Objective To investigate the method and effectiveness of operative treatment of anterior olecranon fracture-dislocation. Methods Between January 2007 and December 2010, 10 cases of anterior olecranon fracture-dislocation were treated. There were 6 males and 4 females with an average age of 46.1 years (range, 27-68 years). The injury was caused by traffic accident in 7 cases, falling from height in 2 cases, and falling in 1 case. Nine cases were fresh fracture and 1 case was old fracture. There were 9 cases of ulnar olecranon comminuted fracture and 1 case of simple oblique fracture. Associated fractures were Regan-Morrey type III coronoid process fractures in 5 cases, Mason type II radial head fracture in 1 case, and Mason type III radial head fracture in 1 case. Open reduction and internal fixation were performed in all cases: reconstruction plates were used in 4 cases, tension band and reconstruction plates in 5 cases, and tension band and one-third tubular plate in 1 case; bone graft was performed in 2 cases. Results All incisions healed by first intention. The patients were followed up 12-26 months (mean, 19.8 months). The X-ray films showed that fractures healing was achieved at 12-24 weeks (mean, 16.4 weeks). No failure of internal fixation, ulnohumeral joint instability, or traumatic arthritis occurred. At last follow-up, the elbow function score was 69-100 (mean, 89.1) according to the Broberg-Morrey evaluation criteria; the results were excellent in 4 cases, good in 4 cases, and fair in 2 cases with an excellent and good rate of 80%. The Disability of Arm-Shoulder-Hand (DASH) score was 0-22 (mean, 9). The visual analogue score (VAS) was 0-3 (mean, 0.5). Conclusion For anterior olecranon fracture-dislocation, an early and stable anatomic reconstruction of the trochlear notch of the ulna with plates and early active mobilization are given, the good functional results can be obtained.
Objective To explore the effectiveness of Colorado 2TM system in the stabil ity reconstruction of sacroil iac joint fracture and dislocation in Tile C pelvic fracture. Methods Between February 2009 and January 2011，8 cases of Tile C pelvic fracture were treated with Colorado 2TM system. There were 3 males and 5 females with an average age of 34.4years (range，22-52 years). Fractures were caused by traffic accident in 3 cases, by fall ing from height in 3 cases，and by crash of heavy object in 2 cases. According to Tile classification, 5 cases were classified as C1-2, 2 cases as C1-3，and 1 case as C2. The time between injury and operation was 5-10 days (mean, 7 days). After skeletal traction reduction, Colorado 2TM system was used to fix sacroil iac joint, and reconstruction plate or external fixation was selectively adopted. Results The postoperative X-ray films showed that the reduction of vertical and rotatory dislocation was satisfactory, posterior pelvic ring achieved effective stabil ity. All the incisions healed by first intention, and no blood vessel or nerve injury occurred. Eight patients were followed up 6-24 months (mean, 12 months). No loosening or breakage of internal fixation was observed and no re-dislocation of sacroil iac joint occurred. The bone heal ing time was 6-12 months (mean, 9 months). According to Majeed’s functional criterion, the results were excellent in 5 cases, good in 2 cases, and fair in 1 case at last follow-up. Conclusion Colorado 2TM system could provide immediate stabil ity of pelvic posterior ring and good maintenance of reduction effect, which is an effective method in the therapy of sacroil iac joint fracture and dislocation in Tile C pelvic fracture.
