Objective To evaluate the effects of T-shaped plate internal fixation in treatment of intra-articular fracture of distal radius. Methods From January 2005 to March 2008, 52 cases of intra-articular fracture of distal radius were treated, including 32 males and 20 females and aging 21-60 years old (mean 47 years old). Fracture was caused by tumbl ing in 30 cases, by fall ing from height in 8 cases, by traffic accident in 11 cases, and by a crashing object in 3 cases. Of 52 cases,there were 50 cases of closed fracture and 2 cases of open fracture. According to AO standard of classification, there were 14 cases of B2 type, 16 cases of B3 type, 15 cases of C1 type, 6 cases of C2 type, and 1 case of C3 type. According to the Cooney’ s general standard of classification of unstable fracture, there were 5 cases of type II, 10 cases of type III, and 37 cases of type IV. The time from injury to operation was 3-14 days (mean 5 days). All patitents received open reduction and T-shaped plate fixation. Seven patients having bone defect were given 6-15 g autologous il ium or 5 mL calcium sulphate artificial aggregate after reduction. Results All incisions healed by first intention. All the patients were followed up for 15 to 30 months postoperatively (mean 24 months). The X-ray films showed good anatomical reduction, even articular surface and no lossening of internal fixation in all the cases. The fractures healed within 9-15 weeks after operation (mean 12 weeks). At last follow-up, the mean palmar tilt was 8° and the mean ulnar variance was 21°, showing statistically significant differences when compared preoperation (— 5° and 5°, P lt; 0.05). The radial length were not abbreviated. According to Dienst assessment, the results were excellent in 42 cases, good in 3 cases, fair in 5 cases and poor in 2 cases 12 weeks after operation, and the excellent and good rate was 86.5%. Conclusion T-shaped plate fixation is rel iable and effective in treatment of intra-articular fracture of distal radius because it has less coml ication of infection, loosening of internal fixation, reduction failure and tendon rupture.
Objective To evaluate the effect of associated ulnar styloid fracture on wrist function after distal radius fracture by comparing the cl inical data between the cases of distal radius fracture with or without ulnar styloid fractures. Methods The cl inical data of 182 patients with distal radius fracture between February 2005 and May 2010 were retrospectively analyzed, including 75 with ulnar styloid fracture (group A), and 107 without ulnar styloid fracture (group B). There was no significant difference in sex, age, disease duration, and fracture classification between 2 groups (P gt; 0.05). In groups A and B, closed reduction and spl intlet or cast fixation were performed in 42 and 63 cases respectively, and openreduction and internal fixation in 33 and 44 cases respectively. All ulnar styloid fractures were not treated. Results Thepatients were followed up 21 months on average in group A and 20 months on average in group B. All incisions healed by first intention after operation. Ulnar wrist pain occurred in 4 patients (5.3%) of group A and 6 patients (5.6%) of group B, showing no significant difference (χ2=0.063, P=0.802). The fracture heal ing time was (10.9 ± 2.7) weeks in group A and (11.6 ± 2.3) weeks in group B, showing no significant difference (t=1.880, P=0.062). There was no significant difference in the palmar tilt angle, the ulnar incl ination angle, and the radial length between groups A and B when fracture healing (P gt; 0.05). At last follow-up, there was no significant difference in wrist flexion-extension, radial-ulnar deviation, pronation-supination, and grip and pinch strength between 2 groups (P gt; 0.05). According to the Gartland-Werley score in groups A and B, the results were excellent in 24 and 35 cases, good in 43 and 57 cases, fair in 5 and 10 cases, and poor in 3 and 5 cases with execllent and good rate of 89.3% and 86.0%, respectively, showing no significant difference between 2 groups (Z= —0.203, P=0.839). There were significant differences in the above indexes between patients undergoing closed reduction and open reduction in group A (P lt; 0.05). Conclusion Associated ulnar styloid fracture has no obvious effect on the wrist function after distal radius fracture. The anatomical reduction of distal radial fracture is the crucial importance in the treatment of distal radial fracture accompanying ulnar styloid fracture.
