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1.
Rev. cuba. ortop. traumatol ; 35(2): e345, 2021. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1357334

ABSTRACT

Introducción: Las lesiones traumáticas con pérdida de cobertura cutánea de la región del tobillo y pie, constituyen un gran reto para el cirujano ortopédico por la exposición y destrucción de tejidos nobles, difíciles de solucionar por ser una zona que presenta escaso tejido adiposo, múltiples tendones, poco volumen muscular, varias prominencias óseas y piel poco elástica. Objetivo: Presentar el colgajo sural de flujo reverso como una buena alternativa para tratar la fractura conminuta cerrada de tibia con pérdida masiva de la piel del tobillo y calcáneo en toda su circunferencia, incluida la almohadilla adiposa de la cara plantar. Presentación del caso: Se presenta paciente de 24 años que sufrió accidente de tránsito con fractura conminuta y cerrada de tibia derecha, además de una herida tipo colgajo que dejó expuesto el calcáneo y la región del tobillo. Luego de colocar fijador externo RALCA para fijar la fractura, se realizó colgajo sural en isla de flujo reverso para cubrir el defecto en la cara plantar y posterior del calcáneo, más injerto libre de piel tomado de la cara antero externa del muslo ipsilateral. Estos procedimientos fueron realizados en dos tiempos quirúrgicos. Conclusiones: El colgajo sural de flujo reverso demostró ser una de las mejores alternativas para la cobertura de lesiones desde el tercio medio de la pierna hasta el pie, por lo que debería ser conocido no solo por cirujanos plásticos, sino también por cirujanos ortopédicos y traumatólogos que lo incorporen a su arsenal terapéutico para su realización(AU)


Introduction: Traumatic injuries with loss of skin coverage of the ankle and foot region constitute great challenge for the orthopedic surgeon due to the exposure and destruction of noble tissues, difficult to solve because this area has little adipose tissue, multiple tendons , little muscle volume, several bony prominences and not very elastic skin. Objective: To establish that the reverse flow sural flap is a good alternative to treat closed comminuted fracture of the tibia with massive skin loss of the entire circumference of the ankle and calcaneus, including the plantar face fat pad. Case report: We report the case of a 24-year-old patient who suffered a traffic accident with a comminuted and closed fracture of the right tibia, as well as a flap-type wound that exposed the calcaneus and the ankle region. After placing RALCA external fixator to fix the fracture, a reverse flow island sural flap was made to cover the defect on the plantar and posterior aspect of the calcaneus, and a free skin graft taken from the anterior external aspect of the ipsilateral thigh. These procedures were performed in two surgical stages. Conclusions: The reverse flow sural flap proved to be one of the best alternatives for the coverage of injuries from the middle third of the leg to the foot, which is why it should be known not only by plastic surgeons, but also by orthopedic surgeons and traumatologists and to incorporate this alternative into their therapeutic arsenal(AU)


Subject(s)
Humans , Female , Young Adult , Surgical Flaps/surgery , Calcaneus/injuries , Heel/injuries , Fractures, Comminuted
2.
Rev. Odontol. Araçatuba (Impr.) ; 42(3): 45-49, set.-dez. 2021. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1291672

ABSTRACT

Os ferimentos por arma de fogo (FAF) são um grande problema de saúde pública. Na face, a mandíbula é o local de maior incidência, sendo a região de corpo mandibular a mais atingida e as lesões aos tecidos moles frequentemente a ela associadas. Em alguns casos, tais ferimentos apresentam-se de difícil resolução, sobretudo, em casos de fraturas cominutivas e lesões de tecidos moles com alta complexidade. Isso torna o atendimento desses pacientes um desafio para cirurgiões buco-maxilo-faciais. Desta forma, o objetivo deste artigo é relatar um caso de FAF em terço inferior da face, com comprometimento de tecidos moles e mandíbula, pela equipe de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Geral do Estado - Bahia. Paciente de 28 anos de idade, sexo feminino, vítima de FAF em terço inferior da face, por disparo acidental de espingarda. Ao exame clínico, pode-se observar ferimento perfuro-contuso em região de mandíbula e fratura cominutiva de corpo e ângulo mandibular à direita. A paciente foi submetida à cirurgia para remoção de fragmentos ósseos/corpos estranhos, fixação dos cotos com placa de reconstrução 2.4mm e sutura dos planos, em mesmo tempo cirúrgico, reestabelecendo a função da mandíbula. Portanto, devido à fisiopatologia variável dos FAF na mandíbula, não se indica um único padrão de tratamento para as fraturas cominutivas. Além disso, é indispensável o emprego de protocolos de limpeza cirúrgica imediata e antibioticoterapia nos casos com alto grau de cominuição, bem como, sugere-se realizar o tratamento definitivo o mais breve possível(AU)


