[Case-control study on poking closed reduction cannulated screw fixation and small incision reduction plate fixation for the treatment of calcaneal fractures].

OBJECTIVE: To compare poking closed reduction cannulated screw fixation and small incision reduction plate fixation in treating calcaneal fractures. METHODS: Clinical data of 98 patients with calcaneal fractures were retrospectively analyzed from June 2015 and June 2018. According to fracture classification and treatment methods, the patients were divided into poking closed reduction cannulated screw fixation (group A) and small incision reduction plate fixation(group B). In group A, there were 50 patients, including 32 males and 18 females with an average of (32.6±6.7) years old; 30 patients were classified to type Sanders II-III and 20 patients were type Sanders IV; treated with poking closed reduction cannulated screw fixation. While in group B, there were 48 patients, including 30 males and 18 females with an average of (31.9±7.2) years old; 28 patients were classified to type Sanders II-III and 20 patients were type Sanders IV; treated with small incision reduction plate fixation. Böhler angle, Gissane angle and AOFAS scores were compared between two groups before operation and 1 month, 1 year after operation. RESULTS: All patients were followed up for 13 to 24 months with an average of (14.6±6.3) months. Böhler angle, Gissane angles and AOFAS score between two groups were improved at different degrees after operation. For Sanders II and III patients, there were no statistical differences in Böhler angle, Gissane angle between two groups before operation, 1 month and 1 year after operation; and there was no differences in AOFAS score between two groups at 1 year after operation. For Sanders IV patients, Böhler angle [(35.40±1.85)°, (35.15±1.90)°] and Gissane angles[(127.80±5.49)°, (127.00±3.06)°] in group B were higher than that of group A[(27.85±3.42) °, (27.25±1.80)° and (118.00±4.13)°, (117.50±5.04)°] at 1 month and 1 year after operation(P<0.05); Böhler angle and Gissane angle at 1 month and 1 year after operation between two groups were improved higher than before operation(P<0.05); AOFAS score in group B (91.00±5.46) was higher than that of group A (84.50±4.64) (P<0.05). CONCLUSIONS: For Sanders II-III calcaneal fractures, the two treatment methods have the equivalent effect. While for Sanders IV patients, small incision reduction plate fixation has better reduction, stable fixation and could improve foot function compared with poking closed reduction cannulated screw fixation.

[Clinical outcomes of total hip arthroplasty using Wagner SL revision stem in femoral intertrochanteric fractures for patients with old fracture or painful arthritis before injury].

OBJECTIVE: To retrospectively study the clinical results of total hip arthroplasty(THA) using Wagner SL revision stem for patients with femoral intertrochanteric fracture. METHODS: From 2006 January to 2009 December, 29 consecutive patients with femoral intertrochanteric fractures were performed THA using Wagner SL revision stem and intertrochanteric reconstruction, including 18 males and 11 females with an average age of 49 years old ranging from 43 to 58. Among them, 8 cases were oboslete femoral intertrochanteric fractures and 21 cases were the intertrochanteric fractures with painful arthritis before injuries. After the operation, the follow-up results were evaluated with clinical and radiographic criteria. The clinical follow-up results were evaluated by Harris score, limb length discrepancy, ROM of hips and the strength of the hip abductor. The X-ray imaging follow-up results were evaluated by periprosthetic osteolysis, prosthesis loosening and radiolucent. RESULTS: All the operations were successfully completed without serious complications associated with THA. Twenty-nine cases were followed up for a mean duration of 8.2 years (ranged, 6 to 10). There was no acceptable thigh pain. The first time walk after operation, 8 patients with oboslete intertrochanteric fracture complained the surgical sides were longer, with the passage of time, the complaint significantly reduced. At 3 months after operation, X-ray films of 21 cases showed intertrochanteric fractures healed well who had painful arthritis before injuries. An average of 6 months after operation (ranged, 3 to 8), X-ray films of 8 cases of oboslete intertrochanteric fracture showed that the bone graft and trochanter with obvious callus connection. There were no obvious prosthesis subsidence on X-ray film at the final follow-up. The recovery of hip movement range was satisfactory, no hip abduction strength was weak. More than 6 years after the operation, according to the Harris scoring evaluation of hip joint, the result was excellent in 18 cases, good in 9 cases, general in 2 cases. CONCLUSIONS: The clinical results of total hip arthroplasty using Wagner SL revision stem for patient with femoral intertrochanteric fracture is a reliable method, intertrochanteric reconstruction not only makes for prosthesis and joint stability, but also increases bone reserve.

