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RESUMO: Modelo de estudo: Relato de Caso. Importância do problema: As fraturas panfaciais recebem essa denominação quando os terços faciais apresentam fraturas concomitantes. Com frequência, essas lesões estão relacionadas a danos importantes aos tecidos moles, cominuição e perda de segmentos ósseos e/ou dentários, que podem gerar má oclusão e graves deformidades faciais, visto que etiologia de tal condição se deve à acidentes de alta dissipação de energia. O tratamento das fraturas panfaciais com o uso de fixação interna rígida permite restaurar as funções mastigatórias, bem como os contornos faciais. Comentários: O objetivo desse trabalho é relatar a reconstrução de uma fratura panfacial, envolvendo a mandíbula e com elevado grau de cominuição do complexo zigomático orbitário e do arco zigomático, em uma paciente do sexo feminino, em que acesso hemicoronal e retromandibular foram escolhidos para reconstrução e reestruturação do complexo facial. Conclusão: O correto manejo das fraturas panfaciais, é um dos grandes desafios do cirurgião buco maxilo facial, visto o nível de dificuldade para reestabelecer de maneira satisfatória as condições estéticas e funcionais existentes previamente ao trauma. Diferentes sequências de tratamento vêm sendo propostas, podendo ser utilizadas com sucesso após análise adequada do caso clínico e correta indicação. (AU)
ABSTRACT: Study model: Case Report. Importance of the problem: Panfacial fractures receive this designation when the facial thirds have concomitant fractures. Frequently, these lesions are related to important soft tissue damage, comminution, and loss of bone and/or dental segments, which may lead to malocclusion and severe facial deformities, since the etiology of such condition is due to accidents of high energy dissipation. The treatment of the panfacial fractures with the use of rigid internal fixation allows restoring the masticatory functions, as well as the facial contours. Comments: This study aimed to report the reconstruction of a panfacial fracture, involving the mandible and with a high degree of comminution of the zygomatic or zygomatic arch, in a female patient, whose hemicoronal and retromandibular access were chosen for reconstruction and restructuring of the facial complex. Conclusion: The correct management of panfacial fractures is one of the greatest challenges of the maxillofacial surgeon, given the level of difficulty to satisfactorily reestablish the aesthetic and functional conditions existing before the trauma. Different treatment sequences have been proposed to be used successfully after adequate analysis of the clinical case and correct indication. (AU)
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Humans , Female , Adult , Zygoma , Facial Bones , Facial Injuries , Oral and Maxillofacial Surgeons , Fracture Fixation, Internal , Malocclusion , MandibleABSTRACT
Objectives To evaluate the 3D printed navigation template used to assist axis pedicle lag-screw placement in the treatment of atypical Hangman's fracture(AHF).Methods From May 2015 to January 2017,12 patients with AHF were treated at Department of Orthopedics,The Fourth Peopled Hospital of Zigong.In their operation,the axis pedicle lag-screw placement was assisted by a 3D printed navigation template.They were 8 men and 4 women,aged from 27 to 53 years(average,45.6 years).There were 7 cases of type Ⅰ,4 cases type Ⅱ and one case of type HA according to the Levine-Edwards classification.There were 2 cases of grade D and 12 cases of grade E according to the assessment of America Spinal Injury Association(ASIA).Their preoperative and postoperative neck pain was evaluated by visual analogue scale(VAS);their preoperative and postoperative ranges of cervical motion were recorded and compared.To evaluate the postoperative safety of screws,the insertion point,position within the pedicle,axial angle and sagittal angle of the screws and maximum fracture displacement were compared between actual operation and simulative operation.Results A total of 12 guide plates were designed and printed;a total of 24 lag-screws were placed.All patients underwent surgery uneventfully.They were followed up for 12 to 20 months,with an average of 14.7 months.Two patients with ASIA grade D recovered to ASIA grade E at the last follow-up.All patients showed a significant improvement in neck pain.Their VAS score at 5 days after surgery(5.86±2.02) was significantly lower than their preoperative score(8.29±1.88)(P<0.05) and their VAS score at the last follow-up(1.73±0.87) was also significantly lower than that at 5 days after surgery(P<0.05).Their range of cervical motion at 6 months after surgery was significantly larger than that at 3 months after surgery(P<0.05);their range of cervical motion returned to normal roughly at the last follow-up,showing no significant difference from that at 6 months(P>0.05).Their postoperative X-ray and CT images showed that the dislocation was all corrected.The last follow-up showed no obvious vertebral instability,screw breakage or loosening.Postoperative CT showed that the 24 screws had been located completely in the pedicle(grade 0),indicating that the screw placement was 100% accurate.The postoperative deviation at insertion point(0.70±0.78 mm),deviation within the pedicle(1.3±0.82 mm),axial angle(8.26°±0.88°) and sagittal angle(22.62°±0.86°) of the screws showed no significant differences from the preoperative simulative data(P>0.05).There was a significant difference in the maximum fracture displacement between the preoperative data(3.94±0.38 mm) and the postoperative data(2.21±0.39 mm)(P<0.05).Conclusion The 3D printed navigation template can be used to better assist axis pedicle lag-screw placement in the treatment of AHF,because it ensures safe screw placement,leading to good reduction and fixation and precise match with the preoperative plan.
