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Objective:To compare the clinical effects robot navigation assisted and conventional proximal femoral nail antirotation (PFNA) implantation and fixation in the treatment of elderly femoral trochanteric fractures.Methods:A total of 86 elderly patients with tuberosity fracture of the femur were admitted as research samples from January to March in 2022 in the Department of Trauma Orthopaedic, Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University, including 37 males and 49 females, who aged from 63 to 92 years, with an average age of (79.6 ± 6.9) years. All patients were treated with intramedullary nails (PFNA), 32 with dimensity robotic-assisted therapy (robot group) and 54 with traditional methods (conventional group). The length of incision, the number of intraoperative fluoroscopy, the amount of intraoperative blood loss, and the operation time were recorded. The occurrence of postoperative complications in the two groups was observed. The rate of excellent hip Harris score at 3 month after surgery was compared between the two groups. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; the comparison of count data were represented as [ n(%)], and was conducted by Chi-square test or Fisher exact probability between groups. Results:All patients were followed up for 9 to 12 months, with an average of (10.6 ± 0.9) months. The incision length and tip apex distance (TAD) of the robot group were (3.40±0.82) cm and (21.85±1.44) mm, which were smaller than (4.82±0.75) cm and (26.83±1.75) mm in the conventional group ( P<0.05 for all). The number of intraoperative fluoroscopy and guide needle adjustment [(14.53±3.26) and 0 times] in the robot group were less than those in the conventional group [(20.67±4.84) and (2.83±1.42)] ( P<0.05). The intraoperative blood loss and drainage rate of the robot group were (87.03±9.41) and (46.40±8.91) mL, which were smaller than that of the conventional group [(110.00±12.52) and (69.62±10.22) mL] ( P<0.05). There was no significant difference in the number of days of hospitalization and operation time between the two groups ( P>0.05). The postoperative complication rate in the robot group was 9.4%, which was lower than that in conventional group (42.6%), and the difference was statistically significant ( χ2=11.88, P=0.036). The excellent rate of postoperative hip joint function in the robot group was 75.0%, and the conventional group was 66.7%, and there was no significant difference between the two groups ( χ2=0.66, P=0.416). Conclusion:Robot-assisted navigation downward PFNA surgery can have good clinical effect in the treatment of femoral tuberosity fracture in the elderly, which can reduce the number of surgical incisions and intraoperative fluoroscopy, and reduce the incidence of postoperative complications, which is helpful to achieve minimally invasive surgery and rapid recovery of elderly patients with femoral tuberosity fracture.
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Objective:To evaluate the clinic efficacy of channel bone grafting [preservation of the sclerotic bone at the broken nonunion ends and fixation with limited contact dynamic compression plate (LC-DCP)] in the treatment of postoperative atrophic nonunion of middle clavicular fracture.Methods:The 41 patients were retrospectively analyzed who had been treated at Department of Orthopaedics and Traumatology, Xi'an Hong-Hui Hospital for atrophic nonunion after internal fixation of middle clavicular fracture from June 2015 to December 2019. They were 23 males and 18 females, with a mean age of 47.6 years (from 28 to 63 years). The left side was affected in 25 cases and the right side in 16 cases. The time interval between initial fracture surgery and nonunion surgery averaged 18.5 months (from 9 to 40 months). Thirty-six cases had undergone one operation and 5 cases 2 operations before admission. The length of bone defect was measured during operation. All nonunions were treated with construction of a graft channel, iliac bone graft and LC-DCP internal fixation above the clavicle. The upper limb function of the affected side was evaluated by the Disabilities of Arm, Shoulder and Hand (DASH) 12 months after operation.Results:The 41 patients were followed up for an average of 13.6 months (from 12 to 15 months). A bone defect ≤2.0 cm was found in 25 cases and that >2.0 cm in 16 ones. Nonunion healed in all patients after an average time of 14 weeks (from 12 to 16 weeks). One patient reported continuous pain in the donor area after operation and the other developed deep venous thrombosis at the right lower limb. The DASH upper limb scores at 12 months after operation averaged 14.7.Conclusion:Channel bone grafting is a feasible clinical treatment of postoperative atrophic nonunion of middle clavicular fracture, because it preserves the sclerotic bone at the broken nonunion ends, reduces the amount of iliac bone graft and leads to fine clinic efficacy.
