RESUMEN
BACKGROUND: The treatment of open tibial shaft fractures is challenging. External fixation (EF) is comparatively safe in treating these open injuries, meanwhile it has the advantages of easy application, minimal additional disruption, and convenient subsequent soft tissue repair. Nevertheless, its application is accompanied by a series of problems in alignment and bone healing. Therefore, limited internal fixation (LIF), such as cortical screws, has been used based on the external fixator for better therapeutic effect. The aim of this study is to compare the outcomes of EF combined with LIF and simple EF in the management of open tibial shaft fractures, evaluating the efficacy and safety of using the combined technique in treating such fractures. METHODS: From January 2012 to December 2016, patients with open tibial shaft fractures treated with EF with or without LIF augmentation were identified. A total of 152 patients were included in the analysis, and there were 85 patients in the simple external fixation group and 67 patients in the EF-LIF group. General assessment indicators included the direct cost of hospitalization and the times of first surgery, full weight bearing, and complete union. Infections and complications in union or limb alignment were compared as primary outcomes. Additionally, the number of patients who changed the fixation system for various reasons were analysed. RESULTS: Effective follow-up of all participants for statistical analysis was obtained. The follow-up time averaged 17.15 months (range: 12.00 to 24.00 months) in the EF group and 16.20 months (range: 12.00 to 19.00 months) in the EF-LIF group. Combined fixation provided shortened time to bear full weight and achieve complete bone union, while requiring additional first surgery time. No significant difference was found in infection rates or direct cost of hospitalization. Delayed union and non-union in the EF-LIF group were significantly decreased (20.9% versus 40.0, 1.5% versus 14.1%, p < 0.05). In limb alignment, patients with combined fixation exhibited reduced malreduction, loss of reduction, and malunion. In terms of secondary fixation, the EF-LIF group showed a markedly lower incidence (5.8% versus 34.1%, p < 0.001). CONCLUSION: Compared with simple EF, combined fixation is an effective and safe alternative for management of open tibial diaphyseal fractures. It provides superior initial reduction, better stability and decreases the risk of inferior alignment and delayed union without increasing the risk of infection.
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Fijadores Externos , Fijación Interna de Fracturas/métodos , Curación de Fractura , Fracturas Abiertas/cirugía , Fracturas de la Tibia/cirugía , Adulto , Anciano , Placas Óseas , Tornillos Óseos , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Bone and cartilage deficits in the posterior acetabular wall are severe complications resulting from the unsuccessful management or delayed treatment of acetabular fracture. This potentially disastrous condition cannot be treated reliably with the use of reconstruction plates and screws alone. Therefore, this technical report describes a modified anatomical reconstruction method that uses a structural iliac crest autograft and an acetabular tridimensional memory alloy fixation system (ATMFS) to treat late-stage deficits in the posterior wall of the acetabulum. This paper also describes a clinical study of 22 patients with an average of 6.3 years follow-up to evaluate the clinical outcomes of this method. METHODS: Twenty-two patients, who had an acetabular reconstruction between January 2000 and December 2011 that used a structured free iliac crest autograft to treat late-stage bone and cartilage deficits in the posterior acetabular wall were followed annually with clinical and radiographic evaluations. The average age of the patients was 36.4 years at the time of the procedure, and the average time of follow-up was 6.3 years. RESULTS: None of the patients in this study lost reduction after surgery, and there were no cases of implant failure. Radiographic analysis using Matta's X-ray evaluation criteria were excellent in eleven cases, good in eight, and fair on three. The Merle D'Aubigné and Postel clinical outcomes at the final follow-up were as follows: seven cases were excellent, ten cases were good, three cases were fair and two cases were poor. CONCLUSIONS: The use of a modified iliac crest grafting and ATMFS fixation, as a biological method to reconstruct the acetabulum anatomically may offer better congruence of the joint surface and may ensure good hip joint stability during early postoperative exercise. The medium to long-term results of this method are encouraging.
