Objective To compare the effects of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures. Methods All randomized controlled trials (RCTs) of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures were identified. Quality assessment and data extraction were performed by two reviewers independently. Results Four published trials involving 530 patients were included. All studies compared operative with nonoperative treatment. It was clear that operative treatment was superior to nonoperative treatment in terms of helping patients back to work, reducing problems wearing shoes, expanding the range of motion of subtalar joint, and improving the recovery of Bohler’s angle. As for foot pain, there was no difference between the two methods. Because the outcome measures varied across the trials, a meta-analysis could not be performed. Conclusions Both operative and nonoperative treatments produce comparable long-term outcomes in the treatment of displaced intra-articular calcaneal fractures. Because of the poor reporting of outcomes, it is not possible to determine if there is any significant difference in outcome measures apart from those listed above. More trials with high methodological quality are needed.
To compare the effect and syndrome of treating intra-articular calcaneal fractures using Kirschner’s wire or AO calcaneal plate. Methods From March 2003 to March 2006, 71 cases (86 feet) of intra-articular calcaneal fractures were treated with Kirschner’s wire or AO calcaneal plate. Among them, 39 cases (48 feet) were treated using Kirschner’s wire, male 34, female 5. The age ranged from 15 to 64 years old, 36 on average. The course of illness was from 4 hoursto 10 days. There were 9 double side bone fractures and 30 one side bone fractures. Based on Sanders type, Type II were 40 feet, Type III were 7 feet and Type IV was 1 foot. The other 32 cases (38 feet) were treated using AO calcaneal plate, male 30, female 2. The age ranged from 18 to 55 years old, 33 on average. The course of illness was from 4 hours to 10 days. There were 6 double side bone fractures and 26 one side bone fractures. A total of 31 feet belonged to Sanders Type II, 5 to Type III, and 2 to Type IV. The 12-month follow-up, at least, was carried out in order to valuate the patients. The valuating items included: preoperative and postoperative Bohler’s angle and Gissane’s angle; heel bone height and width(contrast with the opposite side); to judge reposition circs by means of the CT scan and Borden’s judgment; function valuation adopting the American Orthopedic Foot amp; Ankle Society (AOFAS) grade point system. Results Patients with Kirschner’s wire fixed were followed up for 12 to 48 months, and AOFAS score ranged from 75 to 100 points, 90.6 on average. The excellent and good rate was 87.8%. The preoperative Bohler’s angle was from 0 to 10°, 7.8° on average, and postoperative from 30 to 40°, 33.2° on average. The preoperation Gissane’s anglewas 75 to 95°, 84° on average; and postoperative from 115 to 135°, 125° on average. There was significant difference (P lt; 0.05). The postoperative compl ications were that 1 foot was the incision edge shallow putrescence and 1 foot was the needle way infection. Patients with AO calcaneal plate fixed were followed up for 12 to 48 months, and AOFAS score was from 49 to 100 points, 87.5 on average. The excellent and good rate was 81.6%.There was no significant difference between the two groups (P gt; 0.05). The preoperative Bohler’s angle ranged from 0 to 15°, 6.5° on average, and postoperative from 25 to 40°, 30.2° on average. The preoperative Gissare’s angle was 72 to 92°, 80° on average; and postoperative from 115 to 130°, 120° on average. There was significant difference (P lt; 0.05). The postoperative compl ications were that 5 feet were the incision edge shallow putrescence, 1 was the common peroneal nerve hurt, and 1 was the petrous muscle aponeurotic inflammation. Conclusion There is no remarkable difference between the effects of treating intra-articular calcaneal fractures using plate or Kirschner’s wire, but the treatment with Kirschner’s wire is not only much easier and more economical, but has smaller wounds and fewer soft tissue problems.
