Objective To compare the effectiveness of open reduction and hook plate fixation versus closed indirect reduction and dorsal extension blocking Kirschner wire fixation for bony mallet fingers. Methods The clinical data of 68 patients with bony mallet finger who admitted between May 2019 and June 2022 were retrospectively analyzed. Among them, 33 cases were in the open group (treated with open reduction and hook plate fixation) and 35 cases were in the closed group (treated with closed indirect reduction and dorsal extension blocking Kirschner wire fixation). There was no significant difference between the two groups in terms of gender, age, the affected side, the affected finger, cause of injury, time from injury to operation, and Wehbé-Schneider classification (P>0.05). The operation time, intraoperative fluoroscopy frequency, fracture healing time, time of returning to work, and postoperative complications were recorded and compared between the two groups. At 12 months after operation, visual analogue scale (VAS) score was used to assess the pain of the injured finger, active flexion range of motion and extension deficit of the distal interphalangeal joint (DIP) were measured by goniometer, and the effectiveness was assessed by Crawford criteria. Results All patients in the two groups were followed up 12-26 months, with an average of 15 months. There was no significant difference in the follow-up time between the closed group and the open group (P>0.05). The operation time in the closed group was shorter than that in the open group, and the intraoperative fluoroscopy times, the fracture healing time, and the time of returning to work in the closed group were more than those in the open group, and the differences were significant (P<0.05). In the closed group, there were 5 cases of pinning tract infection and 3 cases of small area pressure ulcer skin necrosis on the dorsal side of the finger, which were cured after intensive nursing and dressing change. Local nail depression deformity occurred in 7 cases in the open group, and the deformity disappeared after removal of plate. The incisions of the other patients healed uneventfully without complications such as infection, skin necrosis, exposure of the internal fixation, or nail deformity. There was no significant difference in the incidence of skin necrosis between the two groups (P>0.05), but the differences in the incidence of infection and nail deformity between the two groups were significant (P<0.05). There was no significant difference in VAS score, DIP active flexion range of motion, DIP extension deficiency, or Crawford criteria evaluation between the two groups at 12 months after operation (P>0.05). At last follow-up, there was no DIP osteoarthritis and joint degeneration in both groups. Conclusion Open reduction and hook plate fixation versus closed indirect reduction and dorsal extension blocking Kirschner wire fixation have their own advantages and disadvantages, but both of them have good results in the treatment of bony mallet fingers. Open reduction and hook plate fixation is recommended for young patients with bony mallet fingers who are eager to return to work.
ObjectiveTo evaluate the effectiveness of open reduction and internal fixation (ORIF) in treatment of acute and delayed occult Lisfranc injuries.MethodsA retrospective review of 26 patients with occult Lisfranc injuries who were treated with ORIF between July 2010 and July 2015 was applied. Fourteen patients were treated within 6 weeks after injury (acute group) and 12 patients were treated after 6 weeks of injury (delayed group). There was no significant difference between the two groups in gender, age, affected sides, and preoperative visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, and physical and mental scores of Study Short Form 12 Health Survey (SF-12) (P<0.05). The joint reduction, internal fixator, and traumatic osteoarthritis were observed by X-ray films. The pain degree, midfoot function, and quality of life were evaluated with VAS score, AOFAS score, and physical and mental scores of SF-12.ResultsAll incisions healed by first intention with no complications. All patients were followed up with the mean follow-up time of 15 months (range, 12-24 months) in acute group and 15 months (range, 12-23 months) in delayed group. At last follow-up, the VAS score, AOFAS score, and physical and mental scores of SF-12 were superior to those before operation in the two groups (P<0.05). And there was no significant difference in all indicators between the two groups (P>0.05). The satisfaction rates were 100% and 83.3% (10/12) in acute group and delayed group, respectively. The internal fixators were removed in 20 patients (11 cases in acute group and 9 cases in delayed group) at 9-24 months after operation (mean, 14.5 months). The results of X-ray films showed no traumatic osteoarthritis, midfoot collapse, internal fixation failure, or reduction loss during follow-up period.ConclusionORIF is an ideal method for both acute and delayed occult Lisfranc injuries and can obtain the similar effectiveness.
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.