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Acetábulo/lesiones , Trasplante Óseo , Fracturas Óseas/cirugía , Procedimientos Ortopédicos/métodos , Acetábulo/cirugía , Adolescente , Adulto , Humanos , Ilion , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVE: To compare the effects of tension band combined with patellar cerclage and memory alloy patellar concentrator fixation in the treatment of comminuted fracture of the lower pole of patella. METHODS: From July 2015 to July 2019, 60 patients with distal patellar fracture were treated and were divided into two groups according to different operation methods. In group A, 30 patients were fixed with memory alloy patellar concentrator (NiTi PC), 17 males and 13 females, aged 20 to 71 (39.4±9.9) years, including 19 cases of falling injury, 9 cases of traffic injury and 2 cases of sports injury. The time from injury to operation was 10 to 75 (33.1±7.8) hours; 30 cases in group B were fixed with tension band andcerclage, 15 males and 15 females, aged 21 to 76 (38.6±10.2) years, including 17 cases of falling injury, 12 cases of traffic injury and 1 case of smashing injury. The time from injury to operation was 10 to 91 (34.5±9.1) hours. The curative effects of two groups were observed and compared. RESULTS: All 60 patients were followed up for 9 to 30 months. There was no significant difference in intraoperative bleeding, operation time, follow-up time and fracture healing time between the two groups. Six months after operation, according to the Bostman function score of knee joint:30 cases in group A, the total score was 28.6±4.7, of which 26 cases were excellent and 4 cases were good. The total score of 30 cases in group B was 25.5±4.4, of which 20 cases were excellent, 8 cases were good and 2 cases were poor. There were significant differences in Bostman total score and curative effect evaluation between two groups (P<0.05). The score of group A was significantly better than that of group B. In group B, 1 case had Kirschner wire withdrawal, 2 cases had joint stiffness and 3 cases had internal fixation irritation. CONCLUSION: Memory alloy patellar concentrator is strong and reliable in the treatment of inferior patellar fracture. It can take early rehabilitation exercise after operation, with good recovery of joint function and range of motion and less complications.
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Fracturas Óseas , Fracturas Conminutas , Adulto , Anciano , Hilos Ortopédicos , Estudios de Casos y Controles , Femenino , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Fracturas Conminutas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Rótula/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To compare the outcomes of the arched shape-memory connector (ASC) only fixation and the lateral one-third tubular plate fixation in managing unstable Type A or B lateral malleolus fractures according to the Weber (AO) classification, and to evaluate the feasibility and reliability of ASC only fixation in treating these fractures. METHODS: From January 2010 to January 2015, 148 patients with Type A or B (Weber (AO) classification) lateral malleolus fractures treated with the arched shape-memory connector (ASC) only fixation or lateral plate fixation were included. There were 66 patients in the ASC only fixation group and 82 patients in the lateral plate group. Intergroup differences were absent regarding patient and fracture characteristics. The incision length, complete-union time, major complications and complaints, incidence of hardware removal, and final radiographic and functional evaluations were compared. RESULTS: The follow-up time averaged 18.2 months in the ASC fixation group and 17.2 months in the lateral plate group. The ASC only fixation group had significantly decreased wound infection (4.55% versus 14.63%) and skin necrosis (none versus 7.32%). Of patients who underwent ASC only fixation 3.03% reported lateral ankle pain, 7.58% received palpable hardware, and 3.03% reported hardware irritation, while the corresponding observations in the lateral plate group were 19.51%, 54.88%, and 14.63%, respectively, representing a statistical difference. Furthermore, compared with the lateral plate group, the incidence of hardware removal was markedly lower in the ASC fixation group (12.12% versus 30.49%). In terms of reduction accuracy, complete-union time, and AOFAS scores, no appreciable differences were observed. CONCLUSIONS: ASC only fixation is a reliable alternative for managing Type A or B lateral malleolus fractures, leading to fewer soft tissue complications, fewer hardware complaints, and a reduced need for hardware removal, and a reduced need for hardware removal. In addition, ASC can be used for augmented plate fixation in certain comminuted fracture patterns.