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Objective To explore a new way assisted by digital technology to establish a quantitative index to assess the matching performance of anatomically contoured plate. Methods We collected the thin-slice CT data of 20 adults with normal tibias who had received 32-slice spiral CT scanning from April 2015 to June 2016. They were 10 males and 10 females, aged from 28 to 52 years (average, 36.2 years). 3D reconstruction of the tibias was performed with Mimics 18.0. Two brands of 8-hole anatomically contoured plate for distal tibia (Kongli versus GE) were digitized. The curve of the plate facing the bone surface was extracted. The operational process of putting the plate curve on the medial surface of the distal tibia was simulated in Rhino 5.0. The volume of the gap between plate curve and bone surface was measured. The mean distance of the gap between plate cure and bone surface was figured out after the volume divided by the plate area. The inverse value of the mean distance of the gap was used as the index for matching performance. The wall thickness analyzing tool in 3-matic Research was used to mark the various thicknesses of the gap with different colors. The matching performances of the 2 brands of plate were assessed and compared according to the matching performance index and nephogram. Results Of the Kongli 8-hole distal tibial plate, the gap volume was 3,834 mm3± 701 mm3, the mean thickness 1.8 mm ± 0.3 mm, and the matching index 0.56 ± 0.10. Of the GE 8-hole tibial plate, the gap volume was 7,690 mm3± 1,503 mm3, the mean thickness 3.0 mm ± 0.6 mm, and the matching index 0.34 ± 0.06. The significant difference in matching performance between the 2 kinds of plate favored the Kongli plate (t=10.402, P <0.01). There were no significant differences in matching per-formance between different genders among the plates of the same brand (P> 0.05). The nephogram showed a large fixed red area at the proximal part in the GE 8-hole tibial plate. Conclusions As this index for matching performance is simple and intuitive, it can be used to assess and compare the matching performances between different kinds of plates. It can be also used before operation to assess the matching performance of a specific plate for a specific patient to avoid mismatch because of individual differences.
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Objective To compare the biomechanical characteristics of medial and lateral locking plates for Schatzker typeⅥfractures of tibial plateau by finite element analysis. Methods A 38 year-old male volunteer was enrolled for CT scan of his lower limbs. His CT images of the left tibial plateau were used for 3D reconstruction of a model of Schatzker type Ⅵ fracture by NX 9.0 software. After the boundary con-ditions were set, a 500 N load was applied to the tibial plateau to simulate the stress on a single leg when an adult weighing 60 kg walked. The displacement and stress on plate and screws were analyzed by Abaqus software. Results The ultimate stress on the model fixated with a medial locking plate was 81.7 MPa, located at the proximal tibiofibular joint surface. The ultimate stress on the model fixated with a lateral locking plate was 487.4 MPa, located at the junction of plate and screws. The ultimate stress on the fibula was much larger in the model fixated with a medial locking plate than in the model fixated with a lateral locking plate. The ultimate displacement was smaller and more homogeneous in the model fixated with a medial locking plate (1.15 mm) than in the model fixated with a lateral locking plate (3.44 mm).Conclusion The Schatzker type Ⅵ fractures of tibial plateau should be fixated with a medial locking plate because it has more biomechanical advantages than a lateral locking plate.
