ObjectiveTo investigate the effectiveness of pronator quadratus muscle sparing in volar plate fixation for unstable distal radius fracture in adults.MethodsThe clinical data of 62 cases of unstable distal radius fractures between January 2017 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative exposure, the patients were divided into the observe group (28 cases with the pronator quadratus muscle sparing surgery) and the control group (32 cases with cutting the pronator quadratus muscle in operation and repairing it after volar plate fixation). There was no significant difference in general data such as gender, age, handedness, cause of injury, fracture classification, time from injury to operation, visual analogue scale (VAS) score, and range of motion (ROM) of wrist (flexion, extension, pronation, and supination) before operation between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, fracture healing time, and postoperative complications were recorded and compared between the two groups. VAS score and ROM of wrist of two groups before operation and at 3 days and 3 months after operation were calculated and compared. The wrist function was evaluated according to the Krimmer evaluation criteria at 6 months after operation.ResultsThere was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). The postoperative hospital stay and fracture healing time of the observe group were significantly shorter than those of the control group (P<0.05). Patients in both groups were followed up 6-30 months, with an average of 13 months. The VAS score and ROM of wrist of the observe group at 3 days after operation were superior to the control group (P<0.05), but there was no significant difference between the two groups at 3 months after operation (P>0.05). At 6 months after operation, according to Krimmer evaluation criteria, the wrist function of the observe group was excellent in 21 cases and good in 7 cases, with an excellent and good rate of 100%; and the wrist function of the control group was excellent in 22 cases, good in 11 cases, and fair in 1 case, with an excellent and good rate of 97.1%. There was no significant difference in wrist function between the two groups (χ2=1.344, P=0.511). One case of poor incision healing occurred in the observe group, and 7 cases of poor incision healing and 5 cases of tendon pain occurred in the control group after operation. The incidence of postoperative complications was less in the observe group (3.6%) than in the control group (35.3%) (χ2=9.325, P=0.002).ConclusionIt is feasible of the pronator quadratus muscle sparing in the volar plate fixation for unstable distal radius fracture in adults. It is beneficial to recover wrist function early after operation, reduce postoperative complications, shorten the length of hospitalization, protect the soft tissue of fracture site, and promote fracture healing.
Objective To find out an ideal method of internal fixation for the treatment of fractures of proximal radius. Methods From August 2001 to April 2004, 24 patients suffering from fractures of proximal radius were treated with NiTi shape memory alloy embracing fixator. Of 24 patients, there were 19 males and 5 females, aging from 16 to 48 years; there were 9 cases of wrestling injury, 5 cases of crush injury, 4 cases of traffic accident injury, 3 cases of direct violence impact injury and 3 cases of high falling injury. All patients were given operation according to fix method of the shape memory alloy embracing fixator. All cases were regularly followed up to observe the fracture healingand functional recovery. Results All cases were followed up postoperatively from 4 months to 21 months with an average of 10 months. No complication occurred during operation and after operation. Healing by first intention was achieved. X－ray showed that all cases achieved clinical union 8－12 weeks after operation. According to Anderson’scriteria and the results were excellent in 18 cases, good in 5 cases, and fairin 1 case. The excellent and good rate was 95.83 %. Conclusion The internal fixation with shape memory alloy embracing fixator has as follows adventages: less trauma, esay－to－do, stable fixation, better tissue compatibility and less complication in treating fractures of proximal radius. This method can enhance the fracture healing and functional recovery. So it is a better method to treat fractures of proximal radius.
ObjectiveTo explore the effectiveness difference between titanium elastic intramedullary nail internal fixation and bone plate internal fixation in the treatment of adult Galeazzi fracture.MethodsNinety-seven patients of Galeazzi fracture according with the selection criteria were divided into 2 groups by prospective cohort study, who were admitted between January 2012 and November 2015. In the patients, 59 were treated with open reduction and bone plate internal fixation (plate group), and 38 with titanium elastic intramedullary nail internal fixation (minimally invasive group). There was no significant difference in the gender, age, cause of injury, fracture site, type of fracture, and time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between 2 groups, and the forearm function was evaluated by Anderson score.ResultsAll the patients were followed up 12-23 months (mean, 17 months). The operation time, intraoperative blood loss, fracture healing time of minimally invasive group were significantly less than those in plate group (P<0.05). There were 1 case of fracture nonunion, 1 case of wound infection in plate group, and 1 case of nail tail slight infection in minimally invasive group, which were all cured after the corresponding treatment. The remaining patients had good fracture healing, and no vascular injury, internal fixation failure, deep infection, or other complications occurred. According to Anderson score at 12 months after operation, the forearm function results were excellent in 46 cases, good in 12 cases, and poor in 1 case, with an excellent and good rate of 98.3% in plate group; and the results were excellent in 26 cases, good in 11 cases, and poor in 1 case, with an excellent and good rate of 97.4% in minimally invasive group; showing no significant difference (χ2=0.10, P=0.75).ConclusionMinimally invasive fixation with titanium elastic nail has such advantages as small damage, quick recovery, no skin scarring, etc. As long as the correct indication is selected, minimally invasive titanium intramedullary nail internal fixation of Galeazzi fractures can also get good effectiveness.
