Surgical treatment for ipsilateral femoral neck and shaft fracture / 中国骨伤

OBJECTIVE@#To retrospectively analyze efficacy of single structure internal fixation and double structure internal fixation in the treatment of ipsilateral femoral shaft and neck fracture, and analyze their indications.@*METHODS@#From June 2015 to December 2020, 21 patients with ipsilateral femoral shaft and femoral neck fracture were treated, including 14 males and 7 females, aged 23 to 69 years old with an average of(38.1±12.9) years old. According to different femoral shaft fracture sites, some patients were fixed with cephalomedullary implant for both femoral neck and the femoral shaft(single structure, InterTan or PFNA Ⅱ), some patients were fixed with cannulated screws for the femoral neck and a retrograde locking nail for the femoral shaft (dual structure), and postoperative function and complications were recorded during follow-up. In 10 cases of single-structure fixation, the femoral necks were all basicervical fractures, and the femoral shaft fractures were located in the proximal isthmus;11 cases were double-structure fixation, 9 cases in 11 were basal type of femoral neck, 2 cases in 11 were neck type, and the femoral shaft fractures were located in the isthmus and the distal isthmus.@*RESULTS@#All patients were followed up for 12 to 27 months. No femoral head necrosis, deformity, delay or nonunion occurred in the patients with single-structure fixation, and no delayed union or nonunion occurred in femoral shaft fractures;At the final follow-up, Harris score of patients with single-structure fixation was 91.8±4.1, with 8 cases were excellent and 2 cases were good. The fractures of patients with dual-structure fixation achieved good union without femoral head necrosis, except 1 case of femoral shaft fracture had delayed union;At the final follow-up, Harris score of patients with dual-structure fixation was 92.4±5.9, 7 cases were excellent, 3 cases were good, and 1 case was fair.@*CONCLUSION@#Good reduction and fixation is the key to the treatment of such fractures. Both the single-structure fixation and the dual-structure fixation are good methods, and it should be selected according to the locations of femoral shaft and femoral neck fractures. Single-structure fixation is a good choice for femoral shaft fractures located at the proximal isthmus and basal femoral neck fractures. For isthmus and distal femoral shaft fractures combined with ipsilateral femoral neck fractures, dual-structure fixation is recommended.

Virtual surgical planning is a useful tool in the surgical management of mandibular condylar fractures / 中华创伤杂志(英文版)

PURPOSE@#The aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference.@*METHODS@#This was a prospective randomized controlled study and recruited 50 patients requiring surgical treatment for their mandibular condylar fractures. The inclusion criteria were patients (1) diagnosed with a condylar fracture by two clinically experienced doctors and required surgical treatment; (2) have given consent for the surgical treatment; and (3) had no contraindications to the surgery. Patients were excluded from this study if: (1) they were diagnosed with a non-dislocated or only slightly dislocated condylar fracture; (2) the comminuted condylar fracture was too severe to be treated with internal reduction and fixation; or (3) patients could not complete follow-up for 3 months. There were 33 male and 17 female patients with 33 unilateral condylar fractures and 17 bilateral condylar fractures included. The 50 patients were randomly (random number) divided into control group (25 patients with 35 sides of condylar fractures) and experimental group (25 patients with 32 sides of condylar fractures). Virtual surgical planning was used in the experimental group, but only clinical experience was used in the control group. The patients were followed up for 1, 3, 6 and 12 months after operation. Variables including the rate of perfect reduction by radiological analysis, the average distance of deviation between preoperative and postoperative CT measurements using Geomagic software and postoperative clinical examinations (e.g., mouth opening, occlusion) were investigated for outcome measurement. SPSS 19 was adopted for data analysis.@*RESULTS@#The average operation time was 180.60 min in the experimental group and 223.2 min in the control group. One week postoperatively, CT images showed that the anatomic reduction rate was 90.63% (29/32) in the experimental group and 68.57% (24/35) in the control group, revealing significant difference (X2 = 4.919, p = 0.027). Geomagic comparative analysis revealed that the average distance of deviation was also much smaller in the experimental group than that in the control group (0.639 mm vs. 0.995 mm; t = 3.824, p < 0.001).@*CONCLUSION@#These findings suggest that virtual surgical planning can assist surgeons in surgical procedures, reduce operative time, and improve the anatomic reduction rate & accuracy, and thus of value in the diagnosis and treatment of condylar fractures.

