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Objective:To explore the risk factors that may affect the stabilization of dorsal intra-articular fragment in distal radius fracture after volar internal fixation.Methods:A retrospective analysis was performed of the patients with distal radius fracture who had been treated by volar internal fixation at Department of Traumatic Orthopedics, Tongji Hospital Affiliated to Tongji University from July 2016 to July 2020. After 3D reconstruction of their preoperative CT scans by software Mimics 20.0, 66 patients with a dorsal intra-articular fragment were screened out. They were 31 males and 35 females, aged from 23 to 78 years (average, 53.4 years). By the AO classification, there were 17 case of type C1, 22 cases of type C2, and 27 cases of type C3. The displacement of dorsal intra-articular fragment was judged by X-ray observation on postoperative day 2 and X-ray follow-up at the outpatient department. The 13 patients with displacement of dorsal intra-articular fragment>2 mm were assigned into a displacement group while the other 53 ones into a displacement-free group. The 2 groups were compared in terms of preoperative general data and anatomical data of the dorsal intra-articular fragment (total preoperative displacement, radius-ulnar length, dorsal-volar length, aspect ratio, proximal-distal length and volume) to analyze the correlations between them and displacement.Results:There was no significant difference in preoperative general data (age, gender, affected side, cause of injury or AO classification) between the 2 groups, showing comparability between groups ( P>0.05). All patients were followed up for 6 to 24 months (mean, 14 months) after surgery. There were no postoperative complications like neurovascular lesion or infection. None of the patients in the displacement group underwent revision surgery, and the fractures healed successfully during the postoperative follow-up. The total preoperative displacement in the displacement group was(10.0±1.3) mm, significantly larger than that in the displacement-free group [(7.8±1.5) mm]; the radius-ulnar length in the displacement group was (8.2±1.3) mm, significantly shorter than that in the displacement-free group [(10.8±2.3) mm]; the aspect ratio of the fragment in the displacement group was 1.2±0.2, significantly lower than that in the displacement-free group (1.4±0.2); the fragment volume in the displacement group was (690.5± 201.4) mm 3, significantly smaller than that in the displacement-free group [(995.8±295.0) mm 3]. There were significant differences in the above items between the 2 groups ( P<0.05). Conclusion:The total preoperative displacement, radius-ulnar length, aspect ratio and volume of a dorsal intra-articular fragment are important factors which may affect the displacement of the dorsal fragment after volar internal fixation.
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Introduction: Distal radius is one of the common fracture sites of the human skeleton. Dorsally displaced distal radius fractures(DRFs) are the most common type of DRF.Materials and Methods: Two matched cohorts of 20 matched patients, one with a displaced dorsal rim fracture >2 mm (Group1), and the other without a dorsal rim fracture (Group 2) were analyzed in this study with volar variable angle locking compressionplate fixation for dorsally unstable DRFs.Results: No significant difference was found between the two groups in overall wrist function or wrist pain. The mean displacementof dorsal rims in Group 1 was 3.0 mm and the mean diameter of the retained articular portion of the dorsal articular wall was2.0 mm. No significant difference was found between the two groups in terms of any radiographic parameters or the arthriticgrading of radiocarpal joints.Conclusion: These results suggest that a displaced dorsal rim fracture does not adversely affect the outcomes after the volarvariable angle locking compression plate fixation of a dorsally displaced DRF, indicating that an additional dorsal approach isunnecessary for reducing a displaced dorsal rim fracture
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ABSTRACT Objective: To evaluate the late clinical and radiological results of patients had locking plate anatomically compatible from superior surface and muscle cover on plate due to clavicle mid-region. Materials and Methods: Forty patients were included retrospectively. Patients had a routine right shoulder anterior posterior graph after examination. The results were assessed by returning to the patient's daily activities, Constant score, the Disability of the Arm, and Shoulder and Hand scoring, followed by radiological and clinical examination. Results: Fourteen (35%) patients were female and 26 (65%) were male. The mean age was 36.2 years. Twenty-six patients had right clavicle fracture and 14 patients had left. Twenty-three fractures were type 2B1 and 17 fractures were type 2B2. Mean follow-up time was 36.4 months. Radiologic union was at a mean of 9.1 ± 1.3 weeks. All patients had excellent results. The mean Constant score was 97.2 ± 1.8, the mean Disability of the Arm, and Shoulder and Hand score was 3.8 ± 2.4. Conclusion: It is possible to obtain complete union with high patient satisfaction by avoiding the complications and difficulties of the conservative treatment with the use of the anatomically compatible locking plates in superior fixation and our surgical dissection. Level of Evidence III, Retrospective Case controlled study.
