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【Objective】 To evaluate the clinical efficacy of utilizing auxiliary steel plates in conjunction with autologous platelet-rich plasma (PRP) therapy for the treatment of bone non-union following intramedullary fixation of long shaft fractures in the limbs. 【Methods】 From January 2020 to September 2022, 33 patients with non union after intramedullary fixation of long shaft fractures of the limbs admitted to the orthopedic trauma ward of the 960th Hospital of the PLA Jonit Logistics Support Force were selected as the research subjects, including 28 males and 5 females.The age range was 22 to 55 years, with an average of (37.2±6.7) years. The patients were divided into the experimental group (n=15) and the control group (n=18) in order of admission. All patients retained intramedullary fixation, and the fracture end was fixed with reconstruction steel plates. According to the random number table method, 15 cases in the experimental group were treated with autologous iliac bone transplantation combined with intraoperative and postoperative autologous PRP. The activated autologous PRP was fully fused with the patient′s autologous iliac bone during surgery and transplanted to the bone defect site.Ultrasound guidance was used to accurately locate the location. Autologous PRP was injected 10 mL/(person) occasion on the 14 th and 28 th day after surgery respectively. Eighteen cases in the control group received the treatment of autologous iliac bone transplantation at the bone defect site only. The clinical healing status of fractures between the two groups of patients were observed and compared. 【Results】 All 33 patients were followed up for a complete period of 9 to 30 months, with an average of (11.8±2.7) months. Compared with the control group, the clinical fracture healing time (months) was 5.25±1.18 vs 7.27±1.38 (P<0.05); The healing rate was 93.3%(14/15)vs 61.1%(11/18) (P<0.05). 【Conclusion】 The combination of intraoperative and postoperative use of autologous PRP and auxiliary steel plates could promote the healing of bone non union after intramedullary fixation of long shaft fractures in the limbs, which is beneficial for early functional exercise of patients.
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BACKGROUND:Intramedullary nail has achieved a good clinical result in the treatment of femoral shaft fractures,but some patients still have aseptic nonunion due to mechanical instability.The femur is the longest and largest bone in the human body,but there are few studies on whether the fracture of the femur has different biomechanical results in different areas and the influence of different inserting methods on the stability of fracture fragments in different areas. OBJECTIVE:To analyze the biomechanical characteristics of anterograde and retrograde intramedullary nails in the treatment of different areas of femoral shaft fractures,and to evaluate the best way of insertion to reduce the incidence of nonunion. METHODS:CT data of a healthy volunteer were selected to import into the software of Mimics 19.0 and Geomagic studio 2017 to extract and optimize the three-dimensional model of the right femur.The anterograde and retrograde intramedullary nail models were built with Solidworks 2017 software and assembled with femoral shaft fracture models at different fracture areas according to standard surgical techniques.The models were imported into Abaqus 2017 software in STEP format to set material attribute parameters,boundary conditions,load and submit calculation,and the results were viewed in the visualization module.Among them,the antegrade and retrograde intramedullary nails of the upper femoral shaft fracture were A1 and A2 models,B1 and B2 models in the middle segment,and C1 and C2 models in the lower segment. RESULTS AND CONCLUSION:(1)In models A1,B1 and C2,the overall stress distribution of the femur was more uniform,and the placement,the displacement and angle of the fracture site,and inversion angle of the proximal femoral bone fragment were smaller.(2)For the upper and middle femoral shaft fractures,the anterograde intramedullary nail has a better biomechanical effect.For lower femoral shaft fractures,a retrograde intramedullary nail is preferable.
