ABSTRACT
OBJECTIVE@#To explore treatment strategy for complex Schatzker Ⅳ tibial plateau fracture.@*METHODS@#Forty-one patients with complex Schatzker type Ⅳ tibial plateau fractures were treated from January 2016 to January 2021, including 28 males and 13 females, aged from 19 to 65 years old with an average of (35.3±19.8) years old. Individualized treatment plan was developed according to preoperative imaging characteristics, medial surgical approach was mainly combined with other auxiliary incisions. Posteromedial inverted L approach was used in 18 patients, posteromedial approach and anterolateral extended approach in 19 patients, and posteromedial approach with anterolateral and lateral condylar osteotomy in 4 patients. Articular surface and facture healing were observed, range of knee joint motion was measured at 12 months after opertaion, and function of knee joint was evaluated by Lysholm scoring system.@*RESULTS@#Forty-one patients were followed up for 12 to 26 months with an average of (13.3±6.8) months. Twenty-nine patients and 10 patients were obtained complete fracture healing at 6 and 12 months after operation respectively, and fracture healing time was 4 to 13 months with an average of (5.0±3.7) months. Two patients occurred posterior medial internal fixation failure and varus deformity of knee joint, and the fracture healed and varus deformity was corrected after the second operation. Range of knee joint motion was (118±29) °, and Lysholm score was(83.0±16.0) points.@*CONCLUSION@#Individualized treatment should be reasonably selected for complex Schatzker Ⅳ tibial plateau fractures, the characteristics of lateral plateau fractures are an important reference for selecting surgical approaches, the effective fixation of posteromedial bone blocks should be pay full attention, and the overall treatment results are satisfied.
Subject(s)
Male , Female , Humans , Young Adult , Adult , Middle Aged , Aged , Adolescent , Tibial Plateau Fractures , Bone Plates , Tibial Fractures/surgery , Treatment Outcome , Knee Joint/surgery , Fracture Fixation, Internal/methods , Retrospective StudiesABSTRACT
BACKGROUND: Simple posterolateral tibial plateau collapse fracture is very rare in the clinic. The displaced collapse fracture in this area must be anatomically reduced, filled with suitable materials, and fixed with internal fixators. OBJECTIVE: To evaluate the stability, clinical results and biocompatibility of modified posterolateral approach to treat simple posterolateral tibial plateau collapse fracture with beta-tricalcium phosphate combined with T-shaped locking plate. METHODS: Fifteen patients with simple posterolateral tibial plateau collapse fractures who received surgical treatment between June 2013 and December 2017 in Zhangjiagang Hospital Affiliated to Soochow University. These patients included 8 males and 7 females, aged 25-53 years. All of them received surgical treatment with beta-tricalcium phosphate combined with T-shaped locking plate through the modified posterolateral approach. After surgery, they were followed up for 12 months. X-ray examination was performed to evaluate fracture healing and internal fixation. Reduction effect was evaluated by Rasmussen radiology score. Knee function and stability were evaluated by HSS knee function score, Lachman test, pivot-shift test and lateral stress test. This study was approved by Medical Ethics Committee, Zhangjiagang Hospital Affiliated to Soochow University, China (approval No. 201305KS001). RESULTS AND CONCLUSION: (1) All patients underwent anatomical reduction of knee fractures, and the fracture healing time was 9-14 weeks. At 12 months after surgery, p-tricalcium phosphate was completely absorbed and replaced by new bone, and repair of bone defect was satisfactory. (2) There were no significant differences in posterior tibia angle, varus angle, Rasmussen imaging collapse score and Rasmussen imaging total score between 12 months after surgery and immediately after surgery in 15 patients (P > 0. 05). (3) At 12 months after surgery, the HSS score of the knee joint was 89-100, and Lachman test, pivot-shift test and lateral stress test results were negative in 15 patients. (4) During the follow up period, infection around implants, allergic reaction, immune reaction, or rejection reaction was not observed. (5) These findings suggest that treatment of simple posterolateral tibial plateau collapse fracture through the modified posterolateral approach with p-tricalcium phosphate combined with T-shaped locking plate exhibits good repair effects and biocompatibility.
ABSTRACT
Objective To explore the efficacy of internal fixation in the treatment of intra-articular calcaneum fractures via the sinus tarsi approach . Methods A retrospective study was made on 55 feet with intra-articular calcaneum fractures in 51 patients treated with open reduction and intemal fixation via sinus tarsi approach from January 2010 to June 2015.According to the Sanders classification, there were 15 feet of type Ⅱfractures and 40 feet of type Ⅲfractures. Results All the patients were followed up for a mean period of 15.7 months (range, 6-33 months).The fractures were completely healed .According to the Maryland Foot Scores , the operative effect was excellent in 43 feet, good in 7 feet, fair in 4 feet, and poor in 1 foot.The excellent and good rate was 90.9%(50/55).The postoperative width of the calcaneum , B?hler angle, and Gissane angle were significantly improved than before operation (P=0.000). Conclusion Open reduction and internal fixation via sinus tarsi approach is a simple and effective method for minimally invasive treatment of Sanders type Ⅱand Ⅲintra-articular calcaneum fractures .
