ObjectiveTo investigate the effectiveness of open reduction and internal fixation on high-energy ankle Logsplitter injuries (a kind of transsyndesmotic ankle fracture dislocation), and compare the prognosis between open and closed Logsplitter fracture.MethodsThe clinical data of 36 Logsplitter fractures treated with open reduction and internal fixation between April 2011 and May 2016 were retrospectively analyzed. Among them, 15 cases were open fracture and dislocation (open group) and 21 cases were closed fracture and dislocation (closed group). There was no significant difference between the two groups in gender, age, combined injury, injury to hospital admission time (P>0.05), with comparability. The wound healing, ankle mobility recovery, complications, and fracture healing were observed after operation. The ankle function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score.ResultsBoth groups were followed up 12-29 months (mean, 19 months). There was no significant difference in the follow-up time between the open group and the closed group (t=1.169, P=0.251). In the open group, there were 3 cases of postoperative infection, 3 cases of nonunion, and 5 cases of post-traumatic osteoarthritis; each mentioned complications had 1 case in the closed group; there was no significant difference in complications incidence between the two groups (P=0.41) except post-traumatic osteoarthritis incidence (P=0.02). At last follow-up, there was no significant difference in AOFAS score between the two groups (t=1.981, P=0.056). According to AOFAS score criterion, the results were good in 10 cases and general in 5 cases in the open group, and good in 13 cases and general in 8 cases in the closed group, showing no significant difference (P=0.796). There was no significant difference in the union duration and ankle flexion, dorsal extension, varus, and valgus motion between the two groups (P>0.05).ConclusionOpen reduction and internal fixation for open or closed Logsplitter fractures can achieve satisfactory results, improve fracture healing rate, effectively reduce the incidence of complications, and improve ankle function.
ObjectiveTo explore the effectiveness of open reduction and internal fixation for bipolar fracture-dislocation of the forearm.MethodsBetween June 2014 and March 2019, 14 patients with bipolar fracture-dislocation of the forearm were treated. There were 9 males and 5 females, aged from 19 to 52 years (mean, 34.9 years). There were 8 cases of falling injuries, 4 cases of traffic accident injuries, 1 case of sports injury, and 1 case of machine strangulation injury. The time from injury to admission was 2-48 hours, with an average of 16.6 hours. All patients were closed injuries. All patients were treated with open reduction and internal fixation; the upper radioulnar joints were treated with circumferential ligament repair or lateral collateral ligament repair according to the joint stability. And the patients with lower radioulnar joint instability were also treated with the TightRope plate with loop fixation. After 3 weeks of plaster fixation, the patients started functional exercises. The fracture healing time, stability and range of motion of wrist and elbow joints, and forearm rotation function were recorded. The effectiveness was evaluated by Anderson’s forearm function score at last follow-up.ResultsThe incisions healed by first intention. All 14 cases were followed up 12-36 months with an average of 24.8 months. All fractures healed, with an average healing time of 14.9 weeks (range, 12-18 weeks). The stabilities of the upper and lower radioulnar joints restored well. At last follow-up, the elbow flexion and extension range of motion was 65°-160°, with an average of 124.6°; the wrist flexion and extension range of motion was 115°-165°, with an average of 155.0°; the forearm rotation range of motion was 65°-165°, with an average of 154.6°. According to Anderson’s forearm function score, 8 cases were excellent, 5 cases were good, and 1 case was unsatisfactory. ConclusionThe treatment of bipolar fracture-dislocation of the forearm needs comprehensive consideration and individualized treatment plan. The focus is to restore the anatomical structure of the radius and ulna and firm internal fixation, stabilize the upper and lower radioulnar joints, and perform functional exercises as soon as possible after operation to obtain satisfactory effectiveness.
Objective To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral “safe zone” for Hawkins type Ⅰ-Ⅲ talar neck fractures. Methods A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral “safe zone” parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups (P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale. Results The operation time in the study group was significantly shorter than that in the control group (P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups (P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant (P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups (P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups (P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients’ satisfaction in the study group were significantly better than those in the control group (P<0.05). ConclusionThe treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral “safe zone” can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.
