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Objective@#To investigate the effect of the socket-shield technique (SST) concurrent with immediate implant placement and provisionalization (IIPP) in the aesthetic restoration of anterior teeth.@*Methods@#A case of maxillary anterior tooth stumps with a thin labial bone wall was treated with SST for preservation of labial soft and hard tissue fullness, combined with an immediate implant placement and immediate provisional crown for restoring the shape of the tooth and gingival molding@*Results@#Immediate implant placement and provisionalization restored the morphology and function of the affected tooth in the shortest possible time. The patient's labial soft and hard tissue contours in the affected tooth area were well preserved in the 18-month follow-up after the application of the SST, which presented a better aesthetic result. The literature review indicates that the indications for SST are unrestorable maxillary anterior teeth, whose dental, periodontal and periapical tissues are healthy and intact. In the esthetic zone, root shielding is effective in maintaining the soft and hard tissue contour on the labial side of the implant. However, there is no consensus on the technical details of SST, such as the ideal coronal height and thickness of the shield, and the management of the gap between the shield and the implant. Thus, more clinical studies and histologic evidence are needed to provide a reference for clinical decision-making. In addition, digital technology can improve the accuracy of implant placement and shield preparation.@*Conclusion@#The correct application of SST combined with IIPP in the esthetic zone can ensure esthetic results. However, more high-quality evidence-based medical evidence is needed for its long-term efficacy, and indications should be strictly controlled during clinical application.
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BACKGROUND:With the application and development of 3D printing technology in medicine,orthopedic internal fixation surgery has become precise and individualized.The equal-scale fracture model obtained by 3D printing technology was simulated and planned before surgery,realizing the leap from traditional 2D images to more vivid and detailed three-dimensional objects.It allows the surgeon to understand the fracture type in advance and rehearse the reduction sequence,so as to realize the individualized implementation of fracture surgery,optimize the surgical process,bring better postoperative recovery and less surgical complications. OBJECTIVE:To compare clinical efficacy of three 3D printed models combined with computerized virtual repositioning technology to assist incision reduction bone plate internal fixation and traditional incision reduction bone plate internal fixation in the treatment of Robinson II B2 clavicle fracture. METHODS:Eighty patients with Robinson II B2 clavicle fracture were randomly divided into trial group(n=40)and control group(n=40).In the trial group,three kinds of 3D printing models(affected clavicle fracture model,computer simulation clavicle fracture reduction model,clavicle mirror model of healthy side)combined with computer virtual reduction technology were used for preoperative in vitro surgery rehearsal.Finally,3D printing was used for clavicle mirror model of healthy side to advance bending and select bone plates for internal fixation.In the control group,open reduction plate internal fixation was applied.The time from admission to surgery,intraoperative blood loss,operation time,frequency of fluoroscopy,number of bends of the bone plate,fracture healing time,complications,and visual analog scale score and Constant score before and after surgery were compared between the two groups. RESULTS AND CONCLUSION:The time from admission to operation in the trial group was greater than that in the control group(P<0.05).Operation time,intraoperative fluoroscopy frequency and bending times of the bone plate in the trial group were lower than those in the control group(P<0.05).The trial group had faster fracture healing and fewer complications(P<0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).Constant score of the two groups had an increasing trend with time(F=613.50,P<0.001),but the difference between the groups was not statistically significant(F=0.08,P=0.78),and there was no interaction between the measurement times and the group assignment(F=0.27,P=0.66).The visual analog scale score decreased with time(F=1 149.55,P<0.001),but there was no significant difference between groups(F=0.02,P=0.88),and there was no interaction between the number of measurements and the group assignment(F=1.02,P=0.36).The results show that the use of 3D printed model combined with computer virtual reduction technology for preoperative rehearsal can shorten the operation time,reduce the number of intraoperative fluoroscopy frequency and the times of bone plate bending,and have the advantages of faster fracture healing,fewer complications,and similar functional recovery to the traditional incision reduction bone plate internal fixation.
