Objective To investigate the effectiveness of disc reduction and anchorage in treatment of diacapitular condylar fracture with disc displacement. Methods Between June 2019 and June 2021, 20 patients (27 sides) with diacapitular condylar fractures with disc displacement were treated with disc reduction and anchorage combined with internal fixation. There were 15 males and 5 females with a median age of 40 years (range, 8-65 years). The fractures were caused by falling from height in 3 cases, traffic accident in 3 cases, and falling in 14 cases. Among them, there were 13 cases of unilateral fracture and 7 cases of bilateral fractures. Five sides were type A fractures and 22 sides were type B. There were 14 simple diacapitular condylar fractures, 12 diacapitular condylar fractures combined with mandibular chin fractures, and 1 diacapitular condylar fracture combined with mandibular angle fracture. The maximum opening was 5-20 mm (mean, 9.7 mm). The time from injury to operation was 4-20 days, with an average of 11.6 days. The postoperative imaging examination was performed to evaluate the reduction of fracture and disc. The maximum opening at 6 months after operation was recorded, and the clinical dysfunction index (Di) of Helkimo index was used to evaluate the temporomandibular joint function. Results All incisions healed by first intention. All 20 patients were followed up 6-10 months (mean, 8 months). Postoperative imaging examination showed that 27 fractures were well reduced, of which 26 were anatomically reduced and 1 was basically reduced; the reduction of the temporomandibular joint disc was excellent in 25 sides, good in 1 side, and poor in 1 side, and the effective rate of disc reduction and anchorage was 96.3%. The occlusion relationship of the patient was stable and basically reached the pre-injury level, the incision scar was hidden, and the mouth opening significantly improved when compared with the preoperative level. The maximum mouth opening was 32-40 mm (mean, 36.8 mm) at 6 months after operation. Maximum opening was more than 35 mm in 17 cases. At last follow-up, joint function reached Di 0 grade in 8 sides, DiⅠ grade in 18 sides, and DiⅡ grade in 1 side. After operation, 2 cases of opening deviation, 1 case of joint click, and 2 cases of temporary disappearance of frontal striae on affected side occurred, which recovered to normal after symptomatic treatment. ConclusionFor diacapitular condylar fractures with disc displacement, it is necessary to adopt disc reduction and anchorage at the same time of fracture reduction and internal fixation, which can achieve good clinical results.
Objective To investigate the effectiveness of a single threaded anchor fixation under shoulder arthroscopy in the treatment of fresh bony Bankart injury. Methods Between January 2017 and May 2021, 12 patients with fresh bony Bankart injury caused by trauma were treated with a single threaded anchor fixation under shoulder arthroscopy. There were 10 males and 2 females with an average age of 38.8 years (range, 21-64 years). The time between injury and operation ranged from 7 to 30 days (mean, 15.8 days). Preoperative American Shoulder and Elbow Surgeons (ASES) score was 44.9±17.4, the University of California at Los Angeles (UCLA) score was 13.1±5.5; the forward supination, lateral external rotation, and lateral internal rotation of shoulder were (130.8±11.8)°, (25.0±7.9)°, and 9.2±1.6, respectively. CT scan and three-dimensional (3D) reconstruction showed that the fracture fragment area was less than 1/4 of the glenoid area in 10 cases, and 1/4-1/2 in 2 cases. The operation time was recorded. During follow-up, ASES score, UCLA score, Rowes score, and shoulder range of motion were used to evaluate the effectiveness, and shoulder CT scan and 3D reconstruction were used to evaluate the fracture position and healing. Results The operation time ranged from 50 to 150 minutes (mean, 85.5 minutes). All patients were followed up 3-18 months (mean, 9.1 months). There was no serious adverse effect such as infection, re-dislocation, or thrombosis. Three patients had shoulder adhesions after operation. At last follow-up, the forward supination of shoulder [(162.1±30.3)°], lateral external rotation [(37.5±11.2)°], and lateral internal rotation (9.2±1.6) significantly improved when compared with those before operation (t=3.331, P=0.003; t=3.153, P=0.005; t=2.716, P=0.013). The ASES score was 89.7±11.8 and the UCLA score was 32.8±2.4, which significantly increased when compared with those before operation (t=7.368, P<0.001; t=11.370, P<0.001). The Rowes score ranged from 75 to 100 (mean, 92.9). Among them, 9 cases were excellent and 3 cases were good, with an excellent and good rate of 100%. CT re-examination showed that the fracture line disappeared in 11 cases, and the fracture alignment was good; the alignment of the fracture fragment was poor in 1 case whose fracture fragment area was between 1/4 and 1/2 of the glenoid area. Conclusion For the fracture fragment area not exceeding 1/4 of the glenoid, the labrum-capsule complex at the lower end of the bone fragment intact, and the non-comminuted fresh bony Bankart injury, a single threaded anchor fixation under shoulder arthroscopy can achieve better effectiveness, has the advantages of less trauma and faster postoperative recovery.