RESUMO Objetivo: Avaliar os resultados clínicos e radiológicos tardios dos pacientes com placa óssea de trava anatomicamente compatível com a superfície superior e a cobertura muscular na placa devido à região média da clavícula. Materiais e Métodos: Quarenta pacientes foram incluídos retrospectivamente. Os pacientes apresentaram um gráfico ântero-posterior de rotina do ombro direito após o exame. Os resultados foram avaliados retornando às atividades diárias do paciente, escore de Constant, incapacidade do braço e escores de ombro e mão, seguidos de exame clínico e radiológico. Resultados: Quatorze (35%) pacientes eram do sexo feminino e 26 (65%) do sexo masculino. A idade média foi de 36,2 anos. Vinte e seis pacientes tiveram fratura da clavícula direita e 14 pacientes saíram. Vinte e três fraturas foram do tipo 2B1 e 17 fraturas do tipo 2B2. O tempo médio de acompanhamento foi de 36,4 meses. A união radiológica foi em média de 9,1 ± 1,3 semanas. Todos os pacientes tiveram excelentes resultados. A pontuação média constante foi de 97,2 ± 1,8, a média de incapacidade do braço e a pontuação do ombro e da mão foi de 3,8 ± 2,4. Conclusão: É possível obter união completa com alta satisfação do paciente, evitando as complicações e dificuldades do tratamento conservador com o uso das placas ósseas de trava anatomicamente compatíveis na fixação superior e na nossa dissecção cirúrgica. Nível de evidência III, Estudo retrospectivo controlado por caso.
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Background: Fractures of clavicle represent approximately 3–12% of all fractures treated by orthopedic surgeons. There hasbeen a debate over the years for the best treatment of midshaft clavicle fractures. Our study is intended to find both conceptualand practical guidance for precision treatment with an expectant favorable functional result.Materials and Methods: Out of 50 patients of clavicle fractures, 25 were treated conservatively and 25 were treated operativelyby locking plate fixation. Outcomes were assessed using the disabilities of the arm, shoulder and hand (DASH) score forfunctional assessment.Results: Functional and anatomical outcomes were found to be better in patients treated operatively with better DASH scorescompared to patients treated with clavicle brace and sling.Conclusion: Surgical fixation of fracture clavicle gives better functional outcomes and shorter time for union with betteranatomical reduction than non-operative treatment. Hence, we recommend surgical fixation with a locking plate is the standardof treatment in these fractures.
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PURPOSE: The purpose of this study was to compare the clinical and radiological outcomes of locking compression plate (LCP)-screw fixation and tension band wiring (TBW) fixation in isolated lateral malleolar fractures.MATERIALS AND METHODS: From May 2016 to August 2018, 52 patients with isolated lateral malleolar fracture were retrospectively reviewed. They were divided into 30 cases of the LCP fixation group (Group I) and 22 cases of the TBW fixation group (Group II). The clinical and radiological results of those groups were compared. Pearson chi-square tests and independent t-tests were used in the statistical analysis.RESULTS: The mean length of the surgical incision was 8.3 cm in Group I and 4.9 cm in Group II. Radiological union was obtained at a mean of 8.4 weeks in both groups. The mean American Orthopaedic Foot and Ankle Society score was 90 (range, 85–97) and 92 (range, 85–100) in Groups I and II, respectively, at the last follow up.CONCLUSION: Both the LCP-screw and TBW techniques revealed excellent results in isolated lateral malleolar fractures. The tension band technique may be a fine alternative method of fixation in the treatment of isolated lateral malleolar fracture.
