Objective To investigate the value of using Footscan system to evaluate the therapeutic effect of two internal fixation methods on calcaneus fractures. Methods From February 2006 to September 2006, 64 patients with fresh unilateral closed calcaneus fractures were randomly divided into two groups. The experimental group: 32 patients underwentminimally invasive open reduction and internal fixation with improved compressing plate and screw, including 28 males and 4 females aged 20-53 years old (average 36.7 years old); the course of disease was 3-14 days; there were 19 cases of type II, 11 of type III, and 2 of type IV according to Sanders fracture classification system. The control group: 32 patients underwent internal fixation of standard AO plate via L-shaped incision, including 29 males and 3 females aged 18-56 years old (average 37.1 years old); the course of disease was 4-15 days; there were 18 cases of type II, 11 of type III and 23 of type IV according to Sanders fracture classification system. No significant difference was noted between two groups in the general information (P gt; 0.05). At 1 and 2 years after operation, dynamic plantar pressure was measured using Footscan system, Maryland foot scores of two groups was compared, and statistical analysis was performed. Results All patients were followed up for 2 years. No infection, cuticular border necrosis, and sural nerve distal end injury occurred in the experimental group, whereas in the control group, 3 patients suffered from cuticular border necrosis and recovered after dressing, and 1 patient had sural nerve distal end injury with decreased sensation in local skin. At 1 and 2 years after operation, in the control group, there were significant differences between the injured foot and the normal foot in terms of impulse, instep index, motion range of subtalar joint, lateral displacement of footplate pressure center, and calcaneal width when patients stood on both feet (P lt; 0.05), whereas in the experimental group, no significant differences were noted between the injured foot and the normal foot in terms of the above parameters (P gt; 0.05). Significant differences were noted between two groups in terms of the above parameters (P lt; 0.05). The Maryland score 1 yearafter operation was (86.74 ± 8.56) points for the experimental group and (71.24 ± 10.06) points for the control group; at 2 years after operation, it was increased to (87.35 ± 8.49) points and (72.41 ± 9.69) points, respectively, indicating there was a significant difference between two groups (P lt; 0.05). Conclusion Operative outcomes of internal fixation with improved compressing plate are superior to those of standard AO plate. Footscan system can provide a quantitative assessment on the operative effect of calcaneus fractures.
Objective To review the biomechanical research progress of internal fixation of tibial plateau fracture in recent years and provide a reference for the selection of internal fixation in clinic. Methods The literature related to the biomechanical research of internal fixation of tibial plateau fracture at home and abroad was extensively reviewed, and the biomechanical characteristics of the internal fixation mode and position as well as the biomechanical characteristics of different internal fixators, such as screws, plates, and intramedullary nails were summarized and analyzed. Results Tibial plateau fracture is one of the common types of knee fractures. The conventional surgical treatment for tibial plateau fracture is open or closed reduction and internal fixation, which requires anatomical reduction and strong fixation. Anatomical reduction can restore the normal shape of the knee joint; strong fixation provides good biomechanical stability, so that the patient can have early functional exercise, restore knee mobility as early as possible, and avoid knee stiffness. Different internal fixators have their own biomechanical strengths and characteristics. The screw fixation has the advantage of being minimally invasive, but the fixation strength is limited, and it is mostly applied to Schatzker typeⅠfracture. For Schatzker Ⅰ-Ⅳ fracture, unilateral plate fixation can be used; for Schatzker Ⅴand Ⅵ fracture, bilateral plates fixation can be used to provide stronger fixation strength and avoid the stress concentration. The intramedullary nails fixation has the advantages of less trauma and less influence on the blood flow of the fracture end, but the fixation strength of the medial and lateral plateau is limited; so it is more suitable for tibial plateau fracture that involves only the metaphysis. Choosing the most appropriate internal fixation according to the patient’s condition is still a major difficulty in the surgical treatment of tibial plateau fractures. Conclusion Each internal fixator has good fixation effect on tibial plateau fracture within the applicable range, and it is an important research direction to improve and innovate the existing internal fixator from various aspects, such as manufacturing process, material, and morphology.
