Objective To compare the effectiveness between locking compression plate (LCP) and locked intramedullary nail (IMN) for humeral shaft fractures of types B and C. Methods Between January 2010 and January 2012, 46 patients with humeral shaft fractures of types B and C were treated, and the clinical data were retrospectively analyzed. LCP was used for internal fixation in 22 cases (LCP group), and IMN in 24 cases (IMN group). There was no significant difference in gender, age, injury causes, the side of fracture, the site of fracture, the type of fracture, associated injury, and time from injury to operation between 2 groups (P gt; 0.05). The regular clinical examination and evaluation of radiography were done. Shoulder function was evaluated by Neer grading system and elbow function was evaluated by Mayo elbow performance score after operation. Results The operation time and intraoperative blood loss in IMN group were significantly lower than those in LCP group (P lt; 0.05). There was no significant difference in hospitalization time between 2 groups (t=0.344, P=0.733). All patients were followed up 16.8 months on average (range, 12-24 months). At 6 months after operation, bone nonunion occurred in 1 patient of LCP group and in 2 patients of IMN group; the bone healing rate was 95.5% (21/22) in LCP group and 91.7% (22/24) in IMN group, showing no significant difference (χ2=0.000, P=1.000). Except for nonunion patients, the bone healing time was (11.77 ± 0.75) weeks in LCP group and (11.38 ± 0.82) weeks in IMN group, showing no significant difference (t=1.705, P=0.095). Between LCP and IMN groups, significant differences were found in radial nerve injury (4 cases vs. 0 case) and impingement of shoulder (0 case vs. 6 cases) (P lt; 0.05), but no significant difference in superficial infection (1 case vs. 0 case) and iatrogenic fracture (1 case vs. 2 cases) (P gt; 0.05). There was no significant difference in shoulder function and elbow function at 1 year after operation between 2 groups (P gt; 0.05). Conclusion LCP fixation and IMN fixation for humeral shaft fractures of types B and C can achieved satisfactory results. More attention should be paid to avoiding radial nerve injury by fixation of LCP; nail tail should be buried deeply into the cortex of the greater tuberosity and rotator cuff should be protected to decrease the rate of impingement of shoulder by fixation of IMN.
Objective To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods. Methods Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n=31), hemiarthroplasty (HA group, n=37), and total hiparthroplasty (THA group, n=40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbl ing (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbl ing (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbl ing (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P gt; 0.05). Results There were significant differences in operation time and blood loss among 3 groups (P lt; 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative compl ications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative compl ications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative compl ication, late postoperative compl ication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P lt; 0.05), but there was no significant difference between HA group and THA group (P gt; 0.05). The mortal ity rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P gt; 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P lt; 0.05). Conclusion According to patient’s age, l ife expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
Objective To investigate the surgical treatment effectiveness of acetabular transverse and posterior wall fractures by Kocher-Langenbeck approach. Methods Between January 2002 and February 2009, 17 patients with acetabulartransverse and posterior wall fractures were treated with Kocher-Langenbeck approach and fracture reduction and fixation. There were 12 males and 5 females with an average age of 33.4 years (range, 20-65 years). The disease causes were traffic accident in 16 cases and fall ing from height in 1 case. The disease duration was 6 hours to 11 days. According to Letournel classification, all fractures were rated as acetabular transverse and posterior wall fractures. Concomitant injuries included posterior hi p dislocation in 3 cases, fracture of extremities in 8 cases, injury of sciatic nerve in 3 cases, craniocerebral injury in 1 case, and l ienal rupture in 1 case. Results The incisions healed primarily and no compl ication of infection and deep venous thrombosis occurred after operation. All patients were followed up 12 to 36 months with an average of 19 months. The X-ray films showed that fracture healed 3 to 5 months after operation. After operation, anatomic reduction was found in 9 cases, satisfactory reduction in 5 cases, and unsatisfactory reduction in 3 cases according to Matta et al criterion. According to modified grading system of Merle D’Aubigne and Postel, the results were excellent in 4 cases, good in 9, fair in 3, and poor in 1 at last follow-up with an excellent and good rate of 76.5%. The nerve function was recovered in patients with sciatic nerve injury at 12 months after symptomatic treatment. Traumatic arthritis occurred in 5 cases, avascular necrosis of the femoral head in 1, and heterotopic ossification in 5 between 9 weeks and 12 months after operation. Conclusion For acetabular transverse and posterior wall fractures, it is important to make adequate preoperative preparation, to get the imaging data, and to perform open reduction andinternal fixation with Kocher-Langenbeck approach as early as possible.
Objective To investigate the characteristics of patients with crush injury in Wenchuan earthquake and the corresponding operational methods. Methods From May 12th 2008 to June 18th 2008, 202 patients with crush injury of soft tissue were treated, including 110 males and 92 females. Twenty-five patients aged 19 months to 16 years, 129 patients aged 17-60 years and 48 patients aged above 61 years. The crushed time was 30 minutes to 154 hours. Sixty cases of openinjuries were treated by debridement and dressing or suture; 16 cases of damaged extremities (18 l imbs) and 6 cases of acute renal failure due to crush syndrome (8 l imbs) received amputation; 32 cases of interfascial space syndrome crisis (42 l imbs) were treated by fascia cavity decompression; 15 cases received the resection of necrotic muscle for 31 times; and 9 cases received continuous renal replacement therapy (CRRT). Results All the wounds healed except 2 cases which died from intestinal bleeding and intracranial hemorrhage during the treatment of CRRT. Two cases were discharged 8 months after treatment, while the other 198 cases recovered and were discharged 15-120 days after treatment. The average hospital ization time was 53 days. Twenty-two cases (26 l imbs) were fixed with artificial l imbs 3-6 months after amputation and achieved good functional outcome. Conclusion The treatment principle of crush injury is “be active to decompress and be prudent to amputate”, the hardening muscle and the increasing level of creatine kinase and blood potassium are the golden indicators of fascia cavity decompression. Decompression at an earl ier period is preferred when there is a dilemma to choose, and open amputation should be performed when the necrotic muscle is hard to clear or the necrosis boundary is not distinct.