Objective To review the injury mechanism and the treatment progress of terrible triad of the elbow, and to analyze the direction of further research. Methods Related literature concerning terrible triad of the elbow was extensively reviewed and comprehensively analyzed. Results The main treatment of terrible triad of the elbow is operation. The ultimate goal of treatment is to reconstruct sufficient stability of the elbow. The treatment includes fixation of the coronoid by suture, screw or plate; fixation of radial head by screw and plate, partial or complete replacement of the radial head; fixation of lateral collateral ligament and the medial collateral ligament by bone suture or anchors and the application of the external fixator. These surgical treatments have their own indications and advantages, most get satisfactory results. Conclusion Generally, surgery is needed to maintain the stability of the elbow for patients of terrible triad elbow. However, medial ligament repair or not, the choice of approach, and mechanism of injury still need further study.
摘要:目的:研究生物降解聚DL乳酸(PDLLA)自锁式捆绑带固定骨折的生物力学性能。方法:80只新西兰大白兔随机分为两组,建立股骨干非负重骨折动物模型,应用生物降解自锁式捆绑带固定骨折为实验组,钢丝固定骨折为对照组,分别于术后1、4、8、12周行生物力学检查进行比较。结果:捆绑带组在术后4、8、12周均比钢丝组的弯曲强度高,但4周、12周时Pgt;005,无统计学差异,8周时Plt;005,提示有统计学差异。离体同种固定物不同时间段抗拉强度自身比较:钢丝固定术后4阶段抗拉强度比较Pgt;005,任何两两比较都没有统计学差异,抗拉强度未随术后时间延长发生明显下降。捆绑带固定术后4周与术后1周比较Pgt;005,抗拉强度无明显降低,但术后8周和术后12周时Plt;005,抗拉强度明显下降。结论:生物降解自锁式捆绑带在非负重骨折治疗中可发挥良好的固定作用。生物降解自锁式捆绑带降解时,应力传导促进了骨折的愈合。Abstract: Objective: To study the biomechanics function of selflocking cerclage band made of biodegradable material polyDLlactic acid (PDLLA) in the fixation of fractures. Methods: Eighty rabbits were divided into two groups. Femur fracture models were made. Fractures were fixed using biodegradable selflocking cerclage band in experimental group and metal fixation material in control group. The biomechanics was analyzed and compared after 1, 4, 8 and 12 weeks respectively． Results: The bending strength of experimental group is more ber than that of control group after 4, 8 and 12 weeks, but it was not statistically significant at 4 and 12 weeks (Pgt;005). It was statistically significant at 8 weeks (Plt;005). The tensile strength of the same cerclage instrument was compared at different stage in vitro, and the result of the control group was not statistically significant at the four stage (〖WTBX〗P〖WTBZ〗gt;005). Regarding the changes of tensile strength of the cerclage instrument at different stage, the result of the experimental group was not statistically significant after 1 and 4 weeks (Pgt;005). However, the decrease of tensile strength was statistically significant after 8 and 12 weeks (Plt;005). Conculsion: Biodegradable selflocking cerclage band could be used in thetreatment of nonweightbearing fractures. The stress force conducting promotes healing of fracture when the selflocking biodegradable cerclage band degrades.
Objective To analyze the causes and managing methods of long bone fracture nonunion after allogeneic bone transplantation. Methods From December 1995 to December 2000, 43 cases of postoperative nonunion of long bone fracture were treated. These cases included 31 males and 12 females at the age of 19-57 years (40 years on average). The locations were femur in 11 cases, tibia in 21 cases, humerus in 8 cases and forearm in 3 cases. Bone nonunionafter allogeneic bone transplantation was caused by extensive soft tissue contusion and poor cover around bone fractue site in 6 cases, by incomplete debridement in 8 cases of osteomyel itis (including 6 without continual lavage and 4 only skin flap transfer), by secondary infection of wounds in 3 cases, by severe primary injury or secondary scar covering bone in 12 cases, instable internal fixation in 7 cases, and by earl ier weight bearing in 7 cases. Accroding to Weber classification, there were 4 cases of hypertrophic type and 39 cases of atrophic type. Basing on the type of nonunion, the methods such as refixation, bone retransplantation and transferring tissue flap were chosen to manage the cases. Results Incision healed by first intention in 37 cases, superficial infection occurred and cured after 2 weeks of dressing change in 5 cases, and sinus formed and cured after 2 months of dressing change and drainage in 1 case. All transferring tissue flap survived, and partial necrosis occurred at flap edge in 4 cases and cured after dressing change. All patients were followed up for 38-91 months with an average of 54.6 months. All the nonunion cases achieved bone union 5-11 months with an average of 7.6 months. But low extreme shorten monstrosity occured in 4 cases, malunion in 2 cases, functional l imitation near joints in 7 cases, and rotational l imitation of forearm in 1 case. Conclusion Fracture nonunion after allogeneic bone transplantation mainly shows atrophic type with overall or partial absorption of the allograft bone. The preconditions to guarantee fracture nonunion heal ing include stabil ity of fracture fixation, using transferring tissue flaps, controll ing infection, and adequate bone transplantion.