[MRI ainalysis of the pseudo-tears of the lateral meniscus of the knee and its clinical significance].

OBJECTIVE: To determine the mechanism of pseudo-tears of the lateral meniscus caused by the transverse geniculate ligament (TL) and the miniscofemoral ligament(MFL) and to investigate a method to differentiate pseudo-tears from true tear of the lateral meniscus. METHODS: Form June 2012 to February 2014, MR examinations of 72 knees (44 left knees and 28 right knees) without tear of the lateral meniscus verified by arthroscopy were performed in the sagittal and coronal plane. There were 41 males and 31 females in the group, with an average age of 33.7 years old (ranged from 25 to 61). The MR appearance of the TL and the MFL was carefully observed. RESULTS: There existed fatty tissue in the gap between the TL and the anterior horn of the lateral meniscus and its central tendinous attachment. On the sagittal images, the fatty tissue formed a linear high-signal cleft between the TL and the anterior horn of the lateral meniscus. This might be mistaken as an oblique tear within the anterior horn of the lateral meniscus. It was called as pseudo-tears of the anterior horn of the lateral meniscus. In sagittal plane, the MFL was identified as a circle-like or short stick-like area of low signal intensity anterior or posterior to the posterior cruciateligament. Nevertheless, a belt-shaped area of low signal intensity from the posterior horn of the lateral meniscus to lateral facet of the medial femoral condyle was identified in the coronal plane. A linear area of high signal intensity between the MFL and the lateral meniscus was found in sagittal plane, which might be mistaken as an oblique tear within the posterior horn of the lateral meniscus. It was called pseudo-tears of the posterior horn of the lateral meniscus. The occurrence rate of the TL was 34.7% (25/72). The prevaleribe of pseudo-tears of the anterior horn of the lateral meniscus was 18 cases. The shape of the anterior horn of the lateral meniscus was regular, and the course of the pseudo-tears cleft was oblique. The occurrence rate of the MFL was 73.6% (53/72), which included the anterior MFL 23.6% (17/72), the posterior MFL 70.8% (51/72) and the two ligaments coexisted 16.7% (12/72). The prevalence of pseudo-tears of the posterior horn of the lateral meniscus was 25 cases. All observed pseudo-tears had either in posteroinferiorly oblique direction (19/25) or in vertical direction (6/25). CONCLUSION: Based on the location and direction of pseudo-tears and observation in the continuous sagittal plane and the coronal plane, pseudo-tears is easily differentiated from the true tear of the lateral meniscus

[Diagnostic value of 3D-indirect magnetic resonance arthrography in detecting meniscal tears of the knees].

OBJECTIVE: To explore the diagnostic value of 3D-indirectmagnetic resonance (MR) arthrography in detecting meniscustears of the knees. METHODS: Form January 2013 to January 2014, routine plain MR of the knees followed by the 3D-indirect MR arthrography was performed in 42 patients with suspected meniscal tears clinically. There were 31 males and 11 females, with an average age of 38.4 years old (ranged, 21 to 67 years old). The duration of the course ranged from 2 h to 15 d. The clinical symptom was knee pain. All the patients got subsequently arthroscopic examination or operation. The sensitivity and specificity of routine plain MR and 3D-indirect MR arthrography were compared based on the results of arthroscopic examination or operation. RESULTS: The signal intensity in the area of meniscal tears on image of 3D-indirect MR arthrography was obviously higher than that of routine plain MR. The sensitivity of 3D-indirect MR arthrography was 85.79% (87/102), while the routine plain MR was 52.94% (54/102), and the specificity improved from 67.78%(61/90) to 86.67%(78/90). The difference was statistically significant (χ2 = 25.90, P < 0.01; χ2 = 9.13, P < 0.01). CONCLUSION: In comparison with the routine plain MR findings, 3D-indirect MR arthrography demonstrates meniscus tears of the knee with the better sensitivity and specificity.