Objective To study the effect of two different absorbable intramedullary nails in treatment of metacarpal and phalanx fractures.Methods From January 2002 to December 2002, open reduction and internal fixation were done with two different absorbable intramedullary nails in 60 cases of metacarpal and phalanx fractures( 52 cases of open fractures and 8 cases of closed fractures). The fracture locations were metacarpal in 24 cases, proximal phalanx in 22 casesand media phalanx in 14 cases. The emergency operation was performed in 47 cases, selective operation in 13 cases.Out of 60 patients, 24 were treated with intramedullary nails of poly-DL-lactic acid (PDLLA) (PDLLA group), 36 with intramedullary wire of PDLLA composed of chitosan(PDLLA+chitosan group). Results In the PDLLA group(n=24), the rejection occurred in 8 cases 3-4 weeks after operation. PDLLA nails were taken out in 6 of the 8 cases after 5-10 days of operation and bone healing was achieved 2 months after re-fixation by Kirschner wire; therejection subsided in the other 2 cases after 25 days of conservative treatment, and bone fracture healed after 14 weeks. No rejection was observed with primary healing in the other 16 cases of the PDLLA group. In PDLLA + chitosan group(n=36), the rejection occurred in 1 case 19 days after operation, but therejection subsided after 3 days of conservative treatment.No rejection was observed in the other 35 cases with primary healing. All patients were followed up 4-11 monthswith an average of 6 months. No rejection was observed and bone healing was achieved during the follow-up. The time of bone healing was 6-16 weeks(8 weeks onaverage). There was statistically significant difference in the curative resultbetween two groups(Plt;0.05). Conclusion Intramedullary nail of PDLLAwas verysuitable to fix fractures of metacarpal and phalanx. During the degradation of PDLLA, the acidic products can cause rejection. When PDLLA mixed with chitosan,PDLLA can not only strengthen the intensity but also neutralize the acidity. So the rejection can be decreased.PDLLA intramedullary nails composed of chitosan were better than PDLLA intramedullary nails in clinical treatment of metacarpal and phalanx fractures.
ObjectiveTo investigate the effectiveness of closed or limited open reduction and intramedullary nail fixation in the treatment of Seinsheimer type Ⅴ subtrochanteric fracture.MethodsBetween May 2014 and July 2018, 36 patients with Scinsheimer type Ⅴ subtrochanteric fractures were treated with closed or limited open reduction and intramedullary nail fixation. There were 25 males and 11 females with an age of 23-86 years (mean, 55.8 years). The cause of injury included falling in 19 cases, traffic accident in 9 cases, falling from height in 7 cases, and heavy object injury in 1 case; all were fresh closed injuries. The interval between injury and operation was 1-14 days (mean, 6.8 days). There were 18 cases of closed reduction and 18 cases of limited open reduction during the operation. Seventeen cases were fixed with femoral reconstruction intramedullary nail, 5 with InterTan long nail, 14 with lengthened proximal femoral nail anti-rotation, and 7 cases were assisted with auxiliary steel wire binding. After operation, through X-ray film and clinical follow-up, the fracture reduction and maintenance status, internal fixation position, and fracture healing were judged; the range of motion, walking ability, and complications of hip joint were observed, and the function of hip joint was evaluated according to Merle d’Aubigne Postel hip joint scoring standard.ResultsAll the incisions of medullary operation healed by first intention, and no vascular, nerve injury, or infection occurred. All patients were followed up 12-24 months, with an average of 14.2 months. Among the 36 patients, 1 patient received revision surgery due to varus displacement of femoral head and screw penetration at 2 months after closed reduction, with poor recovery of hip function. X-ray film re-examination showed that the fractures of the other 35 patients healed after 9-15 months, with an average of 11.5 months. During follow-up, there was no complication such as internal fixation failure, fracture redisplacement, bone nonunion or malunion, and deep vein thrombosis of lower extremity occurred. The function of hip joint recovered well, and the patients could walk and squat normally without affecting daily life or work. At last follow-up, according to Merle d’Aubigne Postel hip joint scoring standard, 28 cases were rated as excellent, 4 cases as good, 3 cases as fair, and 1 case as poor, the excellent and good rate was 88.9%.ConclusionC-arm X-ray fluoroscopic closed or limited open reduction and intramedullary nail fixation for the treatment of Seinheimer Ⅴ type subtrochanteric fracture, if necessary, with the aid of auxiliary steel wire binding, it has the advantages of less blood supply destruction at the fracture end, satisfactory reduction, firm fixation, and early rehabilitation training, with definite effectiveness.