Objective To review and evaluate the advantages and disadvantages of minimally invasive treatment techniques for tibial plateau fractures (TPFs), as well as the research progress and limitations. Methods The relevant domestic and international research literature on the minimally invasive treatment of TPFs in recent years was reviewed. The advantages, disadvantages, and clinical efficacy of various technologies were summarized and analyzed, and an outlook on future development trends was provided. Results Surgery remains the primary method for treating displaced TPFs. Although traditional open reduction and internal fixation has advantages such as direct reduction and simplicity of procedure, it has gradually fallen out of favor with clinical orthopedic doctors due to extensive soft tissue removal, excessive bleeding, tissue adhesion, and postoperative complications such as skin infection, fracture nonunion, and joint dysfunction. As medical technology continues to develop, minimally invasive surgery and precise diagnosis and treatment are gradually being introduced to orthopedic trauma. Guided by concepts such as “minimally invasive treatment”, “homeopathic repositioning of fractures”, and “internal compression fixation”, many traction reduction devices, internal fixation devices, minimally invasive reduction techniques, and computer-aided navigation technologies have become widely used in the clinical treatment of TPFs. This has greatly helped to overcome the challenges of intraoperative reduction, secondary reduction loss, and postoperative functional impairment and effectively promoting the adoption of minimally invasive treatment techniques in the clinical treatment of TPFs. Conclusion Minimally invasive treatment techniques have made significant progress in the clinical treatment of TPFs, particularly with regard to the reduction, and have demonstrated unique advantages. While relevant research results have received international recognition, there is still a need for orthopedic scholars to conduct real-world research to further explore the underlying principles and mechanisms of action.
ObjectiveTo evaluate the effectiveness of the leverage reduction with proximal femoral nail antirotation (PFNA) ball head screw driver for difficult-reducing intertrochanteric fracture.MethodsThe clinical data of 8 patients with difficult-reducing intertrochanteric fractures between July 2015 and February 2018 were retrospectively analysed. There were 3 males and 5 females, aged 66-89 years, with an average age of 76.3 years. According to Evans classification, there were 3 cases of type Ⅲ and 5 cases of type Ⅳ. The time from injury to operation was 2-8 days (mean, 3.9 days). All patients were reducted with ball head screw driver leverage through PFNA proximal incision during operation. The operation time, intraoperative blood loss, reduction time, and fluoroscopy times were recorded. Harris hip function score was used to evaluate the effectiveness at last follow-up.ResultsThe operation time was 52.5-83.7 minutes (mean, 68.1 minutes), the intraoperative blood loss was 49.8-96.4 mL (mean, 73.1 mL), the reduction time was 3.7-9.1 minutes (mean, 6.4 minutes), and the fluoroscopy times were 18.4-27.4 times (mean, 22.9 times). Patients were followed up 6-18 months (mean, 9.6 months). Postoperative X-ray films showed that the fracture obtained good reduction. No fracture displacement, fixation failure, and coxa vara occurred after operation. Fracture healing time was 3-6 months (mean, 4.6 months). At last follow-up, the Harris hip function score was 85-96 (mean, 91.6), with a result of excellent in 6 cases and good in 2 cases.ConclusionThe reduction of difficult-reducing intertrochanteric fracture by using ball head screw driver can obtain good reduction and reliable fixation. The method has such advantages as no more incision, and less blood loss and soft tissue injury.
Objective To investigate the effects of Rho-kinase inhibitor——fasudil hydrochloride hydrate on vein graft intimal hyperplasia in vivo. Methods Twenty-four healthy rabbits (2.3-2.5 kg) were randomly divided into two groups(n=12). Fasudil hydrochloride hydrate (experimental group) and normal sodium (control group) were given 3 days beforeoperation with 30 mg/kg by intravenous injection everyday and continued until the end of the experiment. After a longitudinal incision, the femoral vein and the famoral artery were exposed about 3 cm. An approximately 2.5 cm segment of the famoral vein was harvested for the reversed-vein graft. The femoral artery was removed 1 cm segment and replaced by the harvested femoral vein. At 2 and 4 weeks after operation, the grafts were stained with HE to observe the thickness of the intima. Furthermore, the prol iferating cell nuclear antigen (PCNA) and transmission electron microscope was used to study the prol iferation of smooth muscle cell. In situ apoptosis was detected by TUNEL assay. Results All rabbits survived till the end of the experiment. The color Doppler imaging examination showed that all grafts were patency. At 2 and 4 weeks after the operation, HE staining showed that the intimal hyperplasia were obvious in the two groups. There were lots of cells in the intima, and more fusiform smooth muscle cells in the media. At 2 and 4 weeks, the intimal thickness were (30.33 ± 3.23) μm and (43.11 ± 4.92) μm in experimental group and were (44.83 ± 3.53) μm and (66.16 ± 8.45) μm in control group. The rates of PCNA positive cell were 14.28% ± 2.76% and 7.61% ± 1.06% in experimental group and were 20.08% ± 3.56% and 8.73% ± 1.35% in control group. The rates of TUNEL positive cell were 3.55% ± 0.36% and 1.22% ± 0.18% in experimental group and were 1.11% ± 0.31% and 0.55% ± 0.11% in control group. There were significant differences (P lt; 0.05) between the two groups at 2 weeks or 4 weeks, between2 weeks and 4 weeks within group. Conclusion Intravenous injection of fasudil hydrochloride hydrate is an effective method for prevention of vein graft intimal hyperplasia of rabbit.
