Objective To evaluate the effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus with absorbable screws or metal screws fixation by clinical and radiological data. Methods Between March 2014 and May 2016, the Scarf osteotomy combined with Akin osteotomy was used to treat 62 patients (83 feet) with moderate to severe hallux valgus. Twenty-five patients (35 feet) were fixed by absorbable screws (group A) and 37 patients (48 feet) were fixed by metal screws (group B). The difference in gender, age, affected side, etiology, severity, disease duration, preoperative hallux valgus angle (HVA) and first-second intermetatarsal angle (1-2IMA) measured in weight-bearing anteroposterior X-ray film, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS) scores between 2 groups (P>0.05). The complications and healing time of 2 groups were recorded and compared. At last follow-up, the AOFAS and VAS scores, and HVA, 1-2IMA measured by weight-bearing anteroposterior X-ray film were used to evaluate the effectiveness. Results All incisions healed by first intention and no incision-related complication occurred in the two groups after operation. Both groups were followed up, the follow-up time in group A was 12-36 months (mean, 24.4 months) and in group B was 14-38 months (mean, 25.7 months). In group A, 1 foot was complicated with hallux varus, 2 feet had mild stiffness, 1 foot appeared metastatic metatarsal pain, and in group B was 2, 3, 2 feet, respectively. There was no recurrence of hallux valgus in both groups. The difference in the incidence of complications between the two groups after the first operation was not significant (χ2=0.275, P=0.843). The removal rate of internal fixator in group B was 89.2% (33 cases) during the second operation, among which 3 cases had screw slip and 1 case had screw fracture. And 10.8% (4 cases) refused the second removal operation due to their age. Postoperative X-ray films showed that both groups had good healing at the osteotomy site, and there was no significant difference in healing time between the two groups (t=1.633, P=0.285). At last follow-up, the AOFAS score, VAS score, HVA, and 1-2IMA were significantly improved in the two groups when compared with preoperative ones (P<0.05); but no significant difference was found between the two groups (P>0.05). Conclusion The effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus is significant, with few complications. Compared with being fixed by metal screws, being fixed by absorbable screws has the same effectiveness, but can avoid the risk of second operation to remove the internal fixator.
ObjectiveTo compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation. Methods The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function. ResultsThere was no significant difference in operation time between the two groups (P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference (t=−0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values (P<0.05). However, there was no significant difference in the improvement value between the two groups (P>0.05). ConclusionFor PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.
Objective To compare clinical outcome of bioabsorbable interference screws (BS) with metal Interference screws (MS) for restruction of anterior cruciate ligament (ACL). Methods The electronic databases (PubMed, EMbase, Cochrane Central Register of Controlled Trials, CBM, CNKI, and VIP) were searched in order to retrieve randomized controlled trials (RCTs) about comparing BS with MS for restruction of ACL. In addition, reference lists from original studies and review articles were handsearched. The Jadad’s scale and Cochrane collaboration’s RevMan 5.0 software were used for assessing trial methodological quality and data analyses. Results Eleven RCTs were included. There were 935 participants that met inclusion criteria in all studies. Results of Meta-analyses showed the MS group had a higher Lysholm score. However, no significant differences were found in Lanchman Test, IKDC Data and KT1000 result between patients treated by BS and by MS. Conclusion Bioabsorbable interference screws provide equivalent clinical outcomescompared with metal interference screws. However, further confirmation is required because of varieties of types and complex compositions.
Objective To compare advantage and disadvantage of internal fixation method for tibia intercondylar eminence fracture between absorbable screw and metallic screw. Methods From 1996 to 2002, 200 patients with fracture of tibia intercondylar eminence were divided into group A (with absorbable screw, n=120) andgroup B (with metallic screw, n=80). And the biological compatibility, biomechanics, bone union and complications were compared between two groups.Results There were no obvious differences in operating time and circumstance of recovery position between two groups. Group A was obviously better than group B in biological compatibility, biomechanics, bone union, joint function recovery. The average healing time of group A was three months, that of group B was three and half months. The good rates of joint function in two groups were 98.0% and 95.0% respectively. The occurrence rates of wound arthritis were 1.7% and 3.7%. There wassignificant difference between them(P＜0.01). Conclusion Absorbable screw is a more ideal material of internal fixation to treat tibia intercondylar eminence fracture.
