Clinical observation on plastic splint treatment of middle clavicle fracture based on a new classification / 中国骨伤

OBJECTIVE@#According to 73 patients with middle clavicle fracture treated conservatively, a new classification of middle clavicle fracture was proposed, and the clinical effect of plastic splint in the treatment of middle clavicle fracture was observed.@*METHODS@#Total 73 patients with middle clavicle fracture treated with plastic splint from September 2018 to August 2020 were analyzed retrospectively. All the patients were divided into 4 types according to the degree of fracture displacement. There were 16 cases of typeⅠ, including 7 males and 9 females, ranging in age from 18 to 37 years old, with a mean of (28.6±7.8) years old;12 cases of mild disease, 3 cases of moderate disease and 1 case of severe disease. There were 16 cases of type Ⅱ, including 6 males and 10 females, ranging in age from 25 to 49 years old, with a mean of (37.3±9.4) years old;5 cases of mild disease, 8 cases of moderate disease and 3 cases of severe disease. There were 7 cases of type Ⅲ, including 4 males and 3 females, ranging in age from 33 to 57 years old;2 cases of mild disease, 3 cases of moderate disease and 2 cases of severe disease. There were 34 cases of type Ⅳ, including 16 males and 18 females, ranging in age from 48 to 82 years old, with a mean of(66.4±14.9) years old;7 cases of mild disease, 17 cases of moderate disease and 10 cases of severe disease. All patients received plastic splint external fixation for 4 weeks. Visual analgue scale (VAS) and Constant-Murley shoulder scores before treatment and 1, 3 and 9 months after treatment were observed and recorded to evaluate the change of pain degree and shoulder function recovery before and after treatment. The patients' satisfaction with the appearance after treatment was recorded at the latest follow-up. The X-ray findings at the latest follow-up were used to judge whether the patient had fracture nonunion. And according to the fracture healing time and imaging findings, the excellent and good rate of clinical curative effect in patients with different types was obtained.@*RESULTS@#All patients were followed up, and the duration ranged from 9 to 11 months, with a mean of (9.8±0.7) months. The VAS scores of typeⅠ, typeⅡand type Ⅳ before treatment were 2.88±0.83, 3.67±0.80 and 6.92±1.71 respectively, which were decreased to 0.54±0.19, 0.77±0.25 and 1.18±0.17 respectively after 9 months of treatment. The Constant-Murley shoulder scores of typeⅠ, typeⅡand type Ⅳ were 65.81±2.09, 63.50±2.22 and 47.93±2.91 respectively before treatment, and increased to 88.56±2.11, 85.12±2.23 and 71.25±2.16 respectively after 9 months of treatment. Five patients were not satisfied with the appearance after treatment;6 patients had no obvious continuous callus passing through after 9 months of treatment, which was fracture nonunion.@*CONCLUSION@#The classification of middle clavicle fracture is more appropriate to the clinic, which has a certain clinical guiding significance for the selection of treatment methods and prognosis of middle clavicle fracture. Plastic splint is effective in the treatment of middle clavicle fracture without obvious displacement and overlapping displacement, and the incidence of complications is low. It can be popularized in clinic.

Clinical effect of external-internal four paper splints fixation at a fixed point in the treatment of the unstable distal radius fracture / 国际中医中药杂志

