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Objective@#To investigate the clinical characteristics and outcomes of Maisonneuve fractures.@*Methods@#Data of 21 cases of Maisonneuve fractures from February 2015 to December 2017 were retrospectively analyzed. There were 16 males and 5 females with an average age of 38.8 years (range, 21 to 61 years). The fractures occurred on the left side in 11 patients and on the right side in 10 patients. The causes of injuries were traffic accident in 4 patients, sprain injury in 9 patients and falling injury from height in 8 patients. There were 16 cases of medial malleolar fractures and 5 cases of ruptures of deltoid ligament (4 entirely and 1 partial). There were 17 cases of fractures of the posterior malleolus, among which there were 5 of typeⅠ, 8 of typeⅡ and 4 of type Ⅲ according to the Bartonícek classification of posterior malleolus. There were 4 cases without fracture of posterior malleolus including 1 complete disruption of posterior inferior tibiofibular ligament. Four cases were overlooked of Maisonneuve fracture at the first time. The interval between injury and operation was 2-12 days (mean, 4.9 days).@*Results@#Stabilization of proximal fibular fractures were achieved with plate in 3 cases. There were 16 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 13 cases and with anti-glide plates in 3 cases. The entirely rupture of deltoid ligament was repaired in 4 cases with suture anchors, the partial rupture of deltoid ligament was not repaired. There were 17 cases of posterior malleolar fractures, 12 cases treated with open reduction and internal fixation including cannulated screws in 9 cases and anti-glide plates in 3 cases. Stabilization of syndesmosis was achieved with syndesmotic plate in 1 case; the medial and posterior malleolar fractures were stabilized and anterior inferior tibiofibular ligament was repaired with suture anchor in 1 case; the other 19 cases were stabilized with syndesmotic screws, 2 screws in 11 cases and 1 screw in 8. Twenty-one patients were followed up for 13-48 months with an average of 25.6 months. The time of bony union was from 3 to 6 months with an average time of 4.9 months after operation. All patients received anatomical reduction without postoperative complications such as incision infection, reduction lose, breakage of screw and posttraumatic arthritis. In 13 cases, the syndesmotic screw was removed at the mean time of 15.38 weeks postoperative (range, 13-25 weeks). At the latest follow up, AOFAS score was from 84 to 100, with excellent in 13 cases, good in 8 cases, and the excellent and good rate was 100% (21/21). Baird-Jackson score was from 83 to 100, with excellent in 11 cases, good in 8 and fair in 2, and the excellent and good rate was 90.48%(19/21).@*Conclusion@#The diagnosis of proximal fibular fracture of Maisonneuve fracture is easily missed. The complete rupture of deep deltoid ligament and displaced obviously of posterior malleolar fracture should be reduction and stabilization. The accuracy of reduction of the syndesmosis is of great concern. The outcome of operation is satisfied.
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BACKGROUND:Proximal humeral fracture fixation can provide a more stable fixation, has a stronger biomechanical stability, but open reduction and fixation wil cause extensive soft tissue dissection and heavy damage to the rotator cuff. Closed wear nail has a high failure rate of fixation, fracture re-displacement and other defects. OBJECTIVE:To investigate the technical methods of applying closed reduction, percutaneous pinning anatomical external fixation in repair of proximal humeral fracture, and to analyze the application characteristics and safety in different types of proximal humerus fractures. METHODS:Based on the special anatomical structure of proximal humerus, a shoulder external fixator has been independently researched and developed by author. The clinical data of 23 patients treated with closed reduction and percutaneous pinning anatomical external fixation (homemade) because of proximal humerus fracture at the Department of Traumatology, Tianjin Hospital during March 2010 to March 2014 were retrospectively analyzed. In accordance with Neer classification type, there were 19 cases of 2-part fractures of the humerus, 4 cases of 3-parts fractures of the humerus, with greater tuberosity avulsion fractures, which were al fresh fractures and were treated with closed reduction pinning and external fixation. Regular fol ow-up was conducted after treatment. Radiographic assessment, pain and function evaluation were conducted during fol ow-up, so as to work out the functional recovery, determine the final repair result. RESULTS AND CONCLUSION:Al patients were fol owed up for 6-24 months. Total y 23 patients initial y healed in fracture within 8 weeks. After treatment, visual analogue pain score of patients was 0.8 points. In the final fol ow-up, the American Shoulder and Elbow Surgery Association of shoulder function scoring system (ASES) score was an average of (91.7±2.6) points, Constant shoulder function score was an average of (88.3±4.7) points, the University of California (UCLA) shoulder joint scoring system score was (31.9±3.1) points, simple shoulder test (SST) system score was an average of (9.6±2.4) points. The shoulder function assessment (UCLA score) of these 12 patients was excel ent, of 9 cases was good, and of 2 cases was poor. The excel ent rate reached 91%after treatment. These results suggest that the application of closed reduction, percutaneous nailing anatomical external fixation in repair of proximal humerus fractures has the features of stable fixation, and smal damage of soft tissue. Standardizing the angle of closed nailing and entrance point, fixing from the intersection of three planes in arcuate-shape and connecting with external fixation can achieve a more stable fixed effects.