ObjectiveTo investigate the effectiveness of modified Stoppa approach with medial wall spring plate (MWSP) for involving quadrilateral of acetabulum fracture. MethodsBetween March 2008 and September 2013, 38 patients with involving quadrilateral of acetabulum fracture were treated, including of 23 males and 15 females with an average age of 36.08 years (range, 19-56 years). The causes included traffic accidents injury (21 cases), crash injury of heavy object (10 cases), and falling injury from height (7 cases). The interval of injury and admission was 3 hours to 2 days (mean, 11 hours). There were 12 cases of anterior column fracture (type D), 5 cases of transverse fractures (type E), 8 cases of T shaped fractures (type H), 6 cases of anterior column fracture with posterior transverse fractures (type I), and 7 cases of double column fractures (type J) according to Letournel-Judet classification. Based on fracture types, MWSP was used to fix fracture by modified Stoppa approach in 19 cases or combined with the ilioinguinal approach in 10 cases or combined with Kocher-Langenbeck approach in 9 cases. The operation time, blood loss, and complications were recorded. The effectiveness of reduction and the hip function were evaluated according to Matta score system and Merled' Aubigne and Postel score system. ResultsThe operation time was 85-210 minutes (mean, 130 minutes).The intra-operative blood loss was 450-900 mL (mean, 650 mL). There were 1 case of vascular avulsion, and 1 case of bladder injury during operation; there were 8 cases of venous thrombosis and 2 cases of fat liquefaction of incision after operation. Screw was implanted into the articular joint in 1 case on CT after operation. Matta X-ray assessment showed anatomical reduction in 9 cases, satisfactory reduction in 24 cases, and unsatisfactory reduction in 5 cases, and the satisfaction rate of reduction was 86.84%. Three patients had limb shorting of 0.8-1.0 cm when compared with normal limb. All patients were followed up for 7 to 18 months with an average of 10 months. Fractures healed well within 13-16 weeks with an average of 14 weeks. At 1 year after operation, the results were excellent in 9 cases, good in 21 cases, general in 5 cases, and poor in 3 cases, and the excellent and good rate was 78.95% according to the Merled'Aubigne and Postel hip score standards. ConclusionInvolving quadrilateral of acetabulum fracture can be fixed with MWSP by modified Stoppa approach or combined with other approaches to obtain good exposure, less invasion, satisfactory reduction, stable fixation, and low complications.
ObjectiveTo develop an instrument for sacroiliac joint fixation with less injury and less complications. MethodsFirstly, 18 adult pelvic specimens (8 males and 10 females) were used to measure the anatomical data related to the locking plates and locking screws on the sacrum and ilium, and the polyaxial locking plate screw system of the sacroiliac joint was designed according to the anatomic data. This system was made of medical titanium alloy. Then 4 adult male plevic specimens were harvested and the experiment was divided into 3 groups:group A (normal pelvic), group B (the dislocated sacroiliac joint fixed with sacroiliac screws), and group C (the dislocated sacroiliac joint fixed with polyaxial locking plate screw system). The vertical displacement of sacroiliac joint under the condition of 0-700 N vertical load and the horizontal displacement on angle under the condition of 0-12 N·m torsional load were compared among the 3 groups by using the biological material test system. Finally, the simulated application test was performed on 1 adult male cadaveric specimen to observe soft tissue injury and the position of the locking plate and screw by X-ray films. ResultsAccording to the anatomic data of the sacrum and ilium, the polyaxial locking plate screw system of the sacroiliac joint was designed. The biomechanical results showed that the vertical displacement of the sacroiliac joint under the condition of 0-700 N vertical load in group A was significantly bigger than that in group B and group C (P < 0.05), but there was no significant difference between group B and group C (P>0.05). The horizontal displacement on angle under the condition of 0-12 N·m torsional load in group A was significantly less than that in group B and group C (P < 0.05). The horizontal displacement on angle under the condition of 0-6 N·m torsional load in group B was bigger than that in group C, and the horizontal displacement on angle under the condition of 6-12 N·m torsional load in group B was less than that in group C, but there was no significant difference between group B and group C (P>0.05). The test of simulating application showed that the specimen suffered less soft tissue injury, and this instrument could be implanted precisely and safely. ConclusionThe polyaxial locking plate screw system of the sacroiliac joint has the advantages of smaller volume and less injury; polyaxial fixation enables flexible adjustment screw direction. The simulated application test shows satisfactory fixing effect.