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Humans , Ankle , Ankle Fractures , Follow-Up Studies , Foot , Methods , Retrospective Studies , Surgical Procedures, OperativeABSTRACT
BACKGROUND: Generally, the treatment of distal radius fractures or joint dislocations is generally valued in clinical practice, but little attention is paid to the ulnar styloid fracture, and whether the ulnar styloid fracture needs to be fixed is controversial. In the study of orthopedic biomechanics, the selection of cadaver model may encounter some problems, such as different selection criteria of cadaver model and different mechanical measurement methods. OBJECTIVE: Based on Mimics software, the finite element simulation model of type Frykman VIII fracture of the distal radius fixed by plate and screw was constructed using finite element analysis. The working condition and load were set for mechanical analysis. It is hoped to provide a reference for the choice of the repair plan of this kind of fracture. METHODS: A three-dimensional finite element model of normal wrist joint was established based on the forearm and wrist CT images of a healthy volunteer. After debugging the model, Von Mises stress of the distal radius was obtained by loading the 100 N stress in the axial direction, and the validity of the model was verified by comparing with the experimental data in the literature. Two kinds of finite element models of Frykman VIII fracture with ulnar styloid type I and type II fractures were established by using finite element software to divide the mesh, cut and mold, and the model of plate and screw fixation of distal radius was assembled. Setting load under rotating working conditions, we analyzed the changes of the stress distribution of the steel plate unit in two models, and the relative displacement of the distal radioulnar joint as well as the ulnar styloid fracture broken end. RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of normal wrist joint was established and validated, and the other two models of type Frykman VIII fracture of the distal radius with ulnar styloid type I and type II fractures fixed by plate and screw were established based on this model. (2) Under the same rotating load, this study showed that the stress and stress distribution of the steel plate unit in the steel plate fixation model of Frykman VIII fracture of the distal radius combined with ulnar styloid type I fracture were smaller than those of the fracture model combined with type II fracture of styloid process of ulna; the relative displacement values of the distal radioulnar joint and the ulnar styloid fracture broken end were smaller than the latter too. (3) The three-dimensional finite element model of wrist joint constructed in this study can be used to analyze the mechanical mechanism of wrist fracture. The results of finite element analysis showed that the fracture of styloid process of ulna in Frykman VIII fracture of the distal radius would affect the stability of the distal radioulnar joint, especially in the case of ulnar styloid type II fracture, which can provide a certain clinical reference for the selection of operation scheme of such fracture.
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BACKGROUND: Through clinical research, we found that in the treatment of distal radius fracture combined with ulnar styloid process fracture, the proportion of complications of ulnar column after manual reduction and splint fixation was smaller than that of patients who only received open reduction and internal fixation of distal radius. We deemed that the wrist joint was treated as a whole in the treatment cycle, the splint as elastic fixation could provide the relative stability of the ulnar column and reconstruct the stability of the three columns of the wrist. OBJECTIVE: To explore the biomechanical mechanism of splint intervention on the ulnar column after type Frykman VIII fracture of the distal radius by finite element analysis. METHODS: A three-dimensional finite element model of normal wrist joint was established based on the forearm and wrist CT images of a healthy volunteer. Two kinds of finite element models of type Frykman VIII fracture of the distal radius with ulnar styloid type I and type II fractures were established by using finite element software to divide the mesh, cut and mold. On this basis, four wrist joint finite element models with splint fixation and steel plate fixation for type Frykman VIII fracture of the distal radius were established. Under axial compression, lateral extension, pronation and supination working conditions, stress distribution and relative displacement of the distal radioulnar joint, displacement and direction of the ulnar styloid fracture broken end were analyzed. RESULTS AND CONCLUSION: (1) The stress values of the ulnolunate ligament, ulnotriquetral ligament, and the palmar dorsal radioulnar ligament in the model of type Frykman VIII fracture of the distal radius with ulnar styloid type I fracture after splint intervention were lower than those in the model after plate intervention in the lateral tension, pronation and supination conditions. (2) In the pronation and supination conditions, the relative displacement values of the distal radioulnar joints in type Frykman VIII fracture of the distal radius models with ulnar styloid type I and type II fractures after splint intervention were smaller than those in the models after plate intervention. (3) In the lateral tension, pronation and supination conditions, the relative displacement values of the ulnar styloid fracture broken end in type Frykman VIII fracture of the distal radius models with ulnar styloid type I and type II fractures after splint intervention were smaller than those in the models after plate intervention. (4) The finite element study shows that distal radioulnar joint stability becomes worse after type Frykman VIII fracture of the distal radius, which is more obvious in the model with ulnar styloid type II fracture. In the treatment of this kind of fracture, compared with the simple internal fixation of distal radius fracture, the splint as elastic fixation takes the wrist joint as a whole in the treatment cycle and provides the relative stability of the ulnar column, thus further revealing the advantages of the splint elastic fixation.
