ObjectiveTo discuss the efficacy of skin stretcher applied for repair of postoperative skin and soft tissue defects in tibial fractures.MethodsBetween April 2016 and March 2017, 15 cases with skin and soft tissue defects after tibial fractures fixation were treated with the skin stretcher. There were 11 males and 4 females with an age of 24-59 years (mean, 37.5 years). The causes of injury included traffic accident in 7 cases, bruise in 3 cases, falling from height in 3 cases, and falling in 2 cases; without nerve and vascular injury in all patients. These cases were followed up 1-3 months after their first surgery, consisting of 3 closed fractures treated with open reduction and plate and screw fixation, 12 open fractures treated with external fixation after debridement. The area of skin defects ranged from 14 cm×5 cm to 20 cm×7 cm, all of which were stripped or spindle shaped skin defects. First, the skin was penetrated by two Kirschner wires which were locked by skin stretchers on both sides of the skin defect longitudinally. Then, the tension of skin stretchers was timely adjusted according to the skin flap blood supply and muscle compression. Finally, Kirschner wires and skin stretchers were removed when the edge of skin contacted and been sutured.ResultsAll skin and soft tissue defects were covered after stretching for 6-13 days. The interrupted sutured wounds healed at 12 days. Clinical scores of wound healing decreased from 3.40±0.51 at immediate postoperatively to 1.27±0.46 at 12 days postoperatively, showing significant difference (t=12.911, P=0.000). All the patients were followed up 4-12 months (mean, 6.5 months). After stretching, the skin color, elasticity, and pain and touch feeling were similar with the normal skin, and the hair growth was normal. After operation, 1 case of nail tract infection and 2 cases of calf discomfort occurred, and all were relieved after treatment.ConclusionIt is an effective method for repairing postoperative skin and soft tissue defects in tibial fractures with the application of skin stretchers.
ObjectiveTo investigate the occurrence, treatment, and effectiveness of peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures.MethodsThe clinical data of 16 patients with peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures who met the inclusion criteria between April 2014 and November 2019 were retrospectively analyzed. There were 7 males and 9 females with an average age of 78.4 years (range, 65-93 years). The 14 cases of initial intertrochanteric fractures were classified according to the classification of AO/Orthopaedic Trauma Association (AO/OTA): 5 cases of type A1, 7 cases of type A2, and 2 cases of type A3; the other 2 cases were intertrochanteric combined with subtrochanteric fractures (Seinsheimer type Ⅴ). According to the classification of peri-implant refracture which was proposed by Chan et al., there were 10 cases of type 1 (6 cases of type 1A, 3 cases of type 1B, 1 case of type 1C) and 6 cases of type 2 (4 cases of type 2A and 2 cases of type 2B). The average interval between refracture and initial surgery was 14.6 months (range, 1-52 months). The incidence of peri-implant refracture in short nail group (the length of intramedullary nail used in initial surgery≤240 mm) was 1.92% (11/573), while the incidence of long nail group (the length of intramedullary nail used in initial surgery≥340 mm) was 1.66% (5/301), showing no significant difference between the two groups (χ2=0.073, P=0.786). The peri-implant refractures were revised with extended intramedullary nail (5 cases) or fixed with additional limited invasive stabilization system (11 cases).ResultsThe average operation time was 115.8 minutes (range, 78-168 minutes) and the average intraoperative blood loss was 283.1 mL (range, 120-500 mL). One patient died of myocardial infarction at 3 months after operation, and the other 15 patients were followed up 9-46 months (mean, 16.8 months). The peri-implant refractures healed at 14-20 weeks (mean, 16.4 weeks) after operation. There was no complications such as incision infection, nonunion, internal fixator loosening and rupture, screw cutting-out, and the second refracture during the follow-up. At last follow-up, all injured limbs regained walking function, and the Hospital for Special Surgery (HSS) score was 56-92 (mean, 80.2). The results were classified as excellent in 2 cases, good in 10, fair in 2, and poor in 1, with the excellent and good rate of 80%.ConclusionStress concentration at the tip of initial intramedullary nail and distal interlocking screw aera is the main cause of peri-implant refracture after intramedullary nail fixation for intertrochanteric fractures. Revision with extended intramedullary nail or fixation with limited invasive stabilization system according to the length of initial intramedullary nail and the type of refracture can get satisfactory effectiveness.
Objective To review the research progress in the repair and reconstruction of isolated traumatic radial head dislocation with annular l igament injury in children. Methods In recent years, the related l iterature concering isolated traumatic radial head dislocation with annular l igament injury in children was reviewed. Results For isolated traumatic radial head dislocation with annular l igament injury in children, the surgery should be chosen as the main treatment, includingopen reduction and annular l igament reconstruction surgery. Triceps aponeurosis is usually used as reconstruction materials of annular l igament, mainly because the position of taking material of annular l igament is at the operative incision with less surgery trauma and short operative time; aponeurosis is tough and thick with rigid fixation and low risk of re-dislocation. Artificial materials are paid attention to increasingly because they are easy to get, have rigid fixation, and can avoid operative injury caused by taking material of annular l igament. Conclusion Currently active annular l igament reconstruction surgery should be taken; triceps aponeurosis is widely adopted as reconstruction materials of annular l igament and artificial materials have come to be a new research trend.
