Does a staged treatment of high energy tibial plateau fractures affect functional results and bony union? A case series / 中华创伤杂志(英文版)

PURPOSE@#Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner.@*METHODS@#Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated. All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software.@*RESULTS@#Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale. Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient = -0.554).@*CONCLUSION@#A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.

Clinical effect of staged stent-assisted embolization after initial coiling of acute ruptured wide-neck saccular intracranial aneurysms / 中国脑血管病杂志

Objective: To evaluate the safety and efficacy of coiling in the acute phase followed by staged stenting for ruptured wide-neck saccular intracranial aneurysms. Methods: From November 2006 to December 2017, We retrospectively reviewed 58 consecutive patients with acute ruptured wide-neck saccular intracranial aneurysms(58 ruptured wide-neck saccular intracranial aneurysms) who were treated with staged stent-assisted embolization after initial coiling in the Department of Neurosurgery of NO. 971 Hospital of PLA Navy and the Department of Neurosurgery of First Hospital Affiliated to Naval Medical University. Simple coiling embolization was performed in the acute phase, and stent implantation was performed in the second stage. The immediate postoperative and follow-up angiographic results were assessed using the Raymond scale, and the outcome of clinical follow-up was assessed using the modified Rankin Scale(MRS). Results: All 58 patients(58 ruptured wide-neck saccular intracranial aneurysms) were successfully treated with staged stent-assisted embolization. The median interval of staged stenting treatment was 4. 4(4. 1, 4. 9) weeks. No aneurysm rebleeding occurred prior to the staged stenting treatment. During the treatment of staged stenting, coils were used as many as possible for embolization under the mechanical protection of stents in order to achieve complete occlusion. Immediately after stenting, angiography showed 30 aneurysms (51. 7%) with complete occlusion, 22 aneurysms (37. 9%) with neck remnant and 6aneurysms(10. 3%) with residual sac. One patient suffered in-stent thrombosis two hours after stent implantation, which was relieved with the use of tirofiban. When discharging hospital, showing that a total of 46 patients (79.3%) had MRSO-2, 8 patients(13.8%) had MRS 3 and 4 patients(6.9%) had MRS 4. Imaging follow-up ranged 6-35 months (median 16 months), showing 47 aneurysms (81. 0%) with complete occlusion, 7 aneurysms(12. 1%) with residual neck and 4 aneurysms(6. 9%) with residual sac. There was no recurrence, and the parent arteries were patent in all cases. Clinical follow-up ranged 6-36 months(median 18 months), showing that a total of 8 patients(13. 8%) had MRS 0-2 and 50 patients (86. 2%) had MRS 3. There was no new neurological dysfunction or death. Conclusion: Treatment of ruptured wide-neck saccular aneurysms with coiling in the acute phase followed by staged stenting is safe and effective.

Omphaloceles in combination with a self-made hemispherical cushion: a report of 12 cases

The aim of this study was to discuss the curative effect of applying "capsule-reserved normal saline bag and self-made hemi-spherical cushion oppression" for treating giant omphaloceles. Twelve patients with giant omphaloceles who were admitted to our hospital between January 2008 and June 2016 were selected for treatment as follows: a capsule-reserved normal saline bag was used to promote the gradual return of the abdominal contents into the abdominal cavity in phase I, and a self-made hemi-spherical cushion was used for compression combined with a local dressing change in phase II to treat the giant omphaloceles without surgical treatment. All 12 patients in this group were cured, and after follow-up visits for >10 months, they had no abdominal infections, wound disruption, intestinal obstruction, or other complications, and their growth was normal. Two patients had abdominal hernias, and they recovered after herniorrhaphies. Giant omphaloceles in newborns were treated in stages, and in phase II, non-surgical treatment was applied, which was easily performed with a smaller wound, low cost, an obvious curative effect, and higher safety and effectiveness.

Surgical treatment for open tarsometatarsal joint injury / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the surgical method and clinical efficacy for open tarsometatarsal joint injuries.</p><p><b>METHODS</b>From March 2011 to January 2015, 21 patients with open tarsometatarsal joint injuries were treated with stage-surgery method, including 14 males and 7 females with an average age of 45.6 years old ranging from 20 to 75 years. Injury site occurred in the left foot of 13 cases and right foot of 8 cases. Traffic injury was in 5 cases, crush injury in 6 cases, heavy crushing was in 10 cases. According to Myerson to classify for tarsometatarsal joint injury, 5 cases were type B2, 9 cases were type C1, and 7 cases were type C2. And according to Gustilo to typing for soft tissue injury, 5 cases were type IIB, 10 cases were type IIIA, 6 cases were type IIIB. Fracture healingand complications were observed after operation and clinical effects were evaluated according to the midfoot score of AOFAS.</p><p><b>RESULTS</b>All the patients were followed up from 11 to 40 months with an average of 16.2 months. The fracture healing time was from 10 to 16 weeks with an average of 12.3 weeks. No complications such as deep infection, nonunion and osteomyelitis were found. Midfoot score of AOFAS at last follow-up was 83.0±14.9, 9 cases got excellent results, 8 good, 2 fair, 2 poor. Two patients complicated with severe traumatic arthritis once again underwent tarsometatarsal arthrodesis.</p><p><b>CONCLUSIONS</b>For the treatment of open tarsometatarsal joint injury, reasonable debridement, comprehensive assessment for the soft tissue injury, correctly grasp the surgical indications and time of internal fixation, can reduce the incidence of deep infection and osteomyelitis.</p>

Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture

PURPOSE: To assess the results of staged MIPO (Minimally Invasive Plate Osteosynthesis) for proximal tibial fractures with compromised soft tissue. MATERIALS AND METHODS: Eighteen proximal tibial fractures (AO 41:9 cases, AO 42:9 cases) included this study. Ten were open fractures. After temporary external fixation until soft tissue healed (mean 27.3 days), MIPO was performed secondarily without bone graft. We assessed the bony union and knee function, and affecting factors of the results were investigated. RESULTS: All fractures united at 20 weeks (range, 11~32) except 1 case. Mean range of knee flexion was 134.4degrees and mean IOWA knee score was 89.1. There were 2 superficial and 2 delayed deep infections from open fractures (grade II:1 case, grade III:3 cases), although they healed after implant removal. Open fractures seem to influence the infection rate. Otherwise, there was no related factor affecting the results. CONCLUSION: MIPO after temporary external fixation can provide favorable results in proximal tibial fractures with soft tissue injuries, but attention of delayed infection should be paid in open fractures.

Staged Treatment of High Flow, Large Cerebral Arteriovenous Malformation with a Combination of Preoperative Embolization and Microsurgery

Surgical treatment of cerebral arteriovenous malformations(AVM's) that are high flow and large remain particularly difficult to manage. It has been reported that normal perfusion pressure breakthrough(NPPB) syndrome occur more frequently in such AVM's and managing such AVM's by staged treatment may help to avoid the occurrence of this complication. The authors report our experience with one case of high flow, large AVM that would pose a great operative difficulty if it was to be managed by surgical resection alone. The patient was treated by a staged procedure in which a preoperative embolization was followed by a complete microsurgical excision. The staged, complementary approach proved to be quite useful and safe for the treatment of high flow, large AVM.