Objective To evaluate the effectiveness of limited open reduction and double plates internal fixation in the treatment of Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty. Methods A retrospective analysis was made on the clinical data of 12 patients with Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty between May 2007 and October 2012, who underwent limited open reduction and double plates internal fixation. Of 12 patients, 4 were male and 8 were female, aged 76-85 years (mean, 81.6 years); the left side was involved in 5 patients and the right side in 7 patients. The cement prosthesis was used in 3 cases and cementless prosthesis in 9 cases; double acting head of hip arthroplasty was performed in 4 cases and total hip arthroplasty in 8 cases. The median time from first hip arthroplasty to re-fracture was 13 months (range, 5 months-5 years). The causes of injury were traffic accident in 2 cases and falling in 10 cases. Combined fractures included contralateral tibial and fibular fractures and ipsilateral distal humeral fracture (1 case), ipsilateral proximal humeral fracture (2 cases), ipsilateral distal radial fracture (1 case), and rib fracture (1 case). The time from injury to operation was 5.6 days on average (range, 3-10 days). Results The incisions all healed by first intention, and no infection or deep venous thrombosis of lower extremity occurred. Twelve cases were followed up 6-24 months (mean, 13.3 months). One female patient died of acute myocardial infarction at 16 months after operation. All the fractures were healed, with X-ray healing time of 12.5 weeks on average (range, 10-16 weeks). The time of full weight bearing was 13 weeks on average (range, 10-18 weeks). Ten cases could walk freely after operation, and 2 cases could walk by the aid of walking aid appliance. At last follow-up, the Harris score of hip function was 87.3 on average (range, 75-93). Conclusion The method of limited open reduction and double plates internal fixation for Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty is effective in maintaining stability, protecting blood supply, promoting fracture healing, and doing functional exercise early. The long-term effectiveness needs further observation.
Objective To investigate the effects of different puncture levels on bone cement distribution and effectiveness in bilateral percutaneous vertebroplasty for osteoporotic thoracolumbar compression fractures. Methods A clinical data of 274 patients with osteoporotic thoracolumbar compression fractures who met the selection criteria between December 2017 and December 2020 was retrospectively analyzed. All patients underwent bilateral percutaneous vertebroplasty. During operation, the final position of the puncture needle tip reached was observed by C-arm X-ray machine. And 118 cases of bilateral puncture needle tips were at the same level (group A); 156 cases of bilateral puncture needle tips were at different levels (group B), of which 87 cases were at the upper 1/3 layer and the lower 1/3 layer respectively (group B1), and 69 cases were at the adjacent levels (group B2). There was no significant difference in gender, age, fracture segment, degree of osteoporosis, disease duration, and preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between groups A and B and among groups A, B1, and B2 (P>0.05). The operation time, bone cement injection volume, postoperative VAS score, ODI, and bone cement distribution were compared among the groups. Results All operations were successfully completed without pulmonary embolism, needle tract infection, or nerve compression caused by bone cement leakage. There was no significant difference in operation time and bone cement injection volume between groups A and B or among groups A, B1, and B2 (P>0.05). All patients were followed up 3-32 months, with an average of 7.8 months. There was no significant difference in follow-up time between groups A and B and among groups A, B1, and B2 (P>0.05). At 3 days after operation and last follow-up, VAS score and ODI were significantly lower in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). Imaging review showed that the distribution of bone cement in the coronal midline of injured vertebrae was significantly better in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). In group A, 7 cases had postoperative vertebral collapse and 8 cases had other vertebral fractures. In group B, only 1 case had postoperative vertebral collapse during follow-up. ConclusionBilateral percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures can obtain good bone cement distribution and effectiveness when the puncture needle tips locate at different levels during operation. When the puncture needle tips locate at the upper 1/3 layer and the lower 1/3 layer of the vertebral body, respectively, the puncture sites are closer to the upper and lower endplates, and the injected bone cement is easier to connect with the upper and lower endplates.
