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@#Femoral shaft fractures are increasingly common due to various traumatic injuries. Intramedullary nail (IMN) is considered the gold standard treatment for these fractures, but comorbidities often require thorough trauma life support and intensive care. The primary goal of treatment is rigid fixation, early mobilisation, and long-term functional recovery. This article reviews current concepts in the treatment of femoral shaft fractures, including the effects of early or delayed operation, differences between antegrade or retrograde intramedullary nailing, alternative methods to using a fracture table, methods to predict nail length before operation, assessing femoral rotation during an operation, and complications.
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@#Introduction: Compartment syndrome complicating intramedullary nailing of closed tibia fractures has been described as early as the 1980s, but currently remains less described in literature compared to compartment syndrome directly following trauma. This study aims to review this potentially disabling complication and highlight the importance of timely diagnosis and management of compartment syndrome following fracture fixation, not just after fracture itself, via a review of three cases. Material and methods: A retrospective study of a series of three cases was conducted. The type of fracture, wait time to fixation, surgery duration, reaming, size of nail implant used, tourniquet time, and surgical technique were recorded. Time to diagnosis of compartment syndrome, compartment pressure if available, extent of muscle necrosis, reconstructive procedures performed, and post-operative complications were analysed. Results: The three cases following high-energy trauma from road traffic accidents presented from January to May 2010. Compartment syndrome was diagnosed clinically for all cases, between one to six days post-operatively and supported by elevated compartment pressure measurements in two of the three cases. Conclusion: This study advocates thorough clinical monitoring and maintaining strong clinical suspicion of compartment syndrome in patients even after intramedullary nail fixation of tibial shaft fractures to achieve timely limbsalvaging intervention. While intercompartmental pressure can be used to aid in diagnosis, we do not advise using it in isolation to diagnose compartment syndrome. Tendon transfer improves functional mobility and provides a good result in patients with severe muscle damage, while skin grafting sufficient in patients with minimal muscle damage.
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OBJECTIVE@#To retrospectively analyze efficacy of single structure internal fixation and double structure internal fixation in the treatment of ipsilateral femoral shaft and neck fracture, and analyze their indications.@*METHODS@#From June 2015 to December 2020, 21 patients with ipsilateral femoral shaft and femoral neck fracture were treated, including 14 males and 7 females, aged 23 to 69 years old with an average of(38.1±12.9) years old. According to different femoral shaft fracture sites, some patients were fixed with cephalomedullary implant for both femoral neck and the femoral shaft(single structure, InterTan or PFNA Ⅱ), some patients were fixed with cannulated screws for the femoral neck and a retrograde locking nail for the femoral shaft (dual structure), and postoperative function and complications were recorded during follow-up. In 10 cases of single-structure fixation, the femoral necks were all basicervical fractures, and the femoral shaft fractures were located in the proximal isthmus;11 cases were double-structure fixation, 9 cases in 11 were basal type of femoral neck, 2 cases in 11 were neck type, and the femoral shaft fractures were located in the isthmus and the distal isthmus.@*RESULTS@#All patients were followed up for 12 to 27 months. No femoral head necrosis, deformity, delay or nonunion occurred in the patients with single-structure fixation, and no delayed union or nonunion occurred in femoral shaft fractures;At the final follow-up, Harris score of patients with single-structure fixation was 91.8±4.1, with 8 cases were excellent and 2 cases were good. The fractures of patients with dual-structure fixation achieved good union without femoral head necrosis, except 1 case of femoral shaft fracture had delayed union;At the final follow-up, Harris score of patients with dual-structure fixation was 92.4±5.9, 7 cases were excellent, 3 cases were good, and 1 case was fair.@*CONCLUSION@#Good reduction and fixation is the key to the treatment of such fractures. Both the single-structure fixation and the dual-structure fixation are good methods, and it should be selected according to the locations of femoral shaft and femoral neck fractures. Single-structure fixation is a good choice for femoral shaft fractures located at the proximal isthmus and basal femoral neck fractures. For isthmus and distal femoral shaft fractures combined with ipsilateral femoral neck fractures, dual-structure fixation is recommended.
