OBJECTIVE To investigate the effects of sodium hyaluronate in supplementary treatment of comminuted fracture of ankle. METHODS Thirty-seven patients suffered from comminuted fracture of ankle were operated for restoration by routing methods, and received 2 ml of sodium hyaluronate injection intra-articularly before the closure of incision. The ankle was fixed and given the second intra-articular injection on the 3rd day after operation. Then, the patients were given sodium hyaluronate injection intra-articularly at a week intervals till the paste was removed after 4 weeks. All patients were followed up. The clinical results were evaluated by measuring the symptoms of pain, and the function of walking and other daily living activities. RESULTS All the patients were followed up for 6 to 27 months, among them, 30 patients were cured completely without any symptoms, the ankle function for walking and daily living activities was normal, 6 patients felt pain with violent activity or walking exceeding 1 km, one patient suffered from comminuted fracture with compressed depression was not improved due to his ankle being not restored properly. CONCLUSION Intra-articular injection of sodium hyaluronate is an effective supplementary treatment for comminuted fracture of ankle.
Objective To compare the effect of two different operations on treating severely comminuted intercondylar fracture. Methods From December 2001 to October 2003, 20 cases of severely comminuted intercondylar fracture were operated. Of the 20 cases, 7(group 1) were treated with closed reduction and retrograde intramedullary nailing through arthroscope, 13(group2) were treated with open reduction and retrograde intramedullary nailing without arthroscope. Follow-ups were conducted after operation. Results All cases of fracture were recovered. Swelling in group 1 was alleviated more obviously than that in group 2. In group 1, all knees could flex to 120° during 6th to 9th weeks after the operation. In group 2, only 4 could flex 110°.Conclusion Retrograde intramedullary nailing through arthroscope proves to be less invasive and more effective in treating heavily comminuted intercondylar fracture.
ObjectiveTo observe the effectiveness of digital customized plate in the treatment of complex limb fracture.
MethodsBetween January 2012 and May 2013, CT raw data of complex limb fracture were used to establish the fracture three-dimensional simulation model after reduction, and a customized personalized anatomic plate was designed and used for internal fixation after open reduction in 42 cases. There were 22 males and 20 females, aged 16-53 years (average, 37.4 years). The causes of injury were traffic accident in 21 cases, falling from height in 18 cases, crush by heavy objects in 3 cases, including 26 cases of fresh closed fracture and 16 cases of open fracture (9 cases of type Ⅰ and 7 cases of type Ⅱ according to Gustilo classification). According to AO classification, there were 15 cases of humerus comminuted fracture, 4 cases of radial comminuted fracture, 8 cases of femoral comminuted fracture, and 15 cases of tibia comminuted fracture. The interval of injury and operation was 6-28 days (mean, 10 days).
ResultsReduction and internal fixation of fracture were successfully performed on 42 patients. The length and position of digital customized plate, direction and length of screw implant, number of screw were basically identical with preoperative design. The operation time was 35-120 minutes (mean, 70 minutes); the blood loss volume was 30-500 mL (mean, 180 mL); and X ray fluoroscopy frequency was 2-6 times (mean, 3 times). Superficial infection occurred in 2 cases, and was cured after dressing change; primary healing of incision was obtained in the other patients. Forty-two cases were followed up 6-24 months with an average of 11.5 months. The fracture healing time was 8-19 weeks (mean, 14 weeks) in 41 cases; delayed union occurred in 1 case at 44 weeks after operation. The fracture anatomical reduction was achieved in 19 cases, malunion in 3 cases, and functional reduction in the other patients. At last follow-up, no plate and screw loosening and breakage was observed.
ConclusionDigital customized plate in treatment of complex fractures of limbs, especially for the multiple comminuted fracture of long bones of the limbs has the advantages of convenient operation, less trauma, fewer complications, and good effectiveness.
Objective To investigate the treatment and effectiveness of inferior polar comminuted fractures of patella and patellar tendon injury. Methods Between January 2003 and December 2008, 5 patients with inferior polar comminuted fractures of patella and patellar tendon injury were treated with Nitinol Patellar Concentrator and fascia lata allograft. There were 3 males and 2 females with a mean age of 33.7 years (range, 20-48 years). The interval of injury and operation was 1-5 days. Fracture degree: 3 cases had 3 fractures of patella, 2 cases had 4 fractures; patellar tendon injury degree: 3cases had horizontal rupture of middle l igament, 1 case had obl ique rupture of tibial tubercle, and 1 case had longitudinal partial rupture. Results Heal ing of incision by first intention was achieved in all patients, and no compl ication of infection or deep venous thrombosis occurred. The X-ray films at 2 days after surgery showed that patella recovered to normal height, which meaned ratio of patella height to patellar tendon length recovered to 1 : 1. Five cases were followed up 18 months on average (range, 10-22 months). At 3-12 weeks after surgery, the knee function of the injury side almost reached that of the normal side in 4 patients, and the knee range of motion was about 100° in 1 patient. The fracture heal ing time was 3-5 months. At 12-15 months after surgery, patella holder was taken out and no lost of reduction or refracture occurred. During follow-up, there was no fracture displacement, loosening and breakage of implant, or rerupture of patellar tendon. According to ZHANG Chuncai’ s criterion for knee joint function, the results were excellent in 3 cases, good in 1 cases, and fair in 1 case with an excellent and good rate of 80%. According to XU Shaoting’s criterion for knee joint function, the results were excellent in 2 cases, good in 2 cases, and fair in 1 case with an excellent and good rate of 80%. Conclusion Nitinol Patellar Concentrator and fascia lata allograft is a new method to treat inferior polar comminuted fractures of patella and patellar tendon injury, and it can ensure the knee joint stabil ity in early motion after surgery.