Objective To compare the effectiveness and shoulder function of reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF) in the treatment of Neer three/four-part proximal humeral fractures in the elderly. Methods Randomized controlled analysis was conducted on 68 patients over 70 years old with Neer three/four-part proximal humeral fractures treated with RTSA or ORIF between January 2020 and June 2022. The patients were randomly divided into RTSA group (n=32) and ORIF group (n=36). There was no significant difference (P>0.05) in the baseline data such as age, gender, body mass index, injured side, Neer classification, and preoperative Charlson comorbidity index, visual analogue scale (VAS) score, Constant shoulder score, Oxford shoulder score (OSS), and hemoglobin (Hb). The operation time, intraoperative blood loss, reduction of Hb on the 3rd day after operation, hospital stay, total cost of hospitalization, complication incidence, range of motion of shoulder joint at 2 years after operation, VAS score before operation and at 5 days and 1 month after operation, Constant shoulder score and OSS score before operation and at 2 years after operation, and imaging results during follow-up were recorded and compared between the two groups.ResultsCompared with the ORIF group, the RTSA group had longer operation time, less intraoperative blood loss, and higher total cost of hospitalization (P<0.05). There was no significant difference in Hb reduction on the 3rd day after operation between the two groups (P>0.05). The VAS scores significantly improved in both groups at 5 days and 1 month after operation (P<0.05), but there was no significant difference between the two groups (P>0.05). All patients were followed up 26-35 months, with an average of 31.2 months. In the RTSA group, there were 2 cases of poor healing of superficial incision and 1 case of transient nerve injury. There was no complication such as bone resorption around the prosthesis, lucent band, prosthesis loosening, or periprosthetic fracture in all patients. In the ORIF group, there was 1 case of poor healing of superficial incision, 3 cases of nonunion of fracture, 1 case of arthritis secondary to humeral head necrosis, and 1 case of bone absorption of large tuberosity, and no displacement or fracture failure of internal fixation was found in all patients. There was no significant difference in the incidence of complications [9.4% (3/32) vs 16.7% (6/36)] between the two groups [OR (95%CI): 0.828 (0.171, 4.014), P=0.814]. In the RTSA group, 28 cases were graded 0 and 4 cases were graded 1 at 2 years after operation. Constant and OSS scores of RTSA group were significantly better than those of ORIF group (P<0.05). The Constant score was significantly better than ORIF group in activity and strength, range of motion, lifting, abduction, and external rotation (P<0.05), and there was no significant difference in pain, daily function, and internal rotation between the two groups (P>0.05). The RTSA group had a significantly greater range of motion in lifting, abduction, and external rotation than ORIF group (P<0.05), but there was no significant difference in internal rotation between the two groups (P>0.05). ConclusionApplication of RTSA as the initial treatment of Neer three/four-part proximal humeral fractures in the elderly can achieve better rehabilitation of joint activity and lower risk of early reoperation, and improve the quality of life of elderly fracture patients. However, the difficulty of revision and the high cost of treatment require the surgeon to pay full attention and strictly grasp the indications.
ObjectiveTo evaluate the effectiveness of open reduction and internal fixation (ORIF) in treatment of acute and delayed occult Lisfranc injuries.MethodsA retrospective review of 26 patients with occult Lisfranc injuries who were treated with ORIF between July 2010 and July 2015 was applied. Fourteen patients were treated within 6 weeks after injury (acute group) and 12 patients were treated after 6 weeks of injury (delayed group). There was no significant difference between the two groups in gender, age, affected sides, and preoperative visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, and physical and mental scores of Study Short Form 12 Health Survey (SF-12) (P<0.05). The joint reduction, internal fixator, and traumatic osteoarthritis were observed by X-ray films. The pain degree, midfoot function, and quality of life were evaluated with VAS score, AOFAS score, and physical and mental scores of SF-12.ResultsAll incisions healed by first intention with no complications. All patients were followed up with the mean follow-up time of 15 months (range, 12-24 months) in acute group and 15 months (range, 12-23 months) in delayed group. At last follow-up, the VAS score, AOFAS score, and physical and mental scores of SF-12 were superior to those before operation in the two groups (P<0.05). And there was no significant difference in all indicators between the two groups (P>0.05). The satisfaction rates were 100% and 83.3% (10/12) in acute group and delayed group, respectively. The internal fixators were removed in 20 patients (11 cases in acute group and 9 cases in delayed group) at 9-24 months after operation (mean, 14.5 months). The results of X-ray films showed no traumatic osteoarthritis, midfoot collapse, internal fixation failure, or reduction loss during follow-up period.ConclusionORIF is an ideal method for both acute and delayed occult Lisfranc injuries and can obtain the similar effectiveness.
