Objective To investigate the effectiveness of nickel-titanium shape memory staples in treating multiple metatarsal fractures. MethodsThe clinical data of 27 patients with multiple metatarsal fractures who were treated between January 2022 and June 2023 and met the selection criteria were retrospectively analysed. The cohort consisted of 16 males and 11 females, aged 33-65 years (mean, 47.44 years). The causes of injury included heavy object impact in 11 cases, traffic accidents in 9 cases, and crush in 7 cases. Simultaneous fractures of 2, 3, 4, and 5 bones occurred in 6, 6, 4, and 8 cases, respectively, with tarsometatarsal joint injury in 3 cases. Fixation was performed using staples for 16, 22, and 9 fractures in the metatarsal neck, shaft, and the base, respectively, and 5 tarsometatarsal joint injuries. Preoperative soft tissue injuries were identified in 8 cases and classified according to the Tscherne-Oestern closed soft tissue injury classification as type Ⅰ in 5 cases and type Ⅱ in 3 cases. One case of type Ⅱexhibited preoperative skin necrosis. The patients were treated with fixation using nickel-titanium shape memory staples. Complications and fracture healing were documented. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used to evaluate the function, and the visual analogue scale (VAS) score was used to evaluate the pain. Results The 27 patients were followed up 9-19 months (mean, 12.4 months). Postoperative X-ray films revealed no loss of fracture reduction, and all fractures achieved bony union. No internal fixator loosening, breakage, or other mechanical failures was observed. The mean fracture healing time was 3.13 months (range, 3-4 months). Postoperatively, 4 cases (2 of Tscherne-Oestern type Ⅰ, 2 of type Ⅱ) developed superficial skin necrosis, which resolved with dressing changes. No infection was observed in the remaining patients, and all wounds healed. At last follow-up, the AOFAS forefoot score ranged from 70 to 95, with an average of 86.6, of which 19 cases were excellent, 6 cases were good, and 2 cases were fair, with an excellent and good rate of 92.6%; the VAS score ranged from 0 to 3, with an average of 0.9, of which 24 cases were excellent, and 3 cases were good, with an excellent and good rate of 100%. Conclusion The use of nickel-titanium shape memory staples in the treatment of multiple metatarsal fractures can effectively protect local skin and soft tissues and minimize secondary damage associated with internal fixator insertion. It is a viable surgical option for management of multiple metatarsal fractures.
ObjectiveTo analyze the clinical efficacy of etofenamate gel in patients with chronic trauma of locomotion system. MethodsRandomized parallel-controlled trial was conducted. From September 2011 to March 2012, 120 patients who were diagnosed with chronic trauma of locomotion system were divided into two groups. One was etofenamate gel group (group A), and the other was diclofenac sodium cream group (group B). Treatment course was two weeks. ResultsAfter two weeks of therapy, the effective rate of etofenamate gel was 85.0%, and of diclofenac sodium cream was 83.3%. The difference between etofenamate gel and diclofenac sodium cream had no statistical significance. Two drugs had similar efficacy in treating chronic trauma of locomotion system. Two patients in the etofenamate gel group and three in the diclofenac sodium cream group had very slight adverse reactions. ConclusionEtofenamate gel is effective in patients with chronic trauma of locomotion system, and the efficacy is similar with diclofenac sodium cream. It is particularly suitable for patients with gastrointestinal diseases.
