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.
ObjectiveTo investigate the effectiveness of limited open reduction via “door-shaft method” and internal fixation with locking plate for two- and three-part fractures of the proximal humerus.MethodsThe clinical data of 64 patients with proximal humeral fractures who were admitted between January 2013 and December 2016 and met the selection criteria were retrospectively analyzed. There were 23 males and 41 females, with an average age of 68.0 years (range, 50-89 years). The injuries were caused by falling in 57 cases, traffic accident in 5 cases, and falling from height in 2 cases. The interval between injury and operation was 1-7 days (mean, 2.1 days). According to Neer classification, there were 28 cases of two-part fractures and 36 cases of three-part fractures. According to the angulation direction of the proximal humeral neck shaft angle, there were 21 cases of adduction fractures and 43 cases of abduction fractures. The fractures were treated with limited open reduction via “door-shaft method” and proximal humerus internal locking systems for internal fixation. The operation time, intraoperative blood loss, number of fluoroscopy, hospital stay, and complications were recorded. The fracture healing was reviewed by X-ray film and the healing time was recorded. The shoulder joint function was evaluated by Neer score standard.ResultsThe operation time was 45-127 minutes, with an average of 82.3 minutes. The intraoperative blood loss was 30-125 mL, with an average of 62.7 mL. Intraoperative fluoroscopy was performed 30-69 times, with an average of 37.0 times. The hospital stay was 6-23 days, with an average of 10.3 days. All incisions healed by first intention. All patients were followed up 12-37 months, with an average of 18.3 months. X-ray film re-examination showed that all fractures healed, the healing time was 12-21 weeks, with an average of 14.3 weeks. After operation, 3 cases had shoulder stiffness and 1 case had fracture malunion. At last follow-up, the Neer score of shoulder joint function was 49-97, with an average of 83.1. Among them, 38 cases were excellent, 13 cases were good, 10 cases were fair, and 3 cases were poor. The excellent and good rate was 79.7%. The excellent and good rate of patients with two-part fractures was 82.1% (23/28), and the excellent and good rate of patients with three-part fractures was 77.8% (28/36).ConclusionThe “door-shaft method” not only reduces the difficulty of the Joystick technique in the reduction of proximal humerus fractures, but also provides auxiliary stability. It is used for limited open reduction and internal fixation with locking plate to treat the two- and three-part fractures of the proximal humerus, which can achieve good effectiveness.
ObjectiveTo investigate the effectiveness of open reduction and internal fixation for multiple injuries of superior shoulder suspensory complex (SSSC) with coracoid process fracture.MethodsBetween January 2014 and October 2018, 22 patients with multiple injuries of SSSC with coracoid process fracture were treated by open reduction and internal fixation. There were 16 males and 6 females, aged from 24 to 72 years with an average age of 36.6 years. There were 10 cases of falling injury, 5 cases of traffic accident injury, and 7 cases of falling from height injury. All of them were fresh closed injuries. The time from injury to operation ranged from 2 to 17 days with an average of 6.9 days. Both X-ray film and CT showed the coracoid process fracture complicated with clavicular fracture in 14 cases, acromioclavicular joint dislocation in 12 cases, and acromioclavicular fracture in 5 cases. There were 14 cases of two places of SSSC, 7 cases of three places of SSSC, and 1 case of four places of SSSC.ResultsAll incisions healed in primary stage after operation. All patients were followed up 10-24 months with an average of 14.1 months. X-ray films showed that all fractures healed and the acromioclavicular joint was normal. The healing time ranged from 6 to 12 months, with an average of 6.2 months. No complications such as internal fixation failure and nonunion occurred. According to University of California Los Angeles (UCLA) shoulder scoring system, the shoulder joint function was rated as excellent in 15 cases, good in 5 cases, and poor in 2 cases at last follow-up. The excellent and good rate was 90.9%.ConclusionOpen reduction and internal fixation for treatment of multiple injuries of SSSC with coracoid process fracture is firm and reliable. Combined with active postoperative rehabilitation program intervention, it can accelerate the recovery of shoulder joint function and achieve satisfactory effectiveness.
