Objective To explore the effectiveness of mini external fixation device for comminuted open fractures of the metacarpal and phalange. Methods Between October 2009 and April 2011, 33 patients with comminuted open fractures of the metacarpal and phalange were treated with mini external fixation device. There were 25 males and 8 females, aged from 21 to 62 years with an average of 25.5 years. Of 33 cases, 7 were rated as Gustilo type II and 26 as Gustilo type IIIA; 20 cases were diagnosed as having simple metacarpal and phalangeal comminuted fractures and 13 cases as having combined interphalangeal or metacarpophalangeal joint fractures. Partial or complete rupture of tendon was observed in 18 cases. The time between injury and operation was 2-8 hours (mean, 3.7 hours). After one stage debridement and reduction, fracture was fixed with mini external fixation device. Results Primary healing of incision was obtained in 30 cases and no pin hole infection was found. Incision infection occurred in 3 cases and leaded to nonunion. Nonunion also occured in 2 cases of simple metacarpal and phalangeal fractures. The mean follow-up was 8 months (range, 6 months to 1 year). X-ray films showed fracture healing in 13 cases after 8 weeks (8 cases of simple metacarpal and phalangeal fractures and 5 cases of combined interphalangeal or metacarpophalangeal joint fractures), in 12 cases after 12 weeks (7 cases of simple metacarpal and phalangeal fractures and 5 cases of interphalangeal or metacarpophalangeal joint fractures), and in 3 cases of simple metacarpal and phalangeal fractures after 6 months. After removing the mini external fixation device and functional exercise, 3 cases of simple metacarpal and phalangeal comminuted fractures and 4 cases of combined interphalangeal or metacarpophalangeal joint fractures still had joint stiffness, but had no finger rotation and alignment deformity or chronic pain. According to the measurement of total active movement for 28 patients who obtained fracture healing, the results were excellent in 7 cases, good in 12 cases, fair in 5 cases, and poor in 4 cases, the excellent and good rate was 67.9%. Conclusion The mini external fixation device is a good technique for comminuted open fractures of metacarpal and phalange. In patients having comminuted open fractures with interphalangeal or metacarpophalangeal joint fracture, the results are fair or poor.
Objective To study the clinical outcome of comminuted factures at distal femur and proximal tibia treated with AO less invasive stabilization systems (LISS). Methods The clinical data of 14 cases of distal femoral fracture and proximal tibial fracture from September 2003 to May 2005 were analyzed retrospectively. The injury was caused by traffic accident in 9 cases, by fall in 3 cases and by slipping in 2 cases. Of 14 cases, there were 5 open fractures and 9 close fractures, including 5 cases of distal femoral comminuted fracture and 9 cases of proximal shaft comminuted fractures. According to AO/OTA classification, the fractures were classified as 33C2 in 3 cases，33C3 in 2 cases,41A2 in 2 cases，41A3 in 2 cases，41B2 in 3 cases and 41C2 in 2 cases. All patients were treated by the internal fixation with LISS-distal femur or with LISS-proximal tibia. Healing of wounds, the X-ray films before and after operations, and therecovery of joint function were observed. Results The patients were followed up from 1 month to 20 months (11 months on average). Twelve cases achieved solid osseous unions from 3 months to 5 months postoperativly; 2 cases had a good reduction and recovered smoothly 2-3 months postoperatively. The results were excellent in 10 cases, good in 3 cases and fair in 1 case according to Johner-Wruhs knee scoring. The range of knee flexion-extension was 110-130° in 11 cases, 100° in 2 cases and 80° in 1 case. Conclusion LISS is an effective method of internal fixation for treating comminntedfracture of distal femur or proximal tibia. It has the advantages of less injury, satisfied reduction and reliable fixation.