OBJECTIVE: To investigate the effect of soft tissue repairing at different times on the union of type III b tibial fracture. METHODS: From January 1987 to January 1999, seventy-six type III b tibial fractures were divided into 3 groups: early group(0 to 7 days), subacute group(8 to 30 days), late group(more than 30 days) according to the time of soft tissue repairing. The morbidity rates of complications such as infection, nonunion as well as the time to union were compared respectively. RESULTS: Followed up for 10 to 36 months (averaged 24 months), the infection and nonunion rates of early group were lower than that of subacute and late groups(P lt; 0.01), the average time of fracture union of early group was less than that of subacute and late groups. CONCLUSION: Early soft tissue repairing can decrease the complications and the time to union of Type III b tibial fracture obviously. The time of "early" should be limited in one week and as soon as possible.
Objective To explore the technique and clinicaleffects of internal fixation of complicated distal femoral fractures using the supporting steel of AO femoral condyles.Methods From October 2001 to February 2004, 23 cases of complicated distal femoral fractures were treated with open reduction and internal fixation using the supporting steel of AO femoral condyles. Of 23 cases, there were 19 males and 4 females, aged 27-55 years. The locations were the right side in 10 cases and the left side in 13 cases. Fracture caused by traffic accident in 16 and by fall in 7, including 14 closed fracture and 9 open fracture, 21 fresh fracture and 2 old fracture. Accordingto AO classification, 6 cases were classified as type A extra-articular fracture and 17 cases as type C intra-articular fracture. The X-ay films before operation showed comminuted fracture of femoral intercondyles and femoral supracondyles. All cases received scientific and rational rehabilitative treatment postoperatively. Results The postoperative follow-up ranged from 6months to 20 months, 23 cases achieved fracture healing with an average healing period of 10.3 months (from 7 months to 16 months). According to the criteria of Kolmert and Wulff, the results were excellent in 16 cases, good in 4 cases, fair in 2 case andpoor in 1 case. The excellenct and good rate was 86.9%.Conclusion Internal fixation with the supporting steel of AO femoral condyles for treatment of complicated distal femoral fractures has advantages of reasonable design, convenient operation, firm fixation and reliable clinical outcome .
ObjectiveTo explore the effectiveness percutaneous monoaxial screw combined with polyaxial pedical screw for treating thoracolumbar fracture by comparing with simple polyaxial pedicle screw fixation. MethodsBetween January 2012 and June 2014, 56 cases of thoracolumbar fractures were treated by percutaneous pedicle screw fixation, the clinical data were retrospectively analyzed. Of 56 cases, 30 were treated with percutaneous monoaxial screw combined with percutaneous polyaxial pedical screw fixation (group A), 26 patients with only percutaneous polyaxial pedicle screw fixation (group B). There was no significant difference in gender, age, body mass index, injury causes, time from injury to admission, involved segments, fracture type, and preoperative American Spinal Injury Association (ASIA) stage, visual analogue scale (VAS), the anterior height of the injured vertebrae, Cobb angle, and sagittal index between 2 groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the 2 groups. The VAS score was used to evaluate the improvement of the pain. The sagittal kyphosis Cobb angle, the anterior height of the injured vertebrae, sagittal index, and the average correction (difference between 3 days after oeration and preoperation) and loss degrees (difference between last follow-up and 3 days after operation) were measured on the X-ray films at preoperation, 3 days after operation, and last follow-up. ResultsIncision healing at stage I was obtained, no related complications occurred. The operation time and intraoperative blood loss showed no significant difference between 2 groups (P>0.05). The patients were followed up 20-42 months (mean, 32 months) in group A and 21-44 months (mean, 30 months) in group B. VAS score of group A was significantly lower than that of group B at 3 days after operation (t=-2.277, P=0.027), but no significant difference was found at last follow-up (t=-0.289, P=0.774). X-ray examination showed good position of internal fixation, with no broken nails or exit of nail. There were significant differences in the anterior height of the injured vertebrae, Cobb angle, and sagittal index between at preoperation and at 3 days and last follow-up, and between at 3 days and last follow-up in 2 groups (P<0.05). The anterior height of the injured vertebrae, Cobb angle, and sagittal index of group A were significantly better than those of group B at 3 days and last follow-up (P<0.05), and correction degree were significantly higher than those of group B (P<0.05), but loss degree was not significant between 2 groups (P>0.05). ConclusionPercutaneous monoaxial screw combined with polyaxial pedicle screw fixation is better than simply polyaxial pedicle screw in effects of treating thoracolumbar fracture under the premise of strictly holding indications.
