ObjectiveTo explore the effectiveness difference between titanium elastic intramedullary nail internal fixation and bone plate internal fixation in the treatment of adult Galeazzi fracture.MethodsNinety-seven patients of Galeazzi fracture according with the selection criteria were divided into 2 groups by prospective cohort study, who were admitted between January 2012 and November 2015. In the patients, 59 were treated with open reduction and bone plate internal fixation (plate group), and 38 with titanium elastic intramedullary nail internal fixation (minimally invasive group). There was no significant difference in the gender, age, cause of injury, fracture site, type of fracture, and time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between 2 groups, and the forearm function was evaluated by Anderson score.ResultsAll the patients were followed up 12-23 months (mean, 17 months). The operation time, intraoperative blood loss, fracture healing time of minimally invasive group were significantly less than those in plate group (P<0.05). There were 1 case of fracture nonunion, 1 case of wound infection in plate group, and 1 case of nail tail slight infection in minimally invasive group, which were all cured after the corresponding treatment. The remaining patients had good fracture healing, and no vascular injury, internal fixation failure, deep infection, or other complications occurred. According to Anderson score at 12 months after operation, the forearm function results were excellent in 46 cases, good in 12 cases, and poor in 1 case, with an excellent and good rate of 98.3% in plate group; and the results were excellent in 26 cases, good in 11 cases, and poor in 1 case, with an excellent and good rate of 97.4% in minimally invasive group; showing no significant difference (χ2=0.10, P=0.75).ConclusionMinimally invasive fixation with titanium elastic nail has such advantages as small damage, quick recovery, no skin scarring, etc. As long as the correct indication is selected, minimally invasive titanium intramedullary nail internal fixation of Galeazzi fractures can also get good effectiveness.
ObjectiveTo investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults.MethodsBetween March 2016 and January 2018, 20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing. There were 13 cases and 7 cases, with an average age of 43 years (range, 18-56 years). The causes of injury included the traffic accident in 6 cases, falling in 12 cases, and falling from height in 2 cases. The interval between injury and admission ranged from 1 hour to 2 days (mean, 3.2 hours). The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases. The length of incision, the operation time, the visual analogue scale (VAS) score on the 2nd day after operation, the fracture healing time, the postoperative shoulder function and the Disability of Arm Shoulder and Hand (DASH) score, the complications, and the time of second surgical removal of internal fixator and incision length were recorded.ResultsThe length of incision was 2-6 cm (mean, 4.7cm). The operation time was 45-120 minutes (mean, 77.2 minutes). The VAS score was 1-5 (mean, 3.2) on the 2nd day after operation. All incisions healed by first intention and no infection or nerve injury occurred. All patients were followed up 12-32 months (mean, 18.6 months). All fractures healed with the healing time of 10-15 weeks (mean, 12.1 weeks). The Constant score was 92-98 (mean, 96.3) and DASH score was 0-6.4 (mean, 3.1). The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation. The internal fixators were removed at 12-26 months (mean, 14.6 months) after operation. And the length of incision was 1-2 cm (mean, 1.3 cm) and the operation time was 5-15 minutes (mean, 9.0 minutes). ConclusionFor the midshaft clavicular fracture in adults, the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision, light pain, rapid fracture healing, small secondary operation injury, and avoiding the risk of clavicular epithelial nerve injury, and can obtain good effectiveness.