Operative strategy and clinical results of complex four part distal radius fractures by combined palmar and dorsal internal fixation / 中华外科杂志

Objective@#To explore a standard procedure for the treatment of combined dorsal and palmar internal fixation for complex four part distal radius fractures and assess its clinical results.@*Methods@#From May 2009 to October 2016, 38 patients(39 sides)who suffered from complex four part distal radius fractures were performed operatively with open reduction and internal fixation via combined dorsal and palmar approach in Department of Orthopaedic Trauma, Qilu Hospital of Shandong University(Qingdao). The series included 22 males(22 sides) and 16 females(17 sides). Age of the patients was 53.5 years ranging from 25 to 79 years.According to Melone classification, there were 34 sides of type of Ⅳ, 5 of type Ⅴ.According to Frykman classification, there were 15 sides of type Ⅶ, 24 sides of type Ⅷ, and all the cases were type C3 according to AO/OTA classification.Preoperatively, the key articular fragments in four part distal radius fractures were identified and the individual fracture patterns from conventional X-ray and CT-scan were analyzed. All the patients were performed combined volar and dorsal fixation.Firstly, a palmar approach which gave access to and fix the palmar-ulnar fragment and the radial styloid fragment was performed.Then a limited dorsal approach across the third extensor compartment which gave access to the dorso-ulnar fragment and a limited dorsal arthrotomy to visualize the radiocarpal joint when necessary were performed.Through dorsal approach, we can address the dorso-ulnar fragment, free intra-articular fragment and direct visualize the joint.Use of a retinacular flap was routinely advocated to help prevent against tendon irritation and rupture.The follow-up control included conventional X-ray, range of motion(ROM), grip strength, and the disabilities of the arm, shoulder and hand index(DASH), as well as the patient-rated wrist evaluation(PRWE) score for functional outcome at 6 and 12 months.@*Results@#Thirty-three patients(34 sides) were followed up for at least 12 months.The would healed well in all cases 2 weeks postoperatively, and no soft tissue infections, necrosis or neurovascular complications occurred.All the fractures of 38 cases(39 sides)healed averaged 3.6 months(ranging from 2.5-5.7 months), and no loss of reduction occurred postoperatively.Anatomic reconstruction with a step or gap of <1 mm was achieved in 37 cases(38 sides), Whereas 5 patients were lost to follow-up at 12 months postoperatively.ROM and grip strength were all recovered to over 85% of the unaffected side(exception of the bilateral patient). Median DASH-index and PRWE were 6.5(0-17) and 9.3(0-20)respectively.@*Conclusion@#Combined volar and dorsal approaches allow achieving anatomic reconstruction in complex four part intra-articular distal radius fractures and reveal good functional outcomes at intermediate follow-up.

Application value of carpal shoot through view in the palmar plating of distal radius fractures / 中华骨科杂志

Objective To explore the application value of carpal shoot through view in the palmar plating of distal radius fractures.Methods From March 2015 to May 2016,there were 62 acute distal radius fractures received various operation in our department,in which 48 patients were only performed volar locked plating.Among these 48 cases,there were 21 males and 27 females,with ages ranging from 17 to 75 years (mean 43.6±10.6 years).There were 15 cases of type A,11 cases of type B and 22 cases of type C distal radial fractures according to AO/OTA classification.All the operations were performed through modified Henry's approach between the radial artery and flexor carpi radialis.Once achieved satisfactory reduction,we performed rigid fixation of distal radius using anatomical locking plates.In all cases,bicortical drilling was performed.Screw lengths selected measured 1 to 2 mm less than the depth gauge number avoiding dorsal cortex penetration.After plate fixation of these 48 cases,standard posteroanterior and lateral radiographs were taken followed by the carpal shoot through view.To obtain carpal shoot through view,the patient's forearm was maximally supinated,the elbow flexed about 60°-70°and the wrist maximally dorsiflexed.The image intensifier beam is directed over the base of the thenar eminence.Compare the ratio of dorsal protrusion between standard view and carpal shoot through view,then statistical analysis was performed.After operation,CT scan was routinely taken to further test the effectiveness of carpal shoot through view.Results Five cases were detected dorsal cortex screw protrusion using standard posteroanterior and lateral views (10.4％,5/48).There were totally 16 cases (including the former 5 cases) of dorsal screw penetration uncovered by the carpal shoot through view(33.3％,16/48.Statistically significant difference was existed between the two fluoroscopy methods.Additionally,in 2 cases,a screw had penetrated the distal radioulnar joint (DRUJ),which was only apparent on the shoot through view.All the improper screws were exchanged and again were verified by the carpal shoot through view.The overall screw exchange rate was 37.5％ (18/48).Conclusion Compared with standard AP and lateral fluoroscopy,the carpal shoot through view can reliably reveals dorsal screw penetration.Meanwhile,it provides excellent visualization of DRUJ.

