Efficacy of micro steel plate and Kirschner needle oblique and transverse internal fixation of adjacent metacarpal bone in the treatment of metacarpal diaphyseal oblique fracture / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of micro steel plate and Kirschner needle oblique and transverse internal fixation of adjacent metacarpal bone in the treatment of metacarpal diaphyseal oblique fracture.@*METHODS@#Fifty-nine patients with metacarpal diaphyseal oblique fractures admitted between January 2018 and September 2021 were selected as the study subjects and divided into the observation group (29 cases) and the control group (30 cases) based on different internal fixation methods. The observation group was treated with Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones, while the control group was treated with micro steel plate internal fixation. Postoperative complications, operation time, incision length, fracture healing time, treatment cost, and metacarpophalangeal function were compared between the two groups.@*RESULTS@#No incision or Kirschner wire infections occurred in the 59 patients, except for one in the observation group. No fixation loosening, rupture, or loss of fracture reduction occurred in any of the patients. The operation time and incision length in the observation group were (20.5±4.2) min and (1.6±0.2) cm, respectively, which were significantly shorter than those in the control group (30.8±5.6) min and (4.3±0.8) cm (P<0.05). The treatment cost and fracture healing time in the observation group were (3 804.5±300.8) yuan and (7.2±1.1) weeks, respectively, which were significantly lower than those in the control group (9 906.9±860.6) yuan and (9.3±1.7) weeks (P<0.05). The excellent and good rate of metacarpophalangeal joint function in the observation group was significantly higher than that in the control group at 1, 2, and 3 months after operation (P<0.05), but there was no significant difference between the two groups at 6 months after operation (P>0.05).@*CONCLUSION@#Micro steel plate internal fixation and Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones are both viable surgical methods for treating metacarpal diaphyseal oblique fractures. However, the latter has the advantages of causing less surgical trauma, shorter operation time, better fracture healing, lower cost of fixation materials, and no need for secondary incision and removal of internal fixation.

Distal Humeral Shaft Fracture with Simultaneous Ipsilateral Supracondylar Humeral Fracture in a Child: A Case Report

@#In children, simultaneous ipsilateral fracture of the distal shaft humerus and supracondylar humerus is rare. To the best of our knowledge, there are no available data on supracondylar humeral fracture (SCHF) combined with ipsilateral distal humeral shaft fracture. This report aimed to discuss a novel case with an appropriate management scheme. We present a case of a 5-year-old boy with ipsilateral distal shaft humerus fracture and SCHF. He underwent closed reduction and antegrade elastic stable intramedullary nail (ESIN) fixation with good clinical outcome. These injuries affect a child’s bony growth, and careful treatment is warranted. Upper extremity fractures could present in different combinations. The ESIN procedure with antegrade technique facilitated reduction and fixation of the fracture by prevention of iatrogenic ulnar nerve injury or pin-tract infection. Moreover, it allowed performance of early range of motion exercises.

Percutaneous Iliosacral Screw Fixation with Cement Augmentation in Osteoporotic Sacral Fracture

PURPOSE: The prevalence of osteoporotic sacral fractures is increasing. Traditionally, conservative treatment is the 1st option, but it can increase the risk of comorbidity in the elderly. To reduce the complications and allow early mobility, iliosacral screw fixation with cement augmentation will be one of the treatment options for patients with osteoporotic sacral fractures. MATERIALS AND METHODS: This study reviewed 25 patients (30 cases) who had undergone percutaneous iliosacral screw fixation with cement augmentation for osteoporotic sacral fractures from July 2012 to December 2018 with a minimum follow up of six months. The clinical outcomes were assessed using the measures of pain (visual analogue scale [VAS] score), hospital stay and the date when weight-bearing started. All patients were evaluated radiologically for pull-out of screw, bone-union, and cement-leakage. RESULTS: Bone union was achieved in 30 cases (100%). The mean duration of the hospital stay was 24 days (4–66 days); weight-bearing was performed on an average nine days after surgery. The VAS scores immediately (3.16) and three months after surgery (2.63) were lower than that of the preoperative VAS score (8.3) (p<0.05). No cases of cement-leakage or neurologic symptoms were encountered. Two patients (6.7%) experienced a pulling-out of the screw, but bone-union was accomplished without any additional procedures. CONCLUSION: Percutaneous iliosacral fixation with cement augmentation will be an appropriate and safe surgical option for osteoporotic sacral fractures in the elderly in terms of early weight-bearing, pain reduction, and bone-union.