Objective To investigate the effectiveness of a new tibial plateau posterolateral column universal locking anatomical plate (hereinafter referred to as “new universal locking anatomical plate”) in the treatment of tibial plateau posterolateral column fractures. Methods Between October 2020 and December 2021, 14 patients with tibial plateau posterolateral column fracture were treated with a new universal locking anatomical plate. There were 7 males and 7 females with an average age of 59 years ranging from 29 to 75 years. There were 5 cases on the left side and 9 cases on the right side. The causes of injury included falling from height in 5 cases, traffic accident in 7 cases, and other injuries in 2 cases. The time from injury to operation ranged from 3 to 10 days, with an average of 6 days. According to Schatzker classification, there were 4 cases of type Ⅱ, 8 cases of type Ⅴ, and 2 cases of type Ⅵ. All fractures involved the posterolateral tibial plateau. Three column classification: two columns (anterolateral column+posterior column) in 4 cases, three columns in 10 cases. The operation time, intraoperative blood loss, fracture healing, and complications were recorded. The reduction of tibial plateau fracture was evaluated by Rasmussen radiographic score, and the recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score. Results All 14 cases completed the operation successfully. The operation time was 95-180 minutes, with an average of 154 minutes, and the intraoperative blood loss was 100-480 mL, with an average of 260 mL. All patients were followed up 6-19 months, with an average of 12.5 months. All fractures healed, and the healing time was 15-24 weeks, with an average of 18.7 weeks. During the follow-up, there was 1 case of common peroneal nerve palsy and 1 case of traumatic osteoarthritis. There was no other complication such as vascular injury, incision infection, deep venous thrombosis of lower limbs, heterotopic ossification, bone nonunion, and failure of internal fixation. The reduction of tibial plateau fractures was good immediately after operation, and the Rasmussen radiological score was 10-18, with an average of 15.7; 3 cases were excellent, 10 cases were good, and 1 case was fair, with an excellent and good rate of 92.9%. The scores and grades of HSS at 3 months after operation and at last follow-up significantly improved when compared with those before operation (P<0.05). There was no significant difference between 3 months after operation and last follow-up (P>0.05).Conclusion For the fractures involving the posterolateral column of the tibial plateau, the new universal locking anatomical plate can provide strong fixation, satisfactory postoperative fracture reduction, and good recovery of knee function.
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.
ObjectiveTo compare the effectiveness of minimally invasive percutaneous internal fixation and traditional open reduction via Henry approach and internal fixation in the treatment of unstable distal radial fractures.MethodsFifty-six patients with unstable distal radial fractures that met the selection criteria between October 2013 and December 2014 were randomly divided into minimally invasive group (26 cases) and traditional group (30 cases). They were treated with oblique T-shaped locking plate internal fixation via minimally invasive percutaneous approach or traditional Henry approach. There was no significant difference in gender, age, side, causes of injury, fracture classification, and time from injury to operation between 2 groups (P>0.05). The length of incision, operation time, intraoperative blood loss, hospitalization time, and fracture healing time were recorded in 2 groups. The difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation were compared between 2 groups. The visual analogue scale (VAS) score, the percentage of the lateral wrist flexion and extension range, forearm rotation, and the hand grip strength (recorded as FS%, FR%, and HG% , respectively) were compared between 2 groups at 4 weeks and 3 months postoperatively. The wrist function was evaluated through the disability of arm-shoulder-hand (DASH) scores at 3 months postoperatively.ResultsThe length of incision, operation time, intraoperative blood loss, and hospitalization time in minimally invasive group were significantly less than those in traditional group (P<0.05). The incisions of 2 groups were all achieved primary healing. All patients were followed up 10-16 months (mean, 12.6 months). There was no radial artery injury, screw too long, or screw entering the joint space. In minimally invasive group, 1 patient had the symptoms of median nerve irritation after operation, and recovered completely at 1 month; in traditional group, there were 2 cases of tendon irritation after operation. There was no significant difference in the fracture healing time, the difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation between 2 groups (P>0.05). At 4 weeks after operation, the VAS score in minimally invasive group was significantly less than that in traditional group, and the FS%, FR%, and HG% were significantly higher than those in traditional group (P<0.05). There was no significant difference in above indicators between 2 groups at 3 months after operation (P>0.05). The DASH score in minimally invasive group was significantly less than that in traditional group at 3 months after operation (t=–5.308, P=0.000). The patient’s aesthetic evaluation of postoperative wound in minimally invasive group was better than in traditional group.ConclusionFor treatment of unstable distal radial fractures, the metacarpal minimally invasive internal fixation has the advantages of smaller wound, incisional concealment, and quicker recovery of wrist joint.