Objective To compare the cl inical results of two plating osteosynthesis techniques, open reduction and plating ostosynthesis (ORPO) and minimal invasive plating osteosynthesis (MIPO), in surgical treatment of mid-distal humeralshaft fractures. Methods From March 2004 to October 2006, 40 cases of closed unilateral mid-distal humeral shaft fractures were surgically treated with MIPO or ORPO. In the MIPO treated group (n=19), there were 14 males and 5 females, with a mean age of 39.05 years. Fractures involved in middle humeral shaft in 10 cases and distal fragment in 9 cases. According to OTA classification, there were 3 cases of type A, 13 cases of type B and 3 cases of type C. Four cases compl icated by radial nerve palsies. In the ORPO treated group (n=21), there were 13 males and 8 females with a mean age of 39.05 years, including 14 cases of type A and 7 cases of type B fractures according to OTA classification. The fractures involved in middle humeral shaft in 13 cases and distal fragment in 8 cases. Five cases compl icated by radial nerve palsies. The time from injury to operation in both groups were 2 to 14 days. For patients in the MIPO group, fractures were closely reduced and fixated with an anterior placed plate inserted through two small incisions made at the anterior side of arm, away from fracture sites. The radial nerves were not exposed. For patients in the ORPO group, fractures were exposed, reduced, and fixated with an anterolateral or a posterior positioned plate after careful dissection and protection of radial nerve through an anterolateral or a posterior approach. The operation time, the occurrence of iatrogenic radial nerve palsy and the bone heal ing time were recorded. The functions of the affected shouldersand elbows were evaluated with UCLA end-result score and Mayo elbow perform index (MEPI), respectively. Results All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in the MIPO group after surgery; however, 5 cases of transient iatrogenic radial nerve palsies were identified in the ORPO group after surgery, and the function of radial nerve recovered in these cases at the last follow-up. Eighteen cases were followed up 14-44 months (mean 25.44 months) in MIPO group, and 19 cases were followed up 13-48 months (mean 32.11 months) in ORPO group. The mean bone heal ing time was 17.06 (12-32) weeks in MIPO group and 16.11 (8-58) weeks in ORPO group, showing no significant difference between two groups (P gt; 0.05). There was no nonunion and hardware failure in both groups. The mean forward flexion of the shoulder was 166.94° (150-170°) in MIPO group and 164.74° (130-170°) in ORPO group. The mean UCLA shoulder score was 34.78 (33-35) points in MIPO group and 34.42 (30-35) points in ORPO group. The mean range of motion of the elbow in MIPO and ORPO groups was 133.33° (120-140°) and 136.7° (120-140°), respectively. The MEPI in these two groups was 99.44 (90-100) and 99.74 (95-100) points, respectively. There was no statistically significant difference between two groups in all indexes mentioned above. Conclusion The good results could be obtained when ORPO and MIPO technique are appl ied to treat mid-distal humeral shaft fractures. MIPO technique has advantages to not expose the radial nerve and to decrease the occurrence of iatrogenic radial nerve palsies.
