ObjectiveTo compare the effectiveness of external fixation and volar locking compression plate in the treatment of distal radius fractures of type C. MethodsBetween March 2012 and March 2013, 122 patients with distal radius fractures of type C were enrolled in the prospective randomized study. Fractures were treated by external fixation in 61 patients (external fixation group) and by open reduction and internal fixation using a volar locking compression plate in 61 patients (plate group). There was no significant difference in age, gender, fracture side, weight, height, body mass index, fracture type, and interval of injury and operation between 2 groups (P>0.05). The blood loss, operation time, hospitalization days, fracture union time, wrist function, and complications were compared between 2 groups. And the quality of reduction was observed, including volar tilting angle, ulnar deviation, radial height, and articular reduction. ResultsThe blood loss, operation time, and hospitalization days in plate group were significantly higher than those in external fixation group (P<0.05). All of the patients in both groups were followed up 12-28 months. Postoperative complications occurred in 4 patients (6.6%) of external fixation group (pin tract infection in 2 cases and radial nerve neuritis in 2 cases) and in 5 patients (8.2%) of plate group (wound infection in 1 case, carpal tunnel syndrome in 2 cases, and tendon rupture in 2 cases), showing no significant difference between 2 groups (P=0.500). The X-ray films showed fracture healing in all patients of 2 groups; the union time of plate group was significantly longer than that of external fixation group (P<0.05). At last follow-up, there was no significant difference in ulnar deviation and radial height between 2 groups (P>0.05), but the volar tilting angle of plate group was significantly larger than that of external fixation group (P<0.05). There was no significant difference in wrist function and articular reduction between 2 groups (P>0.05). ConclusionFor distal radius fractures of type C, the use of external fixation or volar locking compression plate can obtain satisfactory clinical outcomes, but the external fixation has the advantages of less invasion, shorter hospitalization days, minor complications, and faster fracture union.
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.
ObjectiveTo investigate the effectiveness of the Ilizarov technique for the treatment of traumatic talipes equinovarus so as to provide the evidence for the clinical practice. MethodsBetween February 2011 and April 2012,42 patients with traumatic talipes equinovarus received treatment by Ilizarov technique,including 29 males and 13 females aged 17-55 years (mean,34.3 years).The left side was involved in 24 cases,and the right side in 18 cases.The disease duration was 6 months to 6 years (mean,2.7 years).According to the principles of Ilizarov,a ring external fixator was applied on the affected foot and lower leg.The threaded rods and screw nuts were revolved according to the tolerance of patients at 3-7 days after fixation.At first,forefoot varus or foot inversion was corrected,and then drooping feet deformity was corrected.The patients were encouraged to begin weight-bearing walking after correction.X-ray films were taken regularly to observe the ankle joint and avoid its dislocation.The external fixator was maintained in neutral position for 8-12 weeks after achieving satisfactory correction.An walking ankle-foot orthosis and a sleeping ankle-foot orthosis were used for more than 16 weeks after removal of the fixator.The outcome was assessed with American Orthopaedic Foot and Ankle Society (AOFAS) comprehensive scoring system and visual analogue scale (VAS) pain score. ResultsForty-two patients were followed up 14.3 months on average (range,10-24 months).All the patients achieved 0° dorsiflexion at 4-13 weeks (mean,6.8 weeks) after treatment with Ilizarov apparatus.The fixator was maintained for 10.7 weeks on average (range,10-16 weeks) after correction.No dislocation of the ankle joint and no damage to nerves and blood vessels occurred.The deformity of plantar flexion (10°) was found in 3 patients.At last follow-up,the patients could walk normally.AOFAS score was significantly increased to 93.4±8.0 from 52.7±10.1 at preoperation (t=-7.035,P=0.008);according to AOFAS scoring system,24 cases were grades as excellent,14 as good,2 as moderate,and 2 as poor,and the excellent and good rate was 90.5%.The VAS score of the foot significantly decreased to 3.51±1.44 from 7.55±1.39 at preoperation (t=-0.564,P=0.025). ConclusionIlizarov technique combined with non-fusion has satisfactory effectiveness in correction of traumatic talipes equinovarus.It is a safe,effective,and minimally invasive method.
Forty cases of intertrochanteric fractures of femur were treated with percutaneous nonmetallic external fixator. The patients were followed up for 6 months to 3 years, and the fractures were all united without coxa vara or shirtening deformities. There was no mortality in this series. This method had the advantages ofbeing simple, save time and effort, less traumatic and early ambulation. The design of the apparatus tallied with the biomechanics of the neck and shaft of the femur.
