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Objective:To evaluate the biomechanical stability of our slot-designed compression bolt (SCB) combined with bilateral locking compression plates (LCPs) in the treatment of intra-articular distal femur fracture.Methods:In 24 adult male knee specimens treated with formalin, the femoral bony part was preserved to establish standard models of intra-articular distal femur fracture (AO type 33-C1). According to the random number table, the fracture models were divided into 2 equal groups: an experimental group ( n=12) subjected to fixation with one SCB combined with bilateral LCPs with 10 locking screws and a control group ( n=12) subjected to fixation with bilateral LCPs with 12 locking screws. In each model, a vertical ballast test was conducted to record the maximum axial displacement of the system and a horizontal torsion test to calculate the torsional stiffness of the system. When the loading pressure was 0-1,000 N in the biomechanical machine, structural abnormalities were observed in the 2 groups of models and the system maximum axial displacement and system torsional stiffness were compared between the 2 groups. Results:When the vertical ballast pressure was 400 N, 600 N, 800 N and 1,000 N, the maximum axial displacement of the system was, respectively, (0.14±0.01) mm, (0.25±0.01) mm, (0.41±0.02) mm and (0.63 ± 0.02) mm in the experimental group, and (0.15 ± 0.01) mm, (0.26 ± 0.01) mm, (0.46 ± 0.03) mm, and (0.67 ± 0.04) mm in the control group. Compared with the control group, the average maximum axial displacement in the experimental group decreased significantly under the axial pressure of 600-1,000 N ( P<0.05). When the horizontal torsion reached 5°, the torsional stiffness was, respectively, (2.00±0.12) Nm/° and (2.02±0.07) Nm/° in the experimental group and the control group, showing no significant difference between the 2 groups ( P>0.05). Conclusions:In the treatment of intra-articular distal femur fracture, compared with simple bilateral LCPs, our SCB combined with bilateral LCPs demonstrate similar torsional stability but better axial biomechanical stability. As our SCB has advantages of bilateral compression and minimal invasion in operation, it may be a new option for the reduction and compression treatment of intra-articular fractures.
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Tibial plateau fracture is a common acute trauma of the knee joint. At present, there are many studies on its classification and treatment, and minimally invasive treatment has become a research hotspot and mainstream direction of tibial plateau fracture. We summarized the clinical results of minimally invasive treatment of more than 300 cases of tibial plateau fractures, and proposed the concept of core weight-bearing area on tibial plateau, that is, the core weight-bearing area of the tibial plateau of the knee joint under normal motion statuswhile walking and moderate-intensity running. We performed thinsection CT scanning of the knee joint in a male volunteer for three-dimension finite element modeling.The results showed that during the walking state (the load was twice that of gravity), the core weight-bearing area of the medial and lateral plateaus was 389 mm 2 and 363 mm 2, accounting for 33.2% and 42.9% of tibial plateau, respectively;during the moderate-intensity running state (the load was four times that of gravity), the core weight-bearing area of the medial and lateral plateaus was 418 mm 2 and 406 mm 2, accounting for 35.6% and 48.0%of tibial plateau, respectively. Accordingly, tibial plateau fractures are supposed to be divided into core weight-bearing fracture and non-core weight-bearing fracture, and there are significant differences in the treatment ofthese twokinds of fractures: reduction is more demanding for core weight-bearing fracture,and the fracture involves the core area closely, the anatomical reduction is sought; for non-core weight-bearing area, the reduction requirements can be appropriately low demanded, and even in some cases , for example simple avulsion fracture, marginal fracture, some tibial plateau Hoffa fractures,can be treated conservatively. In summary, during clinical diagnosis and treatmentpractice, orthopedic surgeons should take the core weight-bearing area fracture as the core of diagnosis and treatment, strictly evaluate the extent of fracture involvement, select targeted internal fixation materials, and target to promote more accurate, minimally invasive, and individualized treatment of tibial plateau fractures.