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Objective To investigate the fixation sequence,key points and clinical value of a new minimally invasive surgery for one-stage treatment of femoral and ipsilateral tibial plateau fractures with a rapid reductor.Methods From October 2015 to January 2017,5 patients with femoral and ipsilateral tibial plateau fractures received surgery at our department.They were 4 men and one woman,aged from 23 to 65 years (mean,45.5 years).The femoral fractures were type A in 2 cases,type B in 2 cases and type C in one case according to AO/OTA classification.The tibial plateau fractures were type Ⅴ in 2 cases and type Ⅵ in 3 according to Schatzker classification.After the tibial plateau fractures were first fixated,Kirschner wires were inserted via the femoral condyle and distal tibia.A rapid reductor was used to reduce the tibial plateau and dual plates were implanted by percutaneous minimally invasive internal fixation.Then the same set of rapid reductor was used to treat femoral fractures by antegrade femoral nailing.The bone traction was completed via the femoral condyle and anterior superior iliac spine.The operative time,bone union time,knee functional recovery and hospital stay were recorded.Results The 5 patients were followed up for an average of 10 months (from 7 to 17 months).No delayed union,nonunion or malunion happened of either femoral or tibial plateau fractures.The healing time for femoral fractures ranged from 4 to 8 months,averaging 5.5 months;the union time for tibial plateau fractures ranged from 10 to 14 weeks,averaging 12.0 weeks.The knee flexion averaged 110° (from 95° to 130°).The overall functional recovery was rated as excellent in 2 cases and good in 3 according to the Karlstr(o)m & Olerud criteria.The average hospital stay was 18 days(from 13 to 32 days).Conclusion Minimally invasive surgery with a rapid reductor can treat femoral and ipsilateral tibial plateau fractures at one stage,leading to fine functional recovery of the knee and greatly reduced hospital stay in particular.
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Objective To investigate outcomes of posterior instrumentation and fusion in treating ankylosing spondylitis (AS) combined with lower cervical fractures.Methods A retrospective case series study was made on 53 AS patients combined with cervical fractures or cervical thoracic fractures treated by posterior instrumentation and fusion from January 2006 to January 2013.There were 51 male and 2 female patients.The mean age of patients was 55 years old (range,34-69 years old).All the patients showed significant kyphosis on the thoracolumbar and cervicothoracic junction.A total of 20 patients had neurological dysfunction at different extents.According to the American spinal injury association (ASIA) classification,neurological status was scored as Grade A in 4 cases,Grade B in 5,Grade C in 4 and Grade D in 7.The operation time,total bleeding and decompression status were recorded during the surgery.Reduction,decompression condition and complications were evaluated.The neurological status and bone fusion were recorded at the follow-up.Results All surgeries were well accomplished.Mean surgical time was 3.7 h (range,2.9-5.3 h).Mean total bleeding was 690 ml (range,470-1 600 ml).Two patients died within 1 year follow-up because of internal diseases (1 case caused by respiratory system disease in 13 months postoperatively and 1 case caused by acute myocardial infarction in 15 months postoperatively).The mean follow-up time of other patients was 25 months (range,18-48 months).The CT scan manifested all patients achieved satisfactory fusion,and the mean time span of the fusion was 3.5 months (range,3-6 months) postoperatively.Among the 20 patients with various levels of neurological deficits before operation,the postoperative ASIA score was Grade A in 4 cases,Grade C in 2,Grade D in 4,and Grade E in 10.No instrumentation failure occurred during follow-up.Conclusion The posterior instrumentation and fusion for treating AS combined with cervical fractures can obtain satisfactory neurological results,spinal stabilization and clinical results,and hence an effective clinical problem-solving algorithm for such kind of patients.
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Objective To investigate outcomes of posterior instrumentation and fusion in treating ankylosing spondylitis (AS) combined with lower cervical fractures.Methods A retrospective case series study was made on 53 AS patients combined with cervical fractures or cervical thoracic fractures treated by posterior instrumentation and fusion from January 2006 to January 2013.There were 51 male and 2 female patients.The mean age of patients was 55 years old (range,34-69 years old).All the patients showed significant kyphosis on the thoracolumbar and cervicothoracic junction.A total of 20 patients had neurological dysfunction at different extents.According to the American spinal injury association (ASIA) classification,neurological status was scored as Grade A in 4 cases,Grade B in 5,Grade C in 4 and Grade D in 7.The operation time,total bleeding and decompression status were recorded during the surgery.Reduction,decompression condition and complications were evaluated.The neurological status and bone fusion were recorded at the follow-up.Results All surgeries were well accomplished.Mean surgical time was 3.7 h (range,2.9-5.3 h).Mean total bleeding was 690 ml (range,470-1 600 ml).Two patients died within 1 year follow-up because of internal diseases (1 case caused by respiratory system disease in 13 months postoperatively and 1 case caused by acute myocardial infarction in 15 months postoperatively).The mean follow-up time of other patients was 25 months (range,18-48 months).The CT scan manifested all patients achieved satisfactory fusion,and the mean time span of the fusion was 3.5 months (range,3-6 months) postoperatively.Among the 20 patients with various levels of neurological deficits before operation,the postoperative ASIA score was Grade A in 4 cases,Grade C in 2,Grade D in 4,and Grade E in 10.No instrumentation failure occurred during follow-up.Conclusion The posterior instrumentation and fusion for treating AS combined with cervical fractures can obtain satisfactory neurological results,spinal stabilization and clinical results,and hence an effective clinical problem-solving algorithm for such kind of patients.