Objective To develop a new type of tail cap for closing the tail of the central hole of the interlocking intramedullary nail so as to reduce difficulty in implantation of the tail cap into intramedullary nail, and ensure the accuracy of implantation, as well as reduce unnecessary operation time. Methods In 2014, the new type of intramedullary nail tail cap (" new tail cap” for short) was successfully developed, and has been granted national utility model patent. A randomized controlled clinical trial was conducted in 34 patients with non pathological femoral shaft fractures treated between August 2014 and March 2016. The patients were randomly divided into groups A and B, 17 patients each group. There was no significant difference in gender, age, side, body mass index, cause of injury, injury to operation time, and fracture AO classification between groups (P>0.05), with comparability. All patients underwent fixation with interlocking intramedullary nail, and the new tail cap and original tail cap were used in groups A and B respectively. The blood loss and operation time during tail cap implantation, fracture healing time, and complications were recorded and compared between 2 groups; the limb function was evaluated by Klemm function evaluation standard. Results The blood loss and operation time during tail cap implantation of group A [(3.5±0.8) mL and (10.57±3.15) s] were significantly less than those of group B [(5.5±1.7) mL and (21.99±6.90) s] (t=–8.281,P=0.010;t=–10.743,P=0.009). All new tail caps were successfully implanted by one-time in group A, and the one-time success rate was 100%; the original tail cap exfoliation occurred in 3 cases of group B, and the one-time success rate was 82.4%. All the patients were followed up 6-16 months (mean, 9.7 months); there was no deep infection, loosening or breakage of internal fixation, and other serious complications. The time of fracture healing was (16.4±3.2) weeks in group A and (15.8±3.5) weeks in group B, showing no significant difference (t=0.514,P=0.611). At last follow-up, according to the Klemm function evaluation standard, the results were excellent in 14 cases and good in 3 cases in group A, and were excellent in 11 cases and good in 6 cases in group B, showing no significant difference between 2 groups (χ2=0.142,P=0.707). Conclusion The new type of femoral intramedullary nail tail cap can simplify operation, shorten operation time, and reduce blood loss, and it has satisfactory effectiveness.
ObjectiveTo analyze the feasibility and effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound.MethodsThe clinical data of 30 patients with the fifth metacarpal neck fractures who were treated with elastic intramedullary nails fixation under the guidance of high frequency ultrasound and met the selection criteria between May 2013 and September 2017 were retrospectively analysed. There were 24 males and 6 females, the age ranged from 18 to 58 years, with an average of 31.4 years. The head-shaft angle of the fifth metacarpal was (55.6±11.3)°. The time from injury to operation was 12 hours to 8 days, with an average of 2.4 days. The operation time, number of intraoperative fluoroscopy, fracture reduction, complications, and fracture healing time were recorded. The head-shaft angle of the fifth metacarpal on the affected side after fracture healing were measured and compared with the healthy side. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint of both sides were measured, and the function was evaluated by using the total active movement (TAM) evaluation standard of the Hand Surgery Association of Chinese Medical Association.ResultsThe operation time was 22-40 minutes, with an average of 32.4 minutes; the intraoperative fluoroscopy was performed once; ultrasound images and X-ray fluoroscopy showed that the fracture was well reduced and no adjustment was required. The incisions healed well after operation, without tendon adhesion or local numbness. All 30 patients were followed up 8-16 months, with an average of 11.7 months. The fracture healing time was 4-8 weeks, with an average of 5.6 weeks. The head-shaft angle of the fifth metacarpal was (13.2±1.4)°, which was significantly improved when compared with preoperative value (t=−20.02, P=0.00); and there was no significant difference (t=1.94, P=0.06) when compared with the healthy side [(12.6±1.0)°]. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint on the affected side was (89.4±2.4)°, showing no significant difference (t=−1.58, P=0.13) when compared with the healthy side [(90.3±2.0)°]. According to the TAM evaluation standard of the Hand Surgery Association of Chinese Medical Association, all patients were considered to be excellent.ConclusionThe effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound is definite. It can dynamically observe the fracture reduction from different angles, reduce ionizing radiation and postoperative complications.
