Minimally invasive percutaneous anterior column screwing assisted by blocking screws for pelvic and acetabular fractures / 中华创伤骨科杂志

Objective:To investigate the feasibility and clinical efficacy of percutaneous anterior column screwing assisted by blocking screws for pelvic and acetabular fractures.Methods:A retrospective analysis was conducted of the 13 patients who had been admitted from July 2019 to April 2022 for pelvic and acetabular fractures. There were 8 males and 5 females with an age of (49.1±13.3) years, 7 acetabular fractures (6 on one side and 1 on both sides; by the Letournel-Judet classification: 5 anterior column fractures on 6 sides, and 2 transverse and posterior wall fractures on 2 sides), and 6 pelvic fractures (5 complicated with pelvic posterior ring fracture; by the Tile classification: 1 case of type B2, 3 cases of type C1, and 2 cases of type C2). According to the anatomic zones of the anterior column, 5 fractures were at zone Ⅲ, 3 ones at zone Ⅳ, and 6 ones at zone Ⅴ. The time from injury to surgery ranged from 3 to 14 days, averaging (8.2±2.9) days. Anterograde anterior column screwing assisted by blocking screws was performed for all the 13 patients; the posterior ring was fixated with percutaneous sacroiliac joint screws for the 5 patients complicated with pelvic posterior ring fracture. The surgical time, intraoperative fluoroscopy frequency, and intraoperative bleeding volume for insertion of anterior column screws, fracture reduction quality, and hip joint function at the last follow-up were recorded.Results:A total of 14 anterior column screws were inserted percutaneously in the 13 patients. For insertion of anterior column screws, the surgical time was (65.0±10.2) min, the intraoperative fluoroscopy frequency (63.5±14.5) times, and the intraoperative bleeding volume for each screw less than 30 mL. All the incisions healed primarily after surgery, without such complications as iatrogenic neurovascular injury or poor wound healing. All the 13 patients were followed up for (11.1±2.2) months after surgery. In the patient with bilateral acetabular anterior column fractures for which 2 anterior column screws had been inserted, one screw had to be removed due to its displacement at 1 month after surgery; no such complications as loosening of internal fixation or fracture re-displacement was found in the other patients. All fractures healed after (10.2±2.1) months. According to the Matta scoring for quality of fracture reduction, 7 sides were excellent, 5 sides good, and 2 sides poor; according to the Majeed scoring for the 6 patients with pelvic fracture at the last follow-up, the efficacy was rated as excellent in 4 cases and as good in 2 ones; according to the modified Merle d'Aubigné & Postel scoring for the 7 patients with 8 acetabular fractures at the last follow-up, the efficacy was rated as excellent in 4 hips, as good in 3 hips, and as fair in 1 hip.Conclusion:For pelvic and acetabular fractures, minimally invasive percutaneous anterior column screwing assisted by blocking screws can result in fine clinical efficacy, in addition to its easy procedures, safety and reliability.

Anastomosis of dorsal branch of the proper digital nerve dorsal distal interphalangeal joint perforator flap to repair finger tip defect of skin tissue / 中国综合临床

Objective To Summarize the application of digital artery dorsal distal interphalangeal joint perforator flap to repair finger tip skin defect,and at the same time,the method and effect of anastomosis of finger dorsal branch of digital nerve sensory reconstruction.Methods From September 2012 to March 2015,78 patients 92 fingers were treated in Orthopedics Department of Jinshan Branch Hospital of the Sixth People′s Hospital of Shanghai,all patients with finger artery distal interphalangeal joint dorsal cutaneous branches of the dorsal flap pedicled with retrograde,transferred to repair the skin defect of finger end,and anastomosis of dorsal branch of the proper digital nerve reconstruction.Results Postoperative vascular crisis occurred in 8 cases,2 cases of partial flap necrosis and healed after symptomatic treatment.All flaps survived,the wounds healed in I stage,and the donor site healed in I stage.All the 73 cases were followed up,the follow-up period ranged from 3.0 to 12.0 months,an average of (7.8±2.5) months.The postoperative appearance and feel good,soft texture,abrasion resistance,no tenderness,cold resistance,dynamic two-point recovered to 4.0-8.0 mm,average (5.3±0.9) mm.Static two-point discrimination was 4.0-9.0 mm,average (5.8±1.2) mm.The method of TAM was used to determine the function of the 67 fingers,good for the 7 finger,but also for the 5 finger and the difference of the 0 finger.The excellent and good rate was up to 93.7%.Conclusion The operation without sacrifice of major arteries and nerves by finger,the middle finger dorsal skin for non functional surface area,and at the same time by anastomosis of dorsal branch of the proper digital nerve reconstruction,without surgery two times,is one of the ideal surgical repair of skin defect of the finger end.

