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Background: Intraarticular fracture distal end of the radius isone of the most common fracture of upper extremities. Here israndomised comparative study of the most effective treatmentmodality to deal with such fracture by external fixator vsbuttress plating.Method: Patients were randomly allocated into two groups of30 each (group A and group B). Patients treated with externalfixator was put in group A while those treated with buttressplating was kept in group B. At the end of 8 months of follow-upfinal assessment was done for fracture union and patients wereassessed for pain, wrist range of motion (ROM), grip strengthand activity and scored according to the Modified Green OBrien Scoring System. The mean duration of treatment and theoutcome were comparable.Results: In group A (external fixator) only 7 patients hadexcellent and 18 had good results while patient in group B(ORIF with plating) 14 patients had excellent and 11 had goodresult.Conclusion: We found that plating predominantly providesmore excellent results as long as the radiological parametersare met and fixation achieved as early as possible along withvigorous physiotherapy.Level of Evidence: Level II randomised comparative series.
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Objective: To evaluate the effectiveness of internal fixation with headless compression hollow embedding screws in the treatment of intraarticular fracture of elbow. Methods: Between March 2012 and September 2018, 12 patients with intraarticular fracture of elbow were treated with internal fixation with headless compression hollow embedding screws. There were 7 males and 5 females with an average age of 50.3 years (range, 22-65 years). Cause of injury included falling in 7 cases, falling from high places in 4 cases, and traffic accident in 1 case. Ten patients were distal humerus fractures which were classified as type 13-B3 in 8 cases and type 13-C3 in 2 cases according to the International Association of Internal Fixation Research (AO/ASIF). Two patients were radial head fractures which were classified as type Ⅲ according to the modified Mason classifications. The preoperative visual analogue scale (VAS) score was 8.25±0.83. The time from injury to operation was 3-5 days (mean, 3.7 days). Results: All incisions healed by first intention. All 12 patients were followed up 6-15 months, with an average of 8.4 months. The results of X-ray films and CT examination showed that the fracture ends were anatomic reduction, and the fractures healed at 6-11 months after operation, with an average of 7.8 months. One patient had heterotopic ossification at 4 months after operation. The VAS scores were 5.17±0.79 at 2 weeks after operation and 0.50±0.50 at last follow-up. There were significant differences between the time points ( P<0.05). At last follow-up, the Mayo elbow function score was 68-95, with an average of 83.9. The activity of elbow joint recovered. Conclusion: The intraarticular fracture of elbow can be firmly fixed by the headless compression hollow embedding screw, which can allow the early functional training of the elbow joint, reduce the incidence of heterotopic ossification, and obtain good effectiveness.
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PURPOSE: To investigate the surgical outcomes of orthogonal locking compression plate fixation for distal humeral intraarticular fractures. MATERIALS AND METHODS: This study included 18 patients presenting a distal humeral intraarticular fracture who were treated with orthogonal locking compression plate fixation. According to the AO/OTA classification, there were eight C2 and ten C3 fractures. We evaluated radiologic outcomes, clinical results with range of motion, operation-related complications, and functional score by Mayo elbow performance score (MEPS). RESULTS: The a verage u nion t ime was 3.5 months, and there was no c ase of r eduction l oss of a rticular f racture at t he last follow-up. Additional surgical procedures were needed in the three cases of C3 fractures. There was one case of heterotrophic ossification and one case of K-wire irritation. The average range of motion of elbow joint was 7° to 122°, and functional results were graded as 14 excellent, three good, and one fair by MEPS. CONCLUSION: Anatomical reduction and internal fixation with orthogonal locking compression plate could provide satisfactory surgical outcomes for the treatment of distal humeral intraarticular fracture.
