Objective To evaluate the effectiveness of the AO anatomical locking compression plate in treating type C distal humeral fracture. Methods Between July 2008 and April 2009, 13 cases of type C distal humeral fracture were treated with the AO anatomical locking compression plates. There were 5 males and 8 females with an average age of 52.1 years (range, 24-80 years). Fractures were caused by tumbl ing in 7 cases, by traffic accident in 4 cases, and by fall ing from height in2 cases. According to Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification, there were 3 cases of type C1, 6 cases of type C2, and 4 cases of type C3. Two cases compl icated by ulnar nerve injuries, 1 by radial nerve injury, 2 by fractures of ulnar olecranon, 3 by fractures of other parts of extremities, and 6 by osteoporosis. The time from injury to hospital ization ranged from 3 hours to 4 days (0.9 day on average). Results All the incisions achieved heal ing by first intention. Thirteen cases were followed up 12 to 21 months with an average of 15.9 months. According to the X-ray films, unions were achieved both at fracture site and the olecranon osteotomy site with a heal ing time of 8 to 13 weeks (10 weeks on average). The function of elbows recovered from 3 to 32 weeks (10 weeks on average). No fixation failure, myositis ossifican, delayed union, or malunion occurred during the follow-up. The Mayo Elbow Performance score ranged from 75 to 100 with an average score of 95.8; the results were excellent in 9 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 92.3%. Conclusion The AO anatomical locking compression plate has a good fixation in treating type C distal humeral fracture. Through the approach of olecranon osteotomy, it is easy to get anatomical reduction, stable fixation, and early exercise.
ObjectiveTo investigate the application of lateral malleolus hook-plate for the treatment of stageⅡsupination-adduction type medial malleolus fractures. MethodsBetween January 2011 and June 2013, 21 patients with stageⅡsupination-adduction type ankle fractures were treated with lateral malleolus hook-plate, including 12 males and 9 females with an average age of 55.5 years (range, 27-65 years). The injury causes were sprain in 17 cases and traffic accident in 4 cases. The mean time between injury and admission was 12.4 hours (range, 2-72 hours). The tibial distal medial articular surface collapse was found in 7 cases by CT examination and in 3 cases by X-ray film. Of 21 cases, there were 12 cases of low transverse fractures of lateral malleolus, 7 cases of short oblique fractures of lateral malleolus, and 2 cases of ankle joint lateral collateral ligament injury without fractures of lateral malleolus. After operation, the clinical outcome was evaluated according to the talus-leg angle, the recovery of Coin-sign continuity, inside-outside and top ankle gap, talus slope, American Orthopedic Foot and Ankle Society (AOFAS) score, Olerud-Molander score, Kofoed evaluation standards, and patient satisfaction. ResultsSeventeen cases were followed up 18.7 months on average (range, 12-25 months). Primary healing was obtained in 16 cases except 1 case of delayed healing. Fracture healed at an average of 14.6 weeks (range, 12-16 weeks). All cases achieved anatomical reduction, the continuity of Coin-sign, and consistency of inside and outside joint gap; no talus tilt occurred. There was no complication of reduction loss, loosening or breakage of internal fixation, or osteoarthritis during follow-up. The talus-leg angle of the affected side was significantly improved to (83.4±1.8)° at 1 week after operation from preoperative (74.8±7.1)° (t=5.370, P=0.000), but no significant difference was found when compared with normal side (83.8±2.3)° (t=0.676, P=0.509). The AOFAS score, Olerud-Molander score, and range of motion at 1 week, 3 months, and 1 year after operation were significantly improved when compared with preoperative ones (P < 0.05). According to Kofoed evaluation standard, the outcome was excellent in 15 cases and good in 2 cases; the excellent and good rate was 100%. According to patient satisfaction, the outcome was excellent in 13 cases, good in 3 cases, and poor in 1 case; the excellent and good rate was 94.1%. ConclusionThe use of lateral malleolus hook-plate for fixation of stageⅡsupination-adduction type medial malleolus fracture not only can effectively maintain anatomical reduction and supporting function, but also can prevent re-collapsing of the reset joint surface. The surgical method can not increase soft tissue complication, so it is a safe and effective method.
