Objective To compare effects of intra-articular injection of corticosteroid or viscoelastic agent alone or a combination of the two drugs for treatment of temporomandibular joint disorders. Methods A prospective quasirandomized controlled trial was conducted to compare 3 treatment protocols of intra-articular injections in the upper compartment of the joint immediately following arthrocentesis repeatedly every 10 days: ① triamcinolone 8 mg alone for 3 times, ② 1% hyaluronate 1 ml alone for 4 times, and ③ triamcinolone 8 mg for 2 times then 1% hyaluronate 1 ml for 2 times. Clinical examinations were done at baseline, 1, 12, and 24 months after end of the treatments. According to improvement of the symptoms and clinical signs, the effectiveness was graded in 3 classes: excellent, better, no change, or worse. The first two were classified as effective. Effective rates of the treatments and subgroups were compared statistically. Results Five hundred and sixty four patients with temporomandibular disorders were included and randomly allocated to 3 groups with 188 patients in each group. The rate of lost follow up at 24 months was 6.9% to 10.1%. At one month after treatment, the triamcinolone group had a better effective rate at 92.0%. At 12 and 24 months of follow up, effective rates of the hyaluronate group were better than those in the triamcinolone alone group (84.6% vs. 54.1% and 83.4% vs. 40.4%). Effective rates of combining triamcinolone and hyaluronate group at 12 and 24 months were 90.4% and 66.3% respectively. Conclusion Intra-articular injection of corticosteroid has better results in a short term and hyaluronate has better results in a long term in the treatment of temporomandibular joint disorders.
Objective To investigate the diagnose and treatment of intra-articular fracture of the 5th metacarpale base with carpometacarpal joint dislocation (reverse Bennett fracture). Methods Between January 2008 and March 2012, 26 cases of reverse Bennett fracture were treated. There were 20 males and 6 females, aged 19-48 years (mean, 26 years). The injury causes included boxing injury in 19 cases, falling injury in 3 cases, heavy pound injury in 3 cases, and crushing injury in 1 case. According to Lundeen classification, there were 8 cases of type A, 9 cases of type B, 3 cases of type C, and 6 cases of type D. The time from injury to operation ranged 1-8 days with an average of 4 days. All patients underwent open reduction and internal fixation with Kirschner wires, screws, or plates by L-shaped dorsal incision. Results Primary healing was obtained in all incisions; no infection, hematoma, and necrosis occurred after operation. All patients were followed up with an average time of 12.5 months (range, 8-24 months). X-ray films showed that all fractures healed after 6-8 weeks (mean, 6.5 weeks); no delayed union or nonunion and no the 5th carpometacarpal joint dislocation were observed. Two cases had mild osteoarthritis. According to the upper extremity functional evaluation standard by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 22 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 96.2%. Conclusion For patients with reverse Bennett fracture, good results can be obtained if early diagnose is done and appropriate internal fixation is selected.
Objective To summarize the preliminary effectiveness of I.T.S. locking plate for intra-articular calcaneal fractures. Methods Between July 2010 and July 2011, 18 cases of intra-articular calcaneal fractures were treated. There were 10 males and 8 females with an average age of 46 years (range, 25-64 years). According to Sanders classification system, there were 3 cases of type II, 9 cases of type III, and 6 cases of type IV. The disease duration was 5-11 days (mean, 6 days). Open reduction and internal fixation with I.T.S. locking plate were performed via an L-shaped lateral extending incision. Results Superficial infection occurred in 1 case, and was cured after dressing changing; healing of incision by first intention was obtained in the other cases. Sixteen cases were followed up 14 months on average (range, 12-18 months). X-ray films demonstrated the bone union in all cases with an average union time of 12 weeks (range, 10-14 weeks). No implant failure or irritation of peroneal tendon occurred during follow-up. X-ray films showed subtalar post-traumatic arthritis with mild pain in 1 case at 11 months after operation, which was relieved by conservative treatment. At last follow-up, the Bouml;hler angle was improved from (12.9 ± 3.2)° preoperatively to (33.8 ± 4.0)° postoperatively, showing significant difference (t=22.78, P=0.00); the Gissane angle was improved from (83.6 ± 6.4)° preoperatively to (119.9 ± 8.5)° postoperatively, showing significant difference (t=17.02, P=0.00). The visual analogue scale (VAS) score was 1.3 ± 1.2, and the ankle and hindfoot scale of American Orthopaedic Foot and Ankle Society (AOFAS) was 80.3 ± 7.9 at last follow-up. Conclusion Treatment of intra-articular calcaneal fracture with I.T.S. locking plate can obtain a stable fixation, which is a safe and effective method.