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Objective To explore a 3D printing model of fracture restoration which can be used in preoperative planning and design for distal tibiofibular fractures.Methods A retrospective analysis was performed of the 35 patients with distal tibiofibular fracture who had been treated from October 2015 to September 2016 at our department.Bilateral tibiofibular CT scan was performed in all the cases to obtain Dicom data.Using Mimics 15.0 software,cross sections were created at 5 cm,10 cm and 15 cm above the knee joint at the bilateral upper tibiae and marked as PT5,PT10 and PT15.The long and short axles on the left and right sides were measured and compared (LL vs.RL;LS vs.RS).After the STL files for 3D models were generated using Mimics 15.0 software,a real-sized 3D model of the distal tibiofibular fracture and a mirror model of the contralateral tibiofibula were printed.The fracture lines were drawn and preoperative manoeuvre was performed on the mirror 3D printed model.The real operation used the implants preoperatively designed;the actual screw lengths were measured and compared radiographically with those designed in the preoperative manoeuvre.Results All the data were collected of the long and short axles on the 3 cross-sections (PT5,PT10 and PT15) of the left and right sides of the proximal tibia.The samples were paired into 6 groups.The correlation coefficients of paired samples were greater than 0.95,showing an extremely strong correlation.The differences between the left and right sides showed no statistically significance in paired samples of LR-RL and LS-RS groups on PT5,PT10 and PT15 cross-sections (P ＞ 0.05).All the 35 cases received surgical operation.The postoperative X-ray review showed fine agreement between actual surgery and preoperative design in terms of screw length and accuracy.The deviations were in an allowable range,leading to satisfactory internal fixation.Conclusions A mirror 3D model of the healthy side is of clinical value to some extent because it can serve as one for an anatomically reduced fracture which can be used for preoperative manoeuvre and preparation of implants.The contrasts between the long and short axles on the 3 cross-sections may simplify and facilitate comparisons of bilateral similarity,avoid the blindness in direct application of the health side mirror model for preoperative planning.
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Objective To compare the clinical outcomes of percutaneous cannulated lag screws versus posterior buttress plate in the fixation for posterior malleolar fractures.Methods We reviewed the 167 patients who had been treated between January 2010 and December 2014 for ankle fracture involving larger than 25％ of the articular surface of the posterior malleolus.They received posterior malleolus fixation with percutaneous cannulated lag screws or with a buttress plate.In the cannulated screw group (84 patients),there were 47 males and 37 females,aged from 23 to 72 years (average,49.7 ±9.1 years),and 39 cases of type B and 45 ones of type C according to the Dennis-Webber classification.In the buttress plate group (83 patients),there were 38 males and 45 females,aged from 31 to 69 years (average,52.3 ± 8.3 years),and 45 cases of type B and 38 ones of type C according to the Dennis-Webber classification.At 6 and 12 months postoperation and the final follow-up,the ankle motion was evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) score and range of motion (ROM).Results The average operation time for the cannulated screw group was significantly shorter than for the buttress plate group (Z =-9.145,P ＜ 0.001).No fracture nonunion,reduction loss or incision infection happened in either group.In the cannulated screw group,we detected malunion with a step-off beyond 2 mm in 5 patients,and penetration of one cannulated lag screw into the tibiofibular syndesmosis in 3 patients.In the buttress plate group,we detected toe flexion contracture in 4 patients,and uncomfortable feeling in ankle motion in 7 patients.At the final follow-up,X-rays and CT scans in the 2 groups showed no obvious post-traumatic osteoarthritis of the ankle.There were no significant differences between the 2 groups regarding the AOFAS scores at 6 and 12 months postoperation and the final follow-up(P ＞ 0.05);the AOFAS scores at the final follow-up for all the patients were significantly different from those at 6 and 12 months postoperation (P ＜ 0.05).At the final follow-up,there were no significant differences between the 2 groups regarding ROMs of dorsal flexion,plantar flexion,varus or valgus (P ＞ 0.05).Conclusions As there are no significant differences between the percutaneous cannulated lag screws and posterior buttress plate in AOFAS score and ROM of the ankle after fixation for posterior malleolar fractures,the 2 fixation methods can both achieve good clinical outcomes.Fixation with cannulated lag screws has advantages of indirect reduction and minimal invasion but also a disadvantage of uncertain quality of reduction;fixation with buttress plates has an advantage of anatomical reduction under direct vision but also shortcomings of relatively large invasion and high cost.