To compare the effectiveness of the operations in treatment of thoracolumber spine fracture and dislocation with spinal cord injury in different periods. Methods Between June 2003 and June 2008, 80 cases of thoracolumber spine fracture and dislocation with spinal cord injury were treated. There were 52 males and 28 females with an average age of 37.6 years (range, 28-49 years). According to different operative time, they were divided into 2 groups by randomized controlled study: group A (n=39, operation was performed within 24 hours) and group B (n=41, operation was performed at 3-7 days). In group A, there were 23 cases of degree I-II (group A1), 16 cases of degree III-V (group A2) according to Meyerding standard, including 17 cases of grade A, 7 cases of grade B, 9 cases of grade C, and 6 cases of grade D according to Frankel scoring system. In group B, there were 21 cases of degree I-II (group B1) and 20 cases of degree III-V (group B2), including 20 cases of grade A, 7 cases of grade B, 11 cases of grade C, and 3 cases of grade D. All cases were treated with posterior spinal cord decompression and reduction, with internal fixation by pedicle screw-rod system and transforamen lumbar interbody fusion. Results The blood loss was (407.4 ± 24.3) mL in group A1 and (397.4 ± 8.2) mL in group B1, showing no significant difference (t=1.804, P=0.078); the blood loss was (1 046.9 ± 128.6) mL in group A2 and (494.4 ± 97.7) mL in group B2, showing significant difference (t=14.660, P=0.000). All 80 patients were followed up 2 years to 2 years and 6 months (mean, 2 years and 3 months) with satisfactory results in spinal cord decompression and reduction, and bony fusion was achieved at 12 months. There was no significant difference in the vertebral canal volume, vertebral height, and Cobb angle at both pre- and postoperation between 2 groups (P gt; 0.05). No loosening or breakage of screws and rods occurred. At 12 months after operation, the cure rates were 47.83% (11/23) in group A1 and 19.05% (4/21) in group B1, showing significant difference (χ2=4.046, P=0.044); the cure rates were 12.50% (2/16) in group A2 and 10.00% (2/20) in group B2, showing no significant difference (χ2=0.056, P=0.813). There was no significant difference (χ2=0.024, P=0.878) in the cure rates in the patients at grades A and B before operation between group A (12.50%, 3/24) and group B (11.11%, 3/27); but there was significant difference (χ2=5.992, P=0.014) in the cure rates in the patients at grades C and D before operation between group A (66.67%, 10/15) and group B (21.43%, 3/14). Conclusion Emergency operation of posterior pedicle screw-rod system for treatment of thoracolumber spine fracture and dislocation with spinal cord injury can provide good reduction, rigid fixation, and high fusion rate, so it is asafe and effective treatment method.
Objective To study the operative procedure and the effectiveness of arthroscopic therapy for ankle joint impingement syndrome after operation of ankle joint fracture dislocation. Methods Between March 2008 and April 2010, 38 patients with ankle joint impingement syndrome after operation of ankle joint fracture dislocation were treated. Among them, therewere 28 males and 10 females with an average age of 28 years (range, 18 to 42 years). The time from internal fixation to admission was 12-16 months (mean, 13.8 months). There were pressing pain in anterolateral and anterior ankle. The dorsal extension ranged from — 20 to — 5° (mean, —10.6°), and the palmar flexion was 30-40° (mean, 35.5°). The total score was 48.32 ± 9.24 and the pain score was 7.26 ± 1.22 before operation according to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. The X-ray films showed osteophyte formation in anterior tibia and talus; MRI showed cartilage injury in 22 cases. Arthroscopic intervention included removing osteophytes, debriding fabric scars and synovial membrane tissues, and removing osteochondral fragments. Arthroscopic microfracture technique was used in 22 patients with cartilage injury. Results All incisions healed primarily. Thirty-eight cases were followed up 10-26 months (mean, 16 months). At last follow-up, 26 patients had normal range of motion (ROM); the dorsal extension was 15-25° (mean, 19.6°) and the palmar flexion was 35-45° (mean, 40.7°). Eight patients had mild l imited ROM; the dorsal extension was 5-15° (mean, 7.2°) and the palmar flexion was 35-45° (mean, 39.5°). Four patients had mild l imited ROM and pain in posterior portion of the ankle after a long walking (3-4 hours); the dorsal extension was 0-5° (mean, 2.6°) and the palmar flexion was 35-40° (mean, 37.5°). The total score was 89.45 ± 9.55 and the pain score was 1.42 ± 1.26 after operation according to AOFAS ankle and hindfoot score system, showing significant differences when compared with preoperative ones (t=21.962, P=0.000; t=16.762, P=0.000). Conclusion Arthroscopic treatment of ankle joint impingement syndrome after operation of ankle joint fracture dislocation is an effective, simple, and safe method.
