Objective To explore the clinical characteristics and treatment of “kissing fracture” of humeroradial joint. Methods A clinical data of 12 patients with “kissing fracture” of the humeroradial joint between January 2016 and June 2021 was retrospectively analyzed. There were 8 males and 4 females with an average age of 41.9 years (range, 15-75 years). The fractures caused by falling in 7 cases, by falling from height in 3 cases, and by sports in 2 cases. The time from injury to admission was 2-72 hours (median, 2 hours). According to Mason’s classification, the radial head fractures were rated as type Ⅰ in 2 cases, type Ⅱ in 8 cases, and type Ⅲ in 2 cases. According to Grantham’s classification, the humeral capitulum fractures were rated as type Ⅰ in 10 cases and type Ⅱ in 2 cases. Among them, 4 cases of Grantham type Ⅰ humeral capitulum fracture were missed by X-ray film and confirmed by CT and/or MRI. Four cases were complicated with other injuries of elbow joint. The radial head fractures were fixed with screws or mini plate in 11 cases and treated conservatively in 1 case; the humeral capitulum fractures were fixed with screw or plate in 9 cases, removed in 1 case, and treated conservatively in 2 cases. X-ray film was used to evaluate the fracture healing; Mayo Elbow Performance Score (MEPS) was used to evaluate the functional recovery of the affected limb, and the range of motion (ROM) of the elbow joint of the affected limb was detected. Results All the incisions healed by first intention without early complications. All patients were followed up 10-24 months, with an average of 15.2 months. X-ray films showed that all fractures healed, and the healing time was 2-3 months, with an average of 2.3 months. At last follow-up, the ROM of flexion-extension of the elbow joint was 65°-161°, with an average of 136.9°; the ROM of rotation was 70°-180°, with an average of 149.2°. MEPS ranged from 70 to 100, with an average of 87.4; 8 cases were excellent, 2 cases were good, and 2 cases were fair; the excellent and good rate was 83.3%. Conclusion The “kissing fracture” of the humeroradial joint is relatively rare, and the humeral capitulum fracture is milder than radial head fracture. X-ray examination alone can easily miss the diagnosis of Grantham type Ⅰ humeral capitulum fracture. The “kissing fracture” of the humeroradial joint is treated according to the principle of intra-articular fracture, and the good effectiveness can obtain.
ObjectiveTo introduce the surgery method to reset and fix tibial plateau fracture without opening joint capsule, and evaluate the safety and effectiveness of this method. MethodsBetween July 2011 and July 2013, 51 patients with tibial plateau fracture accorded with the inclusion criteria were included. All of 51 patients, 17 cases underwent open reduction and internal fixation without opening joint capsule in trial group, and 34 cases underwent traditional surgery method in control group. There was no significant difference in gender, age, cause of injury, time from injury to admission, side of injury, and types of fracture between 2 groups (P>0.05). The operation time, intraoperative blood loss, incision length, incision heal ing, and fracture healing were compared between 2 groups. The tibial-femoral angle and collapse of joint surface were measured on X-ray film. At last follow-up, joint function was evaluated with Hospital for Special Surgery (HSS) knee function scale. ResultsThe intraoperative blood loss in trial group was significantly less than that in control group (P<0.05). The incision length in trial group was significantly shorter than that in control group (P<0.05). Difference was not significant in operation time and the rate of incision heal ing between 2 groups (P>0.05). The patients were followed up 12-30 months (mean, 20.4 months) in trial group and 12-31 months (mean, 18.2 months) in control group. X-ray films indicated that all cases in 2 groups obtained fracture heal ing; there was no significant difference in the fracture healing time between 2 groups (t=1.382, P=0.173). On X-ray films, difference was not significant in tibial-femoral angle and collapse of joint surface between 2 groups (P>0.05). HSS score of the knee in trial group was significantly higher than that of control group (t=3.161, P=0.003). ConclusionIt can reduce the intraoperative blood loss and shorten the incision length to use open reduction and internal fixation without opening joint capsule for tibial plateau fracture. Traction of joint capsule is helpful in the reduction and good recovery of joint surface collapse. In addition, the surgery without opening joint capsule can avoid joint stiffness and obtain better joint function.
ObjectiveTo observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus.MethodsBetween January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days).ResultsAll 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred.ConclusionThe self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.