Objective To summarize the progress of Masquelet technique to repair bone defect. Methods The recent literature concerning the application of Masquelet technique to repair bone defect was extensively reviewed and summarized. Results Masquelet technique involves a two-step procedure. First, bone cement is used to fill the bone defect after a thorough debridement, and an induced membrane structure surrounding the spacer formed; then the bone cement is removed after 6-8 weeks, and rich cancellous bone is implanted into the induced membrane. Massive cortical bone defect is repaired by new bone forming and consolidation. Experiments show that the induced membrane has vascular system and is also rich in vascular endothelial growth factor, transforming growth factor β1, bone morphogenetic protein 2, and bone progenitor cells, so it has osteoinductive property; satisfactory results have been achieved in clinical application of almost all parts of defects, various types of bone defect and massive defect up to 25 cm long. Compared with other repair methods, Masquelet technique has the advantages of reliable effect, easy to operate, few complications, low requirements for recipient site, and wide application. Conclusion Masquelet technique is an effective method to repair bone defect and is suitable for various types of bone defect, especially for bone defects caused by infection and tumor resection.
ObjectiveTo summarize the research progress of difficulty in removing of locking plate and screw. MethodsThe domestic and foreign related literature about difficulty in removing of locking plate and screw was reviewed. The incidence, the reason, preventive measure, removing method, and its advantages and disadvantages were summarized and analyzed. ResultsWith the popularization of locking plate application, cases with difficulty in removing locking screw have significantly increased compared with non-locking plate, so it has become a new clinical problem. The main reasons are stripping, cross-threading, and cold-welding. In recent years, for the difficulty in removing of locking plate and screw, some special extraction tools and new extraction methods have developed, but each has its defects and indications. ConclusionSufficient preoperative preparation, being familiar with its advantage and disadvantage as well as its indications are necessary. The specific situations of patient, including the reason, the screw, the plate, the incision, the bone quantity, and existing equipment, should be comprehensively considered to select appropriate methods.
ObjectiveTo compare the effectiveness of percutaneous compression plate (PCCP) and hollow compression screw in the treatment of displaced femoral neck fractures. MethodsBetween January 2010 and June 2014, 70 patients with displaced femoral neck fractures were randomly divided into 2 groups. After reduction, fracture was fixed with PCCP in 35 cases (group A) and with hollow compression screw in 35 cases (group B). There was no significant difference in the gender, age, cause, side and type of fractures, time from injury to operation, associated disease, pre-operative Harris score and visual analogue scale (VAS) score between 2 groups (P > 0.05). The operation time, intra-operative blood loss, fracture healing time, fracture reduction quality, time of rehabilitation and weightloading; complication, post-operative Harris score and post-operative VAS score were compared between 2 groups. ResultsThe incisions healed by first intention. All patients were followed up 13-34 months (mean, 23.7 months). There were significant differences in operation time, intra-operative blood loss, and fracture healing time between 2 groups (P < 0.05). There was no significant in the fracture reduction quality between 2 groups (P > 0.05). Avascular necrosis of the femoral head occurred in 2 cases of group A after operation (fracture reduction quality: grade IV); and avascular necrosis of the femoral head occurred in 4 cases of group B after operation (fracture reduction quality: grade I in 2 cases, grade Ⅱ in 1 case, grade Ⅲ in 1 case, and grade IV in 1 case), nonunion in 1 case, and screw loosening in 3 cases; and there was significant difference in the incidence of bone nonunion and avascular necrosis of the femoral head between 2 groups (χ2=-3.997, P=0.046). Difference was significant in fracture reduction quality in the patients with avascular necrosis of the femoral head and nonunion between 2 groups (χ2=1.991, P=0.047). The time of rehabilitation and weight-loading of group A was significantly earlier than that of group B (P < 0.05); the Harris and VAS scores of group A were significantly better than those of group B at 12 months after operation (P < 0.05). ConclusionPCCP for treatment of displaced femoral neck fractures has better static stability and better sliding dynamic pressure effect than hollow compression screw, and it can provide earlier rehabilitation and weight-loading postoperatively and obviously decrease the incidence of bone nonunion and avascular necrosis of the femoral head, but avascular necrosis of the femoral head still occur in patients with poor reduction or comminuted fracture.
