Objective To investigate the treatment method of senile patients with femoral intertrochanteric fractures and its cl inical outcomes. Methods From January 2005 to December 2007, 192 senile patients with femoral intertrochanteric fractures were treated, including 85 males and 107 females aged 65-92 years old (average 75 years old). The injury was causedby fall on walking in 106 cases, fall when riding a bicycle in 55 cases, and traffic accidents in 31 cases. According to Evans classification, there were 12 cases of type I A, 43 cases of type I B, 29 cases of type II, 24 cases of type III A, 23 cases of type III B, 26 cases of type IV, and 35 cases of type V. One hundred and fifty patients were associated with cardio-cerebrovascular diseases, 120 patients were compl icated with chronicle hypertension, 90 cases were associated with bronchitis, and 75 cases were compl icated with diabetes. The time from injury to hospital admission was 1 hour to 14 days. Among those patients, 108 were treated with conservative treatment, 68 received dynamic hip screw (DHS) fixation, and 16 underwent proximal femoral Gamma nail fixation. Results All the patients were followed up for 12-36 months (average 18 months). The fracture all reached bone union without occurrence of nonunion and delayed union. Patients could take care of themselves, and there were no occurrences of serious pains and dysfunctions. The therapeutic effect was satisfactory. The conservative treatment group: the average hospital stay length was 48 days; the average bone heal ing time was 14 weeks; 23 cases had different degrees of coxa adducta; Harris score system was adopted to evaluate hip joint function, 45 cases were graded as excellent, 31 as good, 10 as fair, and 22 as poor, and the excellent and good rate was 70.4%. DHS internal fixation group: the average operation time was 60 minutes; the average bleeding volume during operation was 200 mL, the average hospital stay length was 24 days; the average bone heal ing time after operation was 12 weeks; Harris score system was adopted to evaluate the injured hip joint function, 38 cases were graded as excellent, 21 as good, 8 as fair, and 1 as poor, and the excellent and good rate was 86.8%. Gamma nailfixation group: the average operation time was 70 minutes; the average bleeding volume during operation was 200 mL, the average hospital stay length was 14 days; the average bone heal ing time after operation was 12 weeks; Harris score system was adopted to evaluate the injured hip joint function, 11 cases were graded as excellent, 4 as good, 1 as fair, and the excellent and good rate was 93.8%. Conclusion For geriatric femoral intertrochanteric fractures, operative treatment should be performed, the preoperative preparation should be sufficient, and individual-oriented treatment method should be selected on the basis of physical conditions of patients and the types of fractures.
Objective To analyze the treatment of old united lateral condyle fractures of humerus in children.Methods From January 1997 toFebruary 2002, 13 cases of old united lateral condyle fractures of humerus were treated. There were 11 boys and 2 girls. Their age was from 4 to 11 years(7.2 years on average). The primary diagnosis results were 4 cases of degree Ⅰ fracture, 5 cases of degree Ⅱ fracture and 4 indefinitely diagnosed cases. Elbow extension disorder occurred in 13 cases, which was limited 30-70°. The elbow flexion was limited morethan 90°. X-ray films showed 10 nonunion and 3 malunion of fracture. The timefrominjury to operation was 32 to 81 days (56 days on average) in 12 cases and6 months in 1 case. All cases were treated by open reduction and internal fixation. One case was treated combined with implanting bone. Results After a follow-up of 3 to 8 years(5.4 years on average), no cubitus varus or valgus occurred.Five cases had growth disturbances of the lateral condyle of the distal humerus. The movement of these elbow joints improved from 40° to 70° (56° on average). The time of clinical bone union was 6 to 8 weeks and no nonunion and delayed union were observed in X-ray films. Conclusion It is important to accurately diagnose for treatment of lateral condyle fractures of the humerus in children so as to reduce the occurrence of malunion of fracture. It can save the joint function and reduce the cosmetic deformity effectively to operate as earlyas possible.