Supination-external rotation ankle fractures: analysis of clinical results after syndesmotic screw removal / Fraturas do tipo supinação-rotação externa: análise dos resultados clínicos da retirada do parafuso transindesmoidal

ABSTRACT OBJECTIVE: To evaluate the postoperative results of patients with supination-external rotation ankle fractures who underwent syndesmotic screw (SS) removal. METHODS: Retrospective cohort study assessing the late postoperative results of 35 patients operated from January 2013 to June 2015. Patients undergoing treatment of rupture of the distal tibiofibular syndesmosis with SS fixation and who did not have any concomitant surgical injuries in sites other than the ankle were included. Patients who did not complete appropriate follow-up after surgery were excluded from the study. RESULTS: There was no statistical significant difference in the evaluated outcomes among the patients who had their SS removed and those who remained with the SS. CONCLUSION: SS removal did not significantly alter the clinical results of patients surgically treated with SS for supination-external rotation fractures.

RESUMO OBJETIVO: Avaliar o resultado pós-operatório dos pacientes com fratura do tornozelo pelo mecanismo de supinação-rotação externa que foram submetidos a retirada do parafuso transindesmoidal (PT). MÉTODOS: Estudo de coorte retrospectivo que avaliou os resultados pós-operatórios tardios de 35 pacientes operados entre janeiro de 2013 e junho de 2015. Foram incluídos pacientes submetidos ao tratamento da ruptura da sindesmose tibiofibular distal com fixação com PT e que não apresentavam lesões cirúrgicas concomitantes em outros sítios que não o tornozelo. Pacientes que não foram devidamente acompanhados no pós-operatório foram excluídos. RESULTADOS: Não houve diferença estatisticamente significativa nos desfechos avaliados entre os pacientes que tiveram o PT removido e os que permaneceram com o PT. CONCLUSÃO: A retirada do PT não alterou significativamente o resultado clínico dos pacientes tratados cirurgicamente com PT por fraturas do tipo supinação-rotação externa.

What is the best fixation technique for the treatment of supracondylar humerus fractures in children? / Qual a melhor técnica para fixação no tratamento de fratura supracondilar do úmero em crianças?

ABSTRACT OBJECTIVE: To define the best technique for the surgical treatment of supracondylar fracture of the humerus (SFH) in children, evaluating percutaneous pinning with side wires vs. cross-pinning. METHODS: Randomized controlled trials using the Medline, CAPES, and BIREME. The criteria for inclusion of articles criteria were: (1) randomized controlled trials (RCTs) comparing percutaneous wire fixation techniques, (2) SFH Gartland II B, III, and IV, and (3) children aged 1-14 years. The following were used as main variables: incidence of iatrogenic injury to the ulnar nerve and loss reduction. RESULTS: Eight studies were selected (521 patients) comparing surgical treatment with pinning in supracondylar fracture of the humerus in children Gartland II type B, III or IV. Iatrogenic injury to the ulnar nerve was greater with the cross-pinning technique, with RR 0.28 and p= 0.03, while the mini-open technique presented RR 0.14 and p= 0.2. A statistically significant greater loss of reduction in the lateral pinning was observed in FSU Gartland III and IV(p= 0.04). CONCLUSION: Based upon this meta-analysis of prospective randomized clinical trials, the following is recommended: (1) percutaneous pinning with lateral wires in supracondylar fractures of the humerus in children classified as Gartland II type B; (2) use of crossed wires for Gartland type III or IV, using the mini-open technique for the medial wire.