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Male , Female , Humans , Young Adult , Adult , Middle Aged , Aged , Femur Neck , Retrospective Studies , Femoral Neck Fractures/complications , Femoral Fractures/complications , Fracture Fixation, Internal/methods , Femoral Fractures, Distal , Treatment Outcome , Fracture Fixation, Intramedullary/methodsABSTRACT
Fractures of the femoral shaft are one of the most common injuries treated by orthopedic surgeons. These fractures are often associated with polytrauma and can be life-threatening.For physiologically stable individuals, Intramedullary Nailing (IMN) is the most prevalent therapy. Early healing and long-term functional recovery are the goals of fixation. Treatment of modern-day femoral shaft fractures results in excellent outcomes. Aims : To assess the results of intramedullary nailing of femoral shaft fractures by both open and closed methods. Methods : Primary, non-randomized, prospective cohort study, Patients having fracture shaft of femur who was admitted in MGM Medical College & LSK Hospital, Kishanganj was taken for the study, The study period from October 2019 to April 2021. Total 40 cases were enrolled, Open Kuntcher抯 Nail-20 cases & Closed Interlocking Nail-20 cases. Results : Male cases are predominantly high than females among the two groups. Maximum number of fracture (70% in Closed Interlocking Nail group and 80% in Open K-nail group) Radiological union within 15 weeks.Maximum number of the cases found excellent results in both groups. ie, 70% & 65% respectively. In this study, we have not found any poor & fair patients after surgical outcome. Chi-square value 0.1139 & P-value- is 0.735. Conclusion : Except for the period from injury to surgery and operating time, there was no significant difference between the two groups in terms of demographic data, fracture type, and associated co-morbidities and radiological union. When utilised to fix short oblique and transverse fractures near the isthmus of the femur, Kuntscher抯 intramedullary nailing can yield a comparable rate of union to interlocking intramedullary nailing.
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【Objective】 To explore the clinical effects of autologous platelet-rich plasma (PRP) in the treatment of postoperative bone nonunion for long bone shaft fractures during operation and after operation. 【Methods】 A total of 34 patients with postoperative bone nonunion for long bone shaft fracture, who were admitted and cured in the Orthopedics Department of our hospital from January 2019 to June 2020, were selected. They were randomly divided into the experimental group(n=17) and control group(n=17). Individuals in the control were treated with autologous iliac bone alone., while the experimental group were treated with autologous iliac bone graft plus autologous PRP during and after operation. After surgery, the autogenous PRP was accurately injected with ultrasound guidance every 7 days (5 mL/person, 4 occasions in total). The clinical healing time of the fracture, the grading of callus formation and the functional rehabilitation level of limbs on the affected side at different time were observed in both groups. 【Results】 All 34 patients were followed up. In the experimental group and the control group, the clinical healing time (month) of the fracture was (5.03±1.24) vs (6.91±1.41), P<0.05. The healing rate of the fracture for 6 months and 9 months was 94%(16/17)vs 59%(10/17)and 94%(16/17)vs 82%(14/17), respectively (P<0.05). The grading of callus formation within 3, 6 and 9 months was (2.11±0.69) vs (1.53±0.80), (3.06±0.90) vs (2.59±0.87) and (3.82±0.73) vs (3.35±0.86), respectively (P<0.05). The acceptance rate of functional rehabilitation of limbs on the affected side was 82.35%(14/17)vs 76.47%(13/17), P<0.05. 【Conclusion】 The application of autologous PRP in the treatment of postoperative bone nonunion for long bone shaft fractures during operation and after operation can achieve good clinical treatment.
