ObjectiveTo study the surgical treatment method and effectiveness of Rüedi-Allg?wer Ⅲ type Pilon fractures.
MethodsBetween May 2011 and April 2013,25 cases of Rüedi-Allg?wer Ⅲ type Pilon fracture (5 cases of open fractures and 20 cases of closed fractures) were treated.Of 25 cases,16 were male,and 9 were female,aged 24-45 years (mean,31 years).The left side was involved in 8 cases,and the right side in 17 cases.The disease causes were falling from height in 11 cases,traffic accident injury in 9 cases,and crash injury in 5 cases.The interval of injury and admission was 10-36 hours (mean,23.5 hours).The open reduction and internal fixation by posterolateral fibular incision and exposure of distal tibia and tibiotalar articular surface by anterior ankle incision were performed;the tibiotalar articular surface was reset and the tibia fracture end was fixed.
ResultsHealing of incision by first intention was obtained in 15 cases,and healing by second intention in 6 cases undergoing skin grafting.Tension blister occurred in 4 patients,who achieved healing by second intention after treatment.All 25 patients were followed up 6-12 months (mean,8 months).During follow-up,no complication of ankle joint instability,traumatic arthritis,or loosening and breakage of internal fixation occurred.The X-ray films showed stable ankle joint,anatomic or near anatomic reduction of the tibiotalar articular surface,normal alignment of distal tibia,and good bony healing.At 6 to 12 months after operation,the flexion and extension of the ankle were normal,without pain of the ankle joint after removal of internal fixation.According to Mazur et al.rating system for ankle symptoms and function,the results were excellent in 5 cases,good in 12 cases,fair in 5 cases,and poor in 3 cases;the excellent and good rate was 68%.
ConclusionThe procedure by anterior ankle lateral approach and posterolateral fibular approach can completely expose the tibiotalar articular surface,which is advantageous to displaced fracture reduction and fixation,and can achieve good effectiveness in treating Rüedi-Allg?wer Ⅲ type Pilon fractures.
Objective To explore the technique and clinicaleffects of internal fixation of complicated distal femoral fractures using the supporting steel of AO femoral condyles.Methods From October 2001 to February 2004, 23 cases of complicated distal femoral fractures were treated with open reduction and internal fixation using the supporting steel of AO femoral condyles. Of 23 cases, there were 19 males and 4 females, aged 27-55 years. The locations were the right side in 10 cases and the left side in 13 cases. Fracture caused by traffic accident in 16 and by fall in 7, including 14 closed fracture and 9 open fracture, 21 fresh fracture and 2 old fracture. Accordingto AO classification, 6 cases were classified as type A extra-articular fracture and 17 cases as type C intra-articular fracture. The X-ay films before operation showed comminuted fracture of femoral intercondyles and femoral supracondyles. All cases received scientific and rational rehabilitative treatment postoperatively. Results The postoperative follow-up ranged from 6months to 20 months, 23 cases achieved fracture healing with an average healing period of 10.3 months (from 7 months to 16 months). According to the criteria of Kolmert and Wulff, the results were excellent in 16 cases, good in 4 cases, fair in 2 case andpoor in 1 case. The excellenct and good rate was 86.9%.Conclusion Internal fixation with the supporting steel of AO femoral condyles for treatment of complicated distal femoral fractures has advantages of reasonable design, convenient operation, firm fixation and reliable clinical outcome .
The three-dimensional (3-D) Titanium miniplate system is one of the newest internal rigid fixation for the maxillo-mandibular surgery in recent years. The geometry of the plate assures a good stability in the three-dimensions of the fracture sits. Thirty patients suffering from maxillo-mandibular fractures had been operated on using the 3-D Titanium miniplates since 1991. The group of the patient included 16 cases of mandibular fractures, 8 cases of maxillary fractures and 6 cases of maxillo-mandibular fracture. All of the patient had very good result without any complication. The follow-up was 6 months to 3 years. The 3-D Titanium miniplate as an ideal easy to use, good resistance against torque forces and, compact forms of the miniplate were the some of the advantages. Clinical examples had been provided to illustrate the actual usage of the 3-D miniplate in the field of the surgical treatment for the maxillo-mandibular fracture. It is the author’s opinion that the internal rigid fixation by 3-D Titanium miniplates is a promising method of treating fractures of the maxilla and is to be better tolerated by the patients and surgeons.
Objective To explore an effective way fortreating severe complicated distal femoral fractures. Methods Twenty-six patients with complicated distal femoral fracture who all belonged to 33C3.3type according to AO/ASIF lassification, were treated with a lateral condylar buttress plate or self-desinged aliform anatomical plate, and operated on with allogeneic bone grafting. Results All cases were followed up for an average of 14 months (ranging 5-25 months). Twenty-four wounds were primary healing postoperatively, 2 wounds were infected and healed after dressing change. Twenty-four had bone healing after 411 months, 2 needed to operate again because of earlier weight-bearing resulting in fixation failure. According to shelbourne and Brueckmann score, the excellent and good rate was 88.46%. Conclusion The internal fixation forcomplicated distal femoral fracture by self-designed aliform anatomical plate and lateral condylar buttress plate with a great deal of allograft bone is an effective surgical method. As it has long oval holes and the holes are consecutive ,the aliform anatomical plate is more suitable for severe complicated fractures. At the same time, autogenous-ilium transplantation can be substituted by the allograft bone.
