ObjectiveTo review the research progress on intra-articular screw penetration in proximal humeral fracture treated with locking plate. MethodsThe domestic and foreign literature about the proximal humeral fracture treated with locking plate was extensively reviewed. The incidence of screw penetration and risk factors were summarized from both primary and secondary screw penetrations, and the reasons of the intra-articular screw penetration and the technical solutions to avoid the penetration were analyzed. ResultsThe incidence of intra-articular screw penetration is about 11%-30%, which includes primary and secondary screw penetrations. The primary screw penetration is related to improper operation, inaccurate measurement, and “Steinmetz solid” effect, which results in inadequate fluoroscopy and blind zone. The secondary screw penetration is related to the loss of reduction and varus, collapse, and necrosis of the humeral head. The risk factors for intra-articular screw penetration include the bone mass density, the fracture type, the quality of fracture reduction, the applied location, number, and length of the plate and screws, and whether medial column buttress is restored. Improved fracture reduction, understanding the geometric distribution of screws, good intraoperative fluoroscopy, and reconstruction of medial column buttress stability are the key points for success. ConclusionThe risk of the intra-articular screw penetration in the proximal humeral fractures treated with locking plates is still high. Follow-up studies need to further clarify the cause and mechanism of screw penetration, and the risk factors that lead to screw penetration, in order to effectively prevent the occurrence of this complication.
Objective To summarize the method and effectiveness of open reduction and internal fixation in the treatment of 4 cases of bipolar clavicle dislocations. Methods Between June 2017 and June 2022, 4 patients with bipolar clavicle dislocations were admitted. There were 3 males and 1 female. The age ranged from 27 to 63 years, with an average age of 45 years. There were 2 cases of crushing injury of mine car, 1 case of traffic accident injury, and 1 case of heavy object injury. The time from injury to operation was 3-7 days, with an average of 5.0 days. The sternoclavicular joint dislocations were classified as Grade Ⅱ in 1 case and type Ⅲ in 3 cases, and anterior dislocation in 3 cases and posterior dislocation in 1 case. The acromioclavicular joint dislocations were classified as Tossy type Ⅱ in 2 cases and type Ⅲ in 2 cases. After open reduction, the sternoclavicular joint and acromioclavicular joint were fixed with lateral malleolus locking titanium plate and clavicular hook plate, respectively. ResultsAll operations were successfully completed without vascular or nerve injury. All incisions healed by first intention. All patients were followed up 12-18 months, with an average of 14 months. At last follow-up, the shoulder joint functions were rated as excellent in 3 cases and good in 1 case according to Rockwood score. During follow-up, there was no loosening of internal fixator or fracture. The internal fixators were removed in all patients at 5-7 months after operation (mean, 6 months), and no re-dislocation occurred after removal. Conclusion For bipolar clavicle dislocation, open reduction combined with lateral malleolus locking titanium plate fixation of the sternoclavicular joint and clavicle hook plate fixation of the acromioclavicular joint can achieve good effectiveness. It has the advantages of simple operation, high safety, firm fixation, and fewer complications, and the shoulder function recovers well.
Objective To investigate the effectiveness of a new tibial plateau posterolateral column universal locking anatomical plate (hereinafter referred to as “new universal locking anatomical plate”) in the treatment of tibial plateau posterolateral column fractures. Methods Between October 2020 and December 2021, 14 patients with tibial plateau posterolateral column fracture were treated with a new universal locking anatomical plate. There were 7 males and 7 females with an average age of 59 years ranging from 29 to 75 years. There were 5 cases on the left side and 9 cases on the right side. The causes of injury included falling from height in 5 cases, traffic accident in 7 cases, and other injuries in 2 cases. The time from injury to operation ranged from 3 to 10 days, with an average of 6 days. According to Schatzker classification, there were 4 cases of type Ⅱ, 8 cases of type Ⅴ, and 2 cases of type Ⅵ. All fractures involved the posterolateral tibial plateau. Three column classification: two columns (anterolateral column+posterior column) in 4 cases, three columns in 10 cases. The operation time, intraoperative blood loss, fracture healing, and complications were recorded. The reduction of tibial plateau fracture was evaluated by Rasmussen radiographic score, and the recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score. Results All 14 cases completed the operation successfully. The operation time was 95-180 minutes, with an average of 154 minutes, and the intraoperative blood loss was 100-480 mL, with an average of 260 mL. All patients were followed up 6-19 months, with an average of 12.5 months. All fractures healed, and the healing time was 15-24 weeks, with an average of 18.7 weeks. During the follow-up, there was 1 case of common peroneal nerve palsy and 1 case of traumatic osteoarthritis. There was no other complication such as vascular injury, incision infection, deep venous thrombosis of lower limbs, heterotopic ossification, bone nonunion, and failure of internal fixation. The reduction of tibial plateau fractures was good immediately after operation, and the Rasmussen radiological score was 10-18, with an average of 15.7; 3 cases were excellent, 10 cases were good, and 1 case was fair, with an excellent and good rate of 92.9%. The scores and grades of HSS at 3 months after operation and at last follow-up significantly improved when compared with those before operation (P<0.05). There was no significant difference between 3 months after operation and last follow-up (P>0.05).Conclusion For the fractures involving the posterolateral column of the tibial plateau, the new universal locking anatomical plate can provide strong fixation, satisfactory postoperative fracture reduction, and good recovery of knee function.