Progress in the Treatment of Logsplitter Injury: An Illustrated Review

Logsplitter injury is an ankle joint injury caused by high-energyaxial violence with significant separation of inferior tibiofibularsyndesmosis. Surgery is the mainstay treatment. The fractureshould be treated in stages depending on the condition of thesoft tissue. The integrity and smoothness of the ankle jointsurface should be restored as much as possible during thesurgery. This article discusses the treatment strategies oflogsplitter injuries. Thorough research of the availableliteratures was done aiming to provide a standard treatmentprotocol. When combined with posterior malleolus fracture,anatomical reduction of posterior malleolus is necessary toreconstruct posterior tibial notch and then lateral malleolus.This reduction sequence is very important. Anatomical lockingplates have been widely used in the fixation of fibular fractures.Anatomical reduction and fixation of the inferior tibiofibularsyndesmosis is the key factor to achieve good functionalresults. There are still some controversies on how to accuratelyjudge the stability of the inferior tibiofibular syndesmosis.Screws are the main method of fixing the inferior tibiofibularsyndesmosis at present. Ankle arthroplasty or anklearthrodesis may be necessary if the cartilage of the ankle jointis extensively damaged or if the ankle joint is severelycomminuted. At present, the therapeutic and prognostic effectsof these injuries are poor. The main influencing factors includethe degree of injury, anatomical reduction of the fracture anddislocation, recovery of ankle stability and the reconstruction ofankle joint surface.

A quantitative biomechanical study of positive buttress techniques for femoral neck fractures: a finite element analysis / 中华医学杂志(英文版)

Background@#Refractory femoral neck fractures cannot be anatomically reduced by closed traction reduction which may affect fracture healing. We evaluated the biomechanical effects of positive, negative, and anatomic reduction of various degrees of displacement in Pauwels I femoral neck fractures by a finite element analysis.@*Methods@#Five reduction models of Pauwels type I femoral neck fracture were established using the Mimics 17.0 (Materialize, Leuven, Belgia) and Hypermesh 12.0 (Altair Engineering, Troy, MI, USA). According to the degree of fracture displacement, there were three models of positive support, an anatomic reduction model, and a negative 2 mm reduction model. Finite element analysis was conducted using the ABAQUS 6.9 software (Simulia, Suresnes, France). The von Mises stress distribution and the stress peak of internal fixation in different models, the displacement between fracture blocks, and the principal strain of the femoral neck cancellous bone model were recorded under the axial stress of 2100 N.@*Results@#The peak von Mises stress on screw of each model was located at the thread of the screw tip. The peak von Mises stress was the lowest at the tip of the anatomic reduction model screw (261.2 MPa). In the positive 4 mm model, the von Mises stress peak was the highest (916.1 MPa). The anatomic reduction model showed the minimum displacement (0.388 mm) between fracture blocks. The maximum displacement was noted in the positive 4 mm model (0.838 mm). The displacement in the positive 3 mm model (0.721 mm) was smaller than that in the negative 2 mm model (0.786 mm). Among the five models, the strain area of the femoral neck cancellous bone was mainly concentrated around the screw hole, and the area around the screw hole could be easily cut.@*Conclusions@#Compared with negative buttress for femoral neck fracture, positive buttress can provide better biomechanical stability. In Pauwel type I fracture of femoral neck, the range of positive buttress should be controlled below 3 mm as far as possible.