Objective To assess the effect of topical appl ication of 5-fluorouracil (5-FU) on intimal hyperplasia in rabbit vein graft. Methods Sixty-four male New Zealand white rabbits, aged 5 months and weighing 2.8-3.0 kg, were randomly divided into group A, B, C, and D (n=16 rabbits per group). Artery defect model was establ ished by cutting about 1 cm artery from the middle part of the dissociated left common carotid artery. A section about 3 cm was cut from the right external jugular vein, and the harvested vein was inverted and end-to-end anastomosed to the artery defect with 9-0 non-traumatic suture. After anastomosis, the extima of the grafted veins in group A, B, and C was completely wrapped with cotton sheet (12 mm × 30 mm × 1 mm in size) immersed by 5-FU at a concentration of 50.0, 25.0, and 12.5 mg/mL, respectively, and eachvein was treated 5 times (1 minute at a time). In group D, the extima of the graft veins was treated with normal sal ine instead of 5-FU. The grafted veins were obtained 1, 2, 4, and 6 weeks after operation, HE staining and Masson staining were preformed for histological changes of grafted vein wall, prol iferating cell nuclear antigen (PCNA) immunohistochemistry staining and TUNEL label ing staining were conducted for prol iferation and apoptosis of smooth muscle cell of the grafted vein, and transmission electron microscope observation was performed for cellular ultrastructure. Results The HE staining, Masson staining, and PCNA immunohistochemistry staining showed that the thickness of intima in group A and B was obviously less than that in group C and D at 1, 2, 4, and 6 weeks after operation, and the prol iferation cells in group A and B were less than that in group C and D at 1, 2, and 4 weeks after operation. The thickness of the intima, the degree of intima hyperplasia, the degree of vessel lumen stenosis of four groups at different time points were as follows: at 1 week after operation, group A [(12.69 ± 1.68) μm, 0.73 ± 0.05, 0.025 ± 0.003], group B [(17.52 ± 2.01) μm, 0.86 ± 0.06, 0.027 ± 0.004], group C [(21.92 ± 1.85) μm, 1.06 ± 0.09, 0.036 ± 0.006] and group D [(26.45 ± 3.86) μm, 1.18 ± 0.08, 0.041 ± 0.005]; at 2 weeks after operation, group A [(24.61 ± 2.91) μm, 0.86 ± 0.06, 0.047 ± 0.003], group B [(37.28 ± 2.78) μm, 1.17 ± 0.09, 0.060 ± 0.004], group C [(46.52 ± 2.25) μm, 1.44 ± 0.08, 0.073 ± 0.003], and group D [(52.07 ± 3.29) μm, 1.45 ± 0.05, 0.081 ± 0.006]; at 4 weeks after operation, group A [(61.09 ± 6.84) μm, 1.38 ± 0.08, 0.106 ± 0.007], group B [(63.61 ± 8.25) μm, 1.40 ± 0.07, 0.107 ± 0.010], group C [(80.04 ± 7.65) μm, 1.64 ± 0.07, 0.129 ± 0.011], and group D [(84.45 ± 9.39) μm, 1.68 ± 0.10, 0.139 ± 0.014]; at 6 weeks after operation, group A [(65.27 ± 5.25) μm, 1.46 ± 0.07, 0.113 ± 0.005], group B [(65.82 ± 7.12) μm, 1.45 ± 0.05, 0.112 ± 0.011], group C [(84.45 ± 9.39) μm, 1.69 ± 0.09, 0.135 ± 0.007], and group D [(87.27 ± 8.96) μm, 1.76 ± 0.05, 0.140 ± 0.012]. Group A and B were inferior to group C and D in terms of the above three parameters and cell prol iferation index 1, 2 and 4 weeks after operation (P lt; 0.05). Group A and B were superior to group C and D in terms of cell apoptosis index of intima and media 1 and 2 weeks after operation (P lt; 0.05). Transmission electron microscope observation showed that the synthetic cell organelles such as rough endoplasmic reticulum, golgi apparatus, and ribosome in group A and B were obviously less than those in group C and D (P lt; 0.05). Conclusion Topicalappl ication of 5-FU can effectively inhibit intima hyperplasia of the vein grafts.