Firearm injuries (FIs) are a major public health problem. On the face, the mandible is the place with the highest incidence of this trauma, with the mandibular body region being the most affected and the lesions to the soft tissues frequently associated with it. In some cases, such injuries are difficult to resolve, especially in cases of comminuted fractures and soft tissue injuries with high complexity. This makes the care of these patients a challenge for oral and maxillofacial surgeons. Thus, the objective of this article is to report a case of care for a FAF victim in the lower third of the face, with soft tissue and mandible involvement, by the Maxillofacial Surgery and Traumatology team at the Hospital Geral do Estado - Bahia. 28-year-old female patient, victim of FAF in the lower third of the face, due to acidental shotgun firing. On clinical examination, a perforated-blunt wound can be seen in the mandible region and comminuted fracture of the body and angle of the mandible on the right. The patient underwent surgery to remove bone fragments / foreign bodies, fix the stumps with a 2.4 mm reconstruction plate and suture the planes, at the same surgical time, reestablishing the function of the mandible. Therefore, due to the variable pathophysiology of FAF in the mandible, a single treatment pattern is not indicated for comminuted fractures. In addition, it is essential to use immediate surgical cleaning protocols and antibiotic therapy in cases with a high degree of comminution, as well as, it is suggested to carry out the definitive treatment as soon as possible(AU)


Subject(s)
Humans , Female , Adult , Wounds, Gunshot , Soft Tissue Injuries , Fractures, Comminuted , Oral and Maxillofacial Surgeons , Fractures, Bone , Jaw Fractures , Mandible , Anti-Bacterial Agents
4.
Article in Chinese | WPRIM | ID: wpr-921918

ABSTRACT

OBJECTIVE@#To compare the effects of tension band combined with patellar cerclage and memory alloy patellar concentrator fixation in the treatment of comminuted fracture of the lower pole of patella.@*METHODS@#From July 2015 to July 2019, 60 patients with distal patellar fracture were treated and were divided into two groups according to different operation methods. In group A, 30 patients were fixed with memory alloy patellar concentrator (NiTi PC), 17 males and 13 females, aged 20 to 71 (39.4±9.9) years, including 19 cases of falling injury, 9 cases of traffic injury and 2 cases of sports injury. The time from injury to operation was 10 to 75 (33.1±7.8) hours; 30 cases in group B were fixed with tension band andcerclage, 15 males and 15 females, aged 21 to 76 (38.6±10.2) years, including 17 cases of falling injury, 12 cases of traffic injury and 1 case of smashing injury. The time from injury to operation was 10 to 91 (34.5±9.1) hours. The curative effects of two groups were observed and compared.@*RESULTS@#All 60 patients were followed up for 9 to 30 months. There was no significant difference in intraoperative bleeding, operation time, follow-up time and fracture healing time between the two groups. Six months after operation, according to the Bostman function score of knee joint:30 cases in group A, the total score was 28.6±4.7, of which 26 cases were excellent and 4 cases were good. The total score of 30 cases in group B was 25.5±4.4, of which 20 cases were excellent, 8 cases were good and 2 cases were poor. There were significant differences in Bostman total score and curative effect evaluation between two groups (@*CONCLUSION@#Memory alloy patellar concentrator is strong and reliable in the treatment of inferior patellar fracture. It can take early rehabilitation exercise after operation, with good recovery of joint function and range of motion and less complications.


Subject(s)
Adult , Aged , Bone Wires , Case-Control Studies , Female , Fracture Fixation, Internal , Fractures, Bone/surgery , Fractures, Comminuted/surgery , Humans , Male , Middle Aged , Patella/surgery , Treatment Outcome , Young Adult
5.
Article in Chinese | WPRIM | ID: wpr-879453

