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Objective To evaluate a self-designed external fixation restorer used for femoral shaft fractures in children.Methods From September 2016 to October 2017,19 children were treated at Department of Pediatric Orthopaedics,The Third Hospital of Hebei Medical University for irreducible femoral shaft fractures using our self-designed external fixation restorer.They were 15 males and 4 females,aged from 4 years and 2 months to 8 years (average,6.3 years).There were 7 transverse fractures,11 short oblique fractures and one oblique fracture.The restorer was applied directly to the femur for traction and temporary external fixation.The femoral shaft fractures were reduced closely before internal fixation with elastic stable intramedullary nails.The Flynn criteria for lower limb fracture were used to evaluate the curative effects postoperatively.Results The operative time ranged from 32 to 45 minutes (37 minutes on average).All the fractures obtained closed reduction.No such intraoperative complications occurred as traction and compression injury to soft tissues like muscle,nerve and blood vessel.Follow-ups ranged from 8 to 20 months (average,13 months).All the fractures got united after 7 to 15 weeks (average,10.1 weeks).No implant failure or breakage occurred.The implants were removed 6 to 8 months after operation when the fractures got united.According to the Flynn evaluation criteria at the last follow-up,18 cases were excellent and one was good.Conclusions Due to its advantages of simplicity,easy manipulation and direct action on the femur for traction,our self-designed external fixation restorer can improve the closed reduction for femoral shaft fractures in children so that its sustained and effective traction force and high quality of fracture closure avoid surgical opening.The temporarily fixation it provides after fracture reduction can facilitate intraoperative fluoroscopy of the femur.
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Objective@#To evaluate a self-designed external fixation restorer used for femoral shaft fractures in children.@*Methods@#From September 2016 to October 2017, 19 children were treated at Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University for irreducible femoral shaft fractures using our self-designed external fixation restorer. They were 15 males and 4 females, aged from 4 years and 2 months to 8 years (average, 6.3 years). There were 7 transverse fractures, 11 short oblique fractures and one oblique fracture. The restorer was applied directly to the femur for traction and temporary external fixation. The femoral shaft fractures were reduced closely before internal fixation with elastic stable intramedullary nails. The Flynn criteria for lower limb fracture were used to evaluate the curative effects postoperatively.@*Results@#The operative time ranged from 32 to 45 minutes (37 minutes on average). All the fractures obtained closed reduction. No such intraoperative complications occurred as traction and compression injury to soft tissues like muscle, nerve and blood vessel. Follow-ups ranged from 8 to 20 months (average, 13 months). All the fractures got united after 7 to 15 weeks (average, 10.1 weeks). No implant failure or breakage occurred. The implants were removed 6 to 8 months after operation when the fractures got united. According to the Flynn evaluation criteria at the last follow-up, 18 cases were excellent and one was good.@*Conclusions@#Due to its advantages of simplicity, easy manipulation and direct action on the femur for traction, our self-designed external fixation restorer can improve the closed reduction for femoral shaft fractures in children so that its sustained and effective traction force and high quality of fracture closure avoid surgical opening. The temporarily fixation it provides after fracture reduction can facilitate intraoperative fluoroscopy of the femur.
