Six cases of old fracture of the tibia with large sear, bony defect, and shortening deformity of the limb were treated by elongation osteotomy at epiphysis and compression fixation of the fracture with external semilunar fixation frame. The bony defect ranged from 3cm to 6cm. Bony healing developed in all patients 4-7 months after operation. Early postoperative movement was suggested. The results revealed that there was an obvious improvement of the joint function and the shortened legs were corrected. The advantages of this method are that there is no need of bone grafting and operative treatment of the scar prior to treatment of the bone.
目的:评价外固定支架治疗桡骨远端骨折的疗效。方法:2004年3月至2008年8月以外固定支架或辅以克氏针、可吸收螺钉内固定治疗桡骨远端骨折３7例。结果:31例获得4～28 个月(平均14 个月)的随访,所有骨折均临床愈合,平均愈合时间8周。腕关节功能按Sarmiento标准进行评定,优17例,良9例,可4例,差1例,优良率839%。结论:外固定支架治疗桡骨远端骨折疗效可靠,值得推广。
Forty cases of intertrochanteric fractures of femur were treated with percutaneous nonmetallic external fixator. The patients were followed up for 6 months to 3 years, and the fractures were all united without coxa vara or shirtening deformities. There was no mortality in this series. This method had the advantages ofbeing simple, save time and effort, less traumatic and early ambulation. The design of the apparatus tallied with the biomechanics of the neck and shaft of the femur.
Objective To investigate the effectiveness of arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures. Methods Between January 2014 and May 2016, 21 patients who suffered from extreme distal radial fractures were treated by arthroscopy-assisted combined fixation of Kirschner wire and external fixator. There were 14 males and 7 females with an age of 32-57 years (mean, 42.3 years). The causes of injury included falling in 13 cases and traffic accident in 8 cases. The fracture type included 8 cases of type 23C1, 9 cases of type 23C2, and 4 cases of type 23C3 according to AO/OTA classification. The time from injury to operation was 3-7 days (mean, 4.4 days). The Mayo score and disability of arm, shoulder, and hand (DASH) score were used to assess the pain and function of the wrist joint. Results There was no needle red swelling, tendon irritation, or orther early complications. All the patients were followed up 10-35 months (mean, 18.3 months). The fracture healing time was 9-13 weeks (mean, 10.6 weeks). At last follow-up, the Mayo score was 87-94 (mean, 90.9); and 17 cases were excellent and 4 were good. The DASH score was 7-13 (mean, 10.6). Conclusion Arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures has the advantages of firm fixation, early functional exercise, less postoperative complications, and good functional recovery of wrist joint.
【Abstract】 Objective To investigate the effect of the volar capsular l igament complex on stabil ity of the wrist jointand to provide basic biomechanical theoretical criteria for cl inic appl ication of the external fixator. Methods Nine upperl imbs specimens (left 6, right 3) were taken from fresh adult cadavers to make wrist joint-bone capsular l igament complex specimens. Firstly, soft tissues of forearms and hands were resected and capsular membranes and l igaments were reserved to make the bone-articular l igament complex (normal specimen). Secondly, the volar capsular l igament complex was cut off from radial malleolus to ulnar malleolus (impaired specimen). Thirdly, the impaired volar capsular l igament complex was interruptedly sutured by the use of 4# suture silk (repaired specimen). To simulate cl inical operation with external fixator, the biomechanical test was done according to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed). Statistical significance was analyzed through selected loads at the three different shifts (1.5, 2.0, 2.5 cm). Results According to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed), when the shift was 1.5 cm, the different respective loads were (60.74 ± 20.60), (35.23 ± 13.88), (44.36 ± 20.78), (168.40 ± 29.21) and (139.00 ± 33.18) N, respectively. When the shift was 2.0 cm, the different loads were (138.46 ± 12.93), (87.17 ± 24.22), (97.52 ± 23.29), (289.00 ± 54.29) and (257.98 ± 55.74) N, respectively. When the shift was 2.5 cm, the different loads were (312.87 ± 37.15), (198.16 ± 37.14), (225.66 ± 30.96), (543.15 ± 74.33) and (450.35 ± 29.38) N, respectively. There was no statistically significant difference between the impaired and repaired specimens (P gt; 0.05). Similarly, there was statistically significant difference among the rest specimens (P lt; 0.05). The same statistical results were obtained when the two different shifts were compared. There was statistically significant difference at the three different shifts for the same specimen (P lt; 0.05). Conclusion Volar capsular l igament complex is an important anatomic structure to keep stabil ity of the wrist joint. The carpal instabil ity arises out of the injured complex. Repairing the injured complex only can not immediately restore stabil ity of the wrist joint. The external fixator can effectively help to diminish the relative shift of the impaired capsular l igament complex, to reduce the load of the repaired complex and to protect the complex accordingly. The device plays an important role in maintaining stabil ity of the wrist joint.
