To compare the effectiveness between open reduction combined with internal fixation and artificial radial head replacement in treating Mason type-III comminuted fracture of radial head, to provide the evidence for available treatment methods. Methods Between January 2004 and June 2008, 65 cases of Mason type-III comminuted fractures were treated with open reduction, AO mini plate and screw system or a combination of Kirschner treatment (internal fixation group, n=35) and with artificial radial head replacement (replacement group, n=30). In internal fixation group, there were 21 males and 14 females with an age range of 21 to 35 years (mean, 30.7 years); the causes of injury were traffic accidentin 12 cases, fall ing from height in 8 cases, and a fall in 15 cases; the locations were left side in 23 cases and right side in 12 cases; and the time between injury and surgery was 1-7 days (mean, 3 days). In replacement group, there were 19 males and 11 females with an age range of 23 to 67 years (mean, 32.5 years); the causes of injury were traffic accident in 7 cases, fall ing from height in 8 cases, and a fall in 15 cases; the locations were left side in 17 cases and right side in 13 cases; and the time between injury and surgery was 1-6 days (mean, 1.5 days). There was no significant difference in gender, age, disease cause, disease duration, or other general information between 2 groups (P gt; 0.05), so that 2 series of patients had comparabil ity. Results Incisions healed primarily in 2 groups. All patients were followed up 1 to 4 years with an average of 2.5 years. There were significant differences in elbow flexion angle, extension angle, and forearm rotation angle between 2 groups (P lt; 0.05), but no significant difference in elbow pronation or supination weakness (P gt; 0.05). In internal fixation group, primary union occurred in 29 cases, delayed union in 2 cases, nonunion with ectopic ossification in 2 cases, and internal fixation failure in 2 cases. In replacement group, elbow flexion angle lost beyond 30º in 1 case after 1 year, elbow stiffness occurred in 1 case because prosthesis was too long. According to Broberg and Morrey elbow scores system, the scores were 69.51 ± 10.23 in internal fixation group and 81.55 ± 12.06 in replacement group, showing significant difference (P lt; 0.05). The results were excellent in 15 cases, good in 5 cases, fair in 11 cases, and poor in 4 cases with an excellent and good rate of 57.1% in internal fixation group; the results were excellent in17 cases, good in 5 cases, fair in 6 cases, and poor in 2 cases with an excellent and good rate of 73.3%. Conclusion Artificial radial head replacement can achieve better joint function compared with open reduction combined with internal fixation in treating Mason type-III comminuted fractures of radial head.
Objective To compare the effectiveness between minimally invasive cannulated screw and open reduction and plate fixation in treatment of humeral greater tuberosity fracture by a prospective case-control study. Methods Between January 2008 and January 2011, 49 cases of humeral greater tuberosity fractures were treated with minimally invasive cannulated screw in 25 cases (trial group), and with open reduction and plate fixation in 24 cases (control group). There was no significant difference in gender, age, injury cause, disease duration, fracture displacement, injury side, and complications between 2 groups (P gt; 0.05). The length of incision, operation time, intraoperative blood loss, and hospitalization days were recorded. According to Neer grading system, the effectiveness was evaluated; fracture healing was observed by X-ray films. Results The trial group had smaller incision, shorter operation time, less blood loss, and shorter hospitalization days than the control group, showing significant differences (P lt; 0.01). Superficial infection occurred in 2 cases of the control group, and were cured after symptomatic treatment; primary healing of incision was obtained in the others of 2 groups. All patients were followed up 1-4 years (mean, 2.3 years). The fracture healing time was (7.0 ± 2.3) weeks in the trial group, and was (7.8 ± 2.1) weeks in the control group, showing no significant difference (t=1.24, P=0.22). No heterotopic ossification or loosening and breakage of internal fixation occurred during follow-up. The shoulder function Neer score of the trial group (86.3 ± 2.8) was significantly higher than that of the control group (80.1 ± 2.1) (t=6.37, P=0.00). The results were excellent in 14 cases, good in 8 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 88.0% in the trial group; the results were excellent in 12 cases, good in 7 cases, fair in 2 cases, and poor in 3 cases with an excellent and good rate of 79.2% in the control group; and difference had no statistical significance (Z=0.83, P=0.41). Conclusion Compared with open reduction and plate fixation, minimally invasive cannulated screw for greater tuberosity fracture has the advantages of simple operation, less trauma, less intraoperative blood loss, and good shoulder function recovery.