Objective To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection. Methods The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score. Results All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up (P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%. ConclusionLimited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.
Objective To evaluate the effectiveness of unstable femoral neck fracture with posteromedial comminutations treated by cannulated screws and medial bracing plate combined with bone allograft. MethodsThe clinical data of 18 patients with unstable femoral neck fracture with posteromedial comminutations treated by cannulated screws and medial bracing plate combined with bone allograft between July 2016 and March 2020 were retrospectively analyzed. The age ranged from 22 to 64 years, with a median age of 43 years. The causes of injury included 11 cases of falling injury, 3 cases of traffic accident injury, and 4 cases of fall from height injury. According to Garden classification, the femoral neck fracture was classified as type Ⅲ in 3 cases, type Ⅳ in 15 cases, and all patients were type Ⅲ according to Pauwels classification. The time from injury to operation was 1-5 days, with an average of 2.3 days. The fracture healing time and complications were recorded. The quality of fracture reduction was evaluated by Garden index immediately after operation; at last follow-up, the degree of femoral neck shortening was determined by Zlowodzki method, Harris score was used to evaluate hip function. Results The operation time was 62-98 minutes (mean, 75 minutes); intraoperative blood loss was 101-220 mL (mean, 153 mL). Cannulated screws guide wire was inserted 3-5 times (mean, 4 times). Intraoperative fluoroscopy was performed 9-21 times (mean, 15 times). The hospital stay was 5-11 days (mean, 7.2 days). All the patients were followed up 12-40 months with an average of 17.3 months. There was no postoperative complication such as accumulated pneumonia, lower extremity deep venous thrombosis, nail cutting, nail withdrawal, internal fixation fracture, and so on. There was no fracture nonunion and osteonecrosis of the femoral head during the follow-up; the fracture healing time was 7-15 weeks, with an average of 12.1 weeks. The quality of fracture reduction was evaluated immediately after operation, the results were grade Ⅰ in 15 cases and grade Ⅱ in 3 cases. At last follow-up, there were 2 cases with femoral neck shortening less than 5 mm and 1 case with 5-10 mm. The incidence of femoral neck shortening was 16.7%. The Harris score of hip joint was 73-97, with an average of 93.5; among them, 12 cases were rated as excellent, 3 cases as good, and 3 cases as fair, with an excellent and good rate of 83.3%. ConclusionFor the treatment of unstable femoral neck fracture with posteromedial comminutations, cannulated screws and medial bracing plate combined with bone allograft are dramatically effective due to earlier weight bearing, faster fracture healing, and better hip function recovery.
Objective To assess the outcomes of pedicle subtration osteotomy and short-segment pedicle screw internal fixation in kyphosisdeformity. Methods From June 2001 to November 2003, 16 cases of kyphosis deformity were treated with pedicle subtration osteotomy and short-segment pedicle screw internal fixation, including 11 males and 5 females and aging 24-51 years. The kyphosis deformity was caused by ankylosing spondylitis in 12 cases, old lumbothoracic fracturedislocation in 2 cases, and vertebral dysplasia in 2 cases. The disease course was 7-25 years with an average of 12.8years. The whole spine radiographs were taken pre-and postoperatively. The sagittal balance was assessed by measuring thoracic kyphosis angle, lumbar lordosis angle, acrohorizontal angle and distance between posterosuperior point of S1and the vertical line. The clinical outcomes were assessed by Bridwell-Dewald scale for spinal disorders. Results The mean follow-up period was25.6 months. The mean bleeding was 1 100 ml. Satisfactory bone graft healing was achieved at final follow-up. Complications were paralytic intestinal obstruction in 1 case, dura laceration in 1 case, and temporary lower limb paralysis in 2 cases. Final follow-up radiograph showed an increase in lumbar lordosis angle from 9.6±16.4° to 42.6±14.3°(P＜0.05), whereas thoracic kyphosis angle remained relative stable. The distance between posterosuperior point of S1 and the vertical line was decreased from 97.5±45.6 mm to 10.7±9.6 mm(P＜0.05). Satisfactory clinical outcome was achieved by evaluating the changes of pain, social and working status. Conclusion Pedicle subtraction osteotomy and short-segment pedicle screw internal fixation is effective for correction of kyphosis deformity.