Objective:To compare the clinical effects of external-internal four paper splints fixation at a fixed point with the routine paper splint fixation in the treatment of the unstable distal radius fracture.Methods:A total of 66 patients with type C1 or C2 distal radial fractures, from November 2016 to May 2019, were analyzed retrospectively. According to different external fixation methods, patients were divided into 2 groups with 33 patients in each group. Modified group treated with external-internal four paper splint fixation at a fixed point and normal group treated with routine paper splint fixation. The 4th and 6th weeks after the operation, the reduction of the distal radius fracture was evaluated based on anteroposterior and lateral wrist radiographs. After 3 months follow-up, the radial height, radial inclination and palm dip angle were measured and the healing time were recorded. The Gartland-Werley functional scale was used to evaluate the wrist function from four aspects of residual malformation, subjective evaluation, objective evaluation and complications, and to evaluate the clinical efficacy.Results:After 3 months follow-up, all patients got clinical healing. The loss of palm dip angle [(2.9 ± 2.4)° vs. (4.6 ± 3.2)°, t=-2.524], radial inclination [(3.4 ± 2.2)° vs. (5.0 ± 3.0)°, t=-2.506] and radial height [(2.4 ± 1.9) mm vs. (3.6 ± 2.1) mm, t=-2.302] in modified group were significantly less than those in normal group ( P<0.05). There was a lower Gartland-Werley score in modified group compared with normal group [(1.52 ± 2.75) vs. (5.76 ± 8.68); t=-2.677, P<0.05]. The excellent and good rate was 97.0% (32/33) in the modified group and 78.8% (26/33) in the nomal group. There was significant difference between two groups ( Z=-2.315, P=0.021). Conclusions:The external-internal four paper splint fixation at a fixed point can control the redisplacement of unstable distal radius fractures effectively, and maintain the reduction. The effect of modified paper splint fixation at a fixed point is better than routine paper splint fixation.

Clinical observation on pulley suspension traction reduction combined with self-made splint fixation for the treatment of extended distal radius fracture / 中国骨伤

OBJECTIVE@#To explore clinical effects of pulley suspension traction reduction combined with self-made splint fixation in treating extended distal radius fracture.@*METHODS@#From December 2017 to December 2019, 60 patients with extended distal radius fractures were divided into observation group and control group, 30 patients in each group. In observation group, there were 12 males and 18 females, aged from 50 to 75 years old with an average of (59.63±8.08) years old;according to AO classification, 25 patients were type A2 and 5 patients with type A3;fractures were fixed by pulley suspension traction and self-made splint. In control group, there were 11 males and 19 females, aged from 52 to 76 years old with an average of (59.77±8.03) years old;according to AO classification, 24 patients were with type A2 and 6 patients were type A3;fractures were treated by conventional manipulation with self-made splint fixation. The radius height, ulnar angle and palmar angle between two groups were compared before and after treatment, and clinical effects were evaluated by advanced Green and O'Brien wrist joint scoring after treatment.@*RESULTS@#All patients were followed up from 11 to 13 months with an average of (11.90± 0.80) months. The splint was removed for 42 to 60 days with an average of (50.20±4.94) days. After removal of splint, X-rays indicated that all patients obtained bone healing with smooth of joint surface. In observation group, radius height was (4.57± 1.16) mm, ulnar angle was (12.83±3.25) °, palmar angle were (-21.17±3.36) ° respectively before treatment, (10.10± 1.75) mm, (24.30±3.16) °, (9.40±2.13) ° respectively at 8 weeks after treatment;in control group, radius height, ulnar angle, palm angle were (4.50±1.43) mm, (12.83±3.10) °, (-21.50±3.38) ° respectively before treatment, and (8.90±1.24) mm, (21.20±2.91) °, (6.16±2.94) ° respectively at 8 weeks after treatment;there were no significant difference in radius height, ulnar deviation angle and palmar inclination between two groups before treatment (@*CONCLUSION@#Compared with conventional manual traction and reduction, pulley suspension traction reduction combined with self made splint fixation for the treatment of extended distal radius fracture has more advantages with stable and reliable traction, good reduction, and better wrist joint function. It could be selected and applied according to the actual situation of patients.

Small splint external fixation combined with 3D printing brace for the treatment of Colles fractures / 中国骨伤

