Objective To investigate the effectiveness of hinged external fixator with mini-plate to treat terrible triad of the elbow. Methods Between August 2008 and June 2011, 11 patients with terrible triad of the elbow were treated with hinged external fixator combined with mini-plate. There were 9 males and 2 females, aged 22-56 years (mean, 34 years). The injuries were caused by falling from height in 8 cases and traffic accident in 3 cases. All patients were closed injury. The time from injury to operation varied from 8 hours to 7 days (mean, 3.7 days). According to Mason classification standard, all radial head fractures were type IV and complicated by posterior dislocation of the elbow; according to Regan-Morrey classification standard, ulna coronary process fractures were type I in 3 cases, type II in 3 cases, and type III in 5 cases. Results All the patients achieved primary healing of incision after operation and no nerve injury occurred. The patients were followed up 12-20 months (mean, 15 months). Two cases had screw channel infection after 12 weeks of operation, and 1 case had mild heterotopic ossification of the elbow after 4 months of operation. X-ray films showed that all fractures healed from 8 to 20 weeks (mean, 16 weeks). No recurrent dislocation or instability of the elbow occurred. At 12 months after operation, the elbow range of motion (ROM) were 120-145° (mean, 135°) in flexion, 0-25° (mean, 10°) in extension, 50-90° (mean, 70°) in pronation, and 50-80° (mean, 60°) in supination. According to Mayo elbow function evaluation standard, the results were excellent in 5 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. Conclusion Hinged external fixator with mini-plate can enhance postoperative stability of the elbow. This therapy is beneficial to early functional exercise and obviously decrease the disability rate caused by complex damage on the elbow.
Objective To evaluate the surgical techniques and effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture with non-absorbable suture fixation combined with the mini-plate. Methods Between January 2009 and March 2012, 32 patients with ACL tibial eminence avulsion fractures were treated. There were 18 males and 14 females, aged 12-40 years (mean, 17.5 years). The injury causes included traffic accident injury in 15 cases, sport injury in 6 cases, and falling injury in 11 cases. The time from injury to operation ranged 7-18 days with an average of 9.5 days. Before operation, the results of Lachman test were all positive; the Lysholm score was 52.13 ± 4.22 and the International Knee Documentation Committee (IKDC) score was 44.82 ± 2.44. According to Meyers-McKeever classification criteria, there were 12 cases of type II and 20 cases of type III. After arthroscopic poking reduction of fracture, tibial eminence avulsion fractures were fixed with the Ethibond non-absorbable sutures bypass figure-of-eight tibial tunnel combined with the metacarpal and phalangeal mini-plate. Results Primary healing was obtained in all incisions; no joint infection or skin necrosis occurred after operation. All patients were followed up with an average time of 22.4 months (range, 12-50 months). The patients showed negative Lachman test at 12 weeks after operation. Except 3 patients having knee extension limitation at last follow-up, the knee extension range of motion (ROM) was normal in the other patients; the knee flexion ROM was normal in all patients. The Lysholm score and IKDC score were significantly improved to 94.19 ± 0.93 and 94.35 ± 1.22 at last follow-up, showing significant differences when compared with preoperative values (t=55.080, P=0.000; t=101.715, P=0.000). Conclusion The arthroscopic treatment of ACL tibial eminence avulsion fracture with Ethibond non-absorbable suture fixation combined with mini-plate is an effective procedure with the advantages of minimal trauma, reliable fixation, and satisfactory recovery of the knee joint function.
Objective To summarize the experience of treating old metatarsal fractures with surgery methods of miniplate internal fixation and autogenous il iac bone. Methods Between May 2009 and July 2010, 7 patients with old metatarsal fractures were treated surgically, including 5 multi-metatarsal fractures and 2 single metatarsal fractures. There were 5 males and 2 females aged from 25 to 43 years (mean, 33 years). The time from fracture to operation was 4-12 weeks. The X-rayfilms showed that a small amount of callus formed at both broken ends with shortening, angulation, or rotation displacement. The surgical treatments included open reduction, internal fixation by miniplate, and autogenous il iac bone graft (1.5-2.5 cm3). The external plaster fixation was used in all patients for 4 to 6 weeks postoperatively (mean, 5 weeks). Results All incisions healed by first intention. The 7 patients were followed up 8-18 months (mean, 13.5 months). The cl inical fracture heal ing time was 6 to 12 weeks postoperatively (mean, 8.4 weeks). No pain of planta pedis occurred while standing and walking. The American Orthopaedic Foot and Ankle Society (AOFAS) mesopedes and propodium score was 75-96 (mean, 86.4). Conclusion It has the advantages of rel iable internal fixation, high fracture heal ing rate, less compl ications to treat old metatarsal fractures with surgery methods of miniplate internal fixation and autogenous il iac bone graft, so it is an effective treatment method.