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.
ObjectiveTo investigate the safety, feasibility, and effectiveness of modified staging strategy in treatment of type C3 Pilon fractures.MethodsThe clinical data of 23 patients with type C3 Pilon fractures treated with modified staging strategy between January 2012 and January 2018 was retrospectively analyzed. There were 14 males and 9 females with an average age of 47.9 years (range, 22-61 years). Twenty-three cases were high-energy injuries, including 11 cases of traffic accidents and 12 cases of falling from height. One case was an open fracture of Gustilo type ⅢA with no obvious sign of infection on the wound after early treatment. The remaining patients were closed fractures. The time from injury to admission was 3-40 hours with an average of 16.4 hours. The preoperative pain visual analogue scale (VAS) score was 7.22±1.17 and American Orthopaedic Foot and Ankle Society (AOFAS) score was 0. The flexion and plantar flexion activities of ankle joint were (1.13±0.26) and (4.79±0.93)°, respectively. Twenty-two patients had a tibiofibular fracture. In the first-stage operation, the posterior approach was used to reduce the posterior column fracture and the external stent was temporarily assisted. After the soft tissue crisis was removed, the final fracture reduction and internal fixation was performed through the anterior approach in the second-stage operation.ResultsAll 23 patients were followed up 12-84 months with an average of 26.6 months. The waiting time before the first-stage operation was 4-47 hours with an average of 23.4 hours. The interval between the two stage operations was 6-11 days with an average of 7.9 days. The first-stage operation time was 60-90 minutes with an average of 67.8 minutes; the second-stage operation time was 110-160 minutes with an average of 124.1 minutes. The hospital stay was 15-28 days with an average of 23.5 days. One patient (4.35%) had a tourniquet paralysis symptom after the second-stage operation, and two patients (8.7%) had delayed anterior incision healing. The other patients had incision healing without early complications. The radiographic review showed that the quality of articular surface reduction was excellent in 19 cases, good in 2 cases, and poor in 2 cases, with an excellent and good rate of 91.3%. At last follow-up, the fractures healed with no bone nonunion and malunion; the different degrees of osteoarthritis occurred in 7 cases. At last follow-up, the VAS score was 0.89 ±0.88 and the AOFAS score was 81.3±7.8. The flexion and plantar flexion activities of ankle joint were (10.23±5.05) and (20.97±3.92)°, respectively, and the differences between pre- and post-operation were significant (P<0.05).ConclusionThe midified staging strategy can not only provide a template for articular surface reduction for the second-stage anterior surgery, but also improve the quality of the reduction. It can also reduce the interval between the two operations and the operation time of the second-stage operation through the first-stage posterior fascial decompression, and can obtain satisfactory effectiveness.
Objective To analyze the effectiveness of minimally invasive safe approach of the knee joint in the treatment of avulsion fractures of the tibial insertion of the posterior cruciate ligament (PCL). Methods The clinical data of 26 patients with avulsion fractures of tibial insertion of PCL treated with open reduction and internal fixation via minimally invasive safe approach of the knee joint between February 2019 and March 2022 were analyzed retrospectively. There were 18 males and 8 females with an average age of 45.5 years (range, 33-58 years). The causes of injury were traffic accident in 14 cases, falling from height in 7 cases, and sports injury in 5 cases. There were 15 cases of left knee and 11 cases of right knee. The preoperative Lysholm score of knee joint was 34.4±7.3 and the flexion range of motion of knee joint was (69±12)°. According to Meyers classification, there were 8 cases of type Ⅱ and 18 cases of type Ⅲ. The time from injury to operation ranged from 1 to 5 days, with an average of 2 days. ResultsThe operation time was 40-70 minutes, with an average of 55 minutes; the intraoperative blood loss was 10-30 mL, with an average of 15 mL. Delayed incision healing occurred in 1 case after operation, and the incision healed after conservative treatment, and the incisions of the other patients all healed by first intention. Postoperative X-ray films showed satisfactory fracture reduction. All 26 patients were followed up 3-30 months, with an average of 22 months. No complication such as neurovascular injury, infection, and knee extension disorder occurred after operation. X-ray films at 3 months after operation showed that all fractures healed without displacement of the fracture ends; the posterior drawer test was negative. At last follow-up, the flexion range of motion of knee joint was (120±9)°, the Lysholm score was 90.7±3.8, which were significantly improved when compared with those before operation (t=16.376, P<0.001; t=47.665, P<0.001). Conclusion The minimally invasive safe approach of the knee joint for the treatment of PCL tibial insertion avulsion fractures is easy to operate, with minimal surgical trauma, safe and reliable approach, and satisfactory recovery of knee joint function after operation.