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BACKGROUND:The treatment for bacterial biofilms after internal fixation surgery is a very difficult problem in clinic.It is a great significance to establish an animal model of irrigation for treating bacterial biofilms in the early stage after internal fixation surgery. OBJECTIVE:To establish an animal model for treating bacterial biofilms with different drugs through irrigation in early stage after internal fixation surgery. METHODS:Six New Zealand white rabbits were selected.Bilateral femoral surfaces were exposed and drilled holes were made,and bone plates colonized with Pseudomonas aeruginosa(experimental group)and blank bone plates(blank control group)were implanted around the drilled holes on one side,and two drainage tubes were retained and fixed to serve as the"inlet"and"outlet,"respectively.The model was immersed for a certain period of time after simulated perfusion before rinsing.After the simulated irrigation,the plates were soaked for a certain time before washing.At 5 days postoperatively,the rabbits were observed for body temperature,wound condition,bacterial culture of drainage fluid,and crystalline violet staining and scanning electron microscopy of the bone plate. RESULTS AND CONCLUSION:Six rabbits had difficulty in moving the affected limbs after surgery and showed elevated body temperature at 2-4 days after surgery.Local swelling could be touched at some wounds in the experimental group,and the wounds in the blank control group healed well.The results of bacterial culture of drainage fluid showed that Pseudomonas aeruginosa diffused or spread in the experimental group.At 5 days after surgery,the plate in the experimental group became purple shown by crystalline violet staining,and the absorbance value at 570 nm detected by the microplate reader was 2.621±0.088,indicating the presence of bacteria.Scanning electron microscopy at 5 days after surgery showed that a large number of bacterial microcolonies appeared on the surface of the plate in the experimental group,forming a highly inhomogeneous three-dimensional structure similar to the"mushroom-like"and"tower-like"structures,with filamentous water channels connecting the"mushroom-like"structures,which were typical biofilm structures with high densities,while no obvious colonies were seen in the blank control group.Overall,this animal model simulates the state of infected biofilm formation due to early infection after internal fixation and provides an available method of irrigation with different drugs.
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Objective By comparing the fatigue strength of type A and type B locking compression plates (LCP) in distal femoral plate, a theoretical evaluation method was provided for type selection of bone plate when testing its bending strength and fatigue performance. Methods Through bending strength performance test and fatigue performance test on bone plates with different types, combined with ANSYS Workbench, the finite element analysis on total deformation, von Mises stress and fatigue service life of bone plates were conducted. Results The fatigue strength of type A plate was 30.7% higher than that of type B plate, the stress of type A plate was lower than that of type B plate, and the minimum fatigue service life of type A plate was 17% higher than that of type B plate. Conclusions The fatigue performance of type A plate is better than that of type B plate, so the failure possibility of type A plate was lower than that of type B plate.The results provide references for assisting selection of different bone plates when testing the performance of two newly developed bone plates.
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This study briefly introduces the revised content of Guidance for Registration of Metallic Bone Plate Internal Fixation System (Revised in 2021) compared to the original guidance, mainly including the principles of dividing registration unit, main performance indicators of standard specification, physical and mechanical performance research, and clinical evaluation. At the same time, in order to provide some references for the registration of metallic bone plate internal fixation system, this study analyzes the main concerns in the review process of these products based on the accumulation of experience combining with the current review requirements.
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Placas Óseas , Fijación Interna de Fracturas , Fenómenos BiomecánicosRESUMEN
Objective To evaluate biomechanical strength of locking compression plate (LCP) for fixation of periprosthetic proximal femur fractures (PPFF). Methods Eight matched pairs of Vancouver type B1 adult cadaveric PPFF specimens were fixed with the LCP and the inverted distal femoral less invasive stabilization system (LISS), respectively. Four bicortical locking screws (LCP group) and four unicortical locking screws were used to the length of prosthesis stem, and four double cortical locking screws were used to fix the distal end of the fracture in two groups, the distance from the locking screws to the fracture were also equal. The maximum bending load, maximum bending displacement, bending stiffness, maximum torque, maximum torsional angle and torsional stiffness of two groups in four-point bending test and torsion test were compared and analyzed. Results The maximum bending load, maximum bending displacement and bending stiffness of LCP group were all larger than those of LISS group, but the difference was not statistically significant (P>0.05). The maximum torque, maximum torsional angle and torsional stiffness of LCP group were obviously larger than those of LISS group，and there was a statistical difference between two groups (P<0.05). Conclusions The stiffness of anti-torsion with LCP is significantly better than that with LISS. Consequently, LCP has better biomechanical stability for PPFF.