Objective To summarize the general concept of lateral wall, the causes of lateral wall injury, and surgical strategies in order to improve the understanding of lateral wall and reduce the complications of operation. Methods The related literature on lateral wall was extensively reviewed, summarized, and analyzed. Results The superior extent of the lateral wall is vastus lateralis ridge and the inferior extent is the intersection between the lateral femoral cortex and a line drawn at a tangent to the inferior femoral neck. The integrity of the lateral wall is important to prevent the failure of fixation and reoperation of intertrochanteric fractures. The main causes of injury are that there is no suitable typing criteria as a guide, the fracture pattern shown by X-ray does not match with the actual situation of the fracture, the type of fracture is special, and the operation is improper. The main treatment is to reconstruct the lateral wall and choose different reconstruction methods according to different fracture patterns. Conclusion The lateral wall is very important for the treatment of intertrochanteric fracture. Lateral wall fracture should be internal fixation in order to minimize the risk of reoperation.
目的:探讨复杂髋臼骨折的手术治疗方法及与疗效。方法:总结2002年2月～2007年12月对20例复杂髋臼骨折手术治疗的经验。其中男性14例,女性6例;年龄18～58岁,平均41岁。术前根据X线片及CT检查结果,所有骨折均按Letournel-Judet的方法进行分型、复合型20例。根据不同骨折类型,分别采用Kocher-Langenbeck入路10例,髂腹股沟入路4例及前后联合入路6例进行复位、固定。平均手术耗时3.5 h,术中平均失血900 mL。〖HTH〗结果〖HTSS〗:所有患者术后随访时间12～48个月,平均30个月。根据Matta影像学评分,解剖复位12例,复位满意4例,复位不满意4例。根据美国矫形外科学会髋关节功能评价标准,关节功能优6例,良8例,差6例,优良率为70%。解剖复位加满意复位的临床优良率为78.5%,而满意复位和差的复位的优良率为25%(Plt;0.05)。结论:不同的髋臼骨折需采用不同开放复位策略,其选择决定于髋臼骨折的类型,移位方向及其相应的手术入路。解剖复位、牢固固定、早期功能锻炼是提高疗效的关键。
Objective To study the effect of internal fixation with absorbable intramedullary nail on the treatment of phalange fractures in replantation of severed finger. Methods From September 2001 to October 2003, 28 cases with industrial severed finger (21 males and 7 females, with the age of 18-35 years) were replanted within 1-6 hours. The severed locations were index fingers in 11 cases, middle fingers in 8 cases, ring fingers in 6 cases, little fingers in 3 cases. All cases of phalange fractures were fixed by absorbable intramedullary nails of poly-DL-lactic acid(PDLLA) that combined with chitosan. Out of the 28 cases, 15 cases were with proximal phalange, 11 cases were with middle phalange, 2 cases were with distal phalange. The bone marrow cavity of the phalanges were dilated, then the intramedullary nail was inserted with suitable diameter and length to fix the fracture. Postoperatively resin bandage was applied for 3-4 weeks.Results All the 28 patients survived the performance and postoperative follow-up ranged from 3 to 10 months(4 months in average). Rejection was observed in one case 3 weeks after operation, bone unions were obtained in other cases. According to the Chinese Medical Association’s evaluation standard for replantation of amputated finger, 18 fingers resulted in excellence, 9 fingers in good function and 1 with unsatisfactory function. The excellent and good rate was 96.4%. Conclusion Internal fixation with absorbable intramedullary nail of PDLLA combined with chitosan proves to be effective in the replantation of severed finger.