Objective To compare the clinical results of locking compress plate (LCP) as an external fixator and standard external fixator for treatment of tibial open fractures. Methods Between May 2009 and June 2012, 59 patients with tibial open fractures were treated with LCP as an external fixator in 36 patients (group A), and with standard external fixator in 23 patients (group B). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, location, and interval between injury and surgery between 2 groups (P gt; 0.05). The time of fracture healing and incision healing, the time of partial weight-bearing, the range of motion (ROM) of knee and ankle, and complications were compared between 2 groups. Results The incidence of pin-track infection in group A (0) was significantly lower than that in group B (21.7%) (P=0.007). No significant difference was found in the incidence of superficial infection and deep infection of incision, and the time of incision healing between 2 groups (P gt; 0.05). Deep vein thrombosis occurred in 5 cases of group A and 2 cases of group B, showing no significant difference (χ2=0.036, P=0.085). All patients were followed up 15.2 months on average (range, 9-28 months) in group A, and 18.6 months on average (range, 9-47 months) in group B. The malunion rate and nonunion rate showed no significant difference between groups A and B (0 vs. 13.0% and 0 vs. 8.7%, P gt; 0.05); the delayed union rate of group A (2.8%) was significantly lower than that of group B (21.7%) (χ2=5.573, P=0.018). Group A had shorter time of fracture healing, quicker partial weight-bearing, greater ROM of the knee and ankle than group B (P lt; 0.05). Conclusion The LCP external fixator can obtain reliable fixation in treating tibial open fracture, and has good patients’ compliance, so it is helpful to do functional exercise, improve fracture healing and function recovery, and reduce the complication incidence.
To provide the scientific theoretical basis for cl inical practice by comparing biomechanicalcharacteristics of single compressed plate with intramedullary pin, locking intramedullary nail and simple arm externalfixator with simple internal fixation devices. Methods Eighteen wet humeral bone specimens of adult cadaver were madecompl icated fracture models of humeral shaft and divided into 3 groups according to fixation methods. Fracture was fixed by single compressed plate with intramedullary pin in plate group, by locking intramedullary nail in intramedullary nail group and by external fixator with simple internal fixation devices in external fixator group. The intensity and rigidity of compl icated fracture models of humeral shaft was measured in compress test and torsion test. Results In compress test, the maximum load in plate group (6 162.09 ± 521.06) N and in intramedullary nail group (6 738.32 ± 525.89) N was significantly larger than that in external fixator group (2 753.57 ± 185.59) N (P lt; 0.05); but there was no significant difference between plate group and intramedullary nail group (P gt; 0.05). Under 600 N physiological compress load, the rigidity was (171.69 ± 6.49) N/mm in plate group, (333.04 ± 36.85) N/mm in intramedullary nail group and (132.59 ± 2.93) N/mm in external fixator group; showing no significant difference between plate group and external fixator group (P gt; 0.05), and showing significant difference between intramedullary nail group and plate, external fixator groups (P lt; 0.05). In torsion test, the maximum torque in plate group (38.24 ± 7.08) Nm was significantly larger than those in intramedullary nail group (17.12 ± 5.73) Nm and external fixator group (20.26 ± 6.42) Nm (P lt; 0.05), but there was no significant difference between intramedullary nail group and external fixator group (P gt; 0.05). Under 0.80 Nm physiological torque, the rigidity was (16.36 ± 2.07) Ncm/° in plate group and (18.79 ± 2.62) Ncm/° in external fixator group, which was significantly larger than that in intramedullary nail group (11.45 ± 0.22) Ncm/° (P lt; 0.05); but there was no significant difference between plate group and external fixator group (P gt; 0.05). Conclusion Those fracture models fixed by single compressed plate with intramedullary pin have better compress and torsion intensity, they also have better torsion rigidity but less compress rigidity. Those fracture models fixed by locking intramedullary nail have better compress intensity but less torsion intensity, they also have better compress rigidity but less torsion rigidity. Those fracture models fixed by external fixator with simple internal fixation device have less compress and torsion intensity, they also have less compress rigidity but better torsion rigidity.