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BACKGROUND:Fractures of the fifth metacarpal shaft are common in the clinic,and surgical treatment is mostly performed with open reduction plate fixation,but postoperatively,most patients require removal of the internal fixation and require secondary hospitalization.Transcutaneous fixation with a Kirschner wire has many advantages,such as less trauma,small incision,and no need for reoperation. OBJECTIVE:To comparatively analyze the clinical efficacy of percutaneous fixation of a Kirschner wire with miniplate placement in the transverse plane for treatment of the fifth metacarpal shaft fracture. METHODS:A total of 60 patients who underwent surgery for the fifth metacarpal shaft fracture at Binzhou Medical University Hospital between May 2018 and May 2020 were retrospectively analyzed and divided into two groups according to the operation method.30 patients in the plate group were treated with open reduction miniplate internal fixation;30 patients in the Kirschner wire group were treated with closed reduction and percutaneous fixation with a Kirschner wire(of which 5 patients were treated with mini-incision incision assisted fixation).The length of hospital stay,operation time,incision healing grade,incision length,intraoperative blood loss,intraoperative fluoroscopy number,and postoperative complications were compared between the two groups.The fracture healing time,grip strength,and the motion range of the fifth metacarpophalangeal joint were recorded in the two groups,and the functional outcomes of the fingers were evaluated by the total active movement method. RESULTS AND CONCLUSION:(1)Patients in both groups were followed up for 13-18 months.The differences in hospital stay,operation time,and incision healing grade between the two groups were not statistically significant(P>0.05).(2)The amount of intraoperative blood loss and incision length in the Kirschner wire group were less than those in the plate group(P<0.05).The number of intraoperative fluoroscopies in the plate group was less than that in the Kirschner wire group(P<0.05).There was no significant difference in the fracture healing time between the two groups(P>0.05).(3)At the last follow-up,the efficacy was evaluated according to the total active movement method.The excellent and good rate was 87%in the Kirschner wire group and 90%in the plate group,with no significant difference.There were no significant differences between the two groups in the motion range and grip strength of the fifth metacarpophalangeal joint at the last follow-up(P>0.05).(4)Pin tract infection occurred in one case after Kirschner wire placement,which improved after giving iodophor to enhance the dressing change.There was 1 case of pin tail irritating skin symptoms,which resolved after the removal of the Kirschner wires.There were 12 patients in the plate group who were hospitalized after 12 months for personal reasons for plate removal,and all in the Kirschner wire group were removed on an outpatient basis.In the plate group,three patients developed sensory numbness of the skin on the dorsal side of the distal fifth metacarpal and the dorsal side of the little finger,which resolved gradually with oral administration of mecobalamin after surgery.There were no instances of nonunion and refracture with internal fixation in either group.(5)Our results showed that both of these surgical procedures achieved good results in the treatment of fifth metacarpal shaft fracture with excellent functional recovery of the fingers,but the transverse fixation with percutaneous Kirschner wire has many advantages,such as less trauma,small incision,low cost,and convenient removal of internal fixation.
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BACKGROUND:After the treatment of femoral shaft fracture with the intramedullary nail,the third fracture open reduction indications are controversial.Some scholars believe that limited open reduction can achieve anatomical reduction,conducive to fracture healing;but some scholars believe that no open reduction of the third fracture still has a high fracture healing rate. OBJECTIVE:To investigate the effect of the circumference and displacement of the third fragment on fracture healing after intramedullary nailing of femoral shaft fractures with the third fragment. METHODS:A retrospective cohort study was conducted to analyze the clinical data of 142 patients suffered a femoral shaft fracture with a third fragment admitted to the Affiliated Lianyungang Hospital of Xuzhou Medical University from February 2016 to December 2021.The fracture were classified into three types according to the circumference of the third fracture with reference to the diaphyseal circumference at the fracture site:type 1 in 71 cases,type 2 in 52 cases,and type 3 in 19 cases.Referring to the diaphyseal diameter,the fractures were classified into three degrees according to the degree of the third fragment displacement:degree I in 95 cases,degree II in 31 cases,and degree III in 16 cases.All patients were treated with femoral interlocking intramedullary nails,and no intervention was performed for the displaced third fragment during the operation.Postoperative follow-up was performed to compare the fracture healing rate,healing time,and the modified Radiographic Union Scale for Tibia at month 9 after surgery in each group.The effect of third fracture fragment circumference and degree of displacement on fracture healing was assessed. RESULTS AND CONCLUSION:(1)All 142 patients were followed up for at least 12 months,with a mean of(14.7±4.1)months,and the overall healing rate was 73.4%.(2)When the third fragment was displaced by degree I,the healing rate,healing time,and modified Radiographic Union Scale for Tibia score at month 9 were not statistically significant among the three sub-groups of circumference classification.(3)When the third fragments were displaced by degree II or III,the healing rate and healing time were not statistically significant among the three subgroups of circumference classification;the modified Radiographic Union Scale for Tibia score at month 9 in the type 1 group was higher than that in the type 2 and 3 groups(P = 0.017).(4)Logistic regression analysis showed that a greater third fragment displacement and circumference were associated with lower fracture healing rates(P<0.05).(5)These findings indicate that in the treatment of femoral shaft fractures with third fragment by intramedullary nails,when the fracture fragment is displaced to degree I,the circumference size has little effect on fracture healing,and no intervention is required during surgery.When the third fragment is displaced to degree II or III and the circumference of which is type 1,a higher modified Radiographic Union Scale for Tibia score can still be obtained with no intervention of the third fragment.However,when the circumference is of type 2 or type 3,it significantly affects the fracture healing.Consequently,intraoperative intervention to reduce the distance of displacement of the fragment is required to lower the incidence of nonunion.The displacement of the third fracture fragments has a greater impact on fracture healing than their circumference.