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Fracturas de Tobillo/cirugía , Articulación del Tobillo/cirugía , Fijación Interna de Fracturas/instrumentación , Curación de Fractura/fisiología , Inestabilidad de la Articulación/prevención & control , Adulto , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/fisiopatología , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/fisiopatología , Tornillos Óseos , Estudios de Factibilidad , Femenino , Fijación Interna de Fracturas/métodos , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular/fisiología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: To describe the biological characteristics of exosomes and to summarize the current status of stem cell-derived exosomes on fracture healing. Meanwhile, future challenges, limitations and perspectives are also discussed. METHODS: Search and analyze the related articles in pubmed database through the multi-combination of keywords like "stem cells","exosomes","bone regeneration" and "fracture healing". CONCLUSION: Stem cell-derived exosome therapy for fracture healing has been enjoying popularity and is drawing increasing attention. This strategy helps to promote proliferation and migration of cells, as well as osteogenesis and angiogenesis, in the process of bone formation. Although the exact mechanisms remain elusive, exosomal miRNAs seem to play vital roles. Future studies are required to solve multiple problems before clinical application, including comprehensive and thorough understanding of exosomes, the exact roles of exosomes in regulating bone formation, and the optimal source, dose and frequency of treatment, as well as technical and safety issues. Moreover, studies based on fracture models of large animals are could offer guidance and are in demand.
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Regeneración Ósea , Exosomas/genética , Curación de Fractura , MicroARNs/genética , Osteogénesis , Células Madre/citología , Animales , Diferenciación Celular , Movimiento Celular , Proliferación Celular , Exosomas/metabolismo , Exosomas/trasplante , Humanos , MicroARNs/metabolismo , Neovascularización Fisiológica , Medicina Regenerativa/métodos , Células Madre/metabolismoRESUMEN
OBJECTIVE: To analyze causes of missed diagnosis of hiding post-malleolar fractures in treating ankle joint fractures of pronation-external rotation type according to Lauge-Hansen classification and assess its medium-term outcomes. METHODS: Among 103 patients with ankle joint fracture of pronation-external rotation type treated from March 2002 to June 2010,9 patients were missed diagnosis,including 6 males and 3 females,with a mean age of 35.2 years old (ranged, 18 to 55 years old) . Four patients were diagnosed during operation, 2 patients were diagnosed 2 or 3 days after first surgery and 3 patients came from other hospital. All the patients were treated remedially with lag screws and lock plates internal fixation. After operation,ankle joint function was evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS). RESULTS: All the 9 patients were followed up, and the duration ranged from 14 to 30 months (averaged, 17 months). No incision infection was found, and all incision healed at the first stage. At the latest follow-up, AOFAS was 83.0 +/- 4.4, the score of 4 patients diagnosed during operation was 85.0 +/- 2.9, and the score of 5 patients treated by secondary operation was 81.0 +/- 5.3. All the patients got fracture union observed by X-ray at a mean time of 2.2 months after operation. There were no complications such as internal fixation loosing, broken and vascular or nerve injuries. CONCLUSION: Ankle joint fracture of pronation-external rotation type may be combined with hiding post-malleolar fractures. So to patients with ankle joint fracture of pronation-external rotation type, lateral X-ray should be read carefully, and if necessary, CT or MRI examination should be performed. If adding lateral X-ray examination after reduction of exterior and interior ankle joint fixation, the missed diagnosis may be avoided.
