Objective To investigate the effectiveness of one-stage closed reduction and elastic compression fixation with double Kirschner wires for Wehbe-Schneider types ⅠB and ⅡB bony mallet fingers. Methods Between May 2017 and June 2020, 21 patients with Wehbe-Schneider type ⅠB and ⅡB bony mallet fingers were treated with one-stage closed reduction and elastic compression fixation using double Kirschner wires. There were 15 males and 6 females with an average age of 39.2 years (range, 19-62 years). The causes of injury were sports injury in 9 cases, puncture injury in 7 cases, and sprain in 5 cases. The time from injury to admission was 5-72 hours (mean, 21.0 hours). There were 2 cases of index finger injury, 8 cases of middle finger injury, 9 cases of ring finger injury, and 2 cases of little finger injury. The angle of active dorsiflexion loss of distal interphalangeal joint (DIPJ) was (40.04±4.02)°. According to the Wehbe-Schneider classification standard, there were 10 cases of typeⅠB and 11 cases of type ⅡB. The Kirschner wire was removed at 6 weeks after operation when X-ray film reexamination showed bony union of the avulsion fracture, and the functional exercise of the affected finger was started. Results The operation time was 35-55 minutes (mean, 43.9 minutes). The length of hospital stay was 2-5 days (mean, 3.4 days). No postoperative complications occurred. All patients were followed up 6-12 months (mean, 8.8 months). X-ray films reexamination showed that all avulsion fractures achieved bony union after 4-6 weeks (mean, 5.3 weeks). Kirschner wire was removed at 6 weeks after operation. After Kirschner removal, the visual analogue scale (VAS) score of pain during active flexion of the DIPJ was 1-3 (mean, 1.6); the VAS score of pain was 2-5 (mean, 3.1) when the DIPJ was passively flexed to the maximum range of motion. The angle of active dorsiflexion loss of affected finger was (2.14±2.54)°, showing significant difference when compared with preoperative angle (t=52.186, P<0.001). There was no significant difference in the active flexion angle between the affected finger (79.52±6.31)° and the corresponding healthy finger (81.90±5.36)° (t=1.319, P=0.195). At 6 months after operation, according to Crawford functional evaluation criteria, the effectiveness was rated as excellent in 11 cases, good in 9, and fair in 1, with an excellent and good rate of 95.24%. Conclusion For Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers, one-stage closed reduction and elastic compression fixation with double Kirschner wires can effectively correct the deformity and has the advantages of simple surgery, no incision, and no influence on the appearance of the affected finger.
Objective To compare the reduction qualities of three-dimensional visible technique without fluoroscopy and two-dimensional fluoroscopy for unstable pelvic fractures during operations. Methods The clinical data of 40 patients with unstable pelvic fractures, who met the selection criteria in three clinical centers between June 2021 and September 2022, were retrospectively analyzed. According to the reduction methods, the patients were divided into two groups. Twenty patients in trial group were treated with unlocking closed reduction system combined with three-dimensional visible technique without fluoroscopy; 20 patients in control group with unlocking closed reduction system under two-dimensional fluoroscopy. There was no significant difference in the gender, age, injury mechanism, Tile type of fracture, Injury Severity Score (ISS), and the time between injury to operation between the two groups (P>0.05). The qualities of fracture reduction according to the Matta criteria, operative time, intraoperative blood loss, fracture reduction time, times of fluoroscopy, and System Usability Scale (SUS) score were recorded and compared. Results All operations were successfully completed in both groups. According to the Matta criteria, the qualities of fracture reduction were rated as excellent in 19 patients (95%) in trial group, which was better than that in the control group (13 cases, 65%), with a significant difference (χ2=3.906, P=0.048). The operative time and intraoperative blood loss had no significant differences between the two groups (P>0.05). The fracture reduction time and times of fluoroscopy were significantly less in trial group than in control group (P<0.05), and SUS score in trial group was significantly higher in trial group than in control group (P<0.05). ConclusionCompared to using unlocking closed reduction system under two-dimensional fluoroscopy, three-dimensional visible technique without fluoroscopy can significantly improve the reduction quality of unstable pelvic fractures without prolonging the operative time, and is valuable to reduce iatrogenic radiation exposure for patients and medical workers.
