Objective To investigate the clinical efficacy between suture button plate and cortical screw in the treatment of distal tibiofibular syndesmosis seperation. Methods The clinical data and follow-up data 1 week and 2, 4, 6 weeks and 3, 6, 12 months after operation of patients with distal tibiofibular syndesmosis seperation combined with or without ankle fracture who were admitted to hospital from March 2011 to May 2014 were retrospectively collected. According to the fixation ways of distal tibiofibular syndesmosis, the patients were divided into the suture button plate group and the cortical screw group. The operation time, amount of blood loss, combined ankle fracture healing time, American Orthopaedic Foot and Ankle Society (AOFAS) scores at the last follow-up and complications were compared between the two groups. Results A total of 52 patients were enrolled, including 28 cases of suture button plate group and 24 cases of cortical screw group. There were no significant difference in operation time or amount of blood loss between the two groups (P>0.05). All patients were followed up for 12–30 months averaged 14.5 months. All incisions healed by the first intention. The combined ankle fracture healing time in the suture button plate group was (11.2±2.0) weeks, while that was (11.0±2.1) weeks in the cortical screw group, with no significant difference between the two groups (P>0.05). In the suture button plate group, there was no loosening or rupture of internal fixation, while distal tibiofibular syndesmosis seperation was found again in one case 3 weeks after operation, and cured by reoperation at last. In the cortical screw group, rupture of screws was found in 2 cases, which occurred 9 and 11 weeks after operation respectively, and the broken screws were taken out when the fractures were healed and the internal fixation was removed; distal fibiofibular syndesmosis seperation was found again in one case 6 weeks after operation, and no treatment was given due to old age and low demand. At the last follow-up, the AOFAS score in the suture button plate group was 84.6±10.2, while the score in the cortical screw group was 83.7±12.5, with no significant difference between the two groups (P>0.05). Conclusions Suture button plate and cortical screw can effectively treat distal fibiofibular syndesmosis separation. The risk of suture button plate loosening or rupture is poor. Suture button plate fixation can meet the need of early functional exercises, and avoid the routine removal by reoperation.
ObjectiveTo investigate the occurrence, treatment, and effectiveness of peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures.MethodsThe clinical data of 16 patients with peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures who met the inclusion criteria between April 2014 and November 2019 were retrospectively analyzed. There were 7 males and 9 females with an average age of 78.4 years (range, 65-93 years). The 14 cases of initial intertrochanteric fractures were classified according to the classification of AO/Orthopaedic Trauma Association (AO/OTA): 5 cases of type A1, 7 cases of type A2, and 2 cases of type A3; the other 2 cases were intertrochanteric combined with subtrochanteric fractures (Seinsheimer type Ⅴ). According to the classification of peri-implant refracture which was proposed by Chan et al., there were 10 cases of type 1 (6 cases of type 1A, 3 cases of type 1B, 1 case of type 1C) and 6 cases of type 2 (4 cases of type 2A and 2 cases of type 2B). The average interval between refracture and initial surgery was 14.6 months (range, 1-52 months). The incidence of peri-implant refracture in short nail group (the length of intramedullary nail used in initial surgery≤240 mm) was 1.92% (11/573), while the incidence of long nail group (the length of intramedullary nail used in initial surgery≥340 mm) was 1.66% (5/301), showing no significant difference between the two groups (χ2=0.073, P=0.786). The peri-implant refractures were revised with extended intramedullary nail (5 cases) or fixed with additional limited invasive stabilization system (11 cases).ResultsThe average operation time was 115.8 minutes (range, 78-168 minutes) and the average intraoperative blood loss was 283.1 mL (range, 120-500 mL). One patient died of myocardial infarction at 3 months after operation, and the other 15 patients were followed up 9-46 months (mean, 16.8 months). The peri-implant refractures healed at 14-20 weeks (mean, 16.4 weeks) after operation. There was no complications such as incision infection, nonunion, internal fixator loosening and rupture, screw cutting-out, and the second refracture during the follow-up. At last follow-up, all injured limbs regained walking function, and the Hospital for Special Surgery (HSS) score was 56-92 (mean, 80.2). The results were classified as excellent in 2 cases, good in 10, fair in 2, and poor in 1, with the excellent and good rate of 80%.ConclusionStress concentration at the tip of initial intramedullary nail and distal interlocking screw aera is the main cause of peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures. Revision with extended intramedullary nail or fixation with limited invasive stabilization system according to the length of initial intramedullary nail and the type of refracture can get satisfactory effectiveness.