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Fracturas de Tobillo , Fracturas Óseas/diagnóstico , Fracturas Óseas/cirugía , Pronación , Rotación , Adolescente , Adulto , Reacciones Falso Negativas , Femenino , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To explore methods of treating middle and distal tibia nonunion with the treatment of advanced bone graft combined with locking compression plate. METHODS: From January 2011 to December 2012, 12 patients with middle and distal tibia nonunion were treated with advanced bone graft combined with locking compression plate. Among patients, there were 8 males and 4 females aged from 20 to 69 with an average of 47 years old. The time from first injuries to bone nonunion was from 9 months to 5 years, avergaed 19 months. Four cases were treated with external fixation, 6 cases were treated with plate fixation, 2 cases of 12 patients occurred broken of plate and nail. Eleven patients were non-infective bone nonunion and 1 patient was infective bone nonunion. Preoperative X-ray and CT showed all patients had sequestration and formation of ossified bone with different degrees. Operative time, blood loss, wound healing were observed, fracture healing time was evaluated by postoperative X-ray. Johner-Wruhs scoring standards was used to evaluate ankle joint function after operation at 10 months. RESULTS: Operative time ranged from 90 to 185 min with an average of (125.00±20.15) min; blood loss ranged from 225 to 750 ml with an average of (415.00±120.00) ml. All patients were followed up from 10 months to 2.5 years with an average of 1.5 years. Postoperative X-ray showed bone union was formed around fracture after operation at 4 months in all patients, 3 cases obtained bone healing within 6 months after operation, 9 cases obtained from 8 to 12 months. No infection, injury of nerve and vessles, and broken of plate and nail were ocurred. According to Johner-Wruhs scoring at 10 months after operation, 10 cases obtained excellent results, 1 good and 1 moderate. CONCLUSION: Advanced bone graft combined with locking compression plate, which can build fracture multi-point supporting based on full compression of bone nonunion to get effective fixation, is an effective method in treating middle and distal tibia nonunion.
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Placas Óseas , Trasplante Óseo , Fracturas no Consolidadas/cirugía , Fracturas de la Tibia/cirugía , Adulto , Anciano , Femenino , Curación de Fractura , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To explore morphological character and clinical significance of superior-posterior acetabular wall by anatomically measuring and quantitatively analyzing thickness of posterior acetabular wall, then provide a theoretical reference for clinical treatment of acetabular fracture. METHODS: Fifteen adult formalin-preserved cadaveric pelvises (8 males and 7 females) were used for this investigation. Excess soft tissue was removed and the whole acetabular posterior walls were marked with "angle" sector method and the thickness was measured with caliper in different levels of the different split points. The measurement results were validated and analyzed statistically. RESULTS: At 5 mm away from acetabular rim, the average thickness of superior-posterior acetablar wall fluctuated between (6.47±0.61) mm and (7.43±0.71) mm; the average thickness of inferior-posterior acetabuluar wall fluctuated between (5.62±0.51) mm and (6.33±0.61) mm; the average thickness of acetabular roof fluctuated between (7.71±0.74) mm and (8.27±0.99) mm. There was no statistical difference between average thickness of superior-posterior wall of acetabulum and inferior-posterior wall of acetabulum (P>0.05), but the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P<0.05). At 10 mm away from the acetabular rim, the average thickness of superior-posterior acetabular wall fluctuated between (8.81±0.67) mm and (13.35±0.89)mm; the average thickness of inferior-posterior acetabular wall fluctuated between (7.02±0.63) mm and (7.66±0.69) mm; the average thickness of acetabular roof fluctuated between (14.46±0.97) mm and (17.05±1.35) mm. Comparatively, the average thickness of superior-posterior acetabular wall was significantly larger than inferior-posterior wall of acetabulum (P<0.05), and the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P<0.01). At 15 mm away from the acetabular rim, the average thickness of superior-posterior acetabular wall fluctuated between (12.08±0.78) mm and (19.84±1.03) mm; the average thickness of inferior-posterior acetabular wall fluctuated between (10.17±0.76) mm and (11.12± 0.77) mm; the average thickness of acetabular roof fluctuated between (23.23±1.12) mm and (26.01±1.53) mm. Comparatively, the average thickness of superior-posterior wall of acetabulum was significantly larger than inferior-posterior acetabular wall (P<0.01), and the average thickness of acetabular roof was significantly larger than superior-posterior acetabular wall (P< 0.01). CONCLUSION: The thickness of entire acetabular posterior edge revealed an increasing tendency from inferior-posterior wall to the superior-posterior wall to acetabular roof. And this trend became more obvious with increasing distance away from acetabular rim. Therefore, the superior-posterior acetabular wall could not only maintain the stability of hip joint but also bear loading.