OBJECTIVE To investigate the effects of sodium hyaluronate in supplementary treatment of comminuted fracture of ankle. METHODS Thirty-seven patients suffered from comminuted fracture of ankle were operated for restoration by routing methods, and received 2 ml of sodium hyaluronate injection intra-articularly before the closure of incision. The ankle was fixed and given the second intra-articular injection on the 3rd day after operation. Then, the patients were given sodium hyaluronate injection intra-articularly at a week intervals till the paste was removed after 4 weeks. All patients were followed up. The clinical results were evaluated by measuring the symptoms of pain, and the function of walking and other daily living activities. RESULTS All the patients were followed up for 6 to 27 months, among them, 30 patients were cured completely without any symptoms, the ankle function for walking and daily living activities was normal, 6 patients felt pain with violent activity or walking exceeding 1 km, one patient suffered from comminuted fracture with compressed depression was not improved due to his ankle being not restored properly. CONCLUSION Intra-articular injection of sodium hyaluronate is an effective supplementary treatment for comminuted fracture of ankle.
ObjectiveTo summarize the effectiveness of anatomical plate combined with cortical bone plate allografts in the treatment of comminuted fractures of the femoral condyles. MethodsBetween January 2008 and December 2012, 18 patients with comminuted fractures of the femoral condyles were treated, including 13 males and 5 females with an average age of 45 years (range, 23-65 years). Fractures were caused by traffic accident in 11 cases, by falling from height in 4 cases, and by the other in 3 cases. The locations were the left side in 7 cases and the right side in 11 cases. Of 18 fractures, 12 were open fractures and 6 were closed fractures. The mean time from injury to operation was 6 days (range, 4-15 days). The fixation was performed by anatomical plate combined with cortical bone plate allografts, and autograft bone or allogeneic bone grafting were used. ResultsSuperficial local skin necrosis occurred in 1 case, and was cured after skin graft, and other incisions achieved primary healing. All patients were followed up 12-36 months (mean, 23 months). X-ray films showed that bone union was achieved within 3-12 months (5.6 months on average). No related complication occurred, such as fixation loosening, refracture, infection, or immunological rejection. According to Merchan et al. criteria for knee joint function evaluation, the results were excellent in 7 cases, good in 9 cases, fair in 1 case, and poor in 1 case at last follow-up; the excellent and good rate was 88.9%. ConclusionAnatomical plate combined with cortical bone plate allograft fixation is a good method to treat comminuted fractures of the femoral condyles. This method can effectively achieve complete cortical bone on the inside of the femur as well as provide rigid fixation.
ObjectiveTo observe the effectiveness of digital customized plate in the treatment of complex limb fracture. MethodsBetween January 2012 and May 2013, CT raw data of complex limb fracture were used to establish the fracture three-dimensional simulation model after reduction, and a customized personalized anatomic plate was designed and used for internal fixation after open reduction in 42 cases. There were 22 males and 20 females, aged 16-53 years (average, 37.4 years). The causes of injury were traffic accident in 21 cases, falling from height in 18 cases, crush by heavy objects in 3 cases, including 26 cases of fresh closed fracture and 16 cases of open fracture (9 cases of type Ⅰ and 7 cases of type Ⅱ according to Gustilo classification). According to AO classification, there were 15 cases of humerus comminuted fracture, 4 cases of radial comminuted fracture, 8 cases of femoral comminuted fracture, and 15 cases of tibia comminuted fracture. The interval of injury and operation was 6-28 days (mean, 10 days). ResultsReduction and internal fixation of fracture were successfully performed on 42 patients. The length and position of digital customized plate, direction and length of screw implant, number of screw were basically identical with preoperative design. The operation time was 35-120 minutes (mean, 70 minutes); the blood loss volume was 30-500 mL (mean, 180 mL); and X ray fluoroscopy frequency was 2-6 times (mean, 3 times). Superficial infection occurred in 2 cases, and was cured after dressing change; primary healing of incision was obtained in the other patients. Forty-two cases were followed up 6-24 months with an average of 11.5 months. The fracture healing time was 8-19 weeks (mean, 14 weeks) in 41 cases; delayed union occurred in 1 case at 44 weeks after operation. The fracture anatomical reduction was achieved in 19 cases, malunion in 3 cases, and functional reduction in the other patients. At last follow-up, no plate and screw loosening and breakage was observed. ConclusionDigital customized plate in treatment of complex fractures of limbs, especially for the multiple comminuted fracture of long bones of the limbs has the advantages of convenient operation, less trauma, fewer complications, and good effectiveness.