Objective To summarize the method and effectiveness of open reduction and internal fixation in the treatment of 4 cases of bipolar clavicle dislocations. Methods Between June 2017 and June 2022, 4 patients with bipolar clavicle dislocations were admitted. There were 3 males and 1 female. The age ranged from 27 to 63 years, with an average age of 45 years. There were 2 cases of crushing injury of mine car, 1 case of traffic accident injury, and 1 case of heavy object injury. The time from injury to operation was 3-7 days, with an average of 5.0 days. The sternoclavicular joint dislocations were classified as Grade Ⅱ in 1 case and type Ⅲ in 3 cases, and anterior dislocation in 3 cases and posterior dislocation in 1 case. The acromioclavicular joint dislocations were classified as Tossy type Ⅱ in 2 cases and type Ⅲ in 2 cases. After open reduction, the sternoclavicular joint and acromioclavicular joint were fixed with lateral malleolus locking titanium plate and clavicular hook plate, respectively. ResultsAll operations were successfully completed without vascular or nerve injury. All incisions healed by first intention. All patients were followed up 12-18 months, with an average of 14 months. At last follow-up, the shoulder joint functions were rated as excellent in 3 cases and good in 1 case according to Rockwood score. During follow-up, there was no loosening of internal fixator or fracture. The internal fixators were removed in all patients at 5-7 months after operation (mean, 6 months), and no re-dislocation occurred after removal. Conclusion For bipolar clavicle dislocation, open reduction combined with lateral malleolus locking titanium plate fixation of the sternoclavicular joint and clavicle hook plate fixation of the acromioclavicular joint can achieve good effectiveness. It has the advantages of simple operation, high safety, firm fixation, and fewer complications, and the shoulder function recovers well.
ObjectiveTo evaluate the effectiveness of nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid perilunate dislocation.MethodsBetween September 2011 and October 2018, 17 patients with trans-scaphoid perilunate dislocation were treated with nitinol memory alloy two foot fixator and Kirschner wire. There were 12 males and 5 females, with an average age of 32.6 years (range, 23-52 years). The disease duration was 8 hours to 9 days, with an average of 6.5 days. The causes of injury included 6 cases of falling injury, 4 cases of traffic accident injury, 3 cases of stress injury of wrist caused by sports, 2 cases of violent injury of wrist caused by machine impact, 1 case of military training injury, and 1 case of other injury. One case was complicated with nerve injury. According to Herbert’s classification, all the fractures were type B4. At 1 week before operation, 3 months, 6 months after operation and last follow-up, the wrist function was evaluated according to the Krimmer scale score.ResultsAll the 17 patients were followed up 10.5-48 months, with an average of 18.6 months. There was no loosening or infection of the internal fixator, no necrosis of the scaphoid and lunate. The periosteal dislocations of the patients were well reduced and the scaphoid fractures all healed. The healing time was 4-18 months, with an average of 11.3 months. The Krimmer wrist scores were 37.5±4.4, 61.3±7.2, 83.3±9.3, 87.3±8.2 at 1 week before operation, 3 months, 6 months after operation and last follow-up, respectively. The Krimmer wrist score at each time point after operation was significantly improved when compared with that before operation (P<0.05), and at 6 months after operation and last follow-up than at 3 months after operation (P<0.05). There was no significant difference between at 6 months and last follow-up (P>0.05). At last follow-up, the Krimmer wrist function was excellent in 13 cases, good in 2 cases, fair in 1 case, poor in 1 case, and the excellent and good rate was 88.23%.ConclusionNitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid periosteal dislocation has definite effectiveness, simple operation, and good recovery of wrist function after operation.
