Objective To investigate the effectiveness of minimally invasive plate fixation in treatment of unstable pelvic fractures. Methods Between May 2006 and December 2009, 21 patients with unstable pelvic fractures were treated. There were 13 males and 8 females with an average age of 39 years (range, 21-66 years). The causes of injury included traffic accident in 9 cases, falling from height in 6 cases, and heavy pound injury in 6 cases. The time from injury to hospitalization was 1 to 4 hours with an average of 2.8 hours. According to Tile’s classification, there were 12 cases of type B and 9 cases of type C. After admission, bone traction and exo fixation were performed, and minimally invasive plate fixation was given at 5-24 days after injury. Results All incisions healed by first intention, and no complications of nerve and vessel injuries occurred. According to the reduction criteria of Matta radiography, anatomic reduction was achieved in 16 cases, satisfactory reduction in 4 cases, and fair reduction in 1 case. All patients were followed up 12 months. The X-ray films showed all fractures healed at 2-4 months (mean, 2.6 months). According to Majeed clinical evaluation, the results were excellent in 12 cases, good in 7 cases, and fair in 2 cases. Conclusion Minimally invasive plate fixation can provide effective fixation, reconstruct pelvic ring, and reduce perioperative complications in the treatment of unstable pelvic fractures.
Objective To compare the effectiveness of two minimally invasive methods: minimally invasive plating osteosynthesis (MIPO) and expandable intramedullary nail ing technique in treatment of middle third humeral shaft fractures. Methods The cl inical data were retrospectively analyzed and compared from 33 cases with middle third humeral shaft fractures between May 2004 and December 2008. All the patients were divided into 2 groups: 14 patients were treated with MIPOtechnique (group A) and 19 with expandable intramedullary nail ing technique (group B). In group A, there were 10 males and 4 females with an average age of 35 years (range, 21-51 years). The disease cause was traffic accident in 5 cases, tumbl ing in 6 cases, machine related trauma in 2 cases, crushed by a heavy object in 1 case. Six fractures were classified as AO type A, 6 as type B, and 2 as type C. The time from injury to operation was 3 to 11 days with an average of 5.9 days. In group B, there were 12 males and 7 females with an average age of 40 years (range, 19-68 years). The disease cause was traffic accident in 7 cases, tumbl ing in 8 cases, fall ing from height in 3 cases, crush injury in 1 case. Ten fractures were classified as AO type A, 8 as type B, and 1 as type C. The time from injury to operation was 2 to 6 days with an average of 4.2 days. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The operation time was (104.6 ± 25.8) minutes in group A and (85.0 ± 35.7) minutes in group B, showing no significant difference (P gt; 0.05). Incision healed by first intention without iatrogenic radial nerve palsy in 2 groups. The patientswere followed up 21.4 months on average (range, 12-37 months) in group A and 20.5 months on average (range, 22-35 months) in group B. The X-ray films showed bony heal ing in all patients. The fracture union time was (16.4 ± 6.1) weeks in group A and (15.0 ± 2.5) weeks in group B, showing no significant difference (P gt; 0.05). The University of Cal ifornia Los Angeles (UCLA) End- Result scores were 34.1 ± 1.1 in group A and 31.8 ± 2.6 in group B and the Mayo Elbow Performance scores were 100 in group A and 97.6 ± 3.9 in group B; all showing significant differences (P lt; 0.05). Conclusion Good cl inical outcomes could be obtained when middle third humeral shaft fractures are treated by either MIPO or expandable intramedullary nail ing techniques. However, MIPO technique could offer better shoulder and elbow functional results.