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Objective:To compare the efficacy between intramedullary nailing (IMN) and minimally invasive percutaneous pate oteosynthesis (MIPPO) in the treatment of distal tibial fractures.Methods:China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database, Pubmed, Embase, Cochrane, and Web of Science databases were searched by computer for publications on IMN and MIPPO in the treatment of distal tibial fractures published in official journals at home and abroad from January 2010 to August 2020. The studies included were evaluated by 2 authors using the Cochrane collaboration’s tool for assessing risk of bias. The main extraction indexes were operation time, union time, superficial infection, deep infection, malunion, delayed union or nonunion, and soft tissue irritation. Review Manager 5.3 software was used for data analysis.Results:A total of 7 studies with 653 patients were included, with 325 in the IMN group and 328 in the MIPPO group. Meta analysis showed the following: operation time in the IMN group was significantly shorter than that in the MIPPO group ( MD=-10.75, 95% CI:-19.92~-1.58, P=0.02); superficial infection rate in the IMN group was significantly lower than that in the MIPPO group ( RR=0.58, 95% CI: 0.39~0.88, P=0.01); fracture malunion rate in the IMN group was significantly higher than that in the MIPPO group ( RR=1.87, 95% CI: 1.15~3.04, P=0.01). Concerning soft tissue irritation, incidence of anterior knee pain in the IMN group was significantly higher than that in the MIPPO group ( RR=16.98, 95% CI: 3.30~87.34, P=0.0007) while incidence of soft tissue irritation at the fracture site in the IMN group was significantly lower than that in the MIPPO group ( RR=0.13, 95% CI: 0.04~0.40, P=0.0004). There were no significant differences between the 2 groups in fracture healing time, deep infection rate, delayed union rate or nonunion rate ( P>0.05). Conclusions:Although both IMN and MIPPO are fine treatments of distal tibial fractures, IMN may be superior in prevention of superficial tissue infection but prone to anterior knee pain while MIPPO may be superior in prevention of malunion but prone to soft tissue irritation at the fracture site. Therefore, MIPPO is suggested in cases with fine pretibial soft tissues while IMN is used to reduce soft tissue infection otherwise.
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Objective:To investigate the outcomes of the surgical treatment of fracture of the first metatarsal base with plantar plate via the first metatarsal medial approach.Methods:A retrospective study was conducted of the 12 patients who had been treated for fracture of the first metatarsal base from January 2016 to December 2018 at Department of Trauma Orthopaedics, Renji Hospital. They were 8 men and 4 women, with an average age of 39.6 years (from 27 to 54 years). The fracture affected the left foot in 5 cases and the right foot in 7. Their fracture of the first metatarsal base and tarsometatarsal joint instability were fixated by plantar plate via the first metatarsal medial approach, and reduction and fixation was also conducted via a dorsal incision when other metatarsotarsal joint injuries were combined. Postoperative X-ray follow-ups were performed regularly. The American Orthopedic Foot and Ankle Society (AOFAS) midfoot scores, visual analogue scale (VAS) pain scores and complications were recorded at the final follow-up.Results:All the patients were followed up for 12 to 19 months (mean, 15.1 months). Primary incision healing was observed in all the 12 patients. No complications like skin necrosis, infection or neurovascular lesion occurred. Fracture union was achieved in all the 12 patients after 12 to 14 weeks (average, 12.6 weeks). At the final follow-up, all the patients could walk with full weight-bearing, the plantar flexion and dorsiflexion of the ankle and the muscle strengths of varus and valgus were normal, and the X-ray film showed that reduction of the tarsometatarsal joint was not lost. At the final follow-up, the AOFAS midoot scores ranged from 82 to 96 (mean, 88.9) and the VAS scores from 0 to 3 (mean, 1.2).Conclusion:Plantar plate fixation via the first metatarsal medial approach can result in satisfactory outcomes for fractures of the first metatarsal base, especially for those with a major fracture fragment at the metatarsal planter side.
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Objective To study the degradation behavior and mechanical properties of magnesium alloy plate on treatment of tibial fracture in New Zealand rabbits. Methods Thirty-six adult New Zealand rabbits were randomly divided into experimental group (magnesium alloy bone plate group, n=18) and control group (titanium alloy bone plate group, n=18). Tibial fractures in experimental group and control group were fixed with magnesium alloy bone plate and titanium alloy bone plate, respectively. After operation, X-ray, scanning electron microscopy, energy spectrum analysis, weight loss test and four-point bending test were performed in each group to analyze the degradation behavior and mechanical properties of magnesium alloy plate after tibial fracture treatment. Results Magnesium alloy bone plate could be degraded gradually in vivo. The degradation of magnesium alloy bone plate was deepened gradually with the implantation time, and the surface was corroded uniformly. The mechanical properties of magnesium alloy bone plate decreased gradually with the degradation in vivo. Conclusions Magnesium alloy bone plate can degrade gradually with fracture healing in vivo, and its mechanical properties gradually decline, but it can still meet the requirements of fracture internal fixation, and is a kind of good new degradable orthopedic implant material.