ABSTRACT

OBJECTIVE@#To explore clinical effect of locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with bone defects.@*METHODS@#Totally 92 patients of open and comminuted tibial fractures with bone defects were chosen form January 2018 to July 2019, and randomly divided into external fixation group and internal fixation group, 46 patients in each group. In external fixation group, there were 29 males and 17 females, aged from 25 to 62 years old, with an average of (37.45±10.92) years old;according to AO classification, 15 patients were type A, 22 patients were type B and 9 patients were type C;according to Gustilo classification, 21 patients were typeⅡ, 10 patients were type ⅢA, 10 patients were type ⅢB, 5 patients were type Ⅲ C;treated by fracture reduction with locking plate external fixation. In internal fixation group, there were 31 males and 15 females, aged from 23 to 60 years old, with an average of(36.88±10.64) years old;according to AO classification, 18 patients were type A, 20 patients were type B and 8 patients were type C; according to Gustilo classification, 22 patients were typeⅡ, 11 patients were type ⅢA, 7 patients were type ⅢB, 6 patients were type Ⅲ C;treated by traditional open reduction with plate internal fixation. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time and postoperative complications between two groups were observed and compared, bone mineral density, osteocalcin, blood calcium and phosphorus before operation and 1 month after operation.@*RESULTS@#All patients were followed up from 12 to 18 months with an average of (14.92±2.46) months. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time of external fixation group were significantly better than that of internal fixation group(@*CONCLUSION@#Locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with severe post-traumatic bone defects has advantages of less trauma, reliable fixation, shorter fracture healing time, and could improve bone metabolic activity with less postoperative complications.


Subject(s)
Adult , Bone Plates , External Fixators , Female , Fracture Fixation , Fracture Fixation, Internal , Fractures, Comminuted/surgery , Humans , Male , Middle Aged , Technology , Tibial Fractures/surgery , Treatment Outcome , Young Adult
6.
Article in Chinese | WPRIM | ID: wpr-879415

ABSTRACT

OBJECTIVE@#To investigate the related factors of aseptic necrosis of femoral head after closed reduction and internal fixation of femoral neck fracture.@*METHODS@#From January 2009 to January 2016, 236 patients with femoral neck fracture were treated with closed reduction and internal fixation with 3 hollow lag screws, including 111 males and 125 females, aged from 19 to 89 (50.17±12.88) years. According to the follow-up results, the correlation of aseptic necrosis of femoral head was analyzed. Univariate analysis of age, gender, injured side, body weight, injury mechanism, preoperative waiting time, Garden classification and whether there was comminution of femoral neck cortex was conducted to obtain the independent variables with significant difference. Then binary logistic regression analysis was conducted to explore the independent risk factors of avascular necrosis of femoral head.@*RESULTS@#The average follow-up period of 236 cases was 4.58 years. There were significant differences in the range of injury (24.69% vs. 5.16%, @*CONCLUSION@#High energy injury, preoperative waiting time (>48 h) and comminution of femoral neck cortex were independent risk factors for aseptic necrosis of femoral head. In addition, cortical comminution on the pressure side and tension side of the femoral neck is a strong prognostic risk factor for aseptic necrosis of the femoral head, because it indicates a more serious and complex injury mechanism.


Subject(s)
Aged , Female , Femoral Neck Fractures/surgery , Femur Head Necrosis/surgery , Femur Neck , Fracture Fixation, Internal/adverse effects , Fractures, Comminuted , Humans , Male , Risk Factors
7.
Prensa méd. argent ; 106(10): 602-604, 20200000. fig
Article in English | LILACS, BINACIS | ID: biblio-1362562

ABSTRACT

Introduction: Decision making in determining management of post-trauma patient is very important, especially for traumatic in the small bones, fingers and toes. The global predictor to determine the management of retaining or amputating the limb is using the Mangled Extrimity Severity Score (MESS) scoring system, values above 7 are the indication for amputation. The decision maker have to pay attention for the end result of the actions which were performed in the initial management. Material and Methods: One case is reported from Orthopaedic emergency department Hospital in Makassar, South Sulawesi, Indonesia. A 39-year old male with motor vehicle accident trauma at left foot region since 6 hours before admitted to hospital, later was diagnosed with open comminutive fracture shaft proximal phalang of left 5th toe, the Mangled Extrimity Severity Score (MESS) was 8. Patient underwent emergency debridement and retained the toe by performed Open Reduction Internal Fixation (ORIF) K-Wire. Results: This patient has a good clinical outcome by following up 2 weeks and 8 months after surgery by retain the affected side with debridement and Open Reduction Internal Fixation (ORIF) K-Wire. Patient can ambulate normally with full weight bearing, and there is no difficulty to wearing shoe or sandal. Conclusions: Determination of action by retaining the traumatized limb needs to be considered for the good of the patient, but it is necessary to provide informed consent to the patient and family that there will be a possibility of tissue death with the worst possibility of limb amputation


Subject(s)
Humans , Male , Adult , Toe Joint/surgery , Bone Wires , Injury Severity Score , Fractures, Comminuted/surgery , Foot Injuries/therapy , Debridement , Fracture Fixation, Internal
8.
Prensa méd. argent ; 106(8): 496-502, 20200000. fig, tab
Article in English | LILACS, BINACIS | ID: biblio-1363793

ABSTRACT

Introduction: Comminuted distal radius fracture is one of the fractures that difficult to reduce. This study aimed to compare Patient-Rated Wrist Evaluation (PRWE) score between plating on second and third metacarpal groups. Methods: This study used a retrospective analytic research design with a sample of twenty seven cases of distal radius comminutive fractures that have been treated using dorsal distraction plating. Fifthteen cases with distal fixation in second metacarpal and twelve cases in third metacarpal. Data were then analyzed using the Mann-Whitney test. Results: The mean Pain scores in the second metacarpal and third metacarpal groups, respectively were 5.73 compared to 6.17. While the mean score of Function in the second metacarpal group and the third metacarpal group, respectively 12.67 compared to 13.83. The total PRWE score in the second metacarpal group was 18.40 compared to the third metacarpal group which was 20.0 (p>0.05). Conclusions: Patients with distal radius comminuted fracture treated using dorsal distraction plating with distal fixation in second metacarpal showed higher mean Pain, Function and total PRWE compared to third metacarpal, but there were no significant differences


Subject(s)
Humans , Pain , Wrist/surgery , Fractures, Comminuted/surgery , Fractures, Comminuted/therapy , Metacarpal Bones/surgery , Fracture Fixation , Retrospective Studies , Statistics, Nonparametric
9.
Rev. cir. traumatol. buco-maxilo-fac ; 20(4): 35-39, out.-dez. 2020. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1252977

ABSTRACT

Introdução: A face é uma região exposta a diversos traumas que são causados por várias etiologias, dentre eles por projétil de arma de fogo que são a segunda maior causa de fraturas perdendo somente para os acidentes automobilísticos. As fraturas acometem com frequência a região mandibular, por ser um osso de destaque na face devido sua proeminência. O objetivo deste trabalho é elucidar uma fratura cominutiva na região de côndilo e colo mandibular causada por ferimento de arma de fogo e seu respectivo tratamento. Relato de Caso: Paciente de 25 anos, compareceu a um serviço de atendimento de cirurgia bucomaxilofacial vítima de um ferimento por arma de fogo. Após a realização dos exames de imagem constatou-se que o projétil estava alojado no pescoço da vítima, causando a fratura cominutiva o ramo e o côndilo mandibular do lado esquerdo. A paciente foi submetida a anestesia geral para realização da osteossíntese da fratura. Considerações finais: O diagnóstico e o tratamento são realizados por uma equipe multidisciplinar para que o tratamento seja o mais correto e efetivo, com finalidade de minimizar morbidades e mortalidades, já que os pacientes sobrevivem com sequelas permanentes quando o diagnóstico e o tratamento não são realizados de forma correta... (AU)


Introduction: The face is a region exposed to several traumas that are caused by several etiologies, among them a firearm projectile that is the second major cause of fractures losing only to automobile accidents. The fractures frequently affect the mandibular region, as it is a prominent bone in the face due to its prominence. The purpose of this study is to elucidate a comminuted fracture in the condyle and mandibular neck region caused by a firearm injury and its respective treatment. Case Report: A 25-year-old patient who attended a buccomaxillofacial surgery service as a victim of a gunshot wound. After imaging examinations it was found that the projectile was lodged in the victim's neck, causing the comminuted fracture of the branch and mandibular condyle on the left side. The patient underwent general anesthesia to perform the fracture osteosynthesis. Final considerations: Diagnosis and treatment are performed by a multidisciplinary team so that treatment is the most correct and effective, in order to minimize morbidities and mortalities, since patients survive with permanent sequelae when diagnosis and treatment are not performed correctly... (AU)


Subject(s)
Humans , Female , Adult , Wounds, Gunshot/surgery , Fractures, Comminuted/surgery , Mandibular Fractures/surgery , Fracture Fixation, Internal
10.
Article in Chinese | WPRIM | ID: wpr-828296

