Effect of open reduction and internal fixation in the treatment of 50 patients with tibial plateau fractures and its influence on knee functional recovery / 中国基层医药

Objective To evaluate the effect of open reduction and internal fixation in the treatment of 50 patients with tibial plateau fractures(FTP),and its influence on knee functional recovery.Methods 50 patients with FTP were treated with open reduction and internal fixation.The operation time,blood loss,gypsum braking time,hospitalization time and fracture healing time were recorded,and the incidence of complication was analyzed as well.3 days after operation,imaging evaluation was performed to evaluate the effect of operation reduction.The patients were followed up for 6 months.The HSS scores before and after operation were compared,and the clinical efficacy was evaluated by HSS score.Results 50 FTP patients treatment with internal fixation were successful.The operation time was (101.36±15.63)min,the blood loss was (291.45±34.98)mL,the hospitalization time was (6.85±1.21)d,the postoperative plaster brake time was (20.35±3.67)d,the fracture healing time was (87.63±2.36)d.50 patients were all satisfied to reset,excellent reduction in 40 cases,good reduction in 7 cases,satisfaction in 3 cases,postoperative incision infection in 2 cases,pulmonary embolism in 1 case,nonunion in 1 case and fascia compartment syndrome in 1 case,the total incidence rate of complications was 10.0%.6 months after operation,the HSS scores(pain,function,range of motion,muscle strength,flexion deformity,joint stability) were significantly higher than before operation(t=12.070,17.241,19.986,10.850,21.098,10.238,all P=0.000).Of 50 cases with FTP,excellent in 23 cases,good in 19 cases,fair in 7 cases and poor in 1 case,the excellent and good rate was 84.0%.Conclusion Open reduction and internal fixation in the treatment of FTP gets satisfactory reduction effect,it has certain safety,and it can effectively promote fracture healing and knee functional recovery and improvement,its clinical effect is remarkable.

The application value of damage control orthopedics surgery in the management of unstable pelvic fractures / 中国基层医药

Objective To investigate the application value of damage control orthopedic surgery in the man-agement of unstable pelvic fractures.Methods From January 2011 to December 2015,107 patients with unstable pelvic fractures were retrospectively studied.All patients were signed into the damage control surgery group (59 cases)or open reduction and internal fixation in stage I group (48 cases).The postoperative complications, Lindahl evaluation of the quality of fracture reduction,Majeed function score,hospital duration and mortality were observed.Results Compared with the open reduction and internal fixation in stage I group,patients in the damage control surgery group got a significantly lower rate of multiple organ dysfunction (23.73% vs.45.84%,χ2 =5.793, P =0.016);a higher excellent and good rate of Lindahl evaluation of the quality of fracture reduction (93.22% vs. 79.17%,χ2 =4.597,P =0.032 );a higher level of Majeed function score three months after the operation [(84.41 ±10.33)vs.(74.85 ±10.72),t =4.678,P =0.000];and a higher rate of hospital mortality(15.25% vs. 31.25%,χ2 =3.892,P =0.049).There were no differences between the two groups in sepsis,disseminated intravas-cular coagulation,pulmonary embolism,deep vein thrombosis,pulmonary infection,intestinal obstruction and hospital duration (all P >0.05).Conclusion Damage control orthopedic surgery reduced the postoperative complications of unstable pelvic fractures,improved the pelvic function recovery,and decreased the hospital mortality.

A Case of Asymptomatic Giant Right Atrial Aneurysm

A healthy 8 year old boy was referred to our hospital because of cardiomegaly on the chest X ray. No cardiac murmur was detected on chest examination and normal sinus rhythm was checked by electrocardiogram. The 2-D echocardiogram showed a huge dilated right atrium and a normal tricuspid valve and right ventricle. The findings of cardiac angiogram and MRI was compatible with the isolated giant right atrial aneurysm. For the prevention of atrial arrhythmia and thromboembolism, he underwent successful surgical reduction of the right atrium and cryoablation and the follow-up X ray showed no cardiomegaly.

Four Cases of Congenital Depressed Skull Fractures in Neonates

Depressed skull fractures in newborn babies mainly result from birth injury and rarely occurr in intrauterine life without any definable etiology. We present 4 cases of congenital intrauterine depressed skull fractures which were discovered at birth in neonates. Three babies (case 1, 2, 3) had round shallow depressions without adjacent soft tissue injury except the last one (case 4), showing sharp angulation in the center of the depression. They had neither birth trauma nor forceps applications and they were healthy without neurologic symptoms. We performed nonsurgical reduction using vacuum extractor in all cases. Three cases were reduced successfully, but the last one failed due to sharp angulation in the center of the depression. It was reduced successfully by surgical elevation using a Freer elevator. Reduction should be performed in congenital depressed skull fractures without neurologic symptoms, because brain compression by depressed fracture results in brain injury or epileptic focus. Nonsurgical reduction should be prior to surgical reduction because of its technical feasability, safety and good results, but surgical reduction should be attempted in the case of sharp angulation in the center of the depression.

Transpedicular Zielke Instrumentation of Spondylolisthesis after Anatomical Reduction / 대한정형외과학회잡지

The authors report the experience of twenty patients of transpedicular Zielke instrumentation after anatomical reduction of the spondylolisthesis. Anstomical reduction was done with the aid of temporary application of Harrington distraction rod, and the reduced segment was fixed with transpedicular Zielke instrumentation. And, anterior interbody fusion was supplemented in a single stage operation. Follow up period was between 13 to 25 months after operation with the average of 19 months. 1. The age of the patients was 38 years in average ranging from 11 to 61 years. 2. Types of the spondylolisthesis were spondylolytic type in 11 cases, degenerative type in 6 cases, dysplastic type in 1 case and pathologic type in 2 cases. 3. The level of the lesion were L5-Sl in 12 cases, L4-5 in 7 cases and L3-4 in 1 case. 4. Pre-operative clinical feature included low back pain in 95%, radiating pain in 65%, and neurological claudication in 45%. 5. The average percentage of slippage was changed from 24% preoperatively to 6% postoperatively and to 8% at the final follow up. The initial correction rate was 75% and the amount of correction loss during the follow up period was 11% in average. 6. Slip angle was changed from 3°preoperatively to −3°poetoperatively and to 0°at the end of follow up. In the 12 cases with local kyphosis, average slip angle of 14°preoperatively was improved to 2°postoperatively, and to 7°at the end of follow up. 7. Bony fusion was obtained in 19 cases within 4 to 6 months. 8. There were 2 cases of metal failure with considerable loss of reduction ; one patient with pathologic spondylolisthesie due to active tuberculous spondylitis required re-operation and another patient showed fusion eventually in the redisplaced position. Other complication included 1 transient dysuria, 1 ileus and 2 meralgia paresthetics. 9. Clinical symptoms were improved in 95%. Follow up result of the operation according to Gill's criteria were excellent 65%, good 25%, fair 5%, and poor 5%.