Objective To summarize the method and effectiveness of open reduction and internal fixation in the treatment of 4 cases of bipolar clavicle dislocations. Methods Between June 2017 and June 2022, 4 patients with bipolar clavicle dislocations were admitted. There were 3 males and 1 female. The age ranged from 27 to 63 years, with an average age of 45 years. There were 2 cases of crushing injury of mine car, 1 case of traffic accident injury, and 1 case of heavy object injury. The time from injury to operation was 3-7 days, with an average of 5.0 days. The sternoclavicular joint dislocations were classified as Grade Ⅱ in 1 case and type Ⅲ in 3 cases, and anterior dislocation in 3 cases and posterior dislocation in 1 case. The acromioclavicular joint dislocations were classified as Tossy type Ⅱ in 2 cases and type Ⅲ in 2 cases. After open reduction, the sternoclavicular joint and acromioclavicular joint were fixed with lateral malleolus locking titanium plate and clavicular hook plate, respectively. ResultsAll operations were successfully completed without vascular or nerve injury. All incisions healed by first intention. All patients were followed up 12-18 months, with an average of 14 months. At last follow-up, the shoulder joint functions were rated as excellent in 3 cases and good in 1 case according to Rockwood score. During follow-up, there was no loosening of internal fixator or fracture. The internal fixators were removed in all patients at 5-7 months after operation (mean, 6 months), and no re-dislocation occurred after removal. Conclusion For bipolar clavicle dislocation, open reduction combined with lateral malleolus locking titanium plate fixation of the sternoclavicular joint and clavicle hook plate fixation of the acromioclavicular joint can achieve good effectiveness. It has the advantages of simple operation, high safety, firm fixation, and fewer complications, and the shoulder function recovers well.
ObjectiveTo investigate the effectiveness of limited open reduction via “door-shaft method” and internal fixation with locking plate for two- and three-part fractures of the proximal humerus.MethodsThe clinical data of 64 patients with proximal humeral fractures who were admitted between January 2013 and December 2016 and met the selection criteria were retrospectively analyzed. There were 23 males and 41 females, with an average age of 68.0 years (range, 50-89 years). The injuries were caused by falling in 57 cases, traffic accident in 5 cases, and falling from height in 2 cases. The interval between injury and operation was 1-7 days (mean, 2.1 days). According to Neer classification, there were 28 cases of two-part fractures and 36 cases of three-part fractures. According to the angulation direction of the proximal humeral neck shaft angle, there were 21 cases of adduction fractures and 43 cases of abduction fractures. The fractures were treated with limited open reduction via “door-shaft method” and proximal humerus internal locking systems for internal fixation. The operation time, intraoperative blood loss, number of fluoroscopy, hospital stay, and complications were recorded. The fracture healing was reviewed by X-ray film and the healing time was recorded. The shoulder joint function was evaluated by Neer score standard.ResultsThe operation time was 45-127 minutes, with an average of 82.3 minutes. The intraoperative blood loss was 30-125 mL, with an average of 62.7 mL. Intraoperative fluoroscopy was performed 30-69 times, with an average of 37.0 times. The hospital stay was 6-23 days, with an average of 10.3 days. All incisions healed by first intention. All patients were followed up 12-37 months, with an average of 18.3 months. X-ray film re-examination showed that all fractures healed, the healing time was 12-21 weeks, with an average of 14.3 weeks. After operation, 3 cases had shoulder stiffness and 1 case had fracture malunion. At last follow-up, the Neer score of shoulder joint function was 49-97, with an average of 83.1. Among them, 38 cases were excellent, 13 cases were good, 10 cases were fair, and 3 cases were poor. The excellent and good rate was 79.7%. The excellent and good rate of patients with two-part fractures was 82.1% (23/28), and the excellent and good rate of patients with three-part fractures was 77.8% (28/36).ConclusionThe “door-shaft method” not only reduces the difficulty of the Joystick technique in the reduction of proximal humerus fractures, but also provides auxiliary stability. It is used for limited open reduction and internal fixation with locking plate to treat the two- and three-part fractures of the proximal humerus, which can achieve good effectiveness.