Objective To investigate the cl inical effect of minimally invasive internal fixation percutaneous plate osteosynthesis (MIPPO) assisted by arthroscopy on tibial plateau fractures. Methods From September 2005 to December 2007, 29 patients with tibial plateau fracture underwent arthroscopy-assisted MIPPO, including 18 males and 11 females aged18-59 years old (average 34.7 years old). There were 8 cases of type II, 10 of type III, 5 of type IV, 3 of type V, and 3 of type VI according to Schatzker classification system. The fracture was combined with meniscus injury in 13 cases, anterior cruciate l igament injury in 4 cases, and medial collateral l igament injury in 3 cases. The time from injury to operation was 2-10 days. Firstly, the combined injury was treated under arthroscopy. Then, reduction of tibial plateau fractures was performed, bone grafting was conducted in the area of bone defect, and internal fixation using strut plates was performed after establ ishing subcutaneous tunnel via minimally invasion. Early rehabil itation activities were carried out for each patient 1 day after operation. Results No early compl ications such as poor heal ing of incisions, infections, and osteofascial compartment syndrome occurred. Over the follow-up period of 12-39 months (average 24 months), there was no failure of internal fixation, traumatic knee osteoarthritis, and inversion and eversion of the knee. The fractures healed within 3-4.5 months (average 3.5 months). The cl inical effect was excellent in 23 cases, good in 4 cases, and fair in 2 cases according to Lysholm knee rating system, and the excellent and good rate was 93.1%. Conclusion Arthroscopy-assisted MIPPO is a safe and effective way of managing tibial plateau fractures due to its features of minimal invasion, earl ier recovery, fewer compl ications, and simultaneous treatment of associated intra-articular injuries.
To explore the possibil ity of treating mid-distal humeral shaft fractures associated with radial nerve palsies with minimal invasive plating osteosynthesis (MIPO) techniques. Methods From April 2003 to October 2006, 10 patients with mid-distal humeral shaft fractures associated with radial nerve palsies were treated. All patients were male, aged 19-58 years. According to AO/ASIF classification, there were 4 cases of B1 type, 2 cases of B3 type, 1 case of A2 type, 1 caseof B2 type, 1 case of C3 type and 1 case of A3 type. A straight 4.5 mm dynamic compression plate was placed on the anterior aspect of humerus through two small incisions located on the anterior side of proximal and distal part of the arm. The radial nerve exploration was performed through a lateral small incision made on the fracture site. The fractures were then reduced by manual manipulation and the plate was fixated to the main fragments with 3 screws in each end of the plate. The postoperative compl ications, the bone heal ing time, and the recovery time of the radial nerve functions were recorded. The functions of the affected shoulder and elbow were assessed with UCLA and Mayo elbow performance score system respectively. Results All incision healed by first intention. Ten patients were followed up 9-36 months with an average of 15.7 months. The X-ray films showed that the union of fractures was achieved 12-16 weeks (13.6 weeks on average). The function of the radial nerves recovered completely 12-36 weeks (17.8 weeks on average) in 9 patients. The abductions of the affected shoulder were 150-170° (165° on average). The ROM of the elbows were 130-140° (135.5° on average). According to the UCLA shoulder scoring system, 9 patients achieved the excellent result and 1 patient achieved the good result. All the patients had the excellent results according to Mayo elbow performance score system. Conclusion The mid-distal humeral shaft fractures associated with radial nervepalsies can be treated with MIPO technique and the good results can be obtained.
