Objective To compare the effectiveness between minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) for treatment of extra-articular distal tibial fracture. Methods Between March 2009 and March 2012, 57 patients with extra-articular distal tibial fractures were treated, and the clinical data were retrospectively analyzed. Of 57 cases, 31 were treated with MIPO (MIPO group), and 26 with ORIF (ORIF group). There was no significant difference in gender, age, cause of injury, type of fractures, complication, and time from injury to operation between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were compared between 2 groups. Results There was no significant difference in operation time and intraoperative blood loss between 2 groups (P gt; 0.05). Wound infection occurred in 5 cases [2 in MIPO group (6.5%) and 3 in ORIF group (11.5%)], showing no significant difference (χ2=0.651, P=0.499). The other wound obtained healing by first intention. All cases were followed up 13-24 months (mean, 15 months). No significant difference was found in the average healing time between 2 groups and between patients with types A and B by AO classification (P gt; 0.05); in patients with type C, the healing time in MIPO group was significantly shorter than that in ORIF group (t= — 2.277, P=0.033). Delayed union was observed in 3 cases of MIPO group (9.7%) and in 4 cases of ORIF group (15.4%), showing no significant difference (χ2=0.428, P=0.691). Mal-union occurred in 4 cases of MIPO group (12.9%) and in 1 case of ORIF group (3.8%), showing no significant difference (χ2=1.449, P=0.362). No significant difference was found in Mazur score between 2 groups (t=0.480, P=0.633). The excellent and good rate was 93.5% in MIPO group (excellent in 24 cases, good in 5 cases, fair in 1 case, and poor in 1 case) and was 92.3% in ORIF group (excellent in 18 cases, good in 6 cases, and poor in 2 cases), and the difference was not significant (Z= — 0.687, P=0.492). Conclusion Both MIPO and ORIF have good results in treating extra-articular distal tibial fractures. MIPO is superior to ORIF for treating complex and communited fractures.
Objective To assess the effectiveness of the new anterolateral approach of the distal femur for the treatment of distal femoral fractures. Methods Between July 2007 and December 2009, 58 patients with distal femoral fractures were treated by new anterolateral approach of the distal femur in 28 patients (new approach group) and by conventional approach in 30 patients (conventional approach group). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, disease duration, complication, or preoperative intervention (P gt; 0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization days, and Hospital for Special Surgery (HSS) score of knee were recorded. Results Operation was successfully completed in all patients of 2 groups, and healing of incision by first intention was obtained; no vascular and nerves injuries occurred. The operation time and intraoperative fluoroscopy frequency of new approach group were significantly less than those of conventional approach group (P lt; 0.05). But the intraoperative blood loss and the hospitalization days showed no significant difference between 2 groups (P gt; 0.05). All patients were followed up 12-36 months (mean, 19.8 months). Bone union was shown on X-ray films; the fracture healing time was (12.62 ± 2.34) weeks in the new approach group and was (13.78 ± 1.94) weeks in the conventional approach group, showing no significant difference (t=2.78, P=0.10). The knee HSS score at last follow-up was 94.4 ± 4.2 in the new approach group, and was 89.2 ± 6.0 in the conventional approach group, showing significant difference between 2 groups (t=3.85, P=0.00). Conclusion New anterolateral approach of the distal femur for distal femoral fractures has the advantages of exposure plenitude, minimal tissue trauma, and early function rehabilitation training so as to enhance the function recovery of knee joint.