Objective To analyze the effectiveness of shape memory alloy embracing device in the treatment of Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty. Methods The clinical data of 30 patients (30 hips) with Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty between January 2019 and January 2021 were analyzed retrospectively. Among them, 15 cases were treated with shape memory alloy embracing device for fracture fixation (group A) and 15 cases with titanium cable cerclage (group B). There was no significant difference in general data such as gender, age, body mass index, the cause of primary arthroplasty and surgical method, prosthesis type, the cause and side of femoral fracture, the time from injury to operation, and comorbidities between the two groups (P>0.05). The operation time, intraoperative blood loss, and hospital stay of the two groups were recorded. The fracture healing was examined by X-ray film, and the hip joint function was evaluated by Harris score. Results The operations in both groups were completed successfully, and the incisions healed by first intention after operation with no vascular or nerve injury. The operation time and hospital stay in group A were significantly shorter than those in group B (P<0.05), but there was no significant difference in intraoperative blood loss between group A and group B (t=?0.518, P=0.609). Patients were followed up 12-20 months (mean, 16.3 months) in group A and 12-22 months (mean, 16.7 months) in group B. X-ray film showed that all fractures healed, the healing time was (14.73±2.05) weeks in group A and (17.27±2.60) weeks in group B, and there was a significant difference between the two groups (t=?2.960, P=0.006). During follow-up, there was no complication such as prosthesis loosening, periprosthetic infection, joint stiffness, or internal fixator loosening. The Harris score of group A was significantly better than that of group B at 3, 6, and 12 months after operation (P<0.05). Conclusion Compared with titanium cable cerclage, using shape memory alloy embracing device to fix Vancouver B2 periprosthetic femoral fracture can accelerate fracture healing, shorten operation time, and reduce intraoperative blood loss. Patients can perform functional exercise earlier and restore joint function better.
Objective To introduce a clinical treatment for the reconstructionof calcaneal thalamus by bone autograft and subtalar arthrodesis for antiquatedintraarticular calcaneal fractures. Methods From July 2000 to October 2003, 11 cases with antiquated intraarticular calcaneal fractures were treated. Of the 11 cases, 9 were males and 2 females,whose ages ranged from21 to 48 years. All unilateral calcanei were involved in the 11 cases. The modified extended Lshaped approach lateral to calcaneus was adopted. The primary treatment was manipulation and immobilization with the reconstruction of calcaneal thalamus by bone autograft and subtalar arthrodesis. The average volume of the ilium for the autograft was 3.0 cm×2.5 cm×1.8 cm. Protruded osteophyte from the lateral wall of calcaneus were ablated in all 11 cases. Results All the 11 cases were followed up for 3 to 18 months, 11.5 monthson average. The reconstructed calcaneal thalamus was healed 10 to 12 weeks after the operation. Some of the patients could walk with load 8 weeks after the operation, and the average time for all the patients to walk with load was 13.2 weeks. There were 4 cases of excellent result, 5 cases of good result, and 2 cases of fair result, according to ZHANG Tieliang’s foot score system. Plain radiograph showed that Bohler angle, width of calcaneus and height of calcaneal thalamus were nearlyrestored to normal. Conclusion With the improvement of calcaneal abnormality and restoration of the shape and function of hind foot, reconstruction of calcaneal thalamus by bone autograft combined with subtalar arthrodesis is effective in treating antiquated intra-articular calcaneal fractures.
Objective To investigate the effect of treatment with proximal femoral nail (PFN) on femur intertrochanteric fractures in the old. Methods A retrospective study of 62 patients with femur intertrochantericfractures treated with PFN from October 2001 to September 2003 was carried out.The data of operative time, blood loss, intraoperative complications, wound drainage, postoperative complications, healing time, and hip function were recordedand compared with previous literature so as to evaluate the effect. Results All patients were followed up for 8-22 month(13.6 months on average). Intraoperative fracture occurred again in 2 cases. Two patients died of brain embolism and pulmonary infection respectively. Heterogeneous ossification occurred in 2 cases. Hip varus occurred in 1 case. Extra hip anteversion occurred in 1 case. The effect of other cases was satisfactory. The operative time was 76.5±29.1 min, the mean blood loss was 385.7±98.4 ml, the wound drainage was 45.5±21.7 ml, and the healing time was 13.2±3.8 weeks. According to the Sanders post-trauma hip function assessing system, the excellent and good rate was 89.6%. Conclusion The application of PFN is characterized by short operative time, less blood loss, stable fixation, so it is an effective way to treat femur intertrochanteric fracture in the old.
