ABSTRACT
Objective:To investigate the efficacy of an additional augmentative locking compression plate combined with bone graft for aseptic subtrochanteric fracture nonunion after intramedullary nailing.Methods:From October 2016 to October 2019, 32 patients (25 males and 7 females) were treated at Department of Orthopedics, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University for aseptic subtrochanteric fracture nonunion after intramedullary nailing. Their ages ranged from 27 to 68 years (average, 50.5 years) and their nonunion time from 9 to 24 months (average, 12.2 months). According to the Weber-Cech classification for nonunions, 9 cases belonged to the highly vascular type and 23 to the ischemic type. With the original intramedullary nails retained, all patients were fixated with an additional augmentative locking compression plate before simultaneous autologous iliac bone grafting. All patients were followed up regularly for fracture union, function of the affected hip and complications.Results:The 32 patients were followed up for 6 to 24 months (average, 12.9 months). All nonunions obtained clinical and imaging union. The clinical union time ranged from 3 to 8 months (average, 5.2 months), and the imaging union time from 6 to 10 months (average, 7.4 months). At the last follow-up, the therapeutic efficacy was evaluated as excellent in 28 cases and as good in 4, giving a good to excellent rate of 100%(32/32), according to the Sanders scoring for post-traumatic hip joint; the efficacy was evaluated as excellent in 21 cases, as good in 10 cases and as fair in one, giving a good to excellent rate of 96.9%(31/32), according to the Harris hip scoring. No such complications occurred as infection or loosening or breakage of internal fixation.Conclusion:An additional augmentative locking compression plate combined with bone graft is a reliable and effective treatment for aseptic subtrochanteric fracture nonunion after intramedullary nailing.
ABSTRACT
OBJECTIVE: Delayed delivery is sometimes selectively performed in twin pregnancy when the first birth occurs inevitably in order to improve the prognosis and decrease the morbidity and mortality of the second twin. The aim of this study is to explore the maternal and fetal outcomes of pregnancies in which cerclage is carried out following the loss of first fetus in twin gestation for delayed interval delivery. METHODS: Three cases of delayed-interval delivery of dichorionic-diamniotic twin pregnancies were reported in our center between 2017 and 2018 and were retrospectively analyzed. Once the first twin was delivered, the second twin was left in utero and the patient underwent in utero percutaneous umbilical cord ligation, antibiotics, tocolytic therapy and cervical cerclage. RESULTS: Mean gestational age at delivery of the first fetuses was 21.6⯱â¯2.9 weeks and 24.8⯱â¯4.0 weeks for the remaining fetuses, respectively. The mean interval of the delay was 22 days (4-50 days). Mortality of the first fetus was 66.7%, and the retained one was 33.3%. In general, maternal outcome was good, one patient experienced postpartum hemorrhage and placenta accreta. However neonatal aftermath was generally not favorable, probably due to extreme prematurity. CONCLUSIONS: Cervical cerclage after the first delivery could prolong the pregnancy until an adequate gestational age at which an enhanced prognosis and better perinatal outcome for the second twin can be achieved.
