ABSTRACT
Objective:To investigate the clinical efficacy of infra-acetabular screwing in the treatment of acetabular fractures.Methods:A retrospective analysis was conducted of the 22 patients with acetabular fracture who had been admitted to Department of Trauma and Orthopedics, The Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University from January 2016 to January 2019. They were 16 males and 6 females, aged from 19 to 65 years (mean, 45.2 years). According to Letournel-Judet classification, there were 2 anterior column fractures, 12 anterior plus posterior hemi-transverse fractures, 3 T-shaped fractures and 5 both-column fractures. All patients were treated with infra-acetabular screwing through the ilioinguinal approach. Recorded were the patients＇ operation time, intraoperative blood loss, reduction quality, fracture union time, hip function and complications.Results:Operation time for this cohort ranged from 115 to 285 min (mean, 160 min), and intraoperative blood loss from 360 to 1,600 mL (mean, 650 mL). By the Matta scoring, fracture reduction was assessed as excellent in 14 cases, as good in 5 cases and as poor in 3 cases, giving an excellent and good rate of 86.4% (19/22). Of this cohort, 21 were followed up from 12 to 45 months (mean, 28.5 months) and one was lost to the follow-up. The fracture healing time for 21 patients ranged from 1.6 to 3.0 months, averaging 2.2 months. No patient had fracture displacement. The Merle d’Aubigné & Postel hip scores at the last follow-up ranged from 8 to18 points (average, 16 points), giving 12 excellent, 6 good, 2 fair, and one poor cases and an excellent and good rate of 85.7% (18/21). Follow-ups observed injury to the lateral femoral cutaneous nerve in one case, deep venous thrombosis of lower limb in 2 cases, superficial wound infection in one case and traumatic arthritis in one case, yielding a total rate of compilations of 23.8% (5/21).Conclusion:Application of infra-acetabular screwing after anatomical reduction of an acetabular fracture can effectively enhance the strength of internal fixation with no risk of fracture re-displacement, conducive to early functional exercise of the patient and leading to good clinical efficacy.
ABSTRACT
Objective To evaluate the efficacy of proximal humerus internal locking system (PHILOS) combined with allogeneic femoral head bone graft for the treatment of osteoporotic proximal humerus fractures in the elderly patients.Methods A total of 36 osteoporotic proximal humerus fractures were analyzed retrospectively which had been treated at Department of Orthopaedics,Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from April 2015 to April 2017.They involved 14 men and 22 women,aged from 60 to 78 years(average,67 years).By the Neer classification,20 cases were two-part fractures,11 three-part fractures and 5 four-part fractures.They were all treated by PHILOS plating combined with allogeneic femoral head bone grafting.The outcomes were assessed using Neer evaluation system for shoulder function.Results All the 36 cases were followed up for 3 to 18 months (average,12 months).All the incisions healed postoperatively by the first intention,with no postoperative infection,nonunion,humeral head varus,screw cut-out,humeral head necrosis,or loosening of implants.Clinical healing of the fractures was achieved after 8 to 24 weeks (average,12 weeks).According to the Neer evaluation,shoulder function was excellent in 18,good in 15 and poor in 3 cases.Conclusion In the treatment of osteoporotic proximal humerus fractures in the elderly,combination of PHILOS plating and allogeneic femoral head bone grafting can effectively prevent such postoperative complications as humeral head varus,screw cut-out and loosening of implants.
ABSTRACT
Objective To evaluate the clinical efficacy of single ilioinguinal approach combined with screwing for treatment of complex acetabular fractures.Methods Twenty-six patients with complex acetabular fracture were treated by single ilioinguinal approach combined with screwing from May 2015 to April 2017 at Department of Orthopaedics,Hospital of Traditional Chinese Medicine,Xinjiang Medical University.They were 17 men and 9 women,aged from 31 to 69 years (average,54 years).By the Judet-Letournel classification,there were 9 anterior + posterior hemitransverse fractures,13 double-column fractures and 4 T-type fractures.They were treated by pilot surgical plan based on preoperative CT reconstruction,disinfection at floating position for the standby posterior approach,single ilioinguinal approach for standard reduction,followed by intraoperative fixation with lag screws,posterior column screws,or acetabular screws.Operation time,intraoperative blood loss and complications were documented.Fracture reduction was assessed postoperatively using the modified Matta system for X-rays.The function of affected hip was evaluated using Harris hip score at the last Follow-ups.Results The 26 patients were followed up for 6 to 24 months (average,11 months).Their operation time averaged 210 min and intraoperative blood loss 600 mL.The postoperative modified Matta scores showed that 14 cases obtained excellent anatomic reduction,9 good anatomic reduction,one poor anatomic reduction,and 2 articular outline reduction.Fracture union was achieved in all after an average time of 2.3 months.Their Harris hip scores at the last Follow-ups ranged from 70 to 86 points,averaging 80 points.The function of affected hip was excellent in 13 cases,good in 6,fair in 4 and poor in 3,giving an excellent to good rate of 73.1％ (19/26).Postoperatively,deep venous thrombosis of lower extremity was found in 3 patients,injury to the lateral femoral cutaneous nerve in 5,and incision complication in one.No re-displacement of the fracture occurred.Conclusion In treatment of complex acetabular fractures,single ilioinguinal approach combined with screwing can lead to a high rate of fine reduction,limited complications,a low displacement risk,and good clinical efficacy.