Objective To compare the effectiveness between ultrasound-guided and C-arm-guided in closed reduction and pinning for the treatment of metacarpophalangeal fractures. Methods The clinical data of 30 patients with metacarpophalangeal fractures between October 2015 and November 2016 were retrospectively analyzed. According to different treatments, the patients were divided into ultrasound group (using ultrasound-guided closed reduction and pinning, n=15) and C-arm group (using C-arm-guided closed reduction and pinning, n=15). There was no significant difference in gender, age, disease duration, causes of injury, injured finger, location of injury finger, fracture classification between 2 groups (P>0.05). The status and success rate of reduction were compared (excellent, good, and acceptable grades could be regarded as the successful reduction). The operation time, intraoperative fluoroscopy times, and fracture healing time were recorded. And the postoperative functional recovery was evaluated according to the total active movement (TAM) by the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association. Results The operation time of ultrasound group was longer than C-arm group, and the intraoperative fluoroscopy times was less than C-arm group, all showing significant differences (P<0.05). There was no signifi cant difference in the grade and the success rate of reduction between 2 groups (P>0.05). All the patients were followed up 6-18 months (mean, 10 months), without malunion, joint stiffness, tendon adhesions, and other complications. There was also no significant difference in the fracture healing time, the grade of TAM, and the excellent and good rate of TAM between 2 groups (P>0.05). Conclusion The treatment of ultrasound-guided closed reduction and pinning for metacarpophalangeal fractures is effective, which is a feasible auxiliary method of closed reduction and fixation for fracture. And less fluoroscopy can reduce the radiation damage of operation.
ObjectiveTo observe the expressions of transforming growth factor β1 (TGF-β1) and basic fibroblast growth factor (bFGF) induced membrane by Masquelet technique in rats treated with glycoside of short-horned epimedium Herb, and to explore the effect of glycoside of short-horned epimedium Herb on Masquelet induced membrane.MethodsSixty 3-month-old male Wistar rats were randomly divided into 3 groups with 20 rats in each group; a tibial bone defect (6 mm in length) model was established. The blank group (group A) was not treated; the control group (group B) and the experimental group (group C) were filled with vancomycin antibiotic bone cement in the drawing stage, and the bone cement was completely solidified. Group C was given perfused flavonoids glycoside of short-horned epimedium Herb (10 μmol/L) by gavage once a day (0.3 mL) from 1 day after operation, and groups A and B were given the same amount of normal saline by gavage. After operation, the recovery and wound healing of experimental animals were observed; at 4 weeks after operation, X-ray film was taken to observe the recovery of bone defect of proximal tibia; at 6 weeks after operation, the bone defect was observed, and the morphological changes and vascularization degree of granulation tissue and induction membrane tissue were observed; the expressions of TGF-β1 and bFGF were observed by immunohistochemistry staining and ELISA detection.ResultsThe bone defect models of the 3 groups were established successfully, and there was no abnormality after operation. The incisions healed by first intention after operation. At 4 weeks after operation, X-ray films of proximal tibial defect showed that there was obvious space in group A, while bone cement was filled and Kirschner wire fixation was good in groups B and C. At 6 weeks after operation, the gross observation showed that the granulation tissue was filled in the defect area in group A; transparent membrane was formed in groups B and C, and microvessels were seen in some areas, and the microvessels in group C were significantly more than those in group B. Immunohistochemical staining showed that the expressions of TGF-β1 and bFGF were negative in group A, but they were expressed in groups B and C, and the expressions of TGF-β1 and bFGF in group B were significantly less than those in group C. ELISA detection showed that the expressions of TGF-β1 and bFGF in group C were significantly higher than those in groups A and B (P<0.05), but there was no significant difference between groups A and B (P>0.05). ConclusionGlycoside of short-horned epimedium Herb can significantly increase the expressions of TGF-β1 and bFGF, accelerate the process of osteogenesis, and contribute to bone shaping and reconstruction.
Objective To explore the effectiveness of ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture. Methods Between May 2013 and August 2015, 15 patients with fresh nondisplaced carpal scaphoid fractures (Krimmer type A2) were treated with ultrasound-guided Herbert screw fixation. There were 12 males and 3 females with an average age of 33.4 years (range, 18-51 years). The causes of injury included 9 cases of falls, 3 cases of training injuries, and 3 cases of machine injuries. The interval from injury to surgery was 2-15 days (mean, 5 days). No other complication was found. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the fracture healing time were recorded. The wrist function was assessed by the modified Mayo wrist score standard. Results The operation time was 28-53 minutes (mean, 33.9 minutes); the intraoperative blood loss was 5-30 mL (mean, 10.5 mL); the intraoperative fluoroscopy was 2-6 times (mean, 2.6 times). All 15 patients were followed up 6-18 months (mean, 10.5 months). One patient developed pain and soreness in the skin of the nail entrance, and gradually relieved after fumigation. No complication such as infection occurred. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 11.6 weeks). At last follow-up, the modified Mayo wrist score was 76-99 (mean, 92.5). Among them, 12 cases were excellent, 2 cases were good, and 1 case was fair, and the excellent and good rate was 93.3%. Conclusion Ultrasound-guided fixation with Herbert screw is a reliable treatment method for fresh nondisplaced carpal scaphoid fractures with small invasion, less bleeding, and small radiation damage.
