Recent progress in the treatment of posterior tibial plateau fractures / 中国骨伤

There is a lack of ideal clinical classification systems for posterior tibial plateau fractures, and they need to be perfected in clinical practices. There are controversies over surgical approaches due to special characters of posterior tibial plateau fractures. It is difficult for the conventional techniques and approaches to achieve satisfactory reduction and fixation. A modified posterior approach is an ideal approach for the treatment of posterior tibial plateau fractures. This paper summarizes the classification, approach and internal fixation of posterior tibial plateau fractures.

Operative treatment for posteromedial condylar split fracture of tibial plateau / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of surgery reduction and internal fixation through posteromedial knee approaches in the treatment of posteromedial condylar split fracture of tibial plateau.</p><p><b>METHODS</b>From January 2006 to July 2009,21 patients with posteromedial condylar split fracture of tibial plateau were treated by posteromedial knee approaches. Among the patients, 14 cases were males and 7 cases were females,ranging from 28 to 68 years old with an average of 36.9 years old. For traumatic causes, 14 cases were injured by traffic accident and 7 cases by fall. Compound injury, 15 cases combined with anterior cruciate ligament injury and tibia insertion avulsion fracture; 14 cases combined with posterolateral de-pressed tibial plateau fracture. Rasmussen assessment criteria was used to evaluate the therapeutic effects.</p><p><b>RESULTS</b>All patients were followed up,from 12 to 30 months with an average of 17.3 months. All patients didn't undergo infection,looseness and rupture of fixation,nonunion of fracture,inversion and eversion of the knee or displacement of fracture. All cases attained anatomical reduction after operation,only 1 patient felt numbness of posterior lower part of the calf. According to Rasmussen assessment criteria, 12 cases got an excellent result, 7 good and 2 fair.</p><p><b>CONCLUSION</b>It is beneficial for the postermedial knee approaches to be used in the reduction and fixation of posteromedial condylar split fracture of tibial plateau. It has advantages of clearly exposure, convenient placement of the internal fixation, less trauma and good therapeutic effects.</p>

Treatment of unstable pelvic posterior ring fractures with percutaneous reconstruction plate internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the method and clinical effect of percutaneous reconstruction plate internal fixation for the treatment of unstable pelvic posterior ring fractures.</p><p><b>METHODS</b>From March 2004 to October 2008, 36 patients with unstable pelvic posterior ring fractures were treated with percutaneous reconstruction plate internal fixation. Heavy traction was used to correct vertical displacement of sacrum, then arc incisions (3-5 cm) were made from both sides of posterior superior iliac spine to ipsilateral inferior iliac spine along iliac crest. The reconstruction plate was pushed through the cutaneously tunnel to the other incision. There were 26 males and 10 females, the age ranged from 10 to 65 years, with an average of 37.3 years old.</p><p><b>RESULTS</b>All the patients were followed up, the duration ranged from 12 to 36 months (means 17.8 months). There were no infection, no vascular nerve injuries and loosening or breakage of the external fixation. All cases attained bone union and lower limbs were equal. The average length of incisions, operative time and intraoperative blood loss were (4.36 +/- 0.99) cm, (42.61 +/- 7.97) min, (168.61 +/- 40.44) ml, respectively. According to the Majeed standards, the functional recovery was excellent in 12, good in 18 and fair in 6.</p><p><b>CONCLUSION</b>Percutaneous reconstruction plate internal fixation is an ideally safe and effective way to treat unstable pelvic posterior ring fractures, it has many advantages such as minimal invasion, less complications and quicker recovery.</p>

Treatment of unstable pelvic fractures with minimally invasive internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of minimally invasive internal fixation in the treatment of unstable pelvic fractures.</p><p><b>METHODS</b>From January 2005 to January 2009, the data of 48 patients with unstable pelvic fractures were retrospectively analyzed. There were 31 males and 17 females. The age ranged from 12 to 66 years with an average of 37.8 years. Among them, 29 cases were caused by traffic accident, 14 by fall from height and 5 by crush injury. According to Tile's classification, type B1 was in 4 cases, B2 in 3, C1 in 25, C2 in 14 and C3 in 2. All patients were treated with minimally invasive internal fixation of percutaneous reconstruction plate (including 20 cases with percutaneous pubic ramus screws fixation and 8 cases with pubic tubercle screws fixation) and percutaneous sacroiliac screws (including 16 cases with percutaneous pubic ramus screws fixation and 4 cases with pubic tubercle screws fixation). With X-ray films to observe the reduction of fractures and according to Majeed standard to evaluate the clinical effects.</p><p><b>RESULTS</b>All patients were followed up for 12-39 months with an average of 17 months. No infection of incision,nerve injuries, loosening or breakage of the screw was found. All cases attained bone union. Anatomical reduction achieved in 29 cases,satisfactory reduction 18 cases, and unsatisfactory reduction 1 case. According to the Majeed standards, 29 cases obtained excellent results, 15 good and 4 fair, the rate of excellent and good was 91.7%.</p><p><b>CONCLUSION</b>Treatment of unstable pelvic fractures with minimally invasive internal fixation had advantages of minimal trauma, less bleeding, less postoperative complications, high bone union rate, reliable fixation and satisfactorily functional recovery after operation, but the method demanded skillful surgical techniques.</p>