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Objective To evaluate the causes of complications of patients with femoral Intertrochanteric fractures after gamma3 nail fixation.Methods A retrospective analysis was conducted to summarize the treatment of intertrochanteric fractures in 186 cases with Gamma3 nail from May 2006 to July 2011.Complications occurred in 24 cases during the operations.19 were males,5 females,with the age from 42 to 81,the average age of 69.00±3.27 years.According to AO/OTA classification,8 cases were type A1,1 case were type A2.1,15 cases were type A3.All patients included were acute fractures,while pathological fractures were excluded.Supine position were selected during operation,close reduction were performed in traction bed.Gamma3 nail made by Stryker Company was used to fix fractures through small incisions.Operational times were from 45 to 160 minutes,averaged by 80 min.Blood lose were 300-800 ml in average.No patient need blood transfusion.The procedure from hospitalized to operation is from 3 to 12 days,6 days in average,discharged from 3 to 16 days after operation.According to the intraoperative and postoperative follow-up evaluation of the X-ray and Harris evaluation criteria,Gamma3 nail complications were summarized in the application.Results Time of surgery in 24 cases were 45-160 min,average 80 min.Blood loss were 300-800 ml,average 600 ml,walking time 35-106 d.Harris evaluation were 75-91 point,average 81 point.The anti-spiral nail dropped into inner thigh muscles occurred in 1 case,causing defects of femoral lateral wall in 3 cases.Splitting fractures occurred in the proximal femoral shaft during the operations in 5 cases,poor fracture reduction during closed reduction in 6 cases.Fracture site were shifted lately postoperative in 5 cases,lag screw cut-out in 3cases and refracture in the site of distal femoral interlocking nail in 1 case.Conclusion Higher incidence of complications were occurred in some special types of AO classification when using close reduction and short Gamma3 nail.The reduction method,wrong indication selection and unreasonable application of equipment may result in the occurence of complications.We,therefore,should use long or short Gamma nail according to their respective induction method and scope of its application,aiming to avoid complications.
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BACKGROUND:At present, there are many clinical trials concerning plate fixation and smal splint for distal radius fracture, but there is lack of systemic evaluation. OBJECTIVE:To evaluate the curative effect of the plate fixation and smal splint in the treatment of intraarticular fractures of the distal radius. METHODS:We retrieved the Chinese biomedical database (1979-2008), China National Knowledge Infrastructure (1979-2008), VIP database (1989-2008) and Wanfang Digital Periodical Group (1998-2008). Of them, China National Knowledge Infrastructure contained Chinese periodical databases, important meeting ful-text databases, and Master-Doctor thesis database. Foreign databases included PubMed (1966-2008), EMbase (1980-2008) and the Cochrane Library (2008, 4th). The ful text that could access was supplemented by manual search back issues of Traditional Chinese Medicine, Tianjin University Library repository. Clinical randomized control ed trials addressing plate fixation with smal splint in the treatment of intraarticular distal radius fractures were col ected. The data were extracted independent by two evaluators and methodological quality assessment was performed. According to the search strategy and data col ection methods, 363 English articles and 488 Chinese articles were found, including 401 periodical literatures, 79 conference proceedings, and 8 theses. After reading title, abstract, ful text, 12 articles met the inclusion criteria. Meta analysis was conducted with RevMan 5.0.20 software provided by the Cochrane Col aboration Network. RESULTS AND CONCLUSION:The evaluation of this system involves locking compression plate, normal internal fixation with plate, smal splints and plaster external fixation methods. Meta analysis of the results shows that the curative effects of locking compression plate in the treatment of intraarticular fracture of distal radius were better than that of common plate, smal splint or gypsum. Moreover, there were few complications. There is no significant difference in the effects between common plate fixation in treatment of intraarticular fracture of distal radius and the fixation with smal splint or gypsum.