ObjectiveTo compare the effectiveness between open reduction and closed reduction of pediatric subtrochanteric fractures using elastic stable intramedullary nailing (ESIN). MethodsBetween January 2010 and January 2014, 22 children with subtrochanteric fractures were treated by ESIN internal fixation combined with hip cast fixation, and the clinical data were retrospectively reviewed. Closed reduction was used in 12 cases (group A) and miniopen reduction in 10 cases (group B). There was no significant difference in gender, age, sides, fracture causes, type of fracture, complications, and time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between 2 groups, the limb function was evaluated according to the Flynn et al. outcome score. ResultsThe intraoperative blood loss of group A was significantly less than that of group B, but the operation time of group A was significantly longer than that of group B (P<0.05). All the patients were followed up 12-36 months (mean, 14.9 months). There was no major complications in the other patients of both groups except 1 patient having delayed wound healing in group B. There was no significant difference in fracture healing time between 2 groups (t=-1.006, P=0.327). Inverted angle of 10° and shortened limb of 1.8 cm were observed in 1 case of group A, and sagittal plane angle of 15° and shortened limb of 2 cm in 1 case of group B. There was no abnormal walking and function of hip and knee activity at last follow-up. According to the Flynn et al. outcome score, the results were excellent in 8 cases and good in 4 cases in group A, and were excellent in 6 cases and good in 4 cases in group B, showing no significant difference between 2 groups (χ2=0.041, P=0.956). ConclusionBoth closed and open fracture reduction using ESIN have satisfactory outcomes for treating pediatric subtrochanteric fractures. A mini-open reduction should be selected intraoperatively if closed reduction proves to be difficult.
Objective To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral “safe zone” for Hawkins type Ⅰ-Ⅲ talar neck fractures. Methods A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral “safe zone” parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups (P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale. Results The operation time in the study group was significantly shorter than that in the control group (P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups (P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant (P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups (P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups (P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients’ satisfaction in the study group were significantly better than those in the control group (P<0.05). ConclusionThe treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral “safe zone” can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.
Objective To discuss the relationship between recovery of anatomical integrity and functional outcome in elderly patients with distal radius fractures by comparing the effects of open reduction and closed reduction. Methods The cl inical data were retrospectively analyzed from 78 elderly patients with distal radius fractures treating with nonoperation andoperation from February 2005 to March 2009. Thirty-seven patients underwent closed reduction and spl intlet fixation or cast appl ication (non-operation group), and forty-one patients underwent open reduction and internal fixation (operation group). In non-operation group, there were 15 males and 22 females with an average age of 73 years (60-83 years). According to the AO classification system for fracture, there were 8 cases of type A2, 7 cases of type A3, 7 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1, 2 cases of type C2, and 3 cases of type C3. The time from injury to admission was between 30 minutes and 3 days with a mean time of 1 day. In operation group, there were 18 males and 23 females with an average age of 71 years (62-80 years). According to the AO classification system for fracture, there were 5 cases of type A2, 7 cases of type A3, 7 cases of type B1, 6 cases of type B2, 3 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 4 cases of type C3. The time from injury to admission was between 30 minutes and 7 days with a mean time of 1 day. There were no significant differences (P gt; 0.05) in sex, age, disease course and fracture classification between two groups. Results All incisions obtained heal ing by first intention after operation in operation group. All patients were followed up for 9-36 months (20 months on average). Fracture heal ing was achieved within 8 to 15 weeks, with an average of 11 weeks. There were no significant differences (P gt; 0.05) in fracture heal ing time between non-operation group [(10.8 ± 2.0) weeks] and operation group [(11.7 ± 2.5) weeks]. At last follow-up, thepalmar tilt angle was (5.6 ± 2.0)° and (8.6 ± 3.0)°, the radial incl ination angle was (19.1 ± 4.9)° and (21.8 ± 2.0)°, and the radial length was (8.3 ± 1.3) mm and (10.4 ± 1.4) mm in non-operation group and operation group, respectively; showing significant differences (P lt; 0.05) between two groups. According to the Gartland-Werley score, the results were excellent in 9 cases, good in 21 cases, fair in 5 cases, and poor in 2 cases in non-operation group, the excellent and good rate was 81.1%; in operation group, the results were excellent in 13 cases, good in 25 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 92.7%, showing no significant difference (P gt; 0.05) between two groups. There were no significant differences (P gt; 0.05) in flexion and extension activity of wrist, radioulnar partial activity, pronation-supination activity, grip and pinch strength between two groups. Conclusion Open reduction and closed reduction can achieve satisfactory functional outcomes, but closed reduction was inferior to open reduction in anatomic reduction for treating distal radius fractures in elderly patients.