ObjectiveTo investigate the effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in the treatment of extreme distal radius fractures.MethodsBetween July 2014 and July 2018, 15 patients with extreme distal radius fractures were treated with volar oblique T-type locking plate and raft screws reduction and fixation. There were 6 males and 9 females, aged from 30 to 66 years with an average age of 56.6 years. The cause of injury was falling from height in 2 cases and falling in 13 cases. All of them were fresh closed injuries. The fractures were rated as type 23C1 in 8 cases and as type 23C2 in 7 cases according to AO/Orthopaedic Trauma Association (AO/OTA) classification. There were 7 cases of ulnar styloid process fracture and 2 cases of distal radioulnar joint instability. The time from injury to operation was 6 to 9 days with an average of 7.3 days. The fracture healing and the radial height, palm inclination, and ulnar deviation were observed by X-ray reexamination. Cooney score was used to evaluate the effectiveness.ResultsAll incisions healed by first intention. All patients were followed up 12-24 months, with an average of 14.6 months. X-ray films showed that all fractures healed, and the healing time ranged from 5 to 10 months, with an average of 8.2 months. No internal fixation failure or secondary fracture displacement occurred. At last follow-up, the radial height, palm inclination, and ulnar deviation recovered well, and the differences between pre- and post-operation were significant (P<0.05). The pain, function, activity, and grip strength scores and the total score of Cooney score were significantly higher than those before operation (P<0.05). There were 11 cases of excellent, 3 cases of good, and 1 case of good, with an excellent and good rate of 93%.ConclusionFor extreme distal radius fractures, the volar oblique T-type locking plate and raft screws reduction and fixation can restore the radialheight, palm inclination, and ulnar deviation, fix firmly, and recover the wrist joint function exercise early, and obtain satisfactory effectiveness.
ObjectiveTo evaluate the effectiveness of open reduction and internal fixation (ORIF) in treatment of acute and delayed occult Lisfranc injuries.MethodsA retrospective review of 26 patients with occult Lisfranc injuries who were treated with ORIF between July 2010 and July 2015 was applied. Fourteen patients were treated within 6 weeks after injury (acute group) and 12 patients were treated after 6 weeks of injury (delayed group). There was no significant difference between the two groups in gender, age, affected sides, and preoperative visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, and physical and mental scores of Study Short Form 12 Health Survey (SF-12) (P<0.05). The joint reduction, internal fixator, and traumatic osteoarthritis were observed by X-ray films. The pain degree, midfoot function, and quality of life were evaluated with VAS score, AOFAS score, and physical and mental scores of SF-12.ResultsAll incisions healed by first intention with no complications. All patients were followed up with the mean follow-up time of 15 months (range, 12-24 months) in acute group and 15 months (range, 12-23 months) in delayed group. At last follow-up, the VAS score, AOFAS score, and physical and mental scores of SF-12 were superior to those before operation in the two groups (P<0.05). And there was no significant difference in all indicators between the two groups (P>0.05). The satisfaction rates were 100% and 83.3% (10/12) in acute group and delayed group, respectively. The internal fixators were removed in 20 patients (11 cases in acute group and 9 cases in delayed group) at 9-24 months after operation (mean, 14.5 months). The results of X-ray films showed no traumatic osteoarthritis, midfoot collapse, internal fixation failure, or reduction loss during follow-up period.ConclusionORIF is an ideal method for both acute and delayed occult Lisfranc injuries and can obtain the similar effectiveness.
