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.
Objective To summarize the treatment method and to analyze short-term therapeutic effect of Pipkin fracture. Methods From January 2002 to January 2007, 14 cases of Pipkin fracture were treated. There were 10 males and 4 females with an average of 33.5 years (ranged from 28 to 52 years). Fractures were caused by traffic accident. According to Pipkin’s classification, there were 4 cases of type I, 6 cases of type II, 2 cases of type III and 2 cases of type IV. The time from injury to operation was 24 hours to 8 weeks. All patients received open reduction under Kocher-Langenbeck approach, mel iorative posterior-lateral approach or combined approaches. Absorbable screws and suture l ine internal fixation wereperformed in fracture of the femoral head, titanium cannulated screws were used to fix the femoral intertrochanteric fracture in type III, and acetabular tridimensional memory fixation systems were used to fix the posterior acetabular fractur in type IV. Results All cases had one-stage wound heal ing, no compl ications of deep infection and thrombosis of deep vein of lower l imb occurred. All the patients were followed up for 12 - 48 months (mean 26 months). One case of type III fracture for Pipkin had necrosis of femoral head after 1 year of reduction and fixation, and received total hip replacement; other patients achieved bony heal ing after 6-10 months (mean 8 months). According to D’Aubigue-Postel score, the results were excellent in 5 cases, good in 6 cases, fair in 2 cases and poor in 1 case; the excellent and good rate was 78.6%. Conclusion It is important for the patients with Pipkin fracture to early diagnose, to select proper operation approach, to stably fix fracture and to manage after operation in reducing compl ication and recovering hip joint function.
Objective To investigate the effectiveness of double EndoButton suture fixation Latarjet procedure in the treatment of shoulder anterior dislocation with glenoid bone defect caused by military training injuries.MethodsThe clinical data of 14 patients with anterior shoulder dislocation with glenoid bone defect due to military training injuries who met the selection criteria and admitted between August 2021 and December 2022 were retrospectively analyzed. All patients were male, the age ranged from 21 to 38 years, with an average of 26.8 years. The time from initial dislocation to operation was 6-15 months, with an average of 10.2 months. Anterior shoulder dislocation occurred 5-12 times, with an average of 8.2 times. All glenoid bone defects were more than 10%, including 5 cases of 10%-15%, 8 cases of 15%-20%, and 1 case of 24%. All patients were treated by double EndoButton suture fixation Latarjet procedure. The operation time and complications were recorded. The shoulder function and pain were evaluated by the American Association for Shoulder and Elbow Surgery (ASES) score, Rowe score, Instability Severity Index Score (ISIS), and visual analogue scale (VAS) score before and after operation. The range of motion of the shoulder was recorded, including forward flexion, 0° external rotation, and abduction 90° external rotation. The position, healing, and resorption of the bone mass were evaluated by three-dimensional CT of shoulder joint after operation. Results All patients successfully completed the operation, and the operation time was 100-150 minutes, with an average of 119.7 minutes. There was no complications such as infection, vascular and nerve injury. All patients were followed up 12-20 months, with an average of 15.6 months. During the follow-up, 4 patients had bone mass separation, absorption, and recurrent anterior dislocation, and the shoulder joint fear test was positive. Imaging of the remaining patients showed that the bone mass healed well, no anterior dislocation recurrence occurred, and the healing time was 3-7 months (mean, 4.7 months). At last follow-up, the range of motion, ASES score, Rowe score, ISIS score, and VAS score of the patients significantly improved when compared with those before operation (P<0.05). ConclusionThe effectiveness of double EndoButton suture fixation Latarjet procedure for the treatment of anterior shoulder dislocation with glenoid bone defect caused by military training injury is satisfactory.
