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Objective:To compare the effect of posterolateral plate and anterolateral locking plate in surgical treatment for extra-articular distal humeral shaft fractures.Methods:A retrospective case-control study was made on 52 patients with extra-articular distal humeral shaft fractures admitted in Tianjin Hospital from January 2014 to October 2016. There were 32 males and 20 females, with the age from 18 to 56 years [(36.9±10.9)years]. According to the AO/OTA classification, there were 15 patients with type A, 32 type B, and 5 type C. Twenty-three patients were treated with osterolateral locking plate (Group A) and 29 with anterolateral locking plate (Group B). Operation time, bone union time, range of motion of the elbow, Mayo elbow performance score and complication rate were evaluated.Results:All patients were followed up for 12-20 months [(13.7±2.2)months]. Operation time was (79.8±9.6)minutes in Group A and (85.0±11.6)minutes in Group B ( P>0.05). Bone union time was (4.1±1.0)months in Group A and (4.1±1.0)months in Group B ( P>0.05). Degrees of elbow extension was 3.9°(0.0°, 5.0°) in Group A, and 4.4°(0.0°, 5.0°) in Group B ( P>0.05). Degrees of elbow flexion was 127.4°(125.0°, 132.50°) in Group A and 128.5°(122.5°, 132.5°) in Group B ( P>0.05). Mayo elbow performance score was 91.0 (90.0, 93.5) points in Group A and 90.2 (90.0, 92.5)points in Group B ( P>0.05). Radial nerve damage was noted after operation, showing no significant difference between two groups [2 patients (9%) in Group A and 3 patients (10%) in Group B] ( P>0.05), and the symptoms were recovered in all patients within 3 months. Conclusions:Both the posterolateral and anterolateral locking plate are effective in surgical treatment for extra-articular distal humeral shaft fractures. However, the posterolateral plate can be placed closer to the distal end of the humerus and the multi-directional locking design is more stable, which has advantages for the patient with fracture line close to the elbow joint.
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Objective To evaluate clinical efficacy of shoulder dislocation combined with reverse Hill-sachs injury treated with Neer modified McLaughlin procedure. Methods Clinical data of seven patients for shoulder dislocation combined with reverse Hill-sachs injury in our hospital from October 2013 to June 2016 were retrospectively analyzed. All of the patients were received Neer modified McLaughlin procedure with defect area of humeral head from 25%to 40%. The clinical outcomes were evaluated with plain radiographs, subjective satisfaction, range of shoulder motion, University of Califonia Los Angeles (UCLA) shoulder scale and constant score, which were recorded at the final follow up. Results The mean follow-up period was (12.3 ± 4.3) months. No recurence of shoulder dislocation was found. At the final follow up, a patient was found a slight osteoarthritis based on radiographs. Two patients were very satisfied with the surgery and five patients were satisfied. The average anterior flexion, abduction and external rotation of shoulder were 145.7° ± 12.7° and 148.6° ± 15.7° and 47.1° ± 5.7° respectively. The average UCLA score and constant score were (26.6 ± 2.8) and (78.6 ± 7.2) respectively. Conclusion The Neer modified McLaughlin procedure shows a remarkable clinical effect for shoulder dislocation combined with reverse Hill-sachs injury. The short and mid-term effects are definite with few complications.
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Objective To analyze the clinical characteris tics and diagnostic outline and to elucidate the effects of different managements of femoral shaft fractures with ipsila teral femoral neck fractures.Methods A retrospective study was carried out in 18patients with ipsilateral femo ral neck and femoral shaft fractures from 1998to 2001,and their managements and final clinical outcomes were reviewed.Results The follow -up ranged from8to 40months with an average of 16mon ths.All the fractures united except one femoral shaft fracture and one femoral neck fracture.Conclusion Retrograde intramedullary nailing with multiple cancellous screws to t reat ipsilateral femoral neck and femora l shaft fractures has been proved an e ffective technique.For the cases overlooked initially,treatment with multiple nailing around the intramedullary n ail is a good choice.[
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Objective To assess the clinical value of limited internal fixation combined with hinged super-articular external fixator for the treatment of elbow fracture. Methods 10 patents with elbow fracture were treated with hinged external fixator from March 2001 to November 2002. It involved 8 males and 2 females, aged from 22 to 46 years. There were 4 humeral intercondylar fractures of Riseborough type Ⅳ, the fractures were fixed with few cancellous or interfacial screws through the postero-medial approach, the olecranon and the attached triceps were reflected proximally after the olecranon osteotomy. Among the other 6 severe fracture-dislocations of the elbow, 2 complicated with fracture of the coronoid process; 1 fracture of the Regan type Ⅲ, whose fragments were over 50% of the coronoid process, was fixed with screws; another 1 fracture of the Regan type Ⅱ, whose comminution was less than 50%, was sutured with the joint capsule from proximal to distal part; 2 combined with radial head fracture of Mason type Ⅳ, both selected the lateral elbow approach, 1 with resection because of comminution, the other was fixed nearly the 2/3 of its whole dimension; and 2 with olecranon fracture were fixed with tension-band wire. Results All 10 patients were available at final follow up, the mean duration was 12 months (range, 6-18 months). According to the Morry scoring system, there were 6 excellent, 3 good, 1 fair, and the effective rate was 90%. 8 cases united in the first-stage, the other 2 achieved delayed union because of open fracture. Conclusion The technique of hinged external fixator for the fractures around elbow not only can help to stabilize the fractures but also allows early rehabilitation. In comparison with other methods, it can better improve the function of elbow, so it is an effective treatment for this kind of injury.