Subject(s)
Humans , Classification , Elbow , Elbow Joint , Follow-Up Studies , Fracture Fixation , Humeral Fractures , Intra-Articular Fractures , Range of Motion, ArticularABSTRACT
Objective To compare the curative effect of anatomical plate and locking plate in treatment of calcaneous intraarticular fracture. Methods 67 petiants with calcaneous intraarticular fracture were randomly divided into anatomical plate group (n=33) and locking plate group (n=34) . The Bo..hler angle, the Gissane angle, the length of calcaneal axis, the width and height of calcaneous and the Maryland grade were compared at 1 week and 6 month after operation. Results (1) week after operation, the Bo..hler angle, the Gissane angle, the height and width of calcaneous, the length of calcaneal axis, the Maryland grade had no significant difference between 2 groups . 6 months after operation, the Bo..hler angle, the Gissane angle, the height of calcaneous had significant differe nce between 2 groups. There was no significant difference in the length of calcaneal axis and the grade of Maryland between 2 groups. Conclusions The locking plate group is better than anatomical plate group in major anatomical measure indicators in 6 months follow up. The therapy of locking plate is worth of clinical promotion.
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PURPOSE: To evaluate the radiological and clinical results after open reduction and internal fixation with calcaneal F plate and locking calcaneal plate using lateral extensile approach in the treatment of intra-articular calcaneal fracture. MATERIALS AND METHODS: This study included 34 cases of 33 patients followed up for at least 6 months postoperatively. F plate was applied in 18 cases (Group 1), locking plate was used in 16 cases (Group 2) and compared radiological and clinical results between two groups. RESULTS: Radiollogically, the mean Bohler angle was improved from 5.5degrees preoperatively to 20.1degrees postoperatively and 18.8degrees at the last follow up in group 1 and 8.6degrees preoperatively, 21.4degrees postoperatively and 20.3degrees at last follow up in group 2. Bone union was observed in all cases and 4 cases of screw loosening were noted in Group 1 with extended fracture to anterior process. At the last follow up, both groups showed clinical results in American orthopedic foot and ankle society ankle hindfoot score, 76(77 in Sanders type II and 75 in type III) in group 1 and 72(73 in type II and 70 in type III) in group 2. CONCLUSION: F plate and locking plate showed firm fixation and satisfactory clinical results in the treatment of intra-articular calcaneal fracture. We suggest applying locking plate in cases with extended fracture to anterior process, considering screw loosenings in those who were treated with F plate fixation.
Subject(s)
Animals , Humans , Ankle , Calcaneus , Follow-Up Studies , Foot , Intra-Articular Fractures , OrthopedicsABSTRACT
PURPOSE: This study was performed to evaluate the clinical outcomes of operative treatment using mini-open sinus tarsi approach for displaced intraarticular calcaneal fractures. MATERIALS AND METHODS: We studied 18 cases (16 patients) of intraarticular calcaneal fractures who were treated with sinus tarsi approach by same surgeon. The mean age of patients was 44.8 years, and mean follow-up period was 17.2 months. The measurement of Bohler angle, Gissane angle, the degree of articular surface depression, and the period to union were performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). RESULTS: Bohler angle and Gissane angle had improved significantly from preoperative average 9.8degrees, 117.6degrees to average 22.4degrees, 113.4degrees immediate postoperatively, and had maintained to average 21.8degrees and 114.2degrees at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 5.2 mm to 1.2 mm at the last follow-up. All cases achieved bone union, and the period to union was average 10.5 weeks. AOFAS score was average 86.2 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the CNHF scale. Therefore, 16 cases (88.8%) achieved satisfactory results. CONCLUSION: The minimally invasive sinus tarsi approach using headless compression screw seems to be an effective surgical method for displaced intraarticular calcaneal fractures, because of the possibility of accurate restoration of articular surface and the low risk of postoperative soft tissue complications.