Treatment of proximal tibial multi-segment comminuted fractures with closed reduction and less invasive stabilization systems / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of closed reduction and less invasive stablization system for the treatment of proximal tibial multi-segment comminuted fractures, and to discuss the influence of LISS on reduction and bone union.</p><p><b>METHODS</b>From 2003.7 to 2007.12, 19 patients with proximal tibial multi-segment comminuted fractures were treated with closed reduction and LISS fixation. Fourteen patients were male, 5 patients were female, ranging in age from 21 to 49 years, with an average of 39.2 years. Fifteen patients were injured with direct violence, 4 indirect violence. The reasons of the injuries were vehicle crashes for 14 cases and falling from high places for 3 cases and falling to the ground for 2 cases. All the patients were followed up postoperatively. Callus formation and bony union were recorded by X-ray.</p><p><b>RESULTS</b>All the patients were followed up for a period averaged 12.2 months (ranged 8 to 21 months). No failure of fixation and nonunion. No deformation of plates and screws occurred in patients,no superficial wound infection. According to the criteria of Merchan, 14 patients got an excellent result, 3 good, and 2 poor.</p><p><b>CONCLUSION</b>Closed reduction and less invasive stabilization systems can provide rigid internal fixation for proximal tibial multi-segment comminuted fractures. The LISS provides stable fixation, a high rate of union, and a low rate of infection for proximal tibial multi-segment comminuted fractures.</p>

Surgical treatment of talar neck fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effect of talar neck fractures treated by open reduction and internal fixation with screws.</p><p><b>METHODS</b>Among 28 cases in the study, 20 cases were males and 8 cases were female. The age ranged from 22 to 72 years with an average of 38 years. Based on the Hawkins classification,there were 6 cases of type I,18 of type I and 4 of type II. They were treated by open reduction and internal fixation with screws.</p><p><b>RESULTS</b>Twenty-eight cases were followed up for 1 to 7 years(mean 2.8 years). The evaluation of the results by Hawkins functional rating scale revealed excellent in 14 cases,good in 9 cases, fair in 3 cases and poor in 2 cases. The excellent and good rate were 83.2%. Osteonecrosis occurred in 5 cases with 3 of type II and 2 of type III fractures. Two of 3 cases with talar displacement were found with osteonecrosis or painful arthritis. The subtalar arthritis occurred in 6 cases, 3 of which were associated with ankle arthritis. Two cases underwent arthrodesis because of painful arthritis of the subtalar joint or osteonecrosis of the talar body. Wound infection and anteromedial skin necrosis of the ankle were not found.</p><p><b>CONCLUSION</b>Treatment of talar neck fractures could obtain satisfactory clinical results through open reduction and internal fixation with screws. Protection of the residual blood supply, anatomically reduction and stable fixation are essential for successful treatment of talar neck fractures.</p>

Treatment of chronic osteomyelitis with antibiotic-loaded calcium phosphate cement / 中国骨伤

The antibiotic delayed release system which has the characteristics of high local antibiotic concentration,few adverse effects, slow release and long duration, has became one of important methods of treating chronic osteomyelitis. Because of its double action as drug carrier and bone repair material which can induce bone growth and degrade synchronously, drug impregnated calcium phosphate cement (diCPC) is an ideal and safe antibiotic slow release carrier. After clearing focus thoroughly, defect implant with diCPC is an effective method, which has the virtues of convenient operation, good effects and short staying time etc. This paper aims to summarize the biological properties, experimental study and clinical application of diCPC.

Surgical treatment of acetabular posterior wall fractures / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the clinical effect of acetabular posterior wall fractures with reconstruction plate internal fixation.</p><p><b>METHODS</b>From January 2001 to January 2006, 45 cases were studied retrospectively including, 31 males and 14 females. The age ranged from 19 to 68 years, mean 37.6 years. All patients of acetabular posterior wall fractures were treated by open reduction and internal fixation with reconstruction plate. All patients were reviewed retrospectively. All patients were treated with the Kocher-Langenbeck approach.</p><p><b>RESULTS</b>Forty-five patients were followed up for 12 to 48 months, averaged 26 months. By Matta's X-ray reduction criteria, there were 38 cases of anatomical reduction, 7 cases of satisfactory. By modified d'Aubigne clinical evaluation criteria, the clinical results were excellent in 30 cases, good in 10 cases and fair in 5 cases, excellent and good rate of clinical results was 88.9%. There were no infection and non-union. The complications included traumatic osteoarthritis in 4, aseptic necrosis of the femoral head in 2, heterotopic osteogenesis in 2 and deep venous thromboembolism in 1.</p><p><b>CONCLUSION</b>Fractures of acetabular posterior wall with reconstruction plate internal fixation can gain good clinical results. The quality of fracture reduction, the time to surgery after injury, experience of surgical operation and the degree of fracture comminution are the factors influencing the operative results of posterior wall fractures of the acetabulum.</p>