Objective To investigate the curative effects of open reduction and internal fixation with Kirschner wire for Mason type-II radial head or neck fracture in children. Methods From September 2007 to June 2009, 17 cases of Mason type-II radial head or neck fracture were treated, including 11 males and 6 femals with an average age of 8.5 years (4-11 years).The locations were left side in 5 cases and right side in 12 cases. All fractures were caused by fall ing and classified as Mason type- II fracture. Two cases compl icated by radial nerve deep branch injury. The time from injury to operation was 4 hours to 5 days. All cases received open reduction and internal fixation with Kirschner wire. They were evaluated by anteroposterior and lateral radiographs and functionally by Broberg criteria. Results Wound healed primarily in all patients. According to Métaizeau criteria, the results were excellent in 15 patients and good in 2 patients, who achieved anatomical reduction. Seventeen patients were followed up for a mean time of 14 months (6-25 months). Function returned to normal in 2 cases compl icated by radial nerve deep branch injury after 6 months of operation. No compl ications of infection and nerve injury occurred. The X-ray films showed that bony heal ing was achieved in all cases; the heall ing time was 2.0-3.5 months (mean 3 months). According to Broberg criteria, the outcome was excellent in 11 cases, good in 4 cases, and fair in 2 cases, the excellent and good rate was 88.2%. Conclusion Open reduction and internal fixation with Kirschner wire has good effect, satisfactory functional recovery and less compl ication in the treatment of Mason type-II fracture of radial head or neck in children.
Objective To investigate the effect of removing the implanted plate-rod system for scol iosis (PRSS) on maintaining scol iosis curve correction and preserving spinal mobil ity in patients with scol iosis. Methods From June 1998 to February 2002, 119 cases of scol iosis were treated with the implant of PRSS, which was removed 26-68 months later (average46.8 months). Complete follow-up data were obtained in 21 patients, including 6 males and 15 females aged 11-17 years old (average 13.8 years old). The disease course was 9-16 years (average 12.1 years). There were 2 cases of congenital scol iosis and 19 cases of idiopathic scol iosis, which included 5 cases of IA, 2 of IB, 1 of IIA, 2 of IIB, 2 of IIC, 2 of IIIA, 3 of IIIB, and 2 of IVA according to Lenke classification. There were 13 cases of thoracic scol iosis and 8 of thoracolumbar scol iosis. AP view and the lateral and anterior bending view of X-ray films before and at 3 to 6 months after removing PRSS were comparatively analyzed, the coronal and the sagittal Cobb angle were measured, and the height of vertebral body on the concave side and the convex side were measured, so as to know the effect of PRSS on the growth of the vertebral endplates. Results All the implants were removed successfully with an average operation time of 2.5 hours (range 2-4 hours) and a small amount of intraoperative blood loss. Twenty-one cases were followed up for 6-72 months (average 34.4 months). The coronal Cobb angle before and after the removal of PRSS was (20.25 ± 8.25)° and (23.63 ± 8.41)°, respectively, indicating there was no significant difference (P gt; 0.05); while the sagittal Cobb angle was (39.44 ± 12.38)° and (49.94 ± 10.42)°, respectively, indicating there was a significant difference (P lt; 0.05). The height of the top vertebral body on the concave side before and after the removal of PRSS was (1.78 ± 0.40) cm and (2.08 ± 0.35) cm, respectively, and there was a significant difference (P lt; 0.01); while the height on the convex side was (2.16 ± 0.47) cm and (2.18 ± 0.35) cm, respectively, indicating no significant difference was evident (P gt; 0.05). All the 21 patients had good prognosis and no major operative compl ication occurred. Conclusion PRSS is an effective instrumentation for the management of scol iosis. After the removal of the PRSS, the correction of scol iosis can be maintained, and the spinal mobil ity can be protected and restored.