ObjectiveTo observe the characteristics of acetabular labrum injury in Pipkin fractures and the effectiveness of repairing the labrum with suture anchor.
MethodsBetween July 2010 and July 2013, 10 cases of Pipkin fractures accompanied by acetabular labrum injury were treated. There were 7 males and 3 females with an average age of 32.5 years (range, 24-56 years). The causes of injury included traffic accident in 8 cases and falling from height in 2 cases. According to the Pipkin classification criteria, there were 6 cases of type Ⅱ, 2 cases of type Ⅲ, and 2 cases of type Ⅳ. The average interval from injury to operation was 8 days (range, 6-14 days). All the patients underwent open reduction and internal fixation through transtrochanteric approach with trochanteric osteotomy, and repair the labrum with suture anchor. The effectiveness was evaluated according to the Thompson & Epstein scoring scales after operation.
ResultsAll incisions healed primarily without early complication of deep infection or deep vein thrombosis of lower limb. All the cases were followed up 22 months on average (range, 12-48 months). X-ray films showed that all osteotomies and acetabular fractures healed within 3-4 months, femoral head and femoral neck fracture healed within 6-11 months. MRI examinations showed that all repaired acetabular labrums well healed. One case had necrosis of the femoral head at 12 months after operation, and was treated by total hip arthroplasty. According to the Thompson & Epstein scoring scales at last follow-up, the results were excellent in 5 cases, good in 3 cases, fair in 1 case and poor in 1 case, with an excellent and good rate of 80%.
ConclusionThe diagnosis of acetabular labrum injury can be easily missed during Pipkin fracture, preoperative diagnosis should be combined with hip MRI. Trochanteric osteotomy through transtrochanteric approach, and repairing the labrum with suture anchor can restore the hip function effectively.
The earliest research of magnetic surgery was the application of magnetic anastomotic device to anastomose the blood vessels. Now, it has been widely used for anastomosis of blood vessels, gastrointestinal tract and biliary tract. The concept of "magnetic surgery" was named firstly by LU Yi in 2010 and magnetic surgery was classified into magnetic anchoring technique, magnetic navigation technique, magnetic compression technique, magnetic tracing technique, and magnetic suspension technique. The applications of magnetic surgery in the field of thoracic surgery mainly include magnetic compression technique, magnetic anchoring technique and magnetic navigation technique. This paper summarizes the application of magnetic surgery in thoracic surgery and prospects its future development in the field of thoracic surgery.