Objective To evaluate the effectiveness and safety of minimally invasive treatment for bilateral tibial plateau fractures using the double reverse traction reducer. Methods The clinical data of 4 patients with bilateral tibial plateau fractures who met the selection criteria and treated between January 2016 and April 2024 were retrospectively analyzed. The cohort included 3 males and 1 female, aged 30-65 years (mean, 52.5 years). Injury mechanisms comprised traffic accidents (2 cases) and falls (2 cases). According to the Schatzker classification, 2 limbs were type Ⅱ and 6 were type Ⅵ. The time from injury to surgery ranged from 5 to 9 days (mean, 7 days). All patients underwent minimally invasive reduction using the double reverse traction reducer. Surgical duration, intraoperative blood loss, and hospitalization time were recorded. Functional outcomes were assessed at last follow-up using the Hospital for Special Surgery (HSS) knee score and range of motion (ROM), while fracture reduction quality was evaluated using the Rasmussen radiological score. Results All 4 patients successfully completed the procedure without conversion to open reduction. The total mean operation time was 80.25 minutes (range, 73-86 minutes), with a mean total intraoperative blood loss of 132.5 mL (range, 100-150 mL). The mean hospitalization time was 13.5 days (range, 11-16 days). All incisions healed primarily without neurovascular complications. X-ray film at 1 day after operation confirmed satisfactory reduction and articular surface alignment. Follow-up time ranged from 12 to 26 months (mean, 17.0 months). Fractures achieved clinical union at an average of 13 weeks (range, 12-16 weeks). No complications, such as deep vein thrombosis, joint stiffness, post-traumatic arthritis, or implant failure, were observed. At last follow-up, the mean HSS score was 92.9 (range, 90-97), mean knee ROM was 128.1° (range, 115°-135°), and mean Rasmussen radiological score was 16.4 (range, 15-19), with 2 limbs rated as excellent and 6 as good. Conclusion The double reverse traction reducer facilitates minimally invasive treatment of bilateral tibial plateau fractures with advantages including minimal trauma, shorter surgical duration, precise reduction, and fewer complications, effectively promoting fracture healing and functional recovery of the knee joint.
Objective To investigate the biomechanical characteristics of Schatzker type Ⅱ tibial plateau fracture fixed by different bone grafting methods and internal fixations. Methods Twenty-four embalmed specimens of adult knee joint were selected to make Schatzker type Ⅱ tibial plateau fracture models, which were randomly divided into 8 groups (groups A1-D1 and groups A2-D2, n=3). After all the fracture models were restored, non-structural iliac crest bone grafts were implanted in group A1-D1, and structural iliac crest bone grafts in groups A2-D2. Following bone grafting, group A was fixed with a lateral golf locking plate, group B was fixed with lateral golf locking plate combined compression bolt, group C was fixed with lateral tibial “L”-shaped locking plate, and group D was fixed with lateral tibial “L”-shaped locking plate combined compression bolt. Compression and cyclic loading tests were performed on a biomechanical testing machine. A distal femur specimen or a 4-cm-diameter homemade bone cement ball were used as a pressure application mould for each group of models. The specimens were loaded with local compression at a rate of 10 N/s and the mechanical loads were recorded when the vertical displacement of the split bone block reached 2 mm. Then, compressive and cyclic loading tests were conducted on the fixed models of each group. The specimens were compression loaded to 100, 400, 700, and 1 000 N at a speed of 10 N/s to record the vertical displacement of the split bone block. The specimens were also subjected to cyclic loading at 5 Hz and 10 N/s within the ranges 100-300, 100-500, 100-700, and 100-1 000 N to record the vertical displacement of the split bone block at the end of the entire cyclic loading test. The specimens were subjected to cyclic loading tests and the vertical displacement of the split bone block was recorded at the end of the test. Results When the vertical displacement of the collapsed bone block reached 2 mm, the mechanical load of groups A2-D2 was significantly greater than that of groups A1-D1 (P<0.05). The mechanical load of groups B and D was significantly greater than that of group A under the two bone grafting methods (P<0.05); the local mechanical load of group D was significantly greater than that of groups B and C under the structural iliac crest bone grafts (P<0.05). There was no significant difference (P>0.05) in the vertical displacement of the split bone blocks between the two bone graft methods when the compressive load was 100, 400, 700 N and the cyclic load was 100-300, 100-500, 100-700 N in groups A-D. However, the vertical displacement of bone block in groups A1-D1 was significantly greater than that in groups A2-D2 (P<0.05) when the compression load was 1 000 N and the cyclic load was 100-1 000 N. The vertical displacement of bone block in group B was significantly smaller than that in group A, and that in group D was significantly smaller than that in group C under the same way of bone graft (P<0.05). Conclusion Compared with non-structural iliac crest bone grafts implantation, structural iliac crest bone grafts is more effective in preventing secondary collapse of Schatzker type Ⅱ tibial plateau fracture, and locking plate combined with compression bolt fixation can provide better articular surface support and resistance to axial compression, and the lateral tibial “L”-shaped locking plate can better highlight its advantages of ‘raft’ fixation and show better mechanical stability.