RESUMO OBJETIVO: Definir a melhor técnica para o tratamento cirúrgico da fratura supracondilar do úmero (FSU) nas crianças e avaliar a pinagem percutânea com fios laterais vs. cruzados. MÉTODOS: Revisão de ensaios clínicos randomizados nas bases de dados Medline, Capes, Bireme. Os critérios de inclusão dos artigos foram: (1) Ensaios clínicos randomizados que comparam técnicas de fixação percutânea com fios, (2) FSU Gartland II tipo B, III e IV e (3) Crianças com um a 14 anos. Usamos como principais variáveis: incidência de lesão iatrogênica do nervo ulnar e perda da redução. RESULTADOS: Foram selecionados oito estudos (521 pacientes) que comparam tratamento cirúrgico com pinagem em fratura supracondilar do úmero em crianças classificadas como Gartland II tipo B, III ou IV. A lesão iatrogênica do nervo ulnar foi maior com a técnica de pinagem cruzada, apresentou RR 0,28 e p = 0,03, enquanto que na técnica de mini-open encontraram-se RR 0,14 e p = 0,2. Em casos de FSU Gartland III e IV, evidenciou-se maior perda da redução na pinagem lateral, com significância estatística (p = 0,04). CONCLUSÃO: Embasado em nossa metanálise com ensaios clínicos randomizados prospectivos, recomendamos: (1) pinagem percutânea com fios laterais em fraturas supracondilar do úmero em crianças classificadas como Gartland II tipo B (2) Uso de fios cruzados para fraturas Gartland tipo III ou IV, com a técnica de mini-open para o fio medial.

Comparative study of olecranon osteotomy and bilateral triceps brachii approach for the treatment of type C3 distal humerus fracture / 新乡医学院学报

Objective To compare the clinical effect between olecranon osteotomy and bilateral triceps brachii approach combined with bilateral locking plate in the treatment of type C3 distal humerus fracture.Methods Forty-five patients with type C3 distal humerus fracture were performed with operation and follow-up in Department of Osteology of the First People's Hospital of Xinxiang City from July 2006 to February 2016.The patients were divided into olecranon osteotomy group (n =25) and bilateral triceps brachii approach group (n =20).The patients in olecranon osteotomy group were treated with olecranon osteotomy combined with bilateral locking plate,and the patients in bilateral triceps brachii approach group were treated with bilateral triceps brachii approach combined with bilateral locking plate.The incision length,operation time,hospitalization time,fracture healing time,postoperative complications and the score of elbow joint function were compared between the two groups.Results There was no significant difference in the mean follow-up time between the two groups (P ＞ 0.05).The incision length in olecranon osteotomy group was significantly shorter than that in bilateral triceps brachii approach group(P ＜ 0.05).There was no significant difference in the operation time,hospitalization time and fracture healing time between the two groups (P ＞ 0.05).There was one case of infection and two cases of heterotopic ossification in the olecranon osteotomy group,and the incidence of postoperative complications was 12.0％ (3/25).There was one case of heterotopic ossification,one case of fracture delayed union and one case of elbow joint stiffness in the bilateral triceps brachii approach group,and the incidence of postoperative complications was 15.0％ (3/20).There was no significant difference in the incidence of postoperative complications between the two groups (x2 =0.087,P ＞ 0.05).At the end of the follow-up,the excellent rate of the Mayo score of elbow joint function in the olecranon osteotomy group and bilateral triceps brachii approach group was 88.0％ (22/25) and 55.0％ (11/20) respectively,the excellent rate in the olecranon osteotomy group was significantly higher than that in the bilateral triceps brachii approach group (x2 =6.188,P ＜ 0.05).Conclusion Compared with the bilateral triceps brachii approach,the olecranon osteotomy combined with bilateral locking plate fixation is more beneficial to the recovery of elbow joint function in patients with type C3 distal humerus fracture.

