Objective To explore the clinical application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair. Methods Between January 2016 and December 2017, 5 patients with limb wounds were treated with the extra-long latissimus dorsi flaps. The vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery was applied during the operation. There were 4 males and 1 female, with an average age of 45.8 years (range, 43-59 years). The time from post-traumatic admission to flap repair was 7-25 days (mean, 12.3 days). The causes of injury included machine injury in 2 cases, traffic accident in 2 cases, and roller crush injury in 1 case. The wounds were located at the anterior of upper limb in 3 cases, the posterior of upper limb in 1 case, and the posterior of leg in 1 case. The size of wounds ranged from 26 cm×8 cm to 38 cm×10 cm. The size of the latissimus dorsi flap ranged from 36 cm×6 cm to 43 cm×7 cm. The size of the muscle flap ranged from 36 cm×10 cm to 43 cm×15 cm. The donor sites were closed directly. Results The distal flap necrosis occurred in 1 case and healed after symptomatically treatment. The other flaps survived completely. The wounds and incisions at donor sites healed by first intention. All patients were followed up 8-18 months with an average of 14.9 months. At last follow-up, the flaps had satisfactory appearances, soft textures, and function of sweating. Conclusion Application of vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery in repair of limb wound can reduce the incidence of distal flap necrosis and achieve satisfactory effectiveness.
Objective To investigate the effectiveness of arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures. Methods Between January 2014 and May 2016, 21 patients who suffered from extreme distal radial fractures were treated by arthroscopy-assisted combined fixation of Kirschner wire and external fixator. There were 14 males and 7 females with an age of 32-57 years (mean, 42.3 years). The causes of injury included falling in 13 cases and traffic accident in 8 cases. The fracture type included 8 cases of type 23C1, 9 cases of type 23C2, and 4 cases of type 23C3 according to AO/OTA classification. The time from injury to operation was 3-7 days (mean, 4.4 days). The Mayo score and disability of arm, shoulder, and hand (DASH) score were used to assess the pain and function of the wrist joint. Results There was no needle red swelling, tendon irritation, or orther early complications. All the patients were followed up 10-35 months (mean, 18.3 months). The fracture healing time was 9-13 weeks (mean, 10.6 weeks). At last follow-up, the Mayo score was 87-94 (mean, 90.9); and 17 cases were excellent and 4 were good. The DASH score was 7-13 (mean, 10.6). Conclusion Arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures has the advantages of firm fixation, early functional exercise, less postoperative complications, and good functional recovery of wrist joint.
ObjectiveTo investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults.MethodsBetween March 2016 and January 2018, 20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing. There were 13 cases and 7 cases, with an average age of 43 years (range, 18-56 years). The causes of injury included the traffic accident in 6 cases, falling in 12 cases, and falling from height in 2 cases. The interval between injury and admission ranged from 1 hour to 2 days (mean, 3.2 hours). The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases. The length of incision, the operation time, the visual analogue scale (VAS) score on the 2nd day after operation, the fracture healing time, the postoperative shoulder function and the Disability of Arm Shoulder and Hand (DASH) score, the complications, and the time of second surgical removal of internal fixator and incision length were recorded.ResultsThe length of incision was 2-6 cm (mean, 4.7cm). The operation time was 45-120 minutes (mean, 77.2 minutes). The VAS score was 1-5 (mean, 3.2) on the 2nd day after operation. All incisions healed by first intention and no infection or nerve injury occurred. All patients were followed up 12-32 months (mean, 18.6 months). All fractures healed with the healing time of 10-15 weeks (mean, 12.1 weeks). The Constant score was 92-98 (mean, 96.3) and DASH score was 0-6.4 (mean, 3.1). The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation. The internal fixators were removed at 12-26 months (mean, 14.6 months) after operation. And the length of incision was 1-2 cm (mean, 1.3 cm) and the operation time was 5-15 minutes (mean, 9.0 minutes). ConclusionFor the midshaft clavicular fracture in adults, the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision, light pain, rapid fracture healing, small secondary operation injury, and avoiding the risk of clavicular epithelial nerve injury, and can obtain good effectiveness.
ObjectiveTo observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus.MethodsBetween January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days).ResultsAll 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred.ConclusionThe self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.
ObjectiveTo explore the effectiveness of using antibiotic bone cement-coated plates internal fixation technology as a primary treatment for Gustilo type ⅢB tibiofibular open fractures. Methods The clinical data of 24 patients with Gustilo type ⅢB tibiofibular open fractures who were admitted between January 2018 and December 2021 and met the selection criteria was retrospectively analyzed. Among them, there were 18 males and 6 females, aged from 25 to 65 years with an average age of 45.8 years. There were 3 cases of proximal tibial fracture, 6 cases of middle tibial fracture, 15 cases of distal tibial fracture, and 21 cases of fibular fracture. The time from injury to emergency surgery ranged from 3 to 12 hours, with an average of 5.3 hours. All patients had soft tissue defects ranging from 10 cm×5 cm to 32 cm×15 cm. The time from injury to skin flap transplantation for wound coverage ranged from 1 to 7 days, with an average of 4.1 days, and the size of skin flap ranged from 10 cm×5 cm to 33 cm×15 cm. Ten patients had bone defects with length of 2-12 cm (mean, 7.1 cm). After emergency debridement, the tibial fracture end was fixed with antibiotic bone cement-coated plates, and the bone defect area was filled with antibiotic bone cement. Within 7 days, the wound was covered with a free flap, and the bone cement was replaced while performing definitive internal fixation of the fracture. In 10 patients with bone defect, all the bone cement was removed and the bone defect area was grafted after 7-32 weeks (mean, 11.8 weeks). The flap survival, wound healing of the affected limb, complications, and bone healing were observed after operation, and the quality of life was evaluated according to the short-form 36 health survey scale (SF-36 scale) [including physical component summary (PCS) and mental component summary (MCS) scores] at 1 month, 6 months after operation, and at last follow-up. ResultsAll 24 patients were followed up 14-38 months (mean, 21.6 months). All the affected limbs were successfully salvaged and all the transplanted flaps survived. One case had scar hyperplasia in the flap donor site, and 1 case had hypoesthesia (grade S3) of the skin around the scar. There were 2 cases of infection in the recipient area of the leg, one of which was superficial infection after primary flap transplantation and healed after debridement, and the other was sinus formation after secondary bone grafting and was debrided again 3 months later and treated with Ilizarov osteotomy, and healed 8 months later. The bone healing time of the remaining 23 patients ranged from 4 to 9 months, with an average of 6.1 months. The scores of PCS were 44.4±6.5, 68.3±8.3, 80.4±6.9, and the scores of MCS were 59.2±8.2, 79.5±7.8, 90.0±6.6 at 1 month, 6 months after operation, and at last follow-up, respectively. The differences were significant between different time points (P<0.05). ConclusionAntibiotic bone cement-coated plates internal fixation can be used in the primary treatment of Gustilo type ⅢB tibiofibular open fractures, and has the advantages of reduce the risk of infection in fracture fixation, reducing complications, and accelerating the functional recovery of patients.