The dorsal dislocation inferior radio-ulnar joint was treated by the shortening operation of the pronator quadratus muscle by moving the muscle origin to its dorsum, so that the pronator quadratus muscle was always under tension whether the muscle was contracted or relaxed. Thus the anatomic position and stress distribution were improved. We had treated 11 patients in the past four years.The patients were followed from four months to four and half years and the results were 9 patients excellent and 2 good.
【Abstract】 Objective To summarize the technique and effect of the therapy for severe fracture and dislocation ofankle joint by operation. Methods From March 2003 to February 2006, 76 cases were treated with primary open restorationand internal fixation for dislocated ankle joint fracture, with 47 males and 29 females, with the average age of 36.4 years (ranging from 18 years to 65 years). According to AO criterion, these fresh fractures were classified into 13 cases for type C3-1, 45 cases for type C3-2 and 18 cases for type C3-3. Based on the Gustilo-Anderson standard, 23 open fractures were classified into 17 cases for type II and 6 cases for type Ⅲ A. The operation was delayed from 1 hours to 24 hours after the injury. Results All incisions healed at the first stage except 4 cases which delayed union because of simple infection by revision with ointment. A total of 72 cases were followed up, with the average time of 18.5 months (from 12 months to 35 months). The time of bone union was from 12 weeks to 24 weeks. The screws of fixation for lower tibia-fibula joint were found to be ruptured in 2 cases when further consultation was performed in the 16th and 20th week after the operation, respectively, and were broken within 1 year after the operation. These screws were taken out 12 weeks postoperative in 28 cases, while the whole internal fixations of the rest caseswere taken out 1 year after the operation. The postoperative function of malleolus extended from 21.7º to 26.8º and flection from 38.5º to 44.7º. Assessed by the American Orthopaedic Foot and Ankle Society Cl inical Rating Scales, 23 cases were excellent, 36 good, 13 fair, and the choiceness rate reached 81.94%. Conclusion These procedures, together with reduction by twist after hospital, open and internal fixation in time, and parenchyma managed with internal fixation, are important to attain satisfactory effect for the treatment of severe fracture and dislocation of ankle joint.
Sixty-one cases of fracture or dislocation were treated with France-made biopolyester ligament. They consisted of 18 cases of fracture of patella, 13 cases of fracture of olecranon, 8 cases of fracture of distal clavicle, 10 cases of dislocation of acromino-clavicular joint, 6 cases of separation of lower tibio-fibular joint, 3 cases of rapture of cruciate ligament and 3 cases of fracture of upper third of ulna with dislolcation of radial head. The follow-up period lasted from 3 to 12 months with an average of 7.3 months. The result showed that of the 56 follow-up cases, 49 were excellent and 7 were satisfactory. There was no redisplacement occured in this group. The Biopolyester ligament was believed to be a good and safe material for fractures or dislocations and was of good strength of extension and easy to use.
Objective To evaluate surgical results of the titanium screwplate internal fixation in treatment of the lower cervical fracture dislocation. Methods From September 2001 to March 2006, 31 patients(24 males, 7 females; age range, 2063 years) with the lower cervical fracturedislocation were treated in our department. The injuries were caused by a road accident in 25 patients, a high crash in 4, and a heavy object crash in 2. The fracture dislocation occurred in the following cervical segments:C3(1 patient),C4(5 patients), C5(12 patients), C6(10 patients), and C7(3 patients). The disease course ranged from 1 to 23 days. The associated spinal nerve root injury occurred in 29 patients. The Frankle scaling revealed that 14 patients were at Grade A, 3 at Grade B, 7 at Grade C, 3 at Grade D, and 2 at Grade E (associated nerve root injury with hand and shoulder numbness). The 29 patients underwentthe spinal cord decompression, the grafting fusion of the small joints, and thelateral mass titanium screwplate internal fixation; 2 patients without nerve injury underwent only the grafting fusion of the small joints and the lateral mass titanium screwplate internal fixation. The bone fusion, cervical vertebra movement, and internal fixation condition were observed by the X-ray examinations postoperatively. The nerve function recovery was evaluated by the Frankle scaling system. Results The followedup in all the patients for 6months to 4 years revealed that the small joint fusion time was 36 months, with an average of 3.6 months. The cervical X-ray films showed that there was no instability or fracture looseness of the internal fixation at 6 months. Among the 29 patients with the spinal nerve root injury, 14 were at Grade A preoperatively but 13 were improved at Grade B and 1 at Grade C postoperatively; 3 were at Grade B preoperatively but 2 were improved at Grade C and 1 at Grade D postoperatively; 7 were at Grade C preoperatively but 3 were improved at Grade D and 4 at Grade E postoperatively; 3 at Grade D preoperatively but all the 3 were improvedat Grade E postoperatively; 2 were at Grade E preoperatively and remained unchanged postoperatively. In the 2 patients with only the nerve root injury, numbness disappeared soon after operation. Conclusion This posteriorapproach has two advantages: the mobility range of the cervical vertebra can preserved to the greatest extent because of the short segment fixation; the betterstability can obtained because of the titanium screwplate internal fixation on the cervical jointcolumn to prevent the hyperextension and hyperflexion. Therefore, the titanium screwplate internal fixation on the cervical lateral massis an effective treatment of the lower cervical fracture dislocation.