Progress in application of magnesium alloys in the implanted medical devices / 国际生物医学工程杂志

Magnesium alloys have been a hotspot in the field of implanted medical devices due to their biodegradable absorbability, excellent mechanical properties and good biocompatibility.The reduction in their rapid corrosion rates becomes the key to the application of implant medical device materials.In this paper, the latest research progress and the existing problems of magnesium alloys as the material for implantation of medical devices in the fracture internal fixation, bone tissue porous scaffold, and cardiovascular stent are reviewed.Improving corrosion resistant of magnesium alloys by means of alloying, improving purity, surface modification,rapid solidification, deformation processing, non crystallization and preparation of nano alloy technology in body fluid are expounded, and research direction and application prospect of magnesium alloys in the field of implanted medical devices are also expected.

The medium and long term effects of the quadratus femoris muscle pedicle bone graft with screw internal fixation for the treatment of femoral neck fractures in youth / 中华显微外科杂志

Objective To analysis the medium and long term effects of the quadratus femoris muscle pedicle bone graft with screw internal fixation for the treatment of femoral neck fractures in adults.Methods From March 2003 to December 2008,sixty-two patients with femoral neck fractures were operated.There were 50 males and 12 females,with an average age of 39 years (ranged from 16 to 62 years).Fifteen cases suffered from traffic accidents and 47 from falling injury.There were 8 cases which fracture site was infer-head in Garden type Ⅱ,twenty-nine cases in type Ⅲ and 25 cases in type Ⅳ.The average time were 12 hours (2-96 hours) from injured to hospital admission and 4 days (2-8 days) from injured to operation.Partial weight bearing started on 3 months postoperatively and full weight bearing on 6 months.The postoperative duration of follow up was 3 to 5 years in 39 cases.Healing of fractures and avascular necrosis of the femoral head were evaluated based on the X-ray results or MRI if necessary.The pain,function,deformity,range of motion were evaluated based on Harris joint function scores.Results Nonunion of fracture was noted in 2 cases during the follow-up period.The fracture healing rate was 96.8％.The avascular necrosis of the femoral head was noted in 6 cases (15.4％).There were statistical significant differences between 3 months of postoperation and 3 years of postoperation in the pain,function,deformity,range of motion.After 3 years of postoperation,there were excellent in 29 cases,good in 6 cases,general in 1 case,poor in 3 cases according to Harris joint function scores.Conclusion This technique is relatively simple and has high rate of fracture healing.The avascular necrosis of the femoral head rate is low.The medium-and long-term results are satisfactory.

The experience in surgical treatment for serious pilon fractures / 中国综合临床

Objective To analyze the clinical methods of type Ⅲ Pilon fracture internal fixation. Methods The internal fixation with steel plate were performed in 36 cases with Ruedi-AllgoWer type, Ⅲ Pilon fracture and all patients had early post-operative rehabilitation functional exercise. Results Thirty-six cases were followed up for an average period of 16 months. The fracture healed completely in all cases and the successful rates of good function reached 88.9% (32/36) according to YU Guang-rong's evaluation standard. Conclusion For Ruedi-AUgower type Ⅲ Pilon fracture, appropriate surgical time combined with internal fixation with steel plate and early post-operative function exercise showed satisfactory therapeutic effect.

Anterior Stabilisation of Sacroilliac Joint for Complex Pelvic Injuries

Sacroilliac joint diasthesis from high energy trauma is always complicated with chronic pain and long term morbidity. Open anterior stabilisation with plate allow direct reduction and stabilisation with biomechanically advantages. Here we report on four cases of pelvic injury with sacroiliac joint disruption treated with anterior plate stabilisation through a surgical approach similar to that used for anterior ring fractures.

