Comparison of lag screw fixation on posterior malleolar fractures in different directions and screw-related complication / 中国综合临床

Objective@#To compare the effects of indirect reduction, percutaneous anterior posterior screw and direct reduction, posterior anterior screw in the treatment of posterior malleolus fracture.@*Methods@#A retrospective analysis was made on 58 patients with posterior malleolus fracture treated by cannulated screw fixation from January 2013 to December 2017 in the Department of Orthopedics, Affiliated Hospital of Guangdong Medical University.They were divided into anterior and posterior screw group (26 cases) and posterior and anterior screw group (32 cases) according to different treatment methods.The incidence of poor screw position and other complications were compared between the two groups.Health status and ankle function at the last follow-up were compared between the two groups.@*Results@#The incidence of screw malposition in the anterior and posterior screw fixation group was 23.08%(6/26), which was significantly higher than that in the posterior screw fixation group was 3.85%(1/32). The difference between the two groups has statistically significant (χ2=5.381, P=0.020); there was no significant difference in other complications such as infection, traumatic arthritis, bone nonunion (all P>0.05). At the last follow-up, the OMA scores of AP group were (80.70±8.16)and PA group were(75.23±9.33), There were significant differences between the two scores(t=2.240, P=0.029), the AOFAS scores of AP group were (80.57±7.25) and PA group were(75.38±10.19), There were significant differences between the two scores(t=2.110, P=0.039).@*Conclusion@#The Indirect reduction and percutaneous anterior and posterior screw treatment have a high incidence of malposition of the screw, which has an impact on ankle function.Direct reduction and posterior and anterior screw fixation can significantly reduce the incidence of malposition of the screw and obtain better functional results.

Posterior indirect reduction and internal fixation and laminectomy in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury / 局解手术学杂志

Objective To explore the clinical effect of posterior indirect reduction and internal fixation and laminectomy in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury.Methods Eighty patients with thoracolumbar vertebrae burst fracture and spinal cord injury treated in our hospital from March 2014 to March 2015 were selected as the objects,and they were divided into reset group and laminectomy group with forty cases in each group according to surgical method.All the patients were followed up for 1 year,the lumbar function of two groups at 1 week and 1 year after operation were observed respectively,and the pain degree was observed in 1month,3 months and 6 months after operation.The amount of bleeding,operation time,hospitalization time and fracture healing time were observed.Neurological function was assessed by classification criteria of the American Spinal Cord Injury Association(ASIA),and incidence of complications was figured in the two groups.Results The anterior heights of the injured vertebra were higher than those before the operation,and the Cobb's angles were lower than those before the operation,the differences were significant(P ＜ 0.05);while there was no significant differences in the anterior heights of the injured vertebra between the two groups at 1 week and 1 year after operation(P ＞ 0.05).VAS scores of the two groups after 1 month,3 months and 6 months decreased significantly when compared with the preoperative scores(P ＜ 0.05),and VAS scores of each time in the reset group were significantly lower than those in the laminectomy group(P ＜ 0.05).The amount of bleeding,operation time,hospitalization time and fracture healing time in the reset group were less than those in the laminectomy group (P ＜ 0.05).The neurological function recovery of the two groups were significantly improved when compared with that before the operation(P ＜0.05).There was no significant difference in recovery of neurological function between the two groups(P ＞ 0.05).The complication rate was 7.50％ in the reset group,lower than 12.50％ of the laminectomy group,the difference was significant (P ＜ 0.05).Conclusion Posterior indirect reduction and internal fixation of lamina both have a certain effect in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury.But posterior indirect reduction has less complications and less amount of bleeding,which is beneficial to postoperative recovery.

Indirect Reduction Maneuver and Minimally Invasive Approach for Displaced Proximal Humerus Fractures in Elderly Patients