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Objective:To characterize the biomechanical performance of our self-designed novel blocking screws in the treatment of distal tibial fractures.Methods:Thirty artificial composite tibial bones were used to create models of unstable distal tibial fracture (AO type 43-A3) which were randomized into 3 even groups ( n=10) according to modes of fixation. Group A was subjected to fixation with intramedullary nails only with merely preset holes reserved for the blocking screws, group B to fixation with intramedullary nails plus conventional anteroposterior blocking screws, and group C to fixation with intramedullary nails plus novel lateral blocking screws. In all the 3 groups, a lateral bending stress test was conducted to record the maximum transversal displacement of the intramedullary nail, a fatigue test to observe the structural abnormality in the model and an axial stress test to record the maximum axial displacement of the intramedullary nail-bone structure. The 3 groups were compared in structural abnormality, the maximum transversal displacement of the intramedullary nail and the maximum axial displacement of the intramedullary nail-bone structure. Results:The lateral bending stress tests showed the maximum transversal displacements were (5.02±1.03) mm; (4.19±0.64) mm and (4.18±0.65) mm in groups A, B and C; compared with group A, the maximum transversal displacement decreased by 16.6%( P=0.027) in group B and decreased by 16.8%( P=0.025) in group C, showing significant differences but there was no significant difference in the maximum transversal displacement between groups B and C ( P=0.978). In the fatigue test, all models showed no structural abnormality under cyclic loading. In the axial stress test, the maximum axial displacements of the intramedullary nail-bone structure were, respectively, (5.69±0.75) mm, (5.31±0.61) mm and (5.51±0.65) mm in groups A, B and C, showing no statistically significant difference among the 3 groups ( P>0.05). Conclusion:Our self-designed novel blocking screws can be a new means in clinical application, because they are similar to conventional blocking screws in increasing the stability of nail-bone construct and other biomechanical performance.
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Objective:To study the influence of anticoagulation timing on incidence of perioperative deep venous thrombosis (DVT) in elderly patients with hip fracture.Methods:A retrospective analysis was made of the 179 elderly patients with hip fracture who had been admitted to Department of Orthopedics and Traumaology, Hong-Hui Hospital from July 2017 to December 2018. They were 78 males and 101 females, aged from 62 to 91 years (mean, 79.5 years). There were 79 femoral neck fractures and 100 intertrochanteric fractures, 109 of which were treated by internal fixation and 70 by hip replacement. The patients were divided into 3 groups depending on the timing of anticoagulation after injury. In group 1 of 74 cases, anticoagulation started <24 h after injury; in group 2 of 36 cases, anticoagulation started 24 to 48 h after injury; in group 3 of 69 cases, anticoagulation started >48 h after injury. Anticoagulation continued until 12 h before surgery in all patients but was resumed 8 to 12 h after surgery. The 3 groups were compared in incidence of perioperative DVT.Results:The 3 groups were comparable due to insignificant differences between them in their pre-operative general data ( P>0.05). DVT occurred perioperatively in 84 patients, yielding an incidence of 46.9% (84/179). The incidences of perioperative DVT were 27.0% (20/74), 47.2% (17/36) and 68.1% (47/69) in groups 1, 2 and 3, respectively, showing significant differences ( χ2=24.206, P<0.001), between any 2 groups ( P<0.05). Conclusion:Since the earlier anticoagulation starts after injury the lower incidence of perioperative DVT in elderly patients with hip fracture, early standardized prophylactic anticoagulation after injury can effectively reduce incidence of perioperative DVT.