Subject(s)
Animals , Humans , Ankle , Calcaneus , Depression , Follow-Up Studies , Foot , Intra-Articular FracturesABSTRACT
PURPOSE: To evaluate the clinical efficacy of the minimally invasive posterior approach for the surgical treatment of intraarticular fracture of calcaneus. MATERIALS AND METHODS: From March 2006 to October 2008, we studied retrospectively 45 patients, 56 cases who were treated with minimally invasive reduction and pin fixation treatment for displaced intraarticular calcaneal fracture and were followed up for more than 1 year. The clinical results were evaluated with Creighton-Nebraska score and AOFAS score, circle draw test after 1 year. We checked simple AP, lateral, axial and Broden's view preoperatively and 1 year after surgery, and compared Bohler angle and Gissane angle. RESULTS: By Creighton-Nebraska score, Sanders type 1 was 81, type 2 was 75, type 3 was 69, type 4 was 61. By AOFAS score, Sanders type 1 was 88, type 2 was 82, type 3 was 78, type 4 was 63. And by circle draw test, type 1 was 8.8 cm, type 2 was 8.5 cm, type 3 was 8 cm, type 4 was 6.6 cm. Preoperative Bohler angle and Gissane angle were 7.2degrees, 98degrees, and it increased to 21.2degrees, 116degrees after postoperative 1 year. CONCLUSION: Minimally invasive reduction and pin fixation treatment for displaced intraarticular calcaneal fracture was considered to be an effective treatment modality.
Subject(s)
Humans , Calcaneus , Intra-Articular Fractures , Retrospective StudiesABSTRACT
PURPOSE: This study was designed to investigate the usefulness of extensile lateral approach for accurate reduction and rigid internal fixation in comminuted intraarticular fractures of calcaneus. MATERIALS AND METHODS:From October 2002 to May 2007, we managed 55 patients (62 cases) with open reduction and internal fixation using extensile lateral approach. Among these, 38 patients (43 cases) who underwent preoperative and postoperative CT scan were enrolled. All patients were evaluated over 24 months after surgery. Bohler angle and Gissane angle on plain X-ray, displacement and step-off of articular surface of calcaneus on CT scan were measured and we compared the difference between preoperative and postoperative value of them. Clinical results were assessed by using AOFAS Ankle-Hindfoot Scale. RESULTS:The average Bohler angle was restored from 6.8 degrees to 23.5 degrees and Gissane angle was improved from 116.4 degrees to 113.5 degrees after operation. The average distance of displacement was restored from 4.2 mm to 1.4 mm and step-off of articular surface was recovered from 5.1 mm to 1.3 mm. Clinical results were excellent in 17 cases, good in 18 cases, fair in 3 cases, and poor in 5 cases. 10 cases developed postoperative complications such as skin necrosis, heel pain, limitation of motion of ankle and subtalar arthritis. CONCLUSION: The extensile lateral approach is valuable for the comminuted intraarticular fractures of calcaneus that enables accurate anatomical reduction and rigid internal fixation by providing direct exposure of subtalar joint.
Subject(s)
Animals , Humans , Ankle , Arthritis , Calcaneus , Displacement, Psychological , Heel , Intra-Articular Fractures , Necrosis , Postoperative Complications , Skin , Subtalar JointABSTRACT
PURPOSE: To evaluate the usefulness of computed tomography(CT) scanning in classification and selection of treatment method for distal radius fractures involving articular surfaces. MATERIALS AND METHODS: Plain radiographs and CT scans of 42 patients with intraarticular distal radius fractures was analysed for type of fractures and surgical indication and then the results were compared. RESULTS: Fracture types were changed in 15 of 42 patients. 10 patients with AO B1, B3, C1 or C2 type fractures were reclassified as C3 type, which suggested that CT scan revealed articular comminution more accurately. According to the assesment of plain radiographs, 16 patient needed surgical treatment. However additional 17(68%) patients were necessary operation on the bases CT scan evaluation. CONCLUSIONS: Evaluation of intraarticular fractures of distal radius using CT scan was useful for fracture classification and selection of treatment methods, which provided an accurate assessment of fracture patterns and reduction status.