Objective To analyze the clinical effect of clavicular hook plate in treating Neer type Ⅱ fracture of distal clavicle. Methods From March 2004 to April 2006, 15 patients suffering from Neer type Ⅱ fracture of distal clavicle were treated with clavicular hook plate, including 12 males and 3 females with an average age of 39 years (range,17-69 years). All patients had acute injury,including accident injury (8 cases) and falling injury (7 cases). The results were assessed by the JOA method. Results The wounds healed by first intention. No early complications were found. All patients were followed up for an average of 16.4 months(range,9-34 months) .The mean JOA score was 93.1. Themean pain parameter was 28.0, the fuction was 18.8 and the range of motionwas 26.3. The X-ray films showed that bony union was obtained in all patients after 3.6 months, and the mean healing period was 3.9 months.No acromioclavicular subluxation and dislocation occurred. Conclusion The principal advantages of this method are reliable fixation and early rehabilitation. It is necessary to protect rotator cuff and tissues behind acromioclavicular joint and remove the plate as soon as possible after bony union.
Objective To investigate the effectiveness of percutaneous reduction by leverage and fixation using nonabsorbable suture with neckwear knot loop l igature to treat tibial intercondylar eminence avulsion fractures under the arthroscope. Methods Between February 2003 and December 2008, 28 patients with tibial intercondylar eminence avulsion fractures were treated, including 16 left knees and 12 right knees. There were 15 males and 13 females with an average age of19.5 years (range, 14-45 years). The injury causes included traffic accident injury in 11 cases, sport injury in 10 cases, and sprain injury in 7 cases. Based on Meyers-McKeever classification, there were 18 cases of type III and 10 cases of type IV. The X-ray films showed the tibial intercondylar eminence displaced fracture. The mean time between trauma and operation was 7 days (range, 4-12 days). All patients were treated surgically with an arthroscopically assisted reduction by leverage and fixation using 5-0 Ethibond suture with neckwear knot loop l igature. Results All incisions healed by first intention without infection or injuries of nerves and vessels. Twenty-eight patients were followed up 26 months on average (range, 12-66 months). The X-ray films showed fracture heal ing within 9-13 weeks (mean, 11 weeks). At last follow-up, all patients were able to return to their pre-injury activity and daily l ife. The knee joint was stable with no l imp or impingement of intercondylar fossa. The knee joint range of motion was 0-130°. The results of Lachman and anterior drawer tests were negative in all patients. At last follow-up, the Lysholm score was 93.5 ± 2.5, showing significant difference when compared with the preoperative one (29.0±2.2, t=53.000, P=0.000). Conclusion Percutaneous reduction by leverage and fixation using nonabsorbable suture with neckwear knot loop l igature is minimally invasive and satisfied reduction and fixation in treating the tibial intercondylar eminence avulsion fracture under the arthroscope, so it is benefit for early functional exercises, and can achieve excellent results.
Objective To confirm the association between tail femur distance (TFD) and lag screw migration or cutting-out in the treatment of intertrochanteric fracture with the third generation of Gamma nail (TGN). Methods The clinical data of 124 cases of intertrochanteric fracture treated with TGN internal fixation and followed up more than 18 months between January 2012 and December 2015 were reviewed and analyzed. There were 52 males and 72 females, with an age of 46-93 years (mean, 78.5 years). According to AO/Association for the Study of Internal Fixation (AO/ASIF) classification, 43 cases were type 31-A1, 69 cases were type 31-A2, and 12 cases were type 31-A3. The time from injury to operation was 1-10 days (mean, 2.9 days). According to the fracture healing of the patients, the patients were divided into the healing group and failure group. The age, gender, height, bone mineral density (BMD), fracture AO/ASIF classification, the time from injury to operation, and the TFD value at 1 day after operation were recorded and compared. The risk factors for the migration or cutting-out of lag screw were analyzed by logistic regression. Results There were 111 cases in healing group, the healing time was 80-110 days (mean, 95.5 days). There were 13 cases in failure group, including 2 cases of lag screw cutting-out and 11 cases of significant migration. Except for the TFD value at 1 day after operation in failure group was significantly higher than that in the healing group(t=5.14, P=0.00), there was no significant difference in gender, age, height, BMD, fracture of AO/ASIF classification, and the time from injury to operation (P>0.05) between 2 groups. logistic regression analysis showed that TFD value was a risk factor for the migration or cutting-out of lag screw (B=1.22, standardized coefficient=0.32, Wald χ2=14.66, P=0.00, OR=3.37). Conclusion The patients with higher TFD value had higher risk of postoperative lag screw migration or cutting-out. This result indicates that the appropriate length of the lag screw is helpful to reduce TFD value and prevent postoperative lag screw migration or cutting-out.