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Acetábulo/anatomía & histología , Acetábulo/lesiones , Acetábulo/cirugía , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: To review the clinical outcome of the application of cannulated compression screws for the treatment of tibial tubercle avulsion fractures of Ogden type III in adolescents. METHODS: From January 2003 to October 2010,11 adolescent patients with tibial tubercle avulsion fractures were treated with open reduction and internal fixation. There were 9 boys and 2 girls with an average age of 15.2 years old (ranged, 12.4 to 17 years old). According to Ogden classification, there were 9 patients with type IIIa and 2 patients with type IIIb. Postoperative functional exercise and regular follow-up were done and outcomes were evaluated by the Mosier clinical assessment system. RESULTS: All the patients were followed up, and the duration ranged from 7 to 69 months, with a mean of 25.5 months. All fractures healed at the first stage. According to the Mosier clinical assessment system, the final outcome was evaluated as excellent in all. One patient had infrapatellar hypoesthesia, and one patient had prominency of tibial tubercle without any symptoms. CONCLUSION: The cannualted compression screws in the treatment of tibial tubercle avulsion fractures of Ogden type III in adolescents have an excellent outcome without deformity or functional loss.
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Tornillos Óseos , Fijación Interna de Fracturas/métodos , Fracturas de la Tibia/cirugía , Adolescente , Niño , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: To introduce a new trochanteric osteotomy,and evaluate the outcome of the procedure combined a posterior lateral approach in treating acetabular fractures which involving the roof. METHODS: Between March 2007 and Novmber 2010,30 patients with displaced acetabular fractures involving the dome need trochanteric osteotomy were retrospectively reviewed. There were 21 males and 9 females,ranging in age from 18 to 70 years with an average of 35.2 years at the time of injury. According to Letournel-Judet classification, there were 10 posterior wall fractures,7 posterior column fractures,5 transverse fractures, 2 T-shape fractures, 1 transverse associated with posterior wall fracture, 3 posterior column and wall fractures and 2 bicolumn fractures. The standards of Matta,the modified Merle d'Aubigne-Postel, Medical Research Council were respectively used to evaluate the reduction result, function of hip joint and the strength of hip abduction. RESULTS: All patients were followed up with an average time of 25 months (18 to 40) and all osteotomy sites obtained bone union with an average time of 8.4 weeks (6 to 12). No bone non-union, bone block displaceing, internal fixation looseing and breaking,infection of deep part were found. Seventeen patients got anatomic reduction, 12 got satisfied reduction, and 1 got unsatisfied result according to the criteria of Matta. At final follow-up, function of hip joint obtained excellent results in 11 cases, good in 15, fair in 3 and poor in 1. The strength of the abductors of 3 patients were grade 4 and 27 patients were grade 5. CONCLUSION: Posterior partial great trochanteric osteotomy can enhance the exposure and provide a more accurate reduction and degrade the difficulty of acetabular fracture fixation without increasing the risk of complications. The method provide a new way for the treatment of the roof involved acetabular fractures.