ABSTRACT

OBJECTIVE@#To explore the clinical effect of bridging system in the treatment of severe comminuted femoral fracture.@*METHODS@#From March 2016 to October 2018, 50 patients with severe comminuted femoral fracture including 35 males and 15 females, aged 48 to 72(54.6±8.7) years, were admitted. All cases were comminuted fractures of the femoral shaft, 16 with proximal femur fractures and 7 with distal femur fractures. All cases were all unilateral fractures, 23 on the left and 27 on the right. The time from injury to operation was 5 to 60 (26.7±13.3) hours. The cause of injury was traffic accident, 12 cases with high fall, 35 cases fell and 3 cases fell accidentally. The patients were treated with bridge combined internal fixation system, and the operative effect and fracture healing were analyzed.@*RESULTS@#The operation was successful in all patients. There was no change to other fixed operation. The operation time was (75.8±12.3) min, the amount of bleeding was(356.4±64.8) ml, and there was no serious postoperative complications such as infection, internal fixation displacement, re fracture and nonunion. After 6 to 36 months follow-up, the fracture healing was evaluated by Warden's score. With the extension of observation time, Warden's score gradually increased, and the time of bone healing was(5.5±0.9) months. Harris score and HSS score were used to evaluate the function of hip and knee joint respectively. With the extension of time, Harris score and HSS score increased gradually. Six months after operation, Harris score was 83.5±11.2, HSS score was 79.7±10.5. During the follow-up period, there were no serious complications such as internal fixation displacement, re-fracture, nonunion of fracture and deep vein thrombosis of lower extremity.@*CONCLUSION@#The bridge combined internalfixation system has better safety and effectiveness in the treatment of severe comminuted femoral fracture. As long as the requirements of local anatomy and biomechanics are strictly mastered and the operation risks are fully evaluated in combination with imaging, the better fixation effect can be achieved. The operation has less trauma, fewer complications and simple operation, which is believed to have a wider application potential. Due to the limited sample size and follow-up time, no clinical control was set up, the results of the study still need to be further verified by prospective trials.


Subject(s)
Aged , Female , Femoral Fractures , General Surgery , Fracture Fixation, Internal , Fracture Healing , Fractures, Comminuted , General Surgery , Humans , Male , Middle Aged , Prospective Studies , Treatment Outcome
11.
Chinese Journal of Traumatology ; (6): 238-242, 2020.
Article in English | WPRIM | ID: wpr-827843

ABSTRACT

PURPOSE@#Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner.@*METHODS@#Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated. All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software.@*RESULTS@#Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale. Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient = -0.554).@*CONCLUSION@#A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.


Subject(s)
Adult , Compartment Syndromes , Connective Tissue , Female , Fracture Fixation, Internal , Methods , Fracture Healing , Fractures, Comminuted , General Surgery , Humans , Knee , Male , Middle Aged , Range of Motion, Articular , Tibial Fractures , General Surgery , Treatment Outcome
12.
The Egyptian Journal of Hospital Medicine ; 76(7): 4649-4661, 2019. ilus
Article in English | AIM, AIM | ID: biblio-1272786

ABSTRACT

Background: A technique of external fixator combined with T-plate internal fixation for intra-articular fractures of the distal radius is based on the finding that the separate t-plate fixation do not give complete stability to the fracture. However, if it is combined externally by external fixator, you get a solid synthesis of the fractured radius. This enables early mobilization of the wrist without the use of plaster cast. Objective: The aim of the study was to evaluate the results of external fixator combined with palmar T-plate internal fixation for the treatment of comminuted distal radial fractures. Patients and methods: This was a prospective study that was conducted on 20 patients. Patients were treated by the external fixator combined with T-plate internal fixation. All patients were attending to the Emergency Department and Outpatient Clinic of Orthopedic Surgery Department in Tanta University Hospitals. Results: Patients had excellent range of motion, normal ROM of the arm, shoulder and hand. No significant differences in the radiographic parameters were detected between fracture fixation and fracture healing. Complications were few. At final follow-up evaluations, patients had well to excellent results with respect to range of motion scores. Stable fixation allowed starting active and passive motion of the wrist without compromising postoperative alignment. The poor results in this case were due to late intervention, osteoporosis due to old age and poor general condition of the patient, which resulted in incomplete union. Conclusion: External fixator combined with T-plate internal fixation is an efficacious treatment option for intra-articular distal radius fractures with excellent long-term results


Subject(s)
External Fixators , Fracture Fixation, Internal , Fractures, Comminuted , Radius Fractures , Therapeutics
13.
Article in English | WPRIM | ID: wpr-763585

