Objective To investigate the effectiveness of hinged external fixator with mini-plate to treat terrible triad of the elbow. Methods Between August 2008 and June 2011, 11 patients with terrible triad of the elbow were treated with hinged external fixator combined with mini-plate. There were 9 males and 2 females, aged 22-56 years (mean, 34 years). The injuries were caused by falling from height in 8 cases and traffic accident in 3 cases. All patients were closed injury. The time from injury to operation varied from 8 hours to 7 days (mean, 3.7 days). According to Mason classification standard, all radial head fractures were type IV and complicated by posterior dislocation of the elbow; according to Regan-Morrey classification standard, ulna coronary process fractures were type I in 3 cases, type II in 3 cases, and type III in 5 cases. Results All the patients achieved primary healing of incision after operation and no nerve injury occurred. The patients were followed up 12-20 months (mean, 15 months). Two cases had screw channel infection after 12 weeks of operation, and 1 case had mild heterotopic ossification of the elbow after 4 months of operation. X-ray films showed that all fractures healed from 8 to 20 weeks (mean, 16 weeks). No recurrent dislocation or instability of the elbow occurred. At 12 months after operation, the elbow range of motion (ROM) were 120-145° (mean, 135°) in flexion, 0-25° (mean, 10°) in extension, 50-90° (mean, 70°) in pronation, and 50-80° (mean, 60°) in supination. According to Mayo elbow function evaluation standard, the results were excellent in 5 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. Conclusion Hinged external fixator with mini-plate can enhance postoperative stability of the elbow. This therapy is beneficial to early functional exercise and obviously decrease the disability rate caused by complex damage on the elbow.
Objective To evaluate the surgical techniques and effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture with non-absorbable suture fixation combined with the mini-plate. Methods Between January 2009 and March 2012, 32 patients with ACL tibial eminence avulsion fractures were treated. There were 18 males and 14 females, aged 12-40 years (mean, 17.5 years). The injury causes included traffic accident injury in 15 cases, sport injury in 6 cases, and falling injury in 11 cases. The time from injury to operation ranged 7-18 days with an average of 9.5 days. Before operation, the results of Lachman test were all positive; the Lysholm score was 52.13 ± 4.22 and the International Knee Documentation Committee (IKDC) score was 44.82 ± 2.44. According to Meyers-McKeever classification criteria, there were 12 cases of type II and 20 cases of type III. After arthroscopic poking reduction of fracture, tibial eminence avulsion fractures were fixed with the Ethibond non-absorbable sutures bypass figure-of-eight tibial tunnel combined with the metacarpal and phalangeal mini-plate. Results Primary healing was obtained in all incisions; no joint infection or skin necrosis occurred after operation. All patients were followed up with an average time of 22.4 months (range, 12-50 months). The patients showed negative Lachman test at 12 weeks after operation. Except 3 patients having knee extension limitation at last follow-up, the knee extension range of motion (ROM) was normal in the other patients; the knee flexion ROM was normal in all patients. The Lysholm score and IKDC score were significantly improved to 94.19 ± 0.93 and 94.35 ± 1.22 at last follow-up, showing significant differences when compared with preoperative values (t=55.080, P=0.000; t=101.715, P=0.000). Conclusion The arthroscopic treatment of ACL tibial eminence avulsion fracture with Ethibond non-absorbable suture fixation combined with mini-plate is an effective procedure with the advantages of minimal trauma, reliable fixation, and satisfactory recovery of the knee joint function.
Objective To analyse the procedure and effectiveness of internal fixation in treatment of displaced radial head fractures. Methods Between August 2005 and May 2009, 35 patients with displaced radial head fractures underwent open reduction and internal fixation with SmartNail® and/or AO mini-plates. There were 28 males and 7 females with an average age of 28.4 years (range, 17-48 years). The injury mechanism included traffic accident in 16 patients, falling in 13, and falling from height in 6. According to Mason classification, 21 fractures were rated as type II, 9 as type III, and 5 as type IV. All fracturs were closed fractures. Six cases complicated by radial neck fractures, 1 case by olecranon fracture, 3 by posterior dislocations of the elbow, 1 by posterior dislocation of the elbow and coronoid process fracture, and 3 by medial collateral ligament injuries. The time from injury to operation was 3 to 7 days. Results Except 1 patient whose incision healed by second intention, healing of incision by first intention was achieved in the other patients. All patients were followed up 12-25 months with an average of 17 months. The average fracture healing time was 10.2 weeks (range, 8-16 weeks). At last follow-up, the average flexion and extension of the elbow was 119° (range, 95-145°). The average arc of forearm rotation was 126° (range, 90-175°). According to elbow functional evaluation criteria by Broberg and Morrey, the results were excellent in 18 cases, good in 13, and fair in 4; the excellent and good rate was 88.6%. Conclusion In treatment of displaced radial head fractures, open reduction and internal fixation can be performed with SmartNail® and/or AO mini-plates based on different fracture types and the short-term effectiveness is satisfactory.
