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Objective To discuss the clinical results of lateral locking plate combined with bone grafting in the treatment of distal femoral fractures in the elderly.Methods Between January 2006 and December 2013,112 senile patients with distal femoral fracture were treated at our department by lateral locking plate combined with bone grafting.They were 16 men and 96 women,aged from 67 to 85 years (average,76.1 years).By AO classification,48 cases were type 33-A1,11 type 33-A2,3 type 33-A3,7 type 33-B1,4 type 33-B2,32 type 33-C1,and 7 type 33-C2.All of them had a previous history of osteopenia.By the Singh index classification,22 cases were rated as grade Ⅰ,74 as grade Ⅱ,13 as grade Ⅲ,and 3 as grade Ⅳ.Postoperatively,the patients conformed to regular follow-up,accepted functional rehabilitation and continued medication for osteopenia.Radiographic examinations were conducted to observe fracture healing.At the last follow-up,the function of involved knee was assessed according to the criteria by Karlstrom and Olerud.Results All the 112 patients completed their follow-ups,ranging from 10 to 48 months (average,16 months).All fractures united primarily after an average of 4.2 months (range,from 3.5 to 5.0 months).According to the criteria by Karlstrom and Olerud,93 cases were rated as excellent,10 as good and 9 as fair,giving a good-to-excellent rate of 92.0％.No such complications as nonunion,malunion,plate breakage,or screw loosening were observed during the follow-ups.Conclusion Lateral locking plate combined with bone grafting is effective for the treatment of distal femoral fractures in the elderly,if followed by postoperative anti-osteopenia therapy and early functional exercises.
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BACKGROUND:Open reduction pedicle screw fixation for thoracolumbar fracture could obtain satisfactory effects, and has been extensively used. However, it has potential risk during and after repair. Minimaly invasive percutaneous pedicle screw technique minimizes the trauma and complications of soft tissue. It remains poorly understood which is better minimaly invasive percutaneous or conventional open pedicle screw fixation for the repair of thoracolumbar fracture. OBJECTIVE:To perform quality evaluation and meta-analysis on curative effect and postoperative complications of minimaly invasive percutaneous and conventional open pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS:A detailed search of several electronic databases, including Cochrane Library, PubMed, WanFang, CNKI, VIP and CBM, was undertaken. Simultaneously,Chinese Journal of Orthopaedics, Chinese Journal of Orthopaedic Trauma, and Chinese Journal of Trauma were checked by hand to identify controled trials regarding minimaly invasive percutaneous and conventional open pedicle screw fixation in the treatment of thoracolumbar fractures published from inception to 2015, and the references of the included studies were checked. According to inclusion and exclusion criteria, references were screened, data were extracted and quality was evaluated by four investigators independently. Meta-analysis was conducted using RevMan 5.2 software. The quality of references of the included controled trials was assessed with CONSORT statement and some surgery clinical evaluation indexes. RESULTS AND CONCLUSION: We included 28 studies, including 25 randomized controled trials/quasi-randomized controled trials and 3 retrospective comparative studies, with 1 285 patients. Meta-analysis results demonstrated that compared with the conventional open pedicle screw, minimaly invasive percutaneous pedicle screw fixation could significantly reduce operation time, blood loss, hospital stays, postoperative complication rate and height loss (P 0.05). These results indicate that minimaly invasive percutaneous pedicle screw fixation for thoracolumbar fracture was safe and reliable, had smal trauma, less blood loss, rapid recovery, short hospital stay, and less postoperative complications. Nevertheless, methods and results of most studies are not detailed enough. We suggested reporting randomized controled trials according to related standards in order to improve the report quality and authenticity of randomized controled trials.