ABSTRACT

BACKGROUND: To compare the stability of fixed- versus variable-angle locking constructs for the comminuted distal humerus fracture (AO/OTA 13-A3). METHODS: Eight pairs of complete humeri harvested from eight fresh frozen cadavers were used for the study. We fixed the intact humeri using 2.7-mm/3.5-mm locking VA-LCP stainless steel distal humerus posterolateral (nine-hole) and medial (seven-hole) plates. An oscillating saw was used to cut a 1-cm gap above the olecranon fossa. The specimens were loaded in axial mode with the rate of 1 mm per 10 seconds to failure, and stress-strain curves were compared in each pair. The mode of failure was recorded as well as the load needed for 2- and 4-mm displacement at the lateral end of the gap. RESULTS: The stiffness of the constructs, based on the slope of the stress-strain curve, did not show any difference between the fixed- versus variable-angle constructs. Likewise, there was no difference between the force needed for 2- or 4-mm displacement at the lateral gap between the fixed- and variable-angle constructs. The mode of failure was bending of both plates in all specimens and screw pull-out in four specimen pairs in addition to the plate bending. CONCLUSIONS: Our results did not show any difference in the biomechanical stability of the fixed- versus variable-angle constructs. There was not any screw breakage or failure of the plate-screw interface.


Subject(s)
Bone Screws , Cadaver , Fracture Fixation , Fractures, Comminuted , Humerus , Olecranon Process , Stainless Steel
14.
Article in English | WPRIM | ID: wpr-762783

ABSTRACT

BACKGROUND: The open reduction of craniofacial bone fractures requires internal fixation using metal plates and screws, which have been considered the gold standard. However, metal implants pose a risk of palpation, protrusion, and foreign body reaction, and they may require an additional operation for removal. Recently, good results have been reported for absorbable implants which complement the disadvantages of metal implants. This study presents the results of using absorbable mesh, plates, and screws with cyanoacrylate for more accurate and firmer fixation of comminuted fractures of the maxilla. METHODS: In total, 235 patients underwent operations for comminuted fractures of the maxilla. From January 2012 to December 2014, absorbable mesh and screws were used in 114 patients, while from January 2015 to December 2017, absorbable mesh, plates, and screws with cyanoacrylate were used in 121 patients. Open reduction of the bone fragments was performed, after which absorbable implants were accurately molded and fixed by screws. RESULTS: All patients underwent postoperative computed tomography scans, which showed highly accurate reduction and firm fixation in the patients who underwent procedures using absorbable implants, screws, and cyanoacrylate. There were no postoperative complications or cases of abnormal facial contour. CONCLUSION: When absorbable implants and screws are used for maxillary fractures, no additional surgery to remove the metal plate is required. In addition, the use of cyanoacrylate enables accurate and firm fixation of the tiny bone fragments that cannot be fixed with screws.


Subject(s)
Absorbable Implants , Complement System Proteins , Cyanoacrylates , Foreign-Body Reaction , Fractures, Bone , Fractures, Comminuted , Fungi , Humans , Maxilla , Maxillary Fractures , Palpation , Postoperative Complications
15.
Article in English | WPRIM | ID: wpr-785600

ABSTRACT

Emergency physicians in the field are sometimes confronted with cases wherein patients cannot be intubated and ventilated. In some cases, cricothyrotomy, the method of choice for securing an emergency airway, may not have a successful outcome. We report a rare case of a 35-year-old male patient with avulsion of the larynx and a comminuted fracture of the jawbone, due to entrapment in a dung excavator. Prehospital tracheotomy was successfully performed. In cases with crush injuries to the larynx, anatomic structures, including the ligamentum conicum, are destroyed. In addition, massive subcutaneous emphysema blurs the anatomical key structures; hence, only a tracheotomy can prevent a lethal outcome.


Subject(s)
Adult , Emergencies , Emergency Medical Services , Fractures, Cartilage , Fractures, Comminuted , Humans , Larynx , Male , Methods , Subcutaneous Emphysema , Tracheotomy
16.
Article in Chinese | WPRIM | ID: wpr-773896