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OBJECTIVE@#To retrospectively analyze efficacy of single structure internal fixation and double structure internal fixation in the treatment of ipsilateral femoral shaft and neck fracture, and analyze their indications.@*METHODS@#From June 2015 to December 2020, 21 patients with ipsilateral femoral shaft and femoral neck fracture were treated, including 14 males and 7 females, aged 23 to 69 years old with an average of(38.1±12.9) years old. According to different femoral shaft fracture sites, some patients were fixed with cephalomedullary implant for both femoral neck and the femoral shaft(single structure, InterTan or PFNA Ⅱ), some patients were fixed with cannulated screws for the femoral neck and a retrograde locking nail for the femoral shaft (dual structure), and postoperative function and complications were recorded during follow-up. In 10 cases of single-structure fixation, the femoral necks were all basicervical fractures, and the femoral shaft fractures were located in the proximal isthmus;11 cases were double-structure fixation, 9 cases in 11 were basal type of femoral neck, 2 cases in 11 were neck type, and the femoral shaft fractures were located in the isthmus and the distal isthmus.@*RESULTS@#All patients were followed up for 12 to 27 months. No femoral head necrosis, deformity, delay or nonunion occurred in the patients with single-structure fixation, and no delayed union or nonunion occurred in femoral shaft fractures;At the final follow-up, Harris score of patients with single-structure fixation was 91.8±4.1, with 8 cases were excellent and 2 cases were good. The fractures of patients with dual-structure fixation achieved good union without femoral head necrosis, except 1 case of femoral shaft fracture had delayed union;At the final follow-up, Harris score of patients with dual-structure fixation was 92.4±5.9, 7 cases were excellent, 3 cases were good, and 1 case was fair.@*CONCLUSION@#Good reduction and fixation is the key to the treatment of such fractures. Both the single-structure fixation and the dual-structure fixation are good methods, and it should be selected according to the locations of femoral shaft and femoral neck fractures. Single-structure fixation is a good choice for femoral shaft fractures located at the proximal isthmus and basal femoral neck fractures. For isthmus and distal femoral shaft fractures combined with ipsilateral femoral neck fractures, dual-structure fixation is recommended.
Sujets)
Mâle , Femelle , Humains , Jeune adulte , Adulte , Adulte d'âge moyen , Sujet âgé , Col du fémur , Études rétrospectives , Fractures du col fémoral/complications , Fractures du fémur/complications , Ostéosynthèse interne/méthodes , , Résultat thérapeutique , Ostéosynthese intramedullaire/méthodesRésumé
@#Introduction: Compartment syndrome complicating intramedullary nailing of closed tibia fractures has been described as early as the 1980s, but currently remains less described in literature compared to compartment syndrome directly following trauma. This study aims to review this potentially disabling complication and highlight the importance of timely diagnosis and management of compartment syndrome following fracture fixation, not just after fracture itself, via a review of three cases. Material and methods: A retrospective study of a series of three cases was conducted. The type of fracture, wait time to fixation, surgery duration, reaming, size of nail implant used, tourniquet time, and surgical technique were recorded. Time to diagnosis of compartment syndrome, compartment pressure if available, extent of muscle necrosis, reconstructive procedures performed, and post-operative complications were analysed. Results: The three cases following high-energy trauma from road traffic accidents presented from January to May 2010. Compartment syndrome was diagnosed clinically for all cases, between one to six days post-operatively and supported by elevated compartment pressure measurements in two of the three cases. Conclusion: This study advocates thorough clinical monitoring and maintaining strong clinical suspicion of compartment syndrome in patients even after intramedullary nail fixation of tibial shaft fractures to achieve timely limbsalvaging intervention. While intercompartmental pressure can be used to aid in diagnosis, we do not advise using it in isolation to diagnose compartment syndrome. Tendon transfer improves functional mobility and provides a good result in patients with severe muscle damage, while skin grafting sufficient in patients with minimal muscle damage.