Objective To investigate the cl inical effect of minimally invasive internal fixation percutaneous plate osteosynthesis (MIPPO) assisted by arthroscopy on tibial plateau fractures. Methods From September 2005 to December 2007, 29 patients with tibial plateau fracture underwent arthroscopy-assisted MIPPO, including 18 males and 11 females aged18-59 years old (average 34.7 years old). There were 8 cases of type II, 10 of type III, 5 of type IV, 3 of type V, and 3 of type VI according to Schatzker classification system. The fracture was combined with meniscus injury in 13 cases, anterior cruciate l igament injury in 4 cases, and medial collateral l igament injury in 3 cases. The time from injury to operation was 2-10 days. Firstly, the combined injury was treated under arthroscopy. Then, reduction of tibial plateau fractures was performed, bone grafting was conducted in the area of bone defect, and internal fixation using strut plates was performed after establ ishing subcutaneous tunnel via minimally invasion. Early rehabil itation activities were carried out for each patient 1 day after operation. Results No early compl ications such as poor heal ing of incisions, infections, and osteofascial compartment syndrome occurred. Over the follow-up period of 12-39 months (average 24 months), there was no failure of internal fixation, traumatic knee osteoarthritis, and inversion and eversion of the knee. The fractures healed within 3-4.5 months (average 3.5 months). The cl inical effect was excellent in 23 cases, good in 4 cases, and fair in 2 cases according to Lysholm knee rating system, and the excellent and good rate was 93.1%. Conclusion Arthroscopy-assisted MIPPO is a safe and effective way of managing tibial plateau fractures due to its features of minimal invasion, earl ier recovery, fewer compl ications, and simultaneous treatment of associated intra-articular injuries.
Objective To review the diagnosis, treatment method, and surgical technique of tarsometatarsal joint injury. Methods Recent l iterature concerning tarsometatarsal joint injury was reviewed and analyzed in terms of anatomy,injury mechanism, classification, diagnosis, management principle and methods, and surgical techniques. Results It could be difficult to diagnose tarsometatarsal joint injury, and subtle injury was more difficult to diagnose with a high rate of missed diagnosis. Fairly accurate diagnosis of tarsometatarsal joint injury could be made based on medical history, symptoms and signs, and necessary imaging examinations. For the patient of partial l igament rupture caused by subtle or non-displacement injury, a cast for immobil ization could be adopted; the patients of instable injury should be treated with open reduction and internal fixation. For the patients of complete dislocation and severe comminuted fractures, arthrodesis should be suggested. Conclusion The diagnosis and management of tarsometatarsal joint injury is compl icated. The treatment method of tarsometatarsal joint injury has evoked controversy. Surgeons should choose the optimal treatment method and surgical technique according to the injury type, radiological manifestation, and classification so as to obtain the best cl inical outcome.
Objective To explore the relative prognostic factors of Tile C pelvic injury after iliolumbar fixation. Methods Between March 2007 and March 2010, 60 patients with Tile C pelvic injuries were surgically treated with iliolumbar fixation, including 39 males and 21 females with an average age of 37 years (range, 17-66 years). Of them, 27 cases were classified as Tile C1, 20 as Tile C2, and 13 as Tile C3. The preoperative injury severity score (ISS) was 12-66 (mean, 29.4). The time from injury to surgery was 2-25 days (mean, 8.1 days). Iliolumbar fixation was performed in all patients. Unconditional logistic analysis was used to analyze the relationship between the age, sex, body mass index (BMI), operation opportunity, the preoperative combined injury, classification of fracture, the postoperative complication, reduction outcome, sacral nerve injury, and the time of physical exercise and the prognosis. Results All 60 patients were followed up 12-56 months (mean, 27.3 months). Infection of incisions occurred in 12 cases and were cured after dressing change; healing of incision by first intention was obtained in the other patients. Delay sacral nerve injury was found in 15 patients, 6 patients underwent nerve decompression, and 9 underwent conservative treatment. Ten patients had nail protrusion of Schanz screws at the posterior superior illac spine, and 3 patients had pain, which was relieved after removal of the internal fixator. One patient had bone-grafting nonunion of sacroiliac joint, which was improved by pressured bone graft. Five patients had the beam breakage without significant effect. Six patients had deep vein thrombosis, among them 4 underwent filter and 2 underwent nonsurgical treatment. The healing time of fracture was 3-6 months (mean, 3.9 months). According to the Matta function score, the results were excellent in 31 cases, good in 24 cases, fair in 3 cases, and poor in 2 cases with an excellent and good rate of 91.7% at last follow-up. Majeed score was 58-100 (mean, 86), 28 were rated as excellent, 12 as good, 16 as fair, and 4 as poor with an excellent and good rate of 66.7%. The logistic analysis showed that the age, sex, BMI, and postoperative complications were not prognostic factors; early operation (within 10 days), early function exercises (within 7 days), the better reduction quality, and the less sacral nerve injury were in favor of prognosis; and the worse preoperative combined injury and pelvic injury were, the worse the prognosis was. Conclusion Operation opportunity, the preoperative combined injury, reduction outcome, sacral nerve injury, and the time of physical exercise are all significantly prognostic factors of Tile C pelvic injuries