The comparative research on the surgical treatment result of complex acetabula fracture assisted by 3D printing technology / 实用医学杂志

Objective To evaluate the advantage of 3D printing technique in treatment of complicated ace-tabula fracture,we compared the early clinical outcomes of surgical treatment for complex acetabula fracture with traditional surgery(group A)and that assisted by 3D printing technique(group B).Methods A prospective anal-ysis of 35 complicated acetabula fractures was performed at our department,13 patients cured assisted with 3D printing technique. The other 22 patients performed traditional surgery. Surgical trauma,systematic inflammation, immediate reduction effect were evaluated by Matta image assessment standard,and rehabilitation functional status evaluated by Harris score system and Merled' Aubigne and Postel Grading standard. Results There were signifi-cant differences between the two groups regarding intraoperative blood loss,postoperative drainage,operation time (P<0.05),and group B was superior to group A.C reactive protein,leucocyte and creatine kinase MM in periph-eral blood in group A were much higher than those in group B at 24 hours postoperatively(P<0.01).The result of reduction of fracture is poor in group A,but excellent rate of reduction is about 84% in group B. The result of Merled' Aubigne and Postel scores grading was superior in group B(P = 0.013). The excellent and good rate of Harris function score in B group was significantly higher than that in group A(P=0.027).Conclusion The treat-ment of complicated acetabula fracture assisted by 3D printing is excellent in short-term follow up,achieving good reduction with limited trauma,long-term prognosis needs to be further followed up.

The Significance of Calcaneal Posterior Tuberosity Fragment Reduction When Treated with Open Reduction in Displaced Intra-Articular Calcaneal Fractures

PURPOSE: We attempt to evaluate the significance of calcaneal posterior tuberosity fragment reduction when treated with surgical open reduction in displaced intra-articular calcaneal fractures. MATERIALS AND METHODS: A total of 90 patients with displaced intra-articular calcaneal fracture, between January 2010 and December 2015, treated with open reduction and internal fixation were enrolled in this study. At postoperative 3 months, we evaluated the reduction state of calcaneal posterior tuberosity fragment by measuring the degree of lateral displacement of the posterior tuberosity fragment on the calcaneal axial view. Moreover, we also evaluated the difference in the calcaneal length and height with the uninjured side on the lateral view of both sides. In addition, we estimated the reduction state of the posterior facet by measuring the degree of gap and step-off on the semi-coronal view of postoperative computed tomography and estimated the restoration of calcaneal angle by measuring the difference in Böhler's and Gissane angle with the uninjured side on the lateral view of both sides. RESULTS: The correlation coefficient with 3 components for evaluating the reduction state of posterior tuberosity fragment and gap and step-off of posterior facet was r=0.538, 0.467, r=0.505, 0.456, r=0.518, and 0.493, respectively, and restoration of Böhler's and Gissane angle was r=0.647, 0.579, r=0.684, 0.630, r=0.670, and 0.628, respectively. The relationship of each component shows a significant correlation as all p-values were <0.01. CONCLUSION: The precise reduction of calcaneal posterior tuberosity fragment developed by the primary fracture line was considered as an important process of anatomical reduction of calcaneal body, including the posterior facet and calcaneal angle restoration.

Application of cosmetic suture technique for reparation and reconstruction in facial emergency surgery / 局解手术学杂志

Objective To investigate the clinical effect of cosmetic suture technique applied in organs of facial emergency surgery. Methods There were 25 patients who were admitted in our hospital from August 2009 to December 2013. After anatomical reduction and functional restoration, they were given surgery with cosmetic suture technique on the base of debridement. Results All of the patients a-chieved good surgical result, the satisfaction is 100%. After the first stage of operation, 23 patients of them were of no obvious scar and good function recovery. The other 2 patiens also got good effects after secondary surgery. Conclusion Cosmetic suture technique pay attaintion to anatomical and functional restoration. It is of equisite technique, slight injury, less scar after operation and it can maximumly get close to the normal tissue structures and achieve the objective of beauty.