Subject(s)
Humans , Equidae , Intra-Articular Fractures , Radius , Radius FracturesABSTRACT
PURPOSE: To compare the outcomes between T-locking compression plate (T-LCP) and external fixator (EF) for unstable distal radius intraarticular fractures. MATERIALS AND METHODS: We retrospectively analysed the results in 22 cases with T-LCP, 20 cases with EF. We evaluated the clinical results according to the Mayo Wrist Scoring System, radiographic results. RESULTS: The mean score was 84.6 in the T-LCP group and 80.5 in the EF group respectively. Final radiographic measurements for the T-LCP group averaged 10.5 mm radial length, 21.7degrees radial inclination, 9.8degrees volar tilt and 0.25 mm intraarticular step-off. The EF group averaged 10.1 mm radial length, 20.3 degrees radial inclination, 6.3 degrees volar tilt and 0.73 mm intraarticular step-off. CONCLUSION: Both groups showed satisfactory final clinical outcomes. But T-LCP group allowed return to daily living, resulting in early postsurgical wrist motion. By the anatomical reduction, final volar tilt, intraarticular step-off were statistically better in the T-LCP group.
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External Fixators , Radius , Retrospective Studies , WristABSTRACT
PURPOSE: To evaluate the clinical efficacy of the limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus. MATERIALS AND METHODS: From March 2000 to February 2006, we studied retrospectively 186 patients, 203 cases who were treated with open reduction and internal fixation through limited posterior approach and were followed up for more than 1 year. The clinical results were evaluated with Creighton-Nebraska score and circle draw test after 1 year. We checked simple AP, lateral, axial and Broden's view preoperatively and 1 year after surgery, and compared Bohler angle and Gissane angle. RESULTS: By Creighton-Nebraska score, Sanders type 2 was 86.4, type 3 was 74.3, type 4 was 62.4. And by circle draw test, type 2 was 8.9 cm, type 3 was 7.2 cm, type 4 was 5.9 cm. Bohler angle and Gissane angle were 7.6 degrees, 102.4 degrees, and it increased to 23.5 degrees, 128.6 degrees after postoperative 1 year. CONCLUSION: Limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus was considered to an effective treatment modality.
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Humans , Calcaneus , Intra-Articular Fractures , Retrospective StudiesABSTRACT
PURPOSE: We evaluated the results of operative treatment with F or H plates and screws using extensile lateral approach in intraarticular calcaneal fractures. MATERIALS AND METHODS: From August 2003 to July 2006, twenty intraarticular calcaneal fractures which were operated with open reduction and internal fixation with F or H plates and screws were evaluated retrospectively. According to the Essex-Lopresti classification, 3 cases were tongue type and 16 were joint depression type. With the Sanders classification, 2 cases were II A type, 7 were II B, 5 were III AB, 2 were III AC and 3 were IV. We have analysed the Bohler angle, Gissane angle, and calcaneal width in radiologic evaluation, and evaluated clinical result according to the Creighton-Nebraska Health Foundation Score. RESULTS: Radiologic changes showed as follows: Bohler angle improved from 5.8 degrees to 25.9 degrees, Gissane angle from 119.0 degrees to 113.3 degrees, and calcaneal width from 50.4 mm to 37.8 mm. In the clinical results, excellent cases were noted in 8 cases, good in 8 cases, fair in 2 cases, poor in 1 case. CONCLUSION: Operative treatment with F or H plates and screws using extensile lateral approach in intraarticular calcaneal fractures was thought to be a useful operative method allowing anatomical reduction.
Subject(s)
Classification , Depression , Intra-Articular Fractures , Joints , Retrospective Studies , TongueABSTRACT
PURPOSE: To evaluate the relationship between radiographic parameters and clinical results after operative treatment of the displaced intra-articular calcaneal fractures. MATERIALS AND METHODS: We analyzed 35 patients of unilateral displaced intraarticular calcaneal fractures who had operative treatment with minimum follow up of 1 year. At the last follow up, we measured the radiographic parameters including Bohler angle, Gissane angle, heel height, calcaneal length, talocalcaneal angle, talar declination angle, subtalar incongruity between normal and affected site. Clinical results were measured by Creighton-Nebraska Health Foundation Assessment Score (CNH). The correlation between the radiographic parameters and the clinical results were analysed by Pearson correlation method. RESULTS: Among the all radiographic parameters we analyzed, only subtalar incongruity shows strong negative linear correlation with clinical results. The average difference of subtalar incongruity between normal and affected site was 0.54 mm (0~2.5) and the correlation coefficients with CNH score was -0.784 (p=0.002). CONCLUSION: We suggest that the subtalar incongruity is significantly correlated with the clinical results after operative treatment of the displaced intraarticular calcaneal fractures.