BACKGROUND: This study examined the clinical outcomes of indirect reduction maneuver and minimally invasive approach for treating displaced proximal humerus fractures in patients older than 60. METHODS: Thirty-two patients (11 male and 21 female) who had undergone treatment for displaced proximal humerus fracture were evaluated. The mean age of the patients was 72.4 years (range, 60 to 92 years). All cases were followed up for at least 12 months. All patients were interviewed and evaluated on the visual analog scale, with gender-specific constant score correction for age, standardized X-rays to check the neck-shaft angle (NSA) and the presence of medial support, and bone mineral density. Statistical analysis was performed with a multiple regression analysis. RESULTS: The average visual analog scale score was 2.4, and the average gender-specific constant score correction for age was 80.6 points. Final functional outcomes were 8 excellent, 15 good, 7 fair, and 2 poor. The average NSA was 122.8degrees; and the radiological results were 20 good, 11 fair, and 1 poor. There was significant difference of the gender-specific constant score for age between the group of NSA more than 110degrees and the group of NSA less than 110degrees (p = 0.00). There were 26 cases with and 6 cases without medial support, with significant difference between the gender-specific constant score correction for age of these groups (p = 0.01). Complications occurred in 4 patients (12.5%). CONCLUSIONS: The indirect reduction maneuver and minimally invasive approach were safe and reliable options for the treatment of displaced proximal humerus fractures in the elderly patients. An inadequate reduction (i.e., less than 110degrees NSA) or lack of medial support (e.g., no cortical or screw support) were significant factors contributing to poor functional outcomes.

Minimally Invasive Plate Osteosynthesis for the Upper Extremity Fracture Using a Lumbar Spreader: Surgical Technique

The minimally invasive plate osteosynthesis (MIPO) which is extensively performed, is very dependent on the indirect reduction technique to prevent the exposure of fracture sites. Indirect reduction with the use of the femoral distractor is a much more efficient technique to restore the length in the fracture of lower limbs. However, the femoral distractor cannot be used for fracture of upper limbs, and other instruments for indirect reduction have not yet been reported. Therefore, we introduce the novel indirect reduction technique with the use of the lumbar spreader for the MIPO of upper limbs.

Related Factors of Ligamentotaxis with Posterior Instrumentation for the Surgical Treatment of Thoracolumbar Bursting Fracture

PURPOSE: To investigate factors influencing the amount of indirect reduction by ligamentotaxis according to timing of surgery, extent of surgery, and characteristics of fractures. MATERIALS AND METHODS: We reviewed 22 cases of thoracolumbar fracture which had been performed posterior instrumentation and fusion using pedicle screw system. We divided patients into each group according to timing of surgery, number of fusion segment, insertion of screw on fractured vertebra, and rupture of posterior ligament complex, and Denis type. We measured changes of kyphotic angle, anterior vertebral height and wedge angle on plain radiographs, and we compared spinal canal area before and after operation using computed tomographic scans. RESULTS: Kyphotic angle, anterior vertebral height, wedge angle, and area of spinal canal showed significant improvement postoperatively. The wedge angle improved significantly operated within 3 days after injury, however, kyphotic angle and anterior vertebral height had no correlation with variable factors except the rupture of posterior ligament complex. The amount of restoration of spinal canal also affected only by rupture of posterior ligament complex. CONCLUSION: There is little relationship between timing of surgery and canal restoration, so we cannot conclude that prompt operation helps reduction of narrowed spinal canal. Otherwise narrowed spinal canal had much less restored by ligamentotaxis when there were rupture of posterior ligament complexes.

Indirect Reduction of Posterior Column through Ilioinguinal Approach in Case of Both Column Fractures

PURPOSE: To evaluate the efficacy and results of indirect reduction of the posterior column through the ilioinguinal approach in cases of both column fractures. MATERIALS AND METHODS: Between February 2000 and January 2008, 18 patients, who underwent indirect reduction of the posterior column through the ilioinguinal approach, were evaluated clinically and radiographically after a minimum follow-up of one year. The mean follow-up duration was 52.7 months. The reduction quality, clinical results, and radiographic results were analyzed according to the criteria reported by Matta. The complications were also recorded. RESULTS: There were 13 cases (72.2%) of an anatomical reduction, 2 cases (11.1%) of an imperfect reduction, and 3 cases (16.7%) of a poor reduction. Out of 13 anatomically reduced fractures, excellent results were graded in 12 cases clinically and 9 cases radiographically. Poor clinical and radiographic results were graded in 2 of the 3 poorly reduced fractures. Complications included 3 cases with transient lateral femoral cutaneous nerve injury, which resolved during the follow-up period and 1 case with an injury to the superior gluteal artery. CONCLUSION: Indirect reduction of the posterior column through the ilioinguinal approach is effective for both column fractures. During surgery, care should be taken to reduce the risk of iatrogenic lateral femoral cutaneous nerve injury.