Objective To evaluate the effectiveness of operation via anterior approach in treating pelvic crescent fra cture. Methods Between June 2007 and December 2009, 18 patients with pelvic crescent fracture were treated, including 11 males and 7 females with an average age of 32 years (range, 19-52 years). The locations were the right in 8 cases and the leftin 10 cases. Fractures were caused by traffic accident in 10 cases, by fall ing from height in 5 cases, and by crushing with heavy weights in 3 cases. All patients suffered lateral compression injuries of the pelvis. The mean time from injury to operation was 7.8 days (range, 3-22 days). The preoperative mean displacement of the posterior pelvic ring was 13.7 mm (range, 5-24 mm) according to the method described by Matta et al. The operation time, intraoperative blood loss, displacement correction of the posterior pelvic ring, fracture heal ing time, and Hannover pelvic score were recorded. Results The average operation time was 175 minutes (range, 110-230 minutes); the average intraoperative blood loss was 561.7 mL (range, 300-1 100 mL); the postoperative mean displacement of the posterior pelvic ring was 1.2 mm (range, 0-3 mm); and the mean displacement correction of the posterior pelvic ring was 12.6 mm (range, 4-23 mm). No intraoperative lumbosacral nervous injury occurred. Superficial wound infection occurred in 2 cases and was cured after 1 week of wound drainage and appl ication of antibiotic. The others achieved heal ing of incision by first intention. Fifteen patients were followed up 16.1 months on average (range, 13-22 months). The X-ray films showed fracture heal ing in all patients. The fracture heal ing time was 3.6 months on average (range, 3-4 months). No patient had loss of reduction or failure of internal fixation. The cl inical outcome was excellent in 10 cases (66.7%) and good in 5 cases (33.3%) according to Hannover pelvic score; social reintegration was complete in 13 cases (86.7%) and incomplete in 2 cases (13.3%). Conclusion Operation via anterior approach is a good choice in the treatment of pelvic crescent fracture.
Objective To evaluate the cl inical outcomes of modified posterior-anterior operation in the treatment of serious lumbar fracture and dislocation. Methods From January 2002 to February 2006, 24 patients, 17 males and 7 females aged 22-69 years, underwent reduction of posterior spatium intermuscular approach combined with modified anterioroperation. Nine cases were caused by fall ing and 15 by traffic accident, involving: L1 in 5 cases, L2 in 10 cases, L3 in 4 cases, L4 in 2 case, L1,2 in 1 case and L3,4 in 2 cases. According to the Frankel grade, there were 5 cases for grade A, 11 for grade B, 7 for grade C and 1 for grade D. The recovery of neurological function was evaluated. The imageology examination was appl ied to evaluate the condition of internal fixation and bone union. The Cobb’s angle was measured by X-ray film before operation, 3 days after operation and at the final follow-up, and the difference was estimated. Results Nineteen patients were followed up for 8-52 months, 28.4 months on average. Among the 2 cases of grade A, one improved to C and the other had no improvement. Among the 9 cases of grade B, 5 improved to C, 2 improved to D, and other two had no improvement. Among the 7 cases of grade C, 5 improved to D and 2 improved to E. One case of grade D improved to E. The average Cobb’s angle was (—11.5 ± 4.6)° preoperatively, (4.2 ± 4.7)° 3 days after operation and (4.0 ± 4.8)° at the final follow-up, indicating there was a significant difference between preoperation, 3 days after operation and the final follow-up (P lt; 0.001), but no significant difference between 3 days after operation and the final follow-up (P gt; 0.05). The position of internal fixation was good during follow-up. The compl ications such as disruption, loosening and collapse were not observed. Conclusion Reduction of posterior spatium intermuscular approach combined with modified anterior operation in the treatment of serious lumbar fracture and dislocation could complete the reduction, decompression, grafting and internal fixation in one stage, and protect the paraspinal soft tissue and minimize the trauma caused by surgery. It has the merits of short time of operation, small amount of intraoperative hemorrhage, sol id union of internal fixation and satisfactory cl inical outcome.
