[Distal radius T-plate for 18 patients with vertical shear medial malleolus fractures].

OBJECTIVE: To explore clinical effects of distal radius T-plates in treating vertical shear medial malleolus fractures. METHODS: From March 2014 and March 2016, clinical data of 18 patients with vertical shear medial malleolus fractures were retrospectively analyzed, including 12 males and 6 females aged from 22 to 63 years old with an average of (41.3±5.2) years old; 6 patients were on the left side and 12 patients were on the right side; 5 patients combined with external malleolus fractures and 13 patients combined with external malleolus and posterior malleolus fractures. All patients were treated with distal radius T-plate fixation. Fracture healing time, loss of reduction, stability of internal fixation, occurrence of osteoarthritis were observed, postoperative AOFAS score at 12 months was used to evaluate clinical effects. RESULTS: All patients were followed up from 18 to 36 months with an average of (22.5±4.3) months. All incisions healed well at stageⅠ. Review of X-ray showed that ankle joints were got anatomically reset. All fractures healed well ranged from 12 to 18 weeks with an average of (13.4±2.4) weeks. After surgery, patients resumed normal walking from 12 to 17 weeks with an average of (14.5±1.3) weeks. No complications such as loss of reduction, loosening or rupture of internal fixation, nonunion of fracture, radiographic appearance of osteoarthritis occurred during following up. AOFAS scores was 92.4 ±6.7 at 12 months after operation, and 15 patients got excellent result, 3 moderate. CONCLUSION: Distal radius T-plates for treatment of vertical shear medial malleolus fractures have advantages of firm fixation, conforming to biomechanical requirements, better matching with plate anatomy, and less soft tissue stimulation. It could achieve early function exercise, obtain good recovery of function, and it is an ideal choice for the treatment of vertical shear medial malleolus fractures.

[Precise-surgical-opening intramedullary nail insertion in treating unstable femoral intertrochanteric fractures with closed-reposition difficulty].

OBJECTIVE: To compare clinical efficacy of repositioning with precise-surgical-opening intramedullary nail insertion and traditional repositioning in treating unstable femoral intertrochanteric fractures with closed-reposition difficulty. METHODS: Clinical data of 58 patients with unstable femoral intertrochanteric fractures after closed-reposition difficulty (AO 31A2.2-3.3) were retrospective analyzed. Among them, 32 patients were treated with first open intramedullary nail and then reduction operation(modified reductuon group) including 9 males and 23 females with an average age of (80.9±11.1) years old ranging from 46 to 99 years old; and 26 patients were treated by traditional reduction(traditional reduction group) including 7 males and 19 females with an average of(78.1±13.9) years old ranging from 41 to 89 years old. The time of operation, the amount of bleeding, the length of hospital stay, the first weight-bearing time and the time of fracture healing, postoperative complications and Harris hip score were evaluated and compared between the two groups. RESULTS: All patients were followed up for 12 to 24 months with an average of 17.3 months. The operative time(t=3.612, P=0.008 2) nd the blood loss(t=3.389, P=0.007 5) in the modified reduction group were lower than those in the traditional reduction group. There were no significant differences in hospitalization time(t=0.851, P=0.392), fracture healing time(t=0.640, P=0.531), and the first loading time(t=0.845, P=0.411) between two groups. There was no significant difference in the Harris score between two groups(χ²=0.66, P=0.831>0.05). CONCLUSIONS: Traditional repositioning requires a repositioning of the fracture bone and a correct opening reaming before the insertion and fixture of the intramedullary nail, which is a complicated operation in unstable femoral intertrochanteric fractures after closed-reposition difficulty. On the other hand, the new method implements the insertion of the intramedullary nail before the repositioning of the fracture bone, greatly simplifying the operation procedure, shortening the total operation time and reducing the amount of intraoperative blood loss.