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 investigate the effectiveness of open reduction and internal fixation on high-energy ankle Logsplitter injuries (a kind of transsyndesmotic ankle fracture dislocation), and compare the prognosis between open and closed Logsplitter fracture.MethodsThe clinical data of 36 Logsplitter fractures treated with open reduction and internal fixation between April 2011 and May 2016 were retrospectively analyzed. Among them, 15 cases were open fracture and dislocation (open group) and 21 cases were closed fracture and dislocation (closed group). There was no significant difference between the two groups in gender, age, combined injury, injury to hospital admission time (P>0.05), with comparability. The wound healing, ankle mobility recovery, complications, and fracture healing were observed after operation. The ankle function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score.ResultsBoth groups were followed up 12-29 months (mean, 19 months). There was no significant difference in the follow-up time between the open group and the closed group (t=1.169, P=0.251). In the open group, there were 3 cases of postoperative infection, 3 cases of nonunion, and 5 cases of post-traumatic osteoarthritis; each mentioned complications had 1 case in the closed group; there was no significant difference in complications incidence between the two groups (P=0.41) except post-traumatic osteoarthritis incidence (P=0.02). At last follow-up, there was no significant difference in AOFAS score between the two groups (t=1.981, P=0.056). According to AOFAS score criterion, the results were good in 10 cases and general in 5 cases in the open group, and good in 13 cases and general in 8 cases in the closed group, showing no significant difference (P=0.796). There was no significant difference in the union duration and ankle flexion, dorsal extension, varus, and valgus motion between the two groups (P>0.05).ConclusionOpen reduction and internal fixation for open or closed Logsplitter fractures can achieve satisfactory results, improve fracture healing rate, effectively reduce the incidence of complications, and improve ankle function.
ObjectiveTo explore the effectiveness of hollow screw for the treatment of basilar part fracture of hamate hook.MethodsFive patients with basilar part fracture of hamate hook, aged 24-47 years (mean, 31 years) were treated with open reduction and hollow screw fixation between June 2015 and February 2019. There were 4 males and 1 female. The causes of injury were athletic injury in 3 cases, falling injury in 1 case, and crushing injury in 1 case. Among them, 1 case was combined with sensory disturbance of one and a half fingers on the ulnar side of the palm. The grip strength of the affected side was significantly decreased when compared with that of the healthy side in all patients. The intervals between injury and surgery were 3-8 days (mean, 4.2 days). Postoperative follow-up was conducted regularly to measure the grip strength of the affected and healthy fingers and the total motion of ring and little fingers of the affected side. Darrow criteria was used to evaluate the effectiveness.ResultsAll the incisions healed by primary intention. All the patients were followed up 6-32 months (mean, 16 months). X-ray films showed that the basilar part fracture of hamate hook reached bony union, and the healing time was 2.0-3.5 months (mean, 2.2 months). At last follow-up, the grip strength of the affected side was (35.80±3.76) kg, showing no significant difference when compared with healthy side [(36.00±4.94) kg] (t=0.094, P=0.930); and the total motion of ring and little fingers of the affected side was (529.0±8.9)°, which was significantly different from that before operation [(232.0±34.7)°] (t=18.108, P=0.000). In 1 patient with ulnar nerve injury, the two-point discrimination of the innervation area was 4 mm, and the pain sensation and temperature sensation returned to normal. Assessed by Darrow criteria, the results were excellent in 4 cases and good in 1 case.ConclusionFor the basilar part fracture of hamate hook, hollow screw fixation can obtain secure reduction and fixation and provide sustained compression and counter-rotation for the broken end of fracture, thus allowing early joint motion and promoting fracture healing and recovery of wrist function. It is a relatively good method for the treatment of basilar part fracture of hamate hook.