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Objective: To observe the curative effects of artificial femoral head replacement using sternal wire binding and plate fixation in the treatment of the patients with unstable intertrochanteric fracture, and to provide the basis for its treatment. Methods: A total of 52 elderly patients with intertrochanteric fracture treated with artificial femoral head replacement were divided into sternal wire binding group (the patients were given sternal wire binding of greater trochanter, n=28) and plate fixation group (the patients were given plate fixation of greater trochanter, n=24). The operation time, blood loss, the drainage volumes after operation, the time of getting off the bed first, the incidences of early complications, and the Harris scores of hip joint at the discharge time and 1 month, 3 months, 6 months and 12 months after operation of the patients in two groups were recorded. Results: Compared with plate fixation group, the operation time of the patients in sternal wire binding group was decreased (P0. 05). Conclusion: Compared with plate fixation, sternal wire binding of the greater trochanter in femoral head replacement in the treatment of the patients with unstable intertrochanteric fracture has the advantages of shorter operative time, less blood loss volume, better postoperative recovery of hip joint function, which is suitable for the clinical application.
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STUDY DESIGN: A retrospective cohort study. PURPOSE: To compare the clinical and radiological outcomes of patients who underwent anterior cervical discectomy and fusion (ACDF) supplemented with plate fixation using allograft with those who underwent ACDF using tricortical iliac autograft. OVERVIEW OF LITERATURE: As plate fixation is becoming popular, it is reported that ACDF using allograft may have similar outcomes compared with ACDF using autograft. METHODS: Forty-one patients who underwent ACDF supplemented with plate fixation were included in this study. We evaluated 24 patients who used cortical ring allograft filled with demineralized bone matrix (DBM) (group A) and 17 patients who used tricortical iliac autograft (group B). In radiological evaluations, fusion rate, subsidence of grafted material, cervical lordosis, fused segmental lordosis, and radiological adjacent segment degeneration (ASD) were observed and analyzed with preoperative and postoperative plain radiographs. Clinical outcomes were evaluated using the Neck Disability Index score, Odom criteria, and Visual Analog Scale score of neck and upper extremity pain. Radiological union was determined by dynamic radiographs using cutoff values of 1 mm of interspinous motion as the indication of pseudarthrosis. RESULTS: There was no significant difference in the fusion rate, graft subsidence, cervical lordosis, fused segmental lordosis, and ASD incidence between the groups. Operative time was shorter in group A (136 min) than in group B (141 min), but it was not significant (p>0.05). Blood loss was greater in group B (325 mL) than in group A (210 mL, p=0.013). There was no difference in the clinical outcomes before and after surgery. CONCLUSIONS: In ACDF with plate fixation, cortical ring allograft filled with DBM group showed similar radiological and clinical outcomes compared with those of the autograft group. If the metal plate is reinforced, using cortical ring allograft could be a viable alternative to autograft.
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Animals , Humans , Allografts , Autografts , Bone Matrix , Cohort Studies , Diskectomy , Incidence , Lordosis , Neck , Operative Time , Pseudarthrosis , Retrospective Studies , Transplants , Upper Extremity , Visual Analog ScaleABSTRACT
PURPOSE: This study analyzed the results of the midclavicle fracture treatment using the minimally invasive percutaneous plate osteosynthesis (MIPO) technique in a retrospective manner. MATERIALS AND METHODS: Between March 2013 and March 2017, this study analyzed 40 patients who received MIPO surgery. Excluding 1 patient who underwent surgery on another body part injury, and 4 patients who were lost to follow-up over 1 year, 40 patients were analyzed for their operation time, bone union, functional American Shoulder and Elbow Surgeons score, scar lengths, pain relief (visual analogue scale), and complications. RESULTS: All patients over a 1 year of follow-up achieved bone union, and American Shoulder and Elbow Surgeons score 97.6 (94–100) on their shoulder functional scores. Their average operation time was 42.7 minutes, and the average scar length was 6.1 cm. Eighteen patients successfully received metal removal using the previous scar without additional incision. The clavicle length was similar in the normal and operated group. CONCLUSION: Despite its small sample size, clavicle fixation using the MIPO technique can be considered an effective treatment because of its limited number of complications, such as nonunion and rotational angulations.
