ObjectiveTo investigate the effectiveness of posterior minimally invasive approach for internal fixation of displaced scapula fractures. MethodsBetween January 2006 and December 2011,16 patients with scapular fractures underwent surgical fixation by a minimally invasive approach,including 11 cases of displaced glenoid fractures and 5 cases of unstable scapular neck/body fractures.There were 12 males and 4 females,aged 35-69 years (mean,53 years).The causes of injury were traffic accident in 10 cases,falling from height in 4 cases,and tumble in 2 cases.In 11 cases of displaced glenoid fractures,6 were rated as Ideberg type Ⅱ,2 as Ideberg type Ⅲ,1 as Ideberg type IV,and 2 as Ideberg type V,with a fracture displacement of more than 3 mm.In 5 cases of unstable scapular neck/body fractures,there were 3 cases of scapular neck fractures and 2 cases of scapular body fractures,with a fracture end angulation of more than 20°;3 cases had floating shoulder injury.The interval of injury and operation was 4-14 days (mean,6 days). ResultsThe mean operation time was 105.8 minutes;the mean intraoperative blood loss was 105.8 mL,and the mean hospitalization time was 17.6 days.Three patients had inflammation around the surgical incision,which was controlled by change dressing;primary healing of incision was obtained in the others.The patients were followed up 12-36 months (mean,24 months);all fractures healed within 12-19 weeks (mean,15.8 weeks).There was no implant failure or deep infection.Constant shoulder score,disability of the arm,shoulder,and hand (DASH) score,and visual analogue scale (VAS) score at post-operation had a significant improvement when compared with scores at pre-operation (P<0.05),but no significant difference was found between different time points at post-operation (P>0.05).Shoulder joint activities were gradually restored during the follow-up;the shoulder range of motion in elevation,abduction,internal rotation,and external rotation at 12 months after operation and last follow-up were significantly higher than those at 6 months after operation (P<0.05),but difference was not significant between at 12 months and last follow-up (P>0.05). ConclusionPosterior minimally invasive approach for internal fixation has good effectiveness in treating displaced scapula fractures,with the advantages of no need for a large subcutaneous flap and an extensive Judet incision or creation of muscular flaps.
Objective To compare the effectiveness between minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) for treatment of extra-articular distal tibial fracture. Methods Between March 2009 and March 2012, 57 patients with extra-articular distal tibial fractures were treated, and the clinical data were retrospectively analyzed. Of 57 cases, 31 were treated with MIPO (MIPO group), and 26 with ORIF (ORIF group). There was no significant difference in gender, age, cause of injury, type of fractures, complication, and time from injury to operation between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were compared between 2 groups. Results There was no significant difference in operation time and intraoperative blood loss between 2 groups (P gt; 0.05). Wound infection occurred in 5 cases [2 in MIPO group (6.5%) and 3 in ORIF group (11.5%)], showing no significant difference (χ2=0.651, P=0.499). The other wound obtained healing by first intention. All cases were followed up 13-24 months (mean, 15 months). No significant difference was found in the average healing time between 2 groups and between patients with types A and B by AO classification (P gt; 0.05); in patients with type C, the healing time in MIPO group was significantly shorter than that in ORIF group (t= — 2.277, P=0.033). Delayed union was observed in 3 cases of MIPO group (9.7%) and in 4 cases of ORIF group (15.4%), showing no significant difference (χ2=0.428, P=0.691). Mal-union occurred in 4 cases of MIPO group (12.9%) and in 1 case of ORIF group (3.8%), showing no significant difference (χ2=1.449, P=0.362). No significant difference was found in Mazur score between 2 groups (t=0.480, P=0.633). The excellent and good rate was 93.5% in MIPO group (excellent in 24 cases, good in 5 cases, fair in 1 case, and poor in 1 case) and was 92.3% in ORIF group (excellent in 18 cases, good in 6 cases, and poor in 2 cases), and the difference was not significant (Z= — 0.687, P=0.492). Conclusion Both MIPO and ORIF have good results in treating extra-articular distal tibial fractures. MIPO is superior to ORIF for treating complex and communited fractures.