Objective To evaluate the effectiveness of open reduction and medial-lateral double plate internal fixation for type C distal humeral fractures. Methods Between June 2002 and January 2009, 32 patients with distal humeral intra-articular fractures were treated. There were 19 males and 13 females, aged 19-70 years (mean, 43.3 years). The fracture was caused by fall ing in 7 cases, by traffic accident in 15 cases, by fall ing from height in 5 cases, by crush injury in 4 cases, and by machine injury in 1 case. The time from injury to operation was 8 hours-7 days (mean, 3.3 days). Of 32 patients, 1 had open fracture and 31 had closed fracture; 5 patients compl icated by injury of ular nerve. According to AO/Association for the Study of Internal Fixation (AO/ASIF) classification, there were 9 cases of type C1, 16 of type C2, and 7 of type C3. Open reduction and medial-lateral double plate internal fixation were performed through posterior midl ine approach in 8 cases and through medial-lateral two-incision approaches in 24 cases. Results All incisions healed by first intention. The 32 cases were followed up 11-24 months (mean, 14 months). The X-ray films showed that all fractures healed at 3-6 months (mean, 3.8 months). According to Aitken et al. scoring system, the results were excellent in 22 cases, good in 6 cases, fair in 3 cases, and poor in 1 case with an excellent and good rate of 87.5%. In 5 patients with injury of ular nerve, 4 cases completely recovered at 6 months and 1 case still showed some symptoms after 1 year. Conclusion Treatment of type C distal humeral fractures with open reduction and medial-lateral double plate internal fixation can get good cl inical results.
OBJECTIVE: To investigate the treatment results of fracture involved articular surface with absorbable screws and rods. METHODS: From October 1995 to May 2002, 32 patients with fracture involved articular surface were treated with absorbable screws and rods with the materials of SR-PGA and SR-PLLA. Bone traction or plaster external fixation were carried out postoperatively. RESULTS: The followed-up period varied from 3 months to 78 months, with an average of 18.5 months. According to the articular function evaluation criteria, the results were excellent in 24 patients, good in 6 patients and fair in 2 patients. The excellent and good rate was 93.7%. The fractures healed, without dislocation, infection and local effusion. CONCLUSION: Internal fixation of absorbable screws and rods is a perfect procedure for treating fracture involved articular surface, which avoided the pain of taking out internal fixation materials of the second operation.
Objective To summarize the preliminary effectiveness of I.T.S. locking plate for intra-articular calcaneal fractures. Methods Between July 2010 and July 2011, 18 cases of intra-articular calcaneal fractures were treated. There were 10 males and 8 females with an average age of 46 years (range, 25-64 years). According to Sanders classification system, there were 3 cases of type II, 9 cases of type III, and 6 cases of type IV. The disease duration was 5-11 days (mean, 6 days). Open reduction and internal fixation with I.T.S. locking plate were performed via an L-shaped lateral extending incision. Results Superficial infection occurred in 1 case, and was cured after dressing changing; healing of incision by first intention was obtained in the other cases. Sixteen cases were followed up 14 months on average (range, 12-18 months). X-ray films demonstrated the bone union in all cases with an average union time of 12 weeks (range, 10-14 weeks). No implant failure or irritation of peroneal tendon occurred during follow-up. X-ray films showed subtalar post-traumatic arthritis with mild pain in 1 case at 11 months after operation, which was relieved by conservative treatment. At last follow-up, the Bouml;hler angle was improved from (12.9 ± 3.2)° preoperatively to (33.8 ± 4.0)° postoperatively, showing significant difference (t=22.78, P=0.00); the Gissane angle was improved from (83.6 ± 6.4)° preoperatively to (119.9 ± 8.5)° postoperatively, showing significant difference (t=17.02, P=0.00). The visual analogue scale (VAS) score was 1.3 ± 1.2, and the ankle and hindfoot scale of American Orthopaedic Foot and Ankle Society (AOFAS) was 80.3 ± 7.9 at last follow-up. Conclusion Treatment of intra-articular calcaneal fracture with I.T.S. locking plate can obtain a stable fixation, which is a safe and effective method.
ObjectiveTo evaluate the effectiveness of internal fixation with headless compression hollow embedding screws in the treatment of intraarticular fracture of elbow.MethodsBetween March 2012 and September 2018, 12 patients with intraarticular fracture of elbow were treated with internal fixation with headless compression hollow embedding screws. There were 7 males and 5 females with an average age of 50.3 years (range, 22-65 years). Cause of injury included falling in 7 cases, falling from high places in 4 cases, and traffic accident in 1 case. Ten patients were distal humerus fractures which were classified as type 13-B3 in 8 cases and type 13-C3 in 2 cases according to the International Association of Internal Fixation Research (AO/ASIF). Two patients were radial head fractures which were classified as type Ⅲ according to the modified Mason classifications. The preoperative visual analogue scale (VAS) score was 8.25±0.83. The time from injury to operation was 3-5 days (mean, 3.7 days).ResultsAll incisions healed by first intention. All 12 patients were followed up 6-15 months, with an average of 8.4 months. The results of X-ray films and CT examination showed that the fracture ends were anatomic reduction, and the fractures healed at 6-11 months after operation, with an average of 7.8 months. One patient had heterotopic ossification at 4 months after operation. The VAS scores were 5.17±0.79 at 2 weeks after operation and 0.50±0.50 at last follow-up. There were significant differences between the time points (P<0.05). At last follow-up, the Mayo elbow function score was 68-95, with an average of 83.9. The activity of elbow joint recovered.ConclusionThe intraarticular fracture of elbow can be firmly fixed by the headless compression hollow embedding screw, which can allow the early functional training of the elbow joint, reduce the incidence of heterotopic ossification, and obtain good effectiveness.
