Finite element analysis of the stability of Mason type Ⅲ radial head fracture fixed with three cross-bridge headless compression screw and locking plate / 中国骨伤

OBJECTIVE@#To compare the biomechanical stability of three cross-bridge headless compression screws and locking plates in the fixation of Mason type Ⅲ radial head fractures by finite element method.@*METHODS@#Using reverse modeling technology, the radial CT data and internal fixation data of a healthy 25-year-old male were imported into the relevant software. Three-dimensional finite element model of 3 cross-bridge headless compression screws and locking plates for MasonⅢ radial head fractures were established, and the radial head was loaded with 100 N axial loading. The maximum displacement, maximum Von Mises stress and stress distribution of the two groups were compared.@*RESULTS@#The maximum displacements of the three cross-bridge screws group and locking plate group were 0.069 mm and 0.087 mm respectively, and the Von Mises stress peaks were 18.59 MPa and 31.85 MPa respectively. The stress distribution of the three screws group was more uniform.@*CONCLUSION@#Both internal fixation methods can provide good fixation effect. CoMPared with the locking plate fixation method, the 3 cross-bridge headless compression screws fixation is more stable and the stress distribution is more uniform.

Treatment of Ideberg type Ⅱ scapular glenoid fracture with compression screw combined with Buttress plate through direct axillary approach / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of compression screw combined with Buttress plate through direct axillary approach for Ideberg typeⅡ scapular glenoid fractures.@*METHODS@#A retrospective analysis was conducted on 11 patients with Ideberg type Ⅱ scapular glenoid fractures treated with compression screws combined with Buttress plate fixation through the direct axillary approach between January 2014 and June 2022. There were 7 males and 4 females, aged from 34 to 75 years, with an average of 56.0 years. The causes of injury included 4 cases of falling from height injury, 4 cases of heavy object injury, and 3 cases of traffic accident injury. The time from injury to operation was 2-5 days, with an average of 3.8 days. The operation time, intraoperative blood loss, hospital stay, complications, and fracture healing time were recorded. The Constant-Murley score, American Society of Shoulder and Elbow Surgeons (ASES) score, and shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion were used to evaluate shoulder joint pain and function.@*RESULTS@#The operation time was 45-105 minutes, with an average of 79.0 minutes; the intraoperative blood loss was 80-200 mL, with an average of 99.2 mL; the hospital stay was 3-8 days, with an average of 5.8 days. One patient had poor wound healing after operation, and the wound healed after strengthening dressing change; the rest wounds had primary healing, and no axillary nerve paralysis occurred. Except for 1 patient lost follow-up, the remaining 10 patients were followed up 10-54 months, with an average of 26.4 months. The postoperative X-ray film examination showed that the fractures healed well within 8-15 weeks, with an average of 11.0 weeks. There was no complication such as fracture displacement, internal fixator failure or fracture during follow-up. At last follow-up, the patient's shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion, Constant-Murley score, and ASES score significantly improved when compared with those before operation ( P<0.05).@*CONCLUSION@#Compression screw combined with Buttress plate through direct axillary approach is an effective way to treat Ideberg typeⅡ scapular glenoid fracture, with advantages of small trauma, concealed incision, and good effectiveness.