Objective To compare the effects of cutting and retaining the pes anserinus tendon on effectiveness following tibial plateau fracture. MethodsA clinical data of 40 patients with tibial plateau fracture treated with open reduction and internal fixation with plate via posteromedial approach between January 2015 and January 2020 was retrospectively analyzed, including 18 patients retained the pes anserinus tendon (study group) and 22 patients cut the pes anserinus tendon (control group) during operation. There was no significant difference in gender, age, side of affected knee, cause of injury, Schatzker classification, time from injury to operation, and associated ligament injury between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, anatomic reduction rate, incidence of complications, fracture healing time, knee flexion and extension range of motion at 2 weeks and 12 months, and knee extension range of motion at 3 months after operation were recorded and compared between the two groups. The visual analogue scale (VAS) score was used to evaluate the early postoperative pain improvement at 1, 3, and 14 days after operation and hospital for special surgery (HSS) score was used to evaluate the improvement of knee function at 3, 6, and 12 months after operation. ResultsThe patients in both groups were followed up 12-15 months with an average of 12.8 months. There was no significant difference in operation time, intraoperative blood loss, and fracture healing time between the two groups (P>0.05). The hospital stay in the control group was significantly longer than that in the study group (t=8.339, P=0.000). There was no significant difference in the anatomic reduction rate (90.9% vs. 83.3%) between the control group and the study group (χ2=0.058, P=0.810). There were 1 case of proximal tibial osteomyelitis, 3 cases of skin necrosis, 3 cases of traumatic arthritis, and 2 cases of lower deep venous thrombosis after operation in the control group, and 1 case of metaphyseal nonunion, 2 cases of traumatic arthritis, and 1 case of lower deep venous thrombosis in the study group, showing no significant difference in the incidence of complications (40.9% vs. 22.2%) between the two groups (χ2=1.576, P=0.209). In the study group, knee flexion and extension range of motion at 2 weeks and 12 months and knee extension range of motion at 3 months after operation were significantly better than those of the control group (P<0.05). VAS scores and HSS scores in both groups improved with time after operation (P<0.05), in addition, the HSS score and VAS score of the study group were significantly better than those of the control group (P<0.05). ConclusionCompared with traditional pes anserinus tendon cutting group, pes anserinus tendon retaining group can significantly reduce postoperative short-term pain, improve postoperative knee range of motion and knee function within 1 year after operation.
ObjectiveTo explore the epidemiological characteristics and analyze the related diagnosis and treatment information of wound outpatient cases in a tertiay hospital in Leshan City.MethodsThe data of cases admitted to the wound clinic in a tertiary hospital of Leshan City between January 1st, 2017 and December 31st, 2019 were retrospectively collected. The SPSS software was used for statistical analyses in terms of basic patient information, wound type and dressing use, number of visits and expenses.ResultsA total of 10 880 cases were enrolled. The average age of the patients treated was (45.23±13.45) years old. Patients from the Central District, where the hospital was located in, accounted for the highest proportion (38.63%). The proportion of acute skin and soft tissue injuries was higher than that of chronic skin and soft tissue injuries (62.51% vs. 37.49%). According to the proportions from high to low, the top three chronic skin and soft tissue injuries were postoperative refractory wounds (19.63%), skin and soft tissue infections (3.90%), and stoma complications (3.04%), respectively. A total of 22 937 functional wound dressings were used, of which non-woven outer dressings accounted for 47.52%. Patients with acute skin and soft tissue injuries had a higher healing rate compared with those with chronic skin and soft tissue injuries (96.65% vs. 43.03%, P<0.05). The type of skin and soft tissue injuries with the most visits was cancerous wound [the median (lower quartile, upper quartile) was 68 (35, 121) visits], and the one with the least visits was acute skin and soft tissue injuries [the median (lower quartile, upper quartile) was 2 (1, 7) visits].ConclusionsAs the distance between residence and hospital grows, the number of patients decreases, suggesting that the specialized nursing assistance has achieved initial results in remote areas, but the task of assistance in surrounding areas is still heavy. The type of skin and soft tissue injuries is changing under the concept of enhanced recovery after surgery, and wound care plays an important role in the recovery of patients after surgery. The concept of wet healing and new dressings to promote wound healing are widely used, but still need to be further popularized among patients and medical staff. For chronic wounds that are more expensive to treat, it is necessary to formulate comprehensive treatment plans such as wound treatment, psychological support, and systemic nutrition to promote healing.
