Comparative Study Regarding Functional and Radiological Outcomes of Different Modes of Fixation for Distal Femur Fracture.

Treatment of distal femur fractures has recently evolved towards indirect reduction and minimally invasive techniques. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. Advent of MIPO technique has reduced the amount of soft tissue injury, delayed healing, tissue necrosis and infections. The objective was to compare the functional and radiological outcome of fracture distal femur treated by open reduction with LCP by minimally invasive plate osteosynthesis (MIPO). We wanted to compare the clinical and radiological differences between open and MIPO techniques for distal femoral fracture fixation.METHODSThis was a prospective interventional study. 41 subjects with closed supracondylar femur fracture treated surgically from March 2013 to December 2017, were evaluated prospectively for functional and radiological outcome results after fixation with distal femoral locking compression plate in open or minimally invasive way, with minimum follow up of 1 year. IBM SPSS Ver. 25 software was used to perform statistical analysis.RESULTSThe mean age of 41 treated patients was 53.8 ± 13.7 years and ranged from 23 to 84 years. 19 patients were females and 22 were males. Mean time to surgery was 5.7 ± 2.9 days with minimum 2 and maximum of 18 days from injury. Initially 20 patients underwent open surgery and 21 patients were operated by minimally invasive plating technique. In all cases, a 316L stainless steel alloy distal femoral locking plate was used.CONCLUSIONSKnee ROM could be started at a mean of 1.4 weeks earlier in the MIPO group and this was statistically significant. The two groups did not differ significantly in start of full weight bearing. Knee flexion at 6 weeks was also comparable in the two groups. However, knee flexion was average 21.9° higher in MIPO group at 1 year which was significantly different than ORIF group. The proportion of patients with >90° and >110° knee flexion also varied significantly between the groups. VAS score in MIPO group was significantly less at 6 weeks but difference was non-significant at 1 year. There were 2 cases with non-union and implant failure in the ORIF group, but the proportion was not significant. There was 10° FFD in 1 patient of ORIF group, while varus deformity occurred in 3 patients of MIPO group. The proportion of deformity was not significantly different between the two groups.

Distal Femur Fractures and its Treatment with Distal Femur Locking Plate.

In this prospective study, 50 patients with distal femur fracture were treated using distal femur locking plate. Extra-articular fractures were fixed with minimal invasive technique without exposing the fracture site and intra-articular fractures were treated by open technique. Schatzker and Lambert (1979) criteria is used for functional assessment. In our series majority of the patients were males (70%), predominantly with AO type C fracture. RTA was the major mode of trauma (80%). Average union time was 14.2 weeks and average range of motion was 109.50. According to Schatzker and Lambert's criteria 22 patients had excellent results, 16 patients had good results, 8 patients had fair results and 4 patients had failure. We conclude that this implant should be used in distal femur fractures especially in, fractures with articular extension and comminution. Locking compression plate allows early weight bearing which is an additional advantage for good vocational, mental, social and physical health.

Plate fixation and small splint for intraarticular fracture of distal radius:comparison of curative effects / 中国组织工程研究

BACKGROUND:At present, there are many clinical trials concerning plate fixation and smal splint for distal radius fracture, but there is lack of systemic evaluation. OBJECTIVE:To evaluate the curative effect of the plate fixation and smal splint in the treatment of intraarticular fractures of the distal radius. METHODS:We retrieved the Chinese biomedical database (1979-2008), China National Knowledge Infrastructure (1979-2008), VIP database (1989-2008) and Wanfang Digital Periodical Group (1998-2008). Of them, China National Knowledge Infrastructure contained Chinese periodical databases, important meeting ful-text databases, and Master-Doctor thesis database. Foreign databases included PubMed (1966-2008), EMbase (1980-2008) and the Cochrane Library (2008, 4th). The ful text that could access was supplemented by manual search back issues of Traditional Chinese Medicine, Tianjin University Library repository. Clinical randomized control ed trials addressing plate fixation with smal splint in the treatment of intraarticular distal radius fractures were col ected. The data were extracted independent by two evaluators and methodological quality assessment was performed. According to the search strategy and data col ection methods, 363 English articles and 488 Chinese articles were found, including 401 periodical literatures, 79 conference proceedings, and 8 theses. After reading title, abstract, ful text, 12 articles met the inclusion criteria. Meta analysis was conducted with RevMan 5.0.20 software provided by the Cochrane Col aboration Network. RESULTS AND CONCLUSION:The evaluation of this system involves locking compression plate, normal internal fixation with plate, smal splints and plaster external fixation methods. Meta analysis of the results shows that the curative effects of locking compression plate in the treatment of intraarticular fracture of distal radius were better than that of common plate, smal splint or gypsum. Moreover, there were few complications. There is no significant difference in the effects between common plate fixation in treatment of intraarticular fracture of distal radius and the fixation with smal splint or gypsum.