Short term follow-up of unstable femoral neck fractures in young adults treated with femoral neck system and cannulated compression screws / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy of femoral neck system(FNS) and three cannulated compression screws(CCS) in the treatment of unstable femoral neck fractures in young adults.@*METHODS@#The clinical data of 52 young and middle-aged patients with unstable femoral neck fractures admitted from August 2018 to August 2021 were reviewed and analyzed. All patients were divided into two groups according to the internal fixation method, 25 cases were treated with FNS fixation, 27 cases were treated with closed reduction and 3 CCS inverted triangular distribution. The operation time, incision length, intraoperative bleeding, hospitalization expenses and fracture reduction quality of two groups were recorded and compared;The patients were followed up regularly after operation. The fracture healing time, complete weight-bearing time and postoperative complications(nonunion, femoral neck shortening, femoral head necrosis) of two groups were compared. The Harris score was used to evaluate hip function 6 months after surgery.@*RESULTS@#The operation was successfully completed in both groups. The patients in FNS group had more bleeding, longer incision length and higher hospitalization cost than CCS group(P<0.01). There ware no significant difference in operation time and Garden index between two groups(P>0.05). Patients in both groups were followed up for 6 to 32 months.The fracture healing time in FNS group was less than that in CCS group, the time of complete weight bearing after surgery was earlier than that in CCS group, and the hip Harris score was higher than that in CCS group (P<0.01). There were no internal fixation fracture complications in two groups during follow-up. In the FNS group, there were 4 cases of avascular necrosis of the femoral head and 2 cases of femoral neck shortening, of which 3 cases underwent total hip replacement due to avascular necrosis of the femoral head. In the CCS group, there were 2 cases of nonunion, 9 cases of avascular necrosis of the femoral head, and 11 cases of femoral neck shortening, among which 5 cases underwent total hip replacement due to nonunion and avascular necrosis of the femoral head.@*CONCLUSION@#With simple operation, rotational stability and angular stability, FNS enables patients to start functional exercise as early as possible and reduces the incidence of postoperative complications of unstable femoral neck fracture. It is a new choice for the treatment of unstable femoral neck fracture in young adults.

Comparison of curative effect between percutaneous compression plate and cannulated compression screw in the treatment of displaced femoral neck fractures in young and middle-aged patients / 中国骨伤

OBJECTIVE@#To compare the efficacy of percutaneous compression plate and cannulated compression screw in the treatment of displaced femoral neck fractures in young and middle-aged patients.@*METHODS@#From January 2015 to July 2020, 68 young and middle-aged patients with displaced femoral neck fracture were retrospectively analyzed. Among them, 31 cases were fixed by percutaneous compression plate (PCCP), and 37 cases were fixed by cannulated compression screw (CCS). General data such as gender, age, cause of injury, comorbidities, fracture classification and cause of injury of two groups were collected. The operation time, intraoperative blood loss, hospital stay, full weight bearing time, fracture healing time, visual analogue scale(VAS), Harris hip score and complications were compared between two groups.@*RESULTS@#Patients in both groups were followed up for more than 2 years. There were no significant differences in operation time, intraoperative blood loss, fracture reduction quality, hospital stay and VAS between two groups. The fracture healing time in PCCP group was significantly shorter than that in CCS group (t=-4.404, P=0.000). The complete weight bearing time of PCCP group was significantly shorter than that of CCS group (t=-9.011, P=0.000). Harris score of hip joint in PCCP group was better than that in CCS group 2 years after operation (P=0.002). Complications occurred in 3 cases (9.68%) in PCCP group, while 11 cases (29.72%) in CCS group, with a statistically significant difference (P=0.042).@*CONCLUSION@#Both PCCP and CCS can be used for the treatment of displaced femoral neck fractures in young and middle-aged people. Compared with CCS, PCCP fixation can achieve shorter fracture healing time and create conditions for early full weight bearing. PCCP results in higher hip score and lower complications.

Femoral Neck Non-union Treated using Compression Screw with or without Gluteus Medius Trochanteric Flap: A Case Series of Ten patients

@#Non-union is a challenging complication following a femoral neck fracture. Inability to achieve anatomical reduction and compression over the fracture leads to non-union. We reported a 10-case series of femoral neck non-union treated with sliding compression screw and anti-rotational screw with or without gluteus medius local trochanteric flap. When compression could not be achieved and a gap was present over the non-union site, a gluteus medius trochanteric flap was used to enhance the union. Surgeries were performed as a single-stage procedure through the Watson Jones approach. The initial implants were removed, followed by fracture reduction, during which the varus deformity was corrected, and the neck length was preserved as much as possible. Patients were advised for strict non-weight bearing until the presence of trabecular bone crossing the fracture on the radiographs. Union was achieved at three months in all cases. Patients undergoing surgery without trochanteric flap had normal abduction strength, and the neck length was maintained. All cases had no significant loss of function. Patients with trochanteric myo-osseous flap had neck shortening with weak abductors with MRC grade 4. Two out of 10 cases developed avascular necrosis of the femoral head before intervention. One case progressed to collapse of the femoral head requiring implant removal. This and the femoral neck shortening, caused this patient to have weak abductors and a positive Trendelenburg gait. We observed that delayed surgery leads to neck shortening and fracture gap requiring trochanteric myo-osseous flap to achieve union.