OBJECTIVE@#To explore the short-term clinical efficacy of manipulation reduction-combined with small splint and 3D printing wrist brace external fixation of wrist brace for Colles fracture and the advantages of using the brace.@*METHODS@#A total of 60 patients with Colles fractures who were treated in Zhongshan Hospital of Traditional Chinese Medicine from February to December 2017 were selected. Patients were randomly divided into 2 groups according to the order of treatment, with 30 patients in the control group, including 13 males and 17 females, aged from 16 to 66 years, with a mean of (49.46±12.63) years; the time from injury to consultation ranged from 3 to 18 h, averaged (6.86±3.15) h. In the experimental group, there were 30 cases, 12 males and 18 females, ranging in age from 14 to 68 years old, with a mean of (46.73±14.40) years old; the time from injury to consultation ranged from 3 to 19 h, averaged(7.06±3.45)h. All the patients in the experimental group and the control group were treated with the same doctor's manipulation to reduce the fracture. The small splints were applied for external fixation after the satisfactory reduction shown in the X-ray. After 1 week of fracture treatment, the small splints were removed from the patients in the experimental group and the 3D printing braces were replaced to maintain fixation until the fracture healed. In the control group, small splints were maintained until the fracture healed. Wrist joint X-ray films were taken before and after reduction and 4 weeks after reduction to observe the palmar inclination angle, ulnar deviation angle, radius height and compare; VAS score and swelling degree score were recorded before and after reduction for 1 and 2 weeks; Cooney and PRWE score of wrist joint were compared after 6 to 8 weeks of reduction.@*RESULTS@#The VAS score of 2 weeks after reduction was 2.40±0.49 in the experimental group and 2.43±0.50 in the control group. There was no statistical difference in the VAS score between the two groups before and after reduction(=0.364). The swelling degree of 2 weeks after reduction was 0.50±0.50 in the experimental group and 0.53±0.50 in the control group. There was no statistical difference in the swelling degree between the two groups before and after reduction(=0.746). The Cooney and PRWE scores of the experimental group were better than those of the control group 6 to 8 weeks after reduction (<0.05), and the anatomical characteristics of palmar inclination, ulnar deviation and radial shortening of the experimental group were better than those of the control group(<0.05).@*CONCLUSIONS@#3D printing braces are light and breathable, comfortable and beautiful, and convenient for dressing. The combination of small splint sequentially applied to Colles fracture has a definite clinical effect, which enriches the means of external fixation treatment. It is believed that with the deepening of clinical research, the design and materials of 3D printing braces as well as their application in future medical treatment will be further developed.

Finite Element Analysis on Small Splint for the Treatment of Intra-Articular Fracture of Distal Radius / 医用生物力学

Objective To explore the application scope of small splint in the treatment of type-C distal radius fractures. Methods According to CT scan data from the right forearm of a healthy male volunteer, the three-dimensional model of normal distal radius was established. According to AO classification, the fracture line based on normal model was divided to establish nine kinds of high-order tetrahedral mesh models of the upper forearm with C-type fracture. Finite element analysis on nine kinds of fracture models was conducted in ANSYS 15.0 software to obtain the corresponding stress values, and then the stress distribution contours were generated. Results As soft tissues of the wrist were thin with more fracture blocks, after the splint was fixed, the stress on the wrist under 100 N maximum physiological axial load was significantly larger compared with that on the other parts, and the compressive stress was mainly concentrated on the wrist joint. The fixed effect of C2.2, C2.3, C3.2, C3.3-type fracture by small splint was relatively poor, as such comminuted fracture would cause too many and too small fracture blocks, while the fixed effect of C1.1, C1.2, C1.3, C2.1 and C3.1-type fracture was better. Conclusions Through the related finite element study on the treatment of C-type fracture distal radius with small splint, the application scope of small splint was preliminarily determined, which could provide some reference for clinical work.

Clinical study of the manual reduction with small splint external fixation for the elderly Bratons fracture / 国际中医中药杂志

