[Clinical observation of double mini locking plate in the treatment of olecranon fracture].

OBJECTIVE: To investigate the clinical effect of double mini-locking plates in the treatment of ulna olecranon fractures. METHODS: From March 2017 to May 2020, 19 patients with olecranon fractures were treated with double mini locking plates, including 12 males and 7 females, aged from 20 to 75 years old with an average of (40.50±7.62) years old;10 patients had the injuries on the left side and 9 patients on the right side. All the 19 patients were fresh closed fractures without ulnar coronoid process fracture, elbow dislocation and other injuries. The fracture healing time and complications were recorded, and the clinical efficacy was evaluated by Mayo elbow performance score (MEPS) before operation and 12 months after operation. RESULTS: All the 19 patientswas followed up, and the duration ranged from 12 to 17 months with an average of (13.51±3.17) months. Postoperative follow-up showed all fractures healed. Fracture healing time ranged from 2 to 6 months, with an average of(3.77±1.24) months. There was no internal fixation fracture, screw loosening, infection, internal fixation irritation, heterotopic ossification, elbow stiffness and other complications occurred. The MEPS score of affected elbow at 12 months after operation was 91.26±3.87, which was significantly different from that before operation 56.18±9.56 (P<0.05);according to Mayo Elbow function score standard, 11 cases were excellent, 7 cases were good, and 1 case was fair. CONCLUSION: It is a reliable fixation method to treat olecranon fracture with double mini locking plate. The incision lengh is small and the fracture fixation is reliable. Elbow joint function exercise can be performed early after operation. Postoperative internal fixation has less skin irritation and satisfactory elbow joint function recovery.

[Application of vacuum sealing drainage in open ankle fracture and dislocation].

OBJECTIVE: To investigate therapeutic effects of vacuum sealing drainage (VSD) in the treatment of soft tissue defect combined with tendon and bone exposure. METHODS: From October 2007 to February 2011, 397 patients (412 feet) with open ankle fracture and dislocation combined with soft tissue defected were treated by VSD. There were 301 males and 96 females with an average age of 36 years (ranging age from 20 to 73 years). According to AO classification, 74 feet were type I, 211 feet were type II, 108 feet were type III and 19 feet were type IV. The mean time from injury to operation was 5.6 h ( 2 to 12 h). The mean treatment time of was 10 months (4 to 19 months). RESULTS: One hundred and forty-one patients were primarily healed, 97 patients were sutured at stage II. Split-thick skin grafting was performed at stage II was performed in 103 patients; free flap transplantation was performed in 25 patients. Three of the 34 patients with infection were removed steel plate; Eviscerate flap coverage wound was performed in 14 patients caused by the first metatarsal bone exposure; Toe amputation were performed in 22 cases caused by toes necrosis. Tarsometatarasl joints perforators' surgery was performed in 10 patients with forefeet necrosis. Thirty hundred and six patients were followed up from 3 to 20 months (averaged 10 months). The wounds healed well. CONCLUSION: VSD for soft tissue defects caused by ankle injury is a simple and effective method, but can not replace debridement and transfer flap.

[Proximal femoral nail for the treatment of unstable intertrochanteric femoral fractures].

OBJECTIVE: To investigate the clinical results of the proximal femoral nail antirotation (PFNA) system in the treatment of unstable intertrochanteric femoral fractures. METHODS: From September 2006 to September 2009, 90 patients (40 males and 50 females, ranged in age from 64 to 95 years with an average of 73.2 years with unstable intertrochanteric femoral fractures were surgically treated with PFNA. Fifty patients had the fractures in the right hip, and 40 patients had the fractures in the left hip. The fractures were classified according to the AO classification: 11 patients were type A2.1, 21 patients were type A2.2,25 patients were type A2.3 9 patients were type A3.1,6 patients were A3.2 and 18 patients were A3.3. The patients underwent surgery within a mean of 3.2 days(ranged,2 to 20.1 days) from injury. The mean hospital stay was 12.8 days(ranged,7 to 24 days). Closed reduction was achieved in all the patients. Harris hip score were used for the evaluation of clinical effects. RESULTS: The mean operation time was 36.8 min (ranged, 23 to 110 min) and the mean blood loss was 150 mi (ranged, 100 to 500 ml). The mean follow-up period was 12 months (ranged, 6 to 24 months). All the patients had fracture union. Sixty-nine patients got excellent reduction, 14 good and 7 bad. The mean collodiaphysial angle was 135.60 (ranged, 1260 to 1470). Postoperative complications included secondary varus in 2 patients,calcification at the tip of the greater trochanter in 5 patients, medial thigh pain in 7 patients,and screw cut-out in 1 petient. Ten patients had femoral shortness (mean 9.3 mm,ranging from 8 to 14 mm). The mean Harris hip score was (80.5 +/- 9.8). According to Harris hip scores evaluation system, 26 patients reached an excellent result, 37 good, 18 poor and 9 bad. CONCLUSION: Due to advantages of high union rate, short operation time, and early postoperative mobilization, PFNA osteosynthesis is an idea method for surgical treatment of unstable intertrochanteric femoral fractures.

Posterior cervical spine arthrodesis incorporating C2 laminar screw fixation in the treatment of cervical spine injury.

OBJECTIVE: To investigate the clinical application and efficacy of an internal fixation technique incorporating C(2) laminar screws for upper cervical spine injury. METHODS: Using a posterior cervical approach, incorporating C(2) laminar screw fixation and bone grafting were performed on 20 patients with cervical spine injury. There were 12 male and 8 female patients, with a mean age of 45.6 years (range, 32-71 years). All patients were evaluated by X-ray, computed tomography (CT) and magnetic resonance imaging (MRI). RESULTS: The patients were followed up for 11-35 months (mean, 15 months), and bony union was achieved in all patients. There were no spinal cord or vertebral artery injuries during surgery, and only two instances of vein clump injury, in both of which the bleeding was controlled successfully. Postoperative CT scans showed that all the C(2) laminar screws had been placed properly, and were not encroaching on the spinal canal. No spinal instability, evidence of hardware failure or screw loosening was found during the follow-up period in any patient. CONCLUSION: Crossing C(2) laminar screw internal fixation technique is simple, and is not limited by the position of the vertebral artery in the body of C(2). The laminar screw method avoids arterial injuries and also can be used as a salvage method after previous misinsertion. As all relevant structures are directly visualized during C(2) laminar screw placement, this kind of technique may be applicable to a large number of patients.