ObjectiveTo investigate the short- and medium-term effectiveness of percutaneous compression plate (PCCP) internal fixation for femoral neck fractures in the elderly.MethodsThe clinical data of 32 elderly patients with femoral neck fracture treated with PCCP internal fixation between January 2012 and January 2019 were retrospectively analyzed. All of them were traumatic fractures. The causes of injury were falling in 20 cases, traffic accident in 7 cases, and falling from height in 5 cases. According to Garden classification, there were 7 cases of type Ⅱ, 15 cases of type Ⅲ, and 10 cases of type Ⅳ; there were 12 cases with Singh index level Ⅳ, 14 cases with level Ⅴ, and 6 cases with level Ⅵ; the bone mineral density of femoral neck was 0.610-0.860 g/cm2 (mean, 0.713 g/cm2). The time from injury to operation was 3-14 days, with an average of 5.8 days. Patients began to weight-bear gradually within 3 days postoperatively. The operation time, intraoperative blood loss, hospitalization stay, fracture reduction (Garden alignment index), fracture healing, failure of internal fixation, femoral neck shortening, and osteonecrosis of the femoral head were observed; hip function recovery was evaluated by Harris score.ResultsThe operation time was 35-135 minutes (mean, 73.4 minutes), the intraoperative blood loss was 75-385 mL (mean, 116.4 mL), the hospitalization stay was 3-15 days (mean, 8.3 days). At 1 week after operation, the Garden alignment index of fracture reduction was grade Ⅰ in 25 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 1 case. One case of superficial infection of the incision occurred after operation, and no early complications such as deep vein thrombosis in the lower extremities, pulmonary embolism, or bedsores occurred. All the patients were followed up 2.1-4.0 years, with an average of 2.7 years. Except for 2 cases of delayed union (displaced trans-neck and subhead fractures), no nonunion of fracture and failure of internal fixation occurred, the fracture healing time was 4-8 months, with an average of 4.9 months. Femoral neck shortening occurred in 12 cases (37.5%); osteonecrosis of the femoral head occurred in 3 cases (9.4%), all of which were displaced trans-neck and subhead fractures, of which 2 cases received total hip arthroplasty and the other received conservative treatment. The Harris scores of the hip joint at 3 months, 2 years after operation and at last follow-up were significantly improved when compared with those before operation (P<0.05); there was no significant difference between each time point after operation (P>0.05). At last follow-up, the hip joint function was evaluated according to Harris score, the results were excellent in 15 cases, good in 12 cases, and fair in 5 cases, with an excellent and good rate of 84.4%. There was no significant difference in postoperative hip function composition among patients with different ages, Garden classification, Singh index, and Garden alignment index (P>0.05).ConclusionFor elderly patients with femoral neck fractures without severe osteoporosis and with relatively good physical conditions, PCCP internal fixation can achieve satisfactory short- and medium-term effectiveness, but there is a certain risk of osteonecrosis of the femoral head.
ObjectiveTo investigate the countermeasures for difficult removal of screws in the plate. MethodsThe clinical data were retrospectively analyzed from 47 patients having difficult removal of screws in the plate between January 2004 and May 2014. There were 30 males and 17 females, aged 16-58 years (mean, 34 years). The time from internal fixation to removal of internal fixation was 10 months to 20 years (mean, 22 months). The locations of internal fixation were upper extremity in 25 cases and lower extremity in 22 cases. The number of difficult removal screws in the plate was 1 in 18 cases, 2 in 15 cases, 3 in 9 cases, and 4 in 5 cases. The plate types included general plate in 15 cases and locking plate in 32 cases; stainless steel plate in 10 cases and titanium plate in 37 cases. The reason for difficult removal, plate, screw, incision, and bone quality of patient were comprehensively analyzed, and different methods for difficult removal were chosen according to the principle that first simply then complicated. ResultsAll plates and screws were removed, and no iatrogenic fracture or nerve and vascular injuries occurred. The operation time was 65-270 minutes (mean, 125 minutes). The blood loss was 80-775 mL (mean, 157 mL). The postoperative drainage was 20-250 mL (mean, 92 mL). The incision healing by first intention was obtained in 39 cases, and delayed healing in 8 cases. The patients were followed up 3-24 months (mean, 10 months). No infection or re-fracture was observed. ConclusionThere are many countermeasures for difficult removal of screws in the plate, but each has indication. As long as a well arranged preoperative condition, mastering a variety of methods, and being familiar with its indication, as well as reasonably choosing method based on the specific situations, the plate and screw maybe smoothly removed.
ObjectiveTo summarize the research progress in the treatment of fractures by far cortical locking technique. MethodThe domestic and foreign related literature about the treatment of fractures by far cortical locking technique was reviewed, summarized, and analyzed. ResultsIn order to overcome the shortcomings of high stress at the near side of the plate and high stiffness of traditional locking plate, a new far cortical locking technique has been developed recently. The structure retains the overall strength of locking plate, but decreases the stiffness of the fixation by 80%, so it can provide interfragmentary parallel micromotion and help to form symmetric callus, and satisfactory results have been achieved in theory, experiment, and clinical application of treatment of fractures by far cortical locking. ConclusionsThe far cortical locking technique is a major improvement of locking plate, which is expected to significantly reduce delayed healing and nonunion of some fractures treated with traditional locking plate.
Objective To investigate the effectiveness of shortening-lengthening method using Ilizarov technique for repairing large tibial bone and soft tissue defects. Methods Between January 2006 and December 2011, 12 patients with large tibial bone and soft tissue defects were treated by shortening-lengthening method using Ilizarov technique. There were 8 males and 4 females with an average age of 39.3 years (range, 18-65 years). The causes were injury in 8 cases and chronic infection in 4 cases. The area of soft tissue defect was 5 cm × 4 cm to 20 cm × 16 cm, and the length of tibial bone defect was 4.5-8.0 cm with an average of 6.2 cm. Results Incision in the lengthening area healed by first intention; healing of wounds by first intention was achieved in 6 cases, delayed healing in 2 cases, and secondary healing in 4 cases, with no common peroneal nerve injury. All patients were followed up 18-54 months with an average of 29 months. In the lengthening area, the bone healing time was 180-365 days (mean, 267 days), and the healing index was 3.8-4.3 days/mm (mean, 4.1 days/mm). In the shortening area, the bone healing time was 195-380 days (mean, 297 days) in the others except 1 case who was repaired with bone grafting. Mild pin-related infection and loosening were observed in all cases, but no infection occurred in the lengthening or shortening area. At last follow-up, weight bearing of the leg was fully recovered in 12 cases. According to Mazur’s criteria, the function of ankle was excellent in 2 cases, good in 6 cases, and fair in 4 cases. Nine patients had equal limb length, and 3 patients had shortened length less than 2 cm. Conclusion Shortening-lengthening method using Ilizarov technique has the advantages of simple surgery, less complications, easy to close the wound, and good effectiveness in repairing of large tibial bone and soft tissue defects．