ABSTRACT

OBJECTIVE@#To explore the feasibility of using computer-aided design(CAD) combined with 3D printing technology to repair and reconstruct the comminuted fracture of the posterior wall of acetabulum with osteochondral defect, to evaluate the biomechanical properties of composite titanium nitride bioceramic coatings with porous titanium alloy scaffolds and steel plate integrated implants.@*METHODS@#Based on CT images of continuous tomography, the computer-aided design software was used to construct a digital model of porous titanium alloy plate implant with a specially open cellular three-dimensional structure, and the three-dimensional implant was prepared with Ti6Vl4V powder by using the 3D printing technology, following by titanium nitride coating on its articular surface. The degree of matching and attachment between the implant and acetabulum were observed; Ansys software was used for finite element modeling to analyze the stress distribution, stress conduction and deformation displacement of the acetabulum of the normal group, the traditional group and the implant group under the same load state, and to verify the biomechanical properties of the implant.@*RESULTS@#The porous titanium alloy implant fit well with the acetabular bone defects, the shape of the plate was well attached to the bone surface, and it was rated as excellent according to the Matta criteria. The Von Mises stress peak of the implant group 13.38 MPa was close to the normal group 13.11 MPa and smaller than that in the traditional group 15.66 MPa. The Von Mises stress distribution and conduction of implant group were basically consistent with the normal group, slightly better than the traditional group; the maximum relative displacement of the implant was 0.166 mm, according to the finite element analysis.@*CONCLUSIONS@#The porous titanium alloy stent plate implant with titanium nitride coating prepared by 3D technology has excellent matching degree and biomechanical properties; the anatomical reconstruction makes the stress distribution and conduction recovery well, close to normal hip joints, which provides a new option for the clinical treatment of comminuted posterior acetabular wall fractures with severe bone defects.


Subject(s)
Acetabulum , Bone Plates , Finite Element Analysis , Fractures, Comminuted , Humans , Printing, Three-Dimensional , Titanium
17.
Article in Chinese | WPRIM | ID: wpr-773829

ABSTRACT

OBJECTIVE@#To observe and compare the shoulder joint function, complications and clinical effects of hemiarthroplasty and open reduction and locking plate in the treatment of comminuted proximal humeral fracture (Neer IV) with 3D printing technique.@*METHODS@#From March 2012 to April 2018, 31 middle age and elderly patients with comminuted proximal humeral fractures (Neer IV) were treated, including 4 males and 27 females, aged from 55 to 94 years old with an average age of 71 years, with a course of 1 to 3 years. Among them, 20 cases were treated with open reduction and locking plate internal fixation (ORIF group) and 11 cases were treated with lower half shoulder replacement (HA group) assisted by 3D printing technology. Using CT data and Mimics software of Materialise Company in Belgium, the reconstruction of fracture was simulated on computer. The height of fracture end to humeral head, the height of tubercle to humeral head, the angle of humeral head backward obliquity were measured to assist the hemiarthroplasty. Follow-up and X-ray examination were performed, the incidence of complications were observed, and Neer score was used for the shoulder joint function.@*RESULTS@#Thirty-one patients were followed up for 1 to 3 years with an average of 2 years. In HA group, there was no prosthesis loosening, fracture and subsidence, the head of artificial humerus was intact, the fracture of nodules and nodules did not heal in 1 case, Neer score was 84.18±3.55; in ORIF group, there were 8 cases of proximal humerus bone resorption, 1 case of fracture nonunion, 1 case of internal fixation loosening, Neer score was 55.91±10.78; there was significant difference in Neer score of shoulder joint function between the two groups(<0.05).@*CONCLUSIONS@#Ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures, which promise minimal incision, protect sural nerve, ensure quality of tendon anastomosis and fixation, and is a ideal method for repairing acute closed Achilles tendon ruptures.


Subject(s)
Aged , Aged, 80 and over , Bone Plates , Female , Fracture Fixation, Internal , Fractures, Comminuted , Humans , Male , Middle Aged , Shoulder , Shoulder Fractures , General Surgery , Treatment Outcome
18.
Article in Chinese | WPRIM | ID: wpr-776148

ABSTRACT

OBJECTIVE@#To investigate clinical results of reverse total shoulder arthroplasty in treating comminuted fracture of proximal humerus in elderly patients with rotator cuff injury.@*METHODS@#From January 2017 to December 12, 12 comminuted fracture or dislocation of proximal humerus elderly patients were diagnosed as rotator cuff injury by preoperative MRI and operative exploration, and treated by reverse total shoulder arthroplasty. Among them, including 7 males and 5 females aged from 65 to 86 years old; 5 patients injured on the left side and 7 patients injured on the right side. Range of motion, postoperative complication were observed, VAS score was used to evaluate pain release and UCLA score was used to assess recovery of shoulder joint.@*RESULTS@#All patients were followed up from 8 to 18 months. At the latest follow-up, shoulder range of motion conditions were as following:forward bend and lifts ranged from 90° to 150°, external rotation ranged from 10°to 30°, internal rotation could reached L₃ level(S₁-L₁), VAS was for 0 to 6 points, UCLA score ranged from 18 to 32 points, 5 patients were good and 7 patients were poor. No infection, prothesis loosening, shoulder stress fracture, injury of vessel and nerve occurred.@*CONCLUSIONS@#Reverse total shoulder arthroplasty in treating comminuted fracture of proximal humerus in elderly patients with rotator cuff injury has advantages of early recovery of shoulder joint range of motion, less pain and high patients' satisfactory.