ObjectiveTo explore the effectiveness of hollow screw for the treatment of basilar part fracture of hamate hook.MethodsFive patients with basilar part fracture of hamate hook, aged 24-47 years (mean, 31 years) were treated with open reduction and hollow screw fixation between June 2015 and February 2019. There were 4 males and 1 female. The causes of injury were athletic injury in 3 cases, falling injury in 1 case, and crushing injury in 1 case. Among them, 1 case was combined with sensory disturbance of one and a half fingers on the ulnar side of the palm. The grip strength of the affected side was significantly decreased when compared with that of the healthy side in all patients. The intervals between injury and surgery were 3-8 days (mean, 4.2 days). Postoperative follow-up was conducted regularly to measure the grip strength of the affected and healthy fingers and the total motion of ring and little fingers of the affected side. Darrow criteria was used to evaluate the effectiveness.ResultsAll the incisions healed by primary intention. All the patients were followed up 6-32 months (mean, 16 months). X-ray films showed that the basilar part fracture of hamate hook reached bony union, and the healing time was 2.0-3.5 months (mean, 2.2 months). At last follow-up, the grip strength of the affected side was (35.80±3.76) kg, showing no significant difference when compared with healthy side [(36.00±4.94) kg] (t=0.094, P=0.930); and the total motion of ring and little fingers of the affected side was (529.0±8.9)°, which was significantly different from that before operation [(232.0±34.7)°] (t=18.108, P=0.000). In 1 patient with ulnar nerve injury, the two-point discrimination of the innervation area was 4 mm, and the pain sensation and temperature sensation returned to normal. Assessed by Darrow criteria, the results were excellent in 4 cases and good in 1 case.ConclusionFor the basilar part fracture of hamate hook, hollow screw fixation can obtain secure reduction and fixation and provide sustained compression and counter-rotation for the broken end of fracture, thus allowing early joint motion and promoting fracture healing and recovery of wrist function. It is a relatively good method for the treatment of basilar part fracture of hamate hook.
ObjectiveTo compare the clinical and radiographic outcomes of bioabsorbable screw and metallic screw for Maisonneuve fracture.MethodsThe clinical data of 68 patients of Maisonneuve fracture treated with open reduction and internal fixation between October 2012 and October 2016 were retrospectively analyzed. Metallic screw fixation was used in 37 cases (group A) and absorbable screw fixation was used in 31 cases (group B). There was no significant difference in age, gender, weight, operated side, cause of injury, time from injury to operation, and complications between the two groups (P>0.05). At last follow-up, the tibiafibular clear space (TFCS), tibiafibular overlap (TFO), medial clear space (MCS), and syndesmotic malreduction rate were recorded. And the dorsiflexion and plantar-flexion range of motion, pain visual analogue scale (VAS) score, ankle and hind foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and Olerud-Molander (OM) score were recorded.ResultsAll patients were followed up 25-43 months, with an average of 32.3 months. There was no significant difference in the operation time between the two groups (t=1.229, P=0.282). All the fractures healed, and there was no significant difference in fracture healing time between the two groups (t=1.367, P=0.413). At last follow-up, the syndesmotic malreduction rate of group A was 16.2% (6/37), showing no significant difference when compared with group B [6.2% (2/31)] (χ2=1.549, P=0.213). There were 3 complications in group A, 1 was superficial wound infection, 1 was local heterotopic ossification due to failure to remove the screws in time, 1 was local heterotopic ossification of the screws; and there were 2 complications in group B, 1 was rejection and 1 was local heterotopic ossification of the screws. There was no significant difference in the incidence of complications between the two groups (χ2=0.068, P=0.794). There was no significant difference in TFCS, MCS, TFO, ankle dorsiflexion and plantar-flexion range of motion, AOFAS score, OM score, and VAS score between the two groups at last follow-up (P>0.05).ConclusionCompared with metallic screw, absorbable screws provide adequate fixation and functional recovery with avoiding screw removal and lower syndesmotic malreduction.