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@#Femoral shaft fractures are increasingly common due to various traumatic injuries. Intramedullary nail (IMN) is considered the gold standard treatment for these fractures, but comorbidities often require thorough trauma life support and intensive care. The primary goal of treatment is rigid fixation, early mobilisation, and long-term functional recovery. This article reviews current concepts in the treatment of femoral shaft fractures, including the effects of early or delayed operation, differences between antegrade or retrograde intramedullary nailing, alternative methods to using a fracture table, methods to predict nail length before operation, assessing femoral rotation during an operation, and complications.
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Fractures of the femoral shaft are one of the most common injuries treated by orthopedic surgeons. These fractures are often associated with polytrauma and can be life-threatening.For physiologically stable individuals, Intramedullary Nailing (IMN) is the most prevalent therapy. Early healing and long-term functional recovery are the goals of fixation. Treatment of modern-day femoral shaft fractures results in excellent outcomes. Aims : To assess the results of intramedullary nailing of femoral shaft fractures by both open and closed methods. Methods : Primary, non-randomized, prospective cohort study, Patients having fracture shaft of femur who was admitted in MGM Medical College & LSK Hospital, Kishanganj was taken for the study, The study period from October 2019 to April 2021. Total 40 cases were enrolled, Open Kuntcher抯 Nail-20 cases & Closed Interlocking Nail-20 cases. Results : Male cases are predominantly high than females among the two groups. Maximum number of fracture (70% in Closed Interlocking Nail group and 80% in Open K-nail group) Radiological union within 15 weeks.Maximum number of the cases found excellent results in both groups. ie, 70% & 65% respectively. In this study, we have not found any poor & fair patients after surgical outcome. Chi-square value 0.1139 & P-value- is 0.735. Conclusion : Except for the period from injury to surgery and operating time, there was no significant difference between the two groups in terms of demographic data, fracture type, and associated co-morbidities and radiological union. When utilised to fix short oblique and transverse fractures near the isthmus of the femur, Kuntscher抯 intramedullary nailing can yield a comparable rate of union to interlocking intramedullary nailing.
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Objective:To compare the clinical effects between cannulated screwing and plating in combination with interlocking intramedullary nailing for the treatment of ipsilateral discontinuous fractures of the tibial shaft and plateau.Methods:A retrospective analysis was performed of the clinical data of 34 patients who had been treated for ipsilateral discontinuous fractures of the tibial shaft and plateau at Department of Orthopedics and Trauma, Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2015 to January 2020. There were 17 males and 17 females, aged from 26 to 60 years (average, of 43.6 years). The left side was affected in 18 cases and the right side in 16. The patients were divided into 2 groups according to their internal fixation methods: a cannulated screw group of 16 cases treated with cannulated screwing and intramedullary nailing and a plate group of 18 cases treated with plating and intramedullary nailing. The 2 groups were compared in terms of operation time, intraoperative blood loss, incision length, tibial plateau collapse, consumables cost, hospital stay, fracture healing time, weight-bearing time, range of knee motion, reduction of tibial plateau fracture by Rasmussen radiology, Lysholm knee function score at the last follow-up and complications.Results:There was no significant difference in the preoperative general data between the 2 groups, showing the 2 groups were comparable ( P>0.05). All the 34 patients were followed up for 12 to 28 months (average, 17.4 months). There was no significant difference either in operation time, hospital stay, tibial plateau healing time, tibial fracture healing time, weight-bearing time or range of knee motion between the 2 groups ( P>0.05). In the cannulated screw group, the intraoperative blood loss [(89.4 ± 14.5) mL] and consumables cost [(2.0 ± 0.2) ten thousand yuan] were significantly less than those in the plate group [(120.8 ± 22.1) mL and (2.6 ± 0.4) ten thousand yuan], the incision length [(4.1 ± 0.8) cm] was significantly shorter than that in the plate group [(7.1 ± 0.9) cm], and the Lysholm knee function score at the last follow-up [(89.8 ± 4.5) points] was significantly lower than that in the plate group [(93.0 ± 4.2 points] (all P<0.05). The difference was statistically significant between the 2 groups in the quality of tibial plateau reduction ( P<0.05). The postoperative tibial plateau collapse in the plate group [0.5 (0, 2) mm] was insignificantly less than that in the cannulated screw group [1.0 (0, 2) mm] ( P>0.05). In the cannulated screw group, one tibial shaft fracture did not achieve union after operation and deep vein thrombosis occurred in 2 cases after operation; in the plate group, 2 cases suffered from delayed wound healing, one from delayed fracture healing, one from deep venous thrombosis of lower extremity, and one from knee discomfort which was relieved after removal of internal fixation. Conclusions:In the treatment of ipsilateral discontinuous fractures of tibial shaft and plateau, both cannulated screwing and plating in combination with interlocking intramedullary nailing can achieve good clinical effects. Although plating in combination with intramedullary nailing lead to more severe trauma and higher costs, it is conducive to improving the reduction quality of the tibial plateau and postoperative functional recovery of the knee joint.
