Comparison of percutaneous reduction by leverage combined with minimally invasive internal fixation and “l” incision internal fixation in the treatment of Calcaneal fracture / 中国组织工程研究

BACKGROUND: Intra-calcaneal fractures involving subtalar joints account for about 75% of all calcaneal fractures. Surgical treatment of displaced intra-articular calcaneal fractures is superior to non-surgical treatment. However, the timing of treatment, surgical indications, incision selection, and bone grafting are still controversial. The classical “L” approach is gradually replaced by minimally invasive internal fixation because of its high incision complications. OBJECTIVE: To compare the clinical effect of minimally invasive internal fixation and “L” incision for the treatment of Sanders II and III calcaneal fractures. METHODS: Sixty patients with Sanders II or III calcaneal fractures from January 2016 to January 2019 in the Second Department of Orthopedics, Shantou Hospital of Traditional Chinese Medicine were randomly divided into minimal invasion group (n=32) and “L” incision group (n=28). The patients in the minimal invasion group and “L” incision group received percutaneous reduction by leverage combined with minimally invasive internal fixation and “L” incision internal fixation treatment, respectively. At 6 months after operation, the curative effect of the two groups was evaluated according to the American Orthopedic Foot and Ankle Society score. Preoperative waiting days, the operation time, the length of stay and the complication incidence were compared between the two groups. Bfihler angle and Gissane angle were measured and compared preoperatively, postoperatively and during the final follow-up. RESULTS AND CONCLUSION: (1) The excellent and good rate of American Orthopedic Foot and Ankle Society score was 91% in the minimal invasion group and 93% in the “L” incision group (P > 0.05). (2) The postoperative Bohler angle and Gissane angle were significantly improved in both groups (P 0.05). Bohler angle was better in the “L” incision group than in the minimal invasion group (P 0.05). (3) The preoperative waiting days and the length of stay were longer in the “L” incision group than those in the minimal invasion group (P < 0.05). The operation time was shorter in the “L” incision group than in the minimal invasion group (P < 0.05). (4) The incidence of complications was lower in the minimal invasion group (9%) than in the “L" incision group (32%) (P < 0.05). (5) Compared with the traditional “L” incision open reduction and internal fixation, the treatment of Sanders II and III calcaneal fractures with percutaneous reduction by leverage combined with minimally invasive internal fixation are satisfactory, with less trauma and complications. It is worth being recommended in clinic.

Robot-assisted percutaneous reduction and minimally invasive internal fixation for treating Schatzker II-III tibial plateau fracture / 中国组织工程研究

BACKGROUND: Accurate and minimally invasive surgery procedure has become the pursuit of the current surgical goals. With the rapid development of intelligent robots, the precise and minimally invasive treatment of fractures has become an irresistible trend. OBJECTIVE: To evaluate the clinical efficacy of robot-assisted percutaneous reduction and minimally invasive internal fixation for Schatzker II-III tibial plateau fractures. METHODS: Clinical data of patients with Schatzker II-III tibial plateau fractures who received robot- (n=22, robot-assisted group) and traditional fluoroscopy (n=26, traditional group)-assisted internal fixation at Tianjin Hospital from April 2017 to August 2018 were analyzed retrospectively. All patients suffered from unilateral, closed, and fresh tibial plateau fractures. Statistical indicators included: incision length, operation time, intraoperative blood loss, number of fluoroscopy, one-time success rate of screw, hospitalization time, fracture healing time, total weight-bearing time and postoperative complications. At the last follow-up, the range of motion of knee was recorded. The function of knee was evaluated by Rasmussen’s imaging and clinical score. RESULTS AND CONCLUSION: (1) There was no significant difference in the baseline data between two groups (P > 0.05). (2) Compared with the traditional group, the robot-assisted group was better in the intraoperative blood loss, incision length, number of fluoroscopy, total number of drilled screws for fixation, average hospitalization time, fracture healing time, total weight-bearing time, and one-time success rate of fixation screw placement (P < 0.05). There was no significant difference in the operation time between two groups (P=0.932). (3) The range of motion of knee and Rasmussen clinical function score in the robot-assisted group were superior to those in the traditional group (P < 0.05). (4) There were fewer postoperative complications in the robot-assisted group compared with traditional group. (5) These results indicate that robot-assisted percutaneous reduction and minimally internal fixation for the treating Schatzker II-III tibial plateau fracture are satisfactory. It has obvious advantages in minimally invasive surgery, precise reduction, rigid fixation and accelerated postoperative rehabilitation.