Objective Evaluation of the effect of manual reduction with small external fixation on the treatment of elderly Barton fractures.Methods A total of 244 elderly patients with Barton fractures were divided into conservative group (n=126) and operation group (n=118) according to random number table. The conservative group was treated by with manual reduction with small external fixation, and the operation group was treated with open reduction and internal fixation. The complications of the patients, the time of fracture healing, hospitalization time and treatment cost were recorded.The wrist function was evaluated by PRWE wrist score system and Wrightington wrist function score system.The clinical efficacy was evaluated by Gartland-Werley Colles fracture evaluation method.Results The excellent and good effect rate was 91.3% (115/126) in the conservative group and 97.5% (115/118) in the operation group. There was no significant difference between the two groups(χ2=0.857,P=0.354). One year, 6 months, 3 months and 6 weeks after treatment, in the conservative group, the PRWE score (10.4 ± 7.9, 19.1 ± 8.0, 40.5 ± 7.8, 55.7 ± 8.1vs. 80.8 ± 8.2,F=113.665), wrightington score (8.2 ± 3.7, 13.2 ± 4.0, 21.4 ± 3.9, 26.3 ± 4.2vs. 30.1 ± 4.2,F=121.348) were significantly lower than those before treatment (P<0.01). And in the operation group, the PRWE score (10.2 ± 7.8, 15.0 ± 8.0, 26.5 ± 8.0, 44.7 ± 8.2vs. 79.6 ± 8.6,F=81.411), Wrightington score (8.1 ± 3.8, 12.1 ± 4.0, 16.5 ± 4.0, 20.6 ± 4.3vs. 29.8 ± 4.6,F=69.113) were significantly lower than those before treatment (P<0.01). But there was no significant difference in PRWE score and Wrightington scores between the two groups after treatment (t=0.149, 0.104,P=0.881, 0.917, respectively). In the conservative group, the hospitalization time (5.28 ± 2.10 dvs. 12.8 ± 2.21d,t=25.260) was significantly shorter than that of the control group (P<0.01), and the treatment cost (3.26 ± 0.93 thousandvs. 28.66 ± 1.04 thousand,t=200.369) was significantly lower than that in the control group (P<0.01). The overall incidence of complication was 8.7% (11/126) in the conservative group and 17.8% in the surgery group (21/118). There was significant difference between the two groups(χ2=4.396,P=0.036).Conclusions The manual reduction with small splint external fixation was simple, low cost, small trauma, short hospitalization time, and less complications.

Comparative results of non-operative and operative treatment of humeral shaft fractures / 北京大学学报(医学版)

Objective:To compare the difference between non-operative and operative treatment of humeral shaft fractures.Methods:From March 2005 to October 2012,252 cases of humeral shaft fractures were treated and were adequately followed up.According to the treatment methods,the patients were divided into 2 groups:the non-operative group and the operative group.In the non-operative group,there were 76 cases treated with plaster/small splint fixation,meanwhile there were 176 cases treated with inter nal fixation either by plating or by nailing in the operative group.The follow-up parameters included:fracture healing rate,fracture union time,complications rate,Constant-Murley shoulder score and Mayo elbow score.Results:The mean follow-up period was (31.24 ± 20.06) months (ranging 6 to 103 months).There were no statistical differences in age,open fracture number,fracture site and Arbeitsgemeinschaft ftir Osteosynthesefragen (AO) classification between the non-operative group and the operative group.The fracture healing rate:the non-operative group:96.1％ (72/76),the operative group:97.7％ (172/176),P =0.46;the fracture union time:the non-operative group:(10.24 ± 2.93) weeks,the operative group:(10.69 ± 2.51) weeks,P =0.22;the complication rate:the non-operative group:5.3％ (4/76),the operative group:15.3％ (27/176),P =0.03.The complications included:nonunion:the non-operative group:3.95％ (3/76),the operative group:2.3％ (4/176),P =0.434;radial nerve palsies:the non-operative group:0％ (0/76),the operative group:5.7％ (10/176),P =0.035;bone split:the non-operative group:0％ (0/76),the operative group:1.7％ (3/176),P =0.556;elbow stiffness:the non-operative group:l.3％ (1/76),the operative group:0.6％ (1/176),P =1.000;shoulder pain:the non-operative group:0％ (0/76),the operative group:5.1％ (9/176),P =0.061.The Constant-Murley shoulder score:the non-operative group:97.37±4.94,the operative group:96.34 ± 6.88,P =0.244.The Mayo elbow score:the non-operative group:99.80 ± 1.72,the operative group:99.49 ± 2.73,P =0.923.Conclusion:The results of non-operative treatment of humeral shaft fractures appeared with excellent results with lower complications rate compared with that of the operative treatment.