Limited internal fixation combined with external fixation for comminuted humerus shaft fractures / 中华创伤杂志

Objective To evaluate the clinical outcome in the treatment of humerus shaft comminuted fractures using limited open reduction and internal fixation combined with an external fixator.Methods Data of 80 patients with comminuted humerus shaft fractures treated from January 2005 to January 2013 were analysed retrospectively.All the patients underwent limited open reduction and internal fixation combined with an external fixator (treatment group) and open reduction and plate fixation (control group) according to the random number table.In the treatment group,there were 40 patients (28 males,12 females),at mean age of 33.5 years (range,21-54 years),with causes of injury including traffic accidents in five patients,falls in nine,crashes in seven and others in six.There were seven patients with open fractures and 33 with closed fractures.In the control group,there were 40 patients (25 males,15 females),at mean age of 32.9 years (range,19-55 years),with causes of injury including traffic accidents in 16 patients,tumbling in seven,crush in seven and others in ten.There were eight patients with open fractures and 32 with closed fractures.The operation time,intraoperative blood loss,bone union time and complications in both groups were recorded.Clinical efficacy was evaluated using the Stewart and Hundley standard.Results Mean follow-up was 19 months (range,15-24 months).Treatment and control groups showed significant differences in operation time [(55.5 ± 10.3) minutes vs.(120.5 ± 15.3) minutes],intraoperative blood loss [(120.4 ± 20.7) ml vs.(245.4 ± 26.7) ml] and bone union time [(11.6 ± 1.3) weeks vs.(14.9 ± 2.3) weeks] (P ＜ 0.05).Rate of incision infection was 8％ (3/40) in treatment group and 10％ (4/40) in control group (P ＞ 0.05).In treatment group the results were excellent in 31 patients and good in nine.In control group the results were excellent in 27 patients,good in nine,fair in one and poor in three.One patient with radial nerve injury after a second surgery for implant removal and two patients with osteomyelitis or bone nonunion were noted in control group.Conclusion Limited open reduction and internal fixation in combination with an external fixator is associated with small trauma,easy operation,short operation time,few bleeding,rigid fixation,early functional exercises and reduced bone nonunion for treatment of comminuted humerus shaft fractures,which exhibits great clinical value.

Study of biomechanical on internal compression interlocking intramedullary nail / 中国医师杂志

Objective Comparative analysis of pressure in the compress interlocking intramedullary nail and interlocking intramedullary nail in the treatment of tibial shaft fracture stress level changed.Meth-ods Collection of 44 cases of tibial specimens were divided into two groups:A group :normal tibial inter-locking fixation group locking intramedullary nail .B group :internal fixation group locking intramedullary nail.Analyze and measure the biomechanical properties of the system.Results Pressure in a fixed group of interlocking intramedullary nail fixation group and normal tibial interlocking intramedullary nail in compres-sive interlocking intramedullary nail fixation of superior performance,low stress shielding,has more obvious advantage in strength,stiffness and stability,at the same time,it can make the tibial stump maintain normal stress level,and the operation is convenient,not easy to broken nails.Conclusions Internal compression interlocking intramedullary nail can control the physiological stress and conduction,the broken end of tibia stress level close to the normal stress level,to solve the clinical internal fixation fracture without stress con-duction problem,and can effectively control the harmful stress,low stress shielding,when fixed intramedul-lary fixation device before a new generation of tibial fracture.

Biomechanical analysis of different fixation methods in the treatment of posteromedial tibial plateau fracture / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.26.011

Effects of anatomical plates and clavicular hook plates for treatment of distal clavicular fractures / 中华创伤杂志

Objective To compare the clinical results of distal clavicular anatomical plates and clavicular hook plates in treatment of distal clavicular fractures.Methods Twenty-six patients with lateral 1/3 clavicular fractures of Craig Ⅱ type Ⅱ or Ⅴ treated from August 2009 to January 2011 were enrolled in the study.Eleven patients were managed by anatomic plates,including eight patients with type Ⅱ fractures and three with type Ⅴ fractures,while the rest 15 patients were treated by clavicular hook plates,including 11 patients with type Ⅱ fractures and four with type Ⅴ fractures.General information of the two groups was comparable before operation.Shoulder function after operation was evaluated by Constant-Murley score system.Postoperative radiographic findings and complications of patients in the two groups were studied comparatively.Results The distal clavicular anatomical plate group presented a lower incidence of shoulder pain and better mobility of shoulder,as compared with the clavicular hook plate group,but there were no significant differences in incision infection and implant loosening between the two groups.According to the Constant-Murley evaluation standard,excellence rates of the distal clavicular anatomical plate group and clavicular hook plate group were 91％ and 73％,respectively.Conclusion The distal clavicular anatomical plate is conducive to decrease of incidences of shoulder pain,increase of range of motion of shoulder and reduction of complications for treatment of Craig Ⅱ type Ⅱ or Ⅴ distal clavicular fractures and hence is in favor of early functional recovery of the limbs.

Treatment of open pelvic fracture concomitant with perineal laceration using external fixation combined with limited percutaneous internal fixation plus colostomy / 中华创伤杂志

Objective To introduce the methods and key points for the external fixation combinel with limited percutaneous internal fixation plus colostomy in the treatment of open pelvic fracture concomitant with perineal laceration.Methods Nine patients with open pelvic fractures concomitant with perineallaceration were treated by external fixator combined with limited percutaneous internal fixer plus colostomy. Data including injury details, management and outcomes were collected for comparison.Results All the patients survived and attained bony union except for two patients with local infection that was healed several days after repeated wound debridement and use of wide spectrum antibiotics. All the patients had good extremity function at the latest follow-up. Conclusion External fixation combined with limited percutaneous internal fixation plus colostomy is a reliable, safe and less invasive procedure for the treatment of open pelvic fractures concomitant with perineal open wound.