OBJECTIVE: To observe the clinical results in the anterior stabile operation of spinal fracture using red blood salvage. METHODS: Nineteen cases with spinal fracture were performed the anterior decompress operation. Blood cell salvage were used during operation. Other 20 cases were also reviewed as control group, who were received the same operation without blood cell salvage. RESULTS: In the 19 cases, average volume of autologous transfusion was 536 ml. Only two cases had homologous transfusion requirements. In the control group, all cases needed homologous transfusion (averaged 947 ml). CONCLUSION: In the anterior decompress operation, the intraoperative blood salvage is highly effective in reducing transfusion and also improves the security of operation
ObjectiveTo investigate the effectiveness of a modified surgical treatment of old Monteggia fracture.
MethodsBetween March 2006 and December 2013, 40 cases of old Monteggia fracture were treated with modified operation. Modified operation procedure included expanding excision of pedicled forearm fascia flap for reconstruction of the annular ligament and repair of elbow radial lateral collateral ligament complex and extending osteotomy of the ulna, callus replantation, and internal fixation with steel plate. There were 26 boys and 14 girls, aged 2-10 years with an average age of 4 years. Injury was caused by falling in 24 cases, by traffic accident in 8 cases, and by falling from height in 8 cases. The disease duration was 2-11 months (mean, 4 months). Four patients had combined radial nerve palsy.
ResultsIncision healed by first intention after operation, without early complication of radial nerve palsy, fascial compartment syndrome, or decreased hand extensor muscle strength. All the children were followed up 1-5 years (mean, 2.5 years). X-ray films showed fracture healing, and the healing time was 10-20 weeks (mean, 15 weeks). During follow-up, 3 cases had re-dislocation. Neither hand dysfunction caused by hand muscle adhesion nor radial head bottleneck shape change was found. On the basis of the functional evaluation criteria by Mackay, the results were excellent in 32 cases, good in 5 cases, and poor in 3 cases; the excellent and good rate was 92.5% at last follow-up.
ConclusionThe modified surgical treatment of old Monteggia fracture is an effective method, with good matching of humeroradial joint and without internal fixation of the humeroradial joint.
Objective To compare the effectiveness between the posterolateral approach and the posterolateral combined posteromedial approaches in the treatment of Mason type 2B posterior malleolar fracture. Methods A retrospective analysis was performed on the clinical data of 79 patients with posterior ankle fracture who met the selection criteria between January 2015 and January 2022. There were 62 cases of Mason 2B Pilon subtype and 17 cases of avulsion subtype. Among Mason 2B Pilon subtype patients, 35 were treated with posterolateral approach (group A), 27 patients were treated with combined approach (group B). There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, preoperative hospital stay, preoperative visualanalogue scale (VAS) score, and intraoperative internal fixation between the two groups (P>0.05). All patients with Mason 2B avulsion subtype were treated by posterolateral approach, including 7 males and 10 females, aged from 25 to 68 years, with an average of 46.1 years. The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The reduction quality was evaluated by Ovadia deals radiographic score, and the ankle function and pain were evaluated by VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and ankle range of motion. Results Mason 2B Pilon subtype: There was no significant difference in operation time, intraoperative blood loss, postoperative hospital stay, and follow-up time between the two groups (P>0.05). The radiological evaluation of Ovadia deals in group A was significantly worse than that in group B (P<0.05). The VAS score in the two groups significantly improved at each time point after operation, and the VAS score and AOFAS score further improved with the extension of time after operation, and the differences were significant (P<0.05). Except that the AOFAS score of group A was significantly lower than that of group B at last follow-up (P<0.05), there was no significant difference in VAS score and AOFAS score between the two groups at other time points (P>0.05). At last follow-up, the ankle range of motion in group A was significantly less than that in group B (P<0.05). There was no significant difference in the incidence of sural nerve injury, deep tissue infection, limitation of toe movement, and traumatic ankle arthritis between the two groups (P>0.05). Mason 2B avulsion subtype: The operation time was (119.47±20.61) minutes and the intraoperative blood loss was 50 (35, 55) mL. Seventeen patients were followed up 13-25 months, with an average of 18 months. The Ovadia deals score was excellent in 10 cases, good in 6 cases, and poor in 1 case at 1 week after operation, and the excellent and good rate was 94.1%. All fractures healed in 8-18 weeks with an average of 12.35 weeks. There were 1 case of sural nerve injury and 3 cases of traumatic ankle arthritis after operation. No deep tissue infection or limitation of toe movement occurred. The VAS score decreased significantly and AOFAS score increased significantly with time, and the differences were significant between different time points before and after operation (P<0.05). The ankle range of motion at last follow-up was (56.71±2.47)°. ConclusionCompared with the posterolateral approach, the combined approach is a better choice for the treatment of Mason 2B Pilon subtype. If the posteromedial bone block does not affect the reduction of the medial malleolus, the posterolateral approach can achieve good effectiveness for Mason 2B avulsion subtype.