Objective To explore the effectiveness of additional anti-rotation steel plate assisted intramedullary nail technology in treatment of aseptic femoral non-union patients. Methods A retrospective analysis was conducted on 21 patients with aseptic femoral non-union who admitted between September 2020 and October 2024 and treated with additional anti-rotation steel plate assisted intramedullary nail technology. There were 17 males and 4 females, aged 25-67 years (mean, 44 years). There were 19 cases of femoral anterograde intramedullary nail fixation, 1 case of femoral retrograde intramedullary nail fixation, and 1 case of steel plate fixation with fatigue fracture. There were 9 cases of hypertrophic non-union and 12 cases of atrophic non-union. All patients had varying degrees of fracture end atrophy/sclerosis. Among them, 20 patients who were fixed with intramedullary nails underwent removal of soft tissue and hardened bone at the fracture end, and cortical treatment resulted in the appearance of “chili sign” at the fracture end. Iliac bone grafting and anti-rotation steel plate fixation were performed. One patient with steel plate fixation was removed the steel palte and fixed with a retrograde intramedullary nail, while the hardened bone at the fracture end was removed, iliac bone grafting and anti-rotation steel plate fixation were performed. Postoperative follow-up observation included the incision healing, maximum knee flexion range of motion, bone healing, length of lower limbs, and subjective satisfaction. The lower extremity functional scale (LEFS) score was used to evaluate the lower limb function. Results All incisions healed by first intention. All patients were followed up 7-26 months (mean, 15.5 months). At last follow-up, the femoral fracture healed with the obvious callus formation at the fracture end; the maximum knee flexion range of motion was 95°-127° (mean, 112.67°). The LEFS score increased from 29.9±6.7 before operation to 75.9±3.0 at last follow-up, and the difference was significant (t=−29.622, P<0.001). Except for 1 patient who underwent intramedullary nail dynamic treatment before operation and had a lower limb shortening of about 0.9 cm, the other patients had bilateral lower limbs of equal length. All patients had no postoperative infections, mal-union of fractures, deep vein thrombosis, joint stiffness, or other complications. Conclusion The use of additional anti-rotation steel plate assisted intramedullary nail technology in the treatment of aseptic femoral non-union not only overcomes the drawbacks of insufficient stability at the fracture end of intramedullary nails, but also overcomes the shortcomings of biased fixation with steel plates. It has the advantages of minimal trauma, effective maintenance of fracture stability, and ideal postoperative functional recovery, making it an effective treatment for aseptic femoral non-union.