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@#Introduction: The guided growth technique is an alternative to corrective osteotomy for treating angular deformities of the extremities. It has the advantage of being minimally invasive and is effective in a growing child. This study reports on the outcome of guided growth technique using a plate in correcting knee angular deformities. Materials and methods: We conducted a retrospective study of children with angular deformity of the knee treated by the guided growth technique from January 2010 to December 2015 in a tertiary centre. The guided growth technique was done using either the flexible titanium plate (8-plate) or the 2- hole reconstruction plate. Correction of deformity was assessed on radiographs by evaluating the mechanical axis deviation and tibiofemoral angle. The implants were removed once deformity correction was achieved. Results: A total of 17 patients (27 knees) were evaluated. Twenty-two knees (81.5%) achieved complete correction of the deformity. The median age was 4.0 (interquartile range 3.0-6.0) years and the median Body Mass Index (BMI) was 26.0 (25.0-28.0). There were 7 unilateral and 10 bilateral deformities with different pathologies (14 tibia vara, 3 genu valgus). The median rate of correction was 0.71° per month. One patient (1 knee) had screw pull-out and two patients (4 knees) had broken screws in the proximal tibia. Three patients (5 knees) failed to achieve complete correction and were subsequently treated with corrective osteotomies. Out of five patients (8 knees) who were followed-up for at least 12 months after removal of hardware, two had rebound deformities. No permanent growth retardation occurred in our patients. Conclusion: Our outcome for guided growth to correct knee angular deformity was similar to other studies. Guided growth is safe to perform in children below 12 years old and has good outcome in idiopathic genu valgus and Langeskiold II for tibia vara. Patients should be observed for recurrence until skeletal maturity following implant removal.
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BACKGROUND: The common straight plate can affect the biomechanical conduction of fracture ends, and the combined variable stress plate can retain the continuous biomechanical stimulation of the fracture end, affect the changes of bone tissue cell function and bone mineral density, and promote fracture healing. OBJECTIVE: To investigate the effects of internal fixation with two kinds of plates on bone tissue cell function and bone mineral density in experimental goat femoral fracture healing. METHODS: Thirty healthy adult goats were raised in normal environment, and used to successfully construct the models of right lower limb femur fracture. The models were randomly divided into the experimental group (given the combined variable stress plate fixation) and the control group (given the common straight steel plate fixation) (n=15 per group). Serum levels of bone specific alkaline phosphatase, osteocalcin and tartrate resistant acid phosphatase activity were determined at 4, 8, and 12 weeks after surgery in both groups. The goats were sacrificed in batches, and the femoral stump tissue was taken for bone mineral density and histopathological observation. RESULTS AND CONCLUSION: (1) At 4 and 8 weeks, the serum bone specific alkaline phosphatase in the experimental group increased faster than that in the control group, but it was significantly lower than that in the control group at 12 weeks (P < 0.05). (2) At 4 weeks after surgery, the serum osteocalcin of the experimental group was higher than that of the control group, but lower than that of the control group at 12 weeks (P < 0.05). (3) At 4 and 8 weeks after operation, the serum tartrate resistant acid phosphatase activity of the experimental group was significantly higher than that of the control group, but lower than that of the control group at 12 weeks (P < 0.05). (4) At 8 and 12 weeks after operation, the bone mineral density of the fracture end in the experimental group was significantly higher than that of the control group (P < 0.05), while the bone mineral density of the experimental group and the control group increased gradually at 4, 8 and 12 weeks (P < 0.05). (5) At 4 and 8 weeks, the number of osteoblasts of the experimental group was significantly higher than that of the control group. At 8 weeks, the number of osteoclasts of the experimental group was significantly higher than that of the control group. At 12 weeks, the number of osteoblasts and osteoclasts of the experimental group was significantly lower than that of the control group (P < 0.05). (6) Combined variable stress plate fixation can produce continuous compressive stress at the fracture end of goat femur, stimulate the change of the number of bone tissue cells, lead to the secretion of corresponding bone tissue cell functional protein, promote the formation of callus, accelerate the reconstruction of callus, and promote the fracture healing.
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ABSTRACT Objective: This study compared groups of patients with calcaneal fractures of Sanders types II and III. One group was treated with ORIF using an LCP (plate), while the second was treated with a minimally invasive method using a C-Nail. Methods: The study included 217 patients in the ORIF group and 19 patients in the minimally invasive nail osteosynthesis group. Results: In the LCP group, the outcomes were excellent for 35.7% of the patients; good, 38.9%; satisfactory, 19.7%; and poor, 5.7%. In the C-Nail group, the outcomes were excellent for 36.9% of the patients; good; 31.6%; satisfactory, 21%; and poor, 10.2%. The mean values of the restoration of Böhler's angle from post-injury were 6.8° to 32.3° in the LCP group and 7.1° to 33.3° in the C-Nail group. After 12 months, there was only a minimal decrease in Böhler's angle to 29.2° in both the LCP and C-Nail groups. Conclusion: The outcomes obtained with C-Nail fixation are statistically identical to those obtained with LCP fixation. We conclude that osteosynthesis with a C-Nail is suitable as the first-choice treatment for Sanders types II and III fractures. Level of evidence IV, retrospective observational study.
