85 ± 0.73) points to (9.23 ± 0.28) points at last follow-up (P ＜ 0.01).Among 26 patients,5 with ankle stiffness of different degree recovered after rehabilitation care,and 2 with internal malleolus fractures had bone displacement when receiving rehabilitation care,with no side effect on basic function.No serious complications such as wound infection or skin necrosis were found.Conclusion For osteoporotic ankle fractures in the elderly,open reduction and internal fixation can promote functional recovery and relieve pain.
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Objective To compare the clinical efficacy of posterior minimally invasive reconstruction plate and 3D-navigated percutaneous sacroiliac screw fixation of elderly patients with posterior pelvic ring fractures.Methods A retrospective cases control study was performed to analyze the data of 75 elderly patients with posterior pelvic ring fractures admitted from January 2014 to June 2018 in Central Hospital of the PLA.There were 32 males and 43 females,with the age range of 60-83 years (mean,67.7 years).Twenty-four patients in the plate group were treated by posterior minimally invasive reconstruction plate fixation,and 51 patients in the navigation group were treated by percutaneous sacroiliac screw internal fixation with 3 D navigation.The operation time,intraoperative blood loss,X-ray exposure time,complication rate and postoperative visual analogue scale (VAS) were compared between the two groups.Postoperative Matta radiographic criteria was used to assess fracture reduction quality,and Majeed criteria was used to assess pelvic function at the last follow-up.Results All 75 patients were followed up for 6-24 months (mean,13.5 months).The operation time,intraoperative blood loss and X-ray exposure time in the plate group were (126.1 ± 20.6) minutes,(251.6 ± 50.8) ml,and (15.7 ±4.4)s,showing significant differences in comparison with the navigation groups [(49.7 ± 17.5)minutes,(22.8 ±5.1) ml,and (112.8 ± 8.8) s] (P ＜0.05).The incidence of postoperative complications was not significantly different between the plate group (4％) and the navigation group (4％) (P ＞0.05).At day 3,one week,and one month postoperatively,the VAS in the navigation group was (3.3 ± 0.7) points,(3.2 ± 0.7) points,(2.4 ± 0.6) points,better than that in the plate group [(7.2 ± 0.7) points,(6.2 ± 0.8) points and (4.5 ± 0.7) points] (P ＜ 0.05).However,there was no significant difference between the two groups at 3 months and one year after operation (P ＞ 0.05).According to the Matta radiographic criteria,the excellent and good rate was 92％ in plate group (excellent in 14 cases,good in 8,and fair in 2),and was 82％ in the navigation group (excellent in 25 cases,good in 17 and fair in 9).There was no significant difference between the two groups (P ＞0.05).According to the Majeed criteria at the follow-up,the excellent and good rate was 96％ in the plate group (excellent in 15 cases,good in 8 and fair in 1),and was 94％ in the navigation group (excellent in 35 cases,good in 13 and fair in 3).The difference between the two groups was not statistically significant (P ＞ 0.05).Conclusion For elderly patients with osteoporotic posterior pelvic ring fractures,percutaneous sacroiliac screw fixation under 3D navigation has the advantages of shorter operation time,less bleeding,less radiation dose and less postoperative pain than minimally invasive reconstruction plate internal fixation,and hence deserves clinical application.
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RESUMEN Las fracturas expuestas del pilón tibial son lesiones poco frecuentes que se asocian con la aparición de múltiples complicaciones derivadas de la intensidad del trauma, a esto se añade la posibilidad real de sepsis de tejidos blandos o hueso y los trastornos de la consolidación ósea relacionados con la zona afectada. El adecuado manejo de estas afecciones por parte del personal médico evita la aparición de importantes complicaciones, por este motivo se decidió compartir la experiencia en el manejo de estas afecciones mediante la presentación de un caso.
ABSTRACT Exposed fractures of the tibial pylon are infrequent lesions that are associated with the appearance of multiple complications derived from the intensity of the traumain addition to the real sepsis possibility of soft tissues or bone and bone consolidation disorders related to the affected zone. Adequate management of these conditions by the medical staff avoids the appearance of important complications, for this reason it was decided to share the experience in the management of these conditions by presenting a case.