Objective To study the clinical outcome of comminuted factures at distal femur and proximal tibia treated with AO less invasive stabilization systems (LISS). Methods The clinical data of 14 cases of distal femoral fracture and proximal tibial fracture from September 2003 to May 2005 were analyzed retrospectively. The injury was caused by traffic accident in 9 cases, by fall in 3 cases and by slipping in 2 cases. Of 14 cases, there were 5 open fractures and 9 close fractures, including 5 cases of distal femoral comminuted fracture and 9 cases of proximal shaft comminuted fractures. According to AO/OTA classification, the fractures were classified as 33C2 in 3 cases，33C3 in 2 cases,41A2 in 2 cases，41A3 in 2 cases，41B2 in 3 cases and 41C2 in 2 cases. All patients were treated by the internal fixation with LISS-distal femur or with LISS-proximal tibia. Healing of wounds, the X-ray films before and after operations, and therecovery of joint function were observed. Results The patients were followed up from 1 month to 20 months (11 months on average). Twelve cases achieved solid osseous unions from 3 months to 5 months postoperativly; 2 cases had a good reduction and recovered smoothly 2-3 months postoperatively. The results were excellent in 10 cases, good in 3 cases and fair in 1 case according to Johner-Wruhs knee scoring. The range of knee flexion-extension was 110-130° in 11 cases, 100° in 2 cases and 80° in 1 case. Conclusion LISS is an effective method of internal fixation for treating comminntedfracture of distal femur or proximal tibia. It has the advantages of less injury, satisfied reduction and reliable fixation.
ObjectiveTo explore a new method of treating serious tibiofibula comminuted fracture by using three-dimensional (3-D) printing personalized external fixator.
MethodsIn April 2015, a male patient (aged 18 years with a height of 171 cm and a weight of 67 kg) with left tibiofibula comminuted fracture was included in the study. Computer-assisted reduction technique combined with 3-D printing was used to develop a customised personalized external fixator for fracture reduction. The effectiveness was observed.
ResultsThe operation time was about 10 minutes without fluoroscopy, and successful reduction was obtained. The patient had equal limb length after operation. X-ray films showed that the posterior angulation of distal fracture was corrected 37°, and the eversion angle was corrected 4°. The tibial fractures had good paraposition or alignment, and the lower limb force line was corrected completely. No new fracture displacement occurred. The clinical healing time of fracture was 3.5 months and the bone union was achieved after 8 months. The function of affected limb recovered well after operation.
ConclusionA personalized external fixator for serious tibiofibula comminuted fracture reduction made by 3-D printing technique has the merits of easy manipulation, high individuation, accurate reduction, stable fixation, and no need of fluoroscopy.
ObjectiveTo explore the effectiveness and operative methods to treat first metatarsal diaphysis comminuted fractures with mini-plate via medial approach.
MethodsBetween January 2012 and January 2013, 15 patients with first metatarsal shaft comminuted fractures were treated. There were 11 males and 4 females (6 left feet and 9 right feet) with an average age of 38.6 years (range, 27-56 years). The injury causes included falling injury in 6 cases, crash injury of heavy object in 7 cases, and sprain in 2 cases. The left side was involved in 6 cases and the right side in 9 cases. The time from injury to operation was 8.5 days on average (range, 7-10 days). According to AO classification, all cases were rated as 81(T)-C2 type. The surgical treatments included open reduction and internal fixation with mini-plate by medial approach.
ResultsPrimary healing of incision was obtained in all cases, and no infection occurred. Twelve patients were followed up 18 months on average (range, 12-24 months). All fractures healed well, and the mean time of bone union was 11.5 weeks (range, 10-14 weeks). No loosening or breakage of internal fixation was observed. At last follow-up, the patients could walk with full weight-bearing, and had no pain. According to American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, the mean score was 85.2 (range, 76-96).
ConclusionAnatomic reduction and stable internal fixation are important for first metatarsal comminuted fracture, which is the key point for recovery of foot form and foot arch function. And the medial approach could achieve full exposure and improve the cosmetic results.