ObjectiveTo analyze the importance and effectiveness of Tillaux bone block in Ruedi-Allgower type Ⅲ of Pilon fracture surgery.MethodsTwenty-one patients with Pilon fractures with Tillaux dislocation were treated between February 2010 and September 2013. There were 17 males and 4 females, aged from 28 to 68 years with an average age of 42.9 years. The causes of injury included falling from height in 13 cases, falls injury in 4 cases, crush injury in 2 cases, and sprained injury in 2 cases. X-ray film and CT examination showed that all 21 patients had fibula fracture and Tillaux bone block had obvious displacement. According to AO/OTA classification, there were 3 cases of type C1.2, 1 case of type C1.3, 10 cases of type C2, and 7 cases of type C3. The duration from injury to operation ranged from 4 to 31 days, with an average of 10 days. All cases of Pilon fracture were treated with open reduction and plate internal fixation. Steel plate or screw was used to fixation for Tillaux block; allograft bone graft was selected for compression of fracture.ResultsThere were 2 cases of skin necrosis at the corner of wound after operation, and the wound healed after corresponding treatment; the wound healed at first intention in the other 19 cases. The effect of surgical reduction was evaluated by Burwell-Chamley imaging scoring system within 72 hours after operation, there were 19 cases of anatomical reduction and 2 cases of general reduction. All the 21 patients were followed up 18-48 months, with an average of 24.9 months. No complication such as nerve injury, loosening of internal fixation, or periprosthetic fracture was found during follow-up. All fractures obtained bone healing, which lasted from 4 to 8 months, with an average of 6 months. The ankle and hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate the ankle and hindfoot function at 1 year after operation or at last follow-up, the results were excellent in 13 cases, good in 6 cases, and fair in 2 cases, with an excellent and good rate of 90.5%. Internal fixator was removed from 19 patients at 15-19 months after operation. There were 17 cases of joint hyperplasia and 4 cases of osteoarthritis. All joint mobility was restored. The functional recovery of the ankle joint was evaluated according to the Olerud-Molander ankle fracture score standard, the results were good in 6 cases, fair in 8 cases, and poor in 7 cases at postoperative full weight training; and after 1 year of full weight training, the results were excellent in 10 cases, good in 3 cases, fair in 6 cases, and poor in 2 cases.ConclusionThe Tillaux bone block is a reliable marker for the reduction of complex Pilon fractures. The reconstruction of the Tillaux can improve the effectiveness of complex Pilon fractures.
Objective To observe ultrastructural changes of the intervertebraldisk in the corresponding area after internal fixation of spinal column. Methods Twenty-four Japanese big ear rabbits were divided into internal fixation of spinal column group (n=12) and control group (n=12). The internal fixation model was made as follows: The spinous processes and erector spinal muscle were exposed and the T10L3 spinous processes and the relevant two-side articular processes under the periosteumwere isolated. With the help of L-shaped Kirschner wires, the steel wire was threaded through the articular of T11,T12,L1 and L2, and were connected with L-shaped Kirschner wries. After 6 months of operation, the following intervertebral disk tissues were observed with transmission electeon microscope: nucleus pulposus, internal annlus fibrosus and external anulus fibrosus of L1 intervertebraldisk. The T12and L2 intervertebal disk surface structure was observedhorizontally and longitudinally with scanning electron microscope, respectively. Results After internal fixation of spinal column, the structural changes of cells in nucleus pulposus and internal annulus fibrosus occurred earlier than that in the external annulus fibrosus. Proteoglycan and special structure were found in nucleus pulposus and matix of annulus fibrosus. However, the forms of special structure in nucleus pulposus and internal layer of annulus fibrosus were different. In the degeneration matrix of intervertebral disc, the proteoglycan particles and special structure were obviously decreased. Conclusion Abnormal stress environment can result in the degeneration of intervertebral disk. There is a regular distribution of the special structure in nucleus pulposus and matrix of annulus fibrosus, which is related to biology behaviour of proteoglycan particles in the degeneration of intervertebral disk.