Comparison of the clinical efficacy of different fixation systems for the treatment of transverse patellar fractures / 中华创伤杂志(英文版)

PURPOSE@#This study was designed to compare the clinical efficacy of "8" and "0" wire fixation systems combined with double-head cannulated compression screws or Kirschner wires for the treatment of transverse patellar fractures.@*METHODS@#From September 2011 to September 2018, patients with closed transverse patellar fractures treated with a double-head compression screw or Kirschner wire were included and analyzed retrospectively. Patients with patellar fractures combined with distal femoral fractures, tibial plateau fracture or preoperative lower limb dysfunction were excluded. The patients treated with the "8" tension band wire fixation system and Kirschner wire were taken as Group A; those treated with the "0" fixation system and Kirschner wire were taken as Group B; those treated with the "8" fixation system and double-head cannulated compression screw were taken as group C; and those treated with the "0" fixation system and double-head cannulated compression screw were taken as group D. Six weeks and one year after the operation and every month from the third month after the operation until the fractures healed, an X-ray examination was performed to identify fracture healing. The time of fracture healing and postoperative complications of the four groups were compared. One year after the operation, knee function was evaluated by Bostman's score.@*RESULTS@#During the study period, 168 patients with patellar fractures were treated by operations, and 88 patients were excluded because the fracture type did not meet the requirements or because there were combined fractures of the distal femur or tibial plateau. As a result, 80 patients were included in this study, 20 in each group. All the patients were followed up for an average period of 12.2 months. Compared with Group A, patients in Group D presented less postoperative discomfort in the prepatellar region, quicker fracture healing, less fixation failure and better postoperative knee function scores (all p 0.05).@*CONCLUSION@#The "0" wire fixation system combined with a double-head cannulated compression screw seems to be more beneficial than the other three fixation systems for the treatment of transverse patellar fractures.

Biomechanical analysis of computer assisted-two Cannulated screw fixation for treating femoral neck fracture / 中国组织工程研究

BACKGROUND: There are two kinds of cannulated screws (single- and double-headed) In clinic. Common single-headed cannulated compression screw is easy to cause shortened femoral neck, and screw dropping occurs usually when osteoporosis; thereafter, choosing single- or two-headed cannulated compression screw in the treatment of femoral neck fracture remains controversial. OBJECTIVE: To investigate the biomechanical effects of two double-headed and ordinary (single-headed) cannulated compression screws and different spatial configurations in the treatment of femoral neck fractures by finite element analysis. METHODS: The original DICOM data were obtained by collecting a thin layer CT scan of the proximal femur of a healthy adult volunteer (male, 30 years old). The proximal femoral model was established in MIMICS10.01 software. The model was imported into the UG 8.0 software to establish the femur neck fracture model (Pauwels angle 60°). A three-dimensional model of double-headed and ordinary cannulated compression screw was obtained by three-dimensional scanning modeling. In the UG 8.0 software, the femoral neck fracture assembly modeling was performed according to the horizontal and vertical distribution of two screws. The established model was introduced into the ANSYS 14.5 software to calculate the opening angle of the femoral neck fracture, the relative displacement of the fracture end and the stress distribution. RESULTS AND CONCLUSION: (1) In terms of biomechanical stability: The opening angle and displacement of the fracture end in the two screws in the horizontal position group were smaller than those in the vertical position group. The opening angle and displacement of the double-headed cannulated compression screw group were smaller than those in the ordinary cannulated compression screw. (2) Stress distribution: The stress distribution of the two screws was different. The stress distribution on the screw in the double-headed group was more dispersed than that in the ordinary group, and some stress was transmitted to the tail of the screw. In the ordinary group, the stress on the screw was mainly concentrated on the fracture end. There was also a difference in the stress distribution between horizontal and vertical position groups. When the two screws were horizontally fixed, the stress distribution on the front screw was more concentrated, while the vertical position was mainly concentrated on the upper one. (3) These results imply that the double-headed cannulated compression screw is more stable and reliable than the ordinary cannulated compression screw in the treatment of femoral neck fracture. The horizontal fixation of the two screws has better biomechanical stability than the vertical fixation. Therefore, the clinical application of double-head compression screws can be used to treat femoral neck fractures. When two screws are selected, horizontal fixation should be used.