Objective To investigate the clinicalvalue of modified Weaver-Dunn technique in repair of acute acromioclavicular dislocation. Methods From January 1993 to December 1998, 18 cases of acromioclavicular dislocation were treated bymodified Weaver-Dunn technique, and other 17 cases of the same suffering were treated by tension band fixation of the acromioclavicular joints. All of the patients were followed up for 12-36 months before clinical evaluation of the functionof shoulder joints, according to University of Pennsylvanian Shoulder Score System. Results In short term, the shoulder joints recovered much more rapidly in the cases repaired by modified Weaver-Dunn technique; 12, 24 and 36 months after operation, the scores of the cases repaired by modified Weaver-Dunn technique were (1897±67), (193.7±3.6) and (194.7±3.4) respectively according to the Shoulder Score System, while those of the cases treated by tension band fixation were (167.3±7.8), (170.2±6.3) and (165.6±5.9) respectively. The above data indicated that there was significant difference between two groups (P＜0.05). Conclusion The modified Weaver-Dunn technique was a better surgical approach than tension band fixation for repair of acute acromioclavicular dislocation.
Objective To investigate the treatment method and effectiveness of fresh closed fracture-dislocation of the midtarsal joint. Methods Between April 2004 and April 2011, 73 patients (75 feet) with fresh closed fracture-dislocation of the midtarsal joint were treated with closed reduction combined with open reduction and internal fixation. There were 56 males (58 feet) and 17 females (17 feet), aged from 19 to 62 years (mean, 35.8 years). Injuries were caused by falling from height in 35 cases, by sprain in 4 cases, by machine twist in 5 cases, by heavy pound in 9 cases, and by traffic accident in 20 cases. The time from injury to admission ranged from 1 hour and 30 minutes to 48 hours (mean, 4.5 hours). According to Main’s classification standard, 6 feet were rated as vertical compression injury, 33 feet as medial displacement injury, 17 feet as lateral displacement injury, 9 feet as flexion injury, and 10 feet as crush injury. Concomitant injuries included midfoot fracture-dislocation (34 feet), scaphoid fracture (6 feet), cuboid bone fracture (18 feet), calcaneal fracture (8 feet), talus fracture (7 feet), tibiotalar joint dislocation (2 feet), subtalar joint dislocation (2 feet), medial malleolus fracture (1 foot), and acute compartment syndrome (3 feet). Results Healing of incision by first intention was achieved in 65 cases (67 feet), by second intention in 8 cases (8 feet). Sixty-two cases (62 feet) were followed up from 11 months to 7 years and 11 months (mean, 3 years and 6 months). After operation, feet pain occurred in 26 cases, and stiffness or discomfort of the affected foot in 36 feet when walking. The X-ray examination showed good reduction of fracture-dislocation of the midtarsal joint and concomitant injuries with no re-dislocation or bone nonunion in 59 feet; 3 feet had flatfoot secondary to navicular necrosis, and underwent arthrodesis. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 77-90 (mean, 88.6) at last follow-up. Conclusion According to the preoperative evaluation of the damage, using the manual reduction combined with internal fixation (mini-plate or hollow screw with Kirschner wire) methods can obtain good effectiveness in the treatment of fracture-dislocation of the midtarsal joint.
ObjectiveTo summarize the short-term effectiveness of TightRope system for the treatment of syndesmotic tibiofibular diastasis. MethodsBetween June 2013 and June 2015, 23 patients with syndesmotic tibiofibular diastasis were treated by TightRope system, including 15 males and 8 females with an average age of 32.3 years (range, 16-63 years). Injury was caused by sports in 13 cases, by traffic accident in 6 cases, and by falling from height in 4 cases. The locations were the left side in 13 cases and the right side in 10 cases. The time from injury to operation was 6 hours to 12 days (mean, 3.8 days). According to Lauge-Hansen classification, 13 cases were rated as supination-external rotation type, 7 cases as pronation-abduction type, and 3 cases as pronation-external rotation type; according to Weber classification, 5 cases were rated as type A, 11 cases as type B, and 7 cases as type C. ResultsThe mean operative time was 68.1 minutes (range, 48-93 minutes); the mean intraoperative blood loss was 70.3 mL (range, 20-150 mL); and the mean hospitalization days were 7 days (range, 5-13 days). Superficial local skin necrosis occurred in 6 cases, and primary healing of incision was obtained in the others. All patients were followed up 8-30 months (mean, 16.4 months). X-ray films showed bone union was achieved within 6-12 weeks (mean, 9.4 weeks). No related complications of reduction failure and re-fracture occurred. The internal fixators were removed at 10-18 months postoperatively (mean, 13.3 months). According to American Orthopaedic Foot and Ankle Society (AOFAS) score for ankle function evaluation, the results were excellent in 19 cases and good in 4 cases at last follow-up. ConclusionTightRope system is a good method to treat syndesmotic tibiofibular diastasis, because of safety, convenient operation, and satisfactory short-term effectiveness.
