ObjectiveTo explore the early effectiveness and advantages of mini-Swashbuckler approach in treatment of distal femoral type C fractures by comparing with Swashbuckler approach.MethodsA retrospective analysis was made on 43 patients with distal femoral type C fractures between January 2014 and June 2018. Twenty-two patients were treated with open reduction via mini-Swashbuckler approach and internal fixation with less invasive stabilization system (LISS) plate in modified group; and 21 patients were treated with open reduction via Swashbuckler approach and internal fixation with LISS plate in traditional group. There was no significant difference in age, gender, cause of trauma, fracture classification, fracture side, interval between injury and operation, and complications between the two groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, hospitalization time, fracture healing time, Hospital for Special Surgery (HSS) scores of the knee, and postoperative complications were recorded and compared between the two groups.ResultsThe operation successfully completed in both groups. The operation time of the modified group was significantly longer than that of the traditional group, the fluoroscopy times was increased and the blood loss was reduced, the differences were significant (P<0.05). There was no significant difference in hospitalization time between the two groups (t=0.277, P=0.783). All patients in the two groups were followed up 6-8 months, with an average of 7.2 months. Fractures healed in both groups, there was no significant difference in healing time between the two groups (t=0.861, P=0.394). The HSS scores of the modified group were 82.91±2.88 and 89.28±3.63 at 3 and 6 months after operation, respectively, which were superior to those of the traditional group (74.62±3.64) and (81.48±4.55) (t=8.306, P=0.000; t=6.231, P=0.000). There was 1 case of incision infection, 1 case of deep vein thrombosis, and 2 cases of knee flexion and extension dysfunction in traditional group, and 1 case of deep vein thrombosis, 1 case of varus deformity, and 1 case of internal fixation loosening in modified group. There was no significant difference in the incidences of complications between the two groups (P>0.05).ConclusionCompared with Swashbuckler approach, mini-Swashbuckler approach has limited visual field exposure, which leads to prolonged operation time and increased fluoroscopy times, but the risks of complications do not increase. Because of its small soft tissue injury and less blood loss, it is conducive to the recovery of knee joint function after operation.
ObjectiveTo investigate the effectiveness difference between bone transport with a locking plate (BTLP) and conventional bone transport with Ilizarov/Orthofix fixators in treatment of tibial defect. MethodsThe clinical data of 60 patients with tibial fractures who met the selection criteria between January 2016 and September 2020 were retrospectively analyzed, and patients were treated with BTLP (BTLP group, n=20), Ilizarov fixator (Ilizarov group, n=23), or Orthofix fixator (Orthofix group, n=17) for bone transport. There was no significant difference in gender, age, cause of injury, time from injury to admission, length of bone defect, tibial fracture typing, and comorbidities between groups (P>0.05). The osteotomy time, the retention time of external fixator, the external fixation index, and the occurrence of postoperative complications were recorded and compared between groups. The bone healing and functional recovery were evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Results All patients of 3 groups were followed up 13-45 months, with a mean of 20.4 months. The osteotomy time was significantly shorter in the BTLP group than in the Ilizarov group, and the retention time of external fixator and the external fixation index were significantly lower in the BTLP group than in the Ilizarov and Orthofix groups (P<0.05). Twenty-two fractures healed in the Ilizarov group and 1 case of delayed healing; 16 fractures healed in the Orthofix group and 1 case of delayed healing; 18 fractures healed in the BTLP group and 2 cases of delayed healing. There was no significant difference between groups in fracture healing distribution (P=0.824). After completing bone reconstruction treatment according to ASAMI criteria, the BTLP group had better bone healing than the Orthofix group and better function than the Ilizarov groups, showing significant differences (P<0.05). Postoperative complications occurred in 4 cases (20%) in the BLTP group, 18 cases (78%) in the Ilizarov group, and 12 cases (70%) in the Orthofix group. The incidence of complication in the BTLP group was significantly lower than that in other groups (P<0.05). Conclusion BTLP is safe and effective in the treatment of tibial defects. BTLP has apparent advantages over the conventional bone transport technique in osteotomy time, external fixation index, and lower limb functional recovery.