Clinical effect of the relative poking reduction for the treatment of the femoral neck fractures with insertion and forward angle / 中国骨伤

<p><b>OBJECTIVE</b>To explore the reduction and clinical effect in the near future of percutaneous K-wire relative poking reduction techniques for difficult to reduction of complex insert and forward angulation femoral neck fracture.</p><p><b>METHODS</b>The clinical data of traumatic femoral neck fractures treated in our hospital from January 2012 to September 2015 were retrospective analysis, 15 patients with skeletal traction and distal elevation still can not eliminate the fracture angulation deformity were treated by percutaneous K-wire relative poking reduction technique to correct the angular and using cannulated screw fixation, including 5 males and 10 females, aged from 44 to 72 years with an average of 60.06 years old. The fractures were Garden type III. The reduction effect was evaluated according to Garden alignment index and clinical evaluation in the near future outcome was assessed according to Harris Hip Score.</p><p><b>RESULTS</b>All patients were healed by first intention without pulmonary infection and deep vein thrombosis. The patients were followed up for 6 months to 3 years, all the fractures healed, and 1 case had limited necrosis of the femoral head. According to Garden alignment index, 14 cases were level I reducation, and 1 case was level II. Limb shortening was 1 to 5 mm with an average of (2.73±1.37) mm. Functional evaluation according to Harris score standard, at the latest follow-up the average value of pain, function, deformity and joint activity were 42.1±2.5, 37.2±4.6, 3.2±0.5, 4.1±0.3, the total average value was 86.6±9.5;13 cases were excellent, 1 case was good, 1 case was poor.</p><p><b>CONCLUSIONS</b>Percutaneous K-wire relative poking reduction technique to correct the difficult to reduction of complex insert and forward angulation of the femoral neck fracture is simple, repeatable, and achieve the precision of the reset;the effect of blood supply of the hip joint is small, which provides favorable conditions for fracture healing.</p>

Subtrochanteric Fracture: Emphasis on Surgical Techniques in Nailing / 대한정형외과학회잡지

Intramedullary nailing is considered the most biomechanically advantageous therapeutic modality in the treatment of subtrochanteric femoral fractures. Many technical pitfalls and difficulties in nailing are well known. Reduction of the proximal fragment in a flexed, abducted, and externally rotated position should be performed before nailing of subtrochanteric fractures in order to avoid malalignment and nonunion. In this review, various reduction techniques to control the proximal fragment which are useful in nailing will be discussed.

Intramedullary Nailing of Distal Tibial Fractures with Percutaneous Reduction by Pointed Reduction Forceps

PURPOSE: The purpose of this study is to analyze the radiographic and clinical results of intramedullary nailing after percutaneous reduction using pointed reduction forceps for spiral or oblique fractures of the distal tibia. The benefit of percutaneous reduction using pointed reduction forceps in anatomical reduction and maintenance was assessed. MATERIALS AND METHODS: From January 2005 to December 2009, 47 cases of distal one-third tibial fracture were managed by intramedullary nailing using pointed reduction forceps. Thirty-eight cases were spiral fracture and nine cases were oblique fracture. In all cases, the percutaneous reduction was achieved using pointed reduction forceps under fluoroscopy control. While maintaining the reduction with the pointed reduction forceps, the intramedullary nail was inserted. The pointed reduction forceps were removed after insertion of proximal and distal inter-locking screws. Alignment was evaluated with anterior-posterior and lateral radiographs taken immediately post-operation and at the time of union. RESULTS: At immediate post-operation, the mean displacement of valgus and anterior angulation was 0.57degrees and 0.24degrees, respectively. That of valgus and anterior angulation at bone union was 0.37degrees and 0.16degrees, respectively. The average duration of bone union was 16.1 weeks. CONCLUSION: Intramedullary nailing with percutaneous reduction using pointed reduction forceps for distal tibial fractures was an easy and effective method for achievement of accurate alignment intra-operatively. Accurate alignment was successfully maintained until bone union.

