Posterolateral minimal invasive plate osteosynthesis for medial open fractures of distal tibia and tibial shaft / 中华创伤骨科杂志

Objective To analyze the posterolateral minimally invasive plate osteosynthesis (MIPO) in the treatment of medial open fractures of distal tibia and tibial shaft.Methods From May 2016 to September 2017,16 medial open fractures of distal tibia and tibial shaft were treated with posterolateral MIPO at Department of Orthopaedics,The First Affiliated Hospital to Anhui University of Science and Technology.They were 10 men and 6 women,from 22 to 61 years of age(average,36.5 years).According to the Gustilo-Anderson classification,type Ⅰ fracture was identified in 5 patients,type Ⅱ fracture in 6 and type Ⅲ fracture in 5.Initially,all the patients received emergency external fixation or calcaneus traction before open reduction and internal fixation was performed when their conditions of soft tissue allowed.X-ray examination of the ankle joint with anteroposterior and lateral views was performed before and after operation.At the last follow-up,the function of ankle joint was evaluated according to the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS).Results All the 16 patients were followed up for an average of 15.3 months (from 8 to 24 months).Fracture healing was achieved in all after an average time of 26.1 weeks (from 20 to 36weeks).There were no such complications as skin necrosis,wound dehiscence,deep infection,implants exposure or failure,or impingement of the flexor hallucis longus.The AOFAS ankle scores averaged 88.6 points (from 74 to 95 points),giving 9 excellent,6 good and one fair cases.Superficial infection occurred in 2 patients but healed after dressing care.Another case showed 5°varus deformity.Conclusion Application of posterolateral MIPO in the treatment of medial open fractures of distal tibia and tibial shaft can effectively protect the medial soft tissue,reduce postoperative wound complications,and safely expose,reduce and fixate the tibial fragments,leading to satisfactory outcomes.

An analysis of the effect of artificial lengthening femoral head replacement in elderly patients with stage Ⅰ of unstable femoral intertrochanteric fracture / 中国基层医药

Objective To analyze of the effect of artificial lengthening femoral head replacement in elderly patients with stage Ⅰ of unstable femoral intertrochanteric fracture.Methods 203 patients with stage Ⅰ of unstable femoral intertrochanteric fracture were selected as the research object,and they were taken artificial lengthening femoral head replacement,among which 65caese were male,female in 138 cases.The Harris scoring,SF-36,VAS pain scores on admission,2 weeks after operation,postoperative follow-up limb were counted,and the pain of the affected limb and the hip scores were compared amond 3 time periods.Results All 203 cases of senile patients with follow-up,average operation time was 83.64 minutes,the intraoperative blood loss was 355.41mL.The curative effect was evaluated according to the Harris score,SF-36 and VAS pain scoring criteria,and the Harris scores of the affected limbs at admission,at 2 weeks after the operation and after the follow-up were (28.26 ± 5.50) points,(68.26 ±5.50) points,(93.13 ± 5.31) points,respectively,the differences were statistically significant (t =-71.27,-1 397.55,-46.07,all P ＜ 0.01);The VAS pain scores were (8.19 ± 0.48) points,(3.53 ± 0.71) points,(0.23 ± 0.42) points,respectively,the differences were statistically significant (t =88.06,324.17,60.84,all P ＜ 0.01).The sf-36 scores:physiological [(8.35 ± 1.24) points,(15.23 ± 2.17) points,(19.21 ± 2.12) points],social/family [(7.01 ±1.13) points,(14.12 ± 2.12) points,(19.85 ± 2.24) points],emotional [(4.83 ± 1.01) points,(10.12 ±1.22)points,(14.87 ± 1.32) points],function [(6.35 ± 1.21) points,(13.67 ± 1.87) points,(16.81 ±2.12) points],additional focus [(8.85 ± 1.45) points,(16.38 ± 2.12) points,(20.21 ± 2.42) points],total quality of life [(47.35 ± 4.76) points,(74.69 ± 5.87) points,(89.21 ± 6.12) points],the differences were statistically significant(-39.77,-62.92,-20.21,-44.87,-71.89,-26.79,-45.04,-89.01,-38.25,-45.79,-63.41,-15.29,-45.20,-60.39,-17.54,-52.12,-76.49,-22.58,all P＜0.O1).Conclusion Artificial lengthening femoral head replacement in elderly patients with stage Ⅰ of unstable femoral intertrochanteric fracture has good clinical effect,intraoperative high safety,less postoperative complications,postoperative limb functional recovery is good,and it is worthy of clinical promotion and application.

