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.
Objective To compare the short-term effectiveness of repairing distal tibiofibular syndesmosis with metal screws and absorbable screws. Methods A retrospective analysis was performed on the clinical data of 63 patients with ankle fracture combined with injury of the distal tibiofibular syndesmosis admitted between January 2017 and January 2020. Among them, 31 patients were treated with absorbable screw fixation of the distal tibiofibular syndesmosis (research group) and 32 patients were treated with metal screw fixation of the distal tibiofibular syndesmosis (control group). There was no significant difference in gender, age, cause of injury, surgical side, time from injury to operation, fracture type, preoperative visual analogue scale (VAS) score, and American Orthopaedic Foot & Ankle Society (AOFAS) score between the two groups (P>0.05). The operation time and fracture healing time were recorded and compared between the two groups. X-ray film was taken to evaluate the effect of ankle joint reduction and fixation. Olerud-Molander ankle fracture efficacy score (short for OM score), AOFAS score, and VAS score were used to evaluate the effectiveness. Results There was no significant difference in operation time between the two groups (t=−0.683, P=0.497). In the control group, 1 case of delayed healing and 1 case of poor healing occurred in the lateral incision after operation, which healed after dressing change; the rest of the patients had primary healing of the incision. Patients in both groups were followed up 12-24 months, with an average of 13.8 months. In the control group, 1 patient with fracture of pronation and external rotation walked with full weight bearing after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks after operation, the anatomical plate of the lateral malleolus was broken, and the lateral malleolus was fixed again and recovered after 5 months; 1 patient had mild ankle pain after operation, and the pain disappeared after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks. No complication such as nerve and blood vessel injury occurred in all patients. There was no significant difference in fracture healing time between the two groups (t=−1.128, P=0.264). The AOFAS and VAS scores significantly improved in both groups at 12 months after operation (P<0.05). There was no significant difference between the two groups in the OM scores, and the difference of AOFAS and VAS scores between before and after operation (P>0.05). Conclusion Using absorbable screws to repair the distal tibiofibular syndesmosis can effectively restore the ankle acupoint structure, prevent ankle instability, and restore good ankle function. There is no significant difference in effectiveness between absorbable screws and metal screws, and there is no need for secondary operation to remove screws.
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.
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．
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.
ObjectiveTo investigate the effectiveness of open reduction by mini incision and absorbable screw internal fixation for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture. MethodsBetween January 2006 and July 2012, 90 patients (90 knees) with ACL tibial eminence avulsion fracture were treated. There were 58 males and 32 females, aged from 10 to 58 years with an average of 33.7 years. The causes of injury were traffic accident injury in 60 cases, sports injury in 22 cases, and falling injury in 8 cases. The disease duration was 1-365 days with a median of 106 days. Combined injuries included 14 cases of meniscus injury, 5 cases of medial collateral ligament injury, and 3 cases of avulsion fracture of the anterior horn of the lateral meniscus. All patients underwent open reduction by mini incision and internal fixation with absorbable screw. Postoperative rehabilitation exercise was performed. ResultsTwo patients had delayed healing of incision, and others obtained primary healing. All the patients were followed up 6-72 months (mean, 40.1 months). X-ray examination showed that bone union was achieved in all patients at 3-12 months after operation; nail tail came off in 7 cases at 4-13 months after operation, and the nail tail was taken out under arthroscopy. At 6-12 months after operation, the range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score were significantly increased when compared with preoperative ones (P < 0.05). ConclusionA combination of open reduction by mini incision and absorbable screw internal fixation for the treatment of ACL tibial eminence avulsion fracture has the advantages of easy operation, firm fixation, and satisfactory functional rehabilitation, so it is a safe and effective method for the treatment of ACL tibial eminence avulsion fracture.
Objective To investigate the feasibility and effectiveness of absorbable screws for the treatment of tibiofibular syndesmotic disruptions by comparing with metallic screws. Methods Between July 2007 and May 2012, 69 patients with tibiofibular syndesmotic disruptions associated with ankle fractures were treated; absorbable screw fixation was used in 38 cases (group A) and metallic screw fixation was used in 31 cases (group B). There was no significant difference in gender, age, injury causes, the type of fracture, the side of fracture, and disease duration between 2 groups (P gt; 0.05). The fracture healing time, weight bearing time, and complications were recorded and compared between 2 groups. According to Baird-Jackson scoring system, the function of the ankle was assessed after 6 months. Results Infection of incision occurred in 3 cases (7.9%) of group A and 2 cases (6.5%) of group B, and skin necrosis of incision in 1 case (2.6%) of group A and 5 cases (16.1%) of group B, showing no significant difference in the incidences of infection and necrosis of incisions between 2 groups (P gt; 0.05); primary healing of incision was obtained in the other patients. The 69 cases were followed up 12-26 months (mean, 18.6 months). The weight bearing time was (2.97 ± 0.59) months in group A and was (3.16 ± 0.74 ) months in group B, showing no significant difference (t=1.175, P=0.244). X-ray films showed that fractures and tibiofibular syndesmotic disruptions healed in 2 groups; the healing time was (5.71 ± 1.01) months in group A and was (5.81 ± 1.08) months in group B, showing no significant difference (t=0.381, P=0.705). No fixation failure, breakage, or loosening occurred in 2 groups. According to Baird-Jackson scoring system, the results were excellent in 29 cases, good in 5 cases, and fair in 4 cases with an excellent and good rate of 89.5% in group A at 6 months after operation; the results were excellent in 20 cases, good in 7 cases, and fair in 4 cases with an excellent and good rate of 87.1% in group B; no significant difference was found in the excellent and good rate between 2 groups (Z= — 0.991, P=0.321). Conclusion Treatment of tibiofibular syndesmotic disruptions with absorbable screws can get good effectiveness and replace metallic screws because of avoiding additional operation for removing the screw.
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.