Objective To investigate the treatment of ulnar coronoid process fracture with mini-plate and to evaluate the cl inical results. Methods Between September 2006 and March 2009, 14 patients with ulnar coronoid process fracture were treated with open reduction and internal fixation of mini-plate. There were 10 males and 4 females with an average age of 29 years (range, 14-51 years). Fracture was caused by fall ing from height in 4 cases and traffic accident in 10cases. The locations were left side in 6 cases and right side in 8 cases. According to Regan-Morrey classification, there were 2 cases of type I, 6 of type II, and 6 of type III. The flexion-extension arc of the elbow was (60 ± 10)° and the forearm rotation was (70 ± 10)°. The disease duration was 30 minutes to 11 days, and CT scan was used for definite diagnosis. Patients received early functional exercise 1 week postoperatively. Results All incisions healed by first intention. Fourteen cases were followed up 12-25 months (17 months on average). All fractures healed well, and the average union time was 10 weeks with a range of 7-12 weeks. No 1oosening or breakage of the internal fixation occurred except for 2 patients who had heterotopic ossification. The flexion-extension arc of the elbow was (110 ± 10)° and the forearm rotation was (130 ± 15)°, showing significant difference when compared with that before operation (P lt; 0.05). The cl inical results were evaluated according to Morrey’s scale, 8 cases were rated as excellent, 4 as good, and 2 as fair; the excellent and good rate was 85.7%. Conclusion Fixation of ulnar coronoid process fracture with mini-plate provides sufficient stabil ity to do early functional exercise and it can enhance functional outcome.
ObjectiveTo discuss the clinical curative effect of internal fixation for metacarpal and phalanx fractures using stainless steel mini-plate and the early rehabilitation. MethodsThe study included 47 cases treated from January 2006 to June 2011, including 25 cases of 72 phalangeal fractures, 17 cases of 43 metacarpal fractures, and 5 cases of 23 complex metacarpal and phalangeal fractures. All the patients underwent open reduction and micro-plate internal fixation. Three days after surgery, passive function training was initiated. Patients accompanied with blood vessel damage began the training one week later. The training was carried out based on the early rehabilitation schedule. ResultsPrimary healing occurred in all the 47 cases. There was one case of broken plate because of crashing. Postoperative follow-up lasted for 4 to 10 months, and the fractures were healed in 138 lesions. X-ray examination showed that bone union took place at week 8 to 11 averaging at 10. According to the functional evaluation of total autive movement scales, the excellent and good rate was 83.0%. ConclusionThe stainless steel mini-plate in the treatment of metacarpal and phalangeal fractures has a firm fixation and is advantageous. Combined with early rehabilitation training, it can maximize the recovery of hand function with satisfactory clinical results.
ObjectiveTo evaluate the effectiveness of posteromedial double plates in the treatment of complex olecranal fracture. MethodsBetween September 2011 and July 2015, 13 patients with complex olecranal fractures were treated with posterior olecranon locking compression plate and medial mini-plate. There were 8 males and 5 females with an average age of 41.6 years (range, 22-68 years). Injury was caused by traffic accident in 4 cases, falling from height in 6 cases, and crush by object in 3 cases. According to the Mayo classification, fracture was rated as Mayo type ⅡB in 5 cases and as Mayo type ⅢB in 8 cases. Of 13 cases, 7 had Regan-Morrey type Ⅲ coronoid fractures, including 5 anterior dislocations of the elbow joint and 2 posterior dislocations. The time between injury and admission ranged from 1.5 to 10.0 hours (mean, 5.7 hours). At last follow-up, the elbow function was assessed according to the Broberg-Morrey evaluation criteria. X-ray films was performed to observe fracture healing. ResultsAll incisions healed at first stage and no neural complications occurred. The patients were followed up 9-38 months (mean, 22.1 months). All patients achieved bone union at 3.0-5.5 months (mean, 3.7 months) according to X-ray results. Subluxation of radial head and mild heterotopic ossification occurred in 1 patient respectively, who had no uncomfortable symptoms of movement disorder, elbow instability and pain, and no special management was performed. At last follow-up, the flexion and extension range of motion (ROM) of the elbow was 95-130° (mean, 116.4°); the rotation ROM of the forearm was 150-175° (mean, 170.8°); and the elbow function was excellent in 4 cases, good in 7 cases, and fair in 2 cases, and the excellent and good rate was 84.6%. No internal fixation failure, elbow stiffness, or traumatic arthritis occurred. ConclusionFor complex olecranal fractures, an early and stable anatomic reconstruction of trochlear notch in the olecranon with posterior olecranon locking compression plate and medial mini-plate can obtain good effectiveness in joint functions.