Clinical study on repair of anchors with wire combined with open reduction and internal fixation in the treatment of ankle fractures complicated with triangle ligament injury / 中国基层医药

Objective To observe the clinical effect of repair of anchors with wire combined with open reduction and internal fixation in the treatment of ankle fractures complicated with triangle ligament injury.Methods Seventy patients with ankle fractures complicated with triangle ligament injury in our hospital were selected as the research subjects.They were divided into study group and control group according to the random digital table method,35 cases in each group.The control group was treated with open reduction and internal fixation,while the study group was treated with repair of anchors with wire based on the control group.The clinical treatment effect,scores of VAS at different moments and complications were observed and compared between the two groups.Results The total effective rate in the study group was 91.42%,which was higher than 74.29% in the control group(x2=3.846,P0.05).The incidence rate of complications in the study group was 8.57%,which was lower than 14.29% in the control group(x2=1.146,P>0.05).Conclusion The repair of anchors with wire combined with open reduction and internal fixation in the treatment of ankle fractures complicated with triangle ligament injury can effectively improve the clinical treatment effect.

Finite element analysis of femoral prosthesis implant in total knee arthroplasty：positioning parameters and clinical optimization / 中国组织工程研究

BACKGROUND:Three-dimensional finite element simulation has been widely used in biomechanics. However, there is little research in knee joint replacement. The study of femoral prosthesis is less. OBJECTIVE:To analyze the optimal positioning parameters of knee replacement and femoral prosthesis implantation, and to verify the efficacy of Gemini-PS knee prosthesis in total knee arthroplasty. METHODS: (1) Knee finite element model in total knee replacement was constructed. Orthogonal experiment was performed in femoral osteotomy positioning parameters. The shift amount A, external rotation degree B, and valgus degree C of femoral prosthesis were selected as the relevant factors for orthogonal experiment. Three values were taken for each parameter to establish orthogonal tables. Nine experimental combined knee replacement finite element models were created and analyzed with finite element. Analysis of variance and range analysis were used by optimization. (2) Totally 42 patients (47 knees) with knee osteoarthritis received total knee arthroplasty with Gemini-PS knee joint prosthesis. Knee joint function was evaluated after replacement with Hospital for Special Surgery knee score and American Knee Society knee score. Knee pain was assessed with Visual Analogue Scale score. RESULTS AND CONCLUSION:(1) Minimal polyethylene substrate surface compressive stress peak was translation 0 mm, external rotation of 3°, valgus 6°; the peak stress was 15.9 MPa. Among the influential factors, the effects of internal and external translation were larger than that of external rotation angle, and greater than that of valgus angle. The optimal positioning parameter combination was pan 0 mm, external rotation 3°, valgus 6° by range analysis and variance analysis. Orthogonal experiment was valid by simulation. (2) 42 patients were folowed up for 12-36 months. One patient affected subcutaneous fat liquefaction of the lower segment of the incision. Hospital for Special Surgery knee score and American Knee Society knee score were significantly higher after implantation (P < 0.05). Visual Analogue Scale score was significantly lower after replacement (P < 0.05). X-ray films showed that osteolysis, dislocation or loosening was not found. The recovery of knee joint was good after operation. (3) These findings

Volar locking compression plate fixation in treatment of unstable distal radius fractures in the elders / 中国基层医药

ObjectiveTo study the clinical effect of locking compression plate fixation in treatment of the elders with unstable fractures of the distal radius. Methods17 cases with unstable distal radius fractures were treated by volar locking compression plate. The function of the carpal joints and the bone healing conditions were evaluated after operations. ResultsAll cases were followed-up for 7 to 16 months ( mean 12. 6 months). Union was obtained in all the patients after 11.4 weeks. The clinical outcomes were evaluated according to modified X-rays and wrist assessment. 12 cases were graded as excellent and 4 as good. 1 case were graded as poor. The overall satisfactory rate was 94. 1％. ConclusionThe unstable distal radial fractures could be effectively treated with open reduction and LCP fixation through volar approach.