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Objective:To explore the factors related to functional recovery of the knee in patients with tibial plateau fracture complicated with intercondylar ridge fracture.Methods:Included in this retrospective study were 63 patients who had been treated at Emergency Center of Trauma, The Third Hospital of Hebei Medical University from January to June 2019 for tibial plateau fracture complicated with intercondylar ridge fracture. They were 43 males and 20 females, aged from 18 to 66 years (average, 43.9 years). According to our comprehensive classification of tibial plateau fractures, there were 27 simple ones (20 cases of type Ⅰ and 7 cases of type Ⅱ) and 36 complicated ones (16 cases of type Ⅲ, 17 cases of type Ⅳ, one of type Ⅴ and 2 cases of type Ⅵ). To screen out major influencing factors, a multiple linear regression model was used to analyze the 12 factors that might affect functional recovery of the knee by the Hospital for Special Surgery (HSS) scoring: age, gender, occupation, fracture type, way of medical payment, cause of injury, operation method, starting time for rehabilitation, postoperative brace installation, time from injury to operation, length of hospital stay, and presence or absence of a free intercondylar ridge fracture fragment.Results:The 63 patients were followed up for 6.0 to 7.1 months (average, 6.1 months). The HSS knee scores ranged from 45 to 100 points (average, 92.4 points). The HSS knee scores were significantly different between different fracture types ( P<0.05). The HSS scores were significantly higher for the patients without a free intercondylar ridge fracture fragment than for those with ( P<0.05). Multiple linear regression model analysis of the 5 variables with P<0.02 in the single factor analysis (age, fracture type, way of medical payment, hospital stay and presence or absence of a free intercondylar ridge fracture fragment) and HSS scores showed that only fracture type and presence or absence of a free intercondylar ridge fracture fragment had a significant impact on the knee function. Their regression equation was Y=125.591-7.790a-17.277b (Y indicates HSS score, a indicates fracture type and b indicates presence or absence of a free intercondylar ridge fracture fragment). Conclusions:The short-term prognosis for tibial plateau fractures of comprehensive types Ⅰ&Ⅱ (simple ones) may be better than that for tibial plateau fractures of comprehensive types Ⅲ, Ⅳ, Ⅴ&Ⅵ (complicated ones). For patients with a free intercondylar ridge fracture fragment on their lateral knee X-ray film, effective reduction and fixation is indicated but is not for those without.
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Objective:To evaluate the clinical efficacy of minimally invasive treatment of Fraser type Ⅱ floating knee by homeopathic reduction.Methods:From November 2016 to July 2018, 7 patients with Fraser type Ⅱ floating knee were treated by homeopathic reduction and minimally invasive surgery at Trauma Emergency Center, The Third Hospital of Hebei Medical University. They were 5 males and 2 females, aged from 30 to 82 years (average, 52 years). They all suffered from tibial plateau fracture complicated with floating knee, with 5 cases of Fraser type ⅡA (tibial plateau fracture complicated with femoral shaft fracture) and 2 cases of Fraser type ⅡC (tibial plateau fracture complicated with femoral condyle fracture). The femoral and tibial plateau fractures were reduced with a bidirectional traction reduction device, followed by minimally invasive implantation of internal fixators. The operation time, length of a single incision, blood loss and fluoroscopic frequency were recorded. The anteroposterior and lateral X-ray films of the lower limb were taken and fracture healing time was recorded during follow-up. The function of knee joint was evaluated by Hospital for Special Surgery (HSS) scoring system at the last follow-up.Results:For the 7 patients, operation time averaged 87.2 min, length of a single incision 2.8 cm, blood loss 471 mL, and fluoroscopy frequency 37 times. The postoperative X-ray films showed fine alignment and force line and smooth articular surface in all patients. All the incisions healed by grade A. The follow-up time for 7 patients ranged from 12 to 21 months (average, 15.6 months). All the fractures healed after an average time of 12.8 weeks. The HSS scores at the last follow-up showed that 6 cases were excellent and one was good.Conclusion:The fractures of the femur side and of the tibia side can be treated separately by closed reduction and internal fixation using a homeopathic bidirectional traction reduction device so as to obtain better knee joint function.
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Objective:To evaluate our self-designed easily-breaking compression bone bolt plus bone plate in the treatment of tibial plateau fracture.Methods:From July 2018 to December 2018, 12 patients with tibial plateau fracture were treated at Emergency Center of Trauma, The Third Hospital of Hebei Medical University using our self-designed easily-breaking compression bone bolt plus bone plate. They were 8 males and 4 females, aged from 20 to 65 years (average, 45.6 years), with 6 left sides and 6 right sides injured. According to Schatzker classification, there were one case of type I, 3 cases of type Ⅱ, 3 cases of type Ⅲ, 2 cases of type Ⅳ, one case of type Ⅴ and 2 cases of type Ⅵ. The width of tibial plateau was measured and compared before and after operation on X-ray films. Operation time, blood loss and fracture union time were recorded. Loss of reduction and postoperative complications were followed up. Knee function was evaluated at the final follow-up by Rasmussen scoring.Results:For this cohort, operation time averaged 54.6 min, blood loss 25 mL, and fracture union time 17.2 weeks. No nonunion or delayed union was observed. The postoperative width of tibial plateau was (78.9±7.2) mm, significantly narrower than the preoperative value [(87.4±6.1) mm] ( P < 0.05). No loss of reduction or surgical complications occurred postoperation. Deep venous thrombosis of the lower extremity developed in 2 patients but recovered after treatment. The Rasmussen scoring for knee joint function at the final follow-up yielded 9 excellent, 2 good and one poor. Conclusion:In treatment of tibial plateau fractures, our self-designed easily-breaking compression bone bolt plus bone plate can restore width of tibial plateau, compress fracture fragments tightly and allow for early exercise, leading to fine functional recovery of the knee joint.
