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BACKGROUND:There are many ways for surgical treatment of distal radius fractures. Both volar locking plates and Kirschner wires are common methods. Doctors have considerable flexibility in the choice of the ways of fixation, but both at home and abroad there is no comparison between the effects of the two operations for treating distal radius fractures. OBJECTIVE:To systematicaly review the differences in effectiveness and safety of volar locking plates versusKirschner wires for distal radial fracture. METHODS:Databases such as CBM, CNKI, VIP, PubMed and Cochrane Library were electronicaly searched.Chinese Journal of Orthopaedics,Chinese Journal of Orthopaedic Trauma,Chinese Journal of Trauma andJournal of Practical Orthopaedics were searched by hand. In strict accordance with inclusion and exclusion criteria, articles were screened. Methodological quality of included studies was evaluated according to Cochrane Handbook. Data were extracted, and then analyzed with RevMan 5.2 software. RESULTS AND CONCLUSION:Nine randomized controled trials were included. Meta-analysis results demonstrated that upper limb function scores were better in the volar locking plate group than in the Kirschner wire group [MD=-4.55(-7.89,-1.21),P=0.008] at 3 months of folow-up and [MD=-3.13(-6.08,-0.18),P=0.004] at 12 months. The incidence of infection was lower in the volar locking plate group than in the Kirschner wire group [OR= 0.42(0.23, 0.79),P=0.007]. No significant difference in incidence of complex regional pain syndrome [OR=0.28(0.05, 1.38),P=0.12], incidence of carpal tunnel syndrome [OR=0.75(0.20, 2.76),P=0.66] and tendon injury [OR= 1.66(0.51, 5.41),P=0.64] was detected between the volar locking plate group and Kirschner wire group. These results indicated that compared with the Kirschner wire, volar locking plate fixation for the repair of distal radial fracture is safe and effective. In the permission of economic circumstances, it is suggested that elder osteoporosis patients with distal radial fracture should receive plate fixation.
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Objective To describe the method and clinical result of super sural neuromusculocutaneous flap grafting plus catheter irrigation in the treatment for chronic lateral malleolus osteomyelitis. Methods From March 2000 to March 2008, 17 cases, male 14, femal 3, 21 to 75 years old (average 43-year-old),were underwent reversed saphenous musculocutaneous island flap after wide excision of lateralmalleolus lesion. The cause of lateral-malleolus lesions was trauma. The smallest flap was 5 cm× 6 cm and the largest was 7 cm × 11 cm. Catheter irrigation was used in all cases. Results Follow-up ranged from 12 to 96 months, average 49 months. After operation, the wounds were irrigated with sensitive antibiotics 1 to 2.5 months(average 49 days), and all flaps were survived. Except 2 cases, the other 15 were healed in 1 month.The 2 cases were not healed at first stage. According to the lab result,we changed the antibiotic, and in 2.5 months, we took off the catheter. Conclusion To deal with the chronic traumatic lateral-malleolus osteomyelitis, super sural neuromusculocutaneous flap grafting plus catheter irrigation is approprite and effective.
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[Objective]To evaluate the two plates internal fixation treating the distal humeral comminuted and complicated fracture.[Method]Twenty-eight patient with comminuted distal humeral fracture were treated with the double-plate internal fixation from April 2004 to April 2007.According to AO/ASIF classification method,all fractures were C types.There were 9 C1 types,15 C2 types,4 C3 types.All cases were taken from the middle of posterior elbow incision.The patients were treated with the open reduction and double plate internal fixation.Fifteen cases were done through the triceps tongue-shaped flap,13 cases were olecranon osteotomy (including one case with olecranon fractures with ipsilateral).Surgical steps included:the articular surface reduction of intra-articular fractures,small temporary Kirschner wire fixation,making the complete fractures into simple comminuted fractures of humerl condylar fractures,then resetting metaphysis.Internal fixation method used the restruction plate according to the size of fracture.The restruction plate was fixed in the back of the distal humeral radial column.One-third of a good-shaped tubular plate was used to fix the inner edge of humeral ulnar column,two 90 ? of each other into the plane separately fixed on the inner lateral humeral column.[Result]All cases were followed up for an average of 17 months(ranged,8-33 months).Fracture healing time ranged 8-16 weeks.Myositis ossificans was found in 1 case,joint space narrowing was found in 4 cases.No non-union and ulnar nerve injury were found.The final good-to-excellent rate was 82.1%.[Conclusion]The distal humeral comminuted fracture has complicated structure.The internal fixation with two plates and screws,and early functional exercise could improve the elbow function.It has satisfactory curative effect in clinic.