RESUMO Objetivo: Comparar grupos de pacientes com fratura intra-articular do calcâneo tipos II e III de Sanders. Métodos: Estudo retrospectivo que incluiu 217 pacientes no grupo tratado por redução aberta e fixação interna com placa de compressão (Grupo PC) e 19 pacientes que seguiram um método minimamente invasivo com C-Nail. Resultados: No Grupo PC, os resultados foram excelentes em 35,7%, bons em 38,9%, satisfatórios em 19,17% e ruins em 5,7%. Os resultados registados no grupo que recebeu implante de unha foram excelentes em 36,9%, bons em 31,6%, satisfatórios em 21% e ruins em 10,2% Os valores médios do restauro do ângulo de Böhler desde o pós-ferimento variaram entre 6,8° e 32,3°, no Grupo PC, e entre 7,1° e 33,3°, no grupo tratado com C-Nail. Ao fim de 12 meses, apenas se observou redução mínima do ângulo de Böhler para 29,2° nos dois grupos. Conclusão: Os resultados do método recentemente introduzido de osteossíntese minimamente invasiva com C-Nail são estatisticamente idênticos aos obtidos pela redução aberta e fixação interna com placa de compressão. Assim, o novo tipo de osteossíntese com C-Nail é adequado como primeira escolha em fraturas do tipo Sanders II e III. Nível de evidência IV, Estudo retrospectivo de observação.
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The maxillary sinus floor location and the buccal bone plate are factors to be considered in the long-term success with implant treatments mainly in the premolar region. the aim of this study was to establish morphometric characteristics of the buccal cortical bone (BCB) thickness of maxillary premolars and its relation to maxillary sinus floor through CBCT. In this study 350 first and second maxillary premolars were analyzed from 110 CBCT images and the buccal cortical bone (BCB) was measured in a coronal view at the major axis level of each premolar. In addition, in 200 first and second maxillary premolars CBCT images were measured the distance from premolar apex to maxillary sinus floor (MSF) in both frontal and sagittal plane. The type of relationship between the apex and MSF was classified according to Ok et al. (2014). The second premolar was observed with higher values of BCB (p<0.001). In first premolar, higher values were observed in the male sex (p>0.05). In second premolar, only significantly higher values were observed in the male sex in MA-MB-MC (p>0.05). Regarding to MSF and its relation to premolar roots, it was observed that 10 % of the sample was classified as type I, 19 % as type II, 55.5 % as type III and 15.5 % as type IV. The BCB of the upper premolar region is thicker in the apical region and decreases toward the coronal region. Almost 50 % of apex of second premolars are closely and risky related MSF (Type I and II).
La localización del piso del seno maxilar (PSM) y la tabla ósea vestibular (TOV) son factores a considerar en el éxito a largo plazo de los tratamientos de implante dental en la región premolar. El objetivo de este estudio fue establecer características morfométricas del grosor de la TOV en los premolares maxilares y su relación con el PSM a través de CBCT. Se analizaron 350 primeros y segundos premolares en 110 CBCT y la TOV fue medida en vista coronal en el eje axial mayor de cada premolar. Además en 200 primeros y segundos premolares maxilares se midió la distancia desde el ápice del diente hasta el PSM en el plano sagital y frontal. El tipo de relación entre el ápice y el PSM se clasificó según Ok et al. (2014). El Segundo premolar obtuvo los mayores valores de grosor de TOV (p<0.001). En primeros premolares se observaron valores altos en el género masculino (p>0.05). En segundos premolares solo se encontraron valores significativamente altos en el género masculino en MA-MB-MC (p>0.05). En la relación con el PSM y ápices de raíces de premolares, el 10% de la muestra se clasificó como tipo I, el 19% como tipo II, el 55,5% como tipo III y el 15.5% como tipo IV. En conclusión la TOV de la región premolares superior es más grueso en la zona apical, decreciendo hacia la zona coronal. Alrededor del 50% de los ápices de raíces de premolares maxilares están cercanas y en relación de riesgo con el PSM (tipo I y II).