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Objective:To compare the clinical effects between cannulated screwing and plating in combination with interlocking intramedullary nailing for the treatment of ipsilateral discontinuous fractures of the tibial shaft and plateau.Methods:A retrospective analysis was performed of the clinical data of 34 patients who had been treated for ipsilateral discontinuous fractures of the tibial shaft and plateau at Department of Orthopedics and Trauma, Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2015 to January 2020. There were 17 males and 17 females, aged from 26 to 60 years (average, of 43.6 years). The left side was affected in 18 cases and the right side in 16. The patients were divided into 2 groups according to their internal fixation methods: a cannulated screw group of 16 cases treated with cannulated screwing and intramedullary nailing and a plate group of 18 cases treated with plating and intramedullary nailing. The 2 groups were compared in terms of operation time, intraoperative blood loss, incision length, tibial plateau collapse, consumables cost, hospital stay, fracture healing time, weight-bearing time, range of knee motion, reduction of tibial plateau fracture by Rasmussen radiology, Lysholm knee function score at the last follow-up and complications.Results:There was no significant difference in the preoperative general data between the 2 groups, showing the 2 groups were comparable ( P>0.05). All the 34 patients were followed up for 12 to 28 months (average, 17.4 months). There was no significant difference either in operation time, hospital stay, tibial plateau healing time, tibial fracture healing time, weight-bearing time or range of knee motion between the 2 groups ( P>0.05). In the cannulated screw group, the intraoperative blood loss [(89.4 ± 14.5) mL] and consumables cost [(2.0 ± 0.2) ten thousand yuan] were significantly less than those in the plate group [(120.8 ± 22.1) mL and (2.6 ± 0.4) ten thousand yuan], the incision length [(4.1 ± 0.8) cm] was significantly shorter than that in the plate group [(7.1 ± 0.9) cm], and the Lysholm knee function score at the last follow-up [(89.8 ± 4.5) points] was significantly lower than that in the plate group [(93.0 ± 4.2 points] (all P<0.05). The difference was statistically significant between the 2 groups in the quality of tibial plateau reduction ( P<0.05). The postoperative tibial plateau collapse in the plate group [0.5 (0, 2) mm] was insignificantly less than that in the cannulated screw group [1.0 (0, 2) mm] ( P>0.05). In the cannulated screw group, one tibial shaft fracture did not achieve union after operation and deep vein thrombosis occurred in 2 cases after operation; in the plate group, 2 cases suffered from delayed wound healing, one from delayed fracture healing, one from deep venous thrombosis of lower extremity, and one from knee discomfort which was relieved after removal of internal fixation. Conclusions:In the treatment of ipsilateral discontinuous fractures of tibial shaft and plateau, both cannulated screwing and plating in combination with interlocking intramedullary nailing can achieve good clinical effects. Although plating in combination with intramedullary nailing lead to more severe trauma and higher costs, it is conducive to improving the reduction quality of the tibial plateau and postoperative functional recovery of the knee joint.
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Objective To compare biomechanical properties of the traditional and novel locking compression plate （LCP） for treating femoral shaft fracture, so as to provide theoretical basis for selecting more effective bone plate. Methods The bending strength and fatigue tests on the plate were performed, and the finite element analysis on deformation, stress and life of the plate were conducted by using ANSYS Workbench. Results The average bending yield load and bending strength of the novel LCP were 1.4 times of that of the traditional LCP, and the average cycle times of the novel and traditional LCP were 106 and 47 091, respectively. The difference of service life for two LCPs was 33.8%. ConclusionsThe failure probability of the novel LCP is smaller than that of the traditional LCP, and the novel LCP has more effective biomechanical stability.
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@#A bent intramedullary (IM) nail becomes challenging and technically demanding to the orthopaedic surgeon for nail extraction. A broken nail can be easily removed through the fracture site. However, a bent nail has to be broken before it can be removed. Several studies and case reports outline the strategies and techniques for removing a bent IM nail. However, there is a paucity of guidelines and standard protocol describing the best and inexpensive strategy. We report a case where two years following surgery for intramedullary nailing of the right femur, the IM mail was bent following secondary trauma. We used a technique based on the principles of an ability to fully cut the nail and extract it in two pieces by using a Jumbo cutter which is available in the orthopaedic armamentarium. This technique is simple yet economical, with the likelihood of causing less soft tissue damage and thermal necrosis.
