ObjectiveTo evaluate the effectiveness of posteromedial double plates in the treatment of complex olecranal fracture. MethodsBetween September 2011 and July 2015, 13 patients with complex olecranal fractures were treated with posterior olecranon locking compression plate and medial mini-plate. There were 8 males and 5 females with an average age of 41.6 years (range, 22-68 years). Injury was caused by traffic accident in 4 cases, falling from height in 6 cases, and crush by object in 3 cases. According to the Mayo classification, fracture was rated as Mayo type ⅡB in 5 cases and as Mayo type ⅢB in 8 cases. Of 13 cases, 7 had Regan-Morrey type Ⅲ coronoid fractures, including 5 anterior dislocations of the elbow joint and 2 posterior dislocations. The time between injury and admission ranged from 1.5 to 10.0 hours (mean, 5.7 hours). At last follow-up, the elbow function was assessed according to the Broberg-Morrey evaluation criteria. X-ray films was performed to observe fracture healing. ResultsAll incisions healed at first stage and no neural complications occurred. The patients were followed up 9-38 months (mean, 22.1 months). All patients achieved bone union at 3.0-5.5 months (mean, 3.7 months) according to X-ray results. Subluxation of radial head and mild heterotopic ossification occurred in 1 patient respectively, who had no uncomfortable symptoms of movement disorder, elbow instability and pain, and no special management was performed. At last follow-up, the flexion and extension range of motion (ROM) of the elbow was 95-130° (mean, 116.4°); the rotation ROM of the forearm was 150-175° (mean, 170.8°); and the elbow function was excellent in 4 cases, good in 7 cases, and fair in 2 cases, and the excellent and good rate was 84.6%. No internal fixation failure, elbow stiffness, or traumatic arthritis occurred. ConclusionFor complex olecranal fractures, an early and stable anatomic reconstruction of trochlear notch in the olecranon with posterior olecranon locking compression plate and medial mini-plate can obtain good effectiveness in joint functions.
ObjectiveTo compare the effectiveness between toe transfer combined with an abdominal flap and bag-shaped abdominal flap for treatment of totally degloved hand. MethodsBetween January 2005 and January 2012,18 patients with totally degloved hand were treated by two kinds of techniques.Those patients were divided into 2 groups according to the technique.The bag-shaped abdominal flap was used in 8 cases (group A),and toe transfer with a dorsalis pedis skin flap combined with abdominal S-shaped tile-joint subdermal vascular network flaps was performed in 10 cases (group B).There was no significant difference in gender,age,injury cause,injury degree,and interval between injury and operation between 2 groups (P>0.05).The static two-point discrimination (s2PD),grip power of the reconstructed hand,time of returning to work,and active total range of motion (ROM) of the operated finger were compared between 2 groups to assess the effectiveness. ResultsAll flaps and skin grafts survived in 2 groups.One flap suffered vascular crisis at 2 days after operation and survived after surgical exploration in group B.All patients were followed up 12-24 months (mean,16 months).At last follow-up,group B showed a better recovery of s2PD of the thumb and ROM,and shorter time of returning to work than group A (P<0.05),but no significant difference was found in grip power of the reconstructed hand and s2PD of the other fingers between 2 groups (P>0.05). ConclusionThe technique of toe transfer combined with an abdominal flap is better than traditional bag-shaped abdominal flap with the advantages of easy dissection,less time of operation,and satisfactory functional recovery.