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OBJECTIVE@#To compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation.@*METHODS@#The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function.@*RESULTS@#There was no significant difference in operation time between the two groups ( P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference ( t=-0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values ( P<0.05). However, there was no significant difference in the improvement value between the two groups ( P>0.05).@*CONCLUSION@#For PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.
Subject(s)
Humans , Posterior Cruciate Ligament/injuries , Suture Anchors , Fractures, Avulsion/surgery , Retrospective Studies , Tibial Fractures/surgery , Arthroscopy/methods , Fracture Fixation, Internal/methods , Knee Joint/surgery , Bone Screws , Suture Techniques , Treatment OutcomeABSTRACT
Objective: To compare the clinical and radiographic outcomes of bioabsorbable screw and metallic screw for Maisonneuve fracture. Methods: The clinical data of 68 patients of Maisonneuve fracture treated with open reduction and internal fixation between October 2012 and October 2016 were retrospectively analyzed. Metallic screw fixation was used in 37 cases (group A) and absorbable screw fixation was used in 31 cases (group B). There was no significant difference in age, gender, weight, operated side, cause of injury, time from injury to operation, and complications between the two groups ( P>0.05). At last follow-up, the tibiafibular clear space (TFCS), tibiafibular overlap (TFO), medial clear space (MCS), and syndesmotic malreduction rate were recorded. And the dorsiflexion and plantar-flexion range of motion, pain visual analogue scale (VAS) score, ankle and hind foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and Olerud-Molander (OM) score were recorded. Results: All patients were followed up 25-43 months, with an average of 32.3 months. There was no significant difference in the operation time between the two groups ( t=1.229, P=0.282). All the fractures healed, and there was no significant difference in fracture healing time between the two groups ( t=1.367, P=0.413). At last follow-up, the syndesmotic malreduction rate of group A was 16.2% (6/37), showing no significant difference when compared with group B [6.2% (2/31)] ( χ2=1.549, P=0.213). There were 3 complications in group A, 1 was superficial wound infection, 1 was local heterotopic ossification due to failure to remove the screws in time, 1 was local heterotopic ossification of the screws; and there were 2 complications in group B, 1 was rejection and 1 was local heterotopic ossification of the screws. There was no significant difference in the incidence of complications between the two groups ( χ2=0.068, P=0.794). There was no significant difference in TFCS, MCS, TFO, ankle dorsiflexion and plantar-flexion range of motion, AOFAS score, OM score, and VAS score between the two groups at last follow-up ( P>0.05). Conclusion: Compared with metallic screw, absorbable screws provide adequate fixation and functional recovery with avoiding screw removal and lower syndesmotic malreduction.
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Objective It is crucial to restore and fix the position of nasal septum which elaborates supportive function in rhinoplasty for secondary nose deformity of cleft lip and palate patients.The aim of this study was to explore the fixation technique with absorbable material in rhinoplasty for correction cleft lip nose deformity.Methods Nineteen cases with unilateral cleft lip/with or without palate cleft were included in this study.Absorbable screw was used to fix the implanted and re-positioned grafted cartilage septum which was shaped into strip with anterior nasal spine.Results Full success was achieved for all of 19 cases with internal fixation technique to re-position nasal septum to correct nasal deformity.There was no complications occurred.Conclusions Internal fixation technique with absorbable material could be used to correct secondary nasal deformity in cleft lip and palate patients and fixed re-positioned grafted cartilage septum can apply a strong support to ala nasi cartilage in cleft site.
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Objective: To evaluate the effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus with absorbable screws or metal screws fixation by clinical and radiological data. Methods: Between March 2014 and May 2016, the Scarf osteotomy combined with Akin osteotomy was used to treat 62 patients (83 feet) with moderate to severe hallux valgus. Twenty-five patients (35 feet) were fixed by absorbable screws (group A) and 37 patients (48 feet) were fixed by metal screws (group B). The difference in gender, age, affected side, etiology, severity, disease duration, preoperative hallux valgus angle (HVA) and first-second intermetatarsal angle (1-2IMA) measured in weight-bearing anteroposterior X-ray film, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS) scores between 2 groups ( P>0.05). The complications and healing time of 2 groups were recorded and compared. At last follow-up, the AOFAS and VAS scores, and HVA, 1-2IMA measured by weight-bearing anteroposterior X-ray film were used to evaluate the effectiveness. Results: All incisions healed by first intention and no incision-related complication occurred in the two groups after operation. Both groups were followed up, the follow-up time in group A was 12-36 months (mean, 24.4 months) and in group B was 14-38 months (mean, 25.7 months). In group A, 1 foot was complicated with hallux varus, 2 feet had mild stiffness, 1 foot appeared metastatic metatarsal pain, and in group B was 2, 3, 2 feet, respectively. There was no recurrence of hallux valgus in both groups. The difference in the incidence of complications between the two groups after the first operation was not significant ( χ2=0.275, P=0.843). The removal rate of internal fixator in group B was 89.2% (33 cases) during the second operation, among which 3 cases had screw slip and 1 case had screw fracture. And 10.8% (4 cases) refused the second removal operation due to their age. Postoperative X-ray films showed that both groups had good healing at the osteotomy site, and there was no significant difference in healing time between the two groups ( t=1.633, P=0.285). At last follow-up, the AOFAS score, VAS score, HVA, and 1-2IMA were significantly improved in the two groups when compared with preoperative ones ( P0.05). Conclusion: The effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus is significant, with few complications. Compared with being fixed by metal screws, being fixed by absorbable screws has the same effectiveness, but can avoid the risk of second operation to remove the internal fixator.