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Humans , Cicatrix , Clavicle , Elbow , Follow-Up Studies , Lost to Follow-Up , Retrospective Studies , Sample Size , Shoulder , SurgeonsABSTRACT
<p><b>OBJECTIVE</b>To compare the clinical effects between anterior cervical discectomy and fusion(ACDF) combined with anterior cervical corpectomy and fusion(ACCF) and cervical posterior single open-door laminoplasty with mini-titanium plate fixation in treating three-segment cervical spondylotic myelopathy.</p><p><b>METHODS</b>The clinical data of 63 patients (39 males and 24 females) with three-segment cervical spondylotic myelopathy underwent surgical treatment from March 2014 to March 2016 were retrospectively analyzed. Among them, 43 cases were treated by ACDF combined with ACCF(anterior group), and 20 cases were treated by cervical posterior single open-door laminoplasty with mini-titanium plate fixation(posterior group). Operative time, intraoperative blood loss, postoperative complications were compared between two groups. And according to JOA score to evaluate the clinical effect.</p><p><b>RESULTS</b>All the patients were follow-up from 16 to 40 months with an average of 25.8 months. Operative time of anterior group and posterior group were (123.70±6.21) min and(118.70±5.41) min, respectively, there was no significant difference between two groups(>0.05). Intraoperative blood loss of anterior group and posterior group were (85.23±7.51) ml and (107.18±9.41) ml, respectively, there was significant difference between two groups(<0.05). In anterior group, axial symptoms occurred in 6 cases, dysphagia in 1 case, and no C₅ nerve root palsy, hoarseness and choking cough were found, the incidence rate of complication was 16.3%(7/43); and in posterior group, axial symptoms occurred in 5 cases, C5 nerve root palsy in 1 case, and no dysphagia, hoarseness and choking cough were found, the incidence rate of complication was 30.0%(6/20); there was significant defference in incidence rate of complication between two group(<0.05). At 1 week after operation and final follow-up, the JOA scores of anterior group were obviously better than that of posterior group(<0.05).</p><p><b>CONCLUSIONS</b>Above-mintioned two surgical treatment for cervical spondylotic myelopathy can provide instantly stability, the method of ACDF combined with ACCF was obviously better that of the method of cervical posterior single open-door laminoplasty in intraoperative blood loss, the incidence rate of complications, clinical effect.Thus, for the treatment of three-segment cervical spondylotic myelopathy, the method of ACDF combined with ACCF would be firstly chosen.</p>
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Objective To investigate the influence of ROI-C cervical implantation in the C5-6 segment on the C3-7 range-of-motion (ROM), biomechanical properties of the intervertebral disc and the vertebral body, and the mode of force transmission. Methods Two types of surgeries, ROI-C implantation and autograft fusion with plate fixation, were considered to establish the finite element model of cervical C5-6 segment degeneration. The ROM of C3-7 during flexion, extension, lateral bending, and axial rotation, as well as stress distributions on the adjacent discs, vertebral body, and implanted devices under two procedures, were analyzed. Results ROI-C implantation had a relatively small influence on the ROM of the adjacent segment. The stress on the vertebral discs was reduced, but the stress on the vertebral body increased significantly, with the C5 vertebral body stress increasing by 251%. In the fusion surgery model, the ROM of the surgical segment was reduced by 86%-91%, while the ROM of the adjacent segments and the stress on the vertebral disc and vertebral body increased significantly. Conclusions ROI-C implantation surgery has a relatively small influence on the cervical ROM and the intervertebral disc, and it has a greater impact on the vertebral body. The research findings provide a theoretical basis for the design of operation plans and clinical studies on ROI-C implantation and autograft fusion with plate fixation.
