RESUMO
Objective:To compare the clinical effect of buttress plate fixation and cannulated screw fixation of Regan-Morrey type II ulnar coronoid fractures.Methods:A retrospective case control study was made on 53 patients with Regan-Morrey type II ulnar coronoid fractures admitted to Wuxi No.9 People 's Hospital from April 2015 to January 2018，including 36 males and 17 females，aged from 21 to 63 years［（36.3±7.1）years］. Among them，24 patients were treated using buttress plates（plate group），and 29 patients using cannulated screws（screw group）. The operation time and fracture healing time were documented. The visual analogue score（VAS），range of motion of elbow flexion and extension and forearm rotation and Mayo elbow performance score（MEPS）were assessed at postoperative 1，3，6 months and at the last follow-up. The incidence of complications was observed as well. Results:All patients were followed up for 15-18 months［（15.9±1.3）months］. The operation time in plate group［（150.6±24.2）minutes］was longer than that in screw group［（126.8±18.3）minutes］（ P<0.05）. There was no significant difference in fracture healing time or VAS between the two groups（ P>0.05）. After 1，3，6 months and during the last follow-up，the range of motion of elbow joint flexion and extension in plate group［（87.2±5.8）°，（109.2±7.1）°，（121.3±6.2）°，（127.3±5.4）°］was higher than that in screw group［（70.5±9.1）°，（90.2±4.5）°，（108.3±5.1）°，（116.2±4.6）°］，the range of motion of forearm rotation in plate group［（78.3±9.1）°，（98.7±8.6）°，（130.2±7.1）°，（139.2±6.7）°］was higher than that in screw group［（60.1±5.1）°，（80.6±8.7）°，（116.1±5.5）°，（127.3±4.1）°］，and the MEPS in plate group［（30.6±7.6）points，（68.1±6.1）points，（90.2±4.3）points，（95.2±2.1）points］was higher than that in screw group［（27.2±8.1）points，（54.1±7.1）points，（82.1±5.3）points，（88.2±5.2）points］（all P<0.05）. In plate group，one patient sustained superficial wound infection at postoperative 1 week，which was healed uneventfully after surgical debridement and antibiotic therapy；two patients had heterotopic ossification without addition surgery. In screw group，three patients presented screw loosening and fracture redisplacement during early movement，which was healed by reducing the intensity of elbow functional exercise and prolonging the protection time of brace；four patients had heterotopic ossification，among which one combined with elbow stiffness showed improved range of motion of the elbow after elbow release at postoperative 12 months. The incidence of complications in plate group［13%（3/24）］was lower than that in screw group［26%（7/29）］（ P<0.05）. Conclusion:For Regan-Morrey type II ulnar coronoid fractures，the buttress plate fixation is superior to the cannulated screw fixation in fixation strength，recovery of elbow function and incidence of complications in regardless of longer operation time.
RESUMO
Objective:To investigate the clinical effect of Ilizarov bone transport technique with assisted guiding pin in medullary cavity for treatment of posttraumatic bone defect of tibia.Methods:A retrospective case series study was conducted to analyze the clinical data of 17 patients with post-traumatic bone defect of tibia admitted to Third Hospital of Hebei Medical University form November 2014 to March 2018.There were 13 males and 4 females, aged 19-60 years [(37.2±13.4)years]. The bone defect length was 4.6-14.0 cm [(8.6±2.8)cm] after debridement. All patients underwent treatment with Ilizarov bone transport technique. The alignment of transport bone segment was controlled by a guiding pin in medullary cavity of tibia. Bone grafts were performed to accelerate fracture healing of docking point. The wound healing, bone healing, external fixation time, external fixation index (EFI), alignment recovery were recorded. Bone healing and functional results were evaluated according to the criteria given by Association for the Study and Application of the Method of Ilizarov (ASAMI). The complication was recorded according to Paley's criteria. The physical component summary score (PCS) and mental component summary score (MCS) ware recorded according to the MOS 36-item Short-form Health Survey (SF-36) questionnaire and compared with the national norm to evaluate the quality of life.Results:After removal of the apparatus, follow-up period was 12-37 months [(29.9±4.4)months]. Wound healing was achieved without flap transfer. At the latest follow-up, all patients achieved bone healing without recurrent infection. External fixation time was 242-801 days [(436.5±154.6)days] and external fixation index was 35.7-60.5 d/cm [(50.6±6.2)d/cm]. The affected extremity alignment was restored in all patients except for residual angular deformity in one patient. According to ASAMI, the excellent and good rate of bony results and functional results were 88% and 94%. According to Paley's criteria, complications included 12 problems, 7 obstacles and 1 sequelae. The PCS and MCS in SF-36 questionnaire were (85.8±11.6)points and (69.6±11.1)points. Compared with the national norm [PCS: (87.6±16.8)points, MCS: (78.8±15.4)points], PCS showed no statistical difference ( P>0.05), but MCS showed statistical difference ( P<0.05). Conclusions:Ilizarov bone transport combined with intramedullary guiding pin can accelerate wound and fracture healing, control infection and restore lower limb alignment. The physical function of the affected extremity can be restored in spite of some complications and psychological effects. The technique is an effective treatment for posttraumatic bone defect of tibia.