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Humans , Calcaneus , Follow-Up Studies , Heel , Intra-Articular Fractures , MethodsABSTRACT
PURPOSE: To evaluate the clinical outcomes and radiographic results of open reduction and internal fixation for intra- articular calcaneal fractures. MATERIALS AND METHODS: We reviewed 20 cases of calcaneal fractures managed with open reduction and internal fixation from March 2003 to January 2005. We used the computed tomographic classification system proposed by Sanders et al to classify these fractures. Preoperative and postoperative Bohler's angle, heel height (calcaneal facet height) and calcaneal length, calcaneal width were measured. The Creighton-Nebraska Health Foundation Assessment score was used for clinical evaluation. RESULTS: There were 12 cases of type II fractures, 5 of type III fractures and 3 of type IV fractures. The mean clinical score was 84.3 for type II, 82.6 for type III and 56.1 for type IV. The mean preoperative B?hler angle was 6.1 degrees and final was 22.8 degrees. The mean preoperative calcaneal facet height was 76.6 mm and final was 80.3 mm (The mean calcaneal facet height was changed from preop 76.6 mm to postop 80.3 mm). The mean preoperative calcaneal length was 88.2 mm and final was 92.6 mm. The mean preoperative width was 38.1 mm and final was 35.6 mm. CONCLUSION: Open reduction and internal fixation showed good results for type II and III fractures, but for type IV fractures the clinical result was significantly worse than the other types. However, type IV fractures still had restoration of (should be restored in) Bohler's angle, calcaneal facet height, calcaneal length and width which may be helpful in later subtalar fusion.
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Calcaneus , Classification , Heel , Intra-Articular FracturesABSTRACT
PURPOSE: To evaluate the clinical outcomes and radiographic results of operative treatment for intraarticular calcaneal fracture. MATERIALS AND METHODS: We reviewed 57 cases of intraarticular calcaneal fracture managed with operative treatment, from January, 2000 to June, 2003. The type of intraarticular calcaneal fracture is classified by the Essex-Lopresti classification and Sanders by computed tomography. The 20 cases were managed by open reduction, 37 cases by closed reduction. RESULTS: On clinical outcomes in the case of open reduction and internal fixation, above good in 13 cases, poor in 2 cases; closed reduction, above good in 16 cases, poor in 10 cases. Averages of Bohler angle were increased from 11degrees (preoperative state) to 21degrees (last follow up) in open reduction, and from 14degrees to 20.9degrees in closed reduction. CONCLUSION: Open reduction was considered to be one of good treatment option if the anatomical reduction and stable fixation can be obtained.
Subject(s)
Classification , Intra-Articular FracturesABSTRACT
PURPOSE: We evaluated the clinical results of operative treatment of the intraarticular calcaneal fracture according to fracture classification. MATERIALS AND METHODS: There were 25 cases (24 patients) which had at least one year follow up, 17 men and 7 women who were treated from June 1997 to March 2003. We have analysed the Bohler's angle, cruciate angle, width and posttraumatic osteoarthritis in radiological evaluation, and evaluated clinical results according to the Creighton-Nebraska health foundation score. RESULTS: Excellent results were noted in 7 cases, good results in 6 cases, fair results in 4 cases and poor results in 8 cases. Radiological changes showed as follows: Bohler angle 17 degrees, Crucial angle 0.1 degrees, Width 6mm. CONCLUSION: Type II showed satisfactory results and type IV showed unsatisfactory results in Sanders classification. Proper evaluation of the intraarticular calcaneal fracture by X-ray and CT scan is necessory to predict prognosis and decise method of operative treatment.