A Comparative Study of Tensile Strength of Three Operative Fixation Techniques for Metacarpal Shaft Fractures in Adults: A Cadaver Study

BACKGROUND: We sought to estimate the ultimate tensile strength after metacarpal shaft fracture repair in adults using three operative fixation methods: plate fixation, Kirschner wire (K-wire) fixation, and intramedullary headless compression screw fixation. We also compared the advantages and disadvantages of each operative technique. METHODS: We acquired 30 metacarpal bones from four Korean adult cadavers without trauma, operative history, or deformities. The 30 metacarpal bones were divided into ten groups consisting of three metacarpal bones each with matching sizes and lengths. They were fractured, reduced, and fixed with plate and screws, K-wires, or headless compression screws. We performed force testing, collected ultimate tensile strength data, and created a stress-strain graph. RESULTS: The ultimate tensile strength of ten groups according to the fixation method was as follows: late and screw fixation, 246.1 N (range, 175.3 to 452.4 N); K-wire fixation, 134.6 N (62.7 to 175.0 N); and intramedullary headless compression screw fixation, 181.2 N (119.2 to 211.7 N). The median tensile strength of each fixation method was significantly different. In addition, the post-hoc test showed significant difference between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation. CONCLUSIONS: The tensile strength median values decreased in the following order showing significant differences among the fixation methods: plate and screw fixation, headless compression screw fixation, K-wire fixation. Significant differences were also observed between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation.

Biomechanical study of tibial avulsion fracture of anterior cruciate ligament with double-headed cannulated compression screw / 中国内镜杂志

Objective To investigate the biomechanical effects of double-headed cannulated compression screws for tibial avulsion fracture of anterior cruciate ligament and the possibility of reducing the risk of intercondylar fossa impingement. Methods Porcine knee joints (30 cases) were taken as experimental samples. Referring to the Meyers classification, it is made into type III fracture. According to the random number table method, they were divided into group A (double-headed cannulated compression screw), group B (cannulated compression screw) and group C (suture), with 10 samples in each group. By detecting the initial displacement and the failure load (peak load and yield load), the nut embedded in the bone block and the failure type were observed to investigate the biomechanical characteristics of the double headed cannulated screw fixation of the fracture. Results The peak load (443.10 ± 8.54) N of group A was not significantly different from that of group C (457.00 ± 26.53) N (P > 0.05), but significantly higher than that of group B (361.70 ± 18.76) N (P < 0.05). The yield load of group A is obviously larger than that of group B (P < 0.05), but it is obviously smaller than the yield load of group C (P < 0.05). The initial displacement of the group A (1.38 ± 0.14) mm was shorter than that of group B and C (1.94 ± 0.12) mm, (3.98 ± 0.19) mm (P < 0.05). The nuts of group A were embedded in the fracture block, and the nuts of group B obviously protruded from the ACL. Conclusions The early biomechanical strength of the anterior cruciate ligament tibial avulsion fracture was significantly better than that of cannulated compression screw and suture, and compared with the cannulated ompression screw, it is difficult to cause intercondylar fossa impingement.

Effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions / 中国修复重建外科杂志

Objective: To investigate the effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions. Methods: Between January 2012 and December 2016, 36 patients (36 feet) with ankle diseases underwent tibio-talo-calcaneal arthrodesis with parallel double thread headless compression screws via minimal anterior and lateral oblique incisions. There were 14 males and 22 females with an average age of 53.8 years (range, 18-76 years). There were 19 cases of left feet and 17 cases of right feet. There were 21 cases of talar necrosis, 7 cases of post-traumatic arthritis, 3 cases of rheumatoid arthritis, 2 cases of tuberculosis infection (inactive), 1 case of talar absence, 1 case of Charcot’s disease, and 1 case of pigmented villonodular synovitis of ankle and subtalar joints. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 53.7±2.5 and 5.9±0.2, respectively. The operation time was recorded and the wound healing and complications were observed. The bone healing was assessed by X-ray film and CT scanning. The function and pain of joint were evaluated by AOFAS and VAS scores. Results: The mean operation time was 49.8 minutes (range, 33-82 minutes). Incision infection occurred in 1 patient (2.8%) at 3 weeks after operation, and recovered after debridement. The other incisions healed by first intention without complications. Thirty-five patients were followed up with an average of 18.5 months (range, 12-29 months). Imaging examination showed fusion of the ankle and subtalar joints with an average fusion time of 10.9 weeks (range, 8-15 weeks). After 1 year, the AOFAS score (84.7±0.6) and VAS score (0.3±0.1) were significantly higher than preoperative scores ( t=12.596, P=0.000; t=30.393, P=0.000). Conclusion: It is an effective surgical method of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions for end-stage ankle disease because of the less complications incidence and the higher postoperative fusion rate.

Avulsion Fracture of the Posterior Cruciate Ligament from Femoral Insertion Occurred in a Patient with Residual Poliomyelitis: A Case Report

Avulsion fracture of the posterior cruciate ligament from its femoral insertion is quite rare, particularly in adults, and the treatment guidelines have not been established. A 68-year-old female patient with residual poliomyelitis presented with an avulsion fracture of the femoral insertion of the posterior cruciate ligament after a falling accident and was treated with arthroscopic headless compression screw fixation and pull-out suture of the avulsed ligament. We report this case with a relevant discussion of this type of injury.

Pediatric Cartilaginous Tibia Eminence Fracture Overlooked on Plain Radiograph: A Report of Two Cases

In children with open physis, avulsion fracture of the tibia eminence, as an anterior cruciate ligament (ACL) injury, is more commonly observed than an ACL rupture. Pure cartilaginous avulsions of the ACL tibia insertion seldom occurs. In such case, cartilaginous lesion is frequently overlooked or misdiagnosed on plain radiograph and may result in a less favorable treatment outcome. We report two cases of cartilaginous tibia eminence fractures of the children that were initially overlooked from plain radiographs, and then diagnosed by magnetic resonance imaging, which was ultimately treated by arthroscopyassisted headless compression screw fixation.

Pediatric Cartilaginous Tibia Eminence Fracture Overlooked on Plain Radiograph: A Report of Two Cases

In children with open physis, avulsion fracture of the tibia eminence, as an anterior cruciate ligament (ACL) injury, is more commonly observed than an ACL rupture. Pure cartilaginous avulsions of the ACL tibia insertion seldom occurs. In such case, cartilaginous lesion is frequently overlooked or misdiagnosed on plain radiograph and may result in a less favorable treatment outcome. We report two cases of cartilaginous tibia eminence fractures of the children that were initially overlooked from plain radiographs, and then diagnosed by magnetic resonance imaging, which was ultimately treated by arthroscopyassisted headless compression screw fixation.

The Short Term Outcome of Surgical Treatment for the Fifth Metatarsal Base Fracture Using a Headless Cannulated Compression Screw / 대한족부족관절학회지

PURPOSE: This study aimed to evaluate the outcomes, including the complications, of open reduction and internal fixation using a headless cannulated compression screw for a fifth metatarsal base fracture. MATERIALS AND METHODS: We retrospectively investigated 11 patients with 5th metatarsal base fracture who were treated with a headless cannulated compression screw. The mean follow-up period was 13 months (8~15 months), and the mean age was 46.5 years (21~70 years). We analyzed the patients' sex, age, time to union, amount of fracture displacement, and complications. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score was used for clinical assessment. RESULTS: The average amount of displacement decreased significantly from 3.4 mm (2.1~5.2 mm), preoperatively, to 0.4 mm (0~1.3 mm), postoperatively (p<0.001). The average bone union time was 54.1 days (41~68 days). There were no complications, such as a metal failure, irritation, and loss of a reduction. The mean AOFAS midfoot score was 97.7 (90~100) at 6 months, postoperatively. CONCLUSION: We suggest that a headless cannulated compression screw for 5th metatarsal base fracture is a useful and alternative method for a firm fixation without complications.