Result of the Early Exercise and Rehabilitation after Limited Posterior Operative Treatment of the Calcaneal Fractures / 대한족부족관절학회지

PURPOSE: To evaluate the result of the early exercise and rehabilitation after limited posterior operative treatment of the calcaneal fractures. MATERIALS AND METHODS: Between May 2005 and December 2007, 43 cases with intraarticular calcaneal fractures were treated by open reduction with K-wires and Steinmann pins. Mean age and mean follow-up period were 42.5 years old and 15 months. All patients were treated with the same postoperative protocol, the early exercise of subtalar joint without short leg splint and cast was began after postoperative 1 day, non-weight bearing crutch ambulation did after 2 weeks, partial-weight bearing crutch ambulation did after 6 weeks, without crutch ambulation did after 10 weeks. The fractures was classified by Essex-Lopresti and Sanders classification using radiographs and the functional outcomes were evaluated by circle draw exercise, AOFAS score. RESULTS: By Essex-Lopresti classification, the tongue type was 6 cases (14%), the joint depression type was 15 cases (35%), the combined type was 22 cases (51%). By Sanders classification, type II were 10 cases (23%), type III were 15 cases (58%), and type IV were 8 cases (19%). By AOFAS functional evaluation, the mean preoperative scores were 70.3 and 70.5 respectively, mean postoperative scores were 83.7 and 86.9 respectively. There were satisfactory results in 40 cases but 3 cases were unsatisfactory including on case of lateral impingement and 2 cases of traumatic arthritis of subtalar joint. CONCLUSION: We obtained satisfactory result of the early exercise of subtalar joint without short leg splint and cast and rehabilitation after limited posterior operative treatment of the calcaneal fractures.

Treatment of High-energy Distal Tibia Intraarticular Fractures with Two-staged Delayed Minimal Invasive Plate Osteosynthesis

PURPOSE: To evaluate the short-term results of two-staged delayed minimal invasive plate osteosynthesis in high-energy intraarticular fractures of the distal tibia. MATERIALS AND METHODS: Thirteen patients, who underwent two-staged delayed minimal invasive plate osteosynthesis for intraarticular fractures of the distal tibia between January 2002 and July 2004, were followed for more than one year. The mean interval time between first stage and second stage of the procedures was 28.6 days (range, 14~34 days). By Ruedi-Allgower classification, there were two cases in type I, three cases in type II, and eight cases in type III. There were six cases in type B and seven cases in type C patients according to AO/OTA classification. Radiographs were graded by the criteria of Burwell and Charnley and ankle functions were graded by the criteria of Mast and Teipner. Union time and postoperative complications were also analysed. RESULTS: Average union time was 16.9 weeks (range, 14~20 weeks) in twelve of the thirteen fractures, but there was one fracture resulting in soft tissue complication and infected nonunion. At the latest follow-up, review of the radiographic results showed that ten cases of fractures (77%) achieved an anatomic reduction, two cases (15%) achieved fair reduction and one case (8%) achieved a poor reduction. And clinical functional assessment showed that nine cases (69%) were good results, three cases were (23%) fair results and one case (8%) was poor result. CONCLUSION: Two-staged delayed minimal invasive plate osteosynthesis is an excellent option for the treatment of high-energy intraarticular fractures of the distal tibia.