Objective To evaluate short-term effectiveness of staged management for complex tibial plateau fracture with severe soft tissue injury. Methods A clinical data of 12 patients with complex tibial plateau fractures and severe soft tissue injuries between July 2017 and March 2021 and met the selection criteria was retrospectively analyzed. There were 7 males and 5 females with an average age of 43.1 years (range, 33-58 years). All patients were traffic accident injuries and admitted to hospital within 24 hours after injury. The tibial plateau fractures were closed fractures. According to the Schatzker classification standard, the fractures were rated as type Ⅳ in 3 cases, type Ⅴ in 4 cases, and type Ⅵ in 5 cases. According to the Tscherne classification standard, the soft tissue injuries were rated as grade Ⅱ in 4 cases and grade Ⅲ in 8 cases. The treatment of all patients was divided into 3 stages. In the first stage, emergency trans-articular fracture fixation with external fixator was performed; in the second stage, the fracture reduction and internal fixation were performed and bone cement was implanted to fill the bone defect; in the third stage, the bone cement was removed and the bone graft was performed to repair defect. All patients performed joint function exercise after operation as early as possible. Results There was no neurological symptom after all staged managements, the incisions healed by first intention, and no complications such as incision infection or necrosis occurred. All patients were followed up 6-32 months (mean, 16.9 months). The fractures were all anatomical reduction confirmed by the X-ray films after operation. During follow-up, there was no obvious loss of reduction, loosening and rupture of internal fixator, or collapse of the articular surface. All fractures healed after 14-20 weeks (mean, 17.6 weeks). The posterior slope angle of the tibial plateau was (9.7±2.3)° and the varus angle was (3.9±1.9)° immediately after bone grafting, and were (8.5±2.9)° and (4.3±1.9)° respectively at 6 months after operation. There was no significant difference between the two time points (t=0.658, P=0.514; t=−1.167, P=0.103). At last follow-up, the Hospital for Special Surgery (HSS) score was 85-96 (mean, 91.2), and the range of motion of knee was 110°-135° (mean, 120.9°). Conclusion The staged management for complex tibial plateau fracture with severe soft tissue injury can obtain good short-term effectiveness, but the long-term effectiveness needs to be further followed up.
ObjectiveTo investigate the feasibility of the free descending branch of lateral circumflex femoral artery perforator tissue flap (fascia flap plus skin flap) to repair large soft tissue defects of the extremities and its impact on the donor site. MethodsBetween January 2013 and February 2015, 9 cases of large tissue defects of the extremities were repaired with the free descending branch of lateral circumflex femoral artery perforator tissue flap. There were 8 males and 1 female, aged from 13 to 56 years (median, 36 years). The causes included traffic accident injury in 6 cases and crushing injury by heavy object in 3 cases. Soft tissue defect located at the lower limbs in 7 cases and at the upper limbs in 2 cases, including 2 cases of simple tendon exposure, 2 cases of simple bone exposure, and 5 cases of tendon and bone exposure. After debridement, the soft tissue defect area ranged from 13 cm×7 cm to 20 cm×18 cm. The tissue flaps ranged from 14 cm×8 cm to 23 cm×19 cm. The donor site was directly sutured, scalp graft was used to cover the fascia flap. ResultsAfter operation, partial necrosis of the skin grafting on the fascia flap occurred in 2 cases and healed after dressing change. Arterial crisis occurred in 1 case and the flap survived after anastomosis. The other tissue flaps survived and wounds healed by first intention. The skin grafting healed by first intention in 7 cases, by second intention in 2 cases. The patients were followed up 4-24 months (mean, 10 months). The appearance and function of the tissue flaps were satisfactory, only linear scar was observed at the donor site, which had less damage and no effect on walking. ConclusionFree descending branch of lateral circumflex femoral artery perforator tissue flap can repair large soft tissue defect of the extremities. The donor site can be sutured directly, which reduces damage to donor site and is accord with the principle of plastic surgery.
ObjectiveTo explore the effectiveness and operation of repairing multiple soft tissue defects in hands with lateral arm lobulated flaps. MethodBetween October 2013 and September 2015, 13 cases of multiple soft tissue defects in the hand with tendon or bone exposure were treated with lateral arm lobulated flaps. All patients were males with average age of 28 years (range, 23-45 years). Defects were caused by penetrating injury in 7 cases, traffic accident injury in 3 cases, and hot-crush injury in 3 cases. Six patients had skin defect of the left 2 fingers after opening finger amputation, and 7 patients had skin defect of the palm and the back after hand injury. The size of skin defects ranged from 6 cm×5 cm to 9 cm×6 cm. All patients underwent emergency debridement and two-stage repair; the duration from injury to operation was 5-9 days (mean, 7 days). The size of flap was 6 cm×5 cm-9 cm×6 cm. ResultsAll flaps survived completely, with no vascular crisis. Primary healing was obtained at donor and recipient sites, and the grafted skin survived. All cases were followed up 3-24 months (mean, 12 months). The appearance and texture of the flaps were similar to those of adjacent skin. Bulky flap was observed in 4 cases, and second stage operation was performed to make the flap thinner at 3 months after operation. The sensation of flap reached S3-S4. ConclusionsThe lateral arm lobulated flap based on the radial collateral artery has constant vascular anatomy, easy-to-harvest, and large rotation angle. It is an effective procedure to repair small and medium size skin defects of the hand with satisfied texture and sensory recovery.