ABSTRACT
Objective:To investigate the outcomes of the surgical treatment of fracture of the first metatarsal base with plantar plate via the first metatarsal medial approach.Methods:A retrospective study was conducted of the 12 patients who had been treated for fracture of the first metatarsal base from January 2016 to December 2018 at Department of Trauma Orthopaedics, Renji Hospital. They were 8 men and 4 women, with an average age of 39.6 years (from 27 to 54 years). The fracture affected the left foot in 5 cases and the right foot in 7. Their fracture of the first metatarsal base and tarsometatarsal joint instability were fixated by plantar plate via the first metatarsal medial approach, and reduction and fixation was also conducted via a dorsal incision when other metatarsotarsal joint injuries were combined. Postoperative X-ray follow-ups were performed regularly. The American Orthopedic Foot and Ankle Society (AOFAS) midfoot scores, visual analogue scale (VAS) pain scores and complications were recorded at the final follow-up.Results:All the patients were followed up for 12 to 19 months (mean, 15.1 months). Primary incision healing was observed in all the 12 patients. No complications like skin necrosis, infection or neurovascular lesion occurred. Fracture union was achieved in all the 12 patients after 12 to 14 weeks (average, 12.6 weeks). At the final follow-up, all the patients could walk with full weight-bearing, the plantar flexion and dorsiflexion of the ankle and the muscle strengths of varus and valgus were normal, and the X-ray film showed that reduction of the tarsometatarsal joint was not lost. At the final follow-up, the AOFAS midoot scores ranged from 82 to 96 (mean, 88.9) and the VAS scores from 0 to 3 (mean, 1.2).Conclusion:Plantar plate fixation via the first metatarsal medial approach can result in satisfactory outcomes for fractures of the first metatarsal base, especially for those with a major fracture fragment at the metatarsal planter side.
ABSTRACT
Objective To provide an anatomical basis for treatment of coronoid process fractures through an anteromedial elbow approach and evaluate its clinical effects.Methods Forty cadaveric specimens of adult upper limb were dissected to evaluate the anatomical relationships between the median nerve branches and the nearby muscles in the field of the anteromedial elbow approach.On the basis of the anatomical study,10 patients with coronoid fracture were treated from June 2014 to June 2015.They were 7 males and 3 females,from 17 to 63 years of age (average,43 years).By the O'Driscoll classification,there were 2 cases of type Ⅰ1,3 ones of type Ⅰ2,one of type Ⅱ1,3 ones of type Ⅱ2 and one of type Ⅲ2.The anteromedial elbow approach through the intramuscular space between the pronator teres and the flexor carpi radialis was used to reduce and fixate the fractures of unlar coronoid process and to explore and repair the medial collateral ligaments in all the patients.The ranges of extension,flexion and rotation of the elbow joint were measured at the last follow-ups;the function of the elbow was evaluated according to Mayo elbow performance scores (MEPS).Results The main branch of the median nerve ran between the lateral and the medial epicondyles of the humerus,27.34 mm away to the medial epicondyle of the humerus.The mean distance between the first pronator teres nerve branch and the coronoid process was 13.19 mm.The mean distance between the flexor carpi radialis nerve branch and the coronoid process was 47.02 mm.The mean distance from the medial epicondyle to the flexor carpi radialis nerve branch was 64.40 mm.All the patientswere followed up for an average of 12 months (from 6 to 18 months).Fractures united after an average of 1.8 months (from 1.5 to 2.0 months).Deformity,instability,pain or limited motion of the elbow joint was not observed during the follow-ups.At the last follow-ups,the mean flexion-extension arc of the elbow was 133.0° (from 120° to 140°),the mean rotation was 144.5° (from 130° to 160°),and the mean MEPS was 98 points (from 95 to 100 points).Conclusions The anteromedial approach through the intramuscular space between the pronator teres and the flexor carpi radiafis is a reliable and safe access for coronoid process fractures,because it leads to less injury to the median nerve than the anterior approach,and exposes the coronoid more favorably than the medial approach to facilitate reduction and fixation of the fracture fragments.