Expandable Intramedullary Nail in Unreamed Treatment of 31 Patients with Proximate Tibia Fracture / 中国康复理论与实践

@#Objective To evaluate clinical effect of expandable intramedullary nail in unreamed treatment of tibia fracture.Methods 31 patients with proximate tibia fracture were treated with expandable intramedullary nail and unreamed.Among those patients,4 cases were compound fracture,27 cases were closed fracture;16 cases were AO/ASIF type A,4 cases were type B and 11 cases were type C.The following-up of 9 months to 5 years(average 2 years) performed after operation.Results The fractures of 30 patients healed up and patients' functions recovered.1 case with comminuted and multiple fracture got delayed union.Conclusion Expandable intramedullary nail is an utility and satisfactory method to treat proximate tibia fracture.

Impact of endplate facture on prognosis of thoracolumbar fracture / 中国矫形外科杂志

[Objective]To investigate the impact of endplate facture on prognosis of thoracolumbar fracture.[Method]Seventy-three patients with thoracolumbar fractures were treated with transpedicular bone grafting combined with pedicle screw fixation system.Of them,thirty-four cases eligible for the study were divided into groups A and B.Group A:no endplate fracture or minor endplate fracture.Group B:bursting endplate fracture.The height of fractured vertebra and the Cobb angle before and after operation,and at the final follow-up were determined and analysed.[Result]There were no significant differences in Cobb angles and height between growps A and B before operation.After operation,the height of fractured vertebra in group B were lower than that of group A.The Cobb angles had no significant difference between the two groups.The height and Cobb angles between the two groups had significant difference at final follow-up.The improvement in group A was significant higher than in group B.[Conclusion]Endplate bursting facture affects the reduction of fractured vertebra and causes loss of the vertebral height and the corrected angle.

Therapeutic effect analysis of three internal fixation methods in the treatment of intertrochanteric femur fracture / 中国矫形外科杂志

[Objective] To discuss the therapeutic effect of different methods in the treatment of intertrochanteric femur fracture. [Methods]Totally 118 middle aged or old patients with intertrochanteric femur fracture were fixed with dynamic hip screw (DHS), Gamma nail or PFNA.[Results]Totally 112 cases were followed up, and the average time was 16 months, in those 45 patients were fixed with DHS: 29 were excellent, 11 cases were good, and 5 were poor, and the excellent to good rate was 88.9%; 36 patients were treated with Gamma nail, and the excellent, good, poor results were 28, 2, 1, respectively, and the excellent to good rate was 96.8%; 36 patients were fixed with PFNA, and the excellent, good, poor results were 29, 6, 1, respectively. The differences were significant (P=0.02, analyzed by Logistic regression with SPSS software). The excellent and good superiority of Gamma nail and PFNA were 5.1552 and 2.3726 times compared to DHS, and there was significant differences between the groups.[Conclusion]Surgical treatment of intertrochanteric femur fracture can improve the functional recovery and reduce the complication incidence, and PFNA fixing method can shorten the operative time, reduce the bleeding and the therapeutic effect is reliable, and suitable for old patients combined with osteoporosis.

A comparative study of dynamic hip screw and proximal femoral nail antirotation in treatment of femoral intertrochanteric fractures / 中国矫形外科杂志

[Objective]To compare the therapeutic effect on femoral intertrochanteric fractures with dynamic hip screw(DHS) and proximal femoral nail antirotation(PFNA).[Method]A retrospective study of 483 patients with femoral intertrochanteric fractures in Changhai Hospital from December 2001 to January 2008 were carried out.Totally 109 patients were treated with PFNA,while 374 patients were treated with DHS.The data of operative time,blood loss,walking time,union time and hip function scores were recorded.[Result]All the patients were followed up for 6～38 months(15.3 months in average).There were significant differences in operative time,blood loss and walking time between two groups.There were no significant difference in union time.There were no significant difference in the excellent rate between the two groups in stable femoral intertrochanteric fractures.The excellent rate of PFNA group was significantly higher than DHS group in unstable femoral intertrochanteric fractures.[Conclusion]Each of them have its own advantages and indications.Both are effective ways to treat stable femoral intertrochanteric fractures.PFNA has more advantages to treat unstable femoral intertrochanteric fractures.

