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Objective:To study the effect of comfort care to alleviate postoperative pain of tibial eminence fracture by fixation. Methods:55 patients with tibial eminence fracture between Apr 2013 and Mar 2015 in our hospital were selected and divided into observation group with 26 patients and control group with 29 cases according to the nursing methods. The control group was given the orthopaedic routine nursing method, and the observation group was given the comfortable nursing method to compare two groups of patients with postoperative pain and psychological status before and after the intervention (HAMA anxiety score and HAMD depression scale). Results:There were significant differences between two groups of patients with pain score after the intervention (t=9.545, P<0.05), and HAMA and HAMD scores decline. HAMA and HAMD scores in the observation group were significantly lower than that in the control group (t=11.593, t=10.628;P<0.05). Conclusion:Comfort care can significantly relieve postoperative pain of the tibial condyle spine fractures and improve postoperative anxiety and depression. It has good clinical application value.
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PURPOSE: This study examined the outcome of arthroscopic internal fixation for types II and III tibial eminence fractures in children using a cannulated screw. MATERIALS AND METHODS: A series of 10 cases of displaced fractures of tibial eminence of the tibia that were treated with an arthroscopic cannulated screw fixation from February, 1997 to October, 2005 were examined. Four patients had a type II and six patients had a type III tibial eminence fracture according to the Meyer and McKeever's classification. All the patients were reviewed radiographically and clinically for bone union, instability and the range of motion after an average follow-up of 22.4 months (range, 12 to 81 months). RESULTS: There were no cases of nonunion. The clinical examination showed that, all the patients with types II and III lesions had a negative Lachman test, and a full range of motion with the exception of one patient with a type III fracture. The average Lysholm functional score was 96.3 (mim 92.6-max 99.0) for all types II and III lesions. CONCLUSION: Arthroscopic internal fixation with a cannulated screw for types II and III avulsion fractures of the tibial eminence in children can provide a satisfactory outcome through firm fixation of the fragment and an early start of the range of motion.
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Child , Humans , Anterior Cruciate Ligament , Classification , Follow-Up Studies , Range of Motion, Articular , Rehabilitation , TibiaABSTRACT
Objective To report the clinical outcomes of arthroscopic internal fixation by using anchor for tibial eminence fracture.Methods From January 2004 to January 2005,12 cases of tibial eminence were treated by arthroscopy with anchor fixation.Rehabilitation therapy was carried out after the operation.Results The mean operation time was 41 minutes(range 37 to 47).No patient had postoperative complications.They were followed up for 15 to 27 months(mean,23 months).The postoperative Lysholm score ranged from 91 to 98 with a mean of 93.The patients could extend the knee in a normal range,without pain or locking.Conclusion Arthroscopic internal fixation using anchor is a safe,simple,and effective treatment for patients with tibial eminence fracture.
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Objective To conduct a hiomechanical comparison of the four common internal fixation methods for the anterior eruciate ligament(ACL)avulsion fractures of displaced tibial eminence.Methods Sixteen fresh cadaver knee joints were used and randomized into four equal groups of four fixation methods:antegrade wiring group, retrograde wiring group,suturation group,and intramedullary screw group.The knee joint specimens were fixed at flexion of 30?and subject to continuous stretch stresses of 30 N,60 N and 90 N respectively on a material testing machine(MTS 858 Bionix test system,USA)which conducted a simulated Lachman test.The specimens were scanned at different angles by a three dimensional laser scanner.Data were recorded and processed by image software to es- tablish three-dimensional structure models of femur,tibia and knee joint.The test results were analyzed statistically on a computer.Results There were no obvious differences between each fixation group in the length change of ACL when the stresses were 30 N and 60 N(P＞0.05).Under 90 N stress,however,the mean length change between the femoral and tibial attachments of ACL was the smallest(4.8?1.7)mm(2.5 to 6.2 mm)in the suturation group(P＜0.05). There were no distinct differences between the intramedullary screw group and the retrograde wiring group in the changes of A CL shift(P=0.214).The average front shift in the retrograde wiring group was(6.2?1.2)mm(4.8 to 8.2 mm) and significantly smaller than that in the antegrade wiring group(P＜0.05).The antegrade wiring group made the largest average front shift under different stresses and its average front shift was(7.2?1.3)mm(5.6 to 8.7 mm). Conclusions The knee joint stability provided by the suturation fixation is distinctly better than that by the other three fixation methods.The antegrade wire fixation provides the poorest knee joint stability.There is hardly any difference between intramedullary screw fixation and retrograde wiring fixation.
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The studies about tibial spine fracture were less frequently reported, especially in its sdult type, had different opinions according to authors. Meyers and McKeever described it had frequedntly occured as isolated injury without associated ligamentous injury of the same knee in children and mainly caused by bicycle accident. They had classified it by three different types according to the shape of it, managed conservatively type I, II,IIIA, and recommanded simple suturing with absorbable materials as operative method. But, in our cases it had frequently occured in adult and combined with ligamentous injury at the same knee including ACL and MCL. Also, it had frequently been caused by major trauma such as traffic accident. Previous method of management including simple stainless steel wiring had scored poor results in these complicated fractures. The author reviewed 24 cases of the tibial spine fracture treated at the Department of Orthopaedic Surgery, National Medical Center from June, 1980, to June, 1988, and the following results were obtained. 1. The most common causes of the injury were traffic accident (12 cases) and associated with rupture of medial collateral ligament in 7 cases. 2. The fracture was classified as four different types according to its pattern and comminution and most commen types were III and IV, scored 8 cases and 7 cases irrespectively. 3. Initially, closed sreduction and cast immobilization was performed in 15 cases, of which 8 cases had poor results with non-union of the fracture and instability. 4. Simple stainless steel wiring in 2 cases scored poor results and distal advancement of ACL with double wiring revealed good results in these cases. 5. One case of type II fracture had persistently positive anterior drawer sign and subjective instability and needed distal advancement of ACL and double wiring. 6. Distal advancement of ACL and double wiring was performed in 6 cases of which 4 cases revealed excellent results and 2 cases did good ones.