Objective To compare the differences between volar and dorsal plate positions in the treatment of unstable fracture of distal radius. Methods From June 2000 to December 2006, 61 cases with fracture of distal radius weretreated, 27 males and 34 females aged 22-70 years (55.5 years on average), among which 18 cases were caused by traffic accidents and 43 cases falls. All cases were fresh closed fractures. All patients had AP and lateral X-ray films of the wrist preoperatively and 30 cases experienced CT scan. According to AO, there were 25 cases for B1, 18 for B2, 7 for B3, 7 for C1, and 4 for C2. All the cases were randomized into 2 groups: the wrist palmar group (group A, n=34) and dorsal group (group B, n=27), to perform volar and dorsal plate fixation, respectively. As to the measurement of fortune for the preoperative ruler and incl ination angle, group A were (—45.0 ± 53.0)º and (8.6 ± 3.1)º, respectively, and group B were (—40.0 ± 30.0)º and (7.3 ± 5.6)º, respectively. Preoperative radial shortened (12.0 ± 5.3) mm in group A, and (10.3 ± 4.2) mm in group B. Joint surface level was (4.3 ± 2.2) mm in group A, and (4.1 ± 3.3) mm in group B. Results All of the 61 cases were followed up for 6-27 months (16 months on verage). All the fractures were healed, the time to heal ing in group A was (8.2 ± 1.6) weeks, and in group B was (8.1 ± 1.2) weeks, and the difference was not significant (P gt; 0.05). As for the wrist function by Cartland-Werley scoring at the 8th week after operation, 7 cases were excellent, 10 good, and 17 poor in group A with the choiceness rate of 50.0%, while 7 cases were excellent, 11 good and 9 poor in group B with the choiceness rate of 66.7%. There was significant difference between the two groups (P lt; 0.01). And at the 24th week after operation, 21 cases were excellent, 9 good, and 4 poor in group A with the choiceness rate of 88.2%, while 18 cases were excellent, 5 good, and 4 poor in group B with the choiceness rate of 85.2%. There was no significant difference between the two groups (P gt; 0.05). As for radiological assessment by Sarmiento, device and palm incl ination angles in group A were (9.5 ± 3.1)º and (18.0 ± 8.2)º, respectively, and in group B were (11.0 ± 4.7) º and (16.0 ± 7.6)º, respectively. No radial shortening was found either in group A or in group B, and joint surface level in both groups were less than 1 mm. There was no significant difference between group A and group B in terms of all indicators postoperatively (P gt; 0.05), but there was significant difference when compared with preoperation (P lt; 0.001). With regard to comparison of postoperative compl ications between the two groups, there was no significant difference (P gt; 0.05) in early postoperative compl ications, but there was in long-term compl ications (P lt; 0.01). Conclusion The volar and dorsal plate positions may offer effective stabil ity for unstable distal radial fracture and early functional exercise. The volar plate position may influence the pronation function of the wris joint in the short run, while the dorsal plate position may cause more compl ications in the long run.
Objective To investigate an effect of the minimally-invasive locking compression plate (LCP) under the anterior humeral approach to treat the complex humeral shaft fracture. MethodsEleven patients (6 males, 5 females; age, 3266 years) with a humeral shaft fracture were treated with the minimally-invasive LCP under the modified anterior humeral approach from March 2005 to February 2006. Five of the patients were injured in a traffic accident and the remaining 6 were wounded in a fall. All the patients had an unstable fracture. The multiple segment fracture was found in 2 patients, the obligue line fracture in 1 patient, and the long segment comminuted fracture in 8 patients, of whom the radial nerve injury was found in 1 patient, who had an emergency treatment by the loosening of the radial nerve and the internally fixing with LCP. As for the fracture site, the middle and/or the upper-part fracture of the humerus was found in6 patients, and the middle and/or lower-part fracture of the humerus was foundin 5 patients. The patients underwent the operation in the period from 48 hours to 4 days after the injuries. Results All the patients had a complete healing of their fractures 2-4 months after operation. One patient underwent the loosening of the radial nerve and the internally-fixing with LCP, and his function recovered 3 days after operation.The follow-up for 6-12 months revealed that all the patients’ function recovered. According to the Neer Scoring System for the shoulder function evaluation, 7 patients had an excellent result, 3 had a good result, and 1 had a fair result. According to the HSS Scoring System, 9 patients had an excellent result and 2 had a good result. Conclusion The minimally-invasive locking compression plate under the anterior humeral approach to treat the complex humeral shaft fracture is an effective and safe method of treating the complex humeral shaft fracture.
