Objective To investigate the effectiveness of a novel lateral tibial plateau annular plate (hereinafter referred to as the novel plate) fixation via fibular neck osteotomy approach for posterolateral tibial plateau fractures. Methods Between January 2015 and December 2018, 22 patients with posterolateral tibial plateau fractures were treated. There were 10 males and 12 females with an average age of 39.0 years (range, 25-56 years). Seven fractures were caused by falls, 10 by traffic accidents, and 5 by falling from height. The time from injury to hospitalization ranged from 3 to 12 days, with an average of 7.0 days. All patients were closed fractures. According to Schatzker classification, the fractures were classified as type Ⅱ in 8 cases, type Ⅲ in 9 cases, type Ⅴ in 1 case, and type Ⅵ in 4 cases. The fractures were fixed with the novel plates after reduction via fibular neck osteotomy approach. The fracture reduction and healing were observed by X-ray film after operation. The range of motion of the knee joint was recorded and the function was evaluated by modified American Hospital for Special Surgery (HSS) score. Results All operations were completed successfully. The operation time was 60-95 minutes (mean, 77.6 minutes). The intraoperative blood loss was 100-520 mL (mean, 214.5 mL). There was 1 case of common peroneal nerve injury during operation and 2 cases of fat liquefaction of incision after operation. All patients were followed up 13-32 months (mean, 19.4 months). Postoperative X-ray films showed that the fracture reduction was good in 17 cases and moderate in 5 cases, and all fractures healed with a healing time of 10-18 weeks (mean, 13.0 weeks). At last follow-up, the range of motion of the knee joint ranged from 100° to 145° in flexion (mean, 125.5°) and from 0° to 4° in extension (mean, 1.2°). The modified HSS score was 82-95 (mean, 86.3). There was no complications such as plate deformation, screw fracture, fracture reduction loss, skin necrosis, and so on. Conclusion For posterolateral tibial plateau fractures, the novel plate fixation via fibular neck osteotomy approach has the advantages of clear intraoperative field, firm fracture fixation, and less postoperative complications, which is beneficial to the recovery of knee joint function.
ObjectiveTo compare the biomechanical difference of 4 kinds of internal fixations for acetabular fracture in quadrilateral area. MethodsThe transverse fracture models were created in 16 hemipelves specimens from 8 adult males, and were randomly divided into 4 groups according to different internal fixation methods (n=4): infrapectineal buttress reconstruction plate (group A), infrapectineal buttress locking reconstruction plate (group B), reconstruction plate combined with trans-plate quadrilateral screws (group C), and anterior reconstruction plate-lag screw (group D). Then the horizontal displacement, longitudinal displacement of fractures, and axial stiffness were measured and counted to compare the stability after continuous vertical loading. ResultsUnder the same loading, the horizontal and longitudinal displacements of groups A, B, C, and D were decreased gradually; when the loading reached 1 800 N, the longitudinal displacement of group A was more than 3.00 mm, indicating the failure criterion, while the axial stiffness increased gradually. Under 200 N loading, there was no significant difference (P>0.05) in horizontal displacement, longitudinal displacement, and axial stiffness among 4 groups. When the loading reached 600-1 800 N, significant differences were found in horizontal displacement, longitudinal displacement, and axial stiffness among 4 groups (P<0.05) except the horizontal displacement between groups C and D (P>0.05). ConclusionFor acetabular fracture in the quadrilateral area, anterior reconstruction plate-lag screw for internal fixation has highest stability, followed by reconstruction plate combined with trans-plate quadrilateral screws, and they are better than infrapectineal buttress reconstruction plate and infrapectineal buttress locking reconstruction plate.