Objective To explore the treatment of dislocation after total hip replacement. Methods From July 1997 to October 2004, 23 casesof dislocation after total hip replacement were treated,including 9 males and 14 females and aging 5379 years. The CT and serial X-ray films were taken to observe the position of prostheses. The strength of their hip abductor was also tested. In the patients without loosening, closed reduction was attempted at first. The stability of hip was tested. If closed reduction failed, the offset or/and parts of the components was adjusted, then the capsular was repaired. If instabilitystill existed, revision was adopted. Results In 23 cases of dislocation, 10 cases were treated successfully by closed reduction. In 12 patients who failed reduction, 5 were given open reduction combined with capsular repairing; the offset was adjusted by lengthening femoral head in 2 cases; rim liners were elevated in 2 cases; and larger offset was used and abnormal liner was adjusted in 1 case. Revision was used in 1 case having loosening and 2 cases having instability. Allpatients were followed up 1 year to 5 years (1.9 years on average). The Harrisscoring was 7294 (87 on average). Conclusion The treatment of dislocation after total hip replacement should use different ways according to the causes of dislocation and the stability of hip.
ObjectiveTo explore the clinical effect of open reduction and internal fixation with hollow screw fixation in the treatment of difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus.MethodsFrom January 2011 to March 2014, 15 patients with difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus were treated with open reduction and hollow screw fixation. There were 9 males and 6 females, aged from 45 to 77 years with an average of 63.5 years. The causes of injury included 7 cases of falls, 5 cases of high falling injury, and 3 cases of traffic accident injury. The injury-to-admission time was 2 hours to 5 days with an average of 1.5 days. The shoulder joint was the initial dislocation. The types of dislocation showed 14 cases of anterior dislocation and 1 case of posterior dislocation. There were 9 cases of simple avulsion fracture of greater tuberosity of humerus, 5 cases of comminuted fracture, 1 case of both greater tuberosity of humeru with small tuberosity of humerus fracture, and 2 cases of incomplete nerve injury; no exploration was carried out in operation.ResultsThere were 14 patients with wound healing at first intention; 1 suffered superficial infection of the wound, which healed by anti infection treatment. Fifteen cases were followed up for 6 to 18 months with an average of 12.2 months, with 1 case of shoulder joint re-dislocation 1 month after operation, and 2 cases of tuberosity of humerus defect absorption. One year after operation, the shoulder joint function were evaluated according to Neer Scoring System, and the results were excellent in 9 cases, good in 3 cases, fair in 2 cases, and poor in 1 case, with the excellent and good rate of 80.0%.ConclusionThe curative effect of open reduction and internal fixation with hollow screw fixation on difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus is remarkable, which can obtain satisfactory shoulder joint function.
ObjectiveTo explore the cause of prosthesis dislocation after primary artificial hip replacement (AHR) and propose preventive measures. MethodsA total of 221 patients underwent artificial hip replacement from 2000 to 2012, among whom 8 developed dislocation. These cases were retrospectively analyzed to summarize the causes of dislocation and preventive measures were proposed. ResultsAmong 221 cases of hip replacement, 8 suffered from postoperative dislocation. All of them underwent posterolateral-approach total hip arthroplasty. The causes of dislocation included coexisting decreased muscle strength before operation, improper placement of the prosthesis during operation, inappropriate postural changes after operation, improper nursing and health education. Of the 8 dislocation cases, 2 were cured after reoperation and revision, 6 were cured through close reduction under anesthesia, and 7 were followed up for 1-5 years without relapse. ConclusionPreoperative assessment of the patients' soft tissue tension of affected hip and comorbid conditions, selection of proper design of prostheses and the components, removal of tissues possibly causing joint impact, correct placement of artificial prosthesis and components and instructing the patients for the correct movement mode of the affected hip after operation are all crucial for the prevention of postoperative hip dislocation.