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Objective To investigate the effect of minimally invasive plate osteosynthesis combined with locking compression plate fixation on postoperative fracture healing and serum levels of and serum nerve growth factor (NGF),vascular cell adhesion molecule (s VCAM),alkaline phosphatase (ALP) in patients with limb comminuted fracture.Methods From January 2014 to May 2016,seventy-four patients with limb comminuted fracture in the Eighth People's Hospital of Shanghai were enrolled in this study and randomly divided into the control group (37 cases) and the study group (37 cases).The traditional incision and reduction fixation were used in the control group.The study group was treated with locking compression plate internal fixation combined with minimally invasive plate bone grafting technique.The patients were followed up for 1 ～ 4 months after operation.The clinical efficacy,perioperative indicators (operation time,intraoperative blood loss,fracture healing time),serum (nerve growth factor,vascular cell adhesion molecule,alkaline phosphatase) levels change at the time of admission and after first D and complications rate were statistically compared.Results The total effective rate of the study group was 97.30％ (36/37),higher than that in the control group (78.38％ (29/37)),and the difference was statistically significant (x2 =4.554,P＜0.05).The operation time of the study group was (84.76 ± 11.08) min,longer than that of the control group ((71.89 ± 10.54) min),the intraoperative blood loss of the study group ((108.52 ± 21.33) ml) was less than that of the control group ((245.30±24.61) ml),and the fracture healing time of the study group ((9.04 ± 1.81) weeks) was shorter than that of the control group ((12.79 ±2.02) weeks),and the difference was statistically significant (t =5.119,t =25.547,t =8.410,P＜ 0.05).The levels of serum NGF,s VCAM and ALP in the two groups after operation were higher than those before operation,and the levels of serum NGF ((1.33±0.19) ng / L) and ALP ((312.04±31.07) U/L) in the study group were higher than those in the control group ((0.85 ± 0.22) ng/L,(181.28±30.45) U/L),and the level of serum s VCAM ((502.18±40.07) μg/L) was lower than that in the control group ((579.28 ± 41.15) μg/L),and the difference was statistically significant (t =10.044,18.283,8.165,P＜0.05).The incidence of complications in the study group was 8.11％ (3/37),lower than that in the control group (27.03％ (10/37)),the difference was statistically significant (x2 =4.573,P ＜ 0.05).Conclusion Minimally invasive plate osteosynthesis combined with locking compression plate fixation in the treatment of limb comminuted fracture can shorten the healing time of the fracture,improve the treatment effect,improve the levels of serum NGF,s,VCAM and ALP,and it have lower complication rate with higher safety.
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PURPOSE: The purpose of this study was to evaluate the radiological and clinical results of plate fixation and external fixation with additional devices for treating distal radius fracture in AO type C subtypes, and propose a treatment method according to the subtypes. MATERIALS AND METHODS: Two hundred and one AO type C distal radius fracture patients were retrospectively reviewed. Eighty-five patients in group 1 were treated with volar or dorsal plate, and 116 patients in group 2, were treated with external fixation with additional fixation devices. Clinical (range of mtion, Green and O'Brien's score) and radiological outcomes were evaluated. RESULTS: At the 12-month follow-up, group 1 showed flexion of 64.4°, extension of 68.3°, ulnar deviation of 30.6°, radial deviation of 20.8°, supination of 76.1°, and pronation of 79.4° in average; group 2 showed flexion of 60.5°, extension of 66.9°, ulnar deviation of 25.5°, radial deviation of 18.6°, supination of 73.5°, and pronation of 75.0° in average. The mean Green and O'Brien score was 92.2 in group 1 and 88.6 in group 2. The radial height of group 1 and group 2 was 11.6/11.4 mm; radial inclination was 23.2°/22.5°; volar tilt was 11.6°/8.7°; and the ulnar displacement was 1.27/0.93 mm. CONCLUSION: Judicious surgical techniques during device application and tips for postoperative management during external fixation can produce similar clinical results compared with internal fixation patients.
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Humans , Follow-Up Studies , Methods , Pronation , Radius Fractures , Radius , Retrospective Studies , SupinationABSTRACT
PURPOSE: Twenty early surgical management cases of distal humerus type-C fractures were analyzed. MATERIALS AND METHODS: This study analyzed 20 early patients, who received surgical management of distal humerus type-C fractures, and could be followed-ups for more than one year between March of 2013 and May of 2015. The operative time, bone union time, and elbow range of motion were analyzed. The Mayo's functional score was used to evaluate their postoperative function. The primary and secondary complications of each patient immediately after each of their surgery were also reviewed. RESULTS: All patient groups achieved bone union within an average period of 16.4 weeks. Based on the Mayo functional score, 6, 10, and 4 patients scored excellent, good, and fair, respectively. The average range of motion was a flexion contracture of 14.5° with a follow-up improvement averaging 120.7°. Six patients received nine revision operations due to major and minor complications. Two patients received revision fixation from an inadequate fixating power, and another patient received an ulnar nerve transposition. Other complications included olecranon osteotomy site displacement, superficial operational site infection, and pin loosening. CONCLUSION: Distal humerus fractures of the AO-C type can cause a range of complications and has a very high rate of revision due to its difficult nature of surgical manageability. Therefore, it is imperative for a surgeon to expect various complications beforehand and a careful approach to their postoperative rehabilitation is essential.