Subject(s)
Aged , Aged, 80 and over , Arthroplasty, Replacement, Shoulder , Female , Fractures, Comminuted , Humans , Humerus , Male , Range of Motion, Articular , Rotator Cuff Injuries , Shoulder , Shoulder Fractures , General Surgery , Shoulder Joint , Treatment Outcome
19.
Article in Chinese | WPRIM | ID: wpr-776147

ABSTRACT

OBJECTIVE@#To explore clinical efficacy of limited external fixation with plastic paperboard in treating senile proximal comminuted humeral fracture.@*METHODS@#From June 2015 to December 2017, 32 senile patients with proximal comminuted fracture of humerus were treated with plasticized cardboard after manual external fixation. Among them, including 13 males and 19 females aged from 55 to 85 years old with an average of(68.22±8.36) years old; 18 patients on the left side and 14 patients on the right side; all patients were regularly review shoulder X-rays and performed appropriate functional exercises. Constant-Murley shoulder joint scoring was used to evaluate clinical effects.@*RESULTS@#Thirty-two patients were followed up for 3 to 12 months with an average of (4.97±2.39) months. All patients were underwent functional exercise under guidance of physicians. Nine patients were treated with topical Chinese herbal moist heat compresses to promote shoulder function recovery. Thirty-one patients were obtained fracture healing, the time ranged from 5 to 12 weeks with an average of(7.44±1.72)weeks. One patient was not healed due to comminuted fracture of fracture end and the separation was large, the blood supply to humeral head was insufficient for necrosis absorption. Postoperative Constant-Murley shoulder score at 3 months was 87.56±6.93; 15 patients got excellent results, 14 good, 2 fair and 1 poor.@*CONCLUSIONS@#Limited external fixation with plastic paperboard for the treatment of senile proximal comminuted humeral fracture could ensure biomechanical stability of fracture, promote early recovery of shoulder joint function and shorten recovery time.


Subject(s)
Aged , Aged, 80 and over , Female , Fracture Fixation, Internal , Fractures, Comminuted , General Surgery , Humans , Humeral Fractures , General Surgery , Male , Middle Aged , Plastics , Shoulder Fractures , Treatment Outcome
20.
Article in Chinese | WPRIM | ID: wpr-776084

ABSTRACT

OBJECTIVE@#To explore clinical effect of olecranon sled in treating olecranal fracture.@*METHODS@#Four patients with olecranal fracture treated by olecranon sled in March 2017, including 2 males and 2 females, age of 40, 46, 47, 72 years old, 3 patients on the left side and 1 patient on the right side. All patients were caused by falling down. Fracture were transverse, oblique and slightly compressive articular surface fracture. The time from injury to operation ranged from 1 to 3 days. Operative time, blood loss, complications and flexion and extension of elbow joint, and function of forearm were observed, VAS score was used to evaluate relieve degree of pain, and Mayo score was applied to assess recovery of elbow function.@*RESULTS@#Four patients were followed up until September 2018. Operative time ranged from 40 to 60 min, blood loss was for 20 to 40 ml, and no complications occurred. All fracture were healed at 4 months after operation. Elbow flexion was for 140° to 150°, extension of elbow was from 0° and extend to 10°, activity of flexion and extension ranged from 140 ° to 160°, MEPS score was 100. No pain occurred during doing activity, and VAS score was 0.@*CONCLUSIONS@#Low-profile design and integrated design of olecranon sled could avoid irritation of tension band and plate, and it is a simple and ideal internal fixation method for simple and mildly comminuted olecranon fracture, which is not suitable for severely comminuted olecranon fracture.


Subject(s)
Adult , Aged , Bone Plates , Elbow Joint , Female , Fracture Fixation, Internal , Fractures, Comminuted , Humans , Male , Middle Aged , Olecranon Process , Range of Motion, Articular , Treatment Outcome , Ulna Fractures
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