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OBJECTIVE@#To summarize the complications of core drilling intramedullary nail in the treatment of femoral shaft closed fracture and explore the treatment strategy.@*METHODS@#From August 2014 to June 2018, a total of 215 patients with closed femoral shaft fractures were treated with closed reduction core drill intramedullary nail, including 129 males and 86 females, aged from 18 to 62 years, with an average of (44.2±10.6) years old. The time from injury to operation was 3 to 21 days. There were 102 cases of AO type A fracture, 82 cases of AO type B fracture and 31 cases of AO type C fracture. The time of operation, the amount of blood loss during operation, the duration of hospitalization, the time of fracture healing and the HSS score of knee joint function at the last follow-up were recorded. The observation of complications included:iatrogenic fracture, core drill broken, core drill twist, postoperative infection, and fracture nonunion.@*RESULTS@#The average operation time was (63.2± 15.6) min and intraoperative blood loss was (150.0±34.5) ml. All the incisions reached grade A healing. Patients were follow up for a mean of (18.5±3.2) months, the average hospital stay was (4.3±1.2) days, and the average fracture healing time was (5.6±2.3) months. At the final follow-up, the average HSS score of knee joint was 90.3±4.7. Related complications occurred in 37 cases (17.2%). The core drill related complications occurred in 13 cases (6.0%), including core drill broken in 5 cases (2.3%), core removal in 1 case and slotting in 4 cases;core drill twist in 8 cases (3.7%). After the core was cut, the core was removed. Similar complicationsof conventional intramedullary nail:iatrogenic fracture was performed in 12 cases (5.6%), including 10 cases of fracture end split and 2 cases of distal perimedullary fracture of intramedullary nail. The patients with cleavage at the fracture end were not treated after judging their stability, and the patients with fracture around the distal end of the intramedullary nail were fixed with auxiliary steel plate during operation;1 case(0.4%) with delayed infection after operation, debridement and external fixation was replaced and healed after bone transfer; fracture nonunion occurred in 11 cases (5.1%), of which 7 cases (3.3%) were hypertrophic nonunion and healed with additional plate. Atrophic nonunion occurred in 4 cases (1.9%), which healed after additional steel plate and bone graft.@*CONCLUSION@#Core drilling intramedullary nail is an effective method for the treatment of closed femoral shaft fracture, and the complications include core drill related complications and conventional intramedullary nail similar complications. Accurate preoperative evaluation, careful operation during operation and early postoperative symptomatic treatment can effectively reduce the occurrence of related complications.
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Adult , Female , Humans , Male , Middle Aged , Bone Nails , Femoral Fractures/surgery , Fracture Fixation, Intramedullary/adverse effects , Fracture Healing , Fractures, Closed , Treatment OutcomeABSTRACT
BACKGROUND: Patients with poliomyelitis often have abnormalities in the femur and the conventional plant matching degree of fracture is low. There are few reports on individualized treatment for severe deformity of femoral shaft fracture in poliomyelitis. OBJECTIVE: To summarize the clinical features of femoral shaft fracture in poliomyelitis and discuss the operative outcome of 3D printing pre-operation assisted with custom-made plate. METHODS: From May 2015 to May 2018, data of 19 patients with poliomyelitis surgically treated with 3D printing pre-operation assisted with custom-made plate were retrospectively analyzed. There were 11 males and 8 females with an average age of 52.5 years (range, 38-62 years). There were 7 cases on the left side, and 12 cases on the right side. According to AO/OTA classification of femoral shaft fracture, there were type A1 in 6 cases, type A2 in 3 cases, type A3 in 1 case, type B1 in 4 cases, type B2 in 4 cases and type C1 in 1 case. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The 3D printed 1:1 femur model and custom-made plate were designed. Operation was simulated in vitro in femoral model. The placement of the plate was identified. The direction and length of the screws were measured and recorded. The final internal fixation of fracture was performed according to the pre-operation results. Hip and knee functions in the affected limb were assessed based on Harris evaluation criterion and hospital for special surgery knee score evaluation criterion. RESULTS AND CONCLUSION: (1) All 19 patients were followed up for 12-18 months. Bone healing was obtained in all fractures, with a healing time of 5-12 months, averaging 6.6 months. (2) Harris score was (84.95±5.18) before injury, and (84.42±4.83) 1 year after operation. Hospital for special surgery knee score was (84.53±4.36) before injury, and (83.63±3.90) 1 year after operation. Statistical analysis showed no statistical difference between the two groups before and after the injury (P > 0.05). (3) All patients had no internal fixation loosening or fracture. One patient had delayed bone healing and healed after iliac bone grafting. One patient developed wound infection after surgery, and received adequate drainage. Wound was healed after intravenous application of sensitive antibiotics. (4) Patients with poliomyelitis often have abnormalities in the femur with varying degrees of osteoporosis. For femoral shaft fractures that cannot be fixed with conventional internal fixation, 3D printing pre-operation combined with custom-made steel plate provides a new choice for the treatment of femoral shaft fractures in poliomyelitis.