Objective To explore the method and effectiveness of lateral calcaneal U-shaped incision approach to treat calcaneal fractures involving the talocalcaneal and calcaneocuboid joints. Methods Between January 2009 and March 2011, 36 cases of calcaneal fractures involving the talocalcaneal and calcaneocuboid joints were treated by the lateral calcaneal U-shaped incision approach and calcaneal anatomical plate fixation. There were 27 males and 9 females with an average age of 38.7 years (range, 19-58 years). According to the Sanders classification criteria, there were 12 cases of type II, 20 cases of type III, and 4 cases of type IV. The Bouml;hler and Gissane angles were (6.21 ± 10.48)° and (89.85 ± 12.34)°, respectively. The average time from injury to surgery was 4.2 days (range, 2-14 days). Results Superficial skin flap necrosis and wound exudate occurred in 1 case respectively, which were cured after dressing change; primary healing was obtained in the other cases. All the cases were followed up 12-26 months (mean, 15.2 months). The X-ray films showed that all fractures healed with an average healing time of 10.6 weeks (range, 8-12 weeks). The reduction of articular surface was satisfactory, and the heel height returned to normal. No complication of breakage of internal fixation or traumatic arthritis occurred. The Bouml;hler and Gissane angles were (29.64 ± 5.33)° and (121.75 ± 6.65)°, respectively at 3 months after operation, showing significant differences when compared with the preoperative values (t=43.800, P=0.000; t=33.200, P=0.000). The average time of plate removal was 11.2 months (range, 9-20 months). According to Maryland foot score, the results were excellent in 17 cases, good in 15 cases, and fair in 4 cases; the excellent and good rate was 88.9%. Conclusion The lateral calcaneal U-shaped incision approach is an effective method to treat calcaneal fractures involving the talocalcaneal and calcaneocuboid joints, which can expose the fracture fully, restore the anatomy of the calcaneal bone, and do early exercise under the condition of rigid internal fixation.
Objective To illustrate the effect and complication of orthopedic applications for biodegradable and absorbable internal fixation of fractures, and to indicate the existent problem and research aspect currently. Methods The recent literatures on orthopedic applications and study of biodegradable and absorbable internal fixation for fractures were reviewed. The effect of biodegradable materials on bone healing was summarized. Results It is good for the stability of fracture fixation and result of treeatment. The biodegradable and absorbable internal fixation fractures had no adverse effect on bone healing. Conclusion There will be more widespread application for biodegradable and absorbable materials in orthopedics, but the intensive research should be carried out to prevent its complication.
ObjectiveTo investigate the biomechanical properties of artificial ligament in the treatment of injuries to distal tibiofibular syndesmosis so as to provide a scientific basis for clinical application. MethodsSixteen fresh ankle specimens were harvested from 8 normal fresh-frozen cadavers. The initial tests were performed on 16 intact specimens (group A) and then the distal tibiofibular syndesmosis injury models were made (group B); the distal tibiofibular syndesmosis was fixed with artificial ligament in 8 specimens (group C) and with cannulated lag screw in the other 8 specimens (group D). The pros and cons of different fixation methods were analyzed by displacement, stress shielding effect, the strength and stiffness of ankle joints, the contact area of tibiotalar articular surface and the contact stress. ResultsUnder the physiological loading or combined with external rotation moment, the displacement of group C was significantly lower than that of groups B and D (P < 0.05), but no significant difference was found between groups A and C (P > 0.05); and there were significant differences among groups A, B, and D (P < 0.05). The rates of stress shielding in the tibia and fibula of group C were significantly lower than those of group D (t=-71.288, P=0.000;t=-97.283, P=0.000). The stress strength in tibia of group C was significantly higher than that of groups A and D (P < 0.05), but no significant difference was found between groups A and D (P > 0.05). Group C had the highest stress strength in fibula, followed by group A, group D had the lowest; differences were significant among 3 groups (P < 0.05). There was no significant difference in shear strength among groups A, C, and D (P > 0.05). The axial stiffness in tibia of group D was significantly lower than that of groups A and C (P < 0.05), but no significant difference was found between groups A and C (P > 0.05). The axial stiffness in fibula of group C was significantly higher than that of groups A and D (P < 0.05), but no significant difference was found between groups A and D (P > 0.05). Group C had the highest shear stiffness in tibia and fibula, followed by group D, group A had the lowest; differences were significant among 3 groups (P < 0.05). In groups A, C, and D, the contact area of tibiotalar articular surface gradually reduced, and the contact stress gradually increased, and differences were significant among 3 groups (P < 0.05). ConclusionFixation of distal tibiofibular syndesmosis injury with artificial ligament can better meet the physiological functions of the distal tibiofibular syndesmosis and has lower stress shielding, better stress distribution. Hopefully, it can reduce the complications of the distal tibiofibular syndesmosis injuries and become a better treatment choice.
