With the deepening of the research on intertrochanteric fracture, the importance of " lateral wall” of femur is gradually recognized. The integrity of the lateral wall can affect the stability of intertrochanteric fractures, the choice of surgical methods and internal fixation, and the outcome of patients after surgery, which has become a research hotspot. However, there is no unified understanding on the definition of lateral wall, the judgement of injury status and the treatment of lateral wall fracture. This article reviews the literature, and combines with the clinical understanding of the role of the lateral femoral wall, in order to provide reference for orthopaedic surgeons and relevant researchers.
【Abstract】 Objective To evaluate the effectiveness of percutaneous fixation of pelvic fracture by Acutrak full thread headless hollow compression screw. Methods Between March 2008 and April 2010, 31 patients with pelvic fracture underwent percutaneous fixation surgery with Acutrak full thread headless hollow compression screw (surgical group). The effectivenss was compared with those of 14 patients with pelvic fracture treated conservatively (control group). There was no significant difference in age and sex between 2 groups (P gt; 0.05). The injury was more severe in surgical group than in control group. The standard of short-term recovery was active turning over and walking for 5 steps with walking aids. The standard of long-term recovery was pain, gait, fracture healing, and function recovery. Results In surgical group, the other patients reached the standard of short-term recovery at 1-4 days after injury except 1 patient who had sacral plexus injury; in control group, the patients could turn over at 9-13 days (Tile type A2) and 17-25 days (Tile type B2) respectively, and could walk at 17-21 days (Tile type A2) and at 45-57 days (Tile type B2) respectively. The patients of 2 groups were followed up 6-19 months. The time of fracture healing was 2-6 months. The long-term results were excellent in 29 cases and good in 2 cases in surgical group, and were excellent in 8 cases and good in 6 cases in control group, showing significant difference between 2 groups (χ2=6.636, P=0.017).Conclusion Percutaneous internal fixation combined with Acutrak full thread headless hollow compression screw can provide more effective treatment. It can alleviate patients, pain quickly, improve life quality, and has better long-term effectiveness.
ObjectiveTo summarize the research progress of osteonecrosis of femoral head (ONFH) following femoral intertrochanteric fractures in adults.MethodsRelevant literature at home and abroad was extensively reviewed to summarize the pathogenesis, high-risk factors, and treatment of ONFH after femoral intertrochanteric fracture in adults.ResultsONFH after femoral intertrochanteric fracture mostly occurs within 2 years after operation, with a lower incidence. At present, it is believed that comminuted and large displacement fractures caused by high-energy injuries, fracture line close to the base of neck, excessive external rotation deformity, improper intramedullary nail entry points, and rough intraoperative manipulating may injury the deep branch of the medial circumflex femoral artery, causing ONFH. Hip replacement is the main treatment for necrosis, which can achieve good results.ConclusionAddressing the above risks, excessive external rotation, overstretching, and rough manipulating should be avoided. Anatomical reduction should be performed during the operation, the nail entry point should be accurate and avoid repeated drilling and thermally bone necrosis.
Objective To observe the effect of radiofrequency ablation technology for the treatment of infected wounds in minipigs. Methods Infected wounds of full-thickness skin defects (about 6.15 cm2/wound) were prepared in 8 6-month-old minipigs (weighing, 30-35 kg) using the method of Davis et al. The 160 wounds were randomly divided into 4 groups (n=40). Infected wounds were debrided with the radiofrequency ablation technology in group A, with the electric knife in group B, and with the scalpel in group C; no treatment was done in group D as a control. The healing rate, healing time, and tissue filling rate were observed; bacterial quantitative examination and histological examination were done at 0, 2, 7, and 14 days after operation. Results All infected wounds were successfully established after 48 hours when Staphylococcus aureus dilution were inoculated. The wounds after radiofrequency ablation technology treatment were fresh and flat with slight bleeding; the healing time of group A was significantly shorter than that of groups B, C, and D (P lt; 0.05), and the healing rate of group A was significantly higher than that of groups B, C, and D at 7 and 14 days after operation (P lt; 0.05). The tissue filling rate of group A was significantly higher than that of groups B, C, and D at 2 days after operation (P lt; 0.05); the tissue filling rates of groups A, B, and C were significantly higher than that of group D at 7 and 14 days after operation (P lt; 0.05). At 0, 2, 7, and 14 days, there were significant differences in the bacterial count per gram tissue among 4 groups (P lt; 0.05), the order from low to high was groups A, B, C, and D. The histological observation showed that the surface of wound was smooth in group A at 0 day, and group A was better than the other groups in wound healing; at 2 days, some exudates were observed in 4 groups, but it was least in group A. There was inflammatory cell infiltration in various degrees in 4 groups at 7 and 14 days; it was lightest in group A with thick epithelium and dense collagen bundles, followed by groups B and C, and it was severe in group D. Conclusion The radiofrequency ablation technology can effectively remove the necrotic tissues of infected wounds, remarkably reduce the number of bacteria, improve the healing rate, and shorten the healing time of wounds.
Objective To investigate the cl inical effect of vacuum seal ing drainage (VSD) on late-stage large skin avulsion injury with infection. Methods From May 2007 to August 2008, 9 patients with large-area skin avulsion injury and infection were treated. There were 1 male and 8 females aged 9-52 years old (median 27 years old). All patients suffered from closed skin avulsion injury involving the lower back, buttock, and part of the thigh. The injury area varied from 30 cm × 25 cm to92 cm × 38 cm. The time between injury and hospital admission was 15-23 days. The skin avulsion injury was compl icated with pelvis fracture, urethral injury, anal injury, sacrum exposure, and l imb fractures. The interval between hospital admission and operation was 3-23 hours. Free spl it-thickness skin graft was performed after the focus debridement and three VSD treatments (40-60 kPa). Results After three VSD treatments, no patient had general pyemia and severe local tissue necrosis or infection, the tissue edema in the skin avulsion area was alleviated obviously, and all the wound cavities were closed. All the wounds in the graft site healed after 28-45 days of treatment (average 39 days), and all the donor sites healed. Nine patients were followed up for 4-14 months (average 10 months). The appearance of the reparative area was good, and there was no occurrence of joint dysfunction in the injured area due to scar contracture. Conclusion VSD is effective in treating late-stage large skin avulsion injury with infection.