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Female , Humans , Male , Calcaneus , Classification , Follow-Up Studies , Intra-Articular Fractures , Osteoarthritis , Prognosis , Tomography, X-Ray ComputedABSTRACT
PURPOSE: We evaluated the mechanical properties of F plate fixation comparing with Y plate and a screw fixation for the intraarticular calcaneal fractures using synthetic bones. MATERIALS AND METHODS: Using 12 synthetic calcaneal bones, newly designed F plate was compared with the Y-plate, most commonly used, regarding the change of Bohler angle and the displacement of the thalamic fragments of the calcaneus after axial compressive loading by Instron 6022. RESULTS: Y plate fixation lost 8degrees of Bohler angle in average after axial compressive load and 2.6degrees in F plate fixation. Thalamic fragments were displaced 1.72 mm in average in Y plate fixation group and 0.73 mm in F plate fixation group. CONCLUSION: F plate offered more firm fixation than Y plate in the intraarticular calcaneal fracture in the aspect of maintaining the Bohler angle and preventing displacement of the thalamic fragments of calcaneus against axial compressive loading.
Subject(s)
Calcaneus , Intra-Articular FracturesABSTRACT
Fractures of the calcaneus are the most common type of tarsal bone injuries, and about 75% of total calcaneal fractures are intraarticular. Despite increasingly more experiences with this type of fractures, however, there is considerable debate regarding their diagnosis and management. Controversies involve the most appropriate classification system, treatment options, indications for surgery, surgical approaches, and postoperative management. On the basis of current main views on the diagnosis and treatment of intraarticular calcaneal fractures, this article holds that for displaced intraarticular calcaneal fractures, operative treatments are superior to conservative ones.
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Objective To observe and analyze therapeutic effects of internal fixation reconstruction with titanium plate for intra articular calcaneus fractures. Methods 48 patients (56 feet) with calcaneal fracture were treated with reconstruction titanium plate, under the monitoring of C shape X ray. The therapeutic effects were evaluated according to the Maryland foot score system. Results 48 patients were followed up for an average of 18 months. 36 feet achieved excellent results, 14 good, and 6 fair. The good and excellent rate was 89.3%. The length, height, width and Bhler angle of the calcaneus were well improved. Conclusion Open reduction and internal fixation with reconstruction titanium plate is a reliable measure to treat intra articular calcaneus fractures, as long as the surgeon has a good command of the anatomic structure of calcaneus, indication and right timing for the operation.
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PURPOSE: We reviewed the functional and radiological results of unstable intraarticular fractures of the distal radius treated by percutaneous pinning with an external fixator. MATERIALS AND METHODS: Twenty-seven cases of unstable intraarticular fractures of the distal radius were treated by percutaneous pinning and external fixation between October 1996 and September 1999, and followed up for more than 1 year. We classified them using the Frykman classification and evaluated functional and radiological results according to the subjective point system of Cole & Obletz and the objective evaluation by Scheck. RESULTS: Subjectively, we obtained the following results: excellent in 7 cases, good in 13 cases, fair in 6 cases and poor in 1 case, and objectively, 8 cases were excellent, 14 cases were good, 4 cases were fair and 1 case was poor. Radiographically, mean volar tilt, radial inclination and radial length were 9.5degrees, 22.1degrees and 10.3 mm respectively on the last follow-up. Two cases of reflex sympathetic dystrophy and one of each of skin necrosis, pin tract infection, joint stiffness and metacarpal bone fracture occurred during the follow-up period. CONCLUSION: Percutaneous pinning and external fixation is a useful method for reducing mal-alignment and radial length maintenance, preventing reduction loss and restoring the articular surface and function of the distal radius in cases of intraarticular comminution, open fracture with soft tissue injury and multiple injury.