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Objective To explore the clinical efficacy of one-stage anterolateral-posterior approach debridement,bone graft and internal fixation in treatment of thoracolumbar spinal tuberculosis.Methods From January 2010 to December 2014,56 cases of thoracolumbar spinal tuberculosis were retrospectively analyzed, including 31 males and 25 females,aged 18 -72 years (mean 43.1 years).All patients were managed by standard courses of chemotherapy with quadruple anti-TB drugs for 2 - 4 weeks.Patients were treated by anterolateral debridement,autologous iliac bone graft fixed by absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach).We recorded the operation time,the amount of bleeding,bone graft fusion,postoperative erythrocyte sedimentation rate (ESR),Cobb angle,VAS score,and American Spinal Injury Association (ASIA)score to evaluate the surgical results.Results The average operation time was 175-290 min, with an average of (248±42)min.The bleeding volume was 300 -900 mL with an average of (420 ±68)mL.The average follow-up time was (24 ± 5.2 )months,bone fusion rate was 100%,and fusion time was (4.7 ± 0.5 ) months.At the last follow-up,the average Cobb angle was (8.2±3.1)°,VAS was (2.1±0.8),and ESR was (17± 4.2)mm/h.The ASIA neurological functions were all classified as Grade E except for 3 cases of Grade D.All these were significantly different from the preoperative ones.Six patients had complications of different degree but without serious complications.Conclusion One-stage anterolateral debridement,autologous iliac bone graft fixedby absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach)can completely remove the tuberculosis lesions and achieve ideal kyphosis correction,high bone graft fusion,and satisfactory neurological function recovery.Absorbable screws can be safely applied to the bone graft site after debridement.
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Objective To explore the clinical efficacy of one-stage anterolateral-posterior approach debridement,bone graft and internal fixation in treatment of thoracolumbar spinal tuberculosis.Methods From January 2010 to December 2014,56 cases of thoracolumbar spinal tuberculosis were retrospectively analyzed, including 31 males and 25 females,aged 18 -72 years (mean 43.1 years).All patients were managed by standard courses of chemotherapy with quadruple anti-TB drugs for 2 - 4 weeks.Patients were treated by anterolateral debridement,autologous iliac bone graft fixed by absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach).We recorded the operation time,the amount of bleeding,bone graft fusion,postoperative erythrocyte sedimentation rate (ESR),Cobb angle,VAS score,and American Spinal Injury Association (ASIA)score to evaluate the surgical results.Results The average operation time was 175-290 min, with an average of (248±42)min.The bleeding volume was 300 -900 mL with an average of (420 ±68)mL.The average follow-up time was (24 ± 5.2 )months,bone fusion rate was 100%,and fusion time was (4.7 ± 0.5 ) months.At the last follow-up,the average Cobb angle was (8.2±3.1)°,VAS was (2.1±0.8),and ESR was (17± 4.2)mm/h.The ASIA neurological functions were all classified as Grade E except for 3 cases of Grade D.All these were significantly different from the preoperative ones.Six patients had complications of different degree but without serious complications.Conclusion One-stage anterolateral debridement,autologous iliac bone graft fixedby absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach)can completely remove the tuberculosis lesions and achieve ideal kyphosis correction,high bone graft fusion,and satisfactory neurological function recovery.Absorbable screws can be safely applied to the bone graft site after debridement.
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Objective To investigate the clinical curative effect of absorbable screw in the treatment of Limbs joint fracture. Methods From May 2009 to May 2011, 86 patients of Limbs joint fracture in our hospital were randomly divided into the observation group and the control group. The observation group were treated with absorbable screw while the control group were given conventional treatment methods of fracture treatment, and the clinical effect of the two groups were observed after treatment. Results The excellent rate was 56. 3% in control group and 96. 3% in observation group. The excellent rate of the clinical treatment in the observation group was significantly better than the control group with a statistically significant difference (P<0. 05). Conclusion The clinical efficacy of absorbable screw for limbs joint frac-ture is significant, and its operation safety is higher. It improves the life quality of patients and it is worth of clinical promotion.
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[Objective]To introduce an operative treatment of complex talar body fracture and discuss the therapeutic effect in the near future.[Method]From March 1999 to January 2003,8 patients of complex talar body fracture in our department were treated.There were 5 males and 3 females with an average age of 28.9 years from 19 years to 46 years.The injuries were caused by fall in 3 cases,traffic accident in 3 cases,crash in 1 case,and on left 5 cases,right 3 cases.Two cases were combined with malleolus fracture and 1 case with open fracture and dislocation.All patients were treated with operation through approach of internal or external malleolus osteotomy and useing Absorbable screw for fixation.[Result]All the patients were followed up 1 to 3 years,average 1.3 year.By the assessment of clinical effects dependingon the complaints,functions and radiological results of the ankle and subtalar joint,4 patients were rated as being excellent,2 patients good,1 fair and 1 poor,the total rate of being excellent and good was 75%.No postoperative avascular necrosis of the talar was seen on radiographies.[Conclusion]Operation through approach of internal or external malleolus osteotomy and Absorbable scrow for fixation is a good method for treatment of complex talar body fracture.
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Objective To study the curative effects of fixation with absorbable screw and fixative stick to treat ankle joint fracture accompanied by ankle joint dislocation.Methods 27 Patients with ankle joint fracture accompanied with ankle joint dislocation were fixed with absorbable screw and fixative stick since 1995 in our hospital.Internal,outer,backankle with SR-PLLA fixation and the distal tibiofibular syndesmosis separation by SR-PGA with absortive screw and fixative stick.Results All 27 Patients were followed up.The fracture healed up in about 10 weeks.All fracture had no displacement during the course of the treatment and no influencing function after operation.They were evaluated with Sarkision criterion.The successful rate was 92 6%.Conclusion SR-PLLA fixation,PGA absorbable screw and fixative stick are ideal fixation in treating ankle joint fracture accompanied by dislocation.