Indirect Decompression using Segmental Screw Fixation for Cervical Myelopathy Caused by C1-2 Subluxation: Technical Note / 대한정형외과학회잡지

The main aims of surgery for severe cord compression and myelopathy caused by atlantoaxial subluxation are decompression of the spinal cord and achievement of rigid fixation and fusion. Direct decompression by resecting the bony structures that compress the spinal cord includes transoral decompression and resection of the posterior arch of the atlas. The shortcomings of these procedures are a high complication rate and a relatively low rate of union. Indirect decompression can be performed by a reduction of the subluxation and fixation without bone resection. To the best of our knowledge, there are no domestic reports on the use of indirect decompression for severe cord compression and myelopathy for atlantoaxial subluxation. We report a case of a patient that had atlantoaxial subluxation and severe myelopathy; satisfactory reduction of the subluxation and decompression with an improvement in the myelopathy symptoms was achieved by indirect decompression using segmental screw fixation.

Minimally invasive plate osteosynthesis versus ORIF in treatment of intra-articular fracture of knee joint / 中国矫形外科杂志

[Objective]To comparatively analyze the clinical results of minimally invasive plate osteosynthesis (MIPO) and ORIF in treatment of intra-articular fracture of knee joint and to investigate the utilization value of biological fixation.[Method]According to the principles of conservation of the vascularity,21 cases of intra-articular fractures of knee joint underwent surgical treatment of MIPO in recent years.In accordance with the type of fracture and other anticipated factors influenced bony healing,paired-samples treated of ORIF were selected.The two groups were compared following: operation time,intra-operative blood loss,bone union time,axial malalignment radiologically of knee joint,and the ROM of knee.HSS criteria were used to evaluate the results.[Result]In MIPO group,all 21 fractures were followed up for averagely 14.2 months (range 10~16 months).The mean duration of surgery was 60.0 min (range 50~70 min) and bone grafting underwent in 2 cases.Complete fracture healing was achieved with the average time of 10.0 weeks and assessment of vallgus/varus alignment showed a deviation more than 5 degrees in 3 cases.The average HSS score was 86.67.In ORIF group,all 21 fractures were followed up for averagely 21.2months (range 12~48 months).The mean duration of surgery was 79.52 min (range 65-95 min) and bone grafting underwent in 18 cases.Complete fracture healing was achieved with the average time of 12.24 weeks and assessment of valgus/varus alignment showed a deviation more than 5 degrees in 2 cases.The average HSS score was 82.14.All patients got bony union and no patient developed infection,implant failure in both groups.There was significant difference in operation time,union time and function of knee between the two groups.[Conclusion]To the suitable cases,MIPO appears to stabilize fractures with a low intra-operative blood loss and a low incidence of bone grafting; on the other hand it offers many advantages in the aspects of operation procedures and functional recovery postoperatively.

Treatment of distal tibiofibular fractures by indirect reduction and plate fixation through inferior fibula / 中华创伤骨科杂志

Objective To investigate the clinic results of treatment of distal tibiofibular fractures by in- direct reduction and plate fixation through inferior fibula.Methods Between 2002 and 2005,32 cases of distal tibiofibular fractures were treated with indirect reduction and plate fixation through inferior fibula.According to the AO/ASIF classification,there were 17 cases of type A,nine cases of type B,and six cases of type C.Twenty of them also received iliac autograft through a limited median incision at the lower tibia to repair their lateral tibial defects.After operation their ankle joints were fixated at 90?with piaster brace and cast for three months.The bone union,wound and the function of the ankles were observed after surgery.Results All the patients were followed up for an average of 16 months.The average bone union time was 14 weeks.No nonunion,screw loosening,broken plate,or infection of the wounds was found in this series.The excellent and good rate was 84.4% according to Mazur's ankle joint function scoring.Conclusion Indirect reduction and plate fixation through inferior fibula is a satisfactory technique in the treatment of distal tibiofibular fractures.

The Operative Treatment of Patellar Fracture Using Indirect Reduction

The goal of treatment of fracture of the patella is to gain accurate fracture reduction, secure fracture fixation, and early range of motion. In severely comminuted fractures of patella, open reduction requires extensive soft tissue dissection and high risk of infection. Furthermore, it is very difficult to get rigid fixation enough to allow early joint motion. An alternative in the management of severely comminuted patellar fractures is the technique of indirect reduction, in which the soft-tissue attachments of the individual fragments are preserved and used to reduce the fracture. Thirteen patients with fracture of the patella were treated by indirect method. Clinical analysis was done by using anterior knee pain score by Shelboume, Lysholm score, and radiological finding. The average Lysholm score was 88.3 and average anterior knee pain score 87.3. Nearly anatomic reduction was obtained in all cases. Indirect reduction seemed to be useful for the treatment of comminuted patella fracture due to minimal soft tissue damage, moderate rigid fixation to allow early joint motion.