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Objective To evaluate the effectiveness of uncemented distal stem fixation for elderly patients needing revision of femoral prosthesis of hip arthroplasty.Methods From July 2005 to January 2013,22 patients(12 males and 10 females)aged from 70 to 85 years(average:76 years old) with aseptic loosening of the femoral stem undergone revision via uncemented distal stem fixation were enrolled into this study.Of all patients,10 had revision on the right side and 12 on the left side;11 patients received artificial replacement of the femoral head;9 had total hip replacements;2 had femoral fractures.According to the Paprosky classification system,2 cases were type Ⅰ,12 were type Ⅱ,6 were type [Ⅲ A,and 2 were type Ⅲ B.Femoral stems for revision included MP(Link)and Solution(Depuy).The Harris score,clinical and radiological results were retrospectively analyzed.Results All patients were followed up for 48 to 78 months(mean:61 months).The average Harris score increased from 38 (25-46) to 87 (76-94).All prostheses were initially stable,and no infection,dislocation or complication like deep venous thrombosis was observed after revision.All patients were able to walk without assistance;two of them had minor claudication;radiographs after surgery showed well-positioned implants with increased bone density and thickness around the prosthesis and without loosening or subsidence.Conclusions Reliable axial and anti-rotational stability can be achieved by using uncemented distal stem fixation,with good short-and medium-term clinical results for revision in elderly patients with less severe bone defects than those in Paprosky Ⅳ.
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Objective To evaluate the clinical effects of proximal femoral locking compression plate(PFLCP) combined with iliac structural bone grafting for the treatment of comminuted femoral calcar intertrochanteric fractures.Methods A total of 45 patients with comminuted femoral calcar intertrochanteric fractures were treated with PFLCP combined with iliac structural bone grafting.The hip function was evaluated by Harris hip score system.Results All patients were followed up from 8 to 34 months(average 16 months) in the outpatient department.All cases healed without complications of non-union,reduction lost,varus deformity of the hip,losening,breakage or cut-out of the internal fixation,femoral head necrosis and shortening of the limbs.According to Harris hip score,there were 29 excellent cases,11 good cases,4 fair cases and 1 poor case,with excellent and good rate of 88.9%.Conclusion Reconstruction of the comminuted or defected femoral calcar with the iliac structural bone grafting can enhance the internal fixation and promote the bone healing.Combined with PFLCP fixation it is an effective method for treatment of comminuted femoral calcar intertrochanteric fractures.
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Objective To observe the clinical efficacy of loop plate elastic fixation for treatment of distal radioulnar joint dislocation.Methods From December 2014 to November 2016,11 patients with distal radioulnar joint dislocation were treated by loop plate elastic fixation.They were 7 males and 5 females,aged from 23 to 56 years (average,37.5 years).The dislocations were volar in 2 cases,dorsal in 7,transversal in 2 and longitudinal in one.Of them,6 were complicated with ulnar fracture,2 with radial fracture and one with radioulnar fracture.All the fractures were closed.Functional outcomes of the wrist were assessed by the Gartland-Werley scoring system,range of motion and grip strength at the last follow-up.Results The 12 patients were followed up from 6 to 18 months (average,12 months).Reduction of the distal radioulnar joint dislocation was confirmed in all by the anteroposterior and lateral X-ray films after operation.All the concomitant fractures were healed after 2 to 5 months (average,3 months).No re-dislocation of the distal radioulnar joint occurred.According to the Garland-Werley scoring at the last follow-up,the functional outcomes of the wrist were excellent in 10 patients,good in one and fair in one.There were no significant differences between the healthy and affected wrists in active range of flextion or extension,radial or unlnar deviation,pronation or supination,or grip strength (P ＞ 0.05).No infection,skin necrosis,internal fixation failure,dislocation recurrence or traumatic arthritis was observed during follow-up.The loop plate had to be removed in one case because of soft-tissue irritation.Conclusion Loop plate elastic fixation for distal radioulnar joint dislocation may provide firm fixation as well as preserve physiological micro-motion of the joint,leading to fine functional recovery of the wrist and satisfactory short-term outcomes.
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Objective To explore the curative effect of headless compression screws in treatment of avulsion fractures of the fifth metatarsal .Methods 37 cases of patients with avulsion fractures of the fifth metatarsal base were treated by internal fixation with headless compression screws from January 2008 to January 2011 .X-ray films after operation were taken to evaluate the bone healing time and the foot function was evaluated according to AOFAS .Results The 37 cases were followed up from 10 to 24 months (mean 13 months) .The X-ray films showed that all fractures healed at 6 to 12 weeks(mean 8 .1 weeks) .Wound infection occurred in one case with open fracture ,which was healed by therapy .According to AOFAS ,the scores after operation ranged from 86 to 100 (mean 94 .5) .Conclusion Headless compression screws in treatment of avulsion fractures of the fifth metatarsal has the advantages of easy manipulation ,stable fixation and few complications .