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PURPOSE@#The study aims to compare the efficacy and safety of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures.@*METHODS@#It was a retrospective study. Adult patients with closed transverse patellar fracture were included, and with open comminuted patellar fracture were excluded. These patients were divided into minimally invasive osteosynthesis technique (MIOT) group and open reduction and internal fixation (ORIF) group. Surgical time, frequency of intraoperative fluoroscopy, visual analogue scale score, flexion, extension, Lysholm knee score, infection, malreduction, implant migration and implant irritation in two groups were recorded and compared. Statistical analysis was performed by the SPSS software package (version 19). A p < 0.05 indicated statistical significance.@*RESULTS@#A total of 55 patients with transverse patellar fractures enrolled in this study, the minimally invasive technique was performed in 27 cases, and open reduction was performed in 28 cases. The surgical time in the ORIF group was shorter than that in the MIOT group (p = 0.033). The visual analogue scale scores in the MIOT group were significantly lower than those in the ORIF group only in the first month after surgery (p = 0.015). Flexion was restored faster in the MIOT group than that in the ORIF group at one month (p = 0.001) and three months (p = 0.015). Extension was recovered faster in the MIOT group than that in the ORIF group at one month (p = 0.031) and three months (p = 0.023). The recorded Lysholm knee scores in the MIOT group were always greater than those in the ORIF group. Complications, such as infection, malreduction, implant migration, and implant irritation, occurred more frequently in the ORIF group.@*CONCLUSION@#Compared with the ORIF group, the MIOT group reduced postoperative pain and had less complications and better exercise rehabilitation. Although it requires a long operation time, MIOT may be a wise choice for transverse patellar fractures.
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Adult , Humans , Retrospective Studies , Fractures, Bone/surgery , Fracture Fixation, Internal/methods , Minimally Invasive Surgical Procedures/methods , Open Fracture Reduction , Treatment OutcomeABSTRACT
OBJECTIVE@#To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral "safe zone" for Hawkins type Ⅰ-Ⅲ talar neck fractures.@*METHODS@#A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral "safe zone" parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups ( P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale.@*RESULTS@#The operation time in the study group was significantly shorter than that in the control group ( P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant ( P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups ( P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups ( P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients' satisfaction in the study group were significantly better than those in the control group ( P<0.05).@*CONCLUSION@#The treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral "safe zone" can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.
Subject(s)
Humans , Retrospective Studies , Quality of Life , Fractures, Bone/surgery , Fracture Fixation, Internal/methods , Bone Screws , Joint Dislocations , Treatment OutcomeABSTRACT
Treatment of distal femur fractures has recently evolved towards indirect reduction and minimally invasive techniques. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. Advent of MIPO technique has reduced the amount of soft tissue injury, delayed healing, tissue necrosis and infections. The objective was to compare the functional and radiological outcome of fracture distal femur treated by open reduction with LCP by minimally invasive plate osteosynthesis (MIPO). We wanted to compare the clinical and radiological differences between open and MIPO techniques for distal femoral fracture fixation.METHODSThis was a prospective interventional study. 41 subjects with closed supracondylar femur fracture treated surgically from March 2013 to December 2017, were evaluated prospectively for functional and radiological outcome results after fixation with distal femoral locking compression plate in open or minimally invasive way, with minimum follow up of 1 year. IBM SPSS Ver. 25 software was used to perform statistical analysis.RESULTSThe mean age of 41 treated patients was 53.8 ± 13.7 years and ranged from 23 to 84 years. 19 patients were females and 22 were males. Mean time to surgery was 5.7 ± 2.9 days with minimum 2 and maximum of 18 days from injury. Initially 20 patients underwent open surgery and 21 patients were operated by minimally invasive plating technique. In all cases, a 316L stainless steel alloy distal femoral locking plate was used.CONCLUSIONSKnee ROM could be started at a mean of 1.4 weeks earlier in the MIPO group and this was statistically significant. The two groups did not differ significantly in start of full weight bearing. Knee flexion at 6 weeks was also comparable in the two groups. However, knee flexion was average 21.9° higher in MIPO group at 1 year which was significantly different than ORIF group. The proportion of patients with >90° and >110° knee flexion also varied significantly between the groups. VAS score in MIPO group was significantly less at 6 weeks but difference was non-significant at 1 year. There were 2 cases with non-union and implant failure in the ORIF group, but the proportion was not significant. There was 10° FFD in 1 patient of ORIF group, while varus deformity occurred in 3 patients of MIPO group. The proportion of deformity was not significantly different between the two groups.
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Objective To investigate the effecacy of open reduction internal fixation in cases with rib fracture. Methods The pain scores,respiratory related clinical indicators change of 81 rib fractuure cases underwent open reduction internal fixation surgery were ob-served. A comparison was made between the surgical group and the non-surgical group of 37 cases on pain scores trend and hospital stay. Re-sults All operations were successfully completed and postoperative recovery was good. Postoperative pain scores and respiratory rate was sig-nificantly lower(P=0. 000),Oxygen saturation was significantly higher(P=0. 002),the proportion of expectoration difficult,dyspnea and ac-tivities inconvenience were significantly lower(P<0. 05). Pain scores of surgical group significantly decreased after surgery peak hours that was the fourth day hospitalized,but the overall decline of pain scores in non-surgical group was slow. The hospital stay between the surgical group and the non-surgical group was not significantly different(P=0. 084). Conclusion The efficacy of open reduction internal fixation is significant to rib fracture with exact surgery indications,and appropriate timing of surgery is the fourth day after admission.
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Objective: To analyze the effect between minimally invasive percutaneous plate fixation and open reduction internal fixation on patients with Tibial shaft fracture. Methods:Chosen patients with tibial shaft fracture as research subjects, randomly divided observed groups receiving minimally invasive percutaneous plate fixation and control group receiving open reduction internal fixation, detecing surgery-related indicators, AKSS knee score and adverse conditions incidence. Results:1)After surgery, surgery time and total hospital stay of observation group patients were significantly shorter than control group patients, blood loss was significantly less than control group patients (P<0.05);2)After surgery, patients AKSS knee function scores were significantly higher than control group patients(P<0.05);3)After surgery, observation group patients’ adverse events incidence was significantly lower than control group patients (P<0.05). Conclusion:Minimally invasive percutaneous plate osteosynthesis can effectively optimize the surgical procedure to improve postoperative joint function and reduce adverse events healing is ideal tibia fracture mode of operation.
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