ObjectiveTo investigate the feasibility and effectiveness of absorbable anchor combined with Kirschner wire fixation in the reconstruction of extension function of old mallet finger. MethodsBetween January 2020 and January 2022, 23 cases of old mallet fingers were treated. There were 17 males and 6 females with an average age of 42 years (range, 18-70 years). The cause of injury included sports impact injury in 12 cases, sprain in 9 cases, and previous cut injury in 2 cases. The affected finger included index finger in 4 cases, middle finger in 5 cases, ring finger in 9 cases, and little finger in 5 cases. There were 18 patients of tendinous mallet fingers (Doyle type Ⅰ), 5 patients were only small bone fragments avulsion (Wehbe type ⅠA). The time from injury to operation was 45-120 days, with an average of 67 days. The patients were treated with Kirschner wire to fix the distal interphalangeal joint in a mild back extension position after joint release. The insertion of extensor tendon was reconstructed and fixed with absorbable anchors. After 6 weeks, the Kirschner wire was removed, and the patients started joint flexion and extension training. Results The postoperative follow-up ranged from 4 to 24 months (mean, 9 months). The wounds healed by first intention without complications such as skin necrosis, wound infection, and nail deformity. The distal interphalangeal joint was not stiff, the joint space was good, and there was no complication such as pain and osteoarthritis. At last follow-up, according to Crawford function evaluation standard, 12 cases were excellent, 9 cases were good, 2 cases were fair, and the good and excellent rate was 91.3%. Conclusion Absorbable anchor combined with Kirschner wire fixation can be used to reconstruct the extension function of old mallet finger, which has the advantages of simple operation and less complications.
Objective To evaluate the effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures. Methods The data of 17 patients with Cho type ⅡC distal clavicular fractures, who were treated with Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor between June 2019 and June 2021, was retrospectively analyzed. There were 11 males and 6 females with an average age of 38.7 years (range, 19-72 years). The fractures were caused by falling in 12 cases and traffic accident in 5 cases. All patients had fresh closed fractures. The interval from injury to operation was 1-5 days (mean, 2.6 days). The preoperative injury severity score (ISS) was 6-27 (mean, 10.2). The operation time, intraoperative blood loss, hospital stay, fracture healing, and postoperative complications were analyzed. The shoulder joint function was evaluated by disabilities of the arm, shoulder, and hand (DASH) score and Constant score at last follow-up. Results All operations were completed successfully. The operation time was 20-50 minutes (mean, 31.6 minutes). The intraoperative blood loss was 30-100 mL (mean, 50.6 mL). The hospital stay was 4-9 days (mean, 5.3 days). All incisions healed by first intention. All patients were followed up 12-16 months (mean, 13 months). All clavicle fractures healed, and the healing time was 8-15 weeks (mean, 11 weeks). No complications such as fracture displacement or nonunion caused by internal fixation failure occurred. During the follow-up, skin irritation caused by the Kirschner wire withdrawal occurred in 3 cases. The Kirschner wires were removed after fracture healing in 17 patients. At last follow-up, the Constant score of shoulder joint was 90-100 (mean, 98.2). The DASH score was 0-10 (mean, 1.5). ConclusionKirschner wire fixation combined with coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures has less postoperative complications and slight complications. It is convenient to remove the internal fixator. The Kirschner wire does not fix the distal clavicle fracture through the acromion, which has little effect on shoulder joint function and can obtain good effectiveness.
Objective To investigate the outcomes of arthroscopic reduction and internal fixation of tibial eminence avulsion fracture using absorbable double suture anchors. Methods Between February 2007 and August 2009, 18 patients with tibial eminence avulsion fracture were treated with arthroscopic reduction and fixation using absorbable doublensuture anchors. There were 12 males and 6 females with an average age of 30.6 years (range, 17-48 years). The disease causes were traffic accident injury in 4 cases, sport injury in 8 cases, and fall ing from height injury in 6 cases; the locations were left side in 7 cases and right side in 11 cases. The results of the anterior drawer test and Lachman test were positive. According to Meyers-McKeever classification, 10 cases were rated as type II, 7 as type III, and 1 as type IV fractures. The time from injury to treatment was 6-20 days (mean, 10.2 days). Results Incision healed primarily. All the patients were followed up 29.1 months (range, 13-43 months). The X-ray films showed good reduction of fracture immediately after operation and fracture heal ing at 3 months. At the last follow-up, the range of motion of knee was 0-130°. The results of Lachman test and anterior drawer test were negative in 18 cases and 16 cases, repectively; and the results of anterior drawer test were weakly positive in 2 cases. The mean Lysholm score was significantly improved from 53.9 ± 6.7 preoperatively to 91.6 ± 4.2 postoperatively (t=22.100, P=0.000). The Inter national knee Documentation Commitee (IKDC) 2000 subject score improved from 58.1 ± 3.7 preoperatively to 92.8 ± 5.9 postoperatively (t=20.700, P=0.000). Conclusion Arthroscopic treatment using absorbable double suture anchors for tibial eminence avulsion fracture can provide satisfactory reduction, stable fixation, and good heal ing of the avulsed fragment, which is a minimally-invasive, simple, and effective treatment for patients with tibial eminence avulsion fracture.