Objective To explore the biomechanical stabil ity of dynamic sleeve three-wing screw for treatment of femoral neck fracture and to provide theoretical basis for choosing dynamic sleeve three-wing screw in cl inical appl ication. Methods Nine human cadaveric femurs were selected and divided randomly into 3 groups (n=3), excluding deformities, fractures, and other lesions. The central neck of the specimens were sawn with hand saw respectively at Pauwels angles of 30, 50, and 70°. All cut ends were fixed with dynamic sleeve three-wing screw. Instron-8874 servohydraul ic mechanical testing machine was used to fixed the specimens which simulated uni ped standing, at the rate of 10 mm/minute and l inear load 0-1 200 N at 11 key points. The strain values of princi pal pressure side and princi pal tension side under different loads were measured. Results There was a peak at 6th point in the 1 200 N load. The strain values at Pauwels angles of 30, 50, and 70° were (—1 657 ± 171), (—1 879 ± 146), and (—2 147 ± 136) με; showing significant differences (P lt; 0.01). The strain values of princi pal pressure side and princi pal tension side of the femoral neck became higher with the increasing Pauwels angle under the same load, showing significant differences (P lt; 0.01). The strain values became higher with the increasing load under the same Pauwels angle (P lt; 0.01). Conclusion Dynamic sleeve three-wing screw has good biomechanical stabil ity for treatment of femoral neck fracture. It explains theoretically that the fracture is more unstable with the increasing Pauwels angle．
Objective To compare effects, advantages and disadvantages of simple internal fixation to that of l imited internal fixation with external supporting frame fixation in the treatment of complex fractures of tibial plateau. Methods From July 2002 to August 2006, 66 cases of complex fractures of the tibial plateau were divided into the internal fixation group (n=39) and the external fixator group (n=27). The interal fixation group had 18 cases of IV, 7 cases V and 14 cases VI according to Schatzker, including 25 males and 14 females aged 18-79 years with an average of 45.4 years. The external fixator group had 13 cases of IV, 6 cases V and 8 cases VI according to Schatzker, including 18 males and 9 femles aged 18-64 years with an average of 44.2 years. No significant difference was evident between the two groups (P gt; 0.05). Patients were treated by using screws, steel plates or external supporting frame fixation strictly based on the princi ple of internalfixation. Results All patients were followed up for 1-5 years. Fracture healed with no occurrence of nonunion. Two cases inthe internal fixation group presented partial skin infection and necrosis, and were cured through the dressing change and flap displacement. Fracture heal ing time was 6-14 months with an average of 7.3 months. The time of internal fixator removal was 6-15 months with an average of 8.3 months. In the external fixation group, 11 cases had nail treated fluid 7 days to 3 months after operation, combining with red local skin; 3 cases had skin necrosis; and 3 cases had loose bolts during follow-up. Through debridement, dressing change and flap displacement, the skin wounds healed. Fracture heal ing time was 3-11 months with an average of 5.1 months. The time of external fixator removal was 5-11 months with an average of 6.4 months. At 8-14 months after operation, the knee function was assessed according to Merchant criteria. In the internal fixation group, 29 cases were excellent, 4 good, 5 fair and 1 poor, while in the external fixation group, 20 cases were excellent, 3 good, 2 fair and 2 poor. There was no significant difference between the two groups (P gt; 0.05). Conclusion The therapeutic effects of simple internal fixation and l imited internal fixation with external supporting frame fixation were similar in the treatment of complex fractures of tibial plateau. Fixation materials should be selected according to the state of injury and bone conditions for the treatment of tibial plateau fracture of type IV, V and VI based on Sehatzker classification.
Objective To evaluate the cl inical outcomes of anterior decompression, bone graft and internal fixation in treating fourth lumbar burst fractures with il iac fenestration. Methods From February 2001 to May 2006, 8 cases of fourth lumbar burst fractures were treated by anterior decompression, correction, reduction, il iac autograft, Z-plate internal fixation with il iac fenestration. Of them, there were 7 males and 1 female, aging 24-46 years with an average of 29.3 years, including 3 cases of Denis type A and 5 cases of Denis type B. The decompression, intervertebral height were compared betweenpreoperation and postoperation by CT scanning. According to Frankel assessment for neurological status, 2 cases were at grade C, 5 at grade D and 1 at grade E before operation. Four cases had different degrees of disturbance of sphincter. Time from injury to operation was 8 hours to 11 days. The preoperative height of the anterior border of the L4 vertebral body was (13.8 ± 2.3) mm, the Cobb angel of fractured vertebral body was (13.2 ± 2.5)°, the vertebral canal sagittal diameter of L4 was (10.6 ± 3.5) mm. The bone graft volume was (7.5 ± 1.3) cm3 during operation. Results Operations were performed successfully. The mean operative time was (142 ± 25) minutes and the mean amount of blood loss was (436 ± 39) mL. The incisions obtained heal ing by first intention after operation. Two cases suffered donor site pain and recevied no treatment. The follow-up time of 8 cases was from 21 months to 52 months (mean 24.5 months). At one week after operation, the height of the anterior border of the L4 vertebral body was (32.5 ± 2.6) mm, the Cobb angel of fractured vertebral body was (6.8 ± 3.7)°, and the vertebral canal sagittal diameter of L4 was (19.8 ± 5.1) mm, showing significant difference when compared with those of preoperation (P lt; 0.01). At the final follow-up, the results showed that the pressure was reduced sufficiently, all autograft fused well, the neurological status improved at Frankel grade from C to D in 1 patient, from D to E in 3 patients, but the others had no improvement. In 4 patients who had disturbance of sphincter, 3 restored to normal and 1 was better off. Conclusion Cl inical outcomes of anterior surgery for fourth lumbar burst fractures with il iac fenestration are satisfactory. It can facil icate operation, reduce the pressure sufficiently, maintenance intervertebral height and recover the neurological function.
