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BACKGROUND: Open reduction internal fixation and external fixation are two main surgical treatments for comminuted cuboid fractures. With the development of internal fixation devices, especially the appearance of mini-locking plate, the therapeutic effect of internal fixation has been improved. OBJECTIVE: To compare the clinical and imaging effects of mini-locking plate and external fixator in the treatment of comminuted cuboid fracture. METHODS: The data of 43 patients with comminuted cuboid fracture admitted to the Department of Orthopedics, Tianjin Port Hospital from January 2013 to March 2018 were retrospectively analyzed. According to different treatment methods, the patients were divided into two groups: 23 cases in the mini-locking plate group and 20 cases in the external fixator group. All patients signed the informed consent This study was approved by the Hospital Ethics Committee. The patients in both groups were confirmed as comminuted cuboid fracture by CT and three-dimensional reconstruction scan before operation. Bone graft support of allograft was performed during the operation, and the external fixator was removed within 3-4 months after operation. At the last follow-up, bilateral standing and anteroposterior and lateral X-ray examination was performed to compare the loss of height, length, width, lateral longitudinal arch angle, calcaneal fifth metatarsal angle, Maryland loot score, American Orthopedic Foot and Ankle Society Score and the incidence of complications between the two groups. RESULTS AND CONCLUSION: (1) All patients were followed up for more than one year. (2) There were no significant differences in height loss of cuboid bone, width loss, last lateral longitudinal arch angle, and calcaneal fifth metatarsal angle between the two groups (P > 0.05). (3) There were significant differences in the loss of cuboid bone length, Maryland foot score and American Orthopedic Foot and Ankle Society Score and the incidence of complications between the two groups (P < 0.05). Mini-locking plate group was superior to the external fixator group in above indexes. (4) These findings indicated that mini-locking piate and external fixator are effective methods for the treatment of comminuted cuboid fracture. Micro-locking plate has more advantages in maintaining the length of cuboid bone, clinical function and reducing complications. With the prolongation of time, stable foot and good function can be achieved.
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Objective: To summarize the effectiveness of mini locking plate combined with Kirschner wire in treatment of comminuted Jones fracture. Methods: Between January 2011 and October 2016, 25 cases with comminuted Jones fracture were treated with mini locking plate combined with Kirschner wire. There were 9 males and 16 females with an average age of 31.4 years (range, 16-66 years). The fractures located on the left side in 11 cases and on the right side in 14 cases. The causes of injury included spraining in 21 cases, falling down in 3 cases, and bruise in 1 case. The bone fragment of all cases was more than 3 pieces. The fracture line was mostly Y-shape or T-shape. Twelve of them were combined with other fractures. The time from injury to operation was 1-9 days (mean, 5 days). The mini locking plate and Kirschner wire were removed at 9-12 months postoperatively. At 12 months postoperatively, the pain was evaluated by the visual analogue scale (VAS) score, and the function by the American Orthopaedic Foot & Ankle Society (AOFAS) score. Results: All incisions healed by first intention. All cases were followed up 12-36 months with an average of 21.7 months. Fracture union was observed in all patients without complications such as nonunion, delayed union, and malunion. The fracture union time was 8-12 weeks (mean, 9.4 weeks). At 12 months postoperatively, the VAS score was 1.15±0.87; the AOFAS score was 89.45±6.24, and the results were excellent in 14 cases, good in 9 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 92%. Conclusion: The procedure of mini locking plate combined with Kirschner wire for comminuted Jones fracture has such advantages as convenient operation, more rigid fixation, high rate of fracture healing, and good functional recovery in foot.