【Abstract】 Objective To discuss the strategy of condylar reconstruction in the treatment of refractory condylarnonunion and defect of humerus. Methods From September 1998 to September 2005, 18 patients with refractory condylarnonunion concomitant with defect of humerus were treated. The series included 12 males and 6 females, aged 18 to 60 years. Accordingto AO/ASIF system, primal fractures were classified, including 5 cases of type A3, 2 cases of type B1, 4 cases of type C2and 7 cases of type C3 fractures. Condylar nonunion and defect of humerus were confirmed by preoperative X-ray. Defectivebone mass was 1-4 cm2. The mean extension and flexion of elbow joint was 21.5°(5-65°) and 95.8°(85.0-123.5°) respectively. Accordingto Cassebaum scoring system, the excellent and good rate was 27.8% (excellent in 1 case and good in 4 cases). Time frominjury to operation averaged 22.8 months(7-52 months). All patients were operated with approach of olecranon osteotomy.Bone defect was reconstructed with il iac autograft. Shape memory compressive connector, Kirschner wire, cannulated nail, anatomicplates and reconstruction plates were used to fix. Results Eighteen patients were followed up 12-86 months (mean27.6 months). All the incisions healed by first intention. No bone block displacement, loosening or breakage of internal fixationoccurred. The time of bone union averaged 5.7 months(4-8 months). The mean extension and flexion of elbow joint were 11.4°(0-44.5°) and 128.6°(105.5-144.5°) 1 year after operation. Ectopic ossification formed in 1 case at anterior part of elbow 4 monthsafter operation. According to Cassebaum scoring system, the results were excellent in 8 cases, good in 6 cases, fair in 3 cases andpoor in 1 case. The excellent and good rate was 77.8%. Conclusion The shape of humeral condyle can be reconstructed withil iac autograft. Compressive internal fixation of bone block can promote bone union. Anatomical reconstruction, rigid internalfixation and early function exercise can improve the function of elbow joint evidently.
Objective To investigate the early effectiveness of the limited unique coracoid osteotomy suture button fixation Latarjet (LU-tarjet)-congruent-arc (CA) technique (LU-tarjet-CA) in treating recurrent shoulder dislocations with huge glenoid defect. Methods The clinical data of 12 patients with recurrent shoulder dislocation and huge glenoid defect who met the selection criteria and treated with arthroscopic LU-tarjet-CA between January 2021 and December 2023 were retrospectively analyzed. The cohort included 8 males and 4 females, aged 20-40 years with an average age of 30.4 years. The range of glenoid bone loss was 30%-40%, with an average of 35.5%. The time from symptom onset to hospital admission ranged from 1 to 36 months, with an average of 18.5 months. The University of California Los Angeles (UCLA) score, American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and Rowe score were used to evaluate shoulder function preoperatively and at 3, 6, and 12 months postoperatively. CT three-dimensional (3D) reconstruction was used to assess coracoid healing and plasticity at 3, 6, and 12 months postoperatively. Subjective satisfaction of patient was recorded at last follow-up. Results All incisions healed by first intention, with no incision infection or nerve injury. All 12 patients were followed up 12 months. One patient developed Propionibacterium acnes infection within the joint postoperatively and recovered after initial arthroscopic debridement and anti-inflammatory treatment. At 3 months after operation, CT 3D-reconstruction showed 1 case of complete coracoid absorption; neither of these two patients experienced redislocation. The remaining patients exhibited partial coracoid absorption but displayed local reshaping, filling the preoperative defect area, and bony fusion between the coracoid and the glenoid. At last follow-up, 9 patients (75%) were very satisfied with the outcome, and 3 patients (25%) were satisfied; the satisfied patients experienced postoperative shoulder stiffness caused by suboptimal functional exercise but did not have impaired daily life activities. The UCLA score, ASES score, Walch-Duplay score, and Rowe score at 3, 6, and 12 months postoperatively were significantly better than preoperative scores, and each score improved further over time postoperatively, with significant differences between different time points (P<0.05). Conclusion The arthroscopic LU-tarjet-CA technique for treating recurrent shoulder dislocations with huge glenoid defect can achieve the surgical objective of bony blockade and filling bone defects to prevent shoulder dislocation, thereby improving patients’ quality of life and shoulder joint function and stability.