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Objective To compare the radiographic and clinical outcomes of uniaxial and polyaxial locking plates used in the treatment of complex intraarticular calcaneal fractures.Methods A retrospective comparative study was performed on the 50 patients with intraarticular calcaneal fracture (Sanders types Ⅲ and Ⅳ) who had been treated by uniaxial locking plates (n =26) or polyaxial locking plates (n =24) between January 2013 and June 2015.Operation time,intraoperative bleeding,union time,radiological and functional outcomes and functions by the Maryland foot score were compared between the 2 groups.Results All the patients were followed up for 12 to 44 months(average,20.8 months).There were no significant differences between the 2 groups in average operation time (105.2 ± 18.2 min versus 95.5 ± 17.7 min),average intraoperative bleeding (125.2 ±23.4 mL versus 120.3 ±21.5 mL),or union time (12.1 ± 3.7 weeks versus 11.8 ± 3.7 weeks) (P ＞ 0.05).All patients obtained bony union.The polyaxial locking plates group displayed significantly better B(o)hler and Gissane angles at 3 and 12 months after operation than the uniaxial locking plates group (P ＜ 0.05).Evaluated by the Maryland foot score,the excellent and good rate for the polyaxial locking plates group [91.7％ (22/24)] was insignificantly higher than that for the uniaxial locking plates group [84.6％ (22/26)] (P =0.267).Conclusions Both uniaxial locking and polyaxial locking plates can lead to satisfactory therapeutic outcomes for complex intraarticular calcaneal fractures,but polyaxial locking plates may be superior in stability and functional recovery.
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<p><b>OBJECTIVE</b>To investigate the clinical results of scapula fractures with lateral incision combined with bridge internal fixation system.</p><p><b>METHODS</b>From October 2012 to December 2016, 20 cases of scapular fractures were treated through the lateral incision combined with bridge fixation system, including 15 males and 5 females, with an average age of 31.6 years old(ranged, 21 to 52 years old). Fourteen cases were scapular body fracture, 10 were scapular neck fracture, 6 were scapular fracture, 1 was acromion fracture, 1 was coracoid fracture, 4 were the glenoid rim fracture, 3 were the glenoid fossa fracture. The operation time ranged from 4 to 15 d after injury with an average of 10 d.</p><p><b>RESULTS</b>All 20 cases were followed up for 3 to 24 months with an average of 15 months. Wound infection occurred in 2 cases after operation, and was healed after wound debridement and change dressing; no osteomyelitis, iatrogenic nerve injury, breakage of internal fixation, fracture displacement, joint stiffness occurred. Callus growth was observed at the fracture site 3 months after operation, the fracture healing time was 4 to 7 months, fracture healing was good without delayed union or malunion. According to Hardegger shoulder score, the results were excellent in 12 cases, good in 6 cases, moderate in 2 cases.</p><p><b>CONCLUSIONS</b>Lateral incision approach combined with bridge internal fixation system for scapula fractures has the advantages of easy operation, revealed clearly, and the incision can be arbitrary to extend on both sides, to provide favorable conditions for the reduction and fixation of fracture. Bridge combined internal fixation system has the advantages of flexible operation, reliable fixation strength, is a good choice for treatment of scapula fracture.</p>
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Objective To evaluate the biomechanical characteristics of 4 fixation methods (single reconstruction plate,dual reconstruction plates,single cannulated screw and dual cannulated screws) in the treatment of pubic symphysis disruption.Methods Miniature spiral CT scans were performed on the complete pelvis in 5 healthy volunteers.The primary two-dimensional CT scan data at Dicom format were imported into software Mimics 15.0 for three-dimensional reconstruction of bilateral hips and sacrums.The finite element model of skeletal pelvis was obtained by grid partitioning and assignment using software Abqus 6.13.Models of pubic symphysis disruption were simulated by cutting off the unilateral sacroiliac ligament,sacral spine ligament,sacral tuberosity ligament,pubic ligament and pubic arch.Four implants(single reconstruction plate,dual reconstruction plates,single cannulated screw and dual cannulated screws) were simulated and emplaced onto the models according to standard surgical procedures.Compressive and rotational loads were implemented in all models for finite element analysis.The biomechanical properties were recorded and analyzed,including construct stiffness,micromotion of the pubic symphysis and yon Misses stress.Results