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Acetábulo/lesiones , Fracturas Óseas/cirugía , Acetábulo/cirugía , Adolescente , Adulto , Anciano , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To assess the clinical effects of Ni-Ti shape memory alloy bow-teeth screws combined with locking plate internal fixation in treating comminuted fracture of tibial plateau. METHODS: From January 2003 to December 2008, 17 patients with comminuted fracture of tibial plateau were treated with Ni-Ti shape memory alloy bow-teeth screws and locking plate internal fixation. There were 9 males and 8 females with an average age of 33.7 years old (ranged, 23 to 48 years). All fractures were fresh and injured time less 3 weeks and 2 patients with common peroneal nerve injury. According to Schatzker typing, type V was in 1 case and type VI was in 16 cases. RESULTS: All patients were followed up from 10 to 22 months with an average of 18 months and all incisions healed in one stage. At 3 to 12 weeks after operation, knee joint function of 16 cases arrived to the level of uninjured side and 1 case was poor in flexed function. All fractures obtained union at 3 to 5 months after operation, and internal fixtures were removed at 1 year after operation and no reduction lossing or refracture occurred. At final follow-up, no bone block shifting, internal fixture loosening and breakage was found. According to the standard of Xushanding's knee joint function, 9 cases got excellent results, 4 good, 4 fair. CONCLUSION: The design of Ni-Ti shape memory alloy bow-teeth screws is adapt to irregular anatomic structure of comminuted fractures of tibial plateau,it can continuously pressurize and promote bone healing. Multi drop lockedup may avoid wide-ranging stripping local soft tissue, and form three-dimension fixation after combined with locking plate internal fixation, can effective recover anatomic structure of fracture. So Ni-Ti shape memory alloy bow-teeth screws combined with locking plate internal fixation is an effective method in treating comminuted fracture of tibial plateau.
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Placas Óseas , Tornillos Óseos , Fijación Interna de Fracturas/métodos , Fracturas Conminutas/cirugía , Níquel , Fracturas de la Tibia/cirugía , Titanio , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To evaluate the surgical techniques and clinical effect of Ni-Ti patellar concentrator combined with Herbert screw and wirerope in treating comminuted patellar inferior pole fractures. METHODS: From March 2008 to June 2010,34 patients with comminuted patellar inferior pole fracture were treated with Ni-Ti patellar concentrator combined with Herbert screw and wirerope. Of them, there were 19 males and 15 females with an average age of 38.6 years old(ranged from 22 to 75). Early functional exercise was guided postoperatively and the patients were regularly followed up and their outcomes were assessed. RESULTS: All patients were followed up with an average of 13.5 months (ranged,7 to 20). All fractures healed. According to Böstman Clinical Rating System, the average score was 28.43 +/- 2.34,and excellent results in 21 cases,good in 13 cases and no poor case. CONCLUSION: Ni Ti patellar concentrator combined with Herbert screw and wirerope for the treatment of comminuted patellar inferior pole fracture is an effective method and of great value to clinical application.
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Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Fracturas Conminutas/cirugía , Traumatismos de la Rodilla/cirugía , Rótula/cirugía , Adulto , Anciano , Tornillos Óseos , Hilos Ortopédicos , Estudios de Casos y Controles , Femenino , Fijación Interna de Fracturas/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Níquel , Rótula/lesiones , Titanio , Adulto JovenRESUMEN
OBJECTIVE: To investigate clinical results of percutaneous reduction and hollow screw internal fixation for the treatment of calcaneal fractures, and to compare therapeutic effects between close reduction hollow screw internal fixation and open reduction plate internal fixation. METHODS: From August 2007 to May 2010, 53 patients with calcaneal fractures were retrospectively analyzed. All the patients were divided into two groups, 25 patients in group A (PR group) treated with percutaneous reduction and hollow screw internal fixation, including 17 males and 8 females, with an average age of (39.4 +/- 9.9) years. While 28 patients in group B (OR group) treated with open reduction and plate internal fixation, including 18 males and 10 females, with an average age of (38.6 +/- 10.2) years. According to Sanders classification, there were 18 patients with type II fractures, 29 patients with type III and 6 type IV. In both groups, operative time, blood loss, postoperative complications and radiology were recorded. Functional recovery was evaluated by Maryland score. RESULTS: All the patients were followed up, and the duration ranged from nine months to thirty-five months (averaged 20.4 months). There were no significant differences in sex, age, fracture type, fracture classification, initial Böhler angle, or late complications between the two groups. But significant difference can be seen between operative time, blood loss, and skin complications (in group A no nonunion and skin complications occurred, but subtalar posttraumatic arthritis occurred in 1 case; in group B, 3 patients had complications of skin necrosis, 1 patient suffered from a delayed union due to large defect filled with artificial bone, and 1 patient got subtalar posttraumatic arthritis). No difference were found in the latest X-ray film. According to Maryland score, in group A, 8 got an excellent result and 12 good. In group B, 10 got an excellent and 14 good. There were no significant differences between the two groups in Margland score. CONCLUSION: The results of this study suggest that in comparison with open reduction, percutaneous reduction and hollow screw internal fixation minimizes complications and achieves good results. Further study of this technique is needed.