Objective To evaluate the effectiveness and safety of external fixation (EF) and open reduction and internal fixation (ORIF) for unstable distal radius fractures in adults. Methods We searched MEDLINE (1966 to September 2008), Cochrane Central register of controlled Trials (The Cochrane Library, Issue 3, 2008), EMbase (1974 to September 2008), CBM, CNKI, and collected randomized controlled trials (RCTs) of EF and ORIF for unstable distal radius fractures in adults. The quality of the included studies was critically assessed and data analyses were performed with the Cochrane Collaboration’s RevMan 5.0 software. Results Seven RCTs involving 634 patients were included, of which 269 were in EF group, and 293 were in ORIF group. Only 1 study had relative high quality, all the others had some limitation in randomization, blinding, and allocation concealment. The results of meta-analyses showed that, 1) about the effectiveness: according to the Gartland and Werley grade standard, the ORIF group was better than the EF group with statistic difference (RR=1.50, 95%CI 1.11 to 2.03, P=0.008); because of the original studies did not offer the detailed data including pad strength, grip strength, flexion-extension, radial deviation, and ulnar deviation, we only processed a descriptive analysis; and 2) about complications: the infection rate of the pin track was higher in the EF group than that in the ORIF group with statistic difference (RR=0.24, 95%CI 0.08 to 0.76, P=0.02); but there were no differences between the two groups in reflex sympathetic dystrophy (RSD) (RR=0.88, 95%CI 0.30 to 2.56, P=0.82), extensor tendon rupture (RR=3.93, 95%CI 0.45 to 34.62, P=0.22), and compartment syndrome (RR=3.13, 95%CI 0.51 to 19.09, P=0.22). Conclusions Compared with EF, ORIF is much better based on Gartland and Werley grade standard, and causes much less infection. Because of the limited quality and quantity of the included studies, more proofs are required from more RCTs with large sample.
Objective To compare the effects of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures. Methods All randomized controlled trials (RCTs) of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures were identified. Quality assessment and data extraction were performed by two reviewers independently. Results Four published trials involving 530 patients were included. All studies compared operative with nonoperative treatment. It was clear that operative treatment was superior to nonoperative treatment in terms of helping patients back to work, reducing problems wearing shoes, expanding the range of motion of subtalar joint, and improving the recovery of Bohler’s angle. As for foot pain, there was no difference between the two methods. Because the outcome measures varied across the trials, a meta-analysis could not be performed. Conclusions Both operative and nonoperative treatments produce comparable long-term outcomes in the treatment of displaced intra-articular calcaneal fractures. Because of the poor reporting of outcomes, it is not possible to determine if there is any significant difference in outcome measures apart from those listed above. More trials with high methodological quality are needed.
ObjectiveTo investigate the clinical features of ankle fractures involving Tillaux-Chaput in adults, and to observe the surgical effectiveness. MethodsBetween May 2009 and May 2013, 15 adult patients with ankle fractures involving Tillaux-Chaput were treated by open reduction and internal fixation. There were 12 males and 3 females, with an average age of 32 years (range, 19-45 years). The causes included sport injury (8 cases), traffic accident injury (5 cases), and falling injury from height (2 cases). The left ankle was involved in 5 cases and the right side in 10 cases. There were 2 open fractures (Gustilo type I) and 13 close fractures. Five patients had single Tillaux-Chaput fractures. The mean time between injury and surgery was 8.5 days (range, 3 hours to 15 days). According to the Lauge-Hansen classification, there were 9 cases of supination-external rotation, 5 cases of pronation-external rotation, and 1 case of pronation-abduction. ResultsPrimary healing of incisions was obtained in 13 patients without infection and neurovascular injury; 2 patients had superficial infection which was cured after oral antibiotics and dressing change. All cases were followed up for 23 months on average (range, 13-36 months). X-ray films showed complete fracture healing at 10-16 weeks postoperatively (mean, 13 weeks) in all cases. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 87 (range, 78-99), with an excellent and good rate of 80% (excellent in 9 cases, good in 3 cases, and fair in 3 cases). ConclusionOpen reduction and internal fixation for ankle fractures involving Tillaux-Chaput in adults can achieve excellent effectiveness.
