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Objective To investigate the guidance of a new intraoperative classification of distal tibiofibular syndesmosis injury in the selection of internal fixation for ankle fractures.Methods Between January 2010 and January 2015 our department treated 116 patients with displaced closed ankle fracture (Weber type B or C).They were 60 men and 56 women,aged from 18 to 78 years (average,45.6 years).After reduction and fixation of the fibular fracture,we assessed the syndesmosis stability using the fibular hook traction test and radiological findings.We classified the distal tibiofibular syndesmosis injury into 3 grades (grade Ⅰ:＜ 4 mm displacement;grade Ⅱ:4-7 mm displacement;grade Ⅲ:＞ 7 mm displacement).Selection of proper screwing was determined by our new classification.Results Of the 116 cases,82 (70.7％) demonstrated distal tibiofibular syndesmosis injury.Screwing of the distal tibiofibular syndesmosis was not conducted for 30 (25.9％) of them who were of stable grade Ⅰ.52 (44.8％) cases were of unstable grades Ⅱ and Ⅲ.Of the 48 cases of grade Ⅱ,44 were fixated with one screw and the rest 4 became stable grade Ⅰ after Volkmann block fixation and received no screwing.Fixation of the distal tibiofibular syndesmosis with 2 screws was conducted for the 4 cases of unstable grade Ⅲ.All the patients were followed up for 12 to 60 months.No non-union,screw breakage,or syndesmosis separation after screw removal occurred.The American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring showed a good/excellent rate of 93.1％ (108/116).Conclusion Our new intraoperative classification can provide correct judgment of the severity of distal tibiofibular syndesmosis injury,thus guiding the selection of proper screw fixation to enhance the outcomes of ankle fractures.
RESUMO
BACKGROUND: Femoral intertrochanteric fracture is a common fracture type in elderly patients, and which kind of internal fixation system is better remains controversial.OBJECTIVE: To investigate the short-term efficacy of proximal femoral nail antirotation (PFNA) system versus intertrochanteric antegrade nail (InterTan) system in the treatment of femoral intertrochanteric fracture.METHODS: Forty-five patients with femoral intertrochanteric fracture were divided into PFNA (n=19) and InterTan (n=26) groups. The operation time, intraoperative blood loss hospitalization time, incidence of complications and Harris hip scores at postoperative 3 months were compared between two groups.RESULTS AND CONCLUSION: (1) Patients with PFNAs enjoyed a significantly shorter operation time at (125.8±21.5) minutes compared those with InterTans who needed (156.2±54.5) minutes (P < 0.05). (2) The intraoperative blood loss in the PFNA and InterTan groups was (226.3±107.2) mL and (300.0±150.3) mL, respectively, but the difference was not significant (P > 0.05). (3) No significant difference was identified in the hospitalization time, incidence of complications and Harris hip scores at postoperative 3 months between two groups (P > 0.05). (5) Our findings indicate that except for short operation time in PFNA system, there are no significant differences in the intraoperative blood loss, hospitalization time, incidence of complications and Harris hip scores at postoperative 3 months between two internal fixation systems,and both possess good safety and efficacy in postoperative short period.
RESUMO
Objective To investigate the guidance of a new intraoperative classification of distal tibiofibular syndesmosis injury in the selection of internal fixation for ankle fractures.Methods Between January 2010 and January 2015 our department treated 116 patients with displaced closed ankle fracture (Weber type B or C).They were 60 men and 56 women,aged from 18 to 78 years (average,45.6 years).After reduction and fixation of the fibular fracture,we assessed the syndesmosis stability using the fibular hook traction test and radiological findings.We classified the distal tibiofibular syndesmosis injury into 3 grades (grade Ⅰ:＜ 4 mm displacement;grade Ⅱ:4-7 mm displacement;grade Ⅲ:＞ 7 mm displacement).Selection of proper screwing was determined by our new classification.Results Of the 116 cases,82 (70.7％) demonstrated distal tibiofibular syndesmosis injury.Screwing of the distal tibiofibular syndesmosis was not conducted for 30 (25.9％) of them who were of stable grade Ⅰ.52 (44.8％) cases were of unstable grades Ⅱ and Ⅲ.Of the 48 cases of grade Ⅱ,44 were fixated with one screw and the rest 4 became stable grade Ⅰ after Volkmann block fixation and received no screwing.Fixation of the distal tibiofibular syndesmosis with 2 screws was conducted for the 4 cases of unstable grade Ⅲ.All the patients were followed up for 12 to 60 months.No non-union,screw breakage,or syndesmosis separation after screw removal occurred.The American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring showed a good/excellent rate of 93.1％ (108/116).Conclusion Our new intraoperative classification can provide correct judgment of the severity of distal tibiofibular syndesmosis injury,thus guiding the selection of proper screw fixation to enhance the outcomes of ankle fractures.