ObjectiveTo explore the effectiveness difference between titanium elastic intramedullary nail internal fixation and bone plate internal fixation in the treatment of adult Galeazzi fracture.MethodsNinety-seven patients of Galeazzi fracture according with the selection criteria were divided into 2 groups by prospective cohort study, who were admitted between January 2012 and November 2015. In the patients, 59 were treated with open reduction and bone plate internal fixation (plate group), and 38 with titanium elastic intramedullary nail internal fixation (minimally invasive group). There was no significant difference in the gender, age, cause of injury, fracture site, type of fracture, 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, and the forearm function was evaluated by Anderson score.ResultsAll the patients were followed up 12-23 months (mean, 17 months). The operation time, intraoperative blood loss, fracture healing time of minimally invasive group were significantly less than those in plate group (P<0.05). There were 1 case of fracture nonunion, 1 case of wound infection in plate group, and 1 case of nail tail slight infection in minimally invasive group, which were all cured after the corresponding treatment. The remaining patients had good fracture healing, and no vascular injury, internal fixation failure, deep infection, or other complications occurred. According to Anderson score at 12 months after operation, the forearm function results were excellent in 46 cases, good in 12 cases, and poor in 1 case, with an excellent and good rate of 98.3% in plate group; and the results were excellent in 26 cases, good in 11 cases, and poor in 1 case, with an excellent and good rate of 97.4% in minimally invasive group; showing no significant difference (χ2=0.10, P=0.75).ConclusionMinimally invasive fixation with titanium elastic nail has such advantages as small damage, quick recovery, no skin scarring, etc. As long as the correct indication is selected, minimally invasive titanium intramedullary nail internal fixation of Galeazzi fractures can also get good effectiveness.
ObjectiveTo investigate the effectiveness of modified Stoppa approach with medial wall spring plate (MWSP) for involving quadrilateral of acetabulum fracture. MethodsBetween March 2008 and September 2013, 38 patients with involving quadrilateral of acetabulum fracture were treated, including of 23 males and 15 females with an average age of 36.08 years (range, 19-56 years). The causes included traffic accidents injury (21 cases), crash injury of heavy object (10 cases), and falling injury from height (7 cases). The interval of injury and admission was 3 hours to 2 days (mean, 11 hours). There were 12 cases of anterior column fracture (type D), 5 cases of transverse fractures (type E), 8 cases of T shaped fractures (type H), 6 cases of anterior column fracture with posterior transverse fractures (type I), and 7 cases of double column fractures (type J) according to Letournel-Judet classification. Based on fracture types, MWSP was used to fix fracture by modified Stoppa approach in 19 cases or combined with the ilioinguinal approach in 10 cases or combined with Kocher-Langenbeck approach in 9 cases. The operation time, blood loss, and complications were recorded. The effectiveness of reduction and the hip function were evaluated according to Matta score system and Merled' Aubigne and Postel score system. ResultsThe operation time was 85-210 minutes (mean, 130 minutes).The intra-operative blood loss was 450-900 mL (mean, 650 mL). There were 1 case of vascular avulsion, and 1 case of bladder injury during operation; there were 8 cases of venous thrombosis and 2 cases of fat liquefaction of incision after operation. Screw was implanted into the articular joint in 1 case on CT after operation. Matta X-ray assessment showed anatomical reduction in 9 cases, satisfactory reduction in 24 cases, and unsatisfactory reduction in 5 cases, and the satisfaction rate of reduction was 86.84%. Three patients had limb shorting of 0.8-1.0 cm when compared with normal limb. All patients were followed up for 7 to 18 months with an average of 10 months. Fractures healed well within 13-16 weeks with an average of 14 weeks. At 1 year after operation, the results were excellent in 9 cases, good in 21 cases, general in 5 cases, and poor in 3 cases, and the excellent and good rate was 78.95% according to the Merled'Aubigne and Postel hip score standards. ConclusionInvolving quadrilateral of acetabulum fracture can be fixed with MWSP by modified Stoppa approach or combined with other approaches to obtain good exposure, less invasion, satisfactory reduction, stable fixation, and low complications.
