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Objective@#To map OTA/AO type B and type C distal radial fractures according to three-dimensional (3D) CT scan data, and to describe the morphological distribution of fracture lines.@*Methods@#A total of 468 cases of distal radius fractures admitted to the Affiliated Hospital of Chengdu University from January 2016 to March 2019 were analyzed and AO classification were performed. AO type B and type C fractures meet the inclusion criteria and then CT data were 3D reconstructed, and morphological description were performed on the fracture lines of each joint surface, including fracture shape angle, fracture area and fracture ratio. At the same time, the articular surface fracture model was superimposed on the standard model, then fracture line and fracture area distribution map were drawn to create the fracture map of intra-articular distal radial fractures.@*Result@#Intra-articular fractures of the distal radius were 209 cases, accounting for 44.7% (209/468) of the distal radius fractures, among which 67 cases of AO type B fracture. In type B fractures, average fracture height were 20.30±11.26 mm, average fracture width were 12.24±6.83 mm, average fracture area were 189.61±101.84 mm2, average angle were 57.23°±14.95°, and average area ratio of fracture (fracture zone area/joint surface area ratio) were 32.42%±10.24%. 142 cases were OA type C fracture, the average fracture height were 24.43±11.37 mm, average fracture width were 20.38±7.59 mm, average fracture area were 425.26±314.31 mm2, average angle were 51.26°±13.17°, and average area ratio of fracture were 73.81%±26.29%. According to fracture map formed by main fracture lines, five different fracture areas were identified: ① 63 cases in central area; ② 25 cases in Lister's nodule area; ③ 59 cases in scaphoid area; ④ 36 cases in lumbar fossa area; ⑤ 26 cases in lower iliac area. Main fracture lines were concentrated in the area on the dorsal side of the central area and the scaphoid area. The fracture lines of type B fracture mainly concentrated in scaphoid region, which accounted for 29.85% (20/67), and dorsal side and central area accounted for 26.87% (18/67). The fracture lines of type C fracture accounted for 27.46% (39/142) in scaphoid area and 31.69% (45/142) in central area. The fracture line of type C fracture increased in the lumbar fossa region (17.61%, 25/142) and the lower ulnar region (12.68%, 18/142) compared with type B fracture (28.69%). Compared with the type B fracture, the overall distribution of the fracture line of the type C fracture is more central.@*Conclusion@#The map of intra-articular fracture of distal radius was drawn and morphological distribution of fracture lines were quantified. Fracture-prone site and shape of fracture line were visually recognized. At the same time, description of articular surface fracture line and fracture area of type B and type C fractures of OA classification were improved, which may help with new classification and diagnosis.
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Objective To explore the advantages and security of orthopaedic TiRobot used to assist internal fixation with sacroiliac lag screws.Methods From December 2015 to August 2017,11 patients with fracture of pelvic posterior ring or sacroiliac separation were treated by internal fixation with sacroiliac lag screws assisted by an orthopaedic TiRobot at Department of Orthopaedic Surgery,Affiliated Hospital to Chengdu University.They were 7 men and 4 women,aged from 23 to 61 years (average,42.5 years).According to AO classification,there were one case of type B1.2,one case of type B2.2,6 cases of type C1.2,2 cases of type C1.3 and one case of type C2.3.The number of sacroiliac lag screws inserted,time for planning insertion approaches,fluoroscopy frequency,fluoroscopy time,exposure time of C-arm X-ray,operation time,blood loss and reduction quality were documented.Results The 11 patients were followed up for 5 to 22 months (average,9.5 months).A total of 15 sacroiliac screws were inserted.In the operations,time for planning insertion approaches averaged 8.5 minutes (from 9 to 25 minutes),fluoroscopy frequency 8.5 times (from 4 to 15 times),fluoroscopy time 5.5 minutes (from 3.2 to 6.5 minutes),exposure time of C-arm X-ray machine 5.8 seconds (from 2.4 to 16.3 seconds),operation time 34.5 minutes (from 25 to 45 minutes),and blood loss 35 mL (from 10 to 80 mL).All the screw positions were satisfactory,with no penetration into the sacral canal,sacral foramen or bone cortex.No postoperative neurovascular injury happened.All the incisions primarily healed.All the fractures united well after 4 to 7 months (average,5.6 months),without any screw loosening.By the Matta scoring for fracture reduction,9 cases were excellent,one was good and one fair.By the Majeed functional scoring for pelvic fractures,8 cases were rated as excellent and 3 as good at the last follow-up.Conclusion Orthopaedic TiRobots can be used to assist internal fixation with sacroiliac lag screws in the treatment of pelvic posterior ring injuries,with advantages of limited invasion,time,hemorrhage,and high safety and accuracy as well.
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Objective To compare intramedullary nail (IN) and dynamic hip screw (DHS) regarding their effects on hip abduction following fixation of intertrochanteric fractures.Methods From January 2008 to December 2015,310 patients with intertrochanteric firacture were treated at our department.They were divided into 2 groups depending on the manner of treatment.198 patients (71 males and 127 females) were subjected to intramedullary nailing,with an average age of 74.7 ± 5.6 years;there were 50 cases of 31-A 1,134 ones of 3 1-A2 and 14 ones of 3 1-A3 according to the AO classification.112 patients (35 males and 77 females) were subjected to dynamic hip screwing,with an average age of 74.1 ± 6.7 years;there were 24 cases of 31-A1,78 ones of 31-A2 and 10 ones of 31-A3.The 2 groups were compared in terms of time for weight-bearing ambulation and stand on one leg,gait,pelvic tilt,range of hip active abduction,muscle strength of the abductor and hip function at the final follow-up.Results Of this series,284 patients were followed up for 1.5 to 8.5 years (average,3.6 years) and 26 patients died.The IN group achieved significantly better outcomes in terms of time for weight-bearing ambulation (37.6 ±4.9 d),time for stand on one leg (60.1 ± 9.5 d),cases of normal gait and normal pelvic tilt (171 and 179),muscle strength of the abductor (62.3 ±4.4 N · m),and range of hip active abduction than the DHS group (53.0 ±8.4 d;71.0 ± 12.0 d;67 and 85;56.6 ± 3.3 N · m,respectively) (P ＜ 0.05).There was no significant difference between the 2 groups in the hip function at the final follow-up(91.4％ versus 84.5％ in the excellent and good rate)(P ＞ 0.05).Conclusion Compared with dynamic hip screwing,intramedullary nailing has a limited effect on hip abduction so that the patients may benefit from quicker functional recovery and faster improvement in quality of life.