【Abstract】 Objective To assess the results of treatment of unstable distal radius fractures with leverage reductionand bone graft assisted by external fixators. Methods From September 2005 to May 2007, 27 cases of unstable distal radius fractures were treated by leverage reduction and bone graft, meanwhile assisted by external fixators. The cases included 16 males and 11 females, aged from 18 to 69 years with an average of 49. 3 years. Fractures were caused by fall ing in 19 cases, crash from high place in 1 case, traffic accident in 6 cases, and obtuse strike directly in 1 case, which were all closed fresh bone fractures. According to the standard of AO, all cases were classified as type C1 in 13 cases, type C2 in 11 cases, and type C3 in 3 cases. The palmar incl inination was from － 38° to 10°(mean － 12.2°); the ulnar deviation angle was from 6° to 30° (mean 19. 1°) before operations. The operations were performed from 1 to 3 days after injuries. The function of the carpal joints and the boneheal ing conditions were evaluated after operations. Results All cases were followed up for 4-24 months(mean 13. 1 months). No compl ications such as pin loosening, dislocation of fixators, injury of blood vessels and radial nerves, pin track infections occurred. According to Mcbride scoring, the results were excellent in 10 cases, good in 13 cases, fair in 3 cases and poor in 1 case, the excellent and good rate being 85. 2%. One case had traumatic arthritis and 1 case had wrist joint stiffness. All achieved fractures uniton 8-10 weeks (mean 9.3 weeks) after operations. The palmar incl inination angle was from 0° to 20° (mean 13. 4°); the ulnar deviation angle was from 10° to 33° (mean 22. 1°) after operations. Conclusion Treatment of unstable fractures of the distal radius by use of leverage reduction and bone graft with external fixator offers many advantages, such as simple operation, satisfactory reduction, rigid fixation, excellent function and lower incidence rate of traumatic arthritis.
【Abstract】 Objective To summary the effects of staged pelvic closure using external fixator combined withreconstruction plate for old Tile B1 pelvic fracture. Methods From August 2000 to August 2006, 14 patients (9 males and 5 females, age ranging from 21 to 65 years with old Tile B1 pelvic fracture with pubic symphysis separation were treated. The injuries were caused by the traffic accident in 10 patients, high crash in 3, and crush in 1. The duration ranged from 4 weeks to 3 months. The 14 patients were compl icated with other injuries in some degrees. The X-ray and CT showed pubic symphysis separation. In 13 patients, pubic symphysis separation distance was more than 2.5 cm, who also had fracture or dislocation in the posterior structure of pelvis. The X-ray films showed the mean pubic symphysis separation distance was (6.67 ± 2.11) cm preoperatively. The 14 patients underwent pelvic external fixation at first and staged pelvic closure gradually for the pubic symphysis separation. After 2 to 3 weeks, when the pubic symphysis separation distance was less than 1 cm, the patients underwent open reduction and internal fixation with reconstruction plate. Pubic symphysis separation distance was measuredin the preoperative and postoperative pelvic anterioposterior X-ray films. The condition of the posterior structure of pelvis was observed in CT films. The functions of patients were assessed according to Majeed grading system. Results All incisions healed by first intention. The 14 patients were followed up for 6 months to 2 years (15 months on average). The X-ray films showed the mean pubic symphysis separation distance of post-operation was (0.85 ± 0.23) cm, showing statistically significant difference when compared with that of pre-operation (P lt; 0.05). The CT films showed fracture and dislocation of the posterior structure of pelvis had bony heal ing after 6 to 12 months. According to the Majeed grading system, the results were excellent in 5 cases, good in 4 cases, fair in 4 cases and poor in 1 case; the excellent and good rate was 64.29%. Conclusion Staged pelvic closure using external fixation combined with reconstruction plate for old pelvic fracture with pubic symphysis separation can reduce the pubic symphysis separation distance significantly. Satisfactory effects can be expected in treating the patients with TileB1 fracture.
Objective To compare the clinical results of locking compress plate (LCP) as an external fixator and standard external fixator for treatment of tibial open fractures. Methods Between May 2009 and June 2012, 59 patients with tibial open fractures were treated with LCP as an external fixator in 36 patients (group A), and with standard external fixator in 23 patients (group B). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, location, and interval between injury and surgery between 2 groups (P gt; 0.05). The time of fracture healing and incision healing, the time of partial weight-bearing, the range of motion (ROM) of knee and ankle, and complications were compared between 2 groups. Results The incidence of pin-track infection in group A (0) was significantly lower than that in group B (21.7%) (P=0.007). No significant difference was found in the incidence of superficial infection and deep infection of incision, and the time of incision healing between 2 groups (P gt; 0.05). Deep vein thrombosis occurred in 5 cases of group A and 2 cases of group B, showing no significant difference (χ2=0.036, P=0.085). All patients were followed up 15.2 months on average (range, 9-28 months) in group A, and 18.6 months on average (range, 9-47 months) in group B. The malunion rate and nonunion rate showed no significant difference between groups A and B (0 vs. 13.0% and 0 vs. 8.7%, P gt; 0.05); the delayed union rate of group A (2.8%) was significantly lower than that of group B (21.7%) (χ2=5.573, P=0.018). Group A had shorter time of fracture healing, quicker partial weight-bearing, greater ROM of the knee and ankle than group B (P lt; 0.05). Conclusion The LCP external fixator can obtain reliable fixation in treating tibial open fracture, and has good patients’ compliance, so it is helpful to do functional exercise, improve fracture healing and function recovery, and reduce the complication incidence.