ObjectiveTo explore the efficacy and safety of intravenous injection of tranexamic acid (TXA) combined with local use of TXA cocktail in intertrochanteric fracture fixation with proximal femoral nail antirotation (PFNA).MethodsPatients with intertrochanteric fractures who underwent close reduction and internal fixation with PFNA between February 2018 and March 2019 were enrolled in the study. Among them, 45 patients who met the selection criteria were included in the study and randomly allocated into 3 groups (n=15). The patients in group A were not received TXA during perioperative period. The patients were intravenously injected of 1.0 g TXA before operation in group B and combined with local use of TXA cocktail during operation in group C. There was no significant difference in the age, gender, body mass index, fracture classification, disease duration, and complications between groups (P>0.05). The perioperative blood loss and blood transfusion rate, the visual analogue scale (VAS) score before operation and at 12, 24, and 48 hours after operation, the levels of prostaglandin E2 (PGE2) and bradykinin (BK) before operation and at 1 and 3 days after operation, postoperative complications, and the maximum amplitude (MA) of thromboelastogram were recorded and compared between groups.ResultsThe total blood loss, hidden blood loss, and visible blood loss were significantly lower in groups B and C than those in group A (P<0.05), and the total blood loss and hidden blood loss were significantly lower in group C than those in group B (P<0.05). There was no significant difference in the blood transfusion rate, preoperative VAS scores and the levels of PGE2 and BK between groups (P>0.05). The postoperative VAS scores and the levels of PGE2 and BK were significantly lower in group C than in groups A and B (P<0.05). There was no significant difference in pre- and post-operative MA of thromboelastogram between groups (P>0.05). The incidences of postoperative complications were 33.33% (5/15), 20.00% (3/15), and 13.33% (2/15) in groups A, B, and C, respectively, with no significant difference between groups (χ2=1.721, P=0.550).ConclusionFor intertrochanteric fractures, application of intravenous injection of TXA combined with local use of TXA cocktail in PFNA fixation can reduce perioperative blood loss, relieve pain after operation, and do not increase the risk of complications.
ObjectiveTo compare the effectiveness of femoral neck system (FNS) and cannulate compression screw (CCS) in the treatment of femoral neck fractures in young and middle-aged patients. MethodsThe clinical data of 82 young and middle-aged patients with femoral neck fracture treated between January 2018 and September 2020 were retrospectively analyzed. They were divided into FNS group (24 cases) and CCS group (58 cases) according to different surgical methods. There was no significant difference between the two groups (P>0.05) in general data such as gender, age, height, body mass, cause of injury, complications, fracture location, and fracture classification (Garden classification and Pauwells classification). The operation time, intraoperative blood loss, complications (nonunion, osteonecrosis of the femoral head, shortening of femoral neck, etc.), visual analogue scale (VAS) score at 2 days after operation, clinical healing time of fracture, and Harris score of hip joint after operation were recorded and compared between the two groups. ResultsThe operation time and VAS score at 2 days after operation in FNS group were significantly lower than those in CCS group (P<0.05); there was no significant difference in intraoperative blood loss between the two groups (t=0.263, P=0.796). The patients in CCS group were followed up 6-18 months, with an average of 13.6 months; and the follow-up time in FNS group was 3-12 months, with an average of 7.3 months. There was no complication of internal fixator loosening in both groups. There were 2 cases of osteonecrosis of the femoral head, 1 case of bone nonunion, and 13 cases of femoral neck shortening in CCS group and only 2 cases of femoral neck shortening in FNS group. The difference in the incidence of complications between the two groups (27.6% vs. 8.3%) was significant (χ2=36.670, P=0.015). In CCS group, 3 cases underwent secondary artificial hip arthroplasty due to bone nonunion and osteonecrosis of the femoral head, and the remaining 55 cases achieved clinical healing; in FNS group, 6 patients excluded in the statistics because the follow-up time was less than 6 months, and the remaining 18 fractures healed clinically; there was significant difference in fracture healing time between the two groups (t=4.481, P=0.000). The difference of Harris score of hip joint between 9 months and 6 months after operation in FNS group was significantly higher than that in CCS group (P<0.05), and the Harris score at 9 months after operation was significantly higher than that at 6 months after operation in both groups (P<0.05). ConclusionFNS can accelerate the healing of femoral neck fractures in young and middle-aged patients, so that patients can start functional exercise as soon as possible, thereby reducing the incidence of related complications.