[Interlocking intramedullary nailling and micro-invasive internal fixation with plate for multiple segmental tibiofibular fractures: a case-control study].

OBJECTIVE: To compare the clinical effects of interlocking intramedullary nail and micro-invasive internal fixation with plate for the treatment of multiple segmental tibiofibular fractures. METHODS: The clinical data of 39 patients with multiple segmental tibiofibular fractures received treatment from January 2010 to June 2013 were retrospectively analyzed. In the 39 patients, 18 cases were treated by the interlocking intramedullary nail (intramedullary nail group), there were 12 males and 6 females with the mean age of (40.6 ± 9.7) years old (ranged, 24 to 60 years);7 cases were type C2.1, 11 were type C2.2 according to the AO classification. The other 21 cases were treated by micro-invasive internal fixation with plate(plate group), there were 13 males and 8 females with the mean age of (41.7 ± 8.1) years old (ranged, 22 to 52 years), 7 cases were type C2.1, 13 were type C2.2, 1 was type C2.3. Preoperative preparation time, operation time, intraoperative blood loss, postoperative complications, fracture healing time were compared between two groups. Johner-Wruhs evaluation criteria was used to evaluate the clinical effect at last follow-up. RESULTS: All the patients were followed up from 10 to 28 months with an average of 15.2 months. Operative time, intraoperative blood loss in intramedullary nail group were (62.1 ± 5.8) min, (70.9 ± 7.1) ml, respectively; in plate group were (64.3 ± 7.7) min, (74.1 ± 8.5) ml,respectively. There was no significant difference in operation time and intraoperative blood loss between two groups (P > 0.05). However, preoperative preparation time, fracture healing time in intramedullary nail group were (5.3 ± 0.7) days, (11.1 ± 1.9) months, in plate group were (7.1 ± 0.8) days, (14.1 ± 2.2) months, respectively. No postoperative complications were found in intramedullary nail group, and five cases developed with complications in plate group. There was significant difference in preoperative preparation time, postoperative complications and fracture healing time between two groups (P < 0.05). According to Johner-Wruhs criteria at last follow-up, 11 cases got excellent results, 4 good, 3 fair in intramedullary nail group; 11 excellent, 5 good, 2 poor in plate group. CONCLUSION: Interlocking intramedullary nail has advantages of shorter preoperative preparation time, less postoperative complications and faster fracture healing time in treating multiple segmental tibiofibular fractures. But the application scope of interlocking intramedullary nail was inferior to micro-invasive internal fixation with plate , and its indications should be strictly controlled.

Giant aneurysm of the basilar artery in an 86 year old woman.

In this article we present an 80 year old female patient with an unruptured giant aneurysm of the basilar artery presenting with posterior circulation ischemic symptoms. Angiography and CT revealed giant basilar aneurysmal dilatation with severe and wide intracranial arteriosclerosis. We described the uniqueness of this case. Giant basilar aneurysm is associated with various complications particularly brain stem infarction. It is emphasized that arteriosclerosis plays an important role in the formation of giant basilar aneurysms.

[Case-control study on double screws system and compressed three canulated screws in treating femoral neck fractures].