Objective To evaluate the effectiveness of microplate fixation in open-door cervical expansive laminoplasty (ELP) by comparing with anchor fixation. Methods Between January 2005 and October 2008, 35 patients with multi-segment cervical spondylotic myelopathy were treated. Of them, 15 patients underwent ELP by microplate fixation (microplate group) and 20 patients underwent ELP by anchor fixation (anchor group). In microplate group, there were 10 malesand 5 females with the age of (51.2 ± 11.5) years; the disease duration ranged from 6 to 60 months (mean, 14 months); and the preoperative Japanese Orthopoaedic Association (JOA) score was 7.7 ± 2.5. In anchor group, there were 13 males and 7 females with the age of (50.7 ± 10.8) years; the disease duration ranged from 3 to 58 months (mean, 17 months); and the preoperative JOA score was 7.8 ± 2.9. There was no significant difference in the general data, such as gender, age, and JOA score between 2 groups (P gt; 0.05). Results All incisions healed by first intention. Thirty-five cases were followed up 24-68 months (mean, 32 months). The operation time was (113 ± 24) minutes in anchor group and (111 ± 27) minutes in microplate group, showing no significant difference (t=0.231 3, P=0.818 5). The rate of spinal canal expansion in microplate group (60% ± 24%) was significantly higher than that in anchor group (40% ± 18%) (t=2.820, P=0.008). The JOA scores of 2 groups at 3 months and 24 months after operation were significantly higher than the preoperative scores (P lt; 0.01). There was no significant difference in JOA score between 2 groups at 3 months after operation (t=1.620 5, P=0.114 6), but the JOA score of microplate group was significantly higher than that of anchor group at 24 months after operation (t=3.454 3, P=0.001 5). X-ray film, MRI, and CT scan at 3-6 months after operation displayed that door spindle reached bony fusion. There was no occurrence of ‘‘re-close of door’’ in 2 groups. The rate of compl ication in microplate group (13.3%, 2/15) was significantly lower than that in anchor group (25.0%, 5/20) (χ2=7.160 0, P=0.008 6). Conclusion ELP by microplate fixation can achieve the stabil ity quickly after operation, which can help patients to do functional exercises early, and has satisfactory effectiveness and less complications.
Objective To investigate the treatment of ulnar coronoid process fracture with mini-plate and to evaluate the cl inical results. Methods Between September 2006 and March 2009, 14 patients with ulnar coronoid process fracture were treated with open reduction and internal fixation of mini-plate. There were 10 males and 4 females with an average age of 29 years (range, 14-51 years). Fracture was caused by fall ing from height in 4 cases and traffic accident in 10cases. The locations were left side in 6 cases and right side in 8 cases. According to Regan-Morrey classification, there were 2 cases of type I, 6 of type II, and 6 of type III. The flexion-extension arc of the elbow was (60 ± 10)° and the forearm rotation was (70 ± 10)°. The disease duration was 30 minutes to 11 days, and CT scan was used for definite diagnosis. Patients received early functional exercise 1 week postoperatively. Results All incisions healed by first intention. Fourteen cases were followed up 12-25 months (17 months on average). All fractures healed well, and the average union time was 10 weeks with a range of 7-12 weeks. No 1oosening or breakage of the internal fixation occurred except for 2 patients who had heterotopic ossification. The flexion-extension arc of the elbow was (110 ± 10)° and the forearm rotation was (130 ± 15)°, showing significant difference when compared with that before operation (P lt; 0.05). The cl inical results were evaluated according to Morrey’s scale, 8 cases were rated as excellent, 4 as good, and 2 as fair; the excellent and good rate was 85.7%. Conclusion Fixation of ulnar coronoid process fracture with mini-plate provides sufficient stabil ity to do early functional exercise and it can enhance functional outcome.
OBJECTIVE To probe the clinical results of a new designed operation-double semitendinous reconstruction of posterior cruciate ligament (PCL) with invasive mini-plate. METHODS The new surgical technique was performed on 28 patients with PCL deficient knee in our department from September 1994 to October 1997. Protection of popliteal nerves and blood vessels was emphasized in the operation, and the femoral and tibial tunnel placement was critical to the procedure’s success. RESULTS All patients were followed up 18 to 36 months, averaged 22 months, they gained stable knees. The knee function of 28 patients recovered to normal after the operation, 1 patients had a small range of limitation of the knee flexion, but no obvious dysfunction. CONCLUSION Double semitendinous reconstruction of PCL with invasive mini-plate has advantages in the operated field exposure, adequate tibial and femoral fixation and excellent results in motion, stability and function of the knee after the operation.
To fix the ligaments, tendons or other transplantation materials by passing through bone channels was commonly used and a relialde method in the reconstruction of joint stability. Usually an additional incision was necessary on the side of the outlet of the bone channel, that the screws, plates or U-shaped staple could be applied. An instrument was designed that the steel miniplate could be fixed to the bone by noninvasive method. This technique was applied in 20 cases in which anterior cruciate ligament in 14, posterior cruciate ligament in 4, and collateral ligaments in 2 with carbon fibers. The result was successful in all patients. It was shown that it gave simple manipulation, reliable fixation and no need to have an additional incision, and it could lessen patients’ suffering and lead to satisfactory clinical result.
ObjectiveTo discuss the clinical curative effect of internal fixation for metacarpal and phalanx fractures using stainless steel mini-plate and the early rehabilitation. MethodsThe study included 47 cases treated from January 2006 to June 2011, including 25 cases of 72 phalangeal fractures, 17 cases of 43 metacarpal fractures, and 5 cases of 23 complex metacarpal and phalangeal fractures. All the patients underwent open reduction and micro-plate internal fixation. Three days after surgery, passive function training was initiated. Patients accompanied with blood vessel damage began the training one week later. The training was carried out based on the early rehabilitation schedule. ResultsPrimary healing occurred in all the 47 cases. There was one case of broken plate because of crashing. Postoperative follow-up lasted for 4 to 10 months, and the fractures were healed in 138 lesions. X-ray examination showed that bone union took place at week 8 to 11 averaging at 10. According to the functional evaluation of total autive movement scales, the excellent and good rate was 83.0%. ConclusionThe stainless steel mini-plate in the treatment of metacarpal and phalangeal fractures has a firm fixation and is advantageous. Combined with early rehabilitation training, it can maximize the recovery of hand function with satisfactory clinical results.