Objective To explore the application of enhanced recovery after surgery (ERAS) in pain management after knee arthroplasty (TKA). Methods Doctor-nurse pain management team was established based on ERAS between June and July 2016, and the pain management was carried out after training the doctors and nurses. According to the formula of two-sample mean comparison and inclusion and exclusion criteria, 60 TKA patients admitted to the hospital from March to May 2016 were assigned into the control group (before intervention) and 60 TKA patients admitted from August to October 2016 were assigned into the trial group (after intervention). The patients in the control group received routine pain management. In the trial group, preventive analgesia was performed, pain health education paths were built and ISBAR communication mode was made preoperatively; anesthesia protocols were optimized intraoperatively; multimodal analgesia based on time-demand was used postoperatively; continuing analgesia program was provided at the discharge. The pain score, Hospital for Special Surgery (HSS) knee score, average length of stay (ALOS) and average hospitalization cost (excluding materials) were compared between the two groups. Results The pain scores between the two groups at the admission and 6 hours after surgery were not statistically different (P>0.05), and the pain scores in the trial group 24, 48, 72 hours after surgery were significantly lower than those in the control group (P<0.05). The HSS scores between the two groups at the admission were not statistically different (P>0.05), and the HSS scores in the trial group 3 days, 1 week, and 1 month after surgery were significantly higher than those in the control group (P<0.05). And ALOS and average hospitalization cost (excluding materials) in the trial group were significantly lower than those in the control group (P<0.05). Conclusion The application of ERAS in pain management after TKA can effectively alleviate the postoperative pain, improve the patients’ knee function, shorten the ALOS, and decrease the average hospitalization cost.
Objective To explore the effectiveness of expanded curettage in the treatment of chondroblastoma. Methods The clinical data of 37 patients with chondroblastoma who were treated with expanded curettage between January 2011 and May 2016 were retrospectively analyzed. There were 24 males and 13 females, with a median age of 17 years (range, 12-30 years). There were 32 primary patients and 5 recurrent patients. Local pain was the first symptom in all patients. The average disease duration was 4.9 months (range, 2-8 months). The lesions were located in the distal femur in 10 cases, the proximal femur in 7 cases, the proximal tibia in 9 cases, the proximal humerus in 5 cases, the patella in 2 cases, the talus in 1 case, the calcaneus in 1 case, and pelvis in 2 cases. According to the Enneking staging of benign bone tumors, all tumors were rated as the 3rd stage. The length of the lesion ranged from 1.2 to 6.9 cm (mean, 3.2 cm). The lesions involved the epiphyseal plate in 19 cases. Results All incisions healed by first intention, and no complications occurred. All patients were followed up 12-76 months, with an average of 40.5 months. At last follow-up, the Musculoskeletal Tumor Society (MSTS) score was 27.5±1.4, and the difference was significant when compared with pre-operative value (18.5±1.9) (t=23.462, P=0.000). The chondroblastoma recurred in 1 case (2.7%) after 5 months. X-ray film showed that bone resorption was found in 6 cases, but there was no obvious collapse in the articular surface of bone graft. The limb shortening deformity occurred in 3 cases who were epiphyseal plate involvement patients and lesions located around the knee joint. But there was no varus deformity, and knee joint activity was not affected. Conclusion Expanded curettage has advantages of low incidence of recurrence and skeletal deformity, good limb function, and it is one of the ideal options for chondroblastoma.
ObjectiveTo compare the effectiveness of arthroscopic one-stage reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) with LARS artificial ligament and autogenous hamstring tendon, respectively.MethodsA retrospective study was performed on 23 patients with ACL and PCL injuries, who were treated with one-stage reconstruction, between June 2013 and June 2017. The ACL and PCL were reconstructed with LARS artificial ligament in 11 patients (artificial ligament group) and autogenous hamstring tendon in 12 patients (autogenous tendon group). There was no significant difference in gender, age, side of injury, cause of injury, time from injury to operation, and preoperative Lysholm score and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time, the time of recovery of daily activities and preoperative exercise level, the occurrence of surgical-related complications, Lysholm score, IKDC score, and the results of knee stability assessment were recorded and compared between the two groups.ResultsThe operation time and the time of recovery of daily activities and preoperative exercise level were significantly shorter in artificial ligament group than in autogenous tendon group (P<0.05). All incisions healed primarily. In autogenous tendon group, the common fibular nerve injury occurred in 1 case and intermuscular vein thrombosis occurred in 1 case. No complication occurred in the remaining patients of the two groups. All the patients were followed up 24-54 months (mean, 36.4 months). At last follow-up, the Lysholm score and IKDC score of the two groups were significantly higher than preoperative scores (P<0.05). There was no significant difference between the two groups (P>0.05). The varus and valgus stress tests of the two groups were negative. There was no significant difference in anterior drawer test, posterior drawer test, and Lachman test between the two groups (P>0.05).ConclusionThe effectiveness of arthroscopic one-stage reconstruction of ACL and PCL with LARS artificial ligament or autogenous hamstring tendon was similar. The knee function and stability recover well. But the patients with LARS artificial ligament reconstruction can resume daily activities and return to exercise earlier.
