Objective To evaluate the effectiveness of limited open reduction and double plates internal fixation in the treatment of Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty. Methods A retrospective analysis was made on the clinical data of 12 patients with Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty between May 2007 and October 2012, who underwent limited open reduction and double plates internal fixation. Of 12 patients, 4 were male and 8 were female, aged 76-85 years (mean, 81.6 years); the left side was involved in 5 patients and the right side in 7 patients. The cement prosthesis was used in 3 cases and cementless prosthesis in 9 cases; double acting head of hip arthroplasty was performed in 4 cases and total hip arthroplasty in 8 cases. The median time from first hip arthroplasty to re-fracture was 13 months (range, 5 months-5 years). The causes of injury were traffic accident in 2 cases and falling in 10 cases. Combined fractures included contralateral tibial and fibular fractures and ipsilateral distal humeral fracture (1 case), ipsilateral proximal humeral fracture (2 cases), ipsilateral distal radial fracture (1 case), and rib fracture (1 case). The time from injury to operation was 5.6 days on average (range, 3-10 days). Results The incisions all healed by first intention, and no infection or deep venous thrombosis of lower extremity occurred. Twelve cases were followed up 6-24 months (mean, 13.3 months). One female patient died of acute myocardial infarction at 16 months after operation. All the fractures were healed, with X-ray healing time of 12.5 weeks on average (range, 10-16 weeks). The time of full weight bearing was 13 weeks on average (range, 10-18 weeks). Ten cases could walk freely after operation, and 2 cases could walk by the aid of walking aid appliance. At last follow-up, the Harris score of hip function was 87.3 on average (range, 75-93). Conclusion The method of limited open reduction and double plates internal fixation for Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty is effective in maintaining stability, protecting blood supply, promoting fracture healing, and doing functional exercise early. The long-term effectiveness needs further observation.
Objective To compare the effectiveness between minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) for treatment of extra-articular distal tibial fracture. Methods Between March 2009 and March 2012, 57 patients with extra-articular distal tibial fractures were treated, and the clinical data were retrospectively analyzed. Of 57 cases, 31 were treated with MIPO (MIPO group), and 26 with ORIF (ORIF group). There was no significant difference in gender, age, cause of injury, type of fractures, complication, and time from injury to operation between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were compared between 2 groups. Results There was no significant difference in operation time and intraoperative blood loss between 2 groups (P gt; 0.05). Wound infection occurred in 5 cases [2 in MIPO group (6.5%) and 3 in ORIF group (11.5%)], showing no significant difference (χ2=0.651, P=0.499). The other wound obtained healing by first intention. All cases were followed up 13-24 months (mean, 15 months). No significant difference was found in the average healing time between 2 groups and between patients with types A and B by AO classification (P gt; 0.05); in patients with type C, the healing time in MIPO group was significantly shorter than that in ORIF group (t= — 2.277, P=0.033). Delayed union was observed in 3 cases of MIPO group (9.7%) and in 4 cases of ORIF group (15.4%), showing no significant difference (χ2=0.428, P=0.691). Mal-union occurred in 4 cases of MIPO group (12.9%) and in 1 case of ORIF group (3.8%), showing no significant difference (χ2=1.449, P=0.362). No significant difference was found in Mazur score between 2 groups (t=0.480, P=0.633). The excellent and good rate was 93.5% in MIPO group (excellent in 24 cases, good in 5 cases, fair in 1 case, and poor in 1 case) and was 92.3% in ORIF group (excellent in 18 cases, good in 6 cases, and poor in 2 cases), and the difference was not significant (Z= — 0.687, P=0.492). Conclusion Both MIPO and ORIF have good results in treating extra-articular distal tibial fractures. MIPO is superior to ORIF for treating complex and communited fractures.
Objective To assess the effectiveness of the new anterolateral approach of the distal femur for the treatment of distal femoral fractures. Methods Between July 2007 and December 2009, 58 patients with distal femoral fractures were treated by new anterolateral approach of the distal femur in 28 patients (new approach group) and by conventional approach in 30 patients (conventional approach group). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, disease duration, complication, or preoperative intervention (P gt; 0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization days, and Hospital for Special Surgery (HSS) score of knee were recorded. Results Operation was successfully completed in all patients of 2 groups, and healing of incision by first intention was obtained; no vascular and nerves injuries occurred. The operation time and intraoperative fluoroscopy frequency of new approach group were significantly less than those of conventional approach group (P lt; 0.05). But the intraoperative blood loss and the hospitalization days showed no significant difference between 2 groups (P gt; 0.05). All patients were followed up 12-36 months (mean, 19.8 months). Bone union was shown on X-ray films; the fracture healing time was (12.62 ± 2.34) weeks in the new approach group and was (13.78 ± 1.94) weeks in the conventional approach group, showing no significant difference (t=2.78, P=0.10). The knee HSS score at last follow-up was 94.4 ± 4.2 in the new approach group, and was 89.2 ± 6.0 in the conventional approach group, showing significant difference between 2 groups (t=3.85, P=0.00). Conclusion New anterolateral approach of the distal femur for distal femoral fractures has the advantages of exposure plenitude, minimal tissue trauma, and early function rehabilitation training so as to enhance the function recovery of knee joint.
Objective To compare the outcomes between intramedullary nail change and augmentation plating with a retained intramedullary nail for aseptic nonunion of femoral shaft fractures after femoral nailing, and to analyze the cause so as to guide the clinical application. Methods Between June 2001 and June 2011, 28 patients with aseptic nonunion of femoral shaft fractures after femoral nailing were treated with intramedullary nail change (11 patients, group A) and augmentation plating with a retained intramedullary nail (17 patients, group B), and the clinical data were analyzed retrospectively. There was no significant difference in age, gender, smoking, location of fracture, Association for the Study of Internal Fixation (AO/ASIF) classification, type of injury, associated injury, type of nonunion, and time of nonunion between 2 groups (P gt; 0.05). The patients were followed up by imