Long-term outcome of operative management of delayed acetabular fractures / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surgical treatment of acetabular fracture has long been a challenging area in the field of orthopedic trauma. The aim of this research was to investigate the operative methods for delayed acetabular fractures and to assess the operation results.</p><p><b>METHODS</b>The operative approaches, procedures, results, and complications of the delayed acetabular fractures between 1995 and 2005 were retrospectively evaluated at Beijing Jishuitan Hospital. Quality of life was assessed for each patient with the Merle d'Aubingne and Postel fracture function rating scale and the radiological result was assessed using the Matta radiological score.</p><p><b>RESULTS</b>Sixty-eight cases (70 hips) were followed up with a minimal duration of five years (average of 5.8 years). Excellent functional results were observed in 10 hip joints, good results in 40, fair results in 11, and poor results in nine. The risks of poor prognosis include impact fracture or osteochondral fracture of femoral head, a time beyond 42 days from injury to operative management, and dislocation of femoral head during the injury. Some of the problems, which were observed included postoperative infection in two hips, iatrogenic sciatic nerve injury in eight hips, traumatic arthritis in 15 hips, heterotopic ossification in 17 hips, and necrosis of the femoral head in six hips.</p><p><b>CONCLUSION</b>A careful selection of operative indications for delayed acetabular fractures in combination with a proper operative approach and appropriate reduction and fixation could guarantee relatively good results.</p>

Posterior monteggia fracture-dislocations of proximal ulna / 中华外科杂志

<p><b>OBJECTIVES</b>To discuss the diagnosis and differential diagnosis, and to establish an effective protocol to treat the posterior Monteggia fracture-dislocations of proximal ulna in adult according to our experience.</p><p><b>METHODS</b>Between April 2004 and December 2007, 16 patients with posterior Monteggia fracture-dislocations were treated surgically, 13 were followed up at a mean of 28 months (range, 12 - 58 months). All the operations were through the posterior midline approach. The fractures of radial head and coronoid process were reduced and fixed, if possible. The proximal ulna fractures were fixed with a single plate in 7 cases, plate combined with K-wires in 2, plate combined with K-wires tension band in 3, and K-wires tension band combined with screws in 1.</p><p><b>RESULTS</b>No elbow was painful or unstable at the last follow up examination. They had an average of 100 degrees (range, 0 degrees to 145 degrees ) of flexion-extension of elbow. The average motion of forearm rotation was 119 degrees (range, 0 degrees to 170 degrees ). The mean Mayo Elbow Performance Score (MEPS) was 93.1 points (67 - 100 points), excellent and good results were achieved in 92.3%. The mean system of Broberg and Morrey score was 88.8 points (53 - 100 points), excellent and good results were achieved in 76.9%.</p><p><b>CONCLUSIONS</b>Attention should be paid to the diagnosis and differential diagnosis of the posterior Monteggia fracture-dislocation of proximal ulna. Anatomically reduction and stable fixation of proximal ulna is the keystone for the surgical treatment.</p>

The application of computed tomography examination in acetabular fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical significance of computed tomography (CT) in diagnosis and treatment of acetabular fractures.</p><p><b>METHODS</b>The plain and CT films of the 66 cases of acetabular fracture from January 2001 to June 2002 were analyzed retrospectively, and the radiological characteristics and results were compared to each other.</p><p><b>RESULTS</b>The diagnosis of 6 cases were changed after CT examination, and the occurrence ratio of marginal impaction, free body in joint, femoral head fracture, sacro-iliac injury and ischial tubersoity fracture involvement were 3:17, 7:29, 6:15, 0:5 and 1:5 in plain and CT examination respectively.</p><p><b>CONCLUSIONS</b>CT examination has the determinative role in detecting weight-bearing zone, marginal impaction, free body, femoral head fracture, sacro-iliac injury, etc., and for completing the diagnosis and guiding the treatment. It should be the routine examination just as the three standard plain examinations in acetabular fractures, and should be carefully read.</p>

Marginal impaction in acetabular fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To understand the diagnosis and treatment of marginal impaction of acetabular fractures.</p><p><b>METHOD</b>Eighteen of 26 patients with marginal impaction of acetabular fractures were retrospectively reviewed. Marginal impactions was confirmed in 15 patients by CT scan before operation, and in 3 during operation. All patients were treated by ORIF, and the impacted bones were elevated with bone grafts (Bone graft was not used in one patient). All fractures were fixed with a reconstruction plate.</p><p><b>RESULTS</b>The mean follow up was 36.7 months (5 - 71 months). The modified D'Aubingne and Postel score system showed excellent results in 6 patients, good 7, fair 2, and poor 3.</p><p><b>CONCLUSION</b>Posterior fractures and dislocations of acetabular fractures are easily combined with marginal impaction, and can diagnosed by CT scan. Cortical impaction should be recognized as a special type. The impacted bone should be elevated for bone grafting.</p>

Complications of operative treatment of acetabular fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To improve the effect of operative management of acetabular fractures.</p><p><b>METHODS</b>One hundred and seventy eight acetabular fractures were treated operatively from August 1993 to December 2000. Their functional results and complications were analyzed.</p><p><b>RESULTS</b>One hundred and twelve hips were followed up for an average of 45.7 months. Heterotopic ossification was noted in 26 hips, post-operative osteoarthritis in 22 hips, avascular necrosis of the femoral head in 8 hips, and sciatic nerve injury in 7 hips after operations. No death and infection were found in this series.</p><p><b>CONCLUSIONS</b>Ectopic bone formation develops at extended ilio-femoral and Kocher-Langeneck approaches. Cartilaginous injury of the femoral head is contributable to post-operative osteoarthritis, and imperfect reduction is an important factor in the genesis of osteoarthritis.</p>

Operative treatment of delayed acetabular fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the operative methods of delayed acetabular fractures and the operative results.</p><p><b>METHODS</b>The operative approaches, procedures, results and complications of the delayed acetabular fractures between August 1993 and August 2001 in Jishuitan Hospital were evaluated retrospectively.</p><p><b>RESULTS</b>Thirty-two patients were followed up 49.6 months on average. Sciatic nerve palsy was found in 1 patient. Excellent functional results of hip joints were found in 3 patients, good in 16, fair in 10, and poor in 3. Ectopic bone formation was observed in 6 patients and necrosis of the femoral head in 3.</p><p><b>CONCLUSION</b>Careful selection of operative indications of delayed acetabular fractures in combination with proper operative approach and appropriate reduction and fixation, good results can be obtained.</p>