ObjectiveTo observe the effect of ultra early joint movement onthe rehabilitation of shoulder joint function in patients with breast cancer who underwent axillary lymph node dissection (ALND).MethodsA total of 100 patients with breast cancer who underwent ALND between August 2018 and December 2019 in Zhongnan Hospital of Wuhan University were randomly divided into the early movement group (n=50) and the ultra early movement group (n=50). Both groups received early rehabilitation intervention as recommended by the guidelines. Patients in the early movement group started the shoulder joint movement training on the 7th day after surgery, and patients in the ultra early movement group started the shoulder joint movement training on the 3rd day after surgery, 3 times a day, 5 days a week, for 4 weeks. The changes in pain and drainage volume 3 days, 1 week, and 2 weeks after surgery and the changes of shoulder joint range of motion 1 week, 2 weeks , and 3 weeks after surgery were compared between the two groups, changes in shoulder function and quality of life 1 week and 3, 6, and 12 weeks after surgery were compared by the Constant-Murley and the Medical Outcomes Study 36-item Short-form Health Survey (SF-36) scales, respectively.ResultsThree days, 1 week, and 2 weeks after surgery, no significant difference in the pain scores or drainage volumes was observed between the two groups (P>0.05). One week, 2 weeks, and 3 weeks after operation, the motion ranges of shoulder abduction, flexion, and external rotation in the ultra early movement group were significantly better than those in the early movement group (P<0.05), and the motion range of shoulder internal rotation 1 week after operation in the ultra early movement group was significantly better than that in the early movement group (P<0.05). One week and 3, 6, and 12 weeks after operation, the Constant-Murley scores in the ultra early movement group were 25.9±4.3, 55.4±5.3, 64.6±4.5, and 73.3±4.6, respectively, which were better than those in the early movement group (21.3±3.8, 48.9±7.8, 57.3±4.7, and 70.7±3.0, respectively; P<0.05). No significant difference in the SF-36 scale scores was observed between the two groups (P>0.05).ConclusionsUltra early joint movement can significantly improve the motion range and functions of shoulder joint in patients with breast cancer who underwent ALND. What’s more, ultra early joint movement does not increase the early drainage volume or pain, and has no significant impact on the later quality of life. It is worthy of clinical application.
ObjectiveTo compare the patient-reported outcomes regarding function, joint amnesia, and the quality of life after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The clinical data of patients who received UKA or TKA between September 2017 and June 2018 were retrospectively analyzed. After propensity score matching, 40 patients (40 knees) each in TKA group and UKA group were finally included in the study. There was no significant difference between the two groups in gender, age, body mass index, surgical side, preoperative knee range of motion, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, clinical and function scores of knee society score (KSS) (P>0.05). At 2 years after operation, WOMAC score, KSS clinical and function scores were performed on the two groups of patients, and compared with preoperative ones; knee injury and osteoarthritis outcome score-physical function short form (KOOS-PS), short-form 36 health survey scale (SF-36 scale), and forgotten joint score (FJS) were also performed. Results At 2 years after operation, the total score of WOMAC, the clinical and function scores of KSS in the two groups significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference in the total score of WOMAC, the individual score of WOMAC, the clinical and function scores of KSS between the two groups (P>0.05). The total KOOS-PS score in the UKA group was significantly lower than that in the TKA group (t=4.243, P=0.000), and the scores of writhing/knee rotation, kneeling, and squatting in the UKA group were significantly lower than those in the TKA group (P<0.05). The total FJS score in the UKA group was significantly higher than that in the TKA group (t=−6.334, P=0.000). In the UKA group, the scores of 7 items were significantly lower than those of the TKA group (P<0.05) including when walking over 15 minutes, when climbing stairs, when walking on uneven ground, when standing for long periods, when doing housework or gardening, when taking a walk or hiking, and when doing your favorite sport. The SF-36 scales of physiological function, energy, social function, emotional function, and mental health in the UKA group were significantly higher than those in the TKA group (P<0.05). Conclusion Compared with TKA, patients treated with UKA may have better knee function recovery, joint amnesia, and higher quality of life.