Objective To compare the therapeutic effect of transforaminal lumbar interbody fusion (TLIF) and posterior lateral fusion (PLF) in treatment of thoracolumbar spine fracture and dislocation. Methods From January 2005 to July 2007, 35 patients (22 males, 13 females, aged 17-53 years old) with thoracolumbar spine fracture and dislocation (T11-L3) received posterior open reduction and pedicle nail-stick system internal fixation. Among which, 14 patients underwent TLIF(group TLIF), and the rest 21 patients underwent PLF (group PLF). According to AO classification, group TLIF had 3 cases of A3, 7 cases of B and 4 cases of C, while group PLF had 4 cases of A3, 10 cases of B and 7 cases of C. Based on American Spinal Injury Association (ASIA) Scoring Standard formulated in 2000, the motor score of group TLIF and group PLF was (50.6 ± 3.6) and (50.8 ± 4.2) points, respectively; and the sensory score was (170.5 ± 42.7) and (153.8 ± 23.7) points, respectively. No significant difference was noted between 2 groups in general information (P gt; 0.05). Results The operation time of group TLIF and group PLF was (316 ± 32) minutes and (254 ± 27) minutes, and the blood loss of group TLIF and group PLF was (487 ± 184) mL and (373 ± 72) mL, indicating there were significant differences between 2 groups (P lt; 0.05). Wounds of all patients were healed by first intention and there was no death, aggravation of neurological function impairment and compl ication of internal fixation instrument loosening and breaking. All 35 cases were followed up for 9-23 months with an average of 14.6 months. Postoperatively, the thoracolumbar bone fusion rate of group TLIF and group PLF was 100% and 85.7%, respectively, indicating there was a significant difference (P lt; 0.05). At 3 months after operation, the motor score of group TLIF and group PLF was increased by (10.4 ± 10.0) and (9.4 ± 9.3) points, respectively; and the sensory score was upgraded by (26.5 ± 22.8) and (28.8 ± 28.4) points, respectively, showing there were no significant difference (P gt; 0.05). At immediate moment, 3, 6 and 12 months after operation, the spine height restoration of group TLIF was (5.4 ± 2.1), (5.4 ± 1.9), (5.4 ± 1.4) and (5.3 ± 1.3) mm, respectively; while it was (5.3 ± 2.6), (5.3 ± 2.2), (4.8 ± 3.1) and (4.2 ± 3.6) mm for group PLF. Meanwhile, the Cobbangle recovery of group TLIF was (14.5 ± 3.5), (14.5 ± 3.6), (14.4 ± 3.4) and (14.4 ± 3.6)º, respectively; while it was (14.3 ± 2.7), (14.2 ± 3.1), (12.2 ± 2.8) and (11.7 ± 3.3)º for group PLF. Concerning the spine height restoration and the Cobb angle recovery, no significant difference was observed between 2 groups at immediate moment and 3 months after operation (P gt; 0.05), but significant differences were noted at 6 and 12 months after operation (P lt; 0.05). Conclusion For the treatment othoracolumbar spine fracture and dislocation, TLIF is superior to PLF in bony fusion and restoration of spine column height.
OBJECTIVE: To investigate the etiology, pathological mechanism and treatment of cervical fracture-dislocation without spinal cord injury. METHODS: Nine patients with cervical fracture-dislocation without spinal cord injury were male and aged 22 to 63 years. Based on the clinical symptoms and roentgenographic changes, the injury mechanism was analyzed; and the pathological characteristics and treatment principle were put forward. RESULTS: Anterior reduction was employed in all 9 cases. Eight cases were reduced completely while 1 case was reduced partially. After following up 1 to 3 years, 7 cases recovered completely and the other 2 cases relieved their symptoms obviously. No nervous symptoms aggravated during the following-up period. CONCLUSION: Fracture-dislocation of the cervical spine without spinal cord injury has special pathological mechanism. The surgical intervention is needed for solid fixation and complete decompression without any delayed neurosymptoms.
OBJECTIVE: To explore a method of reconstruction of hip joint function after deformed healing of the upper 1/3 of fractured femur as a complication of old fracture dislocation of hip joint. METHODS: A patient with loss of function in hip joint and fusion of knee joint was treated with lock for femur intra-medullary fixation in April 1997. RESULTS: Before operation, the diseased hip joint lost its most functions and the entire lower extremity was disabled because the knee joint had been fused. One year after operation, the follow-up examination revealed that the patient could walk by crutches without discomfort, his daily life and work recovered to normal. CONCLUSION: It is effective to treat a patient suffering old fracture-dislocation of hip joint complicated with deformed healing of the upper 1/3 of fractured femur by means of individualized artificial joint replacement and a prosthesis body with lock for femur intra-medullary fixation, and it is helpful for the development of a new clinical idea to reconstruct functions in the management of some particular cases.