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Objective To explore the technique and clinical efficacy of quick blocking screw insertion in closed reduction and internal fixation with intramedullary nails for distal tibial metaphyseal fractures.Methods The data of 24 distal tibial metaphyseal fractures were retrospectively analyzed which had beentreated with closed reduction and internal fixation with intramedullary nails from October 2013 to December2014 at Department of Orthopaedics,Zhoukou Central Hospital.They were 17 males and 7 females,with anaverage age of 39.7 years (from 21 to 60 years).There were 2 open fractures of Gustilo type Ⅰ.According toAO/OTA classification,3 cases belonged to type 42-A2,4 to type 42-A3,6 to type 42-B1,2 to type 42-B2,3 to type 42-B3,2 to type 42-C1,3 to type 42-C2,and 1 to type 42-C3.In the internal fixation with in-tramedullary nails,the varus or valgus malalignment of the distal tibia was corrected by manual reduction.According to the fracture type,a 3.0 mm Schanz pin was placed in the concave or convex side of deformityfirst and then gradually replaced by a 4.5 mm blocking screw to maintain reduction.The operation time,bleeding volume,fracture healing time,and complications (including infection,hardware loosening orbreakage,delayed union and nonunion) were recorded.The reduction quality and alignment were evaluated bypostoperative X-ray and CT 3D reconstruction.The clinical efficacy was evaluated at the final follow-up based on the Johner-Wruhs criteria.Results The 22 patients were followed up for a mean time of 35.5 months (from 24 to 48 months).The average operation time was 68.3 minutes (from 50 to 85 minutes),and the average bleeding volume was 95 mL (from 60 to 150 mL).One case of delayed union was healed after dynamic treatment.The average healing time was 3.9 months (from 3 to 8.5 months).No infection,hardware loosening or breakage,or malunion was observed.According to the Johner-Wrubs evaluation at the final follow-up,12 cases were excellent,10 good and 2 fair,giving an excellent to good rate of 91.7％.Conclusion In the closed reduction and internal fixation with intramedullary nails for distal tibial metaphyseal fractures,the yarus or valgus malalignment of the distal fragment can be quickly corrected by manual reduction and quick insertion of a blocking screw to gradually replace a preceding Schanz pin.
RESUMO
Objective To summarize the characteristics of deltoid ligament rupture and explore the feasibility and shortterm clinical outcomes of targeted suture anchor repair technique according to the rupture site.Methods From May 2011 to October 2014,19 cases of complete deltoid ligament rupture (17 males and 2 females) were recruited in this study,with an average age of 34.15± 1.23 years (ranged from 15 to 60 years).According to Lauge-Hansen classification,there were 7 cases of pronation external rotation grade ⅣV injury,including 3 cases of Maisonnuve fracture;1 case of pronation abduction type Ⅲ degree injury,1 case of pronation abduction grade ⅣV injury;and 10 cases of supination external rotation grade ⅣV injury.According to AO / OTA classification,there were 9 cases of 43B type injury and 10 cases of 43C type injury.According to the rupture site of deltoid ligament,the targeted suture anchor repair surgery was operated respectively.Early mobilization with the help of hinged ankle brace was encouraged.The evaluation at last follow-up was based on the American Orthopedic and Ankle Association (AOFAS) criteria of ankle and hindfoot,and the visual analogue scale (VAS) scoring system.Results Nineteen patients were all followed up for 24 to 48 months,with an average of 30.42±5.11 months.Fourteen cases (73.7％,14/19) with talus end avulsion were treated by double suture anchor in the talus,with continuous locking suture of the avulsed end.Four cases (21.1％,4/19) with middle part rupture were treated by double suture anchor in the talus,with the sutures crossing three bone tunnels at the medial malleolus.One case (5.3％,1/19) with medial malleolus end avulsion was treated by single suture anchor at the medial malleolus,with continuous locking suture of the avulsed end.At the last follow-up,the AOFAS score was ranged from 70 points to 96 points,with an average of 90.53 points,and excellent in 16 cases,good in 2 cases,fair in 1 case,excellent and good rate was 94.7％.The VAS score was ranged from 0 to 2 points,with an average of 0.42 point.No wide medical clear space was detected.But traumatic arthritis was happened in 2 patients.Conclusion The targeted suture anchor repair technique according to the rupture site was a save technique in treating deltoid ligament rupture,which is conducive to early postoperative functional exercise,with excellent short-term clinical outcomes and few complications.