ObjectiveTo compare the early effectiveness of minimally invasive open reduction and internal fixation via posterior median approach versus arthroscopic double-tunnel suture fixation in treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL).MethodsA clinical data of 31 patients with the tibial avulsion fracture of the PCL and met the criteria between January 2015 and January 2019 was retrospectively analyzed. Nineteen patients (group A) were treated with open reduction and internal fixation with cannulated screw via posterior median approach. The other 12 patients (group B) were treated with arthroscopic double-tunnel suture fixation technique. There was no significant difference between the two groups (P>0.05) in the gender, age, side of effected limb, the injury cause, the time from injury to operation, the combined meniscus injury, Meyers & McKeever classification and preoperative Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) score, and the difference of tibial posterior displacement between bilateral knees. The operation time, postoperative complications, fracture healing, and the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score were recorded.ResultsGroup B spent significantly longer operation time than group A (t=7.347, P=0.000). No postoperative complication occurred in group B, and 1 patient in group A had a screw breakage. All patients were followed up 6-36 months (mean, 22 months). X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, there was no significant difference in the patients with normal knee range of motion between the two groups (P=0.510). At last follow-up, the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score in the two groups were superior to those before operation (P<0.05); while there was no significant difference between the two groups (P>0.05).ConclusionFor the tibial avulsion fracture of PCL, the minimally invasive open reduction and internal fixation and arthroscopic double-tunnel suture fixation can obtain similar early effectiveness. However, arthroscopic surgery has the advantages of being able to simultaneously deal with intra-articular combined injuries, avoiding internal fixator complications, and eliminating the need for secondary operation.
Objective To observe the effectiveness of locking compression hook plate in treatment of humeral greater tuberosity fractures. Methods Between March 2014 and September 2017, 16 patients with isolated humeral greater tuberosity fractures were terated with open reduction and internal fixation with locking compression hook plates. There were 11 males and 5 females, with an average age of 38.4 years (range, 22-67 years). The cause of injury was falling injury in 13 cases and sport injury in 3 cases. All patients were closed fractures. Of all patients, 14 patients accompanied with shoulder joint dislocations. CT scan showed the average displacement of fragment was 12.6 mm (range, 8-21 mm) after reduction. All patients began passive functional exercise at 3 days after operation. Results Primary healing of the incisons achieved in all patients, without complications such as infection and nerve injury. All patients were followed up 12-20 months (mean, 15.3 months). At 3 months after operation, X-ray film showed that all fractures achieved bone union, all of which met the imaging anatomical reduction standard. According to the Neer scoring criteria, 11 cases were excellent and 5 cases were good at last follow-up. One patint presented slight pain of shoulder joint and mild activity limitation, which relieved after 1 year. Conclusion The method of open reduction and locking compression hook plate internal fixation for isolated humeral greater tuberosity fractures has advantages, such as less intraoperative hemorrhage, mild postoperative pain, firm fixation, and allowing patients to perform functional exercise earlier, which is conducive to shoulder functional recovery and obtain satisfactory effectiveness.
ObjectiveTo compare the effectiveness of minimally invasive percutaneous internal fixation and traditional open reduction via Henry approach and internal fixation in the treatment of unstable distal radial fractures.MethodsFifty-six patients with unstable distal radial fractures that met the selection criteria between October 2013 and December 2014 were randomly divided into minimally invasive group (26 cases) and traditional group (30 cases). They were treated with oblique T-shaped locking plate internal fixation via minimally invasive percutaneous approach or traditional Henry approach. There was no significant difference in gender, age, side, causes of injury, fracture classification, and time from injury to operation between 2 groups (P>0.05). The length of incision, operation time, intraoperative blood loss, hospitalization time, and fracture healing time were recorded in 2 groups. The difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation were compared between 2 groups. The visual analogue scale (VAS) score, the percentage of the lateral wrist flexion and extension range, forearm rotation, and the hand grip strength (recorded as FS%, FR%, and HG% , respectively) were compared between 2 groups at 4 weeks and 3 months postoperatively. The wrist function was evaluated through the disability of arm-shoulder-hand (DASH) scores at 3 months postoperatively.ResultsThe length of incision, operation time, intraoperative blood loss, and hospitalization time in minimally invasive group were significantly less than those in traditional group (P<0.05). The incisions of 2 groups were all achieved primary healing. All patients were followed up 10-16 months (mean, 12.6 months). There was no radial artery injury, screw too long, or screw entering the joint space. In minimally invasive group, 1 patient had the symptoms of median nerve irritation after operation, and recovered completely at 1 month; in traditional group, there were 2 cases of tendon irritation after operation. There was no significant difference in the fracture healing time, the difference of the length of the radial styloid process, the volar tilting angle, and the ulnar inclining angle between at 3 months postoperatively and preoperation between 2 groups (P>0.05). At 4 weeks after operation, the VAS score in minimally invasive group was significantly less than that in traditional group, and the FS%, FR%, and HG% were significantly higher than those in traditional group (P<0.05). There was no significant difference in above indicators between 2 groups at 3 months after operation (P>0.05). The DASH score in minimally invasive group was significantly less than that in traditional group at 3 months after operation (t=–5.308, P=0.000). The patient’s aesthetic evaluation of postoperative wound in minimally invasive group was better than in traditional group.ConclusionFor treatment of unstable distal radial fractures, the metacarpal minimally invasive internal fixation has the advantages of smaller wound, incisional concealment, and quicker recovery of wrist joint.