Selectivity treatment of patellar fractures with Cable-Pin system / 中国矫形外科杂志

[Objective]To study the effects of Cable-Pin system used as a treatment alternative for patellar fractures.[Method]Thirty-five cases of patellar fracture were operated with the Cable-Pin system from October 2005 to May 2007.Their diagnosis were 19 transverse close ractures and 16 comminuted of patella.There were 21 males and 14 females.Their ages ranged from 21 to 75 years old.After open reduction,the author used a drill bit vertically through the patella in a superior direction,drilled the threaded portion of the pin across the fracture site,inserted a second Cable Pin through the second hole in a similar manner.A horizontally directed drill hole anterior to the pins was created in the superior pole of the patella.The two cables were crossed in a fighre eight over the an-terior surface of the patella.The Crimper Tensioning Handle was,the cable carefully,the handles of the crimper were squeezed until the crimp was fully crimped.[Result]The 35 patients were followed up for 12 to 18 months(mean 13.2 m).Fractures healed in all the cases without such complications as loosening of screw and cable loop,loss of reduction or irritation to soft tissue.Restoration of the knee joint motion was excellent in 32 cases and good in 3 cases according to Bostman score system.[Conclusion]Cable-Pin system as a new option for the treatment of patella fracture,can result in reliable fixation and low rate of complications.

Anatomical plate for the unstable pertrochanteric femoral fracture / 中国矫形外科杂志

[Objective]To analyze the clinical effect of the unstable pertrochanteric femoral fracture treated with anatomical plate.[Method]To prospectively compare anatomical plate with dynamic hip screw(DHS) in terms of treatment of the unstable pertrochanteric femoral fracture in elderly.Fifty-eight elderly patients with unstable pertrochanteric femoral fracture who were treated from June 2003 to May 2007 and followed up for 9-24 months were randomized into two treatment groups,ie,anatomical plate internal fixation(group I) and dynamic hip screw internal fixation(group II).Of all,32 patients were treated with anatomical plate internal fixation and 26 with DHS internal fixation.The treatment groups were comparable with regard to all demographic and injury variables.[Result]Patients treated with anatomical plate internal fixation had shorter operative times,fewer blood loss and blood transfusion,and higher Harris scores,there were significant differences in the two groups.The incidence rate of early postoperative complication was 9.38% in group I and 11.54% in group Ⅱ.The incidence rate of late postoperative complication was 9.38% in group Ⅰ and 30.78% in group Ⅱ.There were significant differences in late postoperative complication and no significant differences in early postoperative complication between the two groups.[Conclusion]The unstable pertrochanteric femoral fracture treated with anatomical plate could achieve excellent clinical results.

Treament of fractures of distal humerus with open reduction and anatomical plate internal fixation / 中国矫形外科杂志

[Objective]To investigate the treatment of fractuees of distal end of humerus with open reduction and internal fixation with anatomical plate.[Method]From February 2001 to April 2006,open reduction and anatomical plate internal fixation were performed in 22 cases with distal end of humerus fracture,of which olecranon osteotomy approach was carried out in 11 while musculus triceps brachii linguiform flap approach in other 11.All the patients received combined therapy including fumigation and rinsing with Chinese herbs,CPM(continuous passive motion) and manipulation.[Result]All the cases were followed up for 13 to 22 months.All the fractures got union.The postoperative elbow functions were excellent in 9 cases,good in 7 cases according to Mayo standards.The satisfactory rate was 72.71%.[Conclusion]Open reduction and internal fixation with anatomical plate can provide stable fixation and allow early postoperative elbow functional training in treatment of distal humerua fracture.Good clinical results can be achieved using fumigation and rinsing with Chinese herbs,CPM and manipulation after operation.