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BACKGROUND: At present, there are relatively few studies on the closed reduction of intramedullary nail treatment for femoral shaft fractures. OBJECTIVE: To investigate the effect of closed reduction and intramedullary nailing in the treatment of femoral shaft fractures in the lateral position. METHODS: From January 2015 to October 2018, 54 patients with femoral shaft fractures were treated with intramedullary nailing at Department of Orthopedics and Traumatology, the Third Affiliated Hospital of Zunyi Medical University. The patients were randomly assigned to three groups, including 17 cases in the supine mechanical traction group, 17 cases in the lateral artificial traction group, and 20 cases in the lateral mechanical traction group. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Closed reduction success rate, operation time, intraoperative blood loss, fracture healing time, and hospital for special surgery knee score at 6 months after surgery were compared in the three groups. RESULTS AND CONCLUSION: (1) All patients were followed up for 6 to 15 months. (2) The success rate of fracture closure was 100% in the lateral mechanical traction group, 82% in the lateral artificial traction group, and 59% in the supine mechanical traction group. There was no significant difference between supine mechanical traction group and lateral artificial traction group (P > 0.05). The success rate was significantly higher in the lateral mechanical traction group than in the supine mechanical traction group (P=0.002). There was no significant difference between the lateral mechanical traction group and the lateral artificial traction group (P > 0.05). (3) No significant difference was found in operation time between the supine mechanical traction group and the lateral artificial traction group (P > 0.05). The operation time was significantly shorter in the lateral mechanical traction group than in the supine mechanical traction group and lateral artificial traction group (P 0.05). (5) Fracture healing time was significantly longer in the supine mechanical traction group than in the lateral artificial traction group (P=0.030) and lateral mechanical traction group (P 0.05). (6) No significant difference in hospital for special surgery knee score at 6 months after surgery was detected among the three groups (P > 0.05). (7) These results suggested that application of lateral recumbent traction frame closure and intramedullary nailing for the treatment of femoral shaft fractures has the advantages of high success rate, short operation time, less intraoperative blood loss and short fracture healing time. It is worthy of clinical application.
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Objective: To explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation. Methods: The clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness. Results: Both groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction ( P0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant ( P<0.05). Conclusion: Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.
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Background: Fractures of the tibial shaft are important for tworeasons. The first is that they are common, the second is thatthey are controversial - and anything that is both common andcontroversial must be important. Fractures of the shaft of thetibia cannot be treated by following simple sets of rules.Because of its location tibia is exposed to frequent injury and itis the most commonly fractured long bone.Objective: To evaluate the treatment of open tibial shaftfracture of Gustilo IIIA grade by Trans osseous osteosynthesistechnique with Illizarov External Fixator as a primary anddefinite mode of treatment.Methods: Clinical trial (Quasi Experimental study) fromJanuary 2009 to June 2010 (18 months) at National Institute ofTraumatology and Orthopaedic Rehabilitation Purposivesampling was done according to availability of the patients andstrictly considering the inclusion and exclusion criteria andsample size was 17 no of cases.Results: 14 male and 1 female patient between 17 and 51years were studied. Most common age group in this serieswere 26-35 year age group ((53.33%) and average age of thepatients was 30 years with SD of ±8.67. Most of the patientswere male and road traffic accident was the leading cause ofinjury (70.58%). Left side involved in (58.82%) most of thecases and 2 patients had bilateral fractures. Commonest site ofthe fractures were middle third (58.82%) of the tibia. Most ofthe fractures were comminuted type of fractures (47.05%).Most of the patients were operated on the day of admissionand in some cases within 4 - 7 days of admission. Averageduration of hospital stay was 8.06 days ranging from 1 day to28 days. Total duration of treatment was average 186.66 days(26 weeks) highest 291 days (42 weeks) and lowest 140 days(20 weeks). Most of the patient had soft tissue healing bygranulation tissue formation (35.29%). Others were treated byprimary closure, Delayed primary closure, secondary closure,partial thickness skin grafting.Conclusion: In this study the results of open tibia fracture(Gustilo IIIA) by Transosseous osteosynthesis technique withIlizarov External Fixator has been found to be satisfactory.Though there were a few minor complications with the fixatorthe dynamisation and compressing ability of this stable frameprovided good union without any second surgical procedure orbone grafting and prevented any malunion.
