ABSTRACT
OBJECTIVE@#To investigate the effect of intramedullary nail fixation (IMN) and minimally invasive percutaneous plate internal fixation (MIPPO) techniques on tibiofibular fractures and their effect on platelet activation and serum transforming growth factor-β1 (TGF-β1) and bone morphogenetic protein-2 (BMP-2).@*METHODS@#Total of 105 patients with tibiofibular fractures from February 2019 to February 2020 were selected and divided into 53 cases in the MIPPO group and 52 cases in the IMN group. There were 29 males and 24 females with an average age of (41.74±6.05) years old in MIPPO group;in IMN group, 31 males and 21 females with an average age of (40.59±5.26) years old. The perioperative surgical indexes, postoperative complications, ankle function recovery at 12 months postoperatively, platelet activation indexes at 3 and 7 days preoperatively and postoperatively, and serum TGF-β1 and BMP-2 levels at 4 and 8 weeks preoperatively and postoperatively were compared between the two groups.@*RESULTS@#The operating time and fracture healing time in the MIPPO group were shorter than those in the IMN group(P<0.05); Compared with the preoperative period, the levels of GMP-140, PAC-1, CD63, and CD61 increased in both groups at 3 and 7 days after surgery, but were lower in the MIPPO group than in the IMN group(P<0.05);the levels of serum TGF-β1 and BMP-2 increased in both groups at 4 and 8 weeks after surgery compared with the preoperative period, and the postoperative complication rate in the MIPPO group was lower than that in the IMN group(P<0.05);the difference was not statistically significant in the excellent rate of ankle function recovery at 12 months follow-up after surgery between two groups(P>0.05).@*CONCLUSION@#Both intramedullary nail fixation and MIPO technique for treatment of tibia and fibula fractures can improve ankle joint function, but the latter has the advantages of short operation time, fast fracture healing, fewer complications, and light platelet activation. Serum TGF-β1, BMP-2 level improves quickly.
Subject(s)
Male , Female , Humans , Adult , Middle Aged , Tibia/injuries , Transforming Growth Factor beta1 , Fracture Fixation, Intramedullary/methods , Tibial Fractures/surgery , Fracture Fixation, Internal/methods , Bone Plates , Fracture Healing , Postoperative Complications , Fractures, Multiple , Treatment Outcome , Bone Morphogenetic Proteins , Minimally Invasive Surgical Procedures/methods , Retrospective StudiesABSTRACT
Results: All patients were followed up 4-13 months, with an average of 5.7 months. During the treatment, there was no complication such as loosening or breaking of the external fixator, fracture displacement, or re-fracture in 2 groups. The using time of external fixator in group A was (24.77±1.42) weeks and the fracture healing time was (23.04±1.30) weeks, which were all significantly reduced when compared with those in group B [(34.38±1.71) weeks and (32.46±1.66) weeks] ( t=16.10, P=0.00; t=15.58, P=0.00). In group A, there were 2 cases of needle tract infection and 1 case of muscle weakness, the incidence of complication was 23.1%; in group B, there were 3 cases of needle tract infection, 1 case of muscle weakness, and 1 case of delayed union of fracture, the incidence of complication was 38.5%; there was no significant difference in the incidence of complication between 2 groups ( P=1.000).
ABSTRACT
OBJECTIVE: To explore the efficacy and safety of the axial load mechanical testing for removing external fixator. METHODS: Between January 2014 and August 2015, 27 patients with tibia and fibula fractures caused by trauma underwent an external fixation. Of 27 patients, 21 were male and 6 were female with the average age of 45 years (range, 19-63 years), including 7 cases of closed fracture and 20 cases of open fracture. X-ray film results showed spiral unstable fracture in 4 cases and comminuted unstable fracture in 23 cases. All patients underwent an external fixation. Bone nonunion occurred in 3 cases because of infection, and bone nonunion combined with bone defect occurred in 1 case, who received tibial osteotomy lengthening surgery. When X-ray film showed continuity high density callus formation at fracture site, axial load mechanical test was performed. If the axial load ratio of external fixator was less than 10%, the external fixator was removed. RESULTS: At 21-85 weeks after external fixation (mean, 44 weeks), axial load mechanical test was performed. The results showed that the axial load ratio of external fixation was less than 10% in 26 cases, and the external fixator was removed; at 6 weeks after removal of external fixator, the patients could endure full load and return to work, without re-fracture. The axial load ratio was 14% in 1 case at 85 weeks, and the X-ray film result showed that fracture did not completely heal with angular deformity; re-fracture occurred after removing external fixator, and intramedullary fixation was used. CONCLUSIONS: External fixator axial load mechanical testing may objectively reveal and quantitatively evaluate fracture healing, so it is safe and reliable to use for guiding the external fixator removal.
ABSTRACT
Objective To investigate the effects of first external fixator and second locking plate fixation in treating open tibiofibular fractures. Methods We retrospectively analyzed the 36 patients with Gustilo'sⅢtype tibia and fibula fractures from Jan. 2009 to Dec. 2010. All the patients were treated with first external fixator and second locking plate fixation,and the curative effect and the extremity function were evaluated.Results All patients were followed-up for 18 months (6 to 24 months) in average,and all the fractures were healed in 5.5 months averagely. According the Johner-Wruhs evaluation standard, excellent was in 24 cases, good was 10 cases,and bad was in 2 cases. The excellent and good rate was 94%. According the Merchant evaluation standard, excellent was in 26 cases,good was in 5 cases,fair was in 4 cases,bad was in 2 cases. The excellent and good rate was 86.1%.The outcome was satisfactory. Conclusion The first external Fixator and second locking plate fixation in treating open tibiofibular fractures can improve the healing rate and the functional recovery.
ABSTRACT
Objective:To detect the expression of TGF-?1 in tibia and fibula fracture with two methods of compression plate fixation and intramedullary nail fixation,and to evaluate their therapeutic effects.Methods:117 patients with non severe tibia and fibula fractures were separated into two groups.One group received pressurized plates fixation for treatment,the other received intramedullary nail fixation.On 1,7,30 and 90 days after surgery,TGF-?1 was detected by ELISA,and on 30 days after surgery the clinical efficacy were also assessed. Results:The TGF-?1 content increased on 7 days as compared with that on 1 days after surgery,and the TGF-?1 content gradually decreased at on 30 to 90 days after surgery.The TGF-?1 content in compression plate fixation group were lower than that in intramedullary nailing group every points of four days(P