Objective To assess the factors that affect the outcome of distal femoral fractures treated by retrograde intramedullary nail ing. Methods Between November 1999 and June 2006, 30 patients with 31 distal femoral fractures (15 males and 15 females, 1 bilateral) were treated by retrograde nail ing. Their ages ranged from 44 to 82 years old (average, 67.2 years old). The causes of injury were sl ipping downs in 17 patients, traffic accidents in 11, and fall ing from height in 2. Theaverage interval from injury to operation was 1.8 days. There were 14 cases of A1 fracture, 7 cases of A2, 8 cases of A3, and 2 cases of C1 according to AO/OTA classifications. The mean distance between the most distal l ine of the fracture and the intercondylar notch was 7.2 cm (range, 0-12 cm). Closed retrograde nail ing was done without reaming, and bone grafts were not done. Re sults The operation time averaged 76 minutes (range, 45-110 minutes). All patients were followed up for 19-69 months, and the mean follow-up duration was 27 months. Twenty-eight of 31 fractures united on the average of 14.7 weeks (range, 12-22 weeks). Compl ications occurred in 7 cases. There were 3 nonunions in AO-A3 fractures which were treated by changing implants or bone graft. Two patients suffered screw loosening of distal locking, that were re-fixed. Two patients showed l imited knee motion of less than 90 degrees flexion. There were no cases of deep infection, malunion over 10 degrees of angulation or 1 cm of shortening. A satisfactory outcome (excellent and good results) was achieved in 26 of 31 cases (84%), according to Schatzker and Lambert’s criteria. Poor results and compl ications were related to fractures of comminution and located within 5 cm from the intercondylar notch (Pearson Chi-square test, P=0.03). Other possible factors including age, kinds of nails used, associated injury, and numbers of distal locking screws were not related to the outcome and compl ication (Pearson Chi-square test, P gt; 0.05). Conclusion Retrograde nail ing may be a useful option for distal femoral fractures, but attention should be paid to comminuted fractures or fractures close to the knee joint.
Objective To compare the effectiveness of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. Methods A retrospective analysis was conducted on 86 elderly patients with Neer two- and three-part fractures of the proximal humerus met the selection criteria between January 2015 and December 2018. Forty-six patients were treated with locking plate fixation (locking plate group), and 40 patients with intramedullary nail fixation (intramedullary nail group). There was no significant difference in gender, age, cause of injury, fracture side and type, time from injury to operation, and comorbidities between the two groups (P>0.05). Visual analogue scale (VAS) score, American Shoulder and Elbow Surgery (ASES) score, Constant-Murley score, and shoulder range of motion (forward flexion, abduction, and external rotation) were compared between the two groups. X-ray films were taken to assess the fracture healing, and the neck-shaft angle was measured at 2 days after operation and at last follow-up, and the difference between the two time points was calculated. Results Patients in both groups were followed up 18-40 months, with an average of 30.4 months. There was no significant difference in follow-up time between the two groups (t=−0.986, P=0.327). X-ray films reexamination showed that the fractures of two groups healed, and the healing time was (11.3±2.1) weeks in locking plate group and (10.3±2.0) weeks in intramedullary nail group, which had significant difference between the two groups (t=2.250, P=0.027). The difference of neck-shaft angle was (7.63±7.01)° in locking plate group and (2.85±2.82)° in intramedullary nail group, which had significant difference between the two groups (t=4.032, P<0.001). There was no significant difference in Constant-Murley score, ASES score, VAS score, and shoulder range of motion between the two groups at last follow-up (P>0.05). Complications occurred in 13 cases (28.3%) of locking plate group and in 4 cases (10.0%) of intramedullary nail group, and the difference between the two groups was significant (χ2=4.498, P=0.034). Conclusion Both locking plates and intramedullary nails can be used for the treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. The intramedullary nail fixation surgery is more minimally invasive, which has fewer postoperative complications and faster fracture healing.