Treatment of Tibial Plateau Fractures Using a Locking Plate and Minimally Invasive Percutaneous Osteosynthesis Technique

PURPOSE: To acknowledge the importance of precise reduction of articular surface of tibial plateau fractures and to make a guideline of treatment by evaluating outcomes and effectiveness of using locking plate and minimally invasive percutaneous osteosynthesis technique. MATERIALS AND METHODS: Twenty-nine patients who underwent surgery for tibial plateau fracture from November 2005 to March 2010 were enrolled with 12 months follow-up in a retrograde manner. The Shatzker classification was used to classify fractures, and we used lateral submeniscal approach to make a precise reduction of articular surface. Radiologic evaluation was determined by presence of bone union, malalignment, and reduction loss or joint depression of articular surface. Post-operative infection, time of active movement of the knee joint, time of partial weight loading, and range of motion (ROM) of knee joint were evaluated. Lysholm Knee Score was used for functional evaluation. RESULTS: Bone union took place in all but one case that developed osteomyelitis. Angulation deformity of more than 10degrees and reduction loss or joint depression of more than 5 mm were not observed. There was one case of osteomyelitis and one case of superficial surgical site infection. There were satisfactory clinical results, with an average time of active knee joint movement and weight loading of 6 weeks. The average ROM of knee joint was 125degrees in the last follow up. As for functional evaluation using Lysholm Knee Score, cases showed an average Lysholm Knee Score of 94 which was a satisfactory result. CONCLUSION: In cases of tibial plateau fractures, if a surgeon accurately reduces the articular surface of joint and use minimally invasive locking plate it will help in bone union biologically, reducing the incidence of soft tissue injuries, and biomechanically maintaining the articular surface of the joint, proving itself to be a useful method of treatment.

Anatomically Percutaneous Wiring Reduction in Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures

PURPOSE: To report the method of anatomical reduction and its maintenance by percutaneous wiring reduction in minimally invasive plate osteosynthesis for distal tibial fractures. MATERIALS AND METHODS: 17 cases that were diagnosed oblique, spiral or transverse fracture of distal tibia from August 2007 to February 2010 and were able to anatomically reduce by the method of percutanous wiring reduction in minimally invasive plate osteosynthesis were included in this study. Mean age was 50, and mean follow up period was 18 months. We investigated the period until bone union was achieved, degree of angulation angle, and complications. For postoperative evaluation, Olerud and Molander ankle score and VAS pain score in daily living were checked. RESULTS: The mean varus/valgus angulation after bone union on AP radiograph was 0.9 degrees and the mean anterior/posterior angulation on lateral radiograph was 2.0 degrees The mean Olerud and Molander ankle score was 89.4, and mean pain score due to walk adjacent to metal plate was 0 points. CONCLUSION: By the method of percutaneous wiring reduction in distal tibial fracture, anatomical reduction is easily acquired, and only by wire itself, reduction could be maintained, so that without additional manual reduction, plate could be easily fixed.

Clinical Results of Surgical Treatment of Acetabular Fractures according to Quality of Reduction / 대한정형외과학회잡지

PURPOSE: To analyze postoperative clinical and radiological results of displaced acetabular fractures and to determine the factors affecting the clinical results. MATERIALS AND METHODS: Clinical analysis was performed on 51 patients with displaced acetabular fractures who had been operated on and followed up for a minimum of 1 year. The mean follow-up duration after surgery was 45 months (range, 12 to 67 months). The outcome was analyzed clinically using Postel's clinical grade criteria and radiologically using Mattas roentgenographic grading system. RESULTS: There was a statistical relationship between the type of fracture patterns (Letournel classification) and the degree of immediate postoperative reduction (p<0.05). A comparison of the radiological and clinical results at the last follow-up revealed a good correlation between good or excellent radiology results and good or excellent clinical results (p<0.05). The factors affecting the clinical outcomes of the last follow-up were the type of fracture (Letournel classification), the presence or absence of a femoral head injury and the degree of immediate postoperative reduction. CONCLUSION: The results of this study suggest that the degree of reduction was closely related to the clinical result. Therefore, it is important in the surgical treatment of the acetabular fractures to classify the fractures accurately, reduce the fragments anatomically and minimize the complications.