Objective To investigate the cl inical effect of the acetabular tridimensional memoryalloy-fixation system (ATMFS) in treatment of posterior wall acetabular fractures with posterior dislocation of hip. Methods From January 2004 to February 2006, 15 cases of posterior wall acetabular fracture with posterior dislocation of hip were treated. There were 11males and 4 females, aged 21-68 years old with an average of 43.5 years old. Injury was caused by traffic accident in 8 cases, by fall ing from height in 5 cases and others in 2 cases. The locations were the left hip in 9 cases and the right hip in 6 cases. According to Thompson-Epstein’ fracture classification, there were 6 cases of type II, 5 cases of type III, 2 cases of type IV and 2 cases of type V. Imaging showed the acetabular articular surface displacement of 2-5 mm(mean 3 mm). The time from injury to hospital ization was 6 hours to 2 weeks(mean 1.5 days). Skeletal traction on femoral condyle was given, manual reduction was performed in 12 patients and intra-operative reduction in 3 cases. ATMFS was used after 2-7 days of hospital ization, and 4 cases received autologous free il ium because of bone defect. Results The operative time was 90-390 minutes with an average of 210 minutes. Intraoperative blood loss was 350-2 500 mL with an average of 360 mL. The hospital ization days of the patients ranged from 7 to 21 days(mean 10 days). Epidermal infection occurred and was cured after symptomatic management in 1 case. Other incisions healed by first intention. No deep infections, pulmonary embol ism, deep venous thrombosis and other compl ications occurred. The patients were followed up 1 to 3 years with an average of 1.6 years. Ischemic necrosis of femoral head occurred in 1 case. Heterotopic ossification in grade II occurred in 1 case. The hip function was still good without special treatment. According to Matta’s X-ray fracture reduction assessment, the results were excellent in 7 cases, good in 5 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 80%. According to d’Aubigné cl inical efficacy evaluation, the results were excellent in 8 cases, good in 5 cases, fair in 1 case, and poor in 1 case, the excellent and good rate was 86.7% at last followup. Conclusion ATMFS can be used for the treatment of posterior wall acetabular fracture with posterior dislocation of hip, which can improve the anatomy corresponding rate of the femoral head and reduce the incidence of compl ications and restore the function of the hip.
Objective To investigate the effectiveness of acetabular tridimensional memory alloy-fixation system (ATMFS) combined with autologous il iac bone in the treatment of old acetabular posterior wall fracture with bone defect. Methods Between January 2002 and February 2009, 17 patients with old acetabular posterior wall fracture and bone defect were treated, including 11 males and 6 females with an average age of 41.7 years (range，20-60 years). The time from fracture to admission was 14-180 days (mean, 63 days). The displacement of the acetabular articular surface was more than or equal to 3 mm. According to the America Association of Orthopedic Surgeon (AAOS) acetabular fracture and defectclassification standard, there were 4 cases of type I, 6 cases of type II, 5 cases of type III, and 2 cases of type IV. After the residual fracture fragments of the acetabular posterior wall and soft tissue hyperplasia were removed, the femoral head was reducted, and posterior wall defect was repaired with autologous il iac bone graft; ATMFS was used to fix acetabular posterior wall and artificial capsular l igament to reconstruct the hip so as to prevent re-dislocation of the femoral head. Results According to Matta imaging assessment standard, the results were excellent in 8 cases, good in 6 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 82.3%. All incisions healed by first intention, and no sciatic nerve injury occurred. All patients were followed up 1-8 years (mean, 3.9 years). The mean time of fracture union was 3.6 months (range, 2-6 months). Avascular necrosis of femoral head occurred in 1 case, heterotopic ossification around the acetabulum in 1 case. According to Merle d’ Aubigné-Postel scoring system evaluation, the cl inical results were excellent in 9 cases, good in 6 cases, fair in 1 case, and poor in 1 case with an excellent and good rate of 88.2%. Conclusion ATMFS combined with autologous il iac bone graft and artificial l igament reconstruction of the hip joint capsule is a good choice for the treatment of old acetabular posterior wall fractures with bone defect, which can resume the posterior hip joint stabil ity and prevent re-dislocation of the femoral head.