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Background: The management of infective non-union of long bones has always been a dare for orthopedic surgeons. Treatmentgoals were the annihilation of infection and augmenting bony union. For the span of distraction osteogenesis, physiologicalskeletal loading and active mobilization are vital.Aim: This study intended at evaluating the clinicoradiological result of using Ilizarov ring fixator in managing patients withinfective non-union fracture of shaft of the femur.Materials and Methods: A total of 40 patients with infective non-union of the femoral shaft were incorporated in the study between2017 and 2018. The follow-up period lasted for 14–20 months. Skeletal measurements and functional results were calculated,and difficulties were stratified according to the association for the study and relevance of the technique of Ilizarov guidelines.Results: The infection was eradicated in 32 patients before the fixator removal. Tremendous radiological bone healing wasfound in 32 patients and excellent functional result in 28 of 40 patients.Conclusion: Ilizarov ring fixator is a valuable method for the managing of infective non-union of femoral shaft fractures withsatisfactory radiological and clinical outcome and less serious complications.
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INTRODUCTION@#This study compared Polyvinyl Chloride (PVC) made vs Plaster of Paris (POP) made functional braces in the closed treatment of fractures of the humeral shaft. Outcomes examined were the rate of fracture union, radiographic alignment, DASH scores and the range of motion of the shoulder and elbow@*METHODS@#This was a parallel randomized clinical trial conducted at the Corazon Locsin-Montelibano Memorial Regional Hospital from July 2016 to July 2017. All eligible patients were included and randomly allocated into PVC and POP treatment groups. All patients were followed-up on the 3rd, 6th, 10th, and 14th week for clinical and radiographic evaluation.@*RESULTS@#There were 31 patients, 14 and 17 in the PVC and POP groups, respectively. The median rate of union in the PVC and POP groups were 10.50 and 10.00 weeks, respectively. The median varus and valgus angulation in the PVC and POP groups were 15.75° and 16.5°, respectively. The median anterior and posterior alignment in the PVC group was 1.7° and POP group was 9.6°. The median DASH score of the PVC and POP groups were 7.1 and 12.5, respectively. The median range of motion in the elbow was 135° for both groups. The median range of motion in the shoulder in the PVC group was 150° and POP group was 140°.@*CONCLUSION@#There was a high rate of union of humeral shaft fractures with acceptable functional outcome with the use of the PVC made functional brace compared to the traditional POP made functional brace.
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PURPOSE: This study analyzed the results of the midclavicle fracture treatment using the minimally invasive percutaneous plate osteosynthesis (MIPO) technique in a retrospective manner. MATERIALS AND METHODS: Between March 2013 and March 2017, this study analyzed 40 patients who received MIPO surgery. Excluding 1 patient who underwent surgery on another body part injury, and 4 patients who were lost to follow-up over 1 year, 40 patients were analyzed for their operation time, bone union, functional American Shoulder and Elbow Surgeons score, scar lengths, pain relief (visual analogue scale), and complications. RESULTS: All patients over a 1 year of follow-up achieved bone union, and American Shoulder and Elbow Surgeons score 97.6 (94–100) on their shoulder functional scores. Their average operation time was 42.7 minutes, and the average scar length was 6.1 cm. Eighteen patients successfully received metal removal using the previous scar without additional incision. The clavicle length was similar in the normal and operated group. CONCLUSION: Despite its small sample size, clavicle fixation using the MIPO technique can be considered an effective treatment because of its limited number of complications, such as nonunion and rotational angulations.
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Humans , Cicatrix , Clavicle , Elbow , Follow-Up Studies , Lost to Follow-Up , Retrospective Studies , Sample Size , Shoulder , SurgeonsABSTRACT
Objective To compare the efficacy and safety between minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) in the treatment of humeral shaft fracture.Methods Case-control studies and randomized clinical trials comparing MIPO with ORIF in the treatment of humeral shaft fracture from January 2010 to June 2018 were retrieved from PubMed Library,Cochrane Library,Embase Library,China National Knowledge Internet and Wanfang Data.Methodological quality of the studies and trials was critically assessed.REVMANS.3 was used for data analysis.The 2 groups of patients were compared in terms of University of California,Los Angeles shoulder rating scale (UCLA),Mayo Elbow Performance Score (MEPS),union time,nonunion rate and complications.Results A total of 452 patients from 9 articles were included.There were 216 cases in the MIPO group and 236 ones in the ORIF group.The Meta analyses showed that the MIPO group had a significantly higher UCLA score (WMD =0.36,P=0.03),significantly lower incidences of complications (OR =-0.15,P ＜ 0.05) and iatrogenie radial nerve palsy (OR =0.24,P ＜ 0.05),and significantly shorter union time (SMD =-0.36,P =0.02) than the ORIF group.There were no significant differences between the 2 groups in MEPS (WMD =-0.48,P =0.43) or nonunion rate (OR =0.45,P =0.11).Conclusion MIPO may be a better choice for humeral shaft fracture than ORIF in regards to postoperative shoulder functions,union time,and incidences of complications and iatrogenic radial nerve palsy.