Application of convolute manipulation for the treatment of femoral fractures in children / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the application of convoluted manipulation in pediatric femoral fractures.</p><p><b>METHODS</b>From March 2015 to October 2016, 12 children with femoral fractures were treated by Chinese traditional manipulation including 8 males and 4 females with an average age of 6 years old ranging from 1 to 12 years old. The causes of injury were falls in 10 cases and traffic accidents in 2 cases. Of which 1 case was transverse fractures, 4 cases were oblique fractures and 4 cases were spiral fractures, 2 cases were comminuted fracture, 1 case was greenstick fracture. All patients underwent manual reduction within 1 to 2 days, plus small splint with cedar bark, and parallel lower limb traction.</p><p><b>RESULTS</b>All the 12 patients were followed up for 1-3 months, with an average of 2 months. All the 12 patients achieved clinical union, and the average healing time was 6 weeks. There was no obvious shortening and rotational angulation. At the last follow-up, Schatzker-Lambert distal femoral fracture evaluation results were excellent in 11 cases, good in 1 case.</p><p><b>CONCLUSIONS</b>Convoluted manipulation is very important for reduction of femoral fractures in children, with the splint of cedar bark, satisfactory therapeutic effect can be achieved.</p>

Analysis of the axial stretching force of the small splint fixation system / 中国骨伤

<p><b>OBJECTIVE</b>To measure the axial stretching force produced by the small splint fixation system in the treatment of the fracture.</p><p><b>METHODS</b>Dumbbell shaped plexiglass was machined to model the bone shaft with expanded two ends. Force transducer was set at the model fracture site to measure the stretching force produced by fracture fixation of the small splint with cloth aqueous bag that simulated the muscles and other soft tissue underneath.</p><p><b>RESULTS</b>There was positive relationship between the axial stretching force produced at the model fracture site and the transverse pressing force exerted by the external plates. The ratio of which was 1/10.</p><p><b>CONCLUSIONS</b>Muscle enwrapped with fascia is similar to the cloth aqueous bag system in mechanical structure. From this article, axial stretching force exists at the bone shaft fracture site when fixed by small splint which exerts the force transversely from the outside of the extrimity.</p>

Comparison of the curative effect between over-elbow splint and traditional small splint fixation in the treatment of comminuted Colles fracture / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the clinical efficacy of over-elbow small splint fixation for the treatment of comminuted Colles fractures.</p><p><b>METHODS</b>From October 2013 to October 2015, 52 patients with comminuted Colles fracture were divided into two groups (the traditional splint fixation group and the over-elbow small splint fixation group) according to the treatment strategy. There were 26 patients in the over-elbow small splint fixation group including 7 males and 19 females with an average age of (64.615±11.475) years old ranging from 38 to 85 years old, and 26 patients in the traditional splint fixation group including 9 males and 17 females with an average age of (65.269±13.162) years old ranging 36 to 91 years old, respectively. In the over-elbow small splint fixation group, 3 cases were type A3 fractures, 9 cases were type C1, 7 cases were type C2 and 7 cases were type C3;in the traditional splint fixation group, 4 cases were type A3, 8 cases were type C1, 9 cases were type C2 and 5 cases were type C3. After manipulative reduction, the fractures in traditional splint fixation group were fixed with traditional small splint, and the fractures in over-elbow small splint fixation group were added with over-elbow right angle splint for the first three weeks, then continued fixing like the control group until clinical cicatrization. All patients in both groups were regularly taken X-ray examination and changed dressings to obtain the clinical healing. Patients were guided to do functional exercise after splints were taken off. The therapeutic effects were evaluated according to modified Green and O'Brein score system after 8 weeks' functional exercise.</p><p><b>RESULTS</b>All patients got clinical healing without severe complications in both groups. The shortened length of radius in traditional splint fixation group was more than that in over-elbow small splint fixation group (5.923±1.978) mm VS (2.962±1.248) mm(<0.05). There was no significant difference in radial incline between two groups. There was a higher wrist score in over-elbow small splint fixation group compared with traditional splint fixation group 89.615±11.482 vs 80.385±13.485(<0.05).</p><p><b>CONCLUSIONS</b>Over-elbow small splint fixation is better than traditional splint fixation for the treatment of comminuted Colles fracture because of reliable clinical result and excellent wrist functional recovery.</p>