Objective To compare the effectiveness between locking compression plate (LCP) and locked intramedullary nail (IMN) for humeral shaft fractures of types B and C. Methods Between January 2010 and January 2012, 46 patients with humeral shaft fractures of types B and C were treated, and the clinical data were retrospectively analyzed. LCP was used for internal fixation in 22 cases (LCP group), and IMN in 24 cases (IMN group). There was no significant difference in gender, age, injury causes, the side of fracture, the site of fracture, the type of fracture, associated injury, and time from injury to operation between 2 groups (P gt; 0.05). The regular clinical examination and evaluation of radiography were done. Shoulder function was evaluated by Neer grading system and elbow function was evaluated by Mayo elbow performance score after operation. Results The operation time and intraoperative blood loss in IMN group were significantly lower than those in LCP group (P lt; 0.05). There was no significant difference in hospitalization time between 2 groups (t=0.344, P=0.733). All patients were followed up 16.8 months on average (range, 12-24 months). At 6 months after operation, bone nonunion occurred in 1 patient of LCP group and in 2 patients of IMN group; the bone healing rate was 95.5% (21/22) in LCP group and 91.7% (22/24) in IMN group, showing no significant difference (χ2=0.000, P=1.000). Except for nonunion patients, the bone healing time was (11.77 ± 0.75) weeks in LCP group and (11.38 ± 0.82) weeks in IMN group, showing no significant difference (t=1.705, P=0.095). Between LCP and IMN groups, significant differences were found in radial nerve injury (4 cases vs. 0 case) and impingement of shoulder (0 case vs. 6 cases) (P lt; 0.05), but no significant difference in superficial infection (1 case vs. 0 case) and iatrogenic fracture (1 case vs. 2 cases) (P gt; 0.05). There was no significant difference in shoulder function and elbow function at 1 year after operation between 2 groups (P gt; 0.05). Conclusion LCP fixation and IMN fixation for humeral shaft fractures of types B and C can achieved satisfactory results. More attention should be paid to avoiding radial nerve injury by fixation of LCP; nail tail should be buried deeply into the cortex of the greater tuberosity and rotator cuff should be protected to decrease the rate of impingement of shoulder by fixation of IMN.
Objective To exploere the effectiveness and advantages of elastic stable intramedullary nail (ESIN) combined with curettage and graft for the treatment of benign lesions of humerus complicating by pathological fracture in children. Methods ESIN internal fixation combined with curettage and graft was used to treat benign lesions of the humerus complicating by pathological fracture in 11 children patients between January 2007 and January 2011. Of 11 patients, 7 were boy and 4 were girl, aged from 5 to 14 years (mean, 9.4 years). The disease duration ranged from 2 to 14 days (mean, 6 days). All fractures were closed fracture, which locations were the proximal humerus in 6 cases, the humeral shaft in 4 cases, and the distal humerus in 1 case; benign lesions of the humerus included aneurysmal bone cyst in 1 case, simple bone cyst in 7 cases, and fibrous dysplasia in 3 cases. Based on imaging studies, preoperative diagnosis was almost clear. The time from hospitalization to operation was 3-5 days Results Healing of incision by first intention was obtained in all cases, with no infection. The mean follow-up was 25.6 months (range, 12-36 months). All patients achieved pain relief at 6 weeks postoperatively and fractures healed completely at 3 to 4 months after operation (mean, 3.3 months). No recurrence or re-fracture was observed during follow-up. The ESIN was removed at 10-14 months after operation (mean, 12.5 months). The lesion disappeared completely in 8 cases and partially in 3 cases. No pain of affected limb or motion limitation of shoulder and elbows was observed. One patient had limb shortening of 2 cm at last follow-up, but he had no function problem. According to Neer shoulder and Mayo elbow function scores, the results were excellent in 11 cases. Conclusion It is a good method to treat benign lesions of the humerus complicating by pathological fracture in children to use ESIN internal fixation combined with curettage and graft. After only a single operation intervention, it can provide early mechanical stability and rapid fracture healing and allow early rehabilitation exercise.
ObjectiveTo explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation.MethodsThe clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness.ResultsBoth groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction (P<0.05). Incision infection occurred in 1 case (3.03%) of the trial group and 3 cases (6.67%) of the control group after operation. The difference in the incidence of infection was significant (χ2=0.139, P=0.045). The incisions of other patients healed by first intention. X-ray film reexamination showed that the fractures of the two groups healed. The fracture healing time of the trial group was (5.30±1.33) months, while that of the control group was (5.98±1.80) months, with no significant difference (t=−1.815, P=0.073). There was no significant difference in VAS score, Harris scores of knee joint and ankle joint between the two groups before operation and at 3, 6, and 12 months after operation (P>0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant (P<0.05).ConclusionApplication of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.