Objective To investigate the treatment and therapeutic efficacy of intra-articular meniscal cysts by arthroscopy. Methods From January 2005 to December 2009, 9 cases of intra-articular meniscal cysts were treated by arthroscopy, including 5 males and 4 females, with an average age of 33.8 years (range, 24-46 years). Six patients suffered in left knees, 3 in right ones. Just 1 case had trauma history, the others had no obvious predisposing causes. The average course of the disease was 24.2 months (range, 4-36 months). The Lysholm score was (74.2 ± 11.6) points. Arthroscopy showed that the locations of cysts were the anterior horn of lateral meniscus in 8 cases and the anterior horn of medial meniscus in 1 case; all being single cyst (of them, 3 being multilocular cyst). Results All incisions healed primarily with no compl ications of infection and joint effusion. All 9 patients were followed up from 3 to 48 months with an average of 12.7 months. Preoperative symptoms disappeared or reduced and the range of motion of the knee returned to normal. TheLysholm score was (95.1 ± 3.4) points after 3 months of operation, showing significant difference (P lt; 0.01) when compared with the socre before operation. According to assessment standard described by Choy, the treatment outcome was excellent in 6 cases, good in 2 cases, and general in 1 case; the excellent and good rate was 88.9%. No recurrence was found during follow-up. Conclusion Arthroscopic surgery shows the advantages to maintain good function of knee for the treatment of meniscal cyst, it is the best choice for intra-articular meniscal cysts because of its mini-trauma, rapid recovery, thorough treatment and less recurrence. Simultaneously, partial or tatol meniscectomy or menicus repairing under arthroscopy is performed.
Objective To evaluate the effects of T-shaped plate internal fixation in treatment of intra-articular fracture of distal radius. Methods From January 2005 to March 2008, 52 cases of intra-articular fracture of distal radius were treated, including 32 males and 20 females and aging 21-60 years old (mean 47 years old). Fracture was caused by tumbl ing in 30 cases, by fall ing from height in 8 cases, by traffic accident in 11 cases, and by a crashing object in 3 cases. Of 52 cases,there were 50 cases of closed fracture and 2 cases of open fracture. According to AO standard of classification, there were 14 cases of B2 type, 16 cases of B3 type, 15 cases of C1 type, 6 cases of C2 type, and 1 case of C3 type. According to the Cooney’ s general standard of classification of unstable fracture, there were 5 cases of type II, 10 cases of type III, and 37 cases of type IV. The time from injury to operation was 3-14 days (mean 5 days). All patitents received open reduction and T-shaped plate fixation. Seven patients having bone defect were given 6-15 g autologous il ium or 5 mL calcium sulphate artificial aggregate after reduction. Results All incisions healed by first intention. All the patients were followed up for 15 to 30 months postoperatively (mean 24 months). The X-ray films showed good anatomical reduction, even articular surface and no lossening of internal fixation in all the cases. The fractures healed within 9-15 weeks after operation (mean 12 weeks). At last follow-up, the mean palmar tilt was 8° and the mean ulnar variance was 21°, showing statistically significant differences when compared preoperation (— 5° and 5°, P lt; 0.05). The radial length were not abbreviated. According to Dienst assessment, the results were excellent in 42 cases, good in 3 cases, fair in 5 cases and poor in 2 cases 12 weeks after operation, and the excellent and good rate was 86.5%. Conclusion T-shaped plate fixation is rel iable and effective in treatment of intra-articular fracture of distal radius because it has less coml ication of infection, loosening of internal fixation, reduction failure and tendon rupture.
To investigate the operative treatment of displaced intra-articular calcaneal fractures (DIACFs) using a combination of small lateral incision approach and internal fixation and allograft bone transplantation. Methods From January 2005 to December 2007, 28 patients with 34 DIACFs were treated with open reduction, allograft bone transplantationand internal fixation through a small lateral incision approach. Of them, there were 18 males and 10 females, aged 16-65 years. The disease course was 2 hours to 18 days. According to Sanders classification, there were 18 cases of type II fractures, 10 cases of type III fractures and 6 cases of type IV fractures. Results 22 patients with 28 DIACFs were followed up 18.5 months (13-28 months). The wound of 26 feet achieved primary heal ing, the acute rejection was found in 2 patients and developed wound compl ications. Both patients underwent further surgery prior wound heal ing. After the internal fixation were removed, factures was fixed with external fixator, closed continuous irrigation and drainage was employed. In the meantime, both patients received antibiotics and incisional dressing change. As a result, one achieved primary heal ing, the other developed delayed heal ing. Thepreoperative X-ray film showed that Bouml;hler angle was (6.19 ± 9.66)° and Gissane angle was (103.04 ± 15.03)°; the postoperative X-ray film demonstrated that Bouml;hler angle was (34.51 ± 5.89)° and Gissane angle was (112.18 ± 10.50)°; showing statistically significant differences (P lt; 0.05). The internal fixation of 12 patients (14 DIACFs) were removed at 6 -10 months after operation, Bouml;hler angle was (32.81 ± 5.10)° and Gissane angle was (110.81 ± 9.98)°. When compared with preoperative X-ray film, statistically significantdifferences (P lt; 0.05) was found, but there was no statistically significant differences (P gt; 0.05) when compared with normal X-ray film. According to the American Orthopedic Foot and Ankle Society evaluation system for ankle-hind foot, 3 feet scored 60-70 points, 10 feet 70-80 points, 12 feet 80-90 points and 3 feet 90-100 points. Conclusion Allograft bone transplantation is an option for management of DIACFs, because it enables satisfactory reconstruction of bone defects, allows met anatomic reduction and functional recovery, maintaining restoration of calcaneal height and anatomic reduction of the posterior facet.