【摘要】 目的 探讨多功能外固定支架治疗老年股骨粗隆间骨折的疗效和优点。 方法 2007年7月-2009年10月，采用外固定架治疗28例老年股骨粗隆间骨折患者，其中男11例，女17例；年龄74~91岁，平均81岁。致伤原因:摔伤25例，交通事故伤3例。骨折按Evans分型:Ⅰ型1例，Ⅲ型15例，Ⅳ型12例。受伤至手术时间2~7 d。 结果 术后患者切口均Ⅰ期愈合，无延迟愈合及其他早期并发症发生。28例均获随访，随访时间5~14个月，平均9个月。X线片示骨折全部愈合，愈合时间11～24周，平均17周。无髋内翻和下肢短缩等并发症发生。术后3个月，采用Harris评分进行功能评价，优18例，良7例，差3例，优良率89.3%。出现轻度针道感染7例，中度5例，重度2例，针道感染率50%；合并糖尿病者2例出现中度针道感染，2例出现重度针道感染。重度者经局部换药、应用抗生素后愈合，后又反复出现，2~3个月取钉后愈合。无骨感染发生，患者均未出现褥疮，合并症无明显加重。 结论 外固定架治疗粗隆间骨折，手术创伤小，操作简便，符合生物力学原理，可以早期离床活动及早期骨折愈合。【Abstract】 Objective To explore the effectiveness and advantages of multifunctional external fixator for the treatment of femoral intertrochanteric fractures in the elderly patients. Methods Twenty-eight patients with femoral intertrochanteric fractures including 11 males and 17 females receiving external fixator treatment between July 2007 and October 2009 were enrolled in this study. Their age ranged from 74 to 91 years old with the average to be 81 years. Twenty-five patients had the disease because of ground falls, and the other 3 were due to traffic accidents. Based on the Evans Type classification, there were 1 Type-Ⅰ case, 15 Type-Ⅲ cases, and 12 Type-Ⅳ cases. The time between injury and surgery was ranged from 2 to 7 days. Results All incisions of the patients healed during phase Ⅰ without delayed healing or other early complications. Follow-up was done to all the patients for 5 to 14 months, averaging 9 months. X-ray showed all fractures healed, and the healing time ranged from 11 to 24 weeks with an average of 17 weeks. No varus or leg shortening or other complications occurred. Three months after surgery, based on the Harris hip score for functional evaluation, there were 18 excellent cases, 7 good cases and 3 poor cases with a excellent and good rate of 89.3%. Mild pin tract infection was detected in 7 patients, moderate in 5, and severe in 2 with a total pin tract infection rate of 50%. Two patients with diabetes suffering from severe pin tract infection recovered by local medication and antibiotics, but the infection reoccurred repeatedly till the healing nails were taken. No bone infection of ulcers occurred, and the existing complications were not aggravated. Conclusion Treatment of intertrochanteric fractures with multifunctional external fixator is minimally invasive, simple, and consistent with biomechanical principles, which can promote early activities out of bed and early fracture healing for the patients.
ObjectiveTo compare the effectiveness of external fixation and volar locking compression plate in the treatment of distal radius fractures of type C. MethodsBetween March 2012 and March 2013, 122 patients with distal radius fractures of type C were enrolled in the prospective randomized study. Fractures were treated by external fixation in 61 patients (external fixation group) and by open reduction and internal fixation using a volar locking compression plate in 61 patients (plate group). There was no significant difference in age, gender, fracture side, weight, height, body mass index, fracture type, and interval of injury and operation between 2 groups (P>0.05). The blood loss, operation time, hospitalization days, fracture union time, wrist function, and complications were compared between 2 groups. And the quality of reduction was observed, including volar tilting angle, ulnar deviation, radial height, and articular reduction. ResultsThe blood loss, operation time, and hospitalization days in plate group were significantly higher than those in external fixation group (P<0.05). All of the patients in both groups were followed up 12-28 months. Postoperative complications occurred in 4 patients (6.6%) of external fixation group (pin tract infection in 2 cases and radial nerve neuritis in 2 cases) and in 5 patients (8.2%) of plate group (wound infection in 1 case, carpal tunnel syndrome in 2 cases, and tendon rupture in 2 cases), showing no significant difference between 2 groups (P=0.500). The X-ray films showed fracture healing in all patients of 2 groups; the union time of plate group was significantly longer than that of external fixation group (P<0.05). At last follow-up, there was no significant difference in ulnar deviation and radial height between 2 groups (P>0.05), but the volar tilting angle of plate group was significantly larger than that of external fixation group (P<0.05). There was no significant difference in wrist function and articular reduction between 2 groups (P>0.05). ConclusionFor distal radius fractures of type C, the use of external fixation or volar locking compression plate can obtain satisfactory clinical outcomes, but the external fixation has the advantages of less invasion, shorter hospitalization days, minor complications, and faster fracture union.