Objective
To study the short-term effectiveness of absorbable anchor in repairing of partial anterior cruciate ligament (ACL) rupture.
Methods
Between December 2013 and February 2015, 22 patients with partial ACL rupture were repaired with absorbable anchor under arthroscopy. There were 12 males and 10 females with an average age of 27.5 years (range, 20-44 years). The injury located at left knee in 8 cases and at right knee in 14 cases. The time from injury to admission ranged from 2 to 13 days (mean, 9.8 days). Sixteen partial ACL ruptures combined with meniscus injury. The effectiveness was assessed by Tegner score, Lysholm score, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, and MRI, as well as knee laxity was evaluated by KT-1000.
Results
All incisions healed at stage Ⅰ without any complication. All patients were followed up 12 months. ACL rerupture did not occurred during follow-up. There was no significant difference in Tegner score, Lysholm score, and IKDC score between before injury and at 12 months after operation (P>0.05). And the median satisfaction VAS score was 9.5 (range, 9-10). The tibial anterior translation difference was 0.5 mm (range, 0-6 mm). MRI showed that the scarring and continuity of the ligament were rated as grade 1 in all patients.
Conclusion
Arthroscopic repairing by absorbable anchor is a feasible method for partial ACL rupture, with ideal knee function, good satisfaction, and satisfactory short-term effectiveness.
ObjectiveTo evaluate and compare the effectiveness of double Endobutton technique and suture anchor combined Endobutton plate in the treatment of Tossy type Ⅲ acromioclavicular joint dislocation.
MethodsBetween May 2010 and March 2014, a retrospective study was preformed on 56 patients with Tossy type Ⅲ acromioclavicular joint dislocation. The coracoclavicular ligament was reconstructed with double Endobutton technique in 31 cases (Endobutton group), and with suture anchor combined Endobutton plate in 25 cases (Anchor group). There was no significant difference in age, gender, injury causes, injury side, associated injury, medical comorbidities, and disease duration between 2 groups (P>0.05). The operation time, medical device expenses, postoperative complications, preoperative and postoperative Constant-Murley scores, and postoperative Karlsson grading of the injured shoulder were compared between 2 groups.
ResultsThe average operation time in Endobutton group was significantly greater than that in Anchor group (t=4.285, P=0.000); there was no significant difference in the medical device expenses between 2 groups (t=1.555, P=0.126). Primary healing of incision was obtained in all patients of 2 groups; no early complications of infection and skin necrosis occurred. All patients were followed up 15.6 months on average (range, 11-35 months). During follow-up, some loss of reduction and ectopic ossification in the coracoclavicular gap were observed in 1 case and 6 cases of Endobutton group, respectively. No recurrence of acromioclavicular joint dislocation, implant fixation loosening and broken, and secondary fractures occurred in the other patients. There was significant difference in the incidence of postoperative complications between 2 groups (P=0.013). Constant-Murley scores of the injured shoulder significantly increased at 9 months after operation when compared with preoperative values in 2 groups (P<0.05), but no significant difference was observed between 2 groups (P>0.05). At last follow-up, there was no significant difference in Karlsson grading between 2 groups (Z=-0.628, P=0.530).
ConclusionBoth double Endobutton technique and suture anchor combined Endobutton plate have good effectiveness in the treatment of Tossy type Ⅲ acromioclavicular joint dislocation. But the latter is associated with easier operation, less operation time, and less complications.
ObjectiveTo compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation. Methods The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function. ResultsThere was no significant difference in operation time between the two groups (P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference (t=?0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values (P<0.05). However, there was no significant difference in the improvement value between the two groups (P>0.05). ConclusionFor PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.