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Objective:To evaluate arthrography-assisted reduction in minimally invasive treatment of tibial plateau fractures.Methods:From January to May 2019, 9 patients with tibial plateau fracture were treated by arthrography-assisted minimally invasive surgery at Department of Orthopaedics and Traumatology, Hong-Hui Hospital. They were 6 males and 3 females with an average age of 45.5 years (from 27 to 63 years). According to the Schatzker classification, there were 6 cases of type Ⅱ, one of type Ⅲ and 2 cases of type Ⅳ. Arthrography was used to determine the lowest filling point of contrast medium after intra-articular injection and to ensure satisfactory reduction of articular surface after fracture reduction and bone grafting, followed by minimally invasive percutaneous plate implantation. Comparisons were made between preoperation and 6 months postoperation in the range of knee motion and knee scores of The Hospital for Special Surgery (HSS). Knee X-ray films were evaluated by the Rasmussen imaging system at 6 months postoperation. Collapse of articular surface was recorded pre- and post-operation as well as postoperative complications.Results:All the 9 patients were followed up for 6 to 9 months (average, 7 months). All patients achieved bony union within 12 weeks postoperation. The preoperative knee flexion (60.7°±13.1°) and HSS (51.9±5.7) were significantly improved to 122.4°±10.8° and 84.9±5.3 at 6 months postoperation ( P<0.05), but there was no significant difference between preoperation and 6 months postoperation in knee extension (4.4°±2.5° versus 4.6°±2.9°) ( P>0.05). The collapse of articular surface was improved from preoperative 9.5 mm (from 5 to 15 mm) to postoperative 1.3 mm (from 0 to 3 mm). The Rasmussen imaging scores at 6 months postoperation showed 6 excellent and 3 good. No such postoperative complications occurred as incision infection, joint stiffness, loosening or breakage of implants. Conclusion:Arthrography helps minimally invasive treatment of tibial plateau fracture because it can better display fracture collapse during operation and accurately judge indirect reduction of articular surface.
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Objective:To explore the efficacy of our novel reduction technique in the surgical treatment of complicated tibial plateau fractures.Methods:From May 2016 to September 2018, 50 fractures of tibial plateau (Schatzker types Ⅴ and Ⅵ) were treated at Department of Orthopaedics and Traumatology, Hong Hui Hospital. They were 34 males and 16 females, aged from 27 to 56 years (average, 42.3 years). They were divided into 2 groups according to the reduction techniques. In the group of novel reduction ( n=23), bone fragments were reduced one by one from the distal to the proximal until the compression fracture was reduced and fixated. In the conventional reduction group ( n=27), the articular surface was reduced first before fixation of articular fragments with distal ends of tibial fracture. The 2 groups were compared in terms of intraoperative bleeding, operation time, tibial plateau angle (TPA) on the knee anteroposterior X-ray film taken on the second day after operation, and rate of acceptable TPA (±5°). Results:There were no significant differences between the 2 groups in general preoperative data, showing comparability ( P>0.05). There were no significant differences between the 2 groups in either operation time (2.7 h ± 0.4 h versus 3.0 h ± 0.6 h) or intraoperative bleeding (215 mL ± 56 mL versus 221 mL ± 52 mL) ( P>0.05). The novel reduction group had a significantly higher rate of acceptable TPA [78.2% (18/23)] than the conventional reduction group [48.1%(13/27)]( P<0.05). Conclusion:In the surgical treatment of complicated tibial plateau fractures, compared with conventional reduction technique, our novel reduction technique can increase the rate of acceptable reduction but not operation time nor intraoperative bleeding.
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Objective@#To explore the effect of bone transport external fixation combined with locking bone plate internal fixation technology in the treatment of segmental tibial defects.@*Methods@#The clinical data of 12 patients with segmental tibial defects treated with annular external fixator and long locking plate in the Honghui Hospital, Xi′an Jiaotong University College of Medicine from January 2013 to March 2017 were analyzed retrospectively. There were 10 males and 2 females with an average age of 45 years (aged range from 20 to 65 years). External fixation time, external fixation index, healing time, mean healing index and complications were recorded. The follow-up time was 12-48 months, and the Paley bone and functional scores were used to evaluate the efficacy at the last follow-up.@*Results@#All the patients achieved union at the distraction callus and docking site. The average external fixation time was 112.1 d, the average external fixation index was 16.5 d/cm, the average healing time was 299.5 d, and the average healing index was 44.9 d/cm. Seven cases had pain and 4 cases had pin-site infections as minor complications. The bony outcomes were excellent in all patients. The functional outcomes were excellent in eight cases and good in four.@*Conclusion@#Bone transport with external fixation combined with locking plate internal fixation in the treatment of segmental bone defects of tihia can shorten external fixation time and is beneficial to functional rehabilitation after operation.