The causes of development of 56 cases of bone defects from firearm injuries of extremities were analyzed, and the advantages of transfer of vascularized iliac bone graft with deep iliac circumflex vessels in 28 cases and the indications of transfer of vascularked fibular bone graft with fibular vessel in 15 cases and the exporiences in 9 cases from the methed of transter of seapula-cutaneous composite graft were summarized. It was emphatically pointed out that the half-circle typo externa fixators had its unique advantages in the treatment of the bone defects of long bones of extremities from firearm injuries. It would enentually become the method of priority for the treatment of fractures, nonunion of fractures and bone defects of extremities from firearm injuries.
Objective To investigate the feasibility of the preservation of the epiphysis and joint function of the distal femur in children with osteosarcoma with epiphyseal distraction by external fixator. Methods Between July 2007 and May 2011, 6 children with osteoblastic osteosarcoma of the distal femur underwent epiphyseal distraction by external fixator, combined with tumor resection and repair with massive allograft bone transplantation to preserve the epiphysis and joint function of the distal femur. There were 4 boys and 2 girls, aged from 9 to 14 years (mean, 10.5 years). According to Enneking clinical staging, 4 cases were in stage II A and 2 cases in stage II B. According to San-Julian et al. typing for metaphyseal tumor invasion, 3 cases were in type I and 3 cases in type II. The size of tumor ranged from 6 cm × 4 cm to 12 cm × 9 cm. All patients received 2 cycles of COSS 86 chemotherapy before operation and 4 cycles after operation. Results Poor healing of incision was observed in 1 case because of rejection of allograft bone and good healing was obtained after the symptomatic treatment, healing of incision by first intention was achieved in the other children. All 6 cases were followed up 11 to 56 months (mean, 37.5 months). One case died of lung metastasis at 2 years after operation. X-ray films showed no complication of internal fixator loosening and broken or bone nonunion. According to the functional evaluation criteria of International Society of Limb Salvage (ISOLS) at last follow-up, the results were excellent in 3 cases, good in 2 cases, and fair in 1 case; the excellent and good rate was 83.3%. The length of operated limb was (62.97 ± 7.51) cm, showing significant difference when compared with that of normal limb [(64.03 ± 7.47) cm] (t=0.246 6, P=0.813 4). Conclusion On the premise of adaptable indication, effective chemotherapy, and thoroughly tumor resection, the epiphyseal distraction by external fixator can obtain satisfactory results in limb-length and limb function in children with osteoblastic osteosarcoma of the distal femur.
【Abstract】 Objective To investigate the effect of the volar capsular l igament complex on stabil ity of the wrist jointand to provide basic biomechanical theoretical criteria for cl inic appl ication of the external fixator. Methods Nine upperl imbs specimens (left 6, right 3) were taken from fresh adult cadavers to make wrist joint-bone capsular l igament complex specimens. Firstly, soft tissues of forearms and hands were resected and capsular membranes and l igaments were reserved to make the bone-articular l igament complex (normal specimen). Secondly, the volar capsular l igament complex was cut off from radial malleolus to ulnar malleolus (impaired specimen). Thirdly, the impaired volar capsular l igament complex was interruptedly sutured by the use of 4# suture silk (repaired specimen). To simulate cl inical operation with external fixator, the biomechanical test was done according to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed). Statistical significance was analyzed through selected loads at the three different shifts (1.5, 2.0, 2.5 cm). Results According to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed), when the shift was 1.5 cm, the different respective loads were (60.74 ± 20.60), (35.23 ± 13.88), (44.36 ± 20.78), (168.40 ± 29.21) and (139.00 ± 33.18) N, respectively. When the shift was 2.0 cm, the different loads were (138.46 ± 12.93), (87.17 ± 24.22), (97.52 ± 23.29), (289.00 ± 54.29) and (257.98 ± 55.74) N, respectively. When the shift was 2.5 cm, the different loads were (312.87 ± 37.15), (198.16 ± 37.14), (225.66 ± 30.96), (543.15 ± 74.33) and (450.35 ± 29.38) N, respectively. There was no statistically significant difference between the impaired and repaired specimens (P gt; 0.05). Similarly, there was statistically significant difference among the rest specimens (P lt; 0.05). The same statistical results were obtained when the two different shifts were compared. There was statistically significant difference at the three different shifts for the same specimen (P lt; 0.05). Conclusion Volar capsular l igament complex is an important anatomic structure to keep stabil ity of the wrist joint. The carpal instabil ity arises out of the injured complex. Repairing the injured complex only can not immediately restore stabil ity of the wrist joint. The external fixator can effectively help to diminish the relative shift of the impaired capsular l igament complex, to reduce the load of the repaired complex and to protect the complex accordingly. The device plays an important role in maintaining stabil ity of the wrist joint.