Objective To investigate the clinical outcome of open reduction and internal fixation of calcaneal interarticular fractures. Methods From August 1998, 38 calcanneal interarticular fractures in 35 cases, including 8 of type Ⅱ, 14of type Ⅲ and 16 of type Ⅳ according to Sander’s classification, were treatedby open reduction to restore the posterior articular facet, subtalar facet, Bohler angle and Gissane’s angle, following internal fixation by plastic titanicalloy plate. Thirtythree calcanneal interarticular fractures were followed up for6 to 22 months, 12.3 months on average; and the healing time and joint functionwere evaluated according to Maryland Foot Score System. Results The average healing time of fracture was 7.1 weeks, ranging from 5 to 12 weeks; and the joint function was excellent in 18 calcanneus, good in 13 calcanneus, and the satisfactory rate was 93.9%. Conclusion Open reduction and internal fixation with plastic titanium plate is a good choice for calcaneal interarticular fractures.
Objective To introduce a clinical treatment for the reconstructionof calcaneal thalamus by bone autograft and subtalar arthrodesis for antiquatedintraarticular calcaneal fractures. Methods From July 2000 to October 2003, 11 cases with antiquated intraarticular calcaneal fractures were treated. Of the 11 cases, 9 were males and 2 females,whose ages ranged from21 to 48 years. All unilateral calcanei were involved in the 11 cases. The modified extended Lshaped approach lateral to calcaneus was adopted. The primary treatment was manipulation and immobilization with the reconstruction of calcaneal thalamus by bone autograft and subtalar arthrodesis. The average volume of the ilium for the autograft was 3.0 cm×2.5 cm×1.8 cm. Protruded osteophyte from the lateral wall of calcaneus were ablated in all 11 cases. Results All the 11 cases were followed up for 3 to 18 months, 11.5 monthson average. The reconstructed calcaneal thalamus was healed 10 to 12 weeks after the operation. Some of the patients could walk with load 8 weeks after the operation, and the average time for all the patients to walk with load was 13.2 weeks. There were 4 cases of excellent result, 5 cases of good result, and 2 cases of fair result, according to ZHANG Tieliang’s foot score system. Plain radiograph showed that Bohler angle, width of calcaneus and height of calcaneal thalamus were nearlyrestored to normal. Conclusion With the improvement of calcaneal abnormality and restoration of the shape and function of hind foot, reconstruction of calcaneal thalamus by bone autograft combined with subtalar arthrodesis is effective in treating antiquated intra-articular calcaneal fractures.
Objective To assess the treatment effect of intra-articular fracture with absorbable screws and rods.Methods From June 1998 to August 2004， 35 patients with intra-articular fracture were treated by absorbable screws and rods made of self-reinforcedpolyglycolicacid (SR-PGA) and self-reinforcedpoly-L-Lacticacid (SR-PLLA). Of 35 patients, 30 were males and 5 were females (aged from 4 to 62 years). All cases had intra-articular or periarticular fracture. The interval between injury and operation was 3 hours to 29 days. Fracture were fixed with full thread screws of SR-PGA in 9 cases, with tensile screws of SR-PLLA in 26 cases, with rods of SR-PLLA in 15 cases. Bone traction orplaster external fixation were carried out postoperatively. Results The patients were followed from 3 months to 60 months with an average of 28 months．The wounds healed by first intention, and the healing time of bone was 1－3 months. No dislocation, infection and local effusion occurred. Functional recovery was satisfactory．According to AASO articular function standard, the results were excellentin 26 cases, good in 7 cases, fair in 1 case, and poor in 1 case; the total excellent and good rate was 94.3%. Conclusion Internal fixationof absorbable screws and rods are a perfect procedure in treating intraarticular and periarticularfracture, which can avoid the pain of taking out internal fixation materials because of second operation．