To explore a new approach to treat old scaphoid fracture by grafting bones from distal radius and fixing absorbable screws. Methods From January 2002 to May 2007, 18 patients with old scaphoid fractures were treated by grafting bones from distal radius and fixing absorbable screws. All of the 18 patients (13 males and 5 females, aged from 17 to 41 years old) had the injury history of the palm of hand touching the ground. They felt tenderness on the anatomical snuff-box and tubercle of scaphoid bone. The grasping force decreased. The range of motion of the wrist was (36 ± 2)° extension/(30 ± 3)° flexion, (8 ± 3)° radial is/(13 ± 2)° ulnaris. Results The average postoperative follow-up period was 15.7 months．A total of 18 cases achieved bone union. The range of motion of the wrist in the 16 healed cases was (68 ± 2)° extension/(65 ± 3)° flexion, (15 ± 3)° radial is/(28 ± 5)° ulnaris. There was no pain of motion and symptom of powerlessness. As to the other 2 cases, the range of motion of the wrist was (40 ± 8)° extension/(35 ± 6)° flexion, (8 ± 5)° radial is/(12 ± 5)° ulnaris; no obvious improvement was found; the patients occasionally felt painful in daily l ife; the extension force decreased. No infection and break of internal fixation were seen. Conclusion The absorbable screw as a new biomaterial for internal fixation has obvious advantages of good biocompatibil ity, promoting union of the fracture and no need of a second operation for removal．
ObjectiveTo compare the clinical and radiographic outcomes of bioabsorbable screw and metallic screw for Maisonneuve fracture.MethodsThe clinical data of 68 patients of Maisonneuve fracture treated with open reduction and internal fixation between October 2012 and October 2016 were retrospectively analyzed. Metallic screw fixation was used in 37 cases (group A) and absorbable screw fixation was used in 31 cases (group B). There was no significant difference in age, gender, weight, operated side, cause of injury, time from injury to operation, and complications between the two groups (P>0.05). At last follow-up, the tibiafibular clear space (TFCS), tibiafibular overlap (TFO), medial clear space (MCS), and syndesmotic malreduction rate were recorded. And the dorsiflexion and plantar-flexion range of motion, pain visual analogue scale (VAS) score, ankle and hind foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and Olerud-Molander (OM) score were recorded.ResultsAll patients were followed up 25-43 months, with an average of 32.3 months. There was no significant difference in the operation time between the two groups (t=1.229, P=0.282). All the fractures healed, and there was no significant difference in fracture healing time between the two groups (t=1.367, P=0.413). At last follow-up, the syndesmotic malreduction rate of group A was 16.2% (6/37), showing no significant difference when compared with group B [6.2% (2/31)] (χ2=1.549, P=0.213). There were 3 complications in group A, 1 was superficial wound infection, 1 was local heterotopic ossification due to failure to remove the screws in time, 1 was local heterotopic ossification of the screws; and there were 2 complications in group B, 1 was rejection and 1 was local heterotopic ossification of the screws. There was no significant difference in the incidence of complications between the two groups (χ2=0.068, P=0.794). There was no significant difference in TFCS, MCS, TFO, ankle dorsiflexion and plantar-flexion range of motion, AOFAS score, OM score, and VAS score between the two groups at last follow-up (P>0.05).ConclusionCompared with metallic screw, absorbable screws provide adequate fixation and functional recovery with avoiding screw removal and lower syndesmotic malreduction.
OBJECTIVE: To study a new kind of operation for displaced talar neck fractures. METHODS: From April 1996 to March 2001, 9 talar neck fractures were treated by internal fixation of absorbable lag screw with a medial approach and cut of medial malleolus to expose the fractures. A non-weight-bearing below-knee cast was applied for 6 to 12 weeks after operation. Once union of the fracture site is apparent, the patient should remain non-weight bearing in a removable short-leg and keep exercise every day. RESULTS: All the patients received follow-up from 15 to 60 months with an average of 28 months. The fractures healed from 20 to 42 weeks. The excellent and good rate of function was 77.8% (7/9) according to American Orthopedic Foot and Ankle Society Score(AOFAS). One case had the complication of superficial infection of wound and skin edge necrosis after operation, which was Hawkins type III. Late complication included two cases of avascular necrosis(AVN). Among them, one AVN of Hawkins type II was caused by early weight-bearing five weeks after operation and gained the fair score. The other AVN of Hawkins type III was inefficient to conservative therapy and proceeded ankle fusion in the end. The AOFAS of the patient was bad. CONCLUSION: Treatment of talar neck fractures by internal fixation of absorbable lag screw with a medial approach is an ideal method. It can gain a satisfactory result by the operation, strict postoperative care and rehabilitation.