ObjectiveTo investigate the morphology of coronal femoral intertrochanteric fracture and its effect on reduction and internal fixation.MethodsThe clinical and imaging data of 46 patients with femoral intertrochanteric fracture who met the selection criteria between August 2017 and October 2018 were reviewed. There were 15 males and 31 females; the age ranged from 62 to 91 years, with an average of 72.8 years. The causes of injury included walking falls in 35 cases, falling out of bed in 4 cases, and traffic accidents in 7 cases. The AO/Orthopaedic Trauma Association classification was type 31-A1 in 11 cases and type 31-A2 in 35 cases. All patients underwent closed reduction and internal fixation with intramedullary nails. During the operation, fracture reduction and fixation were performed according to the preoperative evaluation results. According to the patients’ preoperative X-ray film and CT three-dimensional reconstruction images, the direction of the coronal fracture line of the femoral intertrochanter and the morphological characteristics of the fracture block were observed; and the coronal fracture discrimination analysis was carried out for the fractures of different AO/OTA types. The percentages of coronal femoral intertrochanteric fractures diagnosed by preoperative X-ray film and CT three-dimensional reconstruction were calculated and statistically analyzed. The fracture reduction, the position of internal fixation [measurement of tip-apex distance (TAD)]. and the reliability of internal fixation were observed after operation.ResultsX-ray film was not easy to identify coronary fracture, and the coronal fracture line and the shape of the fracture piece weree clearly visible in CT three-dimensional reconstruction images. The morphological characteristics of the coronary fracture block: in AO/OTA 31-A1 type, the fracture line extended obliquely backward from the anterior tip of the large rotor, above the small rotor with or without small rotor fracture; in AO/OTA 31-A2 type, fracture line extended obliquely backward from the anterior tip of the large rotor to below the small rotor. Thirteen cases (28.3%) of coronal fractures were found on preoperative X-ray films, and 35 cases (76.1%) were found by CT three-dimensional reconstruction, showing significant difference (χ2=21.083, P=0.000). In AO/OTA 31-A1 type patients, the proportion of coronal fractures found by X-ray film and CT three-dimensional reconstruction was 18.2% (2/11) and 54.5% (6/11), respectively, and that in AO/OTA 31-A2 type patients was 31.4% (11/35) and 82.9% (29/35), respectively, showing significant differences (χ2=3.143, P=0.000; χ2=20.902, P=0.000). Among the 35 patients with coronal fractures, 6 cases (17.1%) of AO/OTA 31-A1 type, 29 cases (82.9%) of AO/OTA 31-A2 type. The operation time of the patient was 80-112 minutes, with an average of 95 minutes; the intraoperative blood loss was 180-450 mL, with an average of 360 mL. There was no complication such as infection, falling pneumonia, and deep vein thrombosis of the lower extremities. At 3 days after operation, the internal fixators were all in the proper position. The TAD was 0.9-1.8 cm, with an average of 1.4 cm. All patients were followed up 14-18 months, with an average of 16 months. All the fractures healed osseously, and there was no complication such as nonunion and loosening of internal fixation.ConclusionCT three-dimensional reconstruction can better identify coronal femoral intertrochanteric fractures than X-ray films, and accurately recognize and analyze the incidence and morphological characteristics of coronal fractures, which can help formulate more effective surgical strategies to promote patient recovery.