ObjectiveTo explore the efficacy and advantages of the lower extremity axial distractor assisted closed reduction and retrograde intramedullary nail internal fixation in the treatment of distal femoral fractures.MethodsThe clinical data of 49 patients with distal femoral fractures treated with retrograde intramedullary nail internal fixation between April 2016 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative reduction, the patients were divided into trial group (29 cases, using lower extremity axial distractor to assist closed reduction) and control group (20 cases, using free-hand retraction reduction). There was no significant difference in general information between the two groups (P>0.05), such as gender, age, side of injury, cause of injury, and fracture classification. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, and callus formation time were recorded and compared between the two groups. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation.ResultsAll patients successfully completed the operation. In the control group, there was 1 case with open reduction and internal fixation, and the rest of the two groups were closed reduction. There was no significant difference in operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency between the two groups (P>0.05). There was no complication such as vascular or nerve injury and iatrogenic fracture, etc. during and after operation, and the incisions healed by first intention. Except for 2 patients in the trial group who were lost to follow-up at 3 months after operation, the rest of the patients were followed up 12-36 months, with an average of 16.0 months. There was no significant difference in the callus formation time between the two groups (t=2.195, P=0.145). During the follow-up, postoperative knee joint stiffness occurred in 1 case in the control group, which improved by strengthening the knee joint function exercise and removing the internal fixator; the rest were not found to be associated with delayed or nonunion fractures, knee stiffness, and internal fixation complication. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation, the trial group achieved excellent results in 22 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 96.3%; in the control group, the results were excellent in 16 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate was 95.0%; showing no significant difference in the excellent and good rate between the two groups (χ2=0.451, P=0.502).ConclusionThe lower extremity axial distractor assisted closed reduction and retrograde intramedullary nailing for the treatment of distal femoral fractures is convenient, which has satisfactory efficacy.
Objective To explore the application value and effectiveness of pelvic unlocking closed reduction device for the treatment of unstable pelvic posterior ring disruption. Methods A retrospective analysis of clinical data of 243 cases of unstable pelvic posterior ring disruption treated with pelvic unlocking closed reduction device in 13 orthopaedic trauma centers across the country between December 2018 and June 2020 was performed. There were 139 males and 104 females; the age ranged from 18 to 92 years, with an average age of 48.5 years. The cause of injury included 132 cases of traffic accident injuries, 102 cases of falling from height, and 9 cases of crushing injuries. According to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 5 cases of type 61-B1, 13 cases of type 61-B2, 32 cases of type 61-C1.1, 47 cases of type 61-C1.2, 89 cases of type 61-C1.3, 35 cases of type 61-C2, and 22 cases of type 61-C3. The time from injury to operation was 2-121 days, with a median of 10 days. Preoperative preparation time, installation time of unlocking closed reduction device, fracture reduction time, intraoperative fluoroscopy times, intraoperative blood loss, and surgical complications were recorded, and Matta scoring standard was used to evaluate the quality of fracture reduction. According to Matta evaluation results, the patients were divided into two subgroups: excellent-good group and fair-poor group. The differences in gender, age, time from injury to operation, AO/OTA classification, and perioperative clinical indicators were compared between the two groups, and the effects of baseline data and perioperative indicators on the quality of fracture reduction were studied. Results Pelvic unlocking closed reduction device did not interfere with the display of the pelvic structure and fracture displacement direction during the intraoperative fluoroscopy, effectively correcting the displacement of the pelvic ring. The preoperative preparation time was 17-60 minutes, with an average of 30 minutes; installation time of unlocking closed reduction device was 10-32 minutes, with an average of 21 minutes; intraoperative fracture reduction time was 15-205 minutes, with an average of 49.2 minutes; intraoperative fluoroscopy times were 41-420 times, with an average of 132 times; intraoperative blood loss was 40-1 500 mL, with an average of 71.5 mL. The reduction quality of pelvic fracture was evaluated according to Matta score immediately after operation. The results were excellent in 153 cases, good in 61 cases, fair in 24 cases, and poor in 5 cases. The excellent and good rate was 88.1%. Further subgroup analysis showed that there was no significant difference in other indexes (P>0.05) between the excellent-good group and the fair-poor group except for the time from injury to operation and AO/OTA classification (P<0.05). Among them, the excellent-good reduction rate was 92.2% (119/129) in patients with injury-to-operation time less than 10 days, and the fair-poor reduction rate was 25.7% (9/35) and 40.9% (9/22) in patients with AO/OTA 61-C2 and 61-C3 types, respectively. There was no surgery-related complication due to the application of the pelvic unlocked reduction device, no secondary iliac fractures, vascular, or nerve injuries, and postoperative CT showed that all channel screws were located in the osseous channel. ConclusionThe pelvic unlocking reduction device can effectively help to reduce the unstable pelvic posterior ring and maintain reduction, meet the needs of different projection angles of pelvic fracture with intraoperative C-arm fluoroscopy. The system facilitate the operation of pelvic reduction and precise fixation.