Study on clinical effect and interrelated questions of revolving self-lock nails and normal operative therapy for humerus shall fracture / 中国矫形外科杂志

[Objective]To summarize the clinical effect of revolving self-lock nails and normal operative therapy for humerus shaft fracture,and discuss the perfect treatment methods.[Method]We retrospectively analyzed and compared the outcome and complications of the the humerus shall fracture by normal operative therapy in 96 cases(compression plate 42 cases,monolateral fixator 26 cases,embracing fixator 28 cases);revolving self-lock nails 39 cases.[Result]The operative time,volume of blood loosing,the radial nerve injury,the infection rate and the breakage rate of the group treated with normal operative therapy were obviously more than the group treated with revolving self-lock nails,and the satisfactory rate after operation of the group treated with normal operative therapy was less than the group treated with revolving self-lock nails.[Conclusion]Revolving self-lock nails can avoid much shortcoming of transverse locking nails.The advances of revolving self-lock nails are convenient in operative procedure,with little invasive of operation,solid internal fixation and safety compared with the normal operative therapy.And revolving self-lock nails has two kind choices:anterograde transfixation and retrograde transfixafion,thus it can protect function of shoulder joint in some ways,so revolving self-lock nails is one of the idea choices to treat the fracture of shaft of humerus.In opposition,normal operative has much shortage and it is restricted by type of fractures.

Clinical analysis of locking plate for proximal humeral complicated fractures / 中国矫形外科杂志

[Objective]To discuss the treatment effect of locking compression plate(LCP)for proximal humeral complicated fractures.[Method]A retrospective study was done on 21 cases of proximal humeral fractures treated with LCP from April 2005 to June 2006.There were 13 male and 8 female,with age of 26-71 year(mean 42.3 year).According to Neer classification,15 cases were three-part fractures including 5 cases with anterior dislocation and 6 cases with primary osteoporosis;6 cases were four-part fractures including 3 cases with anterior dislocation and 2 cases with posterior dislocation.Reduction and fixation were done by deltopectoral-gap approach,the operator put the locking plate on 10mm positerior to the intergroove of tuberosity,5mm away from the tip of humeral greater tuberosity.If there were bone defects in the fracture site after reduction,they were treated with allografts,locking screws and unlocking screws were drilled into proximal and distal part of the fracture.Shoulder exercise should be performed passively three days after operation.One week after operation,active shoulder exercise was done,which was gradually intensified two weeks after operation.[Result]Twenty-one cases were followed up for 10-14 months,average 12.5 months,all fractures were union in 12 month.According to Neer shoulder score,the result was excellent in 11 cases,good in 7 and fair in 3,with excellent and good rate of 85%.[Conclusion]The screw of LCP can lock the plate so that the plate can firmly fixate the proximal humeral comminution fractures and osteoporosis bone,so simultaneously reach fracture union and function exercise,but attentions should be paid to the suitable procedure of LCP to avoid a series of problem of locking plate.

Percutaneous reduction combined with bone graft in the treatment of displaced intra-articular calcaneal fractures / 中国矫形外科杂志

[Objective]To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures.[Method]Percutaneous reduction and internal fixtion combined with bone graft was performed from April 2004 to April 2006 on 15 cases(16 sides) with intra-articular calcaneal fractures including 13 males (14 feet)and 2 females(2 feet),with average age of 36.6 years(24～61 years).All patients underwent radiography including lateral and axial views for calcaneus,oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification,there were 12 feet of type Ⅱ(three type Ⅱa,three type Ⅱb and eight type Ⅱc)and 2 feet of type Ⅲac. The length of caicaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures.Then bone graft was injected to fill the defect of calcaneus through lateral incision.[Result]All patients were followed up for an average of 18.4 months (ranged,12 to 34 months).No complication such as wound infection,screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society(AOFAS) hindfoot score. The rate of excellent and good clinical results was 100%. Radiography showed basic restoration of Bhler's angle,Gissane's angle and calcaneal shape.[Conclusion]The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders II and III type calcaneal fractures,with advantages of simple operation,fewer complications and good clinical results.