Under vertical load,the space of pubic symphysis disruption ＞ 25 mm.The vertical stiffness and rotational construct stiffness of the pelvis decreased significantly from 442.738 ±29.946 N/mm and 10.118 ± 1.432 N · m/Deg in the normal group to 14.754 ±0.876 N/mm and 0.328 ±0.119 N · m/Deg,respectively.Dual reconstruction plates and dual cannulated screws displayed the best vertical tensile strength;their construct stiffness achieved 117.647 ±9.193 N/mm and 131.443 ±4.348 N/mm,respectively.Under anti-rotation load,dual cannulated screws displayed the best performance because they rebuilt 68.6％ of the whole structural stiffness.For the local stability of the pubic symphysis,dual reconstruction plates showed a strong local anti-rotation capability and dual cannulated screws a good local anti-tensile capability.The displacement in the dual cannulated screws group was only-0.240 ±0.119 mm under vertical load while the angular displacement in the dual reconstruction plates group only 0.218°±0.182°.Single reconstruction plate endured the maximum yon Misses stress which was obviously concentrated.Conclusion Dual cannulated screws may have biomechanical advantages for treatment of pubic symphysis disruption.
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As locking plate is widely used in periarticular and comminuted fractures as well as in fixation of osteoporotic bone,the events involving difficulty in removal of a locking plate increase gradually.Little research addresses the difficulty in implant removal.Stripping of the recess of the screw head,cross-threading between threads in the screw head and screw hole and cold welding are the main causes for difficulty in removing screws from a locking plate.Skills for implant removal include simple ones that require no use of special devices and complex ones that require use of special devices.Difficult implant removal will result in lengthened operation time,increased risk of secondary invasive surgery,residues of metallic shavings and so on.Prevention is the most effective countermeasure.This review summarizes the cause for difficult removal of locking plate and screws as well as the removing skills to help orthopedic surgeons prevent and respond to the difficulties intraoperatively.
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<p><b>OBJECTIVE</b>To compare the clinical outcomes of minimally invasive percutaneous pedicle screw fixation and open surgery in the treatment of thoracolumbar fracture.</p><p><b>METHODS</b>A retrospective study of patients who had undergone surgery for thoracolumbar fracture from June 2014 to December 2014 was performed. Sixty-one cases were included and 29 cases were treated by minimally invasive percutaneous pedicle screw fixation (minimally invasive group) and 32 cases were treated by the traditional open pedicle screw fixation(open group). The differences in the total length of the incision, intraoperative fluoroscopy times, operative time, blood loss, the preoperative and postoperative visual analogue scale(VAS), postoperative bedridden time and hospital stay were compared. And the preoperative and postoperative anterior vertebral body height and Cobb angle of the kyphosis were also compared.</p><p><b>RESULTS</b>Compared with the open group, the total length of incision was smaller and intraoperative blood loss was less, bedridden time and hospital stay were shorter, and pain of the wound was less in the minimally invasive group. Postoperatively, the anterior vertebral body height was retorted and the Cobb angle of the kyphosis was corrected obviously in both groups. But no significant difference in the imaging results was found between two groups(>0.05).</p><p><b>CONCLUSIONS</b>Minimally invasive percutaneous pedicle screw fixation has the similar fixation efficacy with open surgery in treating thoracolumbar fracture. However, it can avoid extensive muscle stripping, and obviously reduce the surgical incision, operative time, postoperative pain, bedridden time and hospital stay. According to the clinical efficacy, it is worthy of clinical application.</p>