Objective To explore the relative prognostic factors of Tile C pelvic injury after iliolumbar fixation. Methods Between March 2007 and March 2010, 60 patients with Tile C pelvic injuries were surgically treated with iliolumbar fixation, including 39 males and 21 females with an average age of 37 years (range, 17-66 years). Of them, 27 cases were classified as Tile C1, 20 as Tile C2, and 13 as Tile C3. The preoperative injury severity score (ISS) was 12-66 (mean, 29.4). The time from injury to surgery was 2-25 days (mean, 8.1 days). Iliolumbar fixation was performed in all patients. Unconditional logistic analysis was used to analyze the relationship between the age, sex, body mass index (BMI), operation opportunity, the preoperative combined injury, classification of fracture, the postoperative complication, reduction outcome, sacral nerve injury, and the time of physical exercise and the prognosis. Results All 60 patients were followed up 12-56 months (mean, 27.3 months). Infection of incisions occurred in 12 cases and were cured after dressing change; healing of incision by first intention was obtained in the other patients. Delay sacral nerve injury was found in 15 patients, 6 patients underwent nerve decompression, and 9 underwent conservative treatment. Ten patients had nail protrusion of Schanz screws at the posterior superior illac spine, and 3 patients had pain, which was relieved after removal of the internal fixator. One patient had bone-grafting nonunion of sacroiliac joint, which was improved by pressured bone graft. Five patients had the beam breakage without significant effect. Six patients had deep vein thrombosis, among them 4 underwent filter and 2 underwent nonsurgical treatment. The healing time of fracture was 3-6 months (mean, 3.9 months). According to the Matta function score, the results were excellent in 31 cases, good in 24 cases, fair in 3 cases, and poor in 2 cases with an excellent and good rate of 91.7% at last follow-up. Majeed score was 58-100 (mean, 86), 28 were rated as excellent, 12 as good, 16 as fair, and 4 as poor with an excellent and good rate of 66.7%. The logistic analysis showed that the age, sex, BMI, and postoperative complications were not prognostic factors; early operation (within 10 days), early function exercises (within 7 days), the better reduction quality, and the less sacral nerve injury were in favor of prognosis; and the worse preoperative combined injury and pelvic injury were, the worse the prognosis was. Conclusion Operation opportunity, the preoperative combined injury, reduction outcome, sacral nerve injury, and the time of physical exercise are all significantly prognostic factors of Tile C pelvic injuries
ObjectiveTo investigate the cl inical characteristics of Eyres type V coracoid fracture combined with superior shoulder suspensory complex (SSSC) injuries, and the effectiveness of open reduction and fixation. MethodsBetween March 2004 and July 2012, 13 patients with Eyres type V coracoid fracture and SSSC injuries were treated. There were 10 males and 3 females with an average age of 41 years (range, 23-59 years). Injury was caused by fall ing from height in 4 cases, by traffic accident in 6 cases, and by impact of the heavy weight in 3 cases. The interval from injury to operation was 3-10 days (mean, 5.2 days). SSSC injuries included 9 cases of acromioclavicular joint dislocation, 5 cases of clavicular fractures, and 4 cases of acromion fractures. The coracoid fractures were fixed with cannulated screws; the acromioclavicular joint dislocations were fixed with hook plate (6 cases) or Kirschner wires (2 case) except 1 untreated case; the clavicular fractures were fixed with anatomical locking plate (3 cases) and hook plate (2 cases); the acromion fractures were fixed with cannulated screws (1 case), Kirschner wires (2 cases), or both of them (1 case). ResultsThe mean operation time was 158.0 minutes (range, 100-270 minutes), and the mean intraoperative blood loss was 207.7 mL (range, 150-300 mL). The other patients obtained primary healing of incision except 1 patient who had inflammation around incision, which was cured after change dressing. All patients were followed up for 22.6 months on average (range, 17-35 months). All fractures achieved union at a mean time of 3.6 months (range, 2-6 months). No nerve injury and implant fixation failure complications were observed. At last follow-up, the Constant score and the disabil ity of the arm, shoulder, and hand (DASH) score had a significant improvement when compared with scores at pre-operation (P<0.05). The shoulder range of motion in flexion, abduction, and external rotation at last follow-up were significantly higher than those at pre-operation (P<0.05). ConclusionEyres type V coracoid fracture associated with SSSC injuries usually results in the instabil ity of the shoulder. With individual surgical treatment, the satisfactory function and good effectiveness can be obtained.
ObjectiveTo investigate the biomechanical influence of the oblique locking plate on the fixation of femoral shaft fracture. MethodsForty imitation artificial femur model with mechanical properties similar to human femur were selected and randomly divided into groups A, B, C, and D, 10 in each group; the femur fracture model was made by transverse osteotomy at 15 cm and 17 cm below the lesser trochanter of the femur and fixed with locking plate with 12 holes and cortical bone screws. The plate was placed in the middle of the longitudinal axis of the femur in group A, and was placed at 5, 10, and 15° angle axis in groups B, C, and D respectively. The axial compression, three-point bending, torsion tests were carried out to measure the strain. ResultsWith the compressive load and bending load increasing, the medial and lateral strains were significantly increased in each group (P<0.05); but no significant difference was found in strains under compressive load and bending load among 4 groups (P>0.05). With increasing torque, the strain was significantly increased in each group (P<0.05). At 10 N·m torque, there was no significant difference in the strain values among 4 groups (P>0.05); the strain value was significantly higher in groups C and D than groups A and B (P<0.05) and in group D than group C (P<0.05) at torque of 20 and 50 N·m, but no significant difference was found between groups A and B (P>0.05). ConclusionUnder different stress, the strain will be significantly increased when the plate is placed at >10° angle axis.