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Humans , Contracture , Elbow , Follow-Up Studies , Humerus , Intra-Articular Fractures , Olecranon Process , Operative Time , Orthopedics , Osteotomy , Range of Motion, Articular , Rehabilitation , Surgeons , Ulnar NerveABSTRACT
PURPOSE: To retrospectively compare minimally invasive percutaneous plate osteosynthesis (MIPPO) with open plate fixation for the treatment of clavicle midshaft fracture. MATERIALS AND METHODS: Between November 2011 to May 2014, 40 cases that were followed for more than 1 year–among all cases of MIPPO and open plate fixation–were analyzed. The study population was divided into two groups: group A included 20 cases of MIPPO and group B included 20 open plate fixation cases. The comparative analysis between the two groups was based on the operative time, bone union, functional evaluation (American Shoulder and Elbow Society score), incision length, pain relief (visual analogue scale, VAS), and complication. RESULTS: The bone union was successful for all the cases, and the functional evaluation scores of the shoulder joint were satisfactory for both groups (p>0.05). The operative time was 47.5 minutes and 58.7 minutes for group A and B, respectively (p<0.05). The incision length for group A was 6.2 cm and that for group B was 10.7 cm with statistical significance (p<0.05). Pain relief (VAS) after surgery for group A showed a quick recuperation in the early stages. For complications, there were 2 cases of dysesthesia and 1 case of malunion due to metal fixation failure in group A. There were 6 cases of dysesthesia and 2 cases of cosmetic problem due to hypertrophic scar in group B. CONCLUSION: Surgical results of clavicle shaft fracture were satisfactory for both groups, but group A had advantages of shorter operative time, minimal incision length, and better pain relief in the early stages compared with group B. However, we need further evaluations with long-term follow-up results and complications, such as malunion and exposure on radiation.
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Cicatrix, Hypertrophic , Clavicle , Elbow , Follow-Up Studies , Operative Time , Paresthesia , Retrospective Studies , Shoulder , Shoulder JointABSTRACT
Objective To evaluate the clinical efficacy of the dehopectoral approach and and the deltoid lateral longitudinal separate approach of locking plate fixation for the treatment of proximal humeral fractures.Methods Fifty-seven cases of proximal humerus fracture treated in Chaoyang Central Hospital from March 2010 to May 2015 were selected and were divided into the conventional group(30 cases)and the treatment group(27 cases)according to the different operative approaches.The patients in the conventional group were treated with locking plate fixation by dehopectoral approach and the patients in the treatment group were treated with locking plate fixation by deltoid lateral longitudinal separate approach.The operation time, intraoperative blood loss,fracture healing time,postoperative complication rate were observed in the two groups.Constant scores at different times after operation and the evaluation of shoulder function recovery were observed in the two groups.Results All patients were followed up for 10-25 months,with an average of 19 months.The blood loss in the treatment group was(89.7± 31.5)ml and the fracture healing time was(79.6 ±1.8)d,compared with(243.1±65.7)ml and(90.1±2)d in the conventional group,the differences between the two groups were statistically significant(P=0.000,0.035).There was no significant difference between the two groups in the operation time(P=0.079).Constant scores in the treatment group at 3 weeks and 3 months after operation were better than those in the conventional group,the differences between the two groups were statistically significant(P<0.05).At the last follow-up,there was no significant difference in Constant scores between the two groups(P>0.05).There were significant differences in the incidence of postoperative complications between the conventional group and the treatment group(13.3% vs.3.7%,P = 0.045).Conclusion In the treatment of proximal humeral fractures,the deltoid lateral longitudinal separate approach has advantages of less intraoperative blood loss,shorter fracture healing time,faster recovery of shoulder function and less postoperative complications,which is a safe and effective method for the treatment of proximal humeral fractures.