ObjectiveTo investigate the effectiveness of closed or limited open reduction and intramedullary nail fixation in the treatment of Seinsheimer type Ⅴ subtrochanteric fracture.MethodsBetween May 2014 and July 2018, 36 patients with Scinsheimer type Ⅴ subtrochanteric fractures were treated with closed or limited open reduction and intramedullary nail fixation. There were 25 males and 11 females with an age of 23-86 years (mean, 55.8 years). The cause of injury included falling in 19 cases, traffic accident in 9 cases, falling from height in 7 cases, and heavy object injury in 1 case; all were fresh closed injuries. The interval between injury and operation was 1-14 days (mean, 6.8 days). There were 18 cases of closed reduction and 18 cases of limited open reduction during the operation. Seventeen cases were fixed with femoral reconstruction intramedullary nail, 5 with InterTan long nail, 14 with lengthened proximal femoral nail anti-rotation, and 7 cases were assisted with auxiliary steel wire binding. After operation, through X-ray film and clinical follow-up, the fracture reduction and maintenance status, internal fixation position, and fracture healing were judged; the range of motion, walking ability, and complications of hip joint were observed, and the function of hip joint was evaluated according to Merle d’Aubigne Postel hip joint scoring standard.ResultsAll the incisions of medullary operation healed by first intention, and no vascular, nerve injury, or infection occurred. All patients were followed up 12-24 months, with an average of 14.2 months. Among the 36 patients, 1 patient received revision surgery due to varus displacement of femoral head and screw penetration at 2 months after closed reduction, with poor recovery of hip function. X-ray film re-examination showed that the fractures of the other 35 patients healed after 9-15 months, with an average of 11.5 months. During follow-up, there was no complication such as internal fixation failure, fracture redisplacement, bone nonunion or malunion, and deep vein thrombosis of lower extremity occurred. The function of hip joint recovered well, and the patients could walk and squat normally without affecting daily life or work. At last follow-up, according to Merle d’Aubigne Postel hip joint scoring standard, 28 cases were rated as excellent, 4 cases as good, 3 cases as fair, and 1 case as poor, the excellent and good rate was 88.9%.ConclusionC-arm X-ray fluoroscopic closed or limited open reduction and intramedullary nail fixation for the treatment of Seinheimer Ⅴ type subtrochanteric fracture, if necessary, with the aid of auxiliary steel wire binding, it has the advantages of less blood supply destruction at the fracture end, satisfactory reduction, firm fixation, and early rehabilitation training, with definite effectiveness.