Shoulder hemiarthroplasty in treatment of severe comminuted intraarticular fractures of the proximal humerus(31 cases report) / 中国医师进修杂志

Objective To evaluate retrospectively the hemiarthroplasty in the treatment of severe comminuted intraarticular fractures of the proximal humerus.Method Thirty one patients suffered from severe comminuted intraarticular fractures of the proximal humerus were treated with shoulder hemiarthroplasty through Thompson approach from March 2000 to October 2004.The results were graded into the excellent,the good,the fair and the poor according to the scoring system-modification for hemiarthroplasty(SSMH) of Los Angeles California,USA(UCLA) basing on shoulder paining,functional status muscle strength and range of motion.Rusults The average operative time cost 65 minutes(ranged from 40 to 90 minutes),average amount of bleeding during operation were 280 ml(ranged from 200 to 350 ml).The patients exercised early postoperatively.After an average duration of 14.1 months of follow-up(ranging from 5 to 42 months),there were no infection and/or nerve damage occurred postoperatively,and the position of the prosthesis was confirmed to be excellent,moreover no lessening prosthesis,prosthesis dislocation,and/or prosthesis milieu fractures occurred radiographically.The outcomes of the treatment were excellent in 13,good in 14,fair in 3 and poor in 1 out of the 31 cases. The rate of both the excellent and the good were 87.10%.Conclusion Shoulder hemiarthroplasty is a preferable technique in the treatment of severe comminuted intraarticular fractures of the proximal humerus.

Arthroscopically assisted Minimal Invasive Surgery of Calcaneal Intraarticular Fractures / 대한족부족관절학회지

PURPOSE: To evaluate the surgical procedure and results of arthroscopically assisted minimal invasive surgery of calcaneus intraarticular fractures. MATERIALS AND METHODS: Between June 2001 and March 2004, 10 patients were treated with that method. 9 cases were Sanders type 2 fracture and only one case was Sanders 3 fracture. During calcaneal traction using percutaneus K-wire and tension device into the tuberosity fragment, anatomical reduction was performed under direct arthroscopic and fluoroscopic control. After anatomical reduction was achieved, the fragment was fixed with cannulated screws via incisions. RESULTS: The functional results were good to excellent, with an average AOFAS ankle-hindfoot score of 90.4 (range 85-95) and there were no wound problems. CONCLUSION: Arthroscopically assisted minimal invasive surgery allowed exact assessment of the articular surface and allowed anatomical reduction while adhering to the principles of minimally invasive surgery.

Intraarticular calcaneal fractures Operative management / 中华创伤骨科杂志

Evidence is lacking from these trials concerning the optimal procedure for treatment of displaced intraarticular calcaneal fractures. Clinical trials comparing different treatment , especially as they relate to potential risk fractors such as fracture classification, should be explored.

Result of Intraarticular Fracture of the Calcaneus by Open Reduction / 대한정형외과학회잡지

The Fracture of the os calcis is quite common in relation to fracture in other tarsal bone, and fractures involving the subtalar joint may cause serious and persistant disabilities. The treatment of these calcaneal fractures remains controversial So there is no universal agreement in the treatment of these fractures, especially involving the subtalar joint. Twenty displaced intraarticular fractures of calcaneus in 15 patients were treated by open reduction and internal fixation with a plate and screws and bone graft through a lateral approach to elevate the depressed lateral portion of the posterior facet at the Inchon Chritian Hospital from Jan., 1990 to Dec, 1991. Twenty feet in 15 patients of calcaneal fractures involving the subtalal joint were treated and were clinically analysed and following result were obtained. 1. The 20 cases were classified according to the Sanders classification, 9 in type II, 9 in type III and 2 in type IV. 2. The 20 cases were treated by open reduction andinteranl fixation with plate and screws and iliac bone graft through an Sanders lateral approach. The bone graft is packed under the elevated posterior to prevent late collapse of the central fragment and to supply structral stability. 3. The preoperative average Böhler's angle was 0.4°. The post operative average Böhler's angle was 23.4° which was increased significantly. 4. Based on assessment of result of Salama, excellenwas 6, good was 7, fair was 4 and poor was 3. 5. The most common complication after treatment was persistant pain, especially beneath the lateral malleolus.