Non-Structural Cancellous Bone Graft and Headless Compression Screw Fixation for Treatment of Scaphoid Waist Nonunion

PURPOSE: The authors performed an autologous cancellous bone graft from the iliac crest and headless compression screw fixation for the treatment of Mack-Lichtman type II scaphoid waist nonunion. The purpose of this study was to determine whether this procedure was effective in achieving bony union and restoration of alignment. METHODS: We retrospectively reviewed medical records and radiographs of 30 patients who underwent a cancellous bone graft and headless compression screw fixation for scaphoid waist nonunion. There 28 men and 2 women with a mean age of 32.8 year-old (range, 21–63 year-old). The mean time to surgery from initial injury was 10 months (range, 3–25 months) and the average follow-up duration was 37.5 months (range, 15–52 months). The authors analyzed bony union, lateral intrascaphoid angle (LISA), scapholunate angle (SLA), radiolunate angle (RLA), and scaphoid length in radiographs and evaluated the modified Mayo wrist score (MMWS) as a functional outcome. RESULTS: Bony union was achieved in all cases. In lateral plain X-ray, preoperative anatomic alignment including LISA, SLA, RLA, and scaphoid length was recovered at immediate postoperative measurement. Those alignment restoration was likely to maintain in final follow-up in despite of statistical difference. The wrist motion and the MMWS improved significantly at the last follow-up. CONCLUSION: A non-structural autologous cancellous bone graft from the iliac crest and headless screw fixation provided reliable results and can be one of the effective treatment options for patients with symptomatic Mack-Lichtman type II nonunion in the middle one-third of the scaphoid.

Meta-analysis of quadratus femoris muscle pedicle bone flap transplantation in the repair of femoral neck fracture for young and middle-aged patients / 中华显微外科杂志

Objective To compare the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation versus hollow compression screw fixation in the repair of femoral neck fracture for young and middle-aged patients.Methods Case-controll studies comaring the quadratus femoris muscle pedicle bone flap transplantation with hollow compression screw fixation in the repair of femoral neck fracture were retrieved from CNKI,Chinese Biomedical Database,Wanfang Data and manually (from January,2005 to December,2014).Methodological quality of the trials was critically assessed,and relevant data were extracted.Statidtical software Revman 5.0 was used for data-analysis.Results Eight articles were included in the meta-analysis.The results showed that,compared the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation with hollow compression screw fixation,there were statidtical significance in the rate of fracture healing [OR =5.43,95％CI(2.89,10.20),P ＜ 0.05],the rate of good function of hip joint [OR =5.12,95％ CI(3.21,8.17),P ＜ 0.05],the rate of femoral head necrosis [OR =4.21,95％CI(2.02,8.76),P ＜ 0.05],the time of fracture healing [WMD =-46.85,95％CI(-65.13,-28.56),P ＜ 0.05].Conclusion The transplantation of quadratus femoris muscle pedicle bone flap combined with hollow compression screw fixation is superior to the hollow compression screw fixation in the repair of femoral neck fracture for young and middle-aged patients in regards to the rate of fracture healing,the rate of good function of hip joint,the rate of femoral head necrosis,the time of fracture healing.

PROSPECTIVE RANDOMIZED CONTROLLED STUDY ON TREATMENT OF DISPLACED FEMORAL NECK FRACTURES WITH PERCUTANEOUS COMPRESSION PLATE / 中国修复重建外科杂志

OBJECTIVE: To compare the effectiveness of percutaneous compression plate (PCCP) and hollow compression screw in the treatment of displaced femoral neck fractures.