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Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Adulto Joven , Diente Premolar/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Seno Maxilar/diagnóstico por imagen , Tamaño de los Órganos , Diente Premolar/anatomía & histología , Estudios Transversales , Seno Maxilar/anatomía & histologíaRESUMEN
ABSTRACT Objective: To postoperatively evaluate knee scores, radiological assessment results, deficit correction, patellar height change, bone healing time, and weight bearing time in patients undergoing high tibial osteotomy (HTO) with/without autologous iliac bone grafting. Methods: This retrospective examination of treated controls from a randomized controlled study included 63 knees of 58 patients aged 46-59 years who underwent HTO with locking open wedge osteotomy plates. The patients were divided into two groups: Group A, HTO with autologous iliac bone grafts (n = 31); and Group B, HTO without autologous iliac bone grafts (n = 32). Clinical and radiological data were evaluated prospectively at the preoperative consultation and again at 6, 9, and 12 weeks, 6 months, and 1 year after the surgery (and annually thereafter). Results: There were no significant intergroup differences in the radiological assessment, deficit correction, patellar height change, bone-healing time, and weight-bearing time at any time after surgery. The knee scores changed positively in both groups (p < 0.001). Conclusions: There was no difference in the results of patients undergoing HTO with open wedge osteotomy titanium locking plates with or without autografting, and comorbidities resulting from autografts were eliminated with the use of locking plates. Level of evidence III, Retrospective Study.
RESUMO Objetivo: Avaliar escores de joelho, resultados da avaliação radiológica, correção de déficits, alteração da altura patelar, tempo de consolidação óssea e tempo para apoio de peso no pós-operatório em pacientes submetidos à osteotomia tibial alta (OTA) com ou sem enxerto autólogo de osso ilíaco. Métodos: O exame retrospectivo de controles tratados em estudo randomizado e controlado foi realizado em 63 joelhos de 58 pacientes com idade entre 46 e 59 anos submetidos a OTA com placas bloqueadas de titânio em cunha aberta. Os pacientes foram divididos em dois grupos: Grupo A, OTA com enxerto de osso ilíaco autólogo (n = 31) e Grupo B, OTA sem enxerto autólogo de osso ilíaco (n = 32). Os dados clínicos e radiológicos foram avaliados prospectivamente na consulta pré-operatória e 6, 9 e 12 semanas e 6 meses e 1 ano após a cirurgia (e depois disso, anualmente). Resultados: Não houve diferenças significativas quanto a avaliação radiológica, correção de déficit, mudança de altura da patela, tempo de cicatrização óssea e tempo para apoio de peso entre os dois grupos em nenhum momento após a cirurgia. Os escores de joelho mudaram positivamente em ambos os grupos (p < 0,001). Conclusões: Não houve diferença nos resultados dos pacientes submetidos a OTA com placas bloqueadas de titânio em cunha aberta com e sem autoenxerto, e as comorbidades resultantes dos autoenxertos foram eliminadas com o uso de placas bloqueadas. Nível de Evidência III, Estudo Retrospectivo.
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Objective To evaluate the minimally invasive splayed incisions in the internal fixation with a conventional calcaneal plate for calcaneal fractures of sanders types Ⅱ and Ⅲ.Methods This prospective study was conducted from May 1st,2016 to December 1st,2017 in the 40 patients with calcaneal fracture at Department of Orthopedics,Shanghai Pudong Hospital.Their ages ranged from 23 to 55 years (average,39.5 years).According to the Sanders classification,27 fractures were type Ⅱ and 13 type Ⅲ.They were all treated with a conventional calcaneal plate through minimally invasive splayed incisions.The B(o)hler and Gissane angles,the height,width and length of the affected calcaneus were compared between preoperation,3 months after operation and the last follow-up;the clinical function of the affected feet was graded using the Maryland foot score;postoperative complications were observed.Results The 40 patients were followed up for an average of 12.5 months (from 11 to 16 months).All the skin incisions healed well with no skin necrosis or wound infection.No injury to the sural nerve occurred.All the fractures healed after an average of 8 weeks (from 7 to 10 weeks).All the patients resumed their routine daily activities and returned to their former work post after an average time of 4.1 months (from 3 to 6 months).At pre-operation,3 months after operation and the last follow-up,their B(o)hler angles were respectively 19.2°± 6.3°,30.5°±6.4° and 29.9° ± 6.5°;their Gissane angles 103.9° ± 14.8°,119.3° ± 5.6° and 119.8° ± 6.3°;their calcaneal heights (32.5 ±3.5) mm,(36.8 ± 1.5) mm and (36.5 ± 1.8) mm;their calcaneal widths (36.8 ± 3.4) mm,(33.1 ±3.8) mmand (33.0±3.2) mm;their lengths (61.4±4.5) mm,(65.5±6.9) mmand (65.5 ±9.4) mm.In all the patients,the B(o)hler and Gissane angles and the calcaneal heights and lengths increased significantly while the calcaneal widths decreased significantly at 3 months after operation and the last follow-up (P ＜ 0.05).There were no significant differences between 3 months after operation and the last follow-up in the B(o)hler or Gissane angle,the height,width or length of the affected calcaneus (P ＞ 0.05).Their Maryland foot scores showed 35 excellent cases,4 good cases and one fair case,giving an excellent and good rate of 97.5％.Conclusions A conventional calcaneal plate plus minimally invasive splayed incisions can be effective for calcaneal fractures of Sanders types Ⅱ and Ⅲ,leading to reduced wound complications,anatomical restoration of calcaneal morphology,and smooth subtalar articular surface.