Objective To investigate and compare the effects of restoring and maintaining the cervical curvature and height of the fused segment by using three different anterior cervical plate systems. Methods From January 2002 to June 2004, 122 patients underwent anterior cervical decompression,autogenous iliac bone graft and plate fixation. Of the 122 patients (85 males, 37 females, aged 14-70), 37 underwent surgery involving the fixation with the Orion plate system, 39 with the Zephir plate system, and 46 with the Codman platesystem. The cervical curvature and height of the fused segment were measured onthe lateral X-ray films so as to compare the changes of the conditions preoperatively,1 week after surgery, and during the follow-up, and also to compare the difference among the three groups. Results The follow-up of the patients for 6-35 months (average 17.3 months) showed that all the patients developed the bone fusion 6 months after operation. There was a significant improvement in the cervical curvature and height of the fused segment before operation versus 1 week after operation（Plt;0.05）; however, there were no significant changes 1 week after operation versus during the followup in each group（Pgt;0.05）; there was no significant difference among the three groups（Pgt;0.05）. Conclusion The three plate systems can effectively reconstruct and maintain the cervical curvature and height of the fused segment, with a satisfactory effect in a short term.
Objective To study the effect of anterior plate fixation on the treatment of middle and lower thirds fractures of humerus and the possibility of operating without injuring the radial nerve. Methods Forty-nine patients with the middle and lower thirds fractures of the humerus were treated with anterior plate fixation from March 1998 to December 2002. Of the 49 patients, 27 were with new fractures, 12 with old fractures, and 10 with nonunion fractures. According to AO classification, of the 49 patients, there were 19 type A, 14 type B1, 9 type B2, 5 type B3, 2 type C1. Thirty-seven patients had closed fractures and 12 had open fractures. Of the 12 patients, 8 were type Gustilo Ⅰ, 4 were type Gustilo Ⅱ. Four out of the 49 patients were associated with radial nerve palsy. All patients were treatedwith anterior plate fixation through the anterior approach to the humerus. The radial nerves injured were explored. Results Of the 49 patients, 48 were followed up 6 to 48 months(28.7 months on average). All fractures were healed within 3 to 9 months(4.7 months on average). Fixed plates of 37 patients out of the 49 were removed. No iatrogenic radial nerve injury occurred in the82 times of the operations among the 49 patients. Conclusion The treatment of middle and lower thirds fractures of humerus by anterior platefixation through the anterior approach to the humerus does not interfere with the fracture healing and can prevent the iatrogenic radial nerve injury.
【摘要】 目的 探讨切开复位肱骨近端内固定锁定系统(proximal humeral internal locking system，PHILOS)治疗老年肱骨近端骨折的疗效。 方法 2008年5月-2009年5月，对22例60岁以上肱骨近端新鲜移位骨折按Neer分型，二部分2例，三部分16例，四部分4例；采用肩前方入路切开复位PHILOS治疗。 结果 22例患者获12～18个月随访，平均14.6个月，采用Constant-Murley评分，优8例，良10例，可3例，差1例，优良率81.4%。 结论 切开复位PHILOS治疗老年肱骨近端骨折疗效肯定。【Abstract】 Objective To discuss the clinical effect of open reduction and internal fixation with the proximal humeral internal locking system (PHILOS) plate in treating elder patients with proximal humeral fracture. Methods From May 2008 to May 2009, we classified 22 cases of fresh displaced proximal humeral fracture according to the Neer classification. All patients were older than 60 years. There were two cases of two-part fracture, 16 cases of three-part fracture and four cases of four-part fracture. The open reduction and internal fixation with PHILOS plate was performed with the anterior deltopectoral approach. Results The 22 patients were followed up for 12 to 18 months with a mean period of 14.6 months. According to Constant-Murley Shoulder Score measurement, eight cases were graded as excellent, 10 good, three fair, and one poor with a excellent and good rate of 81.4%. Conclusion The open reduction and internal fixation with Philos plate is effective in treating elder patients with proximal humeral fracture.