目的:回顾性研究人工肱骨头置换治疗复杂肱骨近端骨折患者的肩关节的情况,以进一步提高疗效。方法:对我院2004年至2007年27例肱骨近端骨折患者采用肱骨头置换术治疗,术中修复关节囊和肩袖,术后随访5~38月,评价其肩关节功能。结果:采用半关节成形改良评分系统SSMH综合评分,优:5例,良:17例,可:5例,优良率:815%。肩关节活动:平均前屈上举:96°,外旋:36°,内旋至L2水平。X片示假体无松动断裂,位置良好。结论:对于复杂的肱骨近端骨折,人工肱骨头置换是有效治疗手段,能够最大限度恢复期肩关节活动功能。
Objective To review the basic research and cl inical progress of elbow heterotopic ossification after injury. Methods The recent l iterature concerning heterotopic ossification of the elbow was reviewed. Results Heterotopic ossification was caused by variety of stimul i and conditions. The current methods of prevention and treatment were to improve surgical techniques, to reduce trauma and bleeding, to rinse the area with bone fragments with plenty of salt water, and to use non-steroidal anti-inflammatory drugs. Conclusion Once heterotopic ossification occurred, surgical treatment is unique treatment method, so emphasis is to prevent heterotopic ossification.
To design a new suit of instruments for meniscal suture with tondon, and then authenticate their feasibil ity and the therapeutic effect of the new technique. Methods Instruments were developed, including new ones and others which was improved according to the current instruments. From October 2005 to December 2006, 45 patients with meniscal injury were treated by meniscal suture with tendon. There were 29 males and 16 females, aged 17-40 years (mean 28 years). Injury was caused by sports in 33 cases, by traffic accident in 5 cases, by fall ing in 3 case and others in 4 cases. The disease course was 3 days to 6 months (mean 2 months). There were 23 cases accompanying with anterior cruciate l igament injury and 6 cases accompanying with posterior cruciate l igament injury. E-MRI showed 2 cases of degree II and 43 cases of degree III. Arthroscope showed that injury was at medial meniscus in 39 cases and at lateral meniscus in 6 cases. The pre-operationalLysholm score was 53.0 ± 10.3. Autogeneic or xenogenic tendon was made into suture l ine guided by stitch at the two ends. Thetherapeutic effect of the new technique was authenticated by cl inical results, including the change of symptoms and phy sical signs, and by comparing the pre-operational Lysholm score with the post one. Results Nineteen pieces of instruments weredeveloped. All the operation were successful, with no harm to nerves and vessels. The follow-up was 6 months to 24 mo nths (mean15 months). At the last follow-up, all the symptoms disappeared, including pain, swell ing and locking, etc. The Lysholm sc oreafter 6 months of operation was 87.8 ± 9.2, showing statistically significant difference when compared with per-operati on ( P lt; 0.01). Conclusion It is feasible to suture injured menisci with the new instruments and technique. It is an effective way to repair menisci with tendon according to the short-term results.
【摘要】 目的 评价切开复位Herbert螺钉内固定加外支架治疗对亚急性和陈旧性舟状骨骨折的治疗效果。方法 2008年2月—2009年5月,对15例受伤后4周以上(平均7.6周)入院诊断为亚急性和陈旧性舟状骨骨折的患者均采用Herbert螺钉内固定加外支架治疗,术后随访5～16个月,平均12.5个月,按Gartland amp; Werley和改良Green amp; O’Brein评分系统进行评价治疗效果。结果 15例患者均进行有效随访,末次随访Gartland amp; Werley评分优8例,良5例,中2例,优良率为86.7％,改良Green amp; O’Brein评分优7例,良5例,中3例，优良率为80％。结论 此方法是治疗亚急性和陈旧性舟状骨骨折的有效措施,值得推广。
Objective To evaluate the results of open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus in treatment of post-traumatic elbow stiffness. Methods From March 2003 to December 2007, 33 patients with post-traumatic elbow stiffness were treated with open arthrolysis by elevated the lateral and medial collateral l igament-musculature complex from the supracondylar ridge of the humerus. There were 23 males and 10 females, aged 17-70 years old (mean 41.8 years old). According to Morrey, 15 caseswere extremely serious (less than 30° extension-flexion arc) and 18 cases were serious (30-60° extension-flexion arc). The range of motion of the elbow stiffness was (32.5 ± 28.9)° and the Mayo score was 51.9±13.1 before operation. All initial fractures were healed according to cl inical examination and X-rays films. All patients present with a post-traumatic elbow stiffness and the average period from initial trauma to elbow arthrolysis was 16.9 months (2-72 months). Results Wound infection occurred in 1 patient and cured after dressing change and anti-infectious treatment. The wounds healed by first intension in 32 cases. No patient showed sign of elbow instabil ity and debil itating pain. All patients were followed up 6 months to 5 years (mean 3.3 years). At last follow up, the Mayo score was 82.3 ± 14.4 and the range of motion of elbow stiffness was (108.8 ± 36.0)°; showing significant differences when compared with preoperation (P lt; 0.05). According to Mayo evaluation, the results were excellent in 11 cases, good in 18 cases, fair in 2 cases, and poor in 2 cases, the excellent and good rate was 87.88%. Thirty-one patients achieve satisfactory results. Two patients were not satisfied with the result, but the satisfactory results were achieved by a second arthrol ysis. Conclusion Open elbow arthrolysis and postoperative rehabil itation for patients with elbow stiffness can improve joint function and ensure the stabil ity of elbows.