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Objective To evaluate a self-designed novel anatomical bone plate for fractures of ulnar coronoid process in cadaveric specimens.Methods Our database search in the Imaging Center,Qilu Hospital of Shandong University (Qingdao) yielded CT reconstruction images of 45 normal adult elbows (26 males and 19 females) which met our criteria.On the 3D reformatted CT images,sagittal curvature angle of the ulnar coronal process (△ 1),tangent angle of the coronal process apex to olecranon fossa (△2),projective length (L) and projective height (H) were measured;the transverse width of the coronal process was also measured at 5 mm and 10 mm from the tip (K1 and K2).The minimum value was used for △2° in order to avoid cutting into the joint while the mean value for other parameters.After the shape of the plate and angles of the screws were designed using computer 3D software,a new anatomic plate for coronal process was produced.Five cadaver specimens were used to test the internal fixation of the coronal process with our novel anatomic bone plate.Attachment of the bone plate to the coronal process and screw penetration into the joint cavity were observed by X-ray and 3D CT scanning.Results △ 1 was 45.52° ± 6.07°,△ 2 65.25° ± 7.09° (the minimum value53.2°),L52.27±7.78 mm,H21.62±2.63 mm,K1 16.32±2.22 mmand K2 14.58 ± 2.18 mm.Our new anatomic bone plate was designed based on the above data.X-ray and 3D CT scan after plate internal fixation showed that our self-designed bone plate produced fine attachment and no screws penetrated into the joint.Conclusion Our new anatomical bone plate may perfectly fit the anatomy of the adult ulnar coronal process in size and shape so that the coronary process can be fully covered and no screws will penetrate into the joint cavity.
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Objective@#To evaluate the minimally invasive splayed incisions in the internal fixation with a conventional calcaneal plate for calcaneal fractures of sanders types Ⅱ and Ⅲ.@*Methods@#This prospective study was conducted from May 1st, 2016 to December 1st, 2017 in the 40 patients with calcaneal fracture at Department of Orthopedics, Shanghai Pudong Hospital. Their ages ranged from 23 to 55 years (average, 39.5 years). According to the Sanders classification, 27 fractures were type Ⅱ and 13 type Ⅲ. They were all treated with a conventional calcaneal plate through minimally invasive splayed incisions. The Böhler and Gissane angles, the height, width and length of the affected calcaneus were compared between preoperation, 3 months after operation and the last follow-up; the clinical function of the affected feet was graded using the Maryland foot score; postoperative complications were observed.@*Results@#The 40 patients were followed up for an average of 12.5 months (from 11 to 16 months). All the skin incisions healed well with no skin necrosis or wound infection. No injury to the sural nerve occurred. All the fractures healed after an average of 8 weeks (from 7 to 10 weeks). All the patients resumed their routine daily activities and returned to their former work post after an average time of 4.1 months (from 3 to 6 months). At pre-operation, 3 months after operation and the last follow-up, their Böhler angles were respectively 19.2°±6.3°, 30.5°±6.4° and 29.9°±6.5°; their Gissane angles 103.9°±14.8°, 119.3°±5.6° and 119.8°±6.3°; their calcaneal heights (32.5±3.5) mm, (36.8±1.5) mm and (36.5±1.8) mm; their calcaneal widths (36.8±3.4) mm, (33.1±3.8) mm and (33.0±3.2) mm; their lengths (61.4±4.5) mm, (65.5±6.9) mm and (65.5±9.4) mm. In all the patients, the Böhler and Gissane angles and the calcaneal heights and lengths increased significantly while the calcaneal widths decreased significantly at 3 months after operation and the last follow-up (P<0.05). There were no significant differences between 3 months after operation and the last follow-up in the Böhler or Gissane angle, the height, width or length of the affected calcaneus (P>0.05). Their Maryland foot scores showed 35 excellent cases, 4 good cases and one fair case, giving an excellent and good rate of 97.5%.@*Conclusions@#A conventional calcaneal plate plus minimally invasive splayed incisions can be effective for calcaneal fractures of Sanders types Ⅱ and Ⅲ, leading to reduced wound complications, anatomical restoration of calcaneal morphology, and smooth subtalar articular surface.