ObjectiveTo investigate the safety, feasibility, and effectiveness of modified staging strategy in treatment of type C3 Pilon fractures.MethodsThe clinical data of 23 patients with type C3 Pilon fractures treated with modified staging strategy between January 2012 and January 2018 was retrospectively analyzed. There were 14 males and 9 females with an average age of 47.9 years (range, 22-61 years). Twenty-three cases were high-energy injuries, including 11 cases of traffic accidents and 12 cases of falling from height. One case was an open fracture of Gustilo type ⅢA with no obvious sign of infection on the wound after early treatment. The remaining patients were closed fractures. The time from injury to admission was 3-40 hours with an average of 16.4 hours. The preoperative pain visual analogue scale (VAS) score was 7.22±1.17 and American Orthopaedic Foot and Ankle Society (AOFAS) score was 0. The flexion and plantar flexion activities of ankle joint were (1.13±0.26) and (4.79±0.93)°, respectively. Twenty-two patients had a tibiofibular fracture. In the first-stage operation, the posterior approach was used to reduce the posterior column fracture and the external stent was temporarily assisted. After the soft tissue crisis was removed, the final fracture reduction and internal fixation was performed through the anterior approach in the second-stage operation.ResultsAll 23 patients were followed up 12-84 months with an average of 26.6 months. The waiting time before the first-stage operation was 4-47 hours with an average of 23.4 hours. The interval between the two stage operations was 6-11 days with an average of 7.9 days. The first-stage operation time was 60-90 minutes with an average of 67.8 minutes; the second-stage operation time was 110-160 minutes with an average of 124.1 minutes. The hospital stay was 15-28 days with an average of 23.5 days. One patient (4.35%) had a tourniquet paralysis symptom after the second-stage operation, and two patients (8.7%) had delayed anterior incision healing. The other patients had incision healing without early complications. The radiographic review showed that the quality of articular surface reduction was excellent in 19 cases, good in 2 cases, and poor in 2 cases, with an excellent and good rate of 91.3%. At last follow-up, the fractures healed with no bone nonunion and malunion; the different degrees of osteoarthritis occurred in 7 cases. At last follow-up, the VAS score was 0.89 ±0.88 and the AOFAS score was 81.3±7.8. The flexion and plantar flexion activities of ankle joint were (10.23±5.05) and (20.97±3.92)°, respectively, and the differences between pre- and post-operation were significant (P<0.05).ConclusionThe midified staging strategy can not only provide a template for articular surface reduction for the second-stage anterior surgery, but also improve the quality of the reduction. It can also reduce the interval between the two operations and the operation time of the second-stage operation through the first-stage posterior fascial decompression, and can obtain satisfactory effectiveness.
Objective To summarize the effectiveness of Kirschner wire buckling combined with bone fixation in the treatment of metacarpal avulsion fracture. Methods The clinical data of 35 patients of metacarpal avulsion fracture admitted between March 2017 and June 2022 were retrospectively analyzed. There were 22 males and 13 females; the age ranged from 20 to 55 years, with an average of 31.6 years. There were 17 cases of the second metacarpal avulsion fracture, 6 cases of the fourth metacarpal avulsion fracture, and 12 cases of the fifth metacarpal avulsion fracture. The causes of injury included 21 cases of strangulation, 8 cases of sprain, and 6 cases of sports injury. X-ray film examination showed that the size of the avulsion fracture of metacarpal bone ranged from 0.30 cm×0.20 cm to 0.55 cm×0.45 cm. The total active motion (TAM) of the injured finger before operation was (154.00±17.38)°. The time from injury to operation was 3-10 days, with an average of 5.8 days. Follow-up regularly after operation, X-ray film and CT examination were performed to evaluate fracture healing and TAM of injured finger was measured. The finger function was evaluated by the trial standard of upper limb function evaluation of Hand Surgery Society of Chinese Medical Association. Results All the incisions healed by first intention. All 35 patients were followed up 9-36 months, with an average of 28 months. All metacarpal avulsion fractures achieved bony healing, and the healing time was 4-6 weeks, with an average of 4.8 weeks. The metacarpophalangeal joint of the patient was stable, without stiffness, and the flexion and extension activities were good. At last follow-up, the TAM of the injured finger reached (261.88±6.23)°, which was significantly different from that before operation (t=−35.351, P<0.001). The finger function was evaluated according to the trial standard of upper limb function evaluation of the Society of Hand Surgery of Chinese Medical Association, and 33 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. Conclusion The treatment of metacarpal avulsion fracture with Kirschner wire buckling combined with bone fixation has the advantages of less trauma, firm fixation, and less interference to the soft tissue around metacarpophalangeal joints, which is a good alternative method for the metacarpal avulsion fracture.