Objective To investigate the treatment and effectiveness of inferior polar comminuted fractures of patella and patellar tendon injury. Methods Between January 2003 and December 2008, 5 patients with inferior polar comminuted fractures of patella and patellar tendon injury were treated with Nitinol Patellar Concentrator and fascia lata allograft. There were 3 males and 2 females with a mean age of 33.7 years (range, 20-48 years). The interval of injury and operation was 1-5 days. Fracture degree: 3 cases had 3 fractures of patella, 2 cases had 4 fractures; patellar tendon injury degree: 3cases had horizontal rupture of middle l igament, 1 case had obl ique rupture of tibial tubercle, and 1 case had longitudinal partial rupture. Results Heal ing of incision by first intention was achieved in all patients, and no compl ication of infection or deep venous thrombosis occurred. The X-ray films at 2 days after surgery showed that patella recovered to normal height, which meaned ratio of patella height to patellar tendon length recovered to 1 : 1. Five cases were followed up 18 months on average (range, 10-22 months). At 3-12 weeks after surgery, the knee function of the injury side almost reached that of the normal side in 4 patients, and the knee range of motion was about 100° in 1 patient. The fracture heal ing time was 3-5 months. At 12-15 months after surgery, patella holder was taken out and no lost of reduction or refracture occurred. During follow-up, there was no fracture displacement, loosening and breakage of implant, or rerupture of patellar tendon. According to ZHANG Chuncai’ s criterion for knee joint function, the results were excellent in 3 cases, good in 1 cases, and fair in 1 case with an excellent and good rate of 80%. According to XU Shaoting’s criterion for knee joint function, the results were excellent in 2 cases, good in 2 cases, and fair in 1 case with an excellent and good rate of 80%. Conclusion Nitinol Patellar Concentrator and fascia lata allograft is a new method to treat inferior polar comminuted fractures of patella and patellar tendon injury, and it can ensure the knee joint stabil ity in early motion after surgery.
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.
ObjectiveTo evaluate the technique and effectiveness of dual plating fixation for distal fibular comminuted fractures. MethodsBetween November 2010 and November 2011, 16 patients with distal fibular comminuted fractures were treated, including 10 males and 6 females with an average age of 49.8 years (range, 35-65 years). All the patients had closed injury, which was caused by sprain in 9 cases, by traffic accident in 5 cases, and by falling in 2 cases. The average interval from injury to admission was 8 hours (range, 1-48 hours). Routine X-ray and CT scan were taken for confirmation of classification and involvement. According to Weber classification system, 11 cases were rated as type A, and 5 as type B; 5 cases had bimalleolar fractures with medial malleolar fracture, and 2 cases had trimalleolar fractures with posterior and medial malleolar fracture. Open reduction and dual plating fixation were performed after swelling was subsided. The X-ray films were taken during follow-up. The effectiveness was evaluated with visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot and ankle score system at last follow-up. The range of motion (ROM) of the ankle and complications were also been recorded. ResultsDelayed healing of incision occurred in 1 patient with diabetes, who was cured after changing dressing; primary healing was obtained in the other patients. Twelve patients were followed up 18 months on average (range, 12-24 months). Radiographic examination demonstrated the mean time of bone healing was 12 weeks (range, 10-14 weeks). No complication of implant failure, malunion, nonunion, or post-traumatic arthritis occurred during follow-up. The AOFAS hindfoot and ankle score was 79.6±6.5, and the VAS score was 1.3±1.5. The ROM of the ankle was (70.0±8.0)° of flexion and (84.0±5.1)° of extension. ConclusionDual plating fixation for distal fibular comminuted fractures can obtain a rigid stabilization with a low complication incidence, so it is a safe and effective method.
ObjectiveTo explore a new method of treating serious tibiofibula comminuted fracture by using three-dimensional (3-D) printing personalized external fixator. MethodsIn April 2015, a male patient (aged 18 years with a height of 171 cm and a weight of 67 kg) with left tibiofibula comminuted fracture was included in the study. Computer-assisted reduction technique combined with 3-D printing was used to develop a customised personalized external fixator for fracture reduction. The effectiveness was observed. ResultsThe operation time was about 10 minutes without fluoroscopy, and successful reduction was obtained. The patient had equal limb length after operation. X-ray films showed that the posterior angulation of distal fracture was corrected 37°, and the eversion angle was corrected 4°. The tibial fractures had good paraposition or alignment, and the lower limb force line was corrected completely. No new fracture displacement occurred. The clinical healing time of fracture was 3.5 months and the bone union was achieved after 8 months. The function of affected limb recovered well after operation. ConclusionA personalized external fixator for serious tibiofibula comminuted fracture reduction made by 3-D printing technique has the merits of easy manipulation, high individuation, accurate reduction, stable fixation, and no need of fluoroscopy.
Objective To evaluate the effectiveness of open reduction and trans-carpometacarpal joint internal fixation with mini locked-plate for treatment of comminuted fracture of base of the fifth metacarpal. Methods Between July 2015 and December 2017, 8 cases of comminuted fractures of base of the fifth metacarpals were treated with open reduction and trans-carpometacarpal joint internal fixation with mini locked-plate. There were 7 males and 1 female with an age of 19-45 years (mean, 32.5 years). The causes of injury included 2 cases of hitting hard objects while clenching fist, 6 cases of falling injury. There were 2 cases of subluxation of fifth carpal joints and 1 case of dislocation. The time from injury to operation was 1-5 days (mean, 3.5 days). The stability of fracture ends could not be maintained by preoperative evaluation without over articular fixation or short time over articular fixation. Postoperative complications and fracture healing were observed, and hand function was evaluated at last follow-up according to the total active motion (TAM) recommended by the Branch of Hand Surgery of Chinese Medicine Association. Results All the incisions healed by first intention without complications such as wound infection, cutaneous necrosis, tendon or nerve injury. All the patients were followed up 6-18 months (mean, 12 months). All fractures healed with the healing time of 12-16 weeks (mean, 13 weeks). Within 4 months after operation, all patients were able to return to pre-injury job. At last follow-up, according to the TAM recommended by the Branch of Hand Surgery of Chinese Medicine Association, the results were excellent in 7 cases, good in 1 case, with the excellent and good rate of 100%. Conclusion Applying of mini locked-plate for treatment of comminuted fractures of base of the fifth metacarpal, of which cannot obtain stable fixation through non-transarticular or short-time transarticular fixation, can achieve satisfactory functional results with very few complications through trans-carpometacarpal joint approach, thus the procedure can be used as an alternative operation scheme.