One-stage minimally invasive surgery for femoral and ipsilateral tibial plateau fractures with a rapid reductor / 中华创伤骨科杂志

Objective To investigate the fixation sequence,key points and clinical value of a new minimally invasive surgery for one-stage treatment of femoral and ipsilateral tibial plateau fractures with a rapid reductor.Methods From October 2015 to January 2017,5 patients with femoral and ipsilateral tibial plateau fractures received surgery at our department.They were 4 men and one woman,aged from 23 to 65 years (mean,45.5 years).The femoral fractures were type A in 2 cases,type B in 2 cases and type C in one case according to AO/OTA classification.The tibial plateau fractures were type Ⅴ in 2 cases and type Ⅵ in 3 according to Schatzker classification.After the tibial plateau fractures were first fixated,Kirschner wires were inserted via the femoral condyle and distal tibia.A rapid reductor was used to reduce the tibial plateau and dual plates were implanted by percutaneous minimally invasive internal fixation.Then the same set of rapid reductor was used to treat femoral fractures by antegrade femoral nailing.The bone traction was completed via the femoral condyle and anterior superior iliac spine.The operative time,bone union time,knee functional recovery and hospital stay were recorded.Results The 5 patients were followed up for an average of 10 months (from 7 to 17 months).No delayed union,nonunion or malunion happened of either femoral or tibial plateau fractures.The healing time for femoral fractures ranged from 4 to 8 months,averaging 5.5 months;the union time for tibial plateau fractures ranged from 10 to 14 weeks,averaging 12.0 weeks.The knee flexion averaged 110° (from 95° to 130°).The overall functional recovery was rated as excellent in 2 cases and good in 3 according to the Karlstr(o)m & Olerud criteria.The average hospital stay was 18 days(from 13 to 32 days).Conclusion Minimally invasive surgery with a rapid reductor can treat femoral and ipsilateral tibial plateau fractures at one stage,leading to fine functional recovery of the knee and greatly reduced hospital stay in particular.

Surgical treatment of intra-articular fractures of the calcaneus / 中华创伤骨科杂志

Objective To evaluate the clinical results of surgical treatment of intra articular fractures of the calcaneus using calcaneal anatomical plate. Methods From January 1999 to September 2003, 82 patients with calcaneal fracture were treated differently based on the results of X ray and semi coronal CT scan performed before and after the treatment. According to Sanders classification system, there were 36 cases of type Ⅲand 9 cases of type Ⅳwho received treatment of lateral L type incision and internal fixation with calcaneal anatomical plate. Results The internal fixation with the calcaneal anatomical plate almost restored the height, length and width of the calcaneus for the 45 patients. Infection of incision happened in 3 patients but healed after debridement and administration of antibiotics. Because of severe subtalar osteoarthrosis, 4 patients experienced subtalar arthrodesis. The follow ups averaged 38 months. According to the classification of calcaneal fractures by the American Surgery Association of Foot and Ankle, the results were excellent in 6, good in 26, fair in 7,and poor in 6. The excellent and good rate was 71.1%. Conclusion The internal fixation with the calcaneal anatomical plate to treat intra articular fractures of the calcaneus of Sanders Ⅲand Sanders Ⅳcan renew the calcaneal configuration and achieve preferable clinical effects.