Objective To investigate the effectiveness of joystick technique assisted closed reduction and cannulated screw fixation in the treatment of femoral neck fracture. Methods Seventy-four patients with fresh femoral neck fractures who met the selection criteria between April 2017 and December 2018 were selected and divided into observation group (36 cases with closed reduction assisted by joystick technique) and control group (38 cases with closed manual reduction). There was no significant difference in gender, age, fracture side, cause of injury, Garden classification, Pauwels classification, time from injury to operation, and complications (except for hypertension) between the two groups (P>0.05). The operation time, intraoperative infusion volume, complications, and femoral neck shortening were recorded and compared between the two groups. Garden reduction index was used to evaluate the effect of fracture reduction, and score of fracture reduction (SFR) was designed and was used to evaluate the subtle reduction effect of joystick technique. ResultsThe operation was successfully completed in both groups. There was no significant difference in operation time and intraoperative infusion volume between the two groups (P>0.05). All patients were followed up 17-38 months, with an average of 27.7 months. Two patients in the observation group received joint replacement due to failure of internal fixation during the follow-up, and the other patients had fracture healing. Within 1 week after operation, the Garden reduxtion index of the observation group was better than the control group; the SFR score of the observation group was also higher than that of the control group; the proportion of femoral neck shortening within 1 week after operation and at 1 year after operation in the observation group were lower than those in the control group. The differences of the above indexes between the two groups were significant (P<0.05). ConclusionThe joystick technique can improve the effectiveness of closed reduction of femoral neck fractures and reduce the incidence of femoral neck shortening. The designed SFR score can directly and objectively evaluate the reduction effect of femoral neck fracture.
Objective To summarize the characteristics and clinical significance of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. Methods The clinical data of 4 patients with irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations between January 2010 and December 2019 were collected. There were 2 males and 2 females and the age ranged from 24 to 41 years, with an average age of 33.5 years. The cause of injury included traffic accident in 3 cases and falling in 1 case. Pipkin classification was 2 cases of type Ⅰ and 2 cases of type Ⅱ. The time from injury to operation was 1-2 days. The clinical features were that the hip joint of the affected limb was in a locked position, and the passive range of motion was poor. The affected limb was slightly flexed at the hip joint and shortened, in a state of neutral position or slight adduction and internal rotation. The imaging data suggested that the femoral head dislocated backward and upward, and the hard cortex of the posterior edge of the acetabulum was embedded in the cancellous bone of the femoral head, and the two were compressed and incarcerated. Patients of cases 1-3 underwent closed reduction of hip dislocation 1-2 times at 3, 1, and 3 hours after injury respectively, and femoral neck fracture occurred. The injury types changed to Pipkin type Ⅲ, and open reduction and internal fixation were performed. Patient of case 4 did not undergo closed reduction, but underwent open reduction and internal fixation directly. Results Patients of cases 1-3 were followed up 14, 17, and 12 months, respectively. They developed osteonecrosis of the femoral head at 9, 5, and 10 months after operation respectively, and all underwent total hip arthroplasty. Patient of case 4 was followed up 24 months and had no hip pain and limited mobility; the imaging data indicated that the internal fixator position was good and the fracture healed; no collapse or deformation of the femoral head was seen, and no osteonecrosis of the femoral head occurred. Conclusion Clinicians need to improve their understanding of the unique clinical features and imaging findings of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. It is suggested that open reduction and simultaneous fixation of femoral head fracture should be directly used to reduce the incidence of osteonecrosis of the femoral head.
ObjectiveTo explore the effectiveness of Taylor spatial frame (TSF) in the treatment of tibiofibular fractures and computer-assisted closed reduction.MethodsThe clinical data of 30 cases of tibiofibular fractures with soft tissue injury treated with TSF between January 2015 and September 2017 was retrospectively analyzed. According to different reduction methods, the patients were divided into control group (15 cases, open reduction in TSF external fixation) and trial group (15 cases, closed reduction in 1-3 days after TSF external fixation). There was no significant difference in the general data such as gender, age, affected side, cause of injury, AO classification of fracture, time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator were recorded and compared between the two groups. At 3 months after removal of external fixator, the limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effect of tibial shaft fracture treatment.ResultsBoth groups were followed up 9-16 months, with an average of 14 months. The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator in the trial group were significantly shorter than those in the control group (P<0.05). There were 2 cases of superficial infection of the external fixation (1 case in each group), 1 case of incision infection (control group), 1 case of delayed fracture healing (control group), 2 cases of traumatic arthritis (1 case in each group); no significant difference was found in the incidence of complications between the two groups (χ2=0.370, P=0.543). The wounds of soft tissue defect healed by the first intension in both groups. At 3 months after removal of the external fixator, the limb function results in the trial group were excellent in 3 cases, good in 9 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 80.0%; in the control group, the results were excellent in 3 cases, good in 8 cases, fair in 3 cases, and poor in 1 case, and the excellent and good rate was 73.3%. There was no significant difference in incidence of complication between the two groups (χ2=0.917, P=0.821).ConclusionCompared with intraoperative open reduction, postoperative computer-aided closed reduction can shorten the operation time, reduce the intraoperative blood loss, reduce the risk of long-term operation, avoid to destroy the blood supply of fracture end, shorten the healing time of fracture and the wearing time of stent, and alleviate the pain of patients after TSF treatment of tibiofibular fracture.