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【Objective】 To explore the clinical effects of autologous platelet-rich plasma (PRP) in the treatment of postoperative bone nonunion for long bone shaft fractures during operation and after operation. 【Methods】 A total of 34 patients with postoperative bone nonunion for long bone shaft fracture, who were admitted and cured in the Orthopedics Department of our hospital from January 2019 to June 2020, were selected. They were randomly divided into the experimental group(n=17) and control group(n=17). Individuals in the control were treated with autologous iliac bone alone., while the experimental group were treated with autologous iliac bone graft plus autologous PRP during and after operation. After surgery, the autogenous PRP was accurately injected with ultrasound guidance every 7 days (5 mL/person, 4 occasions in total). The clinical healing time of the fracture, the grading of callus formation and the functional rehabilitation level of limbs on the affected side at different time were observed in both groups. 【Results】 All 34 patients were followed up. In the experimental group and the control group, the clinical healing time (month) of the fracture was (5.03±1.24) vs (6.91±1.41), P<0.05. The healing rate of the fracture for 6 months and 9 months was 94%(16/17)vs 59%(10/17)and 94%(16/17)vs 82%(14/17), respectively (P<0.05). The grading of callus formation within 3, 6 and 9 months was (2.11±0.69) vs (1.53±0.80), (3.06±0.90) vs (2.59±0.87) and (3.82±0.73) vs (3.35±0.86), respectively (P<0.05). The acceptance rate of functional rehabilitation of limbs on the affected side was 82.35%(14/17)vs 76.47%(13/17), P<0.05. 【Conclusion】 The application of autologous PRP in the treatment of postoperative bone nonunion for long bone shaft fractures during operation and after operation can achieve good clinical treatment.
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OBJECTIVE@#To summarize the complications of core drilling intramedullary nail in the treatment of femoral shaft closed fracture and explore the treatment strategy.@*METHODS@#From August 2014 to June 2018, a total of 215 patients with closed femoral shaft fractures were treated with closed reduction core drill intramedullary nail, including 129 males and 86 females, aged from 18 to 62 years, with an average of (44.2±10.6) years old. The time from injury to operation was 3 to 21 days. There were 102 cases of AO type A fracture, 82 cases of AO type B fracture and 31 cases of AO type C fracture. The time of operation, the amount of blood loss during operation, the duration of hospitalization, the time of fracture healing and the HSS score of knee joint function at the last follow-up were recorded. The observation of complications included:iatrogenic fracture, core drill broken, core drill twist, postoperative infection, and fracture nonunion.@*RESULTS@#The average operation time was (63.2± 15.6) min and intraoperative blood loss was (150.0±34.5) ml. All the incisions reached grade A healing. Patients were follow up for a mean of (18.5±3.2) months, the average hospital stay was (4.3±1.2) days, and the average fracture healing time was (5.6±2.3) months. At the final follow-up, the average HSS score of knee joint was 90.3±4.7. Related complications occurred in 37 cases (17.2%). The core drill related complications occurred in 13 cases (6.0%), including core drill broken in 5 cases (2.3%), core removal in 1 case and slotting in 4 cases;core drill twist in 8 cases (3.7%). After the core was cut, the core was removed. Similar complicationsof conventional intramedullary nail:iatrogenic fracture was performed in 12 cases (5.6%), including 10 cases of fracture end split and 2 cases of distal perimedullary fracture of intramedullary nail. The patients with cleavage at the fracture end were not treated after judging their stability, and the patients with fracture around the distal end of the intramedullary nail were fixed with auxiliary steel plate during operation;1 case(0.4%) with delayed infection after operation, debridement and external fixation was replaced and healed after bone transfer; fracture nonunion occurred in 11 cases (5.1%), of which 7 cases (3.3%) were hypertrophic nonunion and healed with additional plate. Atrophic nonunion occurred in 4 cases (1.9%), which healed after additional steel plate and bone graft.@*CONCLUSION@#Core drilling intramedullary nail is an effective method for the treatment of closed femoral shaft fracture, and the complications include core drill related complications and conventional intramedullary nail similar complications. Accurate preoperative evaluation, careful operation during operation and early postoperative symptomatic treatment can effectively reduce the occurrence of related complications.
