ObjectiveTo investigate the operative method and short-term effectiveness in the surgical treatment of Maisonneuve fracture. MethodsBetween January 2010 and February 2013, 23 patients with Maisonneuve fracture were treated. There were 14 males and 9 females with an average age of 40.3 years (range, 30-68 years). The causes of injuries were falling injury in 11 patients, sports related injury in 5 patients, traffic accident injury in 4 patients, and falling injury from height in 3 patients. The interval between injury and operation was 7-10 days (mean, 8.5 days). All of fractures were closed. Three patients had combined injury of deltoid ligament. The surgical procedures included surgical reduction and fixation of medial malleolus fracture and posterior malleolus fracture, repair of the deltoid ligament with ground anchor suture, and fixation of the disrupted distal tibiofibular syndesmosis. ResultsAll incisions achieved primary healing, no postoperative complications such as infection occurred. Twenty-one patients were followed up 24-36 months (mean, 26.5 months). No patients complained of pain, tenderness, and obvious swelling of the ankle. At 3-6 months (mean, 4.6 months) after operation, X-ray films showed bony union of fractures and normal mortises in 21 patients. And no traumatic arthritis was observed with reliable fixation. The range of motion of ankle dorsi flexion and plantar flexion was 30-40° (mean, 34.5°). Baird-Jackson ankle functional score was 85-100 (mean, 94); 16 cases were rated as excellent, 4 as good, and 1 as fair with an excellent and good rate of 95.2%. ConclusionSurgical treatments of Maisonneuve fracture include surgical reduction and fixation of the medial malleolus and posterior malleolus, repair of the deltoid ligament and fixation of the disrupted distal tibiofibular syndesmosis, and good effectiveness can be achieved.
ObjectiveTo review the research progress of the diagnosis and treatment of Hangman fracture. MethodsThe original articles about the diagnosis and treatment of Hangman fracture were extensively reviewed and analyzed. ResultsNot only X-ray, but also MRI and CT scans are necessory for the diagnosis and assessment of Hangman fractures. The treatment of unstable Hangman fracture included posterior C2, C3 fixation, anterior C2, C3 fixation, and anterior C2, C3 fixation combined with posterior C2 pedicle screw fixation. The anterior surgical fixation is used by the anterior retropharyngeal approach or subaxial anterior approach, and it has the advantages of directly resecting the injured C2, C3 discs, getting a satisfactory cervical spine alignment, and avoiding the postoperative axial pain. However, posterior surgical fixation using C2 pedicle screw has the risks of neurovascular injuries. ConclusionThe surgical technique of Hangman fracture should be determined based on the patient's injury and surgeon's experience. Randomized control trials of different surgical techniques should be performed.
ObjectiveTo evaluate the effectiveness of intra-articular radioulnar ligament reconstruction in the treatment of chronic instability of the distal radioulnar joint. MethodsBetween January 2006 and June 2012, the intra-articular radioulnar ligament reconstruction was used to treat chronic instability of the distal radioulnar joint in 12 patients. Of 12 cases, 8 were males and 4 were females with an average age of 37.3 years (range, 22-54 years). The causes of injury were tumble in 9 patients, traffic accident in 2 patients, and sprain in 1 patient. The average time from initial injury to operation was 6.2 months (range, 2-13 months). The pain and function of the wrists were assessed with Patient-Rated Wrist Evaluation (PRWE) (27.5±4.7). Broadening of the distal radioulnar joint space was seen on the anteroposterior radiograph in all the patients. Lateral view showed dorsal instability in 10 patients and palmar instability in 2 patients. There was no radial fracture, ulnar fractures or degeneration of the distal radioulnar joint. ResultsAll patients achieved primary healing of incision. No complication of deep infection or nerve injury occurred. They were followed up from 12 to 30 months (mean, 20.6 months). Pain and the clicking sound of the wrists disappeared; grip strength increased; the range of motion values of the wrist and forearm were restored. PRWE score was 5.8±2.1 at last follow-up, showing significant difference when compared with preoperative score (t=14.215, P=0.000). Imaging examination showed good appositions of the distal radioulnar joint, with no dislocation or subluxation. ConclusionIntra-articular radioulnar ligament reconstruction can rebuild the anatomic stability of the distal radioulnar joint, which does not damage the adjacent structures of the joints and can obtain satisfactory function of the reconstructed joint. It is a good choice for chronic instability of the distal radioulnar joint without articular degeneration.