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Objective To explore the effect of bone transport external fixation combined with locking bone plate internal fixation technology in the treatment of segmental tibial defects.Methods The clinical data of 12 patients with segmental tibial defects treated with annular external fixator and long locking plate in the Honghui Hospital,Xi'an Jiaotong University College of Medicine from January 2013 to March 2017 were analyzed retrospectively.There were 10 males and 2 females with an average age of 45 years (aged range from 20 to 65 years).External fixation time,external fixation index,healing time,mean healing index and complications were recorded.The follow-up time was 12-48 months,and the Paley bone and functional scores were used to evaluate the efficacy at the last follow-up.Results All the patients achieved union at the distraction callus and docking site.The average external fixation time was 112.1 d,the average external fixation index was 16.5 d/cm,the average healing time was 299.5 d,and the average healing index was 44.9 d/cm.Seven cases had pain and 4 cases had pin-site infections as minor complications.The bony outcomes were excellent in all patients.The functional outcomes were excellent in eight cases and good in four.Conclusion Bone transport with external fixation combined with locking plate internal fixation in the treatment of segmental bone defects of tihia can shorten external fixation time and is beneficial to functional rehabilitation after operation.
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Objective To explore the predictive significance of platelet changes on deep venous thrombosis of the lower limbs after total knee replacement,and to guide the early clinical prediction and prevent the occurrence of thrombotic events.Methods A retrospective study was conducted of the 50 patients who had been treated by total knee arthroplasty for degenerative knee osteoarthropathy from January 2016 to June 2018 in the Department of Orthopedics and Traumaology,Xi'an Jiangtong University Medical College Red Cross Hospital.There were 10 males and 40 females,aged from 47 to 80 years (average age 65.1 years).According to the results of B ultrasound examination of the lower extremities,the patients were divided into the non embolic group (24 cases) and the embolic group (26 cases).The platelet counts and hemoglobin levels of the two groups were recorded before and after operation,and their respective differences were calculated.The difference of hemoglobin difference between the two groups was analyzed.At the same time,the difference of platelet count and total knee joint were examined.Whether the deep venous thrombosis of the lower extremity after replacement was statistically significant.If there was no statistical difference in the difference in hemoglobin between the two groups,and the difference in platelet count was statistically significant,the ROC curve was made to determine the optimal screening point.If obeying the normal distribution and the homogeneity of the variance,an independent sample t test was performed on the platelet count difference and the hemoglobin amount difference between the two groups,and the dose data in accordance with the normal distribution was expressed as (Mean ±SD).Results The difference of platelet count was (30.4 ± 14.8) ×109/L in thrombosis group and (53.5 ± 15.2) × 109/L in thrombosis group.The difference of platelet count between the two groups had statistical significance (P ＜ 0.001).The best screening point of platelet count difference was 34.0 × 109/L.The difference of hemoglobin count between thrombosis group and thrombosis group was (20.8 ± 9.3) g/L and (24.0 ± 10.7) g/L,there was no significant difference in hemoglobin between the two groups (P ＞ 0.05).Conclusions Preoperative and postoperative platelet count difference can effectively predict the incidence of lower extremity deep venous thrombosis after total knee arthroplasty.When the platelet count difference before surgery ≥34.0 × 109/L,early prevention of deep venous thrombosis should be avoided.The formation of the occurrence.
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Bone nonunion,a common complication after fracture surgery,is one of the most challenging problems an orthopedist has to face.Although Ilizarov technique has been proved an effective treatment of infected nonunions or bone defects,it bears such shortcomings as long frame-wearing time and poor compliance.In order to tackle them,many scholars have suggested a combination of Ilizarov technique and internal implants for bone nonunion which greatly shortens the time a patient wears the frame and allows for early ambulation,leading to good outcomes.This article reviews the mechanisms of distraction osteogenesis for Ilizarov technique and advances in application of Ilizarov technique combined with internal implants for treatment of bone nonunions.