Sujets)
Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Clous orthopédiques , Fractures du fémur/chirurgie , Ostéosynthese intramedullaire/effets indésirables , Consolidation de fracture , Fractures fermées , Résultat thérapeutiqueRésumé
@#A bent intramedullary (IM) nail becomes challenging and technically demanding to the orthopaedic surgeon for nail extraction. A broken nail can be easily removed through the fracture site. However, a bent nail has to be broken before it can be removed. Several studies and case reports outline the strategies and techniques for removing a bent IM nail. However, there is a paucity of guidelines and standard protocol describing the best and inexpensive strategy. We report a case where two years following surgery for intramedullary nailing of the right femur, the IM mail was bent following secondary trauma. We used a technique based on the principles of an ability to fully cut the nail and extract it in two pieces by using a Jumbo cutter which is available in the orthopaedic armamentarium. This technique is simple yet economical, with the likelihood of causing less soft tissue damage and thermal necrosis.
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Objective To compare biomechanical properties of the traditional and novel locking compression plate （LCP） for treating femoral shaft fracture, so as to provide theoretical basis for selecting more effective bone plate. Methods The bending strength and fatigue tests on the plate were performed, and the finite element analysis on deformation, stress and life of the plate were conducted by using ANSYS Workbench. Results The average bending yield load and bending strength of the novel LCP were 1.4 times of that of the traditional LCP, and the average cycle times of the novel and traditional LCP were 106 and 47 091, respectively. The difference of service life for two LCPs was 33.8%. ConclusionsThe failure probability of the novel LCP is smaller than that of the traditional LCP, and the novel LCP has more effective biomechanical stability.
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Objective: To explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation. Methods: The clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness. Results: Both groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction ( P0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant ( P<0.05). Conclusion: Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.
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BACKGROUND: At present, there are relatively few studies on the closed reduction of intramedullary nail treatment for femoral shaft fractures. OBJECTIVE: To investigate the effect of closed reduction and intramedullary nailing in the treatment of femoral shaft fractures in the lateral position. METHODS: From January 2015 to October 2018, 54 patients with femoral shaft fractures were treated with intramedullary nailing at Department of Orthopedics and Traumatology, the Third Affiliated Hospital of Zunyi Medical University. The patients were randomly assigned to three groups, including 17 cases in the supine mechanical traction group, 17 cases in the lateral artificial traction group, and 20 cases in the lateral mechanical traction group. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Closed reduction success rate, operation time, intraoperative blood loss, fracture healing time, and hospital for special surgery knee score at 6 months after surgery were compared in the three groups. RESULTS AND CONCLUSION: (1) All patients were followed up for 6 to 15 months. (2) The success rate of fracture closure was 100% in the lateral mechanical traction group, 82% in the lateral artificial traction group, and 59% in the supine mechanical traction group. There was no significant difference between supine mechanical traction group and lateral artificial traction group (P > 0.05). The success rate was significantly higher in the lateral mechanical traction group than in the supine mechanical traction group (P=0.002). There was no significant difference between the lateral mechanical traction group and the lateral artificial traction group (P > 0.05). (3) No significant difference was found in operation time between the supine mechanical traction group and the lateral artificial traction group (P > 0.05). The operation time was significantly shorter in the lateral mechanical traction group than in the supine mechanical traction group and lateral artificial traction group (P 0.05). (5) Fracture healing time was significantly longer in the supine mechanical traction group than in the lateral artificial traction group (P=0.030) and lateral mechanical traction group (P 0.05). (6) No significant difference in hospital for special surgery knee score at 6 months after surgery was detected among the three groups (P > 0.05). (7) These results suggested that application of lateral recumbent traction frame closure and intramedullary nailing for the treatment of femoral shaft fractures has the advantages of high success rate, short operation time, less intraoperative blood loss and short fracture healing time. It is worthy of clinical application.