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Objective To explore the clinical efficacy of plate fixation via the lateral transverse incisions and double-window approaches for the treatment of intra-articular calcaneal fractures.Methods A retrospective analysis was performed on the data of 21 intra-articular calcaneal fractures (22 feet) which had been treated at Department of Orthopaedics,The Second Affiliated Hospital to Anhui Medical University from May 2014 to April 2016.There were 19 males and 2 females,aged from 20 to 60 years (average,38.3 years).The fracture affected 13 left feet and 9 right feet.According to the Sanders classification,10 feet were type Ⅱ,11 type Ⅲ and one type Ⅳ.They were treated by plate fixation via the lateral transverse incisions and double-window approaches.Early complications within 3 months after operation,the length,width,height,B(o)hler angle and Gissane angle of the calcaneus one year after operation,functional recovery of the affected feet at the last follow-up,and complications were recorded.Results The 21 patients were followed up for 21 to 44 months (mean,36.7 months).Incisions were all healed at the first postoperative stage with no serious skin or sofi tissue complications like superficial infection,deep infection or wound dehiscence.At the early stage,one patient suffered epidermal necrosis at the margin of incision,which was cured after dressing change.None of the patients developed subtalar arthritis by the last follow-up.The preoperative length,width,height,B(o)hler angle and Gissane angle of the calcaneus (respectively,68.6 ± 1.2 mm,46.7 ± 0.8 mm,39.1 ± 2.0 mm,5.4° ± 12.1° and 104.3°± 10.2°) were significantly improved to 71.7 ± 1.6 mm,48.8 ±2.0 mm,32.8 ± 1.3 mm,29.2° ± 6.8°,and 120.8° ± 6.2° one year after operation(P ＜ 0.05).At the last follow-up,their AOFAS ankle-hind foot scores averaged 92.7 points (from 73 to 98 points);17 feet were rated as excellent,3 as good and 2 as moderate,giving an excellent and good rate of 90.1％.Conclusion Plate fixation via the lateral transverse incisions and double-window approaches can reduce incidences of postoperative soft tissue complications and subtalar arthritis,leading to good clinical results in the treatment of intra-articular calcaneal fractures.
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Objective To evaluate the clinical efficacy of the modified Stoppa approach in the surgical treatment of pelvic fractures of Tile type C combined with acetabular both-column fractures.Methods Between April 2014 and April 2017,a total of 14 patients were treated by open reduction and internal fixation (ORIF) through the modified Stoppa approach at Department of Orthopaedics,Foshan Gaoming Hospital for pelvic fractures of Tile type C combined with acetabular both-column fractures.They were 10 men and 4 women,with an average age of 36.4 years (from 23 to 57 years).The modified Stoppa approach was used exclusively in 4 cases,in combination with the iliac fossa approach in 3 ones,in combination with the Kocher-Langenbeck approach in 4 ones and in combination with the Kocher-Langenbeck and iliac fossa approaches in 3 ones.In all the patients,the pelvic reconstructive plate and screws and lag screws were used.The operation time,intraoperative bleeding volume,postoperative fracture reduction,fracture union time,efficacy and complications were recorded.Results The operation time averaged 170 min (from 110 to 330 min) and the intraoperative bleeding 420 mL (from 240 to 1 100 mL).There were no operative complications.By the Matta evaluation,the postoperative reduction was rated as excellent in the 14 pelvic fractures and 9 acetabular both-column fractures and as good in 5 acetabular both-column fractures.Of this series,13 patients were followed up for an average of 19 months (from 12 to 29 months) and one was lost to the follow-up.The fractures got united after an average time of 3.4 months (from 2.7 to 4.6 months).Screw loosening was observed in one case and mild limitation to hip flexion in one.Follow-ups found no lateral ventral syndrome or femoral head necrosis.Their Harris hip scores at the last follow-up ranged from 70 to 94 points,averaging 84 points.The function of the affected hip was excellent in 6 cases,good in 5 and fair in 2.Conclusion The modified Stoppa approach may be used exclusively or in combination with other approaches to treat effectively the pelvic fractures of Tile type C combined with acetabular both-column fractures,leading to good short-term clinical outcomes.
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Objective To compare the biomechanical performance between the single-versus double-threaded cannulated screws in the treatment of femoral neck fractures of Pauwels type Ⅲ.Methods Models of femoral neck fracture of Pauwels type Ⅲ (70°) were made of the Sawbone synthetic composite femurs.All specimens were divided into 2 groups (n =12).Group A was fixated with single-threaded cannulated screws and group B with double-threaded cannulated screws,both in an inverted triangle configuration.The screws ranged from 90 to 95 mm in length and from 7.3 to 7.5 mm in diameter.All the specimens were subjected to axial stiffness and failure load tests with 7° valgus (simulating normal two-legged weight-bearing stance) and 25° valgus (simulating normal one-legged weight-bearing stance) and torsion test as well.The 2 groups were compared in the torques at axial stiffness angles of 1°,2°,3°,5° and 7°.Results Group B had significantly greater axial stiffness at 7° valgus and 25° valgus (89 ± 26 N/mm and 128 ± 37 N/mm) and failure load (1,154 ±368 N) than groupAdid (36 ±12 N/mm and 47 ±16 N/mm;688 ±94 N) (P ＜0.05).The torques increased with the increase in rotation angle in both groups.However,the torques in groupB (3.26±0.96,4.16±1.23,4.64±1.13,5.59±l.26and6.53±l.47 N·m) were all significantly larger than in group A (1.44 ±0.19,2.03 ±0.41,2.33 ±0.62,2.74 ±0.87 and 3.05 ± 1.07 N · m)(P ＜ 0.05).Conclusion Double-threaded cannulated screws may provide better biomechanical stability than single-threaded ones,due to their substantial improvement in anti-compression and anti-rotation performance.