Objective To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty (UKA) between single adductor canal block (SACB) and continuous adductor canal block (CACB) combined with local infiltration anesthesia (LIA) using a prospective study. Methods The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject. Among them, 60 patients met the selection criteria and were enrolled in the study. They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method. There was no significant difference between the two groups (P>0.05) in terms of age, gender, height, body mass, body mass index, affected side, and preoperative resting visual analogue scale (VAS) score and active VAS score, Oxford knee score (OKS), and American Hospital of Special Surgery (HSS) score. All patients received multimodal analgesia management using LIA combined with SACB or CACB. The operation time, pain related indicators (resting and activity VAS scores, number and timing of breakthrough pain, opioid consumption), joint function related indicators (quadriceps muscle strength, knee range of motion, OKS score, and HSS score), as well as postoperative block complications and adverse events were recorded and compared between the two groups. Results There was no significant difference in the operation time between the two groups (P<0.05). All patients in the two groups were followed up with a follow-up time of (9.70±4.93) months in the SACB group and (12.23±5.05) months in the CACB group, and the difference was not significant (P>0.05). The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group (P<0.05). There was no significant difference in resting and active VAS scores between the two groups at other time points (P>0.05). The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group [9 cases (30.00%) vs. 17 cases (56.67%); P<0.05). However, there was no significant difference in the timing of breakthrough pain occurrence and opioid consumption between the two groups (P>0.05). Four cases in the SACB group and 7 cases in the CACB group experienced adverse events, with no significant difference in the incidence of adverse events between the two groups (P>0.05). The CACB group had significantly better knee joint mobility than the SACB group at 1 and 2 days after operation (P<0.05). There was no significant difference between the two groups in knee joint mobility on 0 day after operation and quadriceps muscle strength and OKS and HSS scores at different time points (P>0.05). Conclusion In UKA, the analgesic effects and knee joint function recovery are similar when compared between LIA combined with SACB and LIA combined with CACB. However, SACB is simpler to perform and can avoid adverse events such as catheter displacement and dislocation. Therefore, SACB may be a better choice.
Objective To investigate the effect of tibial rotation on knee and ankle function in the patients with extra-articular distal tibial fractures after minimally invasive plate osteosynthesis (MIPO). Methods A retrospective analysis was conducted on 45 patients with extra-articular distal tibial fractures who underwent MIPO between January 2021 and December 2022. There were 20 males and 25 females, aged from 19 to 68 years (mean, 43.6 years). The causes of fractures included falling from heights in 11 cases, traffic accidents in 15 cases, bruising by a heavy object in 7 cases, and falling in 12 cases. The time from injury to hospitalization was 1 to 6 hours (mean, 3.7 hours). There were 28 cases of simple tibial fractures and 17 cases of tibial fractures combined with ipsilateral fibular fractures; 9 cases of open fractures and 36 cases of closed fractures. According to AO/OTA classification, the distal tibial fractures were classified as type 43A1 in 12 cases, type 43A2 in 17 cases, and type 43A3 in 16 cases. During follow-up period, the Lower Limb Function Score (LEFS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Knee Injury and Osteoarthritis Score (KOOS) were used to evaluate the lower limb, ankle, and knee joint functions, respectively. The range of motion (ROM) of the knee and ankle joints was measured. The Short Form Health Survey (SF-36) was used to assess the quality of life of the patients. The fracture healing was observed by anteroposterior and lateral X-ray films of the ankle joint. The bilateral tibial rotation angles were measured on CT and the differences between the affected and healthy sides were caculated. The difference ≥10° was judged as tibial malrotation. According to whether there was tibial malrotation, the patients were allocated into a normal group and a malrotation group for efficacy comparison. Results The incisions of all patients healed by first intention without any early complications. All patients were followed up 12-26 months (mean, 18.6 months). Imaging re-examination showed that all fractures healed, with a healing time of 9-14 weeks (mean, 11.2 weeks). At last follow-up, the LEFS score was 60-68 (mean, 62.3); the AOFAS score was 89-97 (mean, 92.6); the KOOS score was 158-164 (mean, 161.3). The ROM of ankle was 40.0°-45.0° (mean, 42.8°) in flexion and 10.5°-22.0° (mean, 17.7°) in extension; the ROM of knee was 130.0°-135.0° (mean, 132.6°) in flexion and –8.8°- –5.0° (mean, –7.1°) in extension. The SF-36 score was 89-93 (mean, 90.7). The absolute value of difference of tibial rotation angle was 2.6°-17.3° (mean, 8.9°) in 45 patients, and the malrotation was observed in 15 patients (33.3%), including 10 cases of internal rotation and 5 cases of external rotation. There was no significant difference (P>0.05) in the proportion of patients with fibular fractures before operation between the malrotation group and the normal group, as well as in the AOFAS score, KOOS score, LEFS score, SF-36 score, and ROMs of knee and ankle joints at last follow-up. ConclusionThe incidence of tibial malrotation after MIPO treatment for extra-articular distal tibial fractures is relatively high, but it has no significant effect on knee and ankle functions. However, careful manipulation and precise evaluation should be performed during operation to avoid the occurrence of malrotation.