ObjectiveTo assess the outcomes in indirect reduction technique via Nice knot for transverse patellar fractures.MethodsThe clinical data of 25 patients with transverse patellar fractures meeting the inclusion criteria between January 2017 and December 2018 were retrospectively analyzed. The patients were divided into trial group (n=13) and control group (n=12) according to different intraoperative reduction methods. No significant difference was found in gender, age, affected side, cause of fracture, classification, or the time from injury to operation between the two groups (P>0.05). In the trial group, No.2 suture was used to cross the quadriceps tendon and patellar tendon to construct the Nice knot, then the suture was tightened to make the distal and proximal fracture segments contact in an indirect reduction pattern. Depend on Nice knot’s sliding compression and self-stabilizing function, the suture mesh created an anterior tension band as a temporary fixation. In the control group, Weber’s clamp was used to hold the fracture segments directly and fixed temporarily. After reduction, terminal fixation was conducted using a titanium Kirschner wire with titanium cable in both groups. The operation time, intraoperative blood loss, follow-up time, fracture healing time, and complications were recorded and compared in the two groups. At last follow-up, the knee function was evaluated according to the B?stman scoring criteria for efficacy in patellar fractures.ResultsThe operation time in the trial group was significantly shorter than that in the control group (t=?2.165, P=0.041). There was no significant difference of intraoperative blood loss between the two groups (t=0.514, P=0.612). The incisions of the two groups healed by first intention. All the patients were followed up 12-16 months, with an average of 14.4 months, no significant difference was found in the follow-up time between the two groups (t=?0.309, P=0.760). One patient in the control group developed soft tissue irritation symptoms at 1 day after operation, and no special treatment was given, the symptoms disappeared at 2 months after operation. The fractures of the two groups healed at the 12-week follow-up. During the follow-up, there was no complication such as loosening and fracture of titanium cables and tendon tissue calcification. At last follow-up, the B?stman score presented no significant difference between the two groups (t=?0.086, P=0.932). In the trial group, an 80-year-old female patient was evaluated as good (score, 27) due to atrophy of the quadriceps femoris, leg weakness, and affected stair climbing, and the rest 24 patients were all evaluated as excellent.ConclusionThe indirect reduction with Nice knot can shorten the operation time in the treatment of transverse patellar fractures, and obtain good effectiveness.
ObjectiveTo investigate the effectiveness of proximal femoral nail anti-rotation (PFNA) and cerclage fixation for complicated femoral subtrochanteric fractures.MethodsA clinical data of 74 patients with complicated femoral subtrochanteric fractures, who were admitted between March 2016 and March 2019 and met the criteria, was retrospectively analyzed. Among them, 39 patients were treated with limited open reduction and PFNA combined with cerclage fixation (observation group) and 35 patients were treated with closed reduction and PFNA fixation (control group). There was no significant difference in gender, age, cause of injury, side and type of fracture, and the time from injury to operation (P>0.05). The ratio of postoperative hemoglobin (1, 3, and 5 days) to the preoperative hemoglobin, the operation time, the first weight-bearing time after operation, and the hospital stay were recorded. X-ray films were taken to observe fracture healing in the two groups and bone resorption around the cerclage in the observation group, and the fracture healing time was recorded. Hip function was evaluated by Harris scoring. ResultsThe operation time of the observation group was significantly longer than that of the control group (P<0.05), but the first weight-bearing time and hospital stay were significantly shorter (P<0.05). All patients were followed up 12 months. There was no significant difference in the ratios of post- to pre-operative hemoglobin (1, 3, and 5 days) between the two groups (P>0.05). X-ray film reexamination showed that the fractures of the two groups healed smoothly, and the fracture healing time of the observation group was significantly shorter than that of the control group (t=?12.989, P=0.000). No bone resorption around the cerclage occurred in the observation group. The Harris scores of the observation group were better than those of the control group at 7 days and 1, 2, and 3 months after operation (P<0.05), and there was no significant difference between the two groups at 6 months after operation (t=1.329, P=0.180).ConclusionCompared with PFNA fixation, PFNA combined with cerclage fixation for the complicated femoral subtrochanteric fractures has a shorter operation time, and can obtain immediate stability after fixation, which can meet the needs of patients for early functional exercise.