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Objective To explore how to make a rapid judgment of distal inward or outward rotation during closed reduction and intramedullary nailing for complex tibial fractures so as to avoid bad reduction of the distal rotation.Methods Twenty-one patients with complex tibial fracture underwent closed reduction and intramedullary nailing from January 2014 to January 2016.They were 16 males and 5 females,aged from 22 to 53 years (average,34.6 years).By AO/OTA classification,6 cases were type 42-C1,2 type 42-C2,and 13 type 42-C3.During surgery,the relationship between the connecting rod of the front pressure lever of intramedullary nail in the tibia and the second metatarsal bone was used to judge the rotation.After surgery CT plane scanning was used to assess reliability of the intraoperative judgment of the rotation.Validity of the rotation judgment was finally evaluated by comparing Functional Index Questionnaire (FIQ) scores,Olerud Molander ankle scores (OMAS) and Health Status Questionnaire (SF-36) scores between pre-injury and final follow-up.Results The 21 patients were followed up for 12 to 24 months (average,18.3 months).Bony union was achieved from 3 to 7 months after surgery (average,4.5 months) without nonunion or refracture.There was no significant difference in the tangent angle between the proximal and distal tibiae on CT scan between the healthy side (47.1° ± 2.9°) and the affected side (44.8° ± 5.6°) (P ＞ 0.05).There were no significant differences either in FIQ scores,OMAS or SF-36 scores between pre-injury and final follow-up (P ＞ 0.05).Conclusion In the course of closed reduction and intramedullary nailing for complex tibial fractures,it is simple and effective to judge the distal inward or outward rotation by pointing the connecting rod of the front pressure lever of intramedullary nail in the tibia to the second metatarsal bone.
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Objective To evaluate the clinical application of our self-designed ultradistal locking tool in the intramedullary nailing for tibial fractures.Methods From January 2014 to May 2016,175 patients with tibial fracture were treated at our department.They were 119 men and 56 women,from 19 to 73 years of age (average,46.3 years).They were divided into 2 groups according to the different targeting devices used in the intramedullary nailing.Conventional locking tools were used in the 83 patients from January 2014 to January 2015 and our self-designed new ultradistal locking tools in the 92 patients from February 2015 to May 2016.The 2 groups were compared in terms of operation time,frequency of intraoperative fluoroscopy,and successful rate of one-time locking.Results There were no significant differences between the 2 groups in general clinical data(P ＞ 0.05),showing similarities of the 2 groups.The operation time(59.8 ±4.3 min),frequency of intraoperative fluoroscopy(11.0 ± 2.1 times),and rate of one-time successful locking[94.4％ (238/252)] in the ultradistal locking group were significantly better than those in the conventional locking group [73.6 ± 5.3 min,23.0 ± 3.8 times and 85.7％ (180/210),respectively] (P ＜ 0.05).Conclusions Our new ultradistal locking tools are superior to the conventional ones in that they lead to shorter operation time,less intraoperative fluoroscopy and higher successful rate of one-time locking.Additionally,the new locking tools are easy to handle and incur no extra costs.
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Objective To explore the impact of modified vacuum sealing drainage (VSD) on prevention of tension blisters during treatment of opening fracture wounds.Methods From March 2015 to February 2016,53 patients with 60 open fracture wounds were treated after surgery by VSD at our department.They were 28 males (33 wounds) and 25 females (27 wounds),aged from 24 to 65 years (average,41.1 years).The patients were divided into 2 groups.Group A (33 wounds) were subjected to traditional VSD after surgery while group B (27 wounds) to modified VSD.The mean time from injury to surgery was 5.2 hours (from 2.0 to 8.3 hours).The VSD dressing was first removed to observe whether any tension blisters would appear surrounding the dressing 5 days after surgery.Results Tension blisters appeared around 9 wounds in group A (with an incidence of 27.3％) but around one wound in group B (with an incidence of 3.7％).The difference between the 2 groups was statistically significant (P =0.037).Conclusion In treatment of open fracture wounds,the modified VSD can effectively prevent formation of tension blisters surrounding the dressing while it is used to cover a wound.