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Objective:To investigate the associations of articular depression depth (ADD) and tibial plateau widening (TPW) by pre-operative CT measurement with incidence of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture.Methods:Included in this retrospective study were 131 patients who had been admitted to Emergency Center of Trauma, The Third Hospital Affiliated to Hebei Medical University from January 2016 to January 2020 for Schatzker type Ⅱtibial plateau fractures. They were 88 males and 51 females, aged from 18 to 60 years (average, 41.5 years), with 74 right and 57 left sides injured. All patients were treated with closed reduction and internal fixation assisted by bidirectional traction. Arthroscopy was used to detect the status of lateral meniscus immediately after closed reduction and internal fixation of the fracture fragments. Furthermore, patients were divided into 2 groups according to the integrity of lateral meniscus: meniscal tear group ( n=70) and tear-free group ( n=61). The 2 groups were compared in terms of age, gender, body mass index(BMI), injury side, time interval from injury to surgery, TPW and ADD. The receiver operating curve (ROC) was drafted to calculate the cut-off values of TPW and ADD in complication of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture. Results:The overall incidence of lateral meniscal tear in this cohort was 53.4% (70/131). There was no statistically significant difference in terms of age, gender, injury side, BMI or time interval from injury to surgery between the 2 groups ( P>0.05); TPW and ADD were significantly higher in the meniscal tear group than in the tear-free group ( P<0.05). To predict lateral meniscal tear in patients with Schatzker type Ⅱtibial plateau fracture, the area under ROC was 0.656 (95% CI: 0.562 to 0.750, P=0.002) for TPW and 0.709 (95% CI: 0.619 to 0.800, P<0.001) for ADD, respectively; the cut-off values of TPW and ADD were 4.3 mm and 6.1 mm. Conclusion:TPW and ADD may be effective predictors for prediction of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture.
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Objective:To analyze the short-term efficacy of pushing reduction via a pretibial bone tunnel for treatment of tibial plateau fracture.Methods:From March 2019 to June 2019, 9 patients were treated at Trauma Emergency Center, Third Hospital of Hebei Medical University for tibial plateau fractures by pushing reduction through a pretibial bone tunnel. They were 7 males and 2 females, aged from 26 to 63 years (average, 38 years). Involved were 5 left sides and 4 right sides. According to the Schatzker classification, there were 7 cases of type Ⅱ and 2 ones of type Ⅲ. According to the Zhang's comprehensive classification of tibial fractures, they were all type Ⅰ. The patients were operated on under general anesthesia or intraspinal anesthesia. According to the length of fracture line, a circular drill was used to establish a bone tunnel which was 1 to 2 cm away from the distal fracture line. The collapsed fracture was reduced by the bar through the bone tunnel. A bicortical autogenous iliac bone or artificial bone bar was selected for bone grafting. The plate was placed through small incisions. Arthroscopic examination was used to measure the fracture displacement. The operation time, incision length, number of fluoroscopy, intraoperative blood loss and postoperative complications were recorded.Results:For the 9 patients, operation time ranged from 40 to 60 minutes (average, 48.3 minutes), intraoperative blood loss from 35 to 60 mL (average, 46.1 mL), number of fluoroscopy from 12 to 21 times (average, 17.4 times), length of reduction incision from 1.6 to 3.0 cm (average, 2.3 cm), fracture displacement after fixation from 0 to 2.0 mm (average, 0.8 mm), and maximum mobility of the knee joint from 125° to 140° (average, 128.9°) 15 days after operation. All incisions healed well by the first intention. Fibular vein thrombosis occurred in one case after operation. There were no infections or related complications.Conclusion:The short-term efficacy of pushing reduction through a pretibial bone tunnel for treatment of tibial plateau fracture is positive, but more reliable results should be waited for when much more surgical cases are available.