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Calcáneo/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Adolescente , Adulto , Anciano , Tornillos Óseos , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the indications, surgical techniques and clinical effects of the fixation of posterior malleolus in complicated external rotation ankle fractures and illuminate the importance of anatomical reduction and rigid internal fixation of posterior malleolar fracture. METHODS: From July 2007 to June 2009, 32 patients were treated with open reduction and internal fixation,involving 21 males and 11 females with an average age of 36 years old (ranged from 19 to 68 years old). According to Lauge-Hansen classification: 13 cases of pronation-external rotation type (IV), 7 and 12 cases of supination-external rotation type (III and IV). Postoperative functional exercise and regular follow-up were done and outcomes were assessed. RESULTS: All the patients were followed up,and the duration ranged from 7 to 20 months,with an average of 14.5 months. According to Ankle Hindfoot Clinical Rating System of the American Orthopaedic Foot & Ankle Society (AOFAS), 23 patients got an excellent result, 7 good, 2 fair, 0 poor. CONCLUSION: Anatomical reduction and rigid internal fixation of posterior malleolar fracture as well as early functional exercise have significance in restoring ankle joint function and reducing the incidence of traumatic arthritis.
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Traumatismos del Tobillo/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , RotaciónRESUMEN
OBJECTIVE: To explore operative method in the treatment of syndesmosis injury of ankle fractures. METHODS: Twenty-four patients with ankle fractures and syndesmosis diastasis were treated with shape memory fracture staples, including 10 males and 14 females ranging in age from 19 to 71 years, with an average of 43 years. All patients were diagnosised with history, body examination and image data and were operated according to classification of Lauge-Hansen. RESULTS: All patients were followed up from 6 to 28 months with an average of 16 months, and all fractures healed, with a mean time 9.2 (8 to 14) weeks. Only one case had radiological and clinical manifestations of traumatic arthritis, but no breakage of shape memory fracture staple in all cases. Sixteen patients got excellent results, good in 5, fair in 2, poor in 1. CONCLUSION: Shape memory staple fixation for the treatment of syndesmosis diastasis in ankle fractures not only can perseve the physical motion of ankles, but also be remove earlier before weight bearing.
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Fracturas de Tobillo , Traumatismos del Tobillo/complicaciones , Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Fijación Interna de Fracturas/instrumentación , Adulto , Anciano , Traumatismos del Tobillo/diagnóstico por imagen , Articulación del Tobillo/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Resultado del Tratamiento , Adulto JovenRESUMEN
Acetabulum, as the important factor for weight bearing of the upper body, has its unique anatomic features and complicated physiological function. The integrity and stability of the lunata articular surface in the dome region of acetabulum, is the important base to bear the physiological function of acetabulum. The fracture related to this part will cause relation change of contact area and stress between head of femur and acetabulum. Furthermore, the deep anatomical position of the dome region, the complicated surrounding anatomical relation, and the irregular bony structure will also increase the difficulty of surgical treatment. Especially for some complicated comminuted or compressed fracture, even with good explosions, it is hard to get satisfied anatomical reduction. Consequently,forward traumatic arthritis has greater probability of occurrence. Therefore, the clinical research on the fracture in the dome region of acetabulum was getting more and more attention worldly. This paper intended to review the relation of fracture classifications and anatomic features, physiological function,diagnostic criteria,and also its clinical treating countermeasure.