Objective To investigate the effectiveness of the acetabular reconstruction surgery in children pathological dislocation of the hip joint. Methods Between January 2006 and January 2011, 59 patients (59 hips) with pathological dislocation were treated by open reduction combined with acetabular reconstruction surgery. There were 22 boys and 37 girls, aged from 1 to 15 years (mean, 4.9 years). There were 9 cases of hip subluxation and 50 cases of hip joint dislocation, which were caused by suppurative arthritis of the hip (33 cases) and tuberculosis of the hip (26 cases). The diseases duration ranged from 1 month to 10 years. At preoperation Harris hip score was 43-78 (mean, 61); 14 cases had normal acetabular index (AI), 32 cases had slightly increased AI, and 13 cases had significantly increased AI. The concomitant diseases included acetabular destruction in 28 cases; avascular necrosis of the femoral head in 25 cases, femoral head partial defect in 12 cases, femoral head complete defect in 6 cases, and femoral head and neck defects in 3 cases; 25 cases had increased anteversion angle; and 9 cases had varus deformity. Results Immediately postoperative X-ray films showed center reduction in all the hips. Healing of incision by first intention was achieved in 55 cases, and delayed healing in 4 cases. Fifty-three children were followed up 2 to 5 years (mean, 3 years). No re-dislocation of the hip occurred during follow-up. Thirty-eight cases had normal AI, 15 cases had slightly increased AI. The anteversion angle was 15-25 ° (mean, 20 ° ); the neck shaft angle was 110-140 ° (mean, 125 ° ); and the anatomical relation between the head and neck returned to normal. After 2 years, 18 cases had normal function of the hip joint; 30 cases had mild limitation of flexion and rotation; and 5 cases had fibrous ankylosis. The Harris hip score was 62-95 (mean, 87). Conclusion Pathological dislocation caused by neonatal acute suppurative arthritis of the hip and the hip joint tuberculosis is often associated with severe bone destruction and deformity of the acetabular and femoral head and neck. Treatment should strictly follow the principle of individual. Proper acetabular reconstruction should be selected according to pathological changes of the hip; if combined with the femoral head and neck reconstruction processing, the satisfactory results can be obtained.
【摘要】 目的 总结复杂胫骨平台骨折手术治疗的临床经验。 方法 2007年1月-2009年12月，采用切开复位内固定治疗复杂胫骨平台骨折56例。男37例，女19例；年龄19～76岁，平均45.6岁。骨折按Schatzker分型:Ⅳ型12例，Ⅴ型26例，Ⅵ型18例。合并半月板损伤20例，膝内侧副韧带损伤9例，外侧副韧带损伤8例，交叉韧带损伤4例。受伤至手术时间7～14 d，平均9 d。 结果 术后53例切口Ⅰ期愈合；2例术后3 d切口出现浅表感染，1例术后7 d外侧切口出现皮肤坏死、钢板外露，均对症处理后愈合。56例均获随访，随访时间14～49个月，平均19个月。骨折均于术后4～8周愈合，平均6周。并发膝关节僵硬1例、创伤性关节炎2例、异位骨化1例，相应处理后治愈。术后12个月按美国特种外科医院评分标准评价疗效，获优43例，良5例，可4例，差4例，优良率85.7%。 结论 手术治疗复杂胫骨平台骨折需重视软组织条件，掌握好手术时机、选择合适内固定、提高手术技巧、术后有效的功能锻炼是保证疗效的关键。【Abstract】 Objective To summarize the clinical experiences of surgical treatment for complex tibial plateau fractures. Methods From January 2007 to December 2009, 56 patients with complex tibial plateau fractures underwent open reduction and internal fixation. The patients included 37 males and 19 females with the age of 19-76 years old (average 45.6 years old). The Schatzker type of the fractures were type Ⅳ in 12 patients, type Ⅴ in 26, and type Ⅵ in 18. The injuries included meniscus injury in 20 patients, injury of lateral collateral ligament of knee in 9, injury of lateral collateral ligament in 8, and cruciate ligaments injury in 4. The time duration between the injury and the surgery was 7-14 days (average 9 days). Results After the surgery, the incision healed at I stage in 53 patients. The incision was superficially infected 3 days after surgery in 2 patients, and the Necrosis of skin around the incision and revealed steel plate were found 7 days after surgery in 1 patient; the injuries was healed after corresponding treatment. All of the patients were followed up with the average follow-up period of 14-49 months (average 19 months). The fractures healed 4-8 weeks (average 6 weeks) after the surgery. Knee joint ankylosis was found in one, traumatic arthritis was found in two, and heterotopic ossification was found in one; the injuries was healed after corresponding treatment. Twelve months after the surgery, the therapeutic effect according to HSS criteria indicated that the score was excellent in 43, good in 5, generally in 4 and poor in 4; with a fine rate of 85.7%. Conclusion Appropriate conditions of the soft tissue, good surgical opportunity, a appropriate fixation, improved surgical technique and effective postoperative functional training are the key points of surgical treatment for complex tibial plateau fractures.
