Objective To summarize the effect and complication of treatment for Pilon fracture using limited internal fixation combined with external fixation. Methods From April 1996 to June 2003, 20 patients with Pilon fracture were treated with limited internal fixation combined with external fixation as the treatment group and 22 patients with Pilon fracture with other methods as the control group. The X-ray films, clinical effect and complication were analyzed and compared between 2 groups. Results All cases were followed up for 8 to 26 months(15.2 months on average). According to Helfet’s criterion forclinical effect, the excellent and good rates were 75% in the treatment group and 72.7%in the control group, being no significant difference (Pgt;0.05). According to Burwell-charnley criterion for reduction, the X-ray film resultsshowed the excellent and good rates were 90% in the treatment group and 86.4% in the control group, being no significant difference (Pgt;0.05). But there was significant difference in complications between 2 groups (Plt;0.05). Conclusion Limited internal fixation combined with external fixation is better in resuming ankle joint function and remarkably reducing complication, especially in reducing soft tissue complication and collapse of bone joint; it is useful in the treatment of Pilon fracture.
目的:探讨有限内固定结合外固定支架在地震伤员膝关节周围开放性骨折早期治疗中的应用。方法:对汶川大地震中25例膝关节周围开放性骨折早期采用有限切开复位有限内固定,同时结合外固定支架治疗,其中胫骨平台骨折13例,(SchatzkerⅤ型4例,SchatzkerⅥ型 9例),股骨远端骨折12例,(AO分型C1型3例,C2型5例,C3型4例),25例开放性骨折按Gustilo分型:GustiloⅡ型5例,GustiloⅢA型8例,GustiloⅢB型10例,GustiloⅢC型2例。结果:术后至患者转院治疗期间两周内,25例开放性伤口均闭合,8例伤口术后出现表浅感染,经加强局部换药感染控制,无伤口深部感染。术后复查X线片无关节面塌陷,骨折无成角畸形,患者出院时无外固定支架钉道松动。结论:有限内固定结合外固定支架为不适宜做内固定治疗的膝关节周围严重开放性骨折提供了一种有效的治疗方法,特别是对于地震等重大灾害所造成的复杂伤情不失为一种较理想的方法。
ObjectiveTo investigate the effectiveness of limited internal fixation combined with hinged super-articular external fixator to treat type C3 fracture of the distal humerus. MethodsBetween September 2007 and November 2012, 37 cases of type C3 fracture of the distal humerus were treated. There were 22 males and 15 females with an average age of 43.6 years (range, 22-66 years). The causes were accident injury in 24 cases, falling injury in 5 cases, falling from height in 4 cases, heavy crush injury in 2 cases, machine injury in 1 case, and other injury in 1 case. There were 22 cases of open injury and 15 cases of closed injury. The time from injury to operation was 3-46 hours (mean, 18 hours). ResultsNeedle tract reaction and incision infection occurred in 3 cases and 1 case respectively, healing of incision by first intension was obtained in the other cases. Thirty-six patients were followed up 9-48 months (mean, 25.4 months). Heterotopic ossification occurred in 3 cases after operation and no recurrence was found by release after fracture healing. Fractures healed in the other patients after 6-14 months (mean, 9 months) of operation except 1 patient who suffered chronic osteomyelitis. One patient had delayed ulnar neuritis at 12 months after operation, and the nerve function returned to normal after the ulnar nerve transposition. There was no bone ischemic necrosis, elbow joint instability, or loosening of internal fixation. At last follow-up, the average range of motion of injured elbow was 105.0° in flexion,-25.0° in extension, 69.2° in pronation, and 75.6° in supination. According to Mayo elbow joint function score (MEPS) and disability of arm shoulder and hand (DASH) score, the results were excellent in 22 cases, good in 8 cases, fair in 4 cases, and poor in 2 cases with an excellent and good rate of 83.3%; and according to Cassebaum elbow joint function score, the results were excellent in 21 cases, good in 7 cases, fair in 5 cases, and poor in 3 cases with an excellent and good rate of 77.8%. ConclusionA combination of limited internal fixation and hinged super-articular external fixator has satisfactory clinical curative effect for type C3 fractures of the distal humerus, relatively few complications.
Objective To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection. Methods The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score. Results All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up (P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%. ConclusionLimited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.