Objective To compare the biomechanical stability of Kirschner wire and tension band wiring, reconstruction plate combined with tension band wiring, and olecranon anatomical plate in fixing proximal ulna combined with olecranon fracture, so as to provide the theoretical evidence for clinical selection of internal fixation. Methods Eight specimens of elbow joints and ligaments were taken from eight fresh male adult cadaveric elbows (aged 26-43 years, mean 34.8 years) donated voluntarily. The model of proximal ulna combined with olecranon fracture was made by an osteotomy in each specimen. Fracture end was fixed successively by Kirschner wire and tension band wiring (group A), reconstruction plate combined with tension band wiring (group B), and olecranon anatomical plate (group C), respectively. The biomechanical test was performed for monopodium compression experiments, and load-displacement curves were obtained. The stability of the fixation was evaluated according to the load value when the compression displacement of fracture segment was 2 mm. Results No Kirschner wire withdrawal, broken plate and screw, loosening and specimens destruction were observed. The load-displacement curves of 3 groups showed that the displacement increased gradually with increasing load, while the curve slope of groups B and C was significantly higher than that of group A. When the compression displacement was 2 mm, the load values of groups A, B, and C were (218.6 ± 66.9), (560.3 ± 116.1), and (577.2 ± 137.6) N, respectively; the load values of groups B and C were significantly higher than that of group A (P lt; 0.05), but no significant difference was observed between groups B and C (t=0.305, P=0.763). Conclusion The proximal ulna combined with olecranon fracture is unstable. Reconstruction plate combined with tension band wiring and olecranon anatomical plate can meet the requirement of fracture fixation, so they are favorable options for proximal ulna combined with olecranon fracture. Kirschner wire and tension band wiring is not a stable fixation, therefore, it should not be only used for proximal ulna combined with olecranon fracture.
Objective To review the efficacy of reconstruction plate combined with tension band wiring for treating proximal ulna and olecranon fractures. Methods Between November 2004 and September 2009, 10 patients with proximal ulna and olecranon fractures were treated by reconstruction plate combined with tension band wiring. There were 6 males and4 females with an average age of 45.3 years (range, 21-75 years). Five fractures were caused by traffic accident, 2 by fall ing from height, 2 by tumbl ing, and 1 by a machine strangulation. The locations were the left side and the right side in 5 cases respectively. One case was open fracture (Gustilo II) and the other 9 were closed fractures. Olecranon fractures included 4 cases of traverse fractures and 6 cases of comminuted fractures, and proximal ulna fractures included 6 cases of comminuted fractures and 4 cases of obl ique fractures. The combined fractures included 6 radial head fractures, 4 coronoid process fractures, 2 proximal humerus fractures, and 3 scapula fractures; other injury included 1 elbow dislocation and 1 shoulder dislocation. Two patients had secondary operation; the other 8 patients received the primary operations and the time from injury to operation varied from 7 days to 20 days, with an average of 11 days. Results One case had infection at the incision 1 week after operation, and recovered after 2 months of antibiotics and debridement; incisions healed by first intention in other 9 patients. All patients were followed up 12-64 months (mean, 40.5 months). The X-ray films showed that fracture heal ing was achieved at 10-24 weeks (mean, 12 weeks). There was no ulnar nerve symptom in all cases. Heterotopic ossification occurred in 1 case at 2 months and stiffness of the elbow in 1 case at 3 months after operation; they were both cured after symptomatic treatment. Proximal migration of Kirschner wires was found in 1 case at 6 months after operation, whose implants were taken out at 9 months after the first operation because fracture had healed. At last follow-up, the flexion and extension arc of the elbow averaged 92.8°(range, 23-130°), and the arc of forearm rotation averaged 124.4° (range, 42-175°). According to the American Hospital for Special Surgery (HSS) evaluation method, the results were classified as excellent in 6 cases, good in 2, fair in 1, and poor in 1. Conclusion Treating proximal ulna and olecranon fractures by reconstruction plate combined with tension band wiring allows patients to do postoperative exercise early and could effectively avoid compl ications.