ObjectiveTo investigate the effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in the treatment of extreme distal radius fractures.MethodsBetween July 2014 and July 2018, 15 patients with extreme distal radius fractures were treated with volar oblique T-type locking plate and raft screws reduction and fixation. There were 6 males and 9 females, aged from 30 to 66 years with an average age of 56.6 years. The cause of injury was falling from height in 2 cases and falling in 13 cases. All of them were fresh closed injuries. The fractures were rated as type 23C1 in 8 cases and as type 23C2 in 7 cases according to AO/Orthopaedic Trauma Association (AO/OTA) classification. There were 7 cases of ulnar styloid process fracture and 2 cases of distal radioulnar joint instability. The time from injury to operation was 6 to 9 days with an average of 7.3 days. The fracture healing and the radial height, palm inclination, and ulnar deviation were observed by X-ray reexamination. Cooney score was used to evaluate the effectiveness.ResultsAll incisions healed by first intention. All patients were followed up 12-24 months, with an average of 14.6 months. X-ray films showed that all fractures healed, and the healing time ranged from 5 to 10 months, with an average of 8.2 months. No internal fixation failure or secondary fracture displacement occurred. At last follow-up, the radial height, palm inclination, and ulnar deviation recovered well, and the differences between pre- and post-operation were significant (P<0.05). The pain, function, activity, and grip strength scores and the total score of Cooney score were significantly higher than those before operation (P<0.05). There were 11 cases of excellent, 3 cases of good, and 1 case of good, with an excellent and good rate of 93%.ConclusionFor extreme distal radius fractures, the volar oblique T-type locking plate and raft screws reduction and fixation can restore the radialheight, palm inclination, and ulnar deviation, fix firmly, and recover the wrist joint function exercise early, and obtain satisfactory effectiveness.
Objective To investigate the tunnel-type open reduction and internal fixation of rib fractures (ORIF) with titanium locking plate in traumatic rib fractures. Methods Clinical data of 10 patients with multiple rib fractures from June 2016 to January 2017 in the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University were analyzed. There were 6 males and 4 males with an average age of 38.5±9.0 years (range, 30–63 years). All patients underwent emergency treatment, chest CT and ultrasound examination before they admitted to the hospital. According to rib fractures and injuries, patients were given the tunnel-type ORIF of rib fractures with titanium locking plates, the chest tube and negative suction drainage. The patients were followed up over three months. Results All patients were cured. There was no complication during follow-up. No wound infection and death occurred. Postoperative three-month follow-up showed that chest pain was significantly relieved without pulmonary atelectasis and pleural effusion or other complications. Conclusion Tunnel-type internal fixation of rib fractures with titanium locking plates is effective, which can quickly restore the stability and integrity of the thorax. Surgical procedure is simple and can get fast postoperative recovery to improve the patient's quality of life.
ObjectiveTo compare the early effectiveness of minimally invasive open reduction and internal fixation via posterior median approach versus arthroscopic double-tunnel suture fixation in treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL).MethodsA clinical data of 31 patients with the tibial avulsion fracture of the PCL and met the criteria between January 2015 and January 2019 was retrospectively analyzed. Nineteen patients (group A) were treated with open reduction and internal fixation with cannulated screw via posterior median approach. The other 12 patients (group B) were treated with arthroscopic double-tunnel suture fixation technique. There was no significant difference between the two groups (P>0.05) in the gender, age, side of effected limb, the injury cause, the time from injury to operation, the combined meniscus injury, Meyers & McKeever classification and preoperative Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) score, and the difference of tibial posterior displacement between bilateral knees. The operation time, postoperative complications, fracture healing, and the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score were recorded.ResultsGroup B spent significantly longer operation time than group A (t=7.347, P=0.000). No postoperative complication occurred in group B, and 1 patient in group A had a screw breakage. All patients were followed up 6-36 months (mean, 22 months). X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, there was no significant difference in the patients with normal knee range of motion between the two groups (P=0.510). At last follow-up, the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score in the two groups were superior to those before operation (P<0.05); while there was no significant difference between the two groups (P>0.05).ConclusionFor the tibial avulsion fracture of PCL, the minimally invasive open reduction and internal fixation and arthroscopic double-tunnel suture fixation can obtain similar early effectiveness. However, arthroscopic surgery has the advantages of being able to simultaneously deal with intra-articular combined injuries, avoiding internal fixator complications, and eliminating the need for secondary operation.
