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ObjectiveTo explore the efficacy of posterior approach in treatment of crescent pelvic fracture.MethodsBetween April 2007 and January 2010, 12 patients with crescent pelvic fracture were treated via posterior approach at our department. They were 8 men and 4 women, aged from 21 to 55 years (average, 31.3 years). Six left and 6 right sides were affected. The fractures were caused by a traffic accident in 8 cases, high falling in 3 cases and heavy weight crushing in one. By Tile classification, there were 8 cases of type B2. 1 and 4 cases of B2.2. The time from injury to operation was 3 to 9 days, with an average of 6. 2 days. They were treated with open reduction and internal fixation via the posterior approach. Operation time,intraoperative blood loss, postoperative loss of pelvic ring reduction, fracture healing time and Hannover pelvic outcome scoring were documented.ResultsThe average operation time was 172.5 ± 34. 1 minutes(from 120 to 240 minutes) . The average blood loss was 412.5 ±- 128.1 mL(from 250 to 700 mL) . The average reduction gained was 11.7 ±4. 6 mm(from 6 to 21 mm). Ten patients obtained an average follow-up of 16. 3 months (from 12 to 20 months). The X-ray films showed bony healing in all patients after an average of 3. 1 ± 0. 3 months(from 3 to 4 months). There was no postoperative loss of pelvic ring reduction or implant failure.By the Hannover scoring system, 7 patients were rated as excellent and 3 as good in clinic symptoms, and complete social reintegration was obtained in 8 cases and incomplete one in 2 cases.ConclusionOperation via posterior approach is a good choice for treatment of crescent pelvic fracture.
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OBJECTIVE: To summarize the current situation and progress of treating transverse acetabular fractures using different types of internal fixations. DATA SOURCES: The databases including PubMed were retrieved using key words of "acetabular/acetabulum, fracture, plate/plates, screw/screws, cable" both in English and Chinese. DATA SELECTION: The basic research, clinical research, review articles, as well as case reports concerning operation opportunity, and internal fixation methods were included. And repeated papers or articles with incomplete data were excluded. MAIN OUTCOME MEASURES: Totally 35 papers were selected, including 3 review articles, 8 basic research and 24 clinical research. RESULTS: Open reduction and internal fixation has been a preferred treatment for transverse acetabular fractures. The goals of treatment are anatomical reconstruction of articular surfaces and rigid internal fixation of the fragments of the fracture, so that to get early active motion. Reconstruction plate was characterized by great strength, good toughness, stable fixation, as well as excellent histocompatibility, which has accepted as standard internal fixation materials. However, the application of newly developed system, such as locking plate, absorbable screws, shape memory alloy staple, and acetabular memory internal fixation system, has received a better clinical results. CONCLUSIONS: There are plenty of internal fixations can be used in treating transverse acetabular fractures, and the reconstruction plate is the most accepted one. Actually, the internal fixations should be combined together to obtain a good result if necessary.
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From January 2006 to December 2007,44 cases of humeral shaft fractures were admitted to Department of Orthopaedics,Sixth People's Hospital of Shanghai Jiao Tong University,including 29 males and 15 females,with an average age of 40.7 years old(ranging 19-89 years).Of them,13 cases of fracture involved upper segment,24 involved middle segment and 7 lower segment.All fractures were close fractures.According to AO/ASIF classification,there were 5 cases of type A1,11 of A2,6 of A3,6 of B1,12 of B2,and 4 of B3.All patients were treated by expendable intramedullary nailing system.Time of operation,hospitalization and healing,blood loss,intra-or postoperative complications and range of shoulder and elbow motion were recorded and analyzed statistically.X-ray was shot to observe the union of fractures.The expendable intramedullary nailing was successfully performed in all patients for 86 minutes(ranging 30-150 minutes).The blood loss ranged from 30 to 200 mL with a mean of 70 mL.Except primary injury-caused radial paralysis,no iatrogenic radial paralysis occurred.All 44 patients were follow-up with an average of 18 months.Of them,41 patients had fracture union,and 3 nonunion.The average healing time was 15.8 weeks.There were 15 patients complained of pain in the shoulder joint,which did not affect daily life.According to UCLA shoulder scoring system,an excellent result was found in 18 patients,good in 23 patients,and fair in 3 patients with an excellent/good rate of 93.2%.All the patients had the excellent results according to Mayo elbow performance score system.No infection,iatrogenic fracture,limb shortening,nail breakage,fat embolism syndrome or peripheral nerve injury was found.The expandable nail offers the advantages of little blood loss,reduced operation time and exposure to radiation.However,nail antegrade insertion may lead to shoulder pain,and it should be paid more attention for cases of rotational instability in inferior segment of the humerus.