ABSTRACT
ObjectiveTo investigate the curative effect of the treatment for the distal humeral shaft fracture with double steel plate internal fixation. Methods A total of 60 individuals who were humeral shaft fractures were included from March 2009 to April 2014 in the second people's hospital of Yunnan province. 28 of them were treated using double plate fixation(group A)and 32 of them were treated using single-plate treatment (group B). Blood loss, hospital stay, postoperative drainage, healing time and Mayo elbow performance score were compared between the two groups. Results(1)Blood loss, hospital stay and postoperative drainage showed no differences between two groups. However, the healing time between these two groups showed difference(P < 0.05).(2)MEPS score results showed a significantly difference in the excellent rate of patients between groups A and B(96.4% and 75%, respectively,P < 0.05). Conclusion The double plate fixation and single plate fixation for treatment of humeral shaft fracture showed no differences in operation time,blood loss,postoperative drainage and hospital stay. However,the double plate fixation showed a shorter healing time and better efficacy. Thus,the double plate fixation of humeral shaft fracture can contribute to obtain the rigid internal fixation,early functional exercise and better clinical efficacy.
ABSTRACT
Aim of the present study was to evaluate the effect of flurbiprofen, which is a member of non-steroidal anti-inflammatory drug group (NSAIDs), on postoperative pain treatment. From September 2013 to May 2014, total of 250 patients were surveyed to perform a systematic evaluation of postoperative pain by comparing flurbiprofen with two other kinds of NSAIDs (diclofenac and ketorolac) and isotonic saline in a double-blind, randomized, placebo-controlled study. Patients were randomized for treatment: 65 cases received flurbiprofen, 60 cases received diclofenac sodium, 60 cases received ketorolac and 65 cases received the placebo (0.9% isotonic saline) (control group). After 24-hours of surgery patients treated with flurbiprofen, ketorolac, and diclofenac showed the lowermost PPI scores compared with those treated with 0.9% isotonic saline (P<0.05). Moreover, flurbiprofen-treated patients also had the lowest PRI(R)T scores (P<0.05). When the pain rating index was examined by subclass, a significantly lower PRI(R)S score was detected in the flurbiprofen group at 24 hours (P<0.05). However, at the 96-hour time point, no differences that were found in PPI and PRI[R] scores between the ketorolac, diclofenac, and flurbiprofen groups, whereas the control group was significantly less effective than the NSAID drugs. Flurbiprofen seemed to be the most effective NSAID for the treatment of pain after internal fixation of fracture, even though at 24 hours after surgery pain was at a maximum.
ABSTRACT
Aim of the present study was to evaluate the effect of flurbiprofen, which is a member of non-steroidal anti-inflammatory drug group (NSAIDs), on postoperative pain treatment. From September 2013 to May 2014, total of 250 patients were surveyed to perform a systematic evaluation of postoperative pain by comparing flurbiprofen with two other kinds of NSAIDs (diclofenac and ketorolac) and isotonic saline in a double-blind, randomized, placebo-controlled study. Patients were randomized for treatment: 65 cases received flurbiprofen, 60 cases received diclofenac sodium, 60 cases received ketorolac and 65 cases received the placebo (0.9% isotonic saline) (control group). After 24-hours of surgery patients treated with flurbiprofen, ketorolac, and diclofenac showed the lowermost PPI scores compared with those treated with 0.9% isotonic saline (P<0.05). Moreover, flurbiprofen-treated patients also had the lowest PRI(R)T scores (P<0.05). When the pain rating index was examined by subclass, a significantly lower PRI(R)S score was detected in the flurbiprofen group at 24 hours (P<0.05). However, at the 96-hour time point, no differences that were found in PPI and PRI[R] scores between the ketorolac, diclofenac, and flurbiprofen groups, whereas the control group was significantly less effective than the NSAID drugs. Flurbiprofen seemed to be the most effective NSAID for the treatment of pain after internal fixation of fracture, even though at 24 hours after surgery pain was at a maximum.
ABSTRACT
Objective To investigate clinical results of bilateral triceps bradhii approach in Gartland Ⅲ supracondylar fracture of humerus in children by comparing with reduction interne and plaster immobilization. Methods 102 children with Gartland Ⅲ supracondylar fracture of humerus,4 ～ 13 years old,from May 2003 to May 2009,were randomly divided into operation group and control group,51 cases separately. The operation group was treated by bilateral triceps bradhii approach, while control group was treated by reduction interne and plaster immobilization. All patients were made function exercise 4 weeks later,X-ray check periodically and followed up about 16 months with angle patronner and elbow joint function recorded. According to Flynn clinical function criteria,all patients were classified and analyzed. Results After follow-up and elbow joint function evaluation,48 cases ( 94. 1% ) show excellent and good results,3 cases(5.9% ) fair and poor in operation group,32 cases(62. 7% ) and 19 cases(37. 3% ) in control group. The differences between two groups was statistically singnificant ( P < 0. 05). Conclusion Comparing with reduction interne and plaster immobilization, bilateral triceps bradhii approach in Gartland Ⅲ supracondylar fracture of humerus in children has good clinical results and may be more effective therapy.
ABSTRACT
Objective To discuss the application value of DHS and cannulated screws in treatment of the intertrochanteric fractures . Methods 23 cases of intertrochanteric fractures were treated with DHS and cannulated screws and 20 cases were followed up for an average period of 12 months. Results All the fractures healed . The recovery of function was excellent in 90%cases. Conclusions Using DHS and cannulated screws to treat the intertrochantenic fractures easily leads to anatomical reduction and rigid fixation, and gives large definitive rotational stability.