Objective To determine the effect of non-reamed versus reamed intramedullary nailing for tibial fractures in adults on the rates of nonunion, the rates of implant failure, the rates of infection, the incidence of compartment syndrome, the rates of malunion, and the time of union. Methods We searched MEDLINE （1966 -July, 2005）, EMBASE （1974 -July, 2005 ）, The Cochrane Library （Issue 2, 2005 ）and CBMdisc （1979 -July, 2005 ）, and handsearched the relevant Chinese and English orthopedic journals. Randomized controlled trials and Clinical controlled trials of nonreamed versus reamed intramedullary nailing for tibial fractures in adults were included. The quality of trials was critically assessed. RevMan 4.2.7 software was used for data analysis. Results Four RCTs and one CCT of non-reamed versus reamed intramedullary nailing for tibial fractures in adults were included. The results of meta-analysis showed that nonreamed intramedullary nailing for tibial fractures in adult increased the rates of nonunion （RR 1.87, 95% CI 1.20 to 2. 91, P =0. 006）, implant failure （RR 2.23, 95% CI 1.49 to 3.34, P〈0. 000 1 ） and the time to union （WMD 9.00, 95% CI 3.19 to 14.81, P =0. 002）. Conclusions Compared with reamed intramedullary nailing for tibial fractures in adults, non-reamed intramedullary nailing increases the rates of nonunion and implant failure is common. There is no statistical difference in the rates of post operative infection, the rates of malunited fracture and the incidence of compartment syndrome between the two groups. However, further studies are needed to determine the effects of reamed and non-reamed intramedullary nailing on these outcomes, expecially when patient has severe open fractures （Gustilo Grade Ⅲ C）and multiple injuries.
Objective To compare differences in the cl inical outcomes between percutaneous pinning with plaster spl int and open reduction and pull ing out wire in the treatment of mallet fingers. Methods From December 2002 to September 2007, 72 patients with mallet fingers were treated. They were divided into two groups: group A and group B. In group A, 38 patients were treated by open reduction and pull ing out wire, 34 males and 4 females, aged (26.0 ± 8.5) years. Among them, 2 patients were injured in the index finger, 11 in the middle finger, 18 in the ring finger and 7 in the l ittle finger. Thirtythreepatients suffered from sports injuries, 5 from fall ing wounds. The average time between the injury and the surgery was(6.1 ± 3.1) days. In group B, 34 patients were treated by percutaneous pinning with plaster spl int, 26 males and 8 females, aged (28.1 ± 10.7) years. Among them, 1 patient was injured in the index finger, 9 in the middle finger, 15 in the ring finger and 9 in the l ittle finger. Thirty-one patients suffered from sports injuries, 3 from fall ing wounds. The average time between the injury and the surgery was (6.3 ± 3.6) days. All the fingers had typical mallet malformation, and X-ray films showed avulsed fractures of distal-segment phalanxes at the dorsal basilar part. Results The operation time was (61.8 ± 12.8) minutes in group A and (7.0 ± 2.6) minutes in group B. All patients in both groups were followed up for 6-24 months (11.9 months on average in group A and 13.2 months in group B). In group A, apart from 3 patients who had flap necrosis and infection, all the other patients obtained heal ing by first intention. One patient had palmar skin ulcer at 6 days after the operation and healed after proper treatment. Thirty-six patients gained bone union at (47.6 ± 8.7) days postoperatively and 2 patients had pseudarthrosis, which improved after reconstruction of the extensor tendon attachment point. According to the total active movement (TAM) functional assessment system, 10 cases were e cellent, 18 good, 8 fair and 2 poor, with the choiceness rate of 73.7%. In group B, all incisions obtained heal ing by first intention without pin-track infection, flap necrosis and migration of the pins and gained bone union at (27.7 ± 3.9) days after the operation. According to the TAM functional assessment system, 19 cases were excellent, 13 good and 2 fair, with the choiceness rate of 94.1%. There were significant differences between the two groups in operation time, compl ications, heal ing time and choiceness rate (P lt; 0.05). Conclusion Percutaneous pinning with plaster spl int is simple in operation and has smaller incisions and fewer compl ications compared with open reduction and pull ing out wire, andproves to be a useful way in the treatment of mallet fingers.