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Objective To investigate the treatment of perinail refracture after surgery of proximal femoral fracture.Methods From January 2010 to January 2015,we treated perinail fractures in 31 patients who had undergone surgery for proximal femoral fracture.They were 11 men and 20 women,with an average age of 75.6 years (range,from 24 to 87 years).On average,their refracture occurred 9.4 months after primary fixation (range,from 3 to 60 months).With reference to the Vancouver classification of peri-prosthestic refractures in the proximal femur and the position and bone quality of perinail refractures,we tried to classify the perinail fractures and chose different treatment protocols accordingly.In our cohort,6 were type A,5 type B,15 type C,and 5 type D.Type A cases were treated conservatively,and types B and C cases with locking compression plate or less invasive stabilization system.In one case of type D,dynamic hip screws were implanted to fixate the femoral neck fracture after removal of the original intramedullary nail,and hip replacement was conducted in the other 4 after removal of the original intramedullary nail.Results The operation time averaged 2.1 hours (range,from 1.6 to 3.0 hours) and intraoperative bleeding 600 mL (range,from 150 to 800 mL) in this cohort.Of them,27 were followed up for an average of 15 months (range,from 12 to 24 months),giving a follow-up rate of 87.1％ (27/31).Six type A fractures obtained bone union after protected weight-bearing walking for 12 weeks.All the 16 fractures of types B and C healed after an average period of 4.2 months (range,from 3 to 6 months).Of the 5 type D fractures,one obtained bone union 12 weeks after change into dynamic hip screwing and 4 had fine functional recovery after hip replacement.No infection,nonunion,or implants failure occurred.Conclusions We have set an exploratory classification system for the perinail refractures at the proximal femur with reference to the Vancouver classification of peri-prosthestic refractures.Our classification can provide effective guidance for the treatment of perinail refracture after surgery of proximal femoral fracture.
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Objective To discuss the clinical results of lateral locking plate combined with bone grafting in the treatment of distal femoral fractures in the elderly.Methods Between January 2006 and December 2013,112 senile patients with distal femoral fracture were treated at our department by lateral locking plate combined with bone grafting.They were 16 men and 96 women,aged from 67 to 85 years (average,76.1 years).By AO classification,48 cases were type 33-A1,11 type 33-A2,3 type 33-A3,7 type 33-B1,4 type 33-B2,32 type 33-C1,and 7 type 33-C2.All of them had a previous history of osteopenia.By the Singh index classification,22 cases were rated as grade Ⅰ,74 as grade Ⅱ,13 as grade Ⅲ,and 3 as grade Ⅳ.Postoperatively,the patients conformed to regular follow-up,accepted functional rehabilitation and continued medication for osteopenia.Radiographic examinations were conducted to observe fracture healing.At the last follow-up,the function of involved knee was assessed according to the criteria by Karlstrom and Olerud.Results All the 112 patients completed their follow-ups,ranging from 10 to 48 months (average,16 months).All fractures united primarily after an average of 4.2 months (range,from 3.5 to 5.0 months).According to the criteria by Karlstrom and Olerud,93 cases were rated as excellent,10 as good and 9 as fair,giving a good-to-excellent rate of 92.0％.No such complications as nonunion,malunion,plate breakage,or screw loosening were observed during the follow-ups.Conclusion Lateral locking plate combined with bone grafting is effective for the treatment of distal femoral fractures in the elderly,if followed by postoperative anti-osteopenia therapy and early functional exercises.
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As fraturas da diáfise do úmero (FDU) representam 3 por cento das fraturas do aparelho locomotor; o terço médio da diáfise direita é o mais acometido. Seu tratamento é, na sua maioria, realizado por meio de métodos não cirúrgicos, mas as indicações cirúrgicas nas FDU são adotadas em situações cada vez mais frequentes. A diversidade de opiniões torna difícil o consenso sobre qual o tipo de osteossíntese, qual a técnica cirúrgica, a quantidade e a qualidade dos materiais de síntese a serem utilizados. Temos a impressão de que o melhor método para o tratamento cirúrgico das FDU está longe de ter um consenso entre os especialistas. Acreditamos que os métodos menos invasivos e que privilegiam a estabilidade relativa são os mais adequados, pois complicações mais temidas são menos frequentes.
Humeral shaft fractures (HSF) represent 3 percent of fractures of the locomotor apparatus, the mid-third section of the shaft being the most commonly affected. In the majority of cases, it is treated by non-surgical methods, but surgical indications in HSF are increasingly being adopted. The diversity of opinions makes it difficult to reach a consensus regarding to the type of osteosynthesis, surgical technique, and quantity and quality of the synthesis materials to be used. It would appear that specialists are far from reaching a consensus as to the best method for the surgical treatment of HSF. We believe that less invasive methods, which favor relative stability, are the most appropriate methods, as the most feared complications are less frequent.