ObjectiveTo investigate the advantages and effectiveness of ISO-C3D guided percutaneous sacroiliac joint screw internal fixation for treatment of pelvic posterior ring injuries by comparing with anterior opened reduction and reconstruction plate internal fixation. MethodsA retrospective analysis was made on the clinical data of 54 patients with posterior ring injury treated between June 2013 and January 2016. Of 54 patients, 33 underwent ISO-C3D guided percutaneous sacroiliac joint screws internal fixation (group A), and 21 underwent anterior opened reduction and reconstruction plate internal fixation (group B). There was no significant difference in gender, age, cause of injuries, injury to operation time, fractures type, combined injuries, and injury severity score (ISS) between 2 groups (P > 0.05). The operation time, intraoperative blood loss, length of operative incision, hospitalization time, postoperative pain degree, reduction evaluation, and functional evaluation were compared between 2 groups. ResultsGroup A was significantly better than group B in operation time, length of operative incision, and hospitalization time (P < 0.05). The intraoperative blood loss of group A (10-20 mL) was significantly less than that of group B[(524.1±160.1) mL]. All patients of the 2 groups were followed up 7 to 24 months with an average of 11.6 months. No injury of vessel or nerve occurred in group A; worse neurological symptoms of lower limbs and incision infection were observed in 2 patients of group B respectively, and the other patients achieved primary healing of incision. At 48 hours after operation, the visual analogue scale (VAS) score of group A (1.7±0.7) was significantly lower than that of group B (8.2±0.8) (t=-30.463, P=0.000). Radiological examination showed fracture reduction. According to the Matta score standard, the reduction results were excellent in 21 cases (63.6%), good in 10 cases (30.3%), and fair in 2 cases (6.1%) in group A; the reduction results were excellent in 16 cases (76.2%), good in 4 cases (19.1%), and fair in 1 case (4.7%) in group B; and there was no significant difference between 2 groups (χ2=0.961, P=0.618). Fracture or dislocation healed well in 2 groups, and the walking function was restored. According to the Majeed standard for evaluation, the results were excellent in 23 cases (69.7%), good in 9 cases (27.3%), and fair in 1 case (3.0%) in group A; the results were excellent in 14 cases (66.7%), good in 5 cases (23.8%), and fair in 2 cases (9.5%) in group B; no significant difference was shown between 2 groups (χ2=1.501, P=0.591). ConclusionCompared with anterior opened reduction and reconstruction plate internal fixation, ISO-C3D navigation percutaneous sacroiliac joint screw internal fixation is an ideal surgical method to treat pelvic posterior ring injury, with the characteristics of less trauma, less pain, precise screw implant and safety.
We developed a three-dimensional finite element model of the pelvis. According to Letournel methods, we established a pelvis model of T-shaped fracture with its three different fixation systems, i.e. double column reconstruction plates, anterior column plate combined with posterior column screws and anterior column plate combined with quadrilateral area screws. It was found that the pelvic model was effective and could be used to simulate the mechanical behavior of the pelvis. Three fixation systems had great therapeutic effect on the T-shaped fracture. All fixation systems could increase the stiffness of the model, decrease the stress concentration level and decrease the displacement difference along the fracture line. The quadrilateral area screws, which were drilled into cortical bone, could generate beneficial effect on the T-type fracture. Therefore, the third fixation system mentioned above (i.e. the anterior column plate combined with quadrilateral area screws) has the best biomechanical stability to the T-type fracture.
ObjectiveTo evaluate the effectiveness of very low profile/variable angle locking plate (VLP) internal fixation for posterior Pilon fractures extending to the medial malleolus by posteromedial approach. MethodsA retrospective analysis was made on the clinical data from 13 patients with posterior Pilon fractures extending to the medial malleolus between December 2011 and August 2012. There were 4 males and 9 females with an average age of 48.9 years (range, 23-68 years). Fractures were caused by falling in 9 cases and by traffic accident in 4 cases. The locations were the left ankle in 6 cases and the right ankle in 7 cases. According to the Orthopedic Trauma Association (OTA) classification, 6 cases were rated as type 43B1, 4 cases as type 43B2, and 3 cases as type 43B3. Twelve cases had fibular fractures, including 11 cases of Denis-Weber type B, 1 case of Denis-Weber type C. The interval of injury and operation was 7-14 days (mean, 11.4 days). Open reduction was performed and VLP internal fixation was used for posterior malleolar fracture by posteromedial approach. ResultsPrimary healing of incision was obtained in all patients. Tibial nerve palsy was observed in 2 cases, and was cured after oral administration of mecobalamin. Twelve cases were followed up 12-18 months (mean, 14.5 months). According to the Burwell-Charnley's radiological evaluation system, 11 cases achieved anatomical reduction, 1 case achieved fair reduction. The fracture union time was 3-6 months (mean, 3.7 months). No loosening or breakage of internal fixation occurred during follow-up. According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, the results were excellent in 7 cases, good in 4, and fair in 1; the excellent and good rate was 91.7%. ConclusionVLP internal fixation for posterior Pilon fractures extending to the medial malleolus by posteromedial approach can achieve good short-term effectiveness. The high quality of reduction is acquired under direct vision with low rate of soft tissue complications.