Asunto(s)
Acetábulo/lesiones , Acetábulo/fisiopatología , Fracturas Óseas/fisiopatología , Soporte de Peso , Acetábulo/cirugía , Fracturas Óseas/diagnóstico , Fracturas Óseas/cirugía , Humanos , PronósticoRESUMEN
OBJECTIVE: To design ABC damage variable and positioning system for acetabular fracture and explore the feasibility and clinical practical value of the system through the multi-center analysis of 1122 acetabular fractures. METHODS: According to acetabular three-column conception, and pelvic ring lesions damage direction caused by acetabular fracture domino effect and injury degree of proximal femur joint, it defined class A as any column acetabular fracture; class B as any two-column acetabular fracture; class C as front, dome and posterior mixture acetabular fracture. Lower case English letters a, m, p represented front, dome, posterior fracture, respectively. Acetabular damage variables: 1 was simple displaced fractures; 2 was comminuted fractures; 3 was compression fractures. Pelvic ring lesions damage variables: alpha was sacroiliac joints or sacroiliac fracture horizontal separation deflection; beta was sacroiliac joints or sacroiliac fracture vertical separation deflection; gamma was pubic symphysis separation/superior and inferior ramus of pubis fracture deflection; alpha beta gamma delta was compound floating damage. Proximal humerus joint damage variables: I was femoral head fracture; II was femoral neck fracture; II was intertrochanteric fractures of femur; IV was I to III compound fracture. The ABC damage variable positioning system for acetabular fracture was made up by the above-mentioned variables. The statistics from March 1997 to February 2010 showed 1122 cases acetabular fractures with 18 cases of double side acetabular fracture and 1140 cases of acetabular fractures. The pelvics anterior-posterior view, ilium and obturator oblique view, and 2/3D-CT materials were analyzed and researched. RESULTS: Each damage variables distribution situation in 1140 cases of acetabular fracture involved A in 237 cases (20.8%), B in 605 cases (53.1%), C in 298 cases (26.1%);front column fracture in 808 cases(70.9%), dome fracture in 507 cases (44.5%), posterior fracture in 1026 cases (90%). Acetabular variables: variabe 1 in 203 cases of simple displaced fracture (17.8%); variabe 2 in 516 cases of comminuted fracture(45.3%); variabe 3 in 421 cases of compression fracture (36.9%); 249 cases of pelvic ring lesions damage (21.8%), 75 cases femoral head fracture (6.6%); 18 cases of double side acetabular fracture and relative pelvic ring and proximal humerus joint variables (1.58%). Key part and curative effect elements of 1140 cases acetabular fracture: 507 cases of dome or posterior acetabular fracture (44.5%); 421 cases of compression fracture (36.9%); 249 cases of pelvic ring variables (21.8%); 75 cases of proximal humerus joint variables (6.6%); 486 cases of simple Aa/pl/2,Bapl/2 acetabular fracture (42.6% ). CONCLUSION: Compression fracture, especially defected compression fracture, takes important part in acetabular damage variables, and also presents that acetabular fracture with pelvic ring and proximal femoral damage variables are not rare at all. The relationship of the acetabular fracture damage variables, and its percentage shows the key points and elements in clinical treatment: weight-bearing to dome accounts for 44.5%; compression to defects account for 36.9%, pelvic ring to float accounts for 21.8%; dome fracture to double side fracture account for 6.6%. The system has significant guiding effects on clinic in terms of evaluation of injury severity, anatomic localization, difficulty index, alternative strategy, operative approach, effect of treatment,and prognosis. And the most important thing is that the system creates the comparison of damage variables in same type of fracture and the communication of homo-language and explores a new method.