Objective To summarize the surgical technique of ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation, and to evaluate the cl inical effectiveness. Methods Between March 2009 and June 2010, 18 patients with ankle joint disease were treated, including 8 cases of post-traumatic arthritis, 3 casesof rheumatoid arthritis, 5 cases of osteoarthritis, and 2 cases of post-traumatic necrosis of talus. There were 10 males and 8 females with an average age of 48 years (range, 36-67 years). The average disease duration was 3 years (range, 1-6 years). The main symptoms included swell ing, pain, and a l imited range of motion of the ankle. Four patients accompanied with ankle varus deformity and 2 patients with valgus deformity. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system, the preoperative score was 43.5 ± 10.2. An ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation was performed in all patients. Results Superficial wound infection and partial skin necrosis occurred in 1 case respectively, and were cured after symptomatic treatment; the other incisions healed by first intention without compl ications. Sixteen patients were followed up 16 months on average (range, 1-2 years). The X-ray films showed that bone fusion was obtained at 8-16 weeks (mean, 12 weeks) after operation. The symptom was rel ieved completely in all patients at last follow-up without compl ication of implant failure, nonunion, and malunion. The postoperative AOFAS ankle and hindfoot score was 83.0 ± 6.3, showing significant difference when compared with the preoperative score (t=26.20, P=0.00). Conclusion Ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation has the advantages of feasible technique, the rigid fixation, and high fusion rate, soit may obtain a good cl inical effectiveness.
Objective To improve the retrograde rotative-type interlocking intramedullary nail based on humeral bone dissection and cl inical appl ication, and investigate the cl inical values of modified retrograde rotative-type interlocking intramedullary nail for humeral shaft fracture. Methods Between March 2006 and March 2010, 146 patients with humeral shaft fractures were treated and fractures were fixed with the modified retrograde rotative-type interlocking intramedullary nail (the modified group, n=73) and with the retrograde rotative-type interlocking intramedullary nail (the original group, n=73). In the original group, there were 40 males and 33 females with an average age of 41 years; 41 cases were classified as transversefracture, 18 as obl ique fracture, 8 as spiral fracure, and 6 as comminuted fracture; the median disease duration was 11 days (range, 3 hours to 2 months); and close reduction fixation was performed in 27 cases and open reduction fixation in 46 cases. In the modified group, there were 39 males and 34 females with an average age of 40 years; 43 cases were classified as transverse fracture, 16 as obl ique fracture, 10 as spiral fracure, and 4 as comminuted fracture; the median disease duration was 13 days (range, 3 hours to 3 months); and close reduction fixation was performed in 31 cases and open reduction fixation in 42 cases. There was no significant difference in sex, age, fracture type, and disease duration between 2 groups (P gt; 0.05). The fracture heal ing and functional recovery of affected l imbs were compared between 2 groups after operation. Results The operation time and intraoperative blood loss in the modified group were significantly less than those in the original group (P lt; 0.05). Iatrogenic fracture occurred in 3 cases of the original group, which were cleavage fracture of supracondylar. No iatrogenic fracture occurred in the modified group. All incisions of 2 groups healed by first intention without compl ications of postoperative infections, metal fracture, and loosening of internal fixation, etc. A total of 116 patients were followed up more than 12 months in 2 groups with 58 patients in each group. The fracture heal ing time was (15 ± 3) weeks (fresh fracture) and (30 ± 12) weeks (old fracture and nonunion) in the modified group, and was (16 ± 4) weeks (fresh fracture) and (35 ± 14) weeks (old fracture) in the original group, showing significant differences between 2 groups (P lt; 0.05). The results of Neer shoulder score were excellent in 65 cases and good in 8 cases, and the results of Aitken and Rorabeck elbow function score were excellent in 61 cases and good in 12 casesin the original group; the results of Neer shoulder score were excellent in 67 cases and good in 6 cases, and the results of Aitken and Rorabeck elbow function score were excellent in 63 cases and good in 10 cases; and the excellent and good rates were 100% in 2 groups. Conclusion The modified retrograde rotative-type interlocking intramedullary nail has the advantages of easy operation and less compl ication, which is an effective and rel iable internal fixator.