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Objective To evaluate the surgical management and its results of type C fractures of distal humerus. Methods From January 1997 to November 2002, 30 patients of type C fractures of distal humerus were treated surgically. There were 11 males and 19 females with mean age of 41 years (range 16-67 years). Thirteen fractures occurred in left extremity and 17 in the right. Nine patients suffered open fracture, including Custilo typeⅠfracture in 5, and typeⅡin 4 cases. Twenty-one patients suffered closed fracture. The fracture were caused by falling injury in 21 cases, by traffic accident in 7 cases and by another cause in 2 cases. Associated injuries included: distal fracture of radius in 2 cases, fracture of rib in 1 case, and fracture of surgical neck of humerus in 1 case. According to AO/ASIF classification, type C1 fracture was found in 4 cases, type C2 in 14 cases and type C3 in 12 cases. Of the 30 patients, 21 cases were operated with the approach of extra-articular osteotomy of olecranon, and 9 cases with the approach of liguliform flap of musculus triceps brachii. The fractures were reduced and fixed with dual-plates(DP) in 17 cases, and double tension bands(DTB) in 13 cases. The operation was performed in 0-17 days after injury with mean 7 days. Clinical data were recorded and reviewed retrospectively according to the surgical approach, operating time, amount of bleeding, types of internal fixation, function of the elbow and the complications. Results All the patients were followed up, with the duration from 6 to 62 months(mean, 28.5 months). The function of the elbow was evaluated according to Morrey's scale, the results showed excellent in 23 cases, good in 4 cases, and poor in 3 cases. Conclusion The modified approach of extra-articular osteotomy of olecranon provide sufficient exposure without injury of articular surface, and the osteotomy healed easily with long-term stability. The type C fractures of distal humerus should be fixed with DP or DTB for two column fixation. DTB provide a new sufficient internal fixation with simple technical procedure, shortening operation time, less bleeding and reliable stability with similar results compared with DP fixation.
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Objective To assess the clinical value of hybrid external fixator combined with limited internal fixation for distal tibial fracture.Methods 22 patients with distal tibial fracture were treated with hybrid external fixator and limited internal fixation from March 2002 to January 2005.In those cases,17 patients were male and 5 patients were female,their age was from 20 to 48 years old,with an averge of 33 years old,all fracture sites were not beyond the ankle joint for 5 cm.Among those cases,18 patients were intraarticular fracture and between them 4 patients belong to Ruedi typeⅡ,14 patients belong to Ruedi type Ⅲ.4 patients were extraarticular fracture.18 patients were close injury and of them 16 patients belong to modified Tscherne typeⅡ,2 patients belong to modified Tscherne typeⅢ.4 patients were open fracture,2 patients belong to GustiloⅡand 2 patients belong to Gustilo Ⅲ.Displaced articular fragments were fixed with cannulated lag screws or Kischner wires,the reduction of extraarticular fracture by adjusting external fixator to acquire.Results All patients were followed-up from 8 to 28 months,mean 18 months and average heal time was 3.2 months.Using Tornetta criteria,excellent 10,good 5,fair 3,with 83% excellent and good rate for intraarticular fracture.Excellent 3,good 1,for extraarticular fracture.There were 20 patients with wound primary healing,2 patients delayed healing and they all were open fracture.Complications included 10? anterior angled malunion in 1 case,and pin tract infection in 2 cases.Conclusion Using this metheod treated distal tibial fracture can reduce soft tissue injury,can obviously reduce the wound infectious rate and admit early motion of ankle joint,so it is beneficial to early restore the ankle joint's function.