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BACKGROUND: Patients with poliomyelitis often have abnormalities in the femur and the conventional plant matching degree of fracture is low. There are few reports on individualized treatment for severe deformity of femoral shaft fracture in poliomyelitis. OBJECTIVE: To summarize the clinical features of femoral shaft fracture in poliomyelitis and discuss the operative outcome of 3D printing pre-operation assisted with custom-made plate. METHODS: From May 2015 to May 2018, data of 19 patients with poliomyelitis surgically treated with 3D printing pre-operation assisted with custom-made plate were retrospectively analyzed. There were 11 males and 8 females with an average age of 52.5 years (range, 38-62 years). There were 7 cases on the left side, and 12 cases on the right side. According to AO/OTA classification of femoral shaft fracture, there were type A1 in 6 cases, type A2 in 3 cases, type A3 in 1 case, type B1 in 4 cases, type B2 in 4 cases and type C1 in 1 case. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The 3D printed 1:1 femur model and custom-made plate were designed. Operation was simulated in vitro in femoral model. The placement of the plate was identified. The direction and length of the screws were measured and recorded. The final internal fixation of fracture was performed according to the pre-operation results. Hip and knee functions in the affected limb were assessed based on Harris evaluation criterion and hospital for special surgery knee score evaluation criterion. RESULTS AND CONCLUSION: (1) All 19 patients were followed up for 12-18 months. Bone healing was obtained in all fractures, with a healing time of 5-12 months, averaging 6.6 months. (2) Harris score was (84.95±5.18) before injury, and (84.42±4.83) 1 year after operation. Hospital for special surgery knee score was (84.53±4.36) before injury, and (83.63±3.90) 1 year after operation. Statistical analysis showed no statistical difference between the two groups before and after the injury (P > 0.05). (3) All patients had no internal fixation loosening or fracture. One patient had delayed bone healing and healed after iliac bone grafting. One patient developed wound infection after surgery, and received adequate drainage. Wound was healed after intravenous application of sensitive antibiotics. (4) Patients with poliomyelitis often have abnormalities in the femur with varying degrees of osteoporosis. For femoral shaft fractures that cannot be fixed with conventional internal fixation, 3D printing pre-operation combined with custom-made steel plate provides a new choice for the treatment of femoral shaft fractures in poliomyelitis.
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Background: Fractures of the tibial shaft are important for tworeasons. The first is that they are common, the second is thatthey are controversial - and anything that is both common andcontroversial must be important. Fractures of the shaft of thetibia cannot be treated by following simple sets of rules.Because of its location tibia is exposed to frequent injury and itis the most commonly fractured long bone.Objective: To evaluate the treatment of open tibial shaftfracture of Gustilo IIIA grade by Trans osseous osteosynthesistechnique with Illizarov External Fixator as a primary anddefinite mode of treatment.Methods: Clinical trial (Quasi Experimental study) fromJanuary 2009 to June 2010 (18 months) at National Institute ofTraumatology and Orthopaedic Rehabilitation Purposivesampling was done according to availability of the patients andstrictly considering the inclusion and exclusion criteria andsample size was 17 no of cases.Results: 14 male and 1 female patient between 17 and 51years were studied. Most common age group in this serieswere 26-35 year age group ((53.33%) and average age of thepatients was 30 years with SD of ±8.67. Most of the patientswere male and road traffic accident was the leading cause ofinjury (70.58%). Left side involved in (58.82%) most of thecases and 2 patients had bilateral fractures. Commonest site ofthe fractures were middle third (58.82%) of the tibia. Most ofthe fractures were comminuted type of fractures (47.05%).Most of the patients were operated on the day of admissionand in some cases within 4 - 7 days of admission. Averageduration of hospital stay was 8.06 days ranging from 1 day to28 days. Total duration of treatment was average 186.66 days(26 weeks) highest 291 days (42 weeks) and lowest 140 days(20 weeks). Most of the patient had soft tissue healing bygranulation tissue formation (35.29%). Others were treated byprimary closure, Delayed primary closure, secondary closure,partial thickness skin grafting.Conclusion: In this study the results of open tibia fracture(Gustilo IIIA) by Transosseous osteosynthesis technique withIlizarov External Fixator has been found to be satisfactory.Though there were a few minor complications with the fixatorthe dynamisation and compressing ability of this stable frameprovided good union without any second surgical procedure orbone grafting and prevented any malunion.