Treatment of Comminuted Subtrochanteric Fractures of the Femur by High-Energy Trauma

PURPOSE: The purpose is to evaluate the effectiveness of open reduction and internal fixation in comminuted subtrochanteric fractures caused by high energy trauma at a non-osteoporotic young age. MATERIALS AND METHODS: Of all cases of subtrochanteric fractures caused by high energy trauma under 60 years old from February 2000 to February 2004, we analyzed 16 patients who had severe comminuted fractures (Seinsheimer classification type IV, V). The mean age is 43.5 (31~54) years old. Mean follow-up period was 22 (14~38) months. We tried to reduce anatomically as much as possible and fixed firmly using a compression hip screw in all cases. Additional procedures such as interfragmentary screw fixation, cerclage wiring or lateral stabilization plating were performed in 13 cases. Bone grafting was performed in 8 cases. We evaluated bony union rate, time to union, status of reduction, varus deformity and rate of implant failure using a simple X-ray. We also analyzed the clinical result using the Harris hip score including range of motion, pain and limping gait, so on. RESULTS: In all 16 cases, bony union was achieved and the mean time to union was 24 (20~32) weeks. There was no intra-operative complication. Postoperative complications such as loss of reduction, varus deformity, implant failure or infection did not occur. Clinically, the Harris hip score was 98.9 (97~100) points. CONCLUSION: Optimal open reduction and firm internal fixation with or without additional fixation was thought to be a recommendable method of treatment for comminuted subtrochanteric fractures of the femur caused by high energy trauma at a young age.

Results of Surgical Treatment in Schatzker Type VI Tibial Plateau Fracture

PURPOSE: The purpose of this study was to evaluate the factors influencing the results for the treatment of the Schatzker type VI tibial plateau fractures. MATERIALS AND METHODS: Twenty-two cases of the 21 patients in Schatzker type VI tibial plateau fractures were analyzed. Treatment results were analyzed according to the type of fracture (open vs closed), method of operative treatment, angulation more than 5 degree and status of infection. The functional results was evaluated by Hohl's functional criteria. Student t-test was used for the statistical analysis. RESULTS: Functional outcome demonstrated 5 excellent, 8 good, 6 fair and 3 poor results. There was no significant difference in the treatment results between type of fracture, method of operative treatment and status of infection. Among 9 cases with angular deformity of more than 5 degree, 2 showed excellent or good result and 7 showed fair or poor result (p<0.05). There was no significant difference between rate of postoperative infection and the mean period of the clinical bone union (p=0.66). CONCLUSION: Accurate anatomical reduction and rigid fixation is essential for the treatment of Schatzker type VI tibial plateau fractures for the prevention of the angular deformity. And early weight bearing exercise should be controlled for the prevention of loss of reduction and loss of alignment leading to angular deformity.

Treatment of the Intertrochanteric Fractures of the Femur in Elderly Patients: Comparision of Wayne-County Reduction and Anatomical Reduction