Objective To investigate the clinical efficacy of selective tarsometatarsal arthrodesis for old Lisfranc injury without significant post-traumatic osteoarthritis (PTOA). Methods The clinical data of patients with old Lisfranc injury without significant PTOA who were treated by selective tarsometatarsal arthrodesis at Chengdu Pidu District People’s Hospital between June 2013 and June 2021 were analyzed retrospectively. The improvement of patients’ Visual Analogue Scale (VAS) score, American Orthopedic Foot Ankle Society (AOFAS) midfoot score and Short Form 12 (SF-12) score before surgery and at the final follow-up were compared. Results Seventeen oldLisfranc injury patients (17 feet) without significant PTOA were finally recorded, including 12 males and 5 females. All patients completed the surgery successfully, and the surgical incisions healed smoothly after surgery without complications such as poor incision healing, soft tissue ischemic necrosis, and deep and superficial infections. All patients were followed up for an average of 22.6 months (12 to 36 months). Three months after surgery, follow-up X-ray films showed bony healing of the fused ends in all patients, and the patient satisfaction was 94.1%. Compared with the preoperative scores, VAS score (6.0±0.3 vs. 0.8±0.2), AOFAS score (50.5±1.5 vs. 86.5±0.9), SF-12 physiological score (21.9±0.6 vs. 46.1±0.5) and SF-12 psychological score (31.1±0.8 vs. 47.3±0.7) at the last follow-up improved (P<0.05). Conclusion Selective tarsometatarsal arthrodesis for the old Lisfranc injuries without significant PTOA can restore the midfoot force lines and stability, avoid stiffness after full feet fusion, preserve midfoot function, and improve patient satisfaction.
ObjectiveTo explore the effectiveness of open reduction and internal fixation for bipolar fracture-dislocation of the forearm.MethodsBetween June 2014 and March 2019, 14 patients with bipolar fracture-dislocation of the forearm were treated. There were 9 males and 5 females, aged from 19 to 52 years (mean, 34.9 years). There were 8 cases of falling injuries, 4 cases of traffic accident injuries, 1 case of sports injury, and 1 case of machine strangulation injury. The time from injury to admission was 2-48 hours, with an average of 16.6 hours. All patients were closed injuries. All patients were treated with open reduction and internal fixation; the upper radioulnar joints were treated with circumferential ligament repair or lateral collateral ligament repair according to the joint stability. And the patients with lower radioulnar joint instability were also treated with the TightRope plate with loop fixation. After 3 weeks of plaster fixation, the patients started functional exercises. The fracture healing time, stability and range of motion of wrist and elbow joints, and forearm rotation function were recorded. The effectiveness was evaluated by Anderson’s forearm function score at last follow-up.ResultsThe incisions healed by first intention. All 14 cases were followed up 12-36 months with an average of 24.8 months. All fractures healed, with an average healing time of 14.9 weeks (range, 12-18 weeks). The stabilities of the upper and lower radioulnar joints restored well. At last follow-up, the elbow flexion and extension range of motion was 65°-160°, with an average of 124.6°; the wrist flexion and extension range of motion was 115°-165°, with an average of 155.0°; the forearm rotation range of motion was 65°-165°, with an average of 154.6°. According to Anderson’s forearm function score, 8 cases were excellent, 5 cases were good, and 1 case was unsatisfactory. ConclusionThe treatment of bipolar fracture-dislocation of the forearm needs comprehensive consideration and individualized treatment plan. The focus is to restore the anatomical structure of the radius and ulna and firm internal fixation, stabilize the upper and lower radioulnar joints, and perform functional exercises as soon as possible after operation to obtain satisfactory effectiveness.