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In the elderly, patient who suffered from hip fracture need to stay in bed for a long time and has a higher prevalence of complications and mortality. Considering the factors of patients in the intraoperative death and postoperative re?habilitation, we take appropriate treatment measures during preoperative, intraoperative and postoperative period respective?ly based on the concept of Enhanced Recovery. Patient will benefit from rapid rehabilitation and reduction of incidence of complications and mortality. ERAS includes preoperative fasting, preventive anagelsia, intraoperative temperature control, anesthesia and surgical approach, postoperative intravenous restriction, nutritional support and painless early motion. This ar?ticle intends to review the security , reliability and clinic efficacy of ERAS.
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Objective To compare the stress distribution of calcaneal compression articular surface and normal surface in biomechanical analysis.Methods The posterior articular facet of the normal finite element model was wedged resected from inside to outside and from front to back,to imitate the malunion model with subtalar articular surface collapse after fracture.The B(o)hler angle was 35° before wedged,and 0° after wedged.On heel and Achilles tendon attachment point,320 N and 160 N loads were applied vertically upwards respectively.Compare calcaneal Vonmises stress distribution between malunion and normal model.Results Judging from the general stress distribution of malunion of calcaneal,subtalar joint stress reduced.The main stress area of normal bone joints was in articular surface,while the main stress area of malunion model was in the lateral calcaneal close to the calcaneocuboid joint.The main stress of the outboard is high-er than that of inboard.Outboard is the main part of supporting load.Judging from the detailed comparison with bone structure,first of all,the subsidence of subtalar joint top resulted in partial backward of the main stress of the calcaneus,which shifted to the Achilles tendon attachment point.It increased from normal (1.51±0.22) MPa to (3.11±0.24) MPa.Joint top of the stress reduced from normal (6.71±0.37) MPa to (2.83± 0.49) MPa.Secondly,the calcaneus stress of the former calcaneocuboid articulation significantly increased,which increased from normal (0.46±0.15) MPa to (2.13±0.15) MPa,and sustentaculum tali stress decreased from 5.18 MPa to 1.41 MPa.Conclusion By finite element model of this subject,the study proves that subtalar joint surface collapsed in calcaneal fractures is the main causes of most pathological changes.The problem of the joint surface subsidence should be resolved firstly in a clinical treatment,and the normal height of the calcaneus should be restored.The internal stress distribution of calcaneal is essential to the pain in the related part of calcaneal.
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[Objective]To discuss the treatment effect of locking compression plate(LCP)for proximal humeral complicated fractures.[Method]A retrospective study was done on 21 cases of proximal humeral fractures treated with LCP from April 2005 to June 2006.There were 13 male and 8 female,with age of 26-71 year(mean 42.3 year).According to Neer classification,15 cases were three-part fractures including 5 cases with anterior dislocation and 6 cases with primary osteoporosis;6 cases were four-part fractures including 3 cases with anterior dislocation and 2 cases with posterior dislocation.Reduction and fixation were done by deltopectoral-gap approach,the operator put the locking plate on 10mm positerior to the intergroove of tuberosity,5mm away from the tip of humeral greater tuberosity.If there were bone defects in the fracture site after reduction,they were treated with allografts,locking screws and unlocking screws were drilled into proximal and distal part of the fracture.Shoulder exercise should be performed passively three days after operation.One week after operation,active shoulder exercise was done,which was gradually intensified two weeks after operation.[Result]Twenty-one cases were followed up for 10-14 months,average 12.5 months,all fractures were union in 12 month.According to Neer shoulder score,the result was excellent in 11 cases,good in 7 and fair in 3,with excellent and good rate of 85%.[Conclusion]The screw of LCP can lock the plate so that the plate can firmly fixate the proximal humeral comminution fractures and osteoporosis bone,so simultaneously reach fracture union and function exercise,but attentions should be paid to the suitable procedure of LCP to avoid a series of problem of locking plate.
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[Objective]To develop a mini-pressure-sensor(MPS)for measurement of plantar pressure(PP)and to evaluate its clinical application.[Method]The MPS was installed in the shoes,and computer was used to accumulate and analyze the change of PP in whole walking stage.Pathologic changes of PP in clinical patients were also analyzed by MPS.[Result]In normal walking,the PP of forefoot was 49% of body weight(BW)and of midfoot and heel was totally 51% of BW,but at pathologic state,the equilibrium of walking was dynamically disrapted inducing a pathologic changes of foot bearing.[Conclusion]Self-developed MPS for measuring PP is help for dynamic analysis of normal PP and is valuable to recognize the pathologic distribution of PP in pathological state and to provide a guide for treatment.