OBJECTIVE: To compare the clinical effects of double screws system and compressed three canulated screws in treating femoral neck fractures. METHODS: From January 2007 to June 2009, the clinical data of 67 patients with femoral neck fractures underwent operation were retrospectively analyzed. There were 38 males and 29 females,aged from 31 to 71 years with an average of 50.6 years, left was in 41 cases and right was in 26 cases. The patients were divided into two groups (group A and B) based on the different fixation method. Of them, 30 cases (group A,19 males and 11 females) were treated with double screws system and 37 cases (group B, 19 males and 18 females) with compressed three canulated screws. In group A, Pauwells angle was more than or equal 50 degrees in 16 cases and Pauwells angle less 50 degrees in 14 cases; in group B, Pauwells angle was more than or equal 50 degrees in 22 cases and Pauwells angle less 50 degrees in 15 cases. Duration of hospitalization, operative time, intraoperative blood loss, postoperative time in bed, infection of incision, postoperative complication, quality of fracture reduction, position of internal fixation, incidence of non-union and femoral head necrosis, incidence of failure fixation, joint function (Harris score) were compared between two groups. RESULTS: All patients were followed up from 30 to 59 months with an average of 42 months. There was no significant differences in aspect of duration of hospitalization, infection of incision, intraoperative blood loss, walking time, postoperative complications between two groups(P>0.05). Operative time of group A [(31.1 +/- 9.7) min]was less than that of group B [(40.4 +/- 12.7) min] (P<0.05). There was no significant differences in quality of fracture reduction, position of internal fixation, incidence of non-union and femoral head necrosis between two groups (P>0.05). In the patients with Pauwells angle more than or equal 50 degrees in group A, there was no retreated screws, broken screws, screw cut-off from the femoral head;a head;and in group B, retreated screws occurred in 2 cases, screw cut-off from the femoral head occurred in 2 cases, screws not completely getting in femoral head occurred in 2 cases; there was significant differences between two groups (P<0.05). The patients with Pauwells angle less 50 degrees in group A, screw loosening occurred in one case; and in group B, screw retreating occurred in one cases; there was no significant differences between two groups (P>0.05). All patients who suffered from screw loosening, retreating or cut-off from the femoral head were more than 65 years old. There was no significant differences in the joint function between two groups at 6 and 30 months after operations (P>0.05). CONCLUSION: Double screws system has advantages of minimal invasion, easy operation, reliable fixation in treatment of femoral neck fractures. Compared with the traditional compressed three canulated screws,double screws system has less fixation failure rate and higher hip function scoring. It has a good clinical effect especially for the patients with Pauwells angle more than or equal 50 degrees.

[Medial plus anterolateral approaches for the treatment of tibial plateau fractures involving three columns].

OBJECTIVE: To study surgical outcomes of medial plus anterolateral approaches for the treatment of tibial plateau fractures involving three columns. METHODS: From March 2010 to March 2012,20 patients with tibial plateau fractures involving three columns were treated with internal fixation by using T-shape, L-shape plate, or distal radius T-plate through medial plus anterolateral approaches. Among the patients, 13 patietns were male and 7 patients were female,ranging in age from 29 to 52 years old with an average of 39.4 years old. The intervals between injury and operation ranged from 8 to 12 days, with a mean of 9 days. At the latest follow-up,the American Hospital for Special Surgery score (HSS) was used to evaluate clinical effect,and the average loateau angle,posterior slope angle and femorotibial angle of tibia were measured on the X-ray films. RESULTS: The average operation time was 2.11 hours; average intraoperative blood loss was 452 ml and average hospital stay was 22.3 days. All the patients were followed up,and the duration ranged from 12 to 20 months,averaged 14.6 months. The fracture healing time ranged from 3 to 8 months, with a mean of 6.1 months. The average loateau angle, posterior slope angle and femorotibial angle of tibia at 3 days after operation were (86.1 +/- 2.7) degrees, (10.7 +/- 1.6) degrees and (168.0 +/- 4.7) degrees respectively; and (84.1 +/- 3.2) degrees, (13.7 +/- 1.9) degrees, (170.0 +/- 5.8) degrees respectively at 1 year after operation (P > 0.05). According to HSS, 11 patietns got an excellent result, 6 good, 2 poor and 1 bad. There were no postoperaive neural and vascular injuries, no plate lossening or broken. One patient had local infection. One patient had skin flap partial necrosis and was cured by conservative treatment. Four patients had postoperative numbness below the inside leg. CONCLUSION: Medial plus anterolateral approaches for the treatment of fractures involving three columns are effective to get good anatomic reduction and stable fixation without changing body position, which is helpful to early functional rehabilition of knee joint.