Objective To explore the choice for the internal fixation in treatment of pelvic posterior lesions. Methods From May 2000 to June 2005, the treatment was given to 40 patients (28 males, 12 females,aged 21-58 years) with pelvic posterior ring fracture and dislocation. Of the patients, 23 had a traffic accident, 11 had a crush injury and 6 had a fall. As for the state of an injury to the pelvic posterior ring, 22 patients had disloation of the sacroiliac joint, 12 had a sacrum fracture dislocation, and 6 had an ala iliac fracture and disloation of the sacroiliac joint. According to the Denis(1988) classification, fracture of the (sacral region Ⅰ was found in 6 cases, fracture of the scaral) region Ⅱ in 3 cases, and fracture of the scaral region Ⅲ in 3 cases. As for the complication of the pelvic front ring fracture:separation of the symphysis pubis was found in 14 cases, fraclure of the superior ramus and inferior ramus of the pubis on one side in 10 cases. The two-side superior ramus of publis and inferion ramus of pubisin 8 cases, homopleural acetabular fracture on one side in 4 cases, acetabularfracture on one side and contralateral superior ramus and inferior ramus fracture of the pubis in 3 cases, and acetabular fracture on the opposite side in 1 case.As for the operation, 28 patients underwent the stillplate internal fixation of the sacroiliac joint from anterior at 24 h to 15 days after the injury, 2 underwent the screwinternal fixation of the sacroiliac joint from posterior, and remaining 10 underwent the internal fixation by the Galveston Technique associated with the ISOLAsystem. The therapeutic results were analyzed. Results The followup of the 40 patients for 6 months to 3 years revealed that before operation 3 had a sacral plexus nerve injury, and after operation 1 patient developed perineum numbness and urinary incontinence, 1 developed claudication，3 developed posterior urethral fragmentation, and 2 developed urinary bladderrupture; however, they had a complete recovery after the reparative surgery. Conclusion In treatment of the pelvic posterior ring lesions，an appropriate internal fixation can be chosen according to the type of the pelvic fracture，applicability of internal fixation， condition of the patient，equipment available, and the doctor’s experience.
ObjectiveTo summary the diagnosis and surgical treatment experiences of posterior collicular fracture of medial malleolus. MethodsBetween March 2008 and November 2010, 14 patients having lateral and (or) posterior malleolus fractures with posterior collicular fracture of medial malleolus were treated with open reduction and internal fixation, including 5 males and 9 females with an average age of 44.5 years (range, 27-60 years). The causes of injuries were strain in 9 cases, traffic accident in 3 cases, and falling from height in 2 cases. The course of fracture ranged from 3 to 9 days (mean, 6.5 days). Fourteen cases were lateral malleolus fractures, 10 cases were posterior malleolus fractures. According to Lauge-Hansen classification, there were 8 cases of pronation-external rotation type, 3 cases of pronation-abduction type, and 3 cases of supination-external rotation type. ResultsAll incisions healed by first intention with no complication. The patients were followed up 12-24 months (mean, 16.8 months). The X-ray films showed that all fractures healed from 2 to 4 months after operation (mean, 2.9 months). The range of motion (ROM) of affected ankles was (38.40 ± 3.50)° of flexion and was (16.30 ± 2.41)° of extension, showing no significant difference when compared with ROM of normal side [(40.50 ± 3.48)° and (17.90 ± 2.28)°, P gt; 0.05]. All patients’ ankle function was evaluated by Olerud-Molander’s score criteria for ankle function evaluation, the results were excellent in 7 cases, good in 6 cases, and fair in 1 case. ConclusionSpiral CT plays an indispensable role in diagnosis of posterior collicular fracture of medial malleolus. Surgical reduction and rigid fixation should be performed.