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[Objective ] To investigate the improvement of the surgical treatment effect on cerebral palsy with spastic diplegia by performing modified surgeries since 2004. [Method ] Twenty-three cases of severe cerebral palsy with spastic diplegia were operated, 14 male, 9 female; age 3 ～ 12 years; the average age of 5.7 years; their main symptoms were unable to stand and walk independently, with severe hypermyotonia of both lower extremities, and a scissoring type of gait when standing, hip and knee flexing contracture, ankle and foot equinovarus. Physical examination: there was hypermyotonia of the iliopsoas, adductor musculus, hamstrings, triceps surae, anterior and posterior tibial muscle, flexor pollicis longus and flexor digitorum longus. The muscle tone was 3 ～4 grade according to Ashworth criterion. Treatment: The intramuscular tenotomy, fascial division or sliding elongation were performed, to lengthen the tendon of the joint flexion contracture, the lateral half of anterior tibial muscle tendon was transferred laterally to balance the muscle force at the foot. Finally, both lower extremities were fixed by a new designed external frame, to straigthen the articular genu, keep both ankles and feet in neutral position, both lower extremities abducting 30°, and to correct all joint deformities. Family rehabilitation programs started after the external frame was removed 6 weeks later. [Result] All cases were followed up in 1 ～3 years with the average 2. 2 years. The results were evaluated as excellent, good and ineffective, according to correction of the joint deformities, the ability to stand and walk, and parent's satisfaction to the treatment. Of them 21 cases were excellent, 2 cases good, and no ineffective case. [ Conclusion ] For the severe cerebral palsy with spastic diplegia in children, reasonable release of the tight tendons of the multi-joint flexion contracture, balance of muscle force at the foot, correction of all deformities and fixation of the lower extremities with the new external frame, and long term of family rehabilitation after the surgery, are more effective treatment.
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BACKGROUND: Recently,Illizarov external frame is commonly used to treat adult talipes equinovarus.However,its application is limited in infant and child due to amount of components,large volume and heavy weight. OBJECTIVE: A new three-dimensional external mini-frame was designed to observe its therapentical effects for congenital talipes equinovarus in infants. DESIGN,TIME AND SETTING: Retraspectively analysis of the therapentical effects of the three-dimensional external mini-frame for congenital talipes equinovarus in infants at the Department of Pediatric Orthopedics,Third Hospital of Hebei Medical University between January 2004 and June 2007. PARTICIPANTS: 106 infants (130 feet) with congenital talipes equinovarus,76 males and 30 females aged 1.6 years (range 0.5-3 years),including 80 left feet and 50 right feet,24 cases bilateral feet and 82 cases unilateral feet. Eighty-one cases underwent orthosis or cost treatment but were not cured; 10 cases underwent surgery in other hospitals but all failed,the other cases were not given any treatment. The new three-dimensional external mini-frame was designed by the authors and produced by Hebei Hengshui Kangda. METHODS: According to the age,degree of deformity,being operated or not and pathological changeS of the foot,different treatment methods were applied: Corrcetion and fixation of the foot directly with the new external mini-frame; Limited soft tissue release,followed by corrcetion and fixation of the foot with the mini-frame; Corrcetion and fixation of the foot with the mini-frame after more soft tissue realse on interior posterior foot; Corrcetion and fixation of the foot with the mini-frame after soft tissue release,tendon transfer and restore of muscle force balance. The postoperative external fixation lasted for about 3 mouths. MAIN OUTCOME MEASURES: Evaluatoin of therapentical effects according to Garceau standards. RESULTS: All cases were followed up for 2.5 years (range 0.5-3.5 years). Eighty-six cases (94 feet) were excellent: the foot looked near normal,the calcar pedis was erect,with plantigrade foot in walking,the range of the joint motion in foot was near normal. Seventeen cases (32 feet) were good: the foot deformity improved obviously,but a light adduction was remained in the forefoot,with plantigrade foot in walking,the range of joint motion in foot was good. Three cases (4 feet) were effective: the forefoot adduct lightly,with lightly calcaneus varus,the motion of foot was limitted partly. CONCLUSION: The new 3D external mini-frame shows favorable effects for congenital talipes equinovarus in infants.
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[Objective]A new type of external frame for the treatment of club foot in three dimensions was reported.The characteristics of this frame and Illizarov frame were compared.[Method]The new frame was consisted of 3 couples with 6 metal rods.The rods have lengthening or compressing force on foot in three dimensions respectively through 4 Kire wires in tibia,calcaneus and tarsals.Sixty-two cases with 85 club feet followed more than 12 months were treated by the frame since Fabruary 2004.[Result]According to Gaeceau standerd and clinical appearance,function of the feet after the treatment,40 feet were excellent,40 feet were good,5 feet were improved,no poor case.[Conclusion]The new type of external frame is safe,effective and reliable for the treatment of club foot in three dimensions.Compared to Illizarov frame,it is more simple,comfortable,cheep and easy to be managed.