ObjectiveTo compare the effectiveness of proximal femoral nail anti-rotation (PFNA) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intertan intramedullary nail fixation by closed reduction in the treatment of AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3.3 intertrochanteric fracture with incomplete lateral wall.MethodsThe clinical data of 54 patients with AO/OTA type 31-A3.3 intertrochanteric fracture who met the selection criteria and were admitted between January 2012 and January 2018 were retrospectively analyzed. According to different surgical methods, the patients were divided into group A (24 cases with lateral wall reconstruction by MIPPO combined with PFNA internal fixation) and group B (30 cases with Intertan intramedullary nail fixation by closed reduction only). There was no significant difference between the two groups (P>0.05) in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The operation time, intraoperative blood loss, time to weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. The tip apex distance (TAD) was measured at 2 days, 2 months, and 1 year after operation. At 12 months after operation, the hip joint function was evaluated according to Harris scoring standard, and the rate of conformity (Harris score were more than 70) was calculated.ResultsThe wounds of the two groups healed by first intention, without infection, skin deformity, and other incision complications. The operation time and intraoperative blood loss of group A were significantly more than those of group B, and the time to weight-bearing and fracture healing were significantly shorter than those of group B (P<0.05). The patients were followed up 9-20 months (mean, 14.7 months) in group A and 9-19 months (mean, 13.8 months) in group B. There was no significant difference in TAD values at 2 days, 2 months, and 1 year after operation between the two groups (P<0.05), and there was also no significant difference in TAD values between the postoperative time points (P>0.05). There was 1 case of infection, 1 case of screw withdrawal, 2 cases of screw removal, and 1 case of bone nonunion in group B, the incidence of complications was 16.7%; there was only 1 case of screw withdrawal combined with screw blade withdrawal in group A, the incidence of complications was 4.2%; there was no significant difference between the two groups (χ2=2.109, P=0.146). At 12 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B (P<0.05). The rate of conformity of group A was 95.83% (23/24) and 76.67% (23/30) in group B, and the difference between the two groups was significant (χ2=3.881, P=0.049).ConclusionFor the AO/OTA type 31-A3.3 intertrochanteric fracture with incomplete lateral wall, compared with the closed reduction Intertan intramedullary nail fixation, the incidence of internal fixation failure after MIPPO reconstruction with lateral wall combined with PFNA fixation was lower, the time to weight-bearing was earlier, and the postoperative function was better.
Objective To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children. Methods Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria. ResultsAll incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up (P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up (P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up (P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%. Conclusion The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.
ObjectiveTo investigate the effectiveness and advantages of skeletal tractor in closed reduction and proximal femoral nail antirotation (PFNA) internal fixation of intertrochanteric fracture compared with traction table.MethodsThe clinical data of 86 patients with intertrochanteric fractures, who were treated with closed reduction and PFNA internal fixation between October 2016 and March 2018 and met the selection criteria, was retrospectively analysed. Among them, 44 cases were treated with skeletal tractor (trial group) and 42 cases were treated with traction table (control group). There was no significant difference between the two groups in gender, age, cause of injury, fracture side, AO classification, and degree of osteoporosis (P>0.05). The preoperative position time, operation time, intraoperative fluoroscopy times, intraoperative blood loss, fracture healing time, intraoperative and postoperative complications, and postoperative Harris score were compared between the two groups.ResultsThe operation was successfully completed in both groups. Compared with the control group, the patients in the trial group had shorter preoperative position time and operation time, fewer intraoperative fluoroscopy times, and less intraoperative blood loss (P<0.05). The patients were followed up 12-21 months in trial group (mean, 14.2 months) and 12-22 months in control group (mean, 14.3 months). Venous thrombosis of lower extremity occurred in 8 patients (3 cases of trial group and 5 cases of control group) after operation. Internal fixation failure occurred in 5 patients (2 cases of trial group and 3 cases of control group) during 1 year after operation. All fractures healed except for those with internal fixation failure, the fracture healing time was (11.6±2.9) weeks in trial group and (12.4±3.6) weeks in control group; and there was no significant difference between the two groups (t=1.250, P=0.214). At 1 year after operation, Harris score of the trial group was 86.2±5.9 and that of the control group was 84.1±6.1. There was no significant difference between the two groups (t=1.768, P=0.080).ConclusionCompared with traction table, skeletal tractor in closed reduction and PFNA internal fixation of intertrochanteric fracture can significantly shorten the preoperative position time and operation time, reduce the intraoperative fluoroscopy times, improve the operation efficiency, and have similar effectiveness.