ObjectiveTo explore the effectiveness of anatomical repair of Atzei-EWAS type 2 triangular fibrocartilage complex (TFCC) injury under wrist arthroscopy. MethodsBetween March 2018 and March 2020, 16 patients with Atzei-EWAS type 2 TFCC injury were admitted, and the TFCCs were anatomically repaired with a three-dimensional suture with a thread anchor under wrist arthroscopy. There were 10 males and 6 females with an average of 40.2 years (range, 22-54 years). The disease duration ranged from 2 to 9 months (mean, 6.4 months). Preoperative grip strength of the affected limb was (20.06±3.38) kg, wrist range of motion in flexion and extension was (117.19±7.74)°, radial-ulnar deviation was (31.25±5.32)°, forearm rotation range of motion was (137.19±14.83)°, visual analogue scale (VAS) score was 5.6±1.2. At last follow-up, the effectiveness was evaluated by the grip strength of the affected limb, the range of motion of the wrist joint, the VAS score, and the modified Mayo wrist score. ResultsAll incisions healed by first intention. One case had paralysis of the dorsal branch of the ulnar nerve after operation, and no other complications occurred in other cases. All patients were followed up 12-18 months (mean, 14.5 months). The distal radioulnar joint stability of all patients recovered. At last follow-up, the grip strength of the affected limb was (24.88±3.26) kg, the range of motion in flexion and extension was (146.59±6.49)°, radial-ulnar deviation was (39.38±6.55)°, and forearm rotation range of motion was (152.50±11.55)°, which were significantly higher than those before operation (P<0.05); the VAS score was 0.9±0.8, which was significantly lower than that before operation (t=21.029, P=0.000). The modified Mayo wrist score was rated as excellent in 10 cases, good in 5 cases, and fair in 1 case. The excellent and good rate was 93.8%. MRI results showed that TFCC healed in all cases. ConclusionFor Atzei-EWAS type 2 TFCC injury, anatomical repair under wrist arthroscopy can restore the anatomical structure of TFCC, effectively relieve wrist pain, improve function, and obtain good effectiveness.
ObjectiveTo analyze the feasibility and effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound.MethodsThe clinical data of 30 patients with the fifth metacarpal neck fractures who were treated with elastic intramedullary nails fixation under the guidance of high frequency ultrasound and met the selection criteria between May 2013 and September 2017 were retrospectively analysed. There were 24 males and 6 females, the age ranged from 18 to 58 years, with an average of 31.4 years. The head-shaft angle of the fifth metacarpal was (55.6±11.3)°. The time from injury to operation was 12 hours to 8 days, with an average of 2.4 days. The operation time, number of intraoperative fluoroscopy, fracture reduction, complications, and fracture healing time were recorded. The head-shaft angle of the fifth metacarpal on the affected side after fracture healing were measured and compared with the healthy side. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint of both sides were measured, and the function was evaluated by using the total active movement (TAM) evaluation standard of the Hand Surgery Association of Chinese Medical Association.ResultsThe operation time was 22-40 minutes, with an average of 32.4 minutes; the intraoperative fluoroscopy was performed once; ultrasound images and X-ray fluoroscopy showed that the fracture was well reduced and no adjustment was required. The incisions healed well after operation, without tendon adhesion or local numbness. All 30 patients were followed up 8-16 months, with an average of 11.7 months. The fracture healing time was 4-8 weeks, with an average of 5.6 weeks. The head-shaft angle of the fifth metacarpal was (13.2±1.4)°, which was significantly improved when compared with preoperative value (t=−20.02, P=0.00); and there was no significant difference (t=1.94, P=0.06) when compared with the healthy side [(12.6±1.0)°]. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint on the affected side was (89.4±2.4)°, showing no significant difference (t=−1.58, P=0.13) when compared with the healthy side [(90.3±2.0)°]. According to the TAM evaluation standard of the Hand Surgery Association of Chinese Medical Association, all patients were considered to be excellent.ConclusionThe effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound is definite. It can dynamically observe the fracture reduction from different angles, reduce ionizing radiation and postoperative complications.
Objective To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury. Methods A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups (P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation. Results All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation (P<0.05); however, the differences in the change values of the above indexes between groups was not significant (P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group (P<0.05), and there was no significant difference between the TFCC group and the combination group (P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group (P<0.05); there was no significant difference between the other groups (P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group (P<0.05); there was no significant difference between the TFCC group and the combination group (P>0.05).ConclusionFor ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.