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BACKGROUND: The purpose of this study was to investigate the outcomes after fixation using a 3.5-mm locking compression plate (LCP) hook plate for isolated greater tuberosity (GT) fractures of the proximal humerus. METHODS: We evaluated the postoperative radiological and clinical outcomes in nine patients who were followed up at least 1 year with isolated GT fractures. Using the deltopectoral approach, we fixed the displaced GT fragments with a 3.5-mm LCP hook plate (Synthes, West Chester, PA, USA). Depending on the fracture patterns, the hook plate was fixed with or without augmentation using either tension suture or suture anchor fixation. RESULTS: All the patient showed successful bone union. The mean time-to-union was 11 weeks. The radiological and clinical outcomes at the final follow-up were generally satisfactory. The mean visual analogue scale for pain, the University of California at Los Angeles score, the American Shoulder and Elbow Surgeons score, and the subjective shoulder value were 1.4, 30.3, 84.3, and 82.2%, respectively. The mean active forward flexion, abduction, external rotation, and internal rotation of the shoulder were 156.7°, 152.2°, 61.1°, and the 10th thoracic vertebral level, respectively. Only one patient presented with a postoperative complication of shoulder stiffness. The patient was treated through arthroscopic capsular release on the 5th postoperative month. CONCLUSIONS: We conclude that fixation using 3.5-mm LCP hook plates for isolated GT fractures of the proximal humerus is a useful treatment method that provides satisfactory clinical and radiological outcomes.
Subject(s)
Humans , California , Elbow , Follow-Up Studies , Humerus , Joint Capsule Release , Methods , Postoperative Complications , Shoulder , Surgeons , Suture Anchors , SuturesABSTRACT
BACKGROUND: The purpose of this study was to investigate the outcomes after fixation using a 3.5-mm locking compression plate (LCP) hook plate for isolated greater tuberosity (GT) fractures of the proximal humerus. METHODS: We evaluated the postoperative radiological and clinical outcomes in nine patients who were followed up at least 1 year with isolated GT fractures. Using the deltopectoral approach, we fixed the displaced GT fragments with a 3.5-mm LCP hook plate (Synthes, West Chester, PA, USA). Depending on the fracture patterns, the hook plate was fixed with or without augmentation using either tension suture or suture anchor fixation. RESULTS: All the patient showed successful bone union. The mean time-to-union was 11 weeks. The radiological and clinical outcomes at the final follow-up were generally satisfactory. The mean visual analogue scale for pain, the University of California at Los Angeles score, the American Shoulder and Elbow Surgeons score, and the subjective shoulder value were 1.4, 30.3, 84.3, and 82.2%, respectively. The mean active forward flexion, abduction, external rotation, and internal rotation of the shoulder were 156.7°, 152.2°, 61.1°, and the 10th thoracic vertebral level, respectively. Only one patient presented with a postoperative complication of shoulder stiffness. The patient was treated through arthroscopic capsular release on the 5th postoperative month. CONCLUSIONS: We conclude that fixation using 3.5-mm LCP hook plates for isolated GT fractures of the proximal humerus is a useful treatment method that provides satisfactory clinical and radiological outcomes.
Subject(s)
Humans , California , Elbow , Follow-Up Studies , Humerus , Joint Capsule Release , Methods , Postoperative Complications , Shoulder , Surgeons , Suture Anchors , SuturesABSTRACT
Objective To investigate the clinical efficacy of double-plate fixation combined with bone graft on SchatzkerⅤ/Ⅵ tibial plateau fractures.Methods Totally 35 cases with tibial plateau fractures from April 2013 to October 2015 were selected into an observation group,and treated with dual plate fixation combined with bone graft.Another 35 cases with tibial plateau fractures from March 2011 to March 2013 were enrolled in a control group,and treated with conventional anatomical plate.The data of the two groups were analyzed.Results Pain scores in observation group were lower than those in the control group,and the knee joint function scores in observation group were higher than those in the control group (P＜0.05);the healing degree was 65.7％ in the control group,which is significantly less than that (91.4％) in the observation group (P＜0.05);the complication incidence rate was 8.6％ in the observation group which was obviously lower than that (34.3％) in the control group (P＜0.05).Conclusion Double-plate fixation combined with bone graft in the treatment of tibial plateau fracture shows a high efficacy,and is worthy of clinical application and promotion.