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Background: The management of infective non-union of long bones has always been a dare for orthopedic surgeons. Treatmentgoals were the annihilation of infection and augmenting bony union. For the span of distraction osteogenesis, physiologicalskeletal loading and active mobilization are vital.Aim: This study intended at evaluating the clinicoradiological result of using Ilizarov ring fixator in managing patients withinfective non-union fracture of shaft of the femur.Materials and Methods: A total of 40 patients with infective non-union of the femoral shaft were incorporated in the study between2017 and 2018. The follow-up period lasted for 14–20 months. Skeletal measurements and functional results were calculated,and difficulties were stratified according to the association for the study and relevance of the technique of Ilizarov guidelines.Results: The infection was eradicated in 32 patients before the fixator removal. Tremendous radiological bone healing wasfound in 32 patients and excellent functional result in 28 of 40 patients.Conclusion: Ilizarov ring fixator is a valuable method for the managing of infective non-union of femoral shaft fractures withsatisfactory radiological and clinical outcome and less serious complications.
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INTRODUCTION@#This study compared Polyvinyl Chloride (PVC) made vs Plaster of Paris (POP) made functional braces in the closed treatment of fractures of the humeral shaft. Outcomes examined were the rate of fracture union, radiographic alignment, DASH scores and the range of motion of the shoulder and elbow@*METHODS@#This was a parallel randomized clinical trial conducted at the Corazon Locsin-Montelibano Memorial Regional Hospital from July 2016 to July 2017. All eligible patients were included and randomly allocated into PVC and POP treatment groups. All patients were followed-up on the 3rd, 6th, 10th, and 14th week for clinical and radiographic evaluation.@*RESULTS@#There were 31 patients, 14 and 17 in the PVC and POP groups, respectively. The median rate of union in the PVC and POP groups were 10.50 and 10.00 weeks, respectively. The median varus and valgus angulation in the PVC and POP groups were 15.75° and 16.5°, respectively. The median anterior and posterior alignment in the PVC group was 1.7° and POP group was 9.6°. The median DASH score of the PVC and POP groups were 7.1 and 12.5, respectively. The median range of motion in the elbow was 135° for both groups. The median range of motion in the shoulder in the PVC group was 150° and POP group was 140°.@*CONCLUSION@#There was a high rate of union of humeral shaft fractures with acceptable functional outcome with the use of the PVC made functional brace compared to the traditional POP made functional brace.
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PURPOSE: This study analyzed the results of the midclavicle fracture treatment using the minimally invasive percutaneous plate osteosynthesis (MIPO) technique in a retrospective manner. MATERIALS AND METHODS: Between March 2013 and March 2017, this study analyzed 40 patients who received MIPO surgery. Excluding 1 patient who underwent surgery on another body part injury, and 4 patients who were lost to follow-up over 1 year, 40 patients were analyzed for their operation time, bone union, functional American Shoulder and Elbow Surgeons score, scar lengths, pain relief (visual analogue scale), and complications. RESULTS: All patients over a 1 year of follow-up achieved bone union, and American Shoulder and Elbow Surgeons score 97.6 (94–100) on their shoulder functional scores. Their average operation time was 42.7 minutes, and the average scar length was 6.1 cm. Eighteen patients successfully received metal removal using the previous scar without additional incision. The clavicle length was similar in the normal and operated group. CONCLUSION: Despite its small sample size, clavicle fixation using the MIPO technique can be considered an effective treatment because of its limited number of complications, such as nonunion and rotational angulations.