ObjectiveTo evaluate the effectiveness of titanium elastic nails for severe displaced proximal humeral fractures in older children. MethodsBetween April 2009 and July 2012, 31 cases of severe displaced proximal humeral fractures were treated with closed or open reduction and fixation with 2 titanium elastic nails, and the clinical data were retrospectively analyzed. There were 23 boys and 8 girls, aged from 10 to 15 years (mean, 12.8 years). The causes of injury were sports injury (16 cases), traffic accident (11 cases), and falling from height (4 cases). The interval from injury to operation was 6 hours to 7 days (mean, 72 hours). According to Neer-Horwitz classification, 17 cases were rated as type III fracture and 14 cases as type IV fracture. There were 21 cases of metaphyseal fractures and 10 cases of epiphyseal fractures. ResultsSatisfactory reduction of fracture and stable fixation were obtained in all patients (closed reduction in 23 cases and open reduction in 8 cases). Primary healing was achieved in all incisions; no infection and neurovascular injury occurred. All patients were followed up 12-36 months with an average of 20 months. X-ray films showed that all fractures healed at 7-10 weeks (mean, 8 weeks). During follow-up, no disturbance of development or angulation deformity caused by premature physeal closure or bone bridge formation was observed. At last follow-up, the average Neer score of the shoulder was 95.7 (range, 83-100). The appearance and motion of the shoulder were normal. There was no significant difference in the upper extremity length between affected side and contralateral side[(67.68±2.56) cm vs. (67.61±2.54) cm; t=-1.867,P=0.072]. ConclusionTitanium elastic nails for severe displaced humeral fractures in older children is a safe and effective method with a low complication incidence.
ObjectiveTo investigate the accuracy and value of digital planning with bone parameters in determining the appropriate prosthesis for total hip arthroplasty (THA). MethodsThe preoperative radiographs was taken in 13 cases scheduled for THA between September 2012 and June 2013; the bone parameters were measured by digital template, and the prosthesis was selected and preoperative plan was made. There were 4 males and 9 females with an average age of 54.08 years (range, 41-79 years), including 8 left hips and 5 right hips. The causes were osteonecrosis of the femoral head in 8 cases and femoral neck fracture in 5 cases (3 cases had osteonecrosis of the femoral head). ResultsThe operation time was 140-254 minutes (mean, 191.8 minutes). Two cases received blood transfusion, and 6 patients received plasma substitutes transfusion. There was no intraoperative fractures or postoperative thrombosis; atherosclerotic plaque occurred in 2 cases. Thirteen cases were followed up 12-24 months with an average of 17.3 months. The pain was relieved and limb function was improved in all patients. Harris score was significantly improved from preoperative 54.0±12.9 to 91.1±4.1 at 3 months after operation (t=7.259, P=0.000). Compared with the actual implants, the appropriate sizes of femoral stem was selected in 12 cases (92.31%) (excellent in 9 cases, good in 3 cases, and poor in 1 case), and the appropriate sizes of acetabular cup was selected in 11 cases (84.62%) (excellent in 7 cases, good in 4 cases, and poor in 2 cases). ConclusionDigital planning could increase the accuracy in choosing the size of prosthesis for THA.