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Objective@#To evaluate a self-designed novel anatomical bone plate for fractures of ulnar coronoid process in cadaveric specimens.@*Methods@#Our database search in the Imaging Center, Qilu Hospital of Shandong University (Qingdao) yielded CT reconstruction images of 45 normal adult elbows (26 males and 19 females) which met our criteria. On the 3D reformatted CT images, sagittal curvature angle of the ulnar coronal process (△1), tangent angle of the coronal process apex to olecranon fossa (△2), projective length (L) and projective height (H) were measured; the transverse width of the coronal process was also measured at 5 mm and 10 mm from the tip (K1 and K2). The minimum value was used for △2° in order to avoid cutting into the joint while the mean value for other parameters. After the shape of the plate and angles of the screws were designed using computer 3D software, a new anatomic plate for coronal process was produced. Five cadaver specimens were used to test the internal fixation of the coronal process with our novel anatomic bone plate. Attachment of the bone plate to the coronal process and screw penetration into the joint cavity were observed by X-ray and 3D CT scanning.@*Results@#△1 was 45.52°±6.07°, △2 65.25°±7.09° (the minimum value 53.2°), L 52.27±7.78 mm, H 21.62±2.63 mm, K1 16.32±2.22 mm and K2 14.58±2.18 mm. Our new anatomic bone plate was designed based on the above data. X-ray and 3D CT scan after plate internal fixation showed that our self-designed bone plate produced fine attachment and no screws penetrated into the joint.@*Conclusion@#Our new anatomical bone plate may perfectly fit the anatomy of the adult ulnar coronal process in size and shape so that the coronary process can be fully covered and no screws will penetrate into the joint cavity.
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Objective To explore the application of 3D printing templates for titanium plate contouring (TrPC) in pelvic ring surgery.Methods From May 2016 to June 2018,12 patients with pelvic ring injury were treated by internal fixation with 24 titanium plates at Department of Orthopedics and Trauma,Sanshui People's Hospital.After solid digital models of the damaged pelves of the patients were reconstructed from their CT images via software,the hollowed ones were created with the wall thickness of 1.2 mm.After the models of damaged pelves were restored to be intact,the templates for titanium plate contouring were designed based on the area of fixation and manufactured via a stereo lithography apparatus.The total manufacturing time and material consumption of 3D printing TTPC were recorded and compared with those of 3D printing solid and hollow models.Before operation,the titanium plates were contoured according to the templates.The time for preoperative shaping the plate and the time for intraoperative preparing the plate before installation were recorded.After operation,all patients underwent CT scan again for reconstruction of 3D models of the postoperative pelves which were compared with their corresponding preoperative ones in the software.Matta criteria were used to evaluate the pelvic reduction and Majeed criteria to evaluate the functional recovery 6 months after operation.Results All patients were followed up for 6 to 28 months (average,16.3 months).The total manufacturing time and material consumption of 3D printing a TTPC were significantly less than those of 3D printing a solid or hollow model (P ＜ 0.05).The time for preoperative shaping the plate was 12.8 ± 4.1 minutes and the time for intraoperative preparing the plate was 1.4 ± 1.1 minutes.The average deviation between the preoperative 3D models and the postoperative ones was 1.4 ± 1.1 mm.According to the Matta criteria for pelvic reduction,6 cases were excellent,4 good and 2 satisfactory.According to the Majeed criteria,the pelvic functions were excellent in 7 cases,good in 4,and fair in one.Conclusion Application of 3D printing TTPC in the surgery for pelvic ring injury is advantageous in lowering the costs of 3D printing and reducing the intraoperative time for contouring the titanium plate,leading to satisfactory outcomes.
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Objective To observe operative outcomes of suture-button technique for acute Lisfranc injury.Methods A retrospective observation was conducted of the 11 patients who had been operatively treated with suture-button technique and plate fixation for acute Lisfranc injury from January 2015 to December 2016.They were 8 men and 3 women,aged from 22 to 54 years(mean,32.1 years).By the Myerson classification for the injury,there were 9 cases of type B2 and 2 cases of type Cl;by the Chiodo classification,there were 7 cases of middle column injury,2 cases of injury to middle and lateral columns and 2 cases of injury to medial and middle columns.Their scores on the visual analogue scale(VAS),mid-foot scores of American Orthopedic Foot and Ankle Society(AOFAS),bone union and complications were observed post-operatively.Results Follow-ups for this cohort lasted for 14 to 34 months(mean,20.5 months).Follow-ups revealed that their VAS scores for the affected foot averaged 0.6(from 0 to 2),significantly higher than those for the nomal foot(Z=2.070,P=0.038).Their AOFAS scores averaged 95.2(from 87 to 100),significantly lowerer than those for the nomal foot(Z=2.121,P=0.034).All fractures were united well.Conclusion Suture-button technique can lead to satisfactory outcomes for acute Lisfranc injury.