Objective To compare the biomechanical stability of Kirschner wire and tension band wiring, reconstruction plate combined with tension band wiring, and olecranon anatomical plate in fixing proximal ulna combined with olecranon fracture, so as to provide the theoretical evidence for clinical selection of internal fixation. Methods Eight specimens of elbow joints and ligaments were taken from eight fresh male adult cadaveric elbows (aged 26-43 years, mean 34.8 years) donated voluntarily. The model of proximal ulna combined with olecranon fracture was made by an osteotomy in each specimen. Fracture end was fixed successively by Kirschner wire and tension band wiring (group A), reconstruction plate combined with tension band wiring (group B), and olecranon anatomical plate (group C), respectively. The biomechanical test was performed for monopodium compression experiments, and load-displacement curves were obtained. The stability of the fixation was evaluated according to the load value when the compression displacement of fracture segment was 2 mm. Results No Kirschner wire withdrawal, broken plate and screw, loosening and specimens destruction were observed. The load-displacement curves of 3 groups showed that the displacement increased gradually with increasing load, while the curve slope of groups B and C was significantly higher than that of group A. When the compression displacement was 2 mm, the load values of groups A, B, and C were (218.6 ± 66.9), (560.3 ± 116.1), and (577.2 ± 137.6) N, respectively; the load values of groups B and C were significantly higher than that of group A (P lt; 0.05), but no significant difference was observed between groups B and C (t=0.305, P=0.763). Conclusion The proximal ulna combined with olecranon fracture is unstable. Reconstruction plate combined with tension band wiring and olecranon anatomical plate can meet the requirement of fracture fixation, so they are favorable options for proximal ulna combined with olecranon fracture. Kirschner wire and tension band wiring is not a stable fixation, therefore, it should not be only used for proximal ulna combined with olecranon fracture.
Objective To review the efficacy of reconstruction plate combined with tension band wiring for treating proximal ulna and olecranon fractures. Methods Between November 2004 and September 2009, 10 patients with proximal ulna and olecranon fractures were treated by reconstruction plate combined with tension band wiring. There were 6 males and4 females with an average age of 45.3 years (range, 21-75 years). Five fractures were caused by traffic accident, 2 by fall ing from height, 2 by tumbl ing, and 1 by a machine strangulation. The locations were the left side and the right side in 5 cases respectively. One case was open fracture (Gustilo II) and the other 9 were closed fractures. Olecranon fractures included 4 cases of traverse fractures and 6 cases of comminuted fractures, and proximal ulna fractures included 6 cases of comminuted fractures and 4 cases of obl ique fractures. The combined fractures included 6 radial head fractures, 4 coronoid process fractures, 2 proximal humerus fractures, and 3 scapula fractures; other injury included 1 elbow dislocation and 1 shoulder dislocation. Two patients had secondary operation; the other 8 patients received the primary operations and the time from injury to operation varied from 7 days to 20 days, with an average of 11 days. Results One case had infection at the incision 1 week after operation, and recovered after 2 months of antibiotics and debridement; incisions healed by first intention in other 9 patients. All patients were followed up 12-64 months (mean, 40.5 months). The X-ray films showed that fracture heal ing was achieved at 10-24 weeks (mean, 12 weeks). There was no ulnar nerve symptom in all cases. Heterotopic ossification occurred in 1 case at 2 months and stiffness of the elbow in 1 case at 3 months after operation; they were both cured after symptomatic treatment. Proximal migration of Kirschner wires was found in 1 case at 6 months after operation, whose implants were taken out at 9 months after the first operation because fracture had healed. At last follow-up, the flexion and extension arc of the elbow averaged 92.8°(range, 23-130°), and the arc of forearm rotation averaged 124.4° (range, 42-175°). According to the American Hospital for Special Surgery (HSS) evaluation method, the results were classified as excellent in 6 cases, good in 2, fair in 1, and poor in 1. Conclusion Treating proximal ulna and olecranon fractures by reconstruction plate combined with tension band wiring allows patients to do postoperative exercise early and could effectively avoid compl ications.