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Objective To investigate the clinical effects of mini-locking plate with vertical or parallel technology in the treatment of Dubberley type B capitellar fractures.Methods A case series study was done on clinical data of 17 cases of Dubberley type B capitellar fractures treated through operation with vertical or parallel mini-locking plate.There were 12 males and 5 females,with age range of 23-77 years (mean 56.4 years).The fractures were classified according to the Dubberley system,including type Ⅰ B in 2 cases,Ⅱ B in 6 and type Ⅱ B in 9.The operations were conducted through the Kocher approach at posterior-lateral rear elbow joint and the fractured bone was fixed firstly with Kirschner wire and mini screws after resetting and then with vertical or parallel mini locking plate.The surgery time and bleeding volume during the surgery were recorded.The position of fracture,healing,avascular necrosis of capitellum,heterotopic ossification,and traumatic arthritis were evaluated.At the final follow-up,the Mayo elbow performance score (MEPS) was used to evaluate the function of elbow,and flexion andextension of the elbow,swing of the forearm and inner stability of the elbow joint were evaluated.Results The surgery time was 50-90 minutes (mean 60 minutes).The bleeding volume during surgery was 40-120 ml (mean 60 ml).All patients were followed up for 12-24 months (mean 12.1 months).Anatomical reduction was seen in 12 cases and ahnost anatomical reduction in 5.None had vessel or nerve wound,and the wound was healed at phase Ⅰ within 10-12 days after operation.The clinical fracture healing time was 8-12 weeks (mean 11.4 weeks).At the final follow-up,the fractures were well healed without complications like fracture reduction loss,ischemic necrosis of the humerus,traumatic arthritis or heterotopic ossification of the elbow joint.MEPS in all cases was 60-100 points (mean 87.6 points).MEPS assessment result was excellent in 13 cases,good in 3 and fair in 1,with the excellent rate of 94％.At the final follow-up,the average activity of the elbow was 6 ° (0°-10°) for extension and 118 ° (90°-130°) for flexion,the average forearm pronation was 70° (60°-90°),the average forearm supination was 82° (70°-90°),and the inner stress test showed no instability.Conclusion Vertical or parallel mini-lockiug plate in the treatment of Dubberley type B capitellar fractures is associated with few complications,early functional exercise after operation,and satisfactory short-term outcome.
ABSTRACT
Objective To investigate the clinical effects of mini-locking plate with vertical or parallel technology in the treatment of Dubberley type B capitellar fractures.Methods A case series study was done on clinical data of 17 cases of Dubberley type B capitellar fractures treated through operation with vertical or parallel mini-locking plate.There were 12 males and 5 females,with age range of 23-77 years (mean 56.4 years).The fractures were classified according to the Dubberley system,including type Ⅰ B in 2 cases,Ⅱ B in 6 and type Ⅱ B in 9.The operations were conducted through the Kocher approach at posterior-lateral rear elbow joint and the fractured bone was fixed firstly with Kirschner wire and mini screws after resetting and then with vertical or parallel mini locking plate.The surgery time and bleeding volume during the surgery were recorded.The position of fracture,healing,avascular necrosis of capitellum,heterotopic ossification,and traumatic arthritis were evaluated.At the final follow-up,the Mayo elbow performance score (MEPS) was used to evaluate the function of elbow,and flexion andextension of the elbow,swing of the forearm and inner stability of the elbow joint were evaluated.Results The surgery time was 50-90 minutes (mean 60 minutes).The bleeding volume during surgery was 40-120 ml (mean 60 ml).All patients were followed up for 12-24 months (mean 12.1 months).Anatomical reduction was seen in 12 cases and ahnost anatomical reduction in 5.None had vessel or nerve wound,and the wound was healed at phase Ⅰ within 10-12 days after operation.The clinical fracture healing time was 8-12 weeks (mean 11.4 weeks).At the final follow-up,the fractures were well healed without complications like fracture reduction loss,ischemic necrosis of the humerus,traumatic arthritis or heterotopic ossification of the elbow joint.MEPS in all cases was 60-100 points (mean 87.6 points).MEPS assessment result was excellent in 13 cases,good in 3 and fair in 1,with the excellent rate of 94％.At the final follow-up,the average activity of the elbow was 6 ° (0°-10°) for extension and 118 ° (90°-130°) for flexion,the average forearm pronation was 70° (60°-90°),the average forearm supination was 82° (70°-90°),and the inner stress test showed no instability.Conclusion Vertical or parallel mini-lockiug plate in the treatment of Dubberley type B capitellar fractures is associated with few complications,early functional exercise after operation,and satisfactory short-term outcome.