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This study shows the case of a patient with peroneus brevis tendon rupture in ankle fracture.The patient complained of swelling,pain and activity limitation in her right ankle caused by sprain.She was diagnosed with ankle fracture,supination-adduction (Lauge-Hansen typing) by medical history,physical examination and imaging.The peroneus brevis tendon was noted complete ruptured when suturing the incision after ORIF,which was then repaired by"8" shaped suture.Based on literature review,the injury mechanism of the case may be because of overload inversion force toward to lateral inferior from the fracture of fibula on the peroneus brevis tendon.Additional attention should be paid to patients who suffered from an supination-adduction ankle fracture for whether peroneus brevis tendon tears before and during surgery.
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This study shows the case of a patient with peroneus brevis tendon rupture in ankle fracture. The patient com-plained of swelling, pain and activity limitation in her right ankle caused by sprain. She was diagnosed with ankle fracture, supina-tion-adduction (Lauge-Hansen typing) by medical history, physical examination and imaging. The peroneus brevis tendon was not-ed complete ruptured when suturing the incision after ORIF, which was then repaired by "8" shaped suture. Based on literature re-view, the injury mechanism of the case may be because of overload inversion force toward to lateral inferior from the fracture of fib-ula on the peroneus brevis tendon. Additional attention should be paid to patients who suffered from an supination-adduction ankle fracture for whether peroneus brevis tendon tears before and during surgery.
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Objective To analyze the feasibility and effect of combining intramedullary nails and plates in the treatment of ipsilateral unicondylar tibial plateau fractures with non.contiguous tibial shaft fractures.Methods From May 2003 to November 2005,21 patients with ipsilateral unicondylar tibial plateau fracture and non-contiguous tibial shaft fracture were treated with combining intramedullary nails and plates,including 15 males and 6 females,with the mean age of 34 years (range,20-55 years).The tibial plateau fractures were classified according to Schatzker et al.; 4 cases were type Ⅰ,11 cases type Ⅱ,6 cases type Ⅲ and 1 case type Ⅵ.Middle third tibial shaft fractures were in 13 patients,and distal third tibial shaft fractures were in 8 patients.Once the reduction was obtained,we first fixed tibial plateau with plate and then tibial shaft with medullary nail in 19 cases; in 2 cases,we first fixed the tibial shaft with medullary nail and then tibial plateau with plate.Results 1All patients were followed up for 0.9 to 4 years (average,2.2 years).Bone union was obtained in all patients.The tibial plateau fractures united after an average of 12 weeks,and the tibial shaft fractures united after an average of 29 weeks.Delayed union of the tibial shaft fracture occurred in 3 patients,and the fracture healed finally by removing the proximal locking.Tibial plateau malunion occurred in one patient due to malreduction.According to HSS scores,excellent result was obtained in 17 patients (80.95％),good in 3 patients (14.29％),fair in 1 patient (4.76％).Conclusion With careful attention to some techniques,ipsilateral unicondylar tibial plateau fractures with non-contiguous tibial shaft fractures can be treated successfully by combining medullary nail and plate.
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Objective To identify the feasibility and the anatomical parameters of posterior transarticular pedicle screw fixation in the thoracic spine, provide a reference for clinical applications. Methods Twenty human cadaveric thoracic spine segments were dissected posteriorly and anteriorly, with care taken to expose the laminas and pedicles. The entrance point of transarticular pedicle screws was located in the 7 mm away from the above at the inferior margin of the lamina and the inside at the exterior margin, respectively. Posterior transarticular pedicle screws implantation was performed under direct visualization into T1,2,T5,6 and T9,10 Under direct abservation, the feasibility of posterior transarticular pedicle screw fixation was assessed. Then a CT was done. On the morphologic CT scan, the angle and length of the transarticular pedicle crew trajectory were measured. Results The thoracic transarticular pedicle screw trajectory were caudal tilting in the sagittal plane and lateral tilting in the axial plane with successful placement. Screws were placed across the facet joint, and from the inferior articular process of upper thoracic vertebra into the pedicle of lower thoracic vertebra. There was little difference between different number of thoracic vertebrae of the angle, but without significance. The average angles of the screws were 41.4°+3.2°caudal tilting in the sagittal plane and 2.1°±0.7° lateral tilting in the axial plane. The average trajectory lengths were (40.6±4.9)mm, and the lengths increased gradually from upper thoracic vertebra to middle and lower. There were significant differences statistically among T1,2, T5,6 and T9.10 (F=74.09, P＜0.01 ). Conclusion Posterior transarticular pedicle screw fixation is feasible, and there are some directions for implantating the screws. Transarticular pedicle fixation in the thoracic spine affords an alternative to standard pedicle screw placement for thoracic stabilization.
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ObjectiveTo investigate application of the anterior cervical pedicle screw in the lower cervical spine.MethodsTwenty disarticulated human vertebrae(C3-C7) were evaluated with computed tomography for pedicle morphometry Parameters included vertebral body height,vertebral body depth,vertebral body width,outer pedicle width,outer pedicle height,pedicle axis length,transverse section angle,sagittal section angle,transverse intersection point distance and sagittal intersection point distance.On the basis of these data,the screw channel was determined and the screws were inserted in the specimen.Five patients underwent surgical reconstruction using anterior pedicle screw fixation.After surgery,physical examination and roentgenograms and CT scans were performed in all patients.ResultsThe transverse section angle increased from C3(45.7°±4.0°) to C5(52.1°±5.9° ),but decreased from C6(47.8°±6.7°) to C7(44.4°± 8.3°).The sagittal section angle gradually increased from C3 (93.4°±7.2°) to C6( 112.1°±6.2°) but decreased a little to C7(102.7°±8.5°).The distances in transverse section was about 1.97-3.98 mm and in sagittal section was 3.4-7.5 mm.Anterior pedicle screws were inserted successfully in all specimens without critical pedicle wall perforations.Patients were permitted to ambulate the next day after surgery with a cervical collar.Postoperative neurological improvement was observed in all cases.Postoperative radiographic evaluation confirmed proper insertion of anterior pedicle screws without pedicle perforaton.The average follow-up time was 10.6 months.No anterior pedicle screw breakage and loosening was observed.ConclusionThe entry point in anterior pedicle screw should located in 5mm to upper endplate and near anterior median line.The transverse section angle should be 45.7°-52.1°and the sagittal section angle should be 93.4°-112.1°.The lengths of the screw should be about 32 mm.