Treatment of transverse fracture of patella with headless compression screw under arthroscope / 重庆医学

Objective To observe the clinical effect of headless compression Screw (HCS)under arthroscope in the treat-ment of patella fracture.Methods Nineteen patients of patella transverse fractures were selected,all of them were treated with HCS fixation under arthroscope,reviewed and followed-up after surgery.Results X-ray examination after surgery of 3 -5 weeks found that the fracture lines blurred or disappeared,and the patella articular surface was smooth without displacement.The healing time of fracture was 8 weeks on average after operation;There was no statistical difference in the range of the knee joint in the af-fected side in (135.42±5.82)°and the contralateral side in (139.38±6.55)°(P >0.05);The knee Lysholm score of the last follow-up was 86-100 points[(93.7±4.14)points],which was significantly higher than the preoperative score of 65.7 (P <0.05);There was no fracture displacement in the period of followed-up,drop of internal fixator,fracture and other complications.Conclusion HCS fixation under arthroscope in treatment of patella fracture is effective.The joint function recovered quickly with less complica-tion.It could be one of the effective methods for the treatment of patella transverse fracture.

Scaphoid Nonunions Treated with 1, 2-Intercompartment Supraretinacular Artery Pedicled Vascularized Bone Graft and Headless Compression Screw Fixation

PURPOSE: The purpose of this study was to evaluate the clinical results of scaphoid nonunions treated with 1, 2-intercompartment supraretinacular artery (ICSRA) pedicled vascularized bone grafting (VBG) and headless compression screw fixation. METHODS: Since August 1, 2005, 11 scaphoid nonunions with avascular necrosis or bone marrow edema of proximal fragments were managed with 1, 2-ICSRA pedicled VBG combined with headless compression screw fixation. The mean age was 37.1 years (range, 21-66 years). 8 patients had avascular necrosis (AVN) of proximal fragments and 3 patients had bone marrow edema in proximal fragments. Serial radiographic evaluations were performed in every 4-8 weeks for bone union and follow up computed tomography scanning were checked in 8 patients. RESULTS: Bone unions were obtained in all 11 patients at 4.9 months (range, 3-9 months) after operation. At last follow up, the average range of motion was 82.5% and the grip power was 84.1% compared to the contralateral side. The mean New York Orthopaedic Hospital wrist score at last follow up was 83.2 (range, 58.1-93.3). CONCLUSION: Combined 1, 2-ICSRA pedicled VBG and headless compression screw fixation were reliable methods for managements of scaphoid nonunions even with AVN at proximal fragments.

The Distal Metatarsal Dorsal-Wedge Osteotomy Using Bio-Compression Screw for Advanced Hallux Rigidus / 대한족부족관절학회지

PURPOSE: This study was performed retrospectively to evaluate clinical outcomes of distal metatarsal osteotomy using bio-compression screw as the joint preservation method for advanced hallux rigidus. MATERIALS AND METHODS: Eleven cases were followed up for more than 1 year after distal metatarsal dorsal wedge osteotomy for advanced hallux rigidus. The clinical evaluation was performed according to the American Orthopaedic Foot and Ankle Society (AOFAS) score and patient's satisfaction score. The range of motion, and the period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were evaluated. As the radiographic evaluation, the interval of 1st MTP (metatarsophalangeal) joint space and the period to union were measured. RESULTS: The AOFAS hallux score had improved significantly from preoperative average 50.7 points to 87.6 points at the last follow-up (p=0.005). The subjective satisfaction score was average 90.6 points. There were no case of subsequent fusion or additional operation, and no complication associated with bio-compression screw. The period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were average of 24.8 weeks, 20.4 weeks, 16.8 weeks, 18.5 weeks respectively. Dorsiflexion of 1st MTP joint had improved significantly from preoperative average 17.5degrees to 44degrees (p<0.001). All cases achieved union of osteotomy site, and the period to union was average 10.4 weeks. The interval of 1st MTP joint space had improved significantly from preoperative average 1.2 mm to 3.5 mm (p=0.014). CONCLUSION: Distal metatarsal osteotomy using bio-compression screw seems to be one of effective treatment methods for advanced hallux rigidus, because of restoration of the first MTP joint motion, and reliable pain relief, and needlessness of hardware removal.