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Humans , Fracture Fixation, Internal , Humeral Fractures/classification , Humeral Fractures/diagnosis , Humeral Fractures/therapy , Orthopedic Procedures , OrthopedicsABSTRACT
Objective To discuss operative treatment method for displaced acetabular fractures so as to improve the curative effects.Methods A retrospective study was done on data of 46 patients with displaced acetabular fractures treated operatively from June 2000 to September 2008.According to Letournel-Judet classification,there were eight patients with posterior column fractures combined with posterior walk fractures,four with anterior column fractures combined with posterior wall fractures,11 with transverse fractures combined with posterior wall fractures,eight with type T fractures and 15 with doublecolumn fractures.All patients were treated with open reduction and internal reconstructive plate fixation through Kocher-Langenbeck,iloinguinal or anteroposterior approaches respectively.Results All patients were followed up for 6 months to 8 years(average 3.9 years).According to modified Merle d' Aubigne and Postel score criteria,the result was excellent in 23 patients,good in 14,fair in 7 and poor in 2,with excellence rate of 80%.Postoperative complications included fat liquefaction in two patients(4%),iatrogenic sciatic nerve injury in two(4%),femoral head necrosis in three(7%),heterotopic ossification in three(7%)and traumatic arthritis in four(9%),with no operative death or nonunion occurred.Conclusions Preoperative accurate assessment of fracture type and displacement direction,appropriate selection of operation time and surgical approach as well as good operative reduction and internal fixation are key to providing satisfactory outcome for displaced acetabular fractures.
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Objective To investigate the clinical value and relating problems in treating atlantoaxial instability by using transpedicular instrumentation with fusion. Methods The study reviewed 18 patients (11 males and 7 females, at age range of 13-82 years, mean 46.5 years) with atlantoaxial instability undergone transpedicular screw internal fixation with bone grafts fusion. There were 15 patients with type Ⅱ odontoid fractures, two with traumatic disruption of transverse atlantal ligament and one with fracture of the anterior ring of C1, all of which were associated with atlantoaxial subluxation or obvious instability. Preoperative JOA score was 6-13 points (average 9.5 points). Results The operation lasted for mean 115 minutes (range 75-180 minutes), with intraoperative blood loss of mean 235 ml (range 130-450 ml). One patient presented intraoperative plexus venous bleeding during removal of lower edge of the posterior arch of atlas and was treated with hemostasis using compession of gelatin sponge. All the patients were followed up for a mean period of 13.5 months (6-38 months), which showed no complications including infection, loosening or breakage of internal fixators or neurovascular injury related to internal fixation. Postoperative JOA score was 12-17 points (average 14.5 points). Reduction and solid fusion of the bone graft were achieved satisfactorily in all patients. Conclusions Posterior transpedicular screw internal fixation with bone grafts fusion can achieve good reduction, reliable fixation, high fusion rate and is a reliable method to manage atlantoaxial instability. Correct selection of the indication, familiarity with local anatomy and mastery of the operation technique are key to a satisfactory curative effect.
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Objective To evaluate the secondary internal fixation plus bone grafting for salvage of failed internal fixation for intertrochanteric hip fractures. Methods Between January 2001 and March 2008, 25 patients with intertrochanteric fractures who had suffered from failed initial internal fixation were treated with secondary open reduction and internal fixation and bone auto grafting. They were 15 men and 10 women, with a mean age of 50 (17 to 72) years. The mean interval between the initial operation and the revision was 12 (4 to 27) months. The failure of original internal implants involved the dynamic hip screw (DHS) in 12 patients, the dynamic condylar screw (DCS) in 3, the angular blade plate (ABP) in 1, the cephalomedullary nail in 3 and the cannulated screw in 6. The replacement of internal implants included PFN in 12 eases, DCS in 7, DHS in 4 and ABP (95°) in 2. Results The mean follow-up was 24 (6 to 84) months. The revisions were uneventful. Of the 25 nonunions, 24 healed (96.0%). The postoperative mean hip rating (Harris score) for the hip joint was 87(35 to 100) points. The X-ray films at the last follow-up revealed the coLlodiaphyseal angle averaged 120° ( 110° to 140°). No avascular necrosis of the femoral head or hip degeneration was found. Conclusion In properly selected patients, secondary internal fixation with bone grafting for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.