Objective To investigate the clinical outcome of open reduction and internal fixation of calcaneal interarticular fractures. Methods From August 1998, 38 calcanneal interarticular fractures in 35 cases, including 8 of type Ⅱ, 14of type Ⅲ and 16 of type Ⅳ according to Sander’s classification, were treatedby open reduction to restore the posterior articular facet, subtalar facet, Bohler angle and Gissane’s angle, following internal fixation by plastic titanicalloy plate. Thirtythree calcanneal interarticular fractures were followed up for6 to 22 months, 12.3 months on average; and the healing time and joint functionwere evaluated according to Maryland Foot Score System. Results The average healing time of fracture was 7.1 weeks, ranging from 5 to 12 weeks; and the joint function was excellent in 18 calcanneus, good in 13 calcanneus, and the satisfactory rate was 93.9%. Conclusion Open reduction and internal fixation with plastic titanium plate is a good choice for calcaneal interarticular fractures.
ObjectiveTo evaluate the effectiveness of nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid perilunate dislocation.MethodsBetween September 2011 and October 2018, 17 patients with trans-scaphoid perilunate dislocation were treated with nitinol memory alloy two foot fixator and Kirschner wire. There were 12 males and 5 females, with an average age of 32.6 years (range, 23-52 years). The disease duration was 8 hours to 9 days, with an average of 6.5 days. The causes of injury included 6 cases of falling injury, 4 cases of traffic accident injury, 3 cases of stress injury of wrist caused by sports, 2 cases of violent injury of wrist caused by machine impact, 1 case of military training injury, and 1 case of other injury. One case was complicated with nerve injury. According to Herbert’s classification, all the fractures were type B4. At 1 week before operation, 3 months, 6 months after operation and last follow-up, the wrist function was evaluated according to the Krimmer scale score.ResultsAll the 17 patients were followed up 10.5-48 months, with an average of 18.6 months. There was no loosening or infection of the internal fixator, no necrosis of the scaphoid and lunate. The periosteal dislocations of the patients were well reduced and the scaphoid fractures all healed. The healing time was 4-18 months, with an average of 11.3 months. The Krimmer wrist scores were 37.5±4.4, 61.3±7.2, 83.3±9.3, 87.3±8.2 at 1 week before operation, 3 months, 6 months after operation and last follow-up, respectively. The Krimmer wrist score at each time point after operation was significantly improved when compared with that before operation (P<0.05), and at 6 months after operation and last follow-up than at 3 months after operation (P<0.05). There was no significant difference between at 6 months and last follow-up (P>0.05). At last follow-up, the Krimmer wrist function was excellent in 13 cases, good in 2 cases, fair in 1 case, poor in 1 case, and the excellent and good rate was 88.23%.ConclusionNitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid periosteal dislocation has definite effectiveness, simple operation, and good recovery of wrist function after operation.