PURPOSE: To compare the radiological and clinical results of Wayne-County reduction with anatomical reduction in treatment of the intertrochanteric fractures of the femur in elderly patients. MATERIALS AND METHODS: Among one hundred-three of intertrochanteric fractures treated with 135- degree angled compression hip scresw, eighty three cases treated by Wayne-County reduction (Group 1, 42 cases) and anatomical reduction (Group 2, 41 cases) with at least 1 year follow-up were reviewed. The average pateint ages were 72.4 (65~92) in group 1, 71.6 (65~89) in group 2, respectively. 33 cases (75.2%) in group 1 and 31 cases (77.5%) displayed unstable fractures by Jensen classification. The radiological observation was included neck-shaft angle, penetrating length of lag screw into head, sliding length of lag screw and time of bony union. The clinical results were evaluated by Koval criteria, Kyle's functional evaluation, leg length inequality and complications. RESULTS: There were no significant changes between group 1 and group 2 in stable fractures in the radiological and clinical results. In unstable fractures, the neck-shaft angle averaged 132.2 degree in group 1 and 129.4 degree in group 2 in the final follow-up films. The penetrating length of lag screw into head were 2.2 mm in group 1 and 3.1 mm in group 2 (p<005). But there were little differences in the sliding length of lag screw, the time of bony union and complication rates between groups. In post- operative evaluation of walking abilility by Koval, 31 patients (73.8%) in group 1 and 28 (68.3%) recovered the activity level before injury by the postoperative 1 year follow-up. Leg length discrepancy at final follow-up was 4.1+/-6 mm shortening in group 1 and 6.5+/-8 mm in group 2, respectively. CONCLUSION: Both Wayne-County reduction and anatomical reduction had a favorable results after treatment of stable intertrochanteric fractures of the femur, but Wayne-County reduction may be a better method in treatment of unstable fractures, especially in elderly patients, in which it is difficult to obtain anatomical reduction.

Surgical Treatment of Displaced Acetabular Fractures / 대한정형외과학회잡지

Accurate anatomical reduction of the displaced acetabular fractures has a great clinical importance because acetabulum is related to weight-bearing and their fractures can lead to serious major sequelae. There are controversies and a lot of problems with regard to the management of the displaced acetabular fractures. The purpose of our study is to analyze the clinical results of operative treatment of the displaced acetabular fractures and to establish guidelines for treatment of their fractures. A clinical analysis was performed on 19 patients with displaced unstable acetabular fractures who had been operated on and followed for minimum 1 year period at Asan Medical Center from September 1989 to August 1992. The results were as follows: 1. The most common type was posterior wall fracture according to Letournel's classification. 2. Excellent or good results were obtained in 84% according to Goodwin's assessment method. All of the elementary fracture.s presented excellent or good results, while fair or poor results were observed in some T-shaped fractures or transverse and posterior wall fracture. 3. Complications were observed in 5 cases, including ectopic ossification(2 cases), traumatic arthritis(1 case), avascular necrosis of femoral head(1 case) and deep wound infection(1 case). Those seemed to be related with severe acetabular injury and extensive approach. 4. Kocher-Langenbeck approach was satisfactory for reduction and fixation of posterior column in transverse fracture, while extended iliofemoral approach was necessary for fixation of both column in T-shaped fracture. 5. Reduction of fracture of ilium was prerequisite for reduction of acetabular articular surface. 6. In displaced unstable acetabular fractures, early surgical intervention shich includes accurate anatomical reduction, and rigid internal fixation should be undertaken, and early joint motion should be followed to restore the joint function and to decrease the complication rate.

A Clinical Study of Ankle Fractures / 대한정형외과학회잡지

Through the review of 137 cases of ankle fracture treated and followed up in Department of Orthopedic Surgery, National Police Hospital, we got the following results. 1. Slipping was the most frequent cause of the fractures(45.3%). 2. Supination-external rotation type of Lauge-Hansen classification was more common than any other types(67.9%). 3. 94 cases out of 137 cases were treated by open reduction and internal fixation, and remaining 43 cases were treated conservatively. 4. The average duration of cast immobilization was 7.3 weeks for the operatively treated cases and 9.1 weeks for the conservatively treated cases. 5. The result of treatment was good or excellent in 87 cases(92.6%) of operatively treated 94 cases and in 36 cases(83.7%) of conservatively treated 43 cases. 6. We think that the anatomical reduction of the lateral malleolar or distal fibular fracture is necessary for better end results.

Clinical Study on Trochanteric Fractures of Femur / 대한정형외과학회잡지

The trochanteric region of femur is composed of cancellous bone, and so trochanteric fractures are seldome subject to the complication of non-union or proximal fragment necrosis. Cinicians agree that these fractures should be treated by proper alignment of the fragments and operative internal fixation, but disagreement persists about the type of reduction and the technique of internal fixation. Kaufer said that non-anatomical stable reduction.