Randomized Controlled Trial of Type A2 Distal Radius Fracture Treated with Small Splint Fixation and Plaster Fixation / 广州中医药大学学报

Objective To compare the efficacy of small splint fixation and plaster fixation in treating distal radius fracture. Methods One hundred and four cases of type A2 distal radius fracture admitted from January of 2012 to May of 2013 were randomly divided into small splint fixation group and plaster fixation group. After reduction, patients in the two groups were fixed with small splint and plaster separately. Wrist function scores, 36-item Short Form ( SF-36) scores and roentgenographic scores were evaluated for the two groups at different time points. Results ( 1) Within 3 months of follow up, the improvement of wrist function in small splint fixation group was significantly superior to that in plaster fixation group (P0.05). (2) SF-36 scores of the two groups were gradually increased along with the follow up. After follow-up for one week, 2 weeks, one month and 3 months, the SF-36 scores in small splint fixation group were significantly higher than that in plaster fixation group ( P0.05). ( 3) After follow up for one year, the excellent rate for roentgenographic scores was higher than 80% in both groups, and there was no significant difference between the two groups (P>0.05). Conclusion Both small splint fixation and plaster fixation have satisfacory efficacy in treating type A2 distal radius fracture. But during the therapeutic process, wrist function scores and life quality scores in the small splint fixation group were higher than those in the plaster fixation group.

Case-control Study on Small Splint and Plaster External Fixation after Closed Manipulative Reduction in the Treatment of Elderly Type C Colles Fractures / 中国中医药信息杂志

Objective To compare the clinical effects of small splint fixation after closed manipulative reduction with plaster external fixation in the treatment of elderly type C Colles fractures.Methods Totally 96 elderly patients with type C Colles fractures were randomly divided into two groups, 48 patients in each group. Both groups were treated with closed manipulative reduction. The fractures were externally fixed with splint in the treatment group, and those were externally fixed with pipe plaster in the control group. The figure of radius length, palmar tilt and ulnar deviation were detected respectively in pre-reduction, the same day with reduction, and the day when external fixation was removed (6th week), in order to evaluated the drop of anatomical position. The therapeutic effects were evaluated according to Gartland-Werley wrist score when external fixation was taken off after 6 months.Results In both groups, figures of radius length, palmar tilt and ulnar deviation evidently increased in the day after reduction and the day of external fixation removal, compared with pre-reduction (P<0.05). Compared with the day after reduction, the radius length, palmar tilt and ulnar deviation of the day of external fixation removal all dropped in both groups (P<0.05). But the drop degree in control group was significantly higher than treatment group (P<0.05). For the joint function, 9 cases for excellent, 26 for good, 6 for fair, and 4 for bad in the therapy group. The excellent and good rate was 77.8% (35/45). In the control group, 4 cases for excellent, 22 for good, 10 for fair and 9 for bad. The excellent and good rate was 57.8% (26/45). The curative effect of treatment group was remarkably superior to control group (P<0.05).Conclusion Closed manipulative reduction combined with splint external fixation is more effective than pipe plaster in treatment of elderly type C Colles fractures.

Clinical Observation of Manipulative Reduction Combined with Small-splint Fixation for Treatment of Barton's Fracture / 广州中医药大学学报

Objective To observe the therapeutic effect of manipulative reduction combined with small-splint fixation for the treatment of Barton's fracture.Methods The apposition state,time for swelling disappearance,time for pain relief,and the score evaluated with Gartland-Werley(GW) criteria modified by Sarmiento were observed for the evaluation of therapeutic effect on Barton's fracture patients.Results After manipulative reduction combined with small-splint fixation,the apposition state was good,and volar tilting angle and ulnar inclination were improved in the patients.Time for the disappearance of swelling on the back of hand ranged from 4 to 14 days,averaged 6.0?1.6 days.Time for pain relief ranged from 3 to 10 days,averaged 6.4?1.6 days.Time for the union of fracture ranged from 30 to 60 days,averaged 35.4?8.3 days.The mean modified GW score was 3.6?2.5,and the score was excellent in 29 patients and good in 41 patients.Conclusion Manipulative reduction combined with small-splint fixation is effective and practical for the treatment of Barton's fracture.