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Objective: To explore the effectiveness of Ilizarov external fixation without bone graft in the treatment of atrophic femoral shaft nonunion. Methods: The clinical data of 12 patients with atrophic femoral shaft nonunion admitted between October 2010 and January 2017 were retrospectively analyzed. There were 8 males and 4 females, aged from 24 to 61 years, with an average age of 41.7 years. The nonunion sites located in the middle and upper femur in 7 cases and in the distal femur or supracondylar in 5 cases. The disease duration ranged from 1 to 9 years, with an average of 3.7 years. Previous operations ranged from 1 to 9 times, with an average of 2.8 times. The original fixator was removed, the fracture end of nonunion was debrided, and Ilizarov external fixator was installed. In patients with the length of bone defect less than 4 cm, direct compression fixation was performed during operation; in patients with limb shortening more than 2.5 cm, proximal femoral osteotomy and bone lengthening components were required to prepare limb lengthening after operation; all patients did not receive bone graft. The wearing time of external fixator, clinical bone healing time of nonunion fracture end, and complications were recorded. The effectiveness was evaluated by Paley's nonunion evaluation criteria. Results: All patients were followed up 24-50 months, with an average of 30 months. Bony union was achieved in all 12 cases with a healing time of 6.0-23.5 months (mean, 11.5 months). The wearing time of external fixator ranged from 7 to 25 months, with an average of 13.5 months. At last follow-up, according to Paley's nonunion evaluation criteria, the results were excellent in 6 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 83.3%. Sagittal angulation deformity of femur more than 7° occurred in 4 cases, with no significant effect on knee extension function, and no special treatment such as osteotomy was performed. Two patients had shorter limbs (>2.5 cm) after operation and were replaced by high shoes; 4 patients with trans-knee fixation lost knee joint mobility of 10-30° after operation; 10 cases of needle tract infection occurred, of which 4 cases with infection and loosening of fixed needle were replaced and re-fixed after needle extraction, the remaining 6 cases of infection without loosening of fixed needle were controlled by local dressing change, needle nursing, and oral cephalosporin anti-inflammatory drugs. No complications such as deep infection and vascular nerve injury occurred. Conclusion: Ilizarov external fixation has a high healing rate for atrophic femoral shaft nonunion, which is relatively minimally invasive and can avoid bone grafting. Its preliminary effectiveness is exact, and it is also effective for patients who have experienced multiple failed operations. It is necessary to pay attention to the nursing and rehabilitation training after external fixation.
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Objective: To review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation. Methods: The results of the clinical studies about the AP in treatment of femoral shaft nonunion after intramedullary nail fixation in recent years were widely reviewed and analyzed. Results: The AP has been successfully applied to femoral shaft nonunion after intramedullary nail fixation since 1997. According to breakage of the previous nailing, AP is divided into two categories: AP with retaining the previous intramedullary nail and AP with exchanging intramedullary nail. AP is not only suitable for simple nonunion, but also for complex nonunion with severe deformity. Compared with exchanging intramedullary nail, lateral plate, and dual plate, AP has less surgical trauma, shorter healing time, higher healing rate, and faster returning to society. However, there are still some problems with the revision method, including difficulty in bicortical screw fixation, lack of anatomic plate suitable for femoral shaft nonunion, and lack of postoperative function and quality of life assessment. Conclusion: Compared with other revision methods, AP could achieve higher fracture healing rate and better clinical prognosis for patients with femoral shaft nonunion. However, whether patients benefit from AP in terms of function and quality of life remain uncertain. Furthermore, high-quality randomized controlled clinical studies are needed to further confirm that AP are superior to the other revision fixations.
ABSTRACT
BACKGROUND: This study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types. METHODS: From 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20–87 years), and mean follow-up period was 2.3 years (range, 1.0–6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed. RESULTS: Radiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (p<0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (p=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (p=0.352). CONCLUSIONS: Intramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.