Application value of spiral CT with 3D reconstruction on diagnosis and treatment of tibial plateau fractures / 中国基层医药

ObjectiveTo evaluate the value of application of spiral CT with 3D reconstructure on diagnosis and treatment of tibial plateau fractures.Methods15 cases of tibial fractures treated with x-ray and 16-slices spiral CT,3 D images were made,fractures were classified and evaluated with 3D images and treated with correct treatment.ResultsAll of the 15 patients got correct diagnosis by 16-slices spiral CT with 3D reconstructure,1 failed by x-ray.10 fractures were operated under 3D reconstructure guide and operation proved fractures revealed by 3D reconstructure finally.ConclusionSpiral CT with 3D reconstructure could offer more accurate location and classification of tibial plateau fractures,and it had obvious advantage on demonstration of spatial relationship,and it also could provide better planning and management for the tibial plateau fractures.

Comparison of different internal fixation in treatment of fermoral intertrochanteric fractures in elderly patients / 中国基层医药

Objective To compare the therapeutic effect of anatomic plate (AP)and locking compression plate(LCP) in treatment of fermoral intertrochanteric fracture in elderly patients. Methods Nineteen and three patients with fermoral intertrochanteric fracture were treated with anatomic plate (AP) and locking compression plate (LCP). The therapeutic effects were compared in the study. Results All operations were done successfully. Of all cases,72 patients were followed up for 5-24 months. Excellence rate: AP was 66. 7% and LCP was 88. 2%.Conclusions AP had significantly low excellence rate with more complications when compared with LCP. LCP could be the first choice in treatment of fermoral intertrochanteric fractures with high excellence rates and few complications.

Femoral neck fractures treatment by cannulated screw fixation / 中国基层医药

Objective To investigate the curative effect and the feasibility of treating femoral neck fractures with cannulated screw fixation.Methods Twenty-three patients with femoral neck fractures were treated with cannulated screw fixation,their average age was 51 years old(range,12～86 years),including 7 male patients and 16 females totally.Garden Ⅱ 2 cases,Garden Ⅱ 6 cases,Garden Ⅲ 12 cases,Garden Ⅳ 3 cases.A patient who suffered from fractures displacement needed traction for 3～7 days before surgical operation and the opening reduction was necessary if reduction was not satisfactory.Results During the follow-up 11～33 months the rate of nonunion was 9%(2 cases) and the rate of avascular necrosis was 13%(3 cases).Conclusion Trectin femoral neck fracture with cannulated screw fixating is very simple and the trauma is small.This may improve the cure rate of the femoral neck fractures and it is easy to be spreaded across the basic-level hospital.

Clinical application if Kirschner with a hole and tensile band wire / 中国基层医药

Objective To evaluate the technique of Kirschner with a hole and tensile developed from the Kirschner tensile band wire.Methods Forty-two cases with fracture of patella and 23 cases with fracture of ulna olecranon were successfully operated with this apparatus.Average age was 42 years old(range,24～78 years),including 38 male patients and 27 females totally.Results Fracture healing rate was 100%,the rate of excellent and good result was 95% after 9 months to 3 years follow-up.No tenderness,skin penetrating caused by the bolt ends,and loosen fixations were found.Conclusion This apparatus can be considered as a rigid,safe and effective method and can meet the biomechanics principle of the Kirschner tensile band wire,complication of the Kirschner tensile band wire could be avoided by using this technique.