Technique and Early Results of Percutaneous Reduction of Sagittally Unstable Intertrochateric Fractures

BACKGROUND: This paper introduces a percutaneous reduction technique using one or two Steinman pin(s) to reduce sagittally unstable intertrochanteric fractures. METHODS: A fracture was defined as a sagittally unstable intertrochanteric fracture when posterior sagging of a distal fragment and flexion of the proximal fragment worsens after usual maneuvers for a closed reduction. Of 119 intertrochanteric fractures treated from June 2007 to December 2008, twenty-one hips showed sagittal instability. The sagittal displacement was reduced using a Steinmann pin as a joystick, and stabilized with a nail device. Nineteen hips were followed up for more than one year. The clinical and radiological results were reviewed in 19 hips and compared with those of the remaining cases. RESULTS: The demographics were similar in both groups. The mean anesthetic time did not differ. Although the pre-injury and final activity levels were significantly lower in the study group, the degree of recovery was the same. No clinical complications related to this technique were encountered. Radiologically, the reduction was good in all hips in both groups. Union was obtained in all cases without any time differences. CONCLUSIONS: This less invasive reduction technique is simple and safe to use for this type of difficult fracture.

The Treatment of Posterolateral Malleolar Fractures using Percutaneous Reduction Technique

PURPOSE: To evaluate the usefullness of the percutaneous reduction technique with K-wire that could reduce the displaced posterolateral fracture fragment which persisted even after an anatomical reduction of the lateral malleolar fracture. MATERIALS AND METHODS: From January 2004 to December 2006, we reviewed 72 patients who underwent surgical treatment for their trimalleolar fractures. We estimated the clinical and radiological results of 5 cases treated by percutaneous reduction technique with K-wire when more than the distal tibial articular step-off was left after reduction of the lateral malleolar fracture. The method of reduction starts with temporary fixation of lateral malleolar fracture followed by checking ankle radiographic image to confirm the accuracy of reduction. In case of incomplete reduction of the posterior fragment, a K-wire is inserted into the posterior fragment and pushed downward to the ankle joint level, and then lag screws were inserted. RESULTS: The average articular involvement by the posterolateral fracture fragment was 30.2%. The average step-off after reduction of the lateral malleolar fracture was 3.7 mm. At the final follow up, step-off was less than 2 mm in all cases. In clinical results by Baird and Jackson score, 3 out of 5 cases were excellent, other 2 were good. CONCLUSION: Percutaneous reduction technique for posterolateral fragment using the K-wire is relatively easy. This technique may be useful when the posterolateral fragment is large (more the 25% of articular surface) and not severely comminuted.

The Usefulness of Arthroscopy in the Operative Treatment of Intra-Articular Calcaneal Fracture / 대한족부족관절학회지

PURPOSE: We tried to evaluate the usefulness of the arthroscopy in the operative treatment of intra-articular calcaneal fracture. MATERIALS AND METHODS:Between March 2005 and May 2008, 9 patients with intra-articular calcaneal fractures (Tongue type or Sanders type IIC) were treated with arthroscopically assisted percutaneous reduction and screw fixation. American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), preoperative and postoperative Bohler's angle and the rate of complication were evaluated. RESULTS:AOFAS score at postoperative 1 year was 88.2 (range, 71-92), and mean VAS score was 2.8 (range, 1-4). Bohler angle was improved from preoperative mean 16.2 degrees to postoperative mean 29.7 degrees . There were no complications such as wound problem, infection or nerve injury. CONCLUSION: Subtalar arthroscopy provides precise view of posterior facet during the operation. Therefore, it can be a useful tool in treating intra-articular calcaneus fractures, especially tongue type and Sanders type IIC fractures.

Percutaneous reduction combined with bone graft in the treatment of displaced intra-articular calcaneal fractures / 中国矫形外科杂志

[Objective]To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures.[Method]Percutaneous reduction and internal fixtion combined with bone graft was performed from April 2004 to April 2006 on 15 cases(16 sides) with intra-articular calcaneal fractures including 13 males (14 feet)and 2 females(2 feet),with average age of 36.6 years(24～61 years).All patients underwent radiography including lateral and axial views for calcaneus,oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification,there were 12 feet of type Ⅱ(three type Ⅱa,three type Ⅱb and eight type Ⅱc)and 2 feet of type Ⅲac. The length of caicaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures.Then bone graft was injected to fill the defect of calcaneus through lateral incision.[Result]All patients were followed up for an average of 18.4 months (ranged,12 to 34 months).No complication such as wound infection,screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society(AOFAS) hindfoot score. The rate of excellent and good clinical results was 100%. Radiography showed basic restoration of Bhler's angle,Gissane's angle and calcaneal shape.[Conclusion]The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders II and III type calcaneal fractures,with advantages of simple operation,fewer complications and good clinical results.