Objective To introduce a clinical treatment for the reconstructionof calcaneal thalamus by bone autograft and subtalar arthrodesis for antiquatedintraarticular calcaneal fractures. Methods From July 2000 to October 2003, 11 cases with antiquated intraarticular calcaneal fractures were treated. Of the 11 cases, 9 were males and 2 females,whose ages ranged from21 to 48 years. All unilateral calcanei were involved in the 11 cases. The modified extended Lshaped approach lateral to calcaneus was adopted. The primary treatment was manipulation and immobilization with the reconstruction of calcaneal thalamus by bone autograft and subtalar arthrodesis. The average volume of the ilium for the autograft was 3.0 cm×2.5 cm×1.8 cm. Protruded osteophyte from the lateral wall of calcaneus were ablated in all 11 cases. Results All the 11 cases were followed up for 3 to 18 months, 11.5 monthson average. The reconstructed calcaneal thalamus was healed 10 to 12 weeks after the operation. Some of the patients could walk with load 8 weeks after the operation, and the average time for all the patients to walk with load was 13.2 weeks. There were 4 cases of excellent result, 5 cases of good result, and 2 cases of fair result, according to ZHANG Tieliang’s foot score system. Plain radiograph showed that Bohler angle, width of calcaneus and height of calcaneal thalamus were nearlyrestored to normal. Conclusion With the improvement of calcaneal abnormality and restoration of the shape and function of hind foot, reconstruction of calcaneal thalamus by bone autograft combined with subtalar arthrodesis is effective in treating antiquated intra-articular calcaneal fractures.
Objective To assess the treatment effect of intra-articular fracture with absorbable screws and rods.Methods From June 1998 to August 2004， 35 patients with intra-articular fracture were treated by absorbable screws and rods made of self-reinforcedpolyglycolicacid (SR-PGA) and self-reinforcedpoly-L-Lacticacid (SR-PLLA). Of 35 patients, 30 were males and 5 were females (aged from 4 to 62 years). All cases had intra-articular or periarticular fracture. The interval between injury and operation was 3 hours to 29 days. Fracture were fixed with full thread screws of SR-PGA in 9 cases, with tensile screws of SR-PLLA in 26 cases, with rods of SR-PLLA in 15 cases. Bone traction orplaster external fixation were carried out postoperatively. Results The patients were followed from 3 months to 60 months with an average of 28 months．The wounds healed by first intention, and the healing time of bone was 1－3 months. No dislocation, infection and local effusion occurred. Functional recovery was satisfactory．According to AASO articular function standard, the results were excellentin 26 cases, good in 7 cases, fair in 1 case, and poor in 1 case; the total excellent and good rate was 94.3%. Conclusion Internal fixationof absorbable screws and rods are a perfect procedure in treating intraarticular and periarticularfracture, which can avoid the pain of taking out internal fixation materials because of second operation．
OBJECTIVE: To investigate the treatment results of fracture involved articular surface with absorbable screws and rods. METHODS: From October 1995 to May 2002, 32 patients with fracture involved articular surface were treated with absorbable screws and rods with the materials of SR-PGA and SR-PLLA. Bone traction or plaster external fixation were carried out postoperatively. RESULTS: The followed-up period varied from 3 months to 78 months, with an average of 18.5 months. According to the articular function evaluation criteria, the results were excellent in 24 patients, good in 6 patients and fair in 2 patients. The excellent and good rate was 93.7%. The fractures healed, without dislocation, infection and local effusion. CONCLUSION: Internal fixation of absorbable screws and rods is a perfect procedure for treating fracture involved articular surface, which avoided the pain of taking out internal fixation materials of the second operation.
Objective To compare the effects of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures. Methods All randomized controlled trials (RCTs) of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures were identified. Quality assessment and data extraction were performed by two reviewers independently. Results Four published trials involving 530 patients were included. All studies compared operative with nonoperative treatment. It was clear that operative treatment was superior to nonoperative treatment in terms of helping patients back to work, reducing problems wearing shoes, expanding the range of motion of subtalar joint, and improving the recovery of Bohler’s angle. As for foot pain, there was no difference between the two methods. Because the outcome measures varied across the trials, a meta-analysis could not be performed. Conclusions Both operative and nonoperative treatments produce comparable long-term outcomes in the treatment of displaced intra-articular calcaneal fractures. Because of the poor reporting of outcomes, it is not possible to determine if there is any significant difference in outcome measures apart from those listed above. More trials with high methodological quality are needed.