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Objective To analyze the short-term outcomes of rod-shaped glass bone graft for the treatment of tibial plateau fracture.Methods From January 2019 to February 2019,4 patients with tibial plateau fracture underwent minimally invasive reduction and new glass bone graft at Trauma Emergency Center,The Third Hospital of Hebei Medical University.They were 2 men and 2 women,aged from 31 to 67 years (average,42 years).The fractures happened at 3 left sides and one right side.According to Schanzker's classification,3 cases were type Ⅱ and one case was type Ⅲ.According to Zhang's classification for tibial plateau fractures,they were all type Ⅰ.The reduction was carried out under general anesthesia by a Zhang's traction device and a self-made rod.A rod-shaped glass bone graft of appropriate size was implanted along the bone tunnel.The plate was implanted through small incisions after fluoroscopy results were satisfactory.Intraoperative arthroscopic examination was used to assess fracture displacement before wound closure.The operation time,incision length,fluoroscopic frequency for insertion of guide needle,intraoperative blood loss,and short-term postoperative complications were recorded for each patient.Results The operation time for the patients averaged 37.5 min,the total length of all incisions 7.0 cm,the fluoroscopy required for insertion of guide needle 8.8 times,and the intraoperative blood loss 40.0 ml.All incisions were healed by the first intention.Postoperative intermuscular thrombosis occurred in 2cases.No postoperative infection or related complications happened.Conclusion Rod-shaped glass bone graft can lead to positive short-term outcomes for tibial plateau fractures,but a more reliable conclusion necessitates further clinical trials with a large sample size and long-term follow-up.
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Objective To discuss the clinical effects of minimally invasive reduction and fixation with Zhang's reduction device for fractures of tibial intercondylar spine.Methods Five patients with tibial intercondylar spine fracture underwent treatment and reduction with Zhang's reduction device from December 2018 to February 2019 at Orthopedic Trauma Center,The Third Hospital of Hebei Medical University.They were 3 men and 2 women,aged from 25 to 56 years (average,43 years).The left side was affected in 2 cases and the right side in 3.By the Meyers classification,there were 2 cases of type Ⅱ and 3 ones of type Ⅲ.All the patients underwent the same surgical procedures and postoperative treatment.Their operation time,amount of bleeding,number of fluoroscopy required for insertion of guide pin,postoperative complications,fracture healing and knee joint range of motion at the last follow-up were recorded.Results The operation time for the 5 patients averaged 50.0 min,amount of bleeding 23.0 mL,and number of fluoroscopy required for insertion of guide pin 12.6 times.Their knee joint range of motion at the last follow-up ranged from 0° to 136.0°.All the incisions obtained primary union with no infection.Their hospitalization time ranged from 7 to 15 d (average,10.5 d).They obtained an average follow-up of 4.3 months (from 2 to 6months).All the fractures achieved union with no malunion,nonunion or refracture.Conclusions The minimally invasive reduction and fixation with Zhang's reduction device for fractures of tibial intercondylar spine can lead to satisfactory clinical effects.It is less invasive than open reduction and simpler than arthroscopic surgery so that it is more appropriate to be popularized in primary hospitals.However,this method has not been widely applied in clinic and more clinical trials are needed.
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Objective To analyze the correlation of serum hs‐CRP and IL‐6 levels with cerebral hemorrhage volume and nerve function damage .Methods One hundred and two cerebral hemor‐rhage patients served as an experimental group and 64 individuals undergoing physical examina‐tion served as a control group in this study .The patients in experimental group were further di‐vided into mild damage group (n= 29) ,moderate damage group (n= 42) ,severe damage group (n=31) ,10 ml hemorrhage group(n=15) ,10 -30 ml hemorrhage group (n=52) ,and >30 ml hemorrhage group (n=35) .Their serum hs‐CRP and IL‐6 levels were measured on days 1 ,5 ,10 and 15 after admission .Results The serum hs‐CRP and IL‐6 levels in experimental group in‐creased gradually in the first 5 days ,reached their peak on day 5 and then decreased gradually (P<0 .05) .The serum hs‐CRP and IL‐6 levels were significantly higher in severe damage group than in mild and moderate damage groups ( P<0 .05) ,and in experimental group than in control group (9 .46 ± 1 .26 mg/L vs 4 .24 ± 0 .94 mg/L ,P=0 .02) .Conclusion The serum hs‐CRP and IL‐6 levels are related with cerebral hemorrhage volume and nerve function damage ,and can thus be considered as an important parameter in clinical testing .