Objective To compare the effectiveness of the proximal femoral nail anti-rotation (PFNA) and locking compression plate (LCP) in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in elderly patients. Methods Between May 2009 and August 2012, 69 elderly patients with intertrochanteric fractures with the lateral unsubstantial femoral wall were treated. Fractures were fixed with PFNA in 36 patients (PFNA group), and with LCP in 33 patients (LCP group). There was no significant difference in gender, age, injury cause, side of fracture, and fracture AO type between 2 groups (P > 0.05). The incision length, operation time, intraoperative blood loss, total blood loss, fluoroscopy frequency, time for ambulation, and early (within 3 months) and late (more than 12 months) complications were compared. Fracture healing was assessed according to X-ray reexamination, the function of the hip joint was assessed according to the Harris hip scoring system. Results The incision length, operation time, intraoperative blood loss, and time for ambulation of PFNA group were significantly less than those of LCP group (P < 0.05), but the fluoroscopy frequency of PFNA group was significantly more than that of LCP group (P < 0.05). There was no significant difference in total blood loss between 2 groups (t=-1.686, P=0.096). The patients were followed up 12-24 months in PFNA group and 15-30 months in LCP group. The X-ray reexamination revealed fracture healing at (12.667±2.527) weeks in patients of PFNA group, and at (13.364±1.194) weeks in the others of LCP group except 1 case of nonunion, showing no significant difference (t=-1.443, P=0.154). There was no significant difference in Harris hip score between PFNA group (84.611±7.076) and LCP group (81.785±7.500) at 12 months after operation (t=1.626, P=0.109). The early complication rate and late complication rate were 16.7% (6/36) and 5.6% (2/36) in PFNA group and were 9.1% (3/33) and 9.1% (3/33) in LCP group, all showing no significant difference between 2 groups (χ2=0.871, P=0.481; χ2=0.320, P=0.665). Conclusion Both PFNA and LCP have good effectiveness in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in the elderly patients. Each has its own advantages and disadvantages.
Objective To analyze the effectiveness of flexible internal fixation with locking plate for distal femoral fractures. Methods Between January 2015 and June 2016, 21 cases of distal femoral fractures were treated. There were 5 males and 16 females with an average age of 62 years (range, 32-88 years). Injury was caused by falling in 14 cases, by traffic accident in 5 cases, and by falling from height in 2 cases. The fractures located at the left side in 13 cases and the right side in 8 cases. Twenty cases were fresh closed fractures and 1 case was open fracture. According to AO/Association for the Study of Internal Fixation (AO/OTA) typing, there were 5 cases of type 33-A1, 3 of type 33-A2, 8 of type 33-A3, 2 of type 33-C2, and 3 of type 33-C3. The time from injury to operation was 3-13 days (mean, 6.5 days). Results All operation incisions healed primarily. Eighteen patients were followed up 12-24 months (mean, 16 months). All fractures healed, and the healing time was 8-24 weeks (mean, 16.6 weeks). The articular surface was smooth and the thigh length was recovered. No screw loosening, plate breakage, valgus or varus of the knee, stiff of the knee or non-unions occurred during follow-up. There was no significant difference in visual analogue scale (VAS) score between at 6 and 12 months after operation (P>0.05), and the difference was significant bewteen the other time points (P<0.05). There were significant differences in the range of motion of knee between 1 month and 3, 6, 12 months (P<0.05); there was no significant difference between 3, 6, and 12 months (P>0.05). There were significant differences in the Neer scores between 1, 3, 6, and 12 months after operation (P<0.05). According to Neer score criteria, the results were excellent in 12 cases and good in 6 cases at 12 months after operation. Conclusion Flexible internal fixation with locking plate for distal femoral fractures can get good functional recovery.
目的 探讨应用经皮接骨板固定技术（MIPPO）结合锁定钢板（LCP）固定治疗胫腓骨骨折的疗效。 方法 2009年11月－2012年1月应用MIPPO技术结合LCP固定治疗胫腓骨干骨折62例。其中男42例，女20例；年龄16～85岁，平均45岁。骨折按AO分型：A1型10例，A2型3例，A3型3例，B1型18例，B2型8例，B3型4例，C1型10例，C2型5例，C3型1例。闭合骨折47例；开放骨折15例，根据Gustilo-Anderson分型，Ⅰ型8例，Ⅱ型6例，ⅢA型1例。伤后内固定时间3 h～10 d，平均6 d。 结果 开放骨折有3例伤口Ⅱ期愈合，其中1例伤口皮缘坏死，1例钢板部分外露经换药和清创减张缝合后伤口愈合，1例骨外露经皮瓣转移愈合；其余患者术后伤口均Ⅰ期愈合。62例均获随访，随访时间6～16个月，平均9个月。无感染、神经损伤、骨筋膜室综合征发生。术后2～4个月骨折均愈合。根据Johner-Wruhs疗效评价，优48例，良14例；开放性骨折15例中优10例，良5例。 结论 MIPPO技术结合LCP固定治疗胫腓骨干骨折，具有创伤小、骨折愈合快等优点。