ABSTRACT
BACKGROUND: The pain caused by osteoporosis and osteoporotic fracture is usually treated with non-steroidal anti-inflammatory drugs (NSAIDs) in clinic, which has been reported that dysfunction of liver and kidney will follow the use, but what has happened in the tissue of liver and kidney is not reported. OBJECTIVE: To study the effect of NSAIDs on the tissue of liver and kidney in osteoporotic fracture rats. DESIGN, TIME AND SETTING: Randomized controlled animal experiment. The experiment was completed in the Animal Experiment Center in Shanghai University of Traditional Chinese Medicine from August 2007 to February 2008.MATERIALS: A total of 24 female SD rats, 8-month-old, weighing 300-320 g, were randomly divided into 3 groups, saline group,diclofenac sodium (fracture before medicine) group and diclofenac sodium (fracture after medicine) group, with 8 rats in each group.METHODS: The rats were housed for 3 months after ovariectomized to establish osteoporosis models. Rats in the saline group and diclofenac sodium (fracture before medicine) group were administrated saline and diclofenac sodium after transverse osteotomy at the middle shaft of bilateral femur respectively; in the diclofenac sodium (fracture after medicine) group were femur.MAIN OUTCOME MEASURES: The histological observation of liver and kidney was performed at weeks 2, 3, 4 and 6 after fracture.RESULTS: In the diclofenac sodium (fracture before medicine) group, diclofenec sodium caused the inflammatory response at glomeruli, which exhibited expansion of tubular lumen, edema of epithelial cells, disappeared cell nuclei, degeneration and necrosis of renal tubule, cell debris and drugs crystals accumulated in the tubular lumen, congestion and inflammatory cell infiltration of renal interstitium. Administrating diclofenac sodium may cause the inflammatory response at portal area, indistinct structure of hepatic Iobule, hepatic cells edema, steatosis and necrosis. Administrating diclofenac sodium before osteoporotic fracture also resulted in tissue lesions in kidney and liver, the damage would continue about 3 weeks.CONCLUSION: The diclofenac sodium cause histological lesions of kidney and liver in osteoporotic rats, especially in kidney. The histological lesions of kidney and liver are inreversible after administrating diclofenac sodium for a long time.
ABSTRACT
BACKGROUND:The pain caused by osteoporosis and osteoporotic fracture is usually treated with non-steroidal anti-inflammatory drugs (NSAIDs) in clinic,which has been reported that dysfunction of liver and kidney will follow the use,but what has happened in the tissue of liver and kidney is not reported.OBJECTIVE:To study the effect of NSAIDs on the tissue of liver and kidney in osteoporotic fracture rats.DESIGN,TIME AND SETTING:Randomized controlled animal experiment.The experiment was completed in the Animal Experiment Center in Shanghai University of Traditional Chinese Medicine from August 2007 to February 2008.MATERIALS:A total of 24 female SD rats,8-month-old,weighing 300-320 g,were randomly divided into 3 groups,saline group,diclofenac sodium (fracture before medicine) group and diclofenac sodium (fracture after medicine) group,with 8 rats in each group.METHODS:The rats were housed for 3 months after ovariectomized to establish osteoporosis models.Rats in the saline group and diclofenac sodium (fracture before medicine) group were administrated saline and diclofenac sodium after transverse osteotomy at the middle shaft of bilateral femur respectively;in the diclofenac sodium (fracture after medicine) group were administrated 5 mg/(kg?d) diclofenac sodium for 3 weeks,then received transverse osteotomy at the middle shaft of bilateral femur.MAIN OUTCOME MEASURES:The histological observation of liver and kidney was performed at weeks 2,3,4 and 6 after fracture.RESULTS:In the diclofenac sodium (fracture before medicine) group,diclofenac sodium caused the inflammatory response at glomeruli,which exhibited expansion of tubular lumen,edema of epithelial cells,disappeared cell nuclei,degeneration and necrosis of renal tubule,cell debris and drugs crystals accumulated in the tubular lumen,congestion and inflammatory cell infiltration of renal interstitium.Administrating diclofenac sodium may cause the inflammatory response at portal area,indistinct structure of hepatic lobule,hepatic cells edema,steatosis and necrosis.Administrating diclofenac sodium before osteoporotic fracture also resulted in tissue lesions in kidney and liver,the damage would continue about 3 weeks.CONCLUSION:The diclofenac sodium cause histological lesions of kidney and liver in osteoporotic rats,especially in kidney.The histological lesions of kidney and liver are inreversible after administrating diclofenac sodium for a long time.