[Kirschner wire retractor-assisted reduction and inverted insertion of elastic nail in the treatment of children's irreducible subradial 1/3 fractures].

OBJECTIVE: To explore the clinical effect of Kirschner wire retractor-assisted reduction and inverted insertion of elastic nail in the treatment of children's irreducible subradial 1/3 fractures. METHODS: A total of 34 children with irreducible subradial 1/3 fractures treated by surgery from August 2016 to December 2020 were retrospective analyzed. Among them, 16 cases underwent Kirschner wire retractor-assisted closed reduction and percutaneous elastic intramedullary nailing with inverted insertion(observation group), 10 males and 6 females, aged from 4 to 10 years old with an average of(6.0±0.4)years;18 cases underwent open reduction and plate internal fixation (control group), 11 males and 7 females, the age from 3 to 10 years with an average of(7.0±0.5) years. The operation time, intraoperative blood loss, hospital stay, incision length, fracture healing time and complications of the two groups were observed and the wrist function was evaluated by Cooney wrist joint score. RESULTS: All patients were followed up for 3-12 years old with an average of (11.40±0.48) months in the observation group and 4-13 months with an average of (11.50±0.39) months in the control group. Bone healing was achieved in all patients, and there was no incision infection in both groups. The operation time, intraoperative blood loss, hospital stay and incision length in observation groups were lower than those of control group (P<0.05). There was no significant difference in the fracture healing time between two groups(P>0.05). There was no significant difference in postoperative healing and recovery of wrist function between groups(P>0.05). CONCLUSION: Compared with open reduction and plate internal fixation, Kirschner wire retractor-assisted reduction and percutaneous elastic intramedullary nail fixation for irreducible subradial radial 1/3 fractures has the advantages of less trauma, shorter operation time, less blood loss, and satisfactory short-term clinical results.

[Case-control study on reduction for external and posterior malleolar fractures combined with compressive articular surface through tibiafibular fractures region].

OBJECTIVE: To compare clinical outcomes of external and posterior malleolar fractures associated with compressive articular surface through posteriorlateral incision and posteriormedial incision. METHODS: From January 2012 to January 2015, 52 patients with external and posterior malleolar fractures associated with compressive articular surface were treated by interfix. Among them, 24 patients were treated through posteriourlateral incision, including 16 males and 8 females, aged from 20 to 65 years old with an average of(35.2±6.4);28 patients were treated through posteromedi and posterior lateral incision, including 18 males and 10 females, aged from 22 to 62 years old with an average of(36.4±4.8). Operation time, blood loss, length of incision, times of X-ray exposure and complications between two groups were recorded and compared, AOFAS scores were applied for evaluate clinical outcomes. RESULTS: All patients were followed up, group A were followed up from 13 to 55 months with an average of (27.5±2.5) months;group B were followed up from 12 to 54 months with an average of (28.5±2.4) months. All fractures were obtained good reduction, and the healing time ranged from 10 to 16 weeks with an average of 12 weeks. Two patients in group B occurred incision infection, and 1 patient occurred screw loosening; while no incision infection occurred in group A, and 1 patient occurred screw loosening. There were statistical significance in operation time, blood loss, times of X-ray exposure and complications between two group;while no significant difference in ankle AOFAS score between two groups. CONCLUSIONS: Compared with reduction through achilles tendon, reduction for external and posterior malleolar fractures combined with compressive articular surface through tibiafibular fractures region has advantages of less blood loss, shorter operation time, less times of X-ray exposure, good recovery of ankle joint function, especially in treating external and posterior malleolar combined with compressive articular surface which could not obtained good reduction through normal pathway.

[A new type sternoclavicular hook plate for unstable sternoclavicular joint dislocation and fracture].

OBJECTIVE: To evaluate the therapeutic effect of a new type sternoclavicular hook plate fixation in treating unstable sternoclavicular joint dislocation and fracture. METHODS: From June 2011 to December 2013, 32 patients with sternoclavicular joint dislocation and fracture were treated with a new type sternoclavicular hook plate fixation, including 24 males and 8 females with an average age of 42 years ranging from 25 to 76 years;12 patients were anterior dislocation, 5 pations were posterior dislocation, 10 patients were internal extremity of clavicle fracture and 5 patients were sternoclavicular joint dislocation combined with fracture. The anterior fracture dislocation of the sternoclavicular joint adopted standard sternoclavicular joint hook plate, and the posterior dislocation was at the distal end of the hook of the steel plate, that is, the front part of the handle of the breast was added with a nut and a gasket to prevent the re-dislocation after operation. The results were evaluated according to Rockwood score. RESULTS: No complication happened in all patients. X-ray and CT showed that the dislocation and fracture of the sternoclavicular joint was well reduced and the plate was on right position. All patients were followed up for 6 to 24 months with an average of 10 months. At 6 to 3 months after operation, the fracture was healing without re-dislocation of the sternoclavicular joint, the medial end of the clavicle anatomical structure were restored, functional satisfaction, in which 9 patients with the swelling around sternoclavicular joint, but no pain and other symptoms. The total Rockwood score was 12.78±1.43; the results were excellent in 24 cases, good in 8 cases. CONCLUSIONS: The use of the new type of locking hook plate for the treatment of unstable fracture of the sternoclavicular joint, internal fixation is reliable, high security, easy to operate, to provide a reliable method for the treatment of such trauma.

[Comparative study of two operation methods on complicated fractures of the distal radius and ulna].

OBJECTIVE: To compare the differences between external fixator and volar T-shaped plate in the treatment of complicated fractures of the distal radius and ulna, and evaluate the appropriate operation method for the fractures. METHODS: From July 2005 to July 2007, forty-eight cases of complicated fractures of the distal radius and ulna were treated with operation. There were 21 males and 9 females in the internal fixator group, ranged from 22 to 52 years old (with an average of 38.4 +/- 1.5 years). There were 10 mals and 8 femals in the external fixator group,ranged from 25 to 56 years old (with an average of 40.5 +/- 2.3 years). The X-ray films were measured to acquire radial length, palmar tilt and radial inclination after operations. The functional evaluation were scored with a modified Gartland and Werley's (GW) scoring system at 6 and 12 months after operation. RESULTS: The patients were followed up for 12 to 18 months with an average of 14.2 months. The radial length was (8.82 +/- 0.55) mm, palmar tilt (9.23 +/- 0.86) degrees, radial inclination (19.66 +/- 1.38) degrees in the internal fixator group, while those were (8.25 +/- 0.36) mm, (8.56 +/- 0.72) degrees, (18.82 +/- 1.42) degrees in the external fixator group. The film parameter of internal fixator group was better than the external fixator group, but with no statistical significance (P > 0.05). In the internal fixator group, 16 cases obtained excellent, 7 good, 5 fair, 2 poor, while in the external fixator group, 4 cases obtained excellent, 2 good, 8 fair, 4 poor in 6 months. The GW scores of internal fixator group were lower than that of the external fixator group (P < 0.05). At 12 months after surgery, in the internal fixator group, 17 cases obtained excellent, 7 good, 5 fair, 1 poor; while in the external fixator group, 5 cases obtained excellent, 9 good, 2 fair, 2 poor. The GW score was similar between the two groups (P > 0.05). CONCLUSION: The volar T-shaped plate fixation may offer effective stability,the short-term outcome is better than the external fixator group,and there are relatively fewer complications. But the treatment outcome of the two operation methods are similar for the long time follow up.