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.
ObjectiveTo investigate the effects of fibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery. MethodsBetween July 1999 and March 2013, 76 patients with neoplasms of the proximal tibia underwent tumor resection, prosthetic replacement, and gastrocnemius medial head flap transfer. Among them, 38 patients underwent fibular head resection (group A) and 38 underwent fibular head preservation (group B). There was no significant difference in gender, age, side, tumor classification and stage, and disease duration between 2 groups (P>0.05). The complications and the position of the components were observed, and American society for bone tumors scoring system (MSTS93) was used to evaluate the joint function. ResultsAll patients were followed up 12-150 months (mean, 87 months). Incision infection occurred in 1 patient (2.63%) of group A and 6 patients (15.79%) of group B, showing significant difference (χ2=3.934, P=0.047). Necrosis of gastrocnemius medial head flap was found in 1 patient of group A and 2 patients of group B. Prosthetic loosening and instability of the knee were observed in 4 and 2 cases of group A and in 6 and 4 cases of group B, respectively. In groups A and B, there were 3 and 5 cases of local recurrence, 7 and 6 cases of distant metastasis, and 8 and 7 deaths, respectively. According to MSTS93, the results were excellent in 23 cases, good in 10 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.84% in group A; the results were excellent in 21 cases, good in 11 cases, fair in 3 cases, and poor in 3 cases, with an excellent and good rate of 84.21% in group B; and no significant difference was found in the excellent and good rate between 2 groups (χ2=0.106, P=0.744). ConclusionFibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery is beneficial to intra-operative tissue coverage, and it can reduce trauma by skin transplantation and related complications. Good stability and motion of the joint can be obtained after operation.
ObjectiveTo explore the method and feasibility of digital internal fixation for proximal tibia fractures using standard parts database and three-dimensional (3D) printing technology. MethodsTen adult lower extremity specimens were selected to take continuously thin-layer scanning. After Dicom image was imported into the Mimics software, the model of Schatzker Ⅱ-VI types proximal tibia fracture was established, 2 cases each type. The virtual internal fixation was performed with plate and screw from standard parts database. The pilot hole of the navigation module design was printed by 3D printing technique. The plate and screw were inserted by the navigation module. X-ray film and CT were taken postoperatively to observe the position. Thirty patients with proximal tibia fracture underwent digital internal fixation using standard parts database and 3D printing technology (study group), and another 30 patients underwent traditional open reduction and internal fixation (control group). There was no significant difference in sex, age, side, causes, fracture classification, associated injury, and course of disease between 2 groups (P>0.05). The preparative time, incision length, fracture healing time, operation time, and intraoperative blood loss were recorded. Follow up of imaging evaluation, clinical efficacy was evaluated by MacNab criteria. ResultsThe navigation models were designed to fit the bony structure of proximal tibia and to guide implant insertion. The parameters of orientation, length, diameter, and angle were consistent with the preoperative plan. No statistically significant difference was found in the preparative times of pre-operation between 2 groups (t=1.393, P=0.169). The incision length, wound healing time, blood loss, operation time, and the cost of treatment in study group were significantly less than those in control group (P<0.05). All patients were followed up 12-16 months (mean, 13.5 months). The fracture healing time of study group was significantly shorter than that of control group (t=4.070, P=0.000). At 12 months postoperatively, there was no significant difference in the efficacy based on MacNab criteria between 2 groups (U=377.000, P=0.238). ConclusionDigital internal fixation for proximal tibia fractures using standard parts database and 3D printing technology has the advantages of short process, less blood loss, high safety and rapid fracture healing.
ObjectiveTo investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma.MethodsBetween 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively.ResultsAll patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively.ConclusionThe proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.