Objective To investigate the tunnel-type open reduction and internal fixation of rib fractures (ORIF) with titanium locking plate in traumatic rib fractures. Methods Clinical data of 10 patients with multiple rib fractures from June 2016 to January 2017 in the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University were analyzed. There were 6 males and 4 males with an average age of 38.5±9.0 years (range, 30–63 years). All patients underwent emergency treatment, chest CT and ultrasound examination before they admitted to the hospital. According to rib fractures and injuries, patients were given the tunnel-type ORIF of rib fractures with titanium locking plates, the chest tube and negative suction drainage. The patients were followed up over three months. Results All patients were cured. There was no complication during follow-up. No wound infection and death occurred. Postoperative three-month follow-up showed that chest pain was significantly relieved without pulmonary atelectasis and pleural effusion or other complications. Conclusion Tunnel-type internal fixation of rib fractures with titanium locking plates is effective, which can quickly restore the stability and integrity of the thorax. Surgical procedure is simple and can get fast postoperative recovery to improve the patient's quality of life.
ObjectiveTo investigate the effectiveness of open reduction and internal fixation on high-energy ankle Logsplitter injuries (a kind of transsyndesmotic ankle fracture dislocation), and compare the prognosis between open and closed Logsplitter fracture.MethodsThe clinical data of 36 Logsplitter fractures treated with open reduction and internal fixation between April 2011 and May 2016 were retrospectively analyzed. Among them, 15 cases were open fracture and dislocation (open group) and 21 cases were closed fracture and dislocation (closed group). There was no significant difference between the two groups in gender, age, combined injury, injury to hospital admission time (P>0.05), with comparability. The wound healing, ankle mobility recovery, complications, and fracture healing were observed after operation. The ankle function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score.ResultsBoth groups were followed up 12-29 months (mean, 19 months). There was no significant difference in the follow-up time between the open group and the closed group (t=1.169, P=0.251). In the open group, there were 3 cases of postoperative infection, 3 cases of nonunion, and 5 cases of post-traumatic osteoarthritis; each mentioned complications had 1 case in the closed group; there was no significant difference in complications incidence between the two groups (P=0.41) except post-traumatic osteoarthritis incidence (P=0.02). At last follow-up, there was no significant difference in AOFAS score between the two groups (t=1.981, P=0.056). According to AOFAS score criterion, the results were good in 10 cases and general in 5 cases in the open group, and good in 13 cases and general in 8 cases in the closed group, showing no significant difference (P=0.796). There was no significant difference in the union duration and ankle flexion, dorsal extension, varus, and valgus motion between the two groups (P>0.05).ConclusionOpen reduction and internal fixation for open or closed Logsplitter fractures can achieve satisfactory results, improve fracture healing rate, effectively reduce the incidence of complications, and improve ankle function.
Objectives To systematically review the efficacy of conservative treatment and open reduction with internal fixation for multiple rib fractures. Methods We searched WanFang Data, CNKI, VIP, PubMed, EMbase, The Cochrane Library and Web of Science from inception to December 2017 to collect studies on conservative treatment and open reduction with internal fixation for multiple rib fractures. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. RevMan 5.3 software was used for meta-analysis. Results A total of 16 studies were included, involving 1 374 patients, 723 patients in the surgical group and 651 patients in the conservative group. The meta-analysis showed that the length of stay in the ICU (MD=–3.41, 95%CI –4.92 to –2.43, P<0.000 01), total length of stay (MD=–7.60, 95 %CI–10.67 to–4.53,P<0.000 01), incidence of pulmonary arylene (RR=0.40, 95%CI 0.29 to 0.54,P<0.000 01), incidence of lung infections (RR=0.43, 95%CI 0.30 to 0.61,P<0.000 01), and incidence of chest wall malformation (RR=0.05, 95%CI 0.03 to 0.11,P<0. 0.000 01) in the surgical group were superior to the conservative group. Conclusions Compared with conservative treatment, open reduction with internal fixation can significantly improve the recovery time of patients with multiple rib fractures, reduce hospitalization time, the incidence of perioperative complications, and significantly enhance the prognosis of patients, which is more conducive to the rehabilitation of patients.
Objective To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral “safe zone” for Hawkins type Ⅰ-Ⅲ talar neck fractures. Methods A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral “safe zone” parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups (P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale. Results The operation time in the study group was significantly shorter than that in the control group (P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups (P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant (P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups (P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups (P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients’ satisfaction in the study group were significantly better than those in the control group (P<0.05). ConclusionThe treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral “safe zone” can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.