目的 探讨应用经皮接骨板固定技术（MIPPO）结合锁定钢板（LCP）固定治疗胫腓骨骨折的疗效。 方法 2009年11月－2012年1月应用MIPPO技术结合LCP固定治疗胫腓骨干骨折62例。其中男42例，女20例；年龄16～85岁，平均45岁。骨折按AO分型：A1型10例，A2型3例，A3型3例，B1型18例，B2型8例，B3型4例，C1型10例，C2型5例，C3型1例。闭合骨折47例；开放骨折15例，根据Gustilo-Anderson分型，Ⅰ型8例，Ⅱ型6例，ⅢA型1例。伤后内固定时间3 h～10 d，平均6 d。 结果 开放骨折有3例伤口Ⅱ期愈合，其中1例伤口皮缘坏死，1例钢板部分外露经换药和清创减张缝合后伤口愈合，1例骨外露经皮瓣转移愈合；其余患者术后伤口均Ⅰ期愈合。62例均获随访，随访时间6～16个月，平均9个月。无感染、神经损伤、骨筋膜室综合征发生。术后2～4个月骨折均愈合。根据Johner-Wruhs疗效评价，优48例，良14例；开放性骨折15例中优10例，良5例。 结论 MIPPO技术结合LCP固定治疗胫腓骨干骨折，具有创伤小、骨折愈合快等优点。
Objective To analyze the effectiveness of flexible internal fixation with locking plate for distal femoral fractures. Methods Between January 2015 and June 2016, 21 cases of distal femoral fractures were treated. There were 5 males and 16 females with an average age of 62 years (range, 32-88 years). Injury was caused by falling in 14 cases, by traffic accident in 5 cases, and by falling from height in 2 cases. The fractures located at the left side in 13 cases and the right side in 8 cases. Twenty cases were fresh closed fractures and 1 case was open fracture. According to AO/Association for the Study of Internal Fixation (AO/OTA) typing, there were 5 cases of type 33-A1, 3 of type 33-A2, 8 of type 33-A3, 2 of type 33-C2, and 3 of type 33-C3. The time from injury to operation was 3-13 days (mean, 6.5 days). Results All operation incisions healed primarily. Eighteen patients were followed up 12-24 months (mean, 16 months). All fractures healed, and the healing time was 8-24 weeks (mean, 16.6 weeks). The articular surface was smooth and the thigh length was recovered. No screw loosening, plate breakage, valgus or varus of the knee, stiff of the knee or non-unions occurred during follow-up. There was no significant difference in visual analogue scale (VAS) score between at 6 and 12 months after operation (P>0.05), and the difference was significant bewteen the other time points (P<0.05). There were significant differences in the range of motion of knee between 1 month and 3, 6, 12 months (P<0.05); there was no significant difference between 3, 6, and 12 months (P>0.05). There were significant differences in the Neer scores between 1, 3, 6, and 12 months after operation (P<0.05). According to Neer score criteria, the results were excellent in 12 cases and good in 6 cases at 12 months after operation. Conclusion Flexible internal fixation with locking plate for distal femoral fractures can get good functional recovery.
Objective To analyse the procedure and effectiveness of internal fixation in treatment of displaced radial head fractures. Methods Between August 2005 and May 2009, 35 patients with displaced radial head fractures underwent open reduction and internal fixation with SmartNail® and/or AO mini-plates. There were 28 males and 7 females with an average age of 28.4 years (range, 17-48 years). The injury mechanism included traffic accident in 16 patients, falling in 13, and falling from height in 6. According to Mason classification, 21 fractures were rated as type II, 9 as type III, and 5 as type IV. All fracturs were closed fractures. Six cases complicated by radial neck fractures, 1 case by olecranon fracture, 3 by posterior dislocations of the elbow, 1 by posterior dislocation of the elbow and coronoid process fracture, and 3 by medial collateral ligament injuries. The time from injury to operation was 3 to 7 days. Results Except 1 patient whose incision healed by second intention, healing of incision by first intention was achieved in the other patients. All patients were followed up 12-25 months with an average of 17 months. The average fracture healing time was 10.2 weeks (range, 8-16 weeks). At last follow-up, the average flexion and extension of the elbow was 119° (range, 95-145°). The average arc of forearm rotation was 126° (range, 90-175°). According to elbow functional evaluation criteria by Broberg and Morrey, the results were excellent in 18 cases, good in 13, and fair in 4; the excellent and good rate was 88.6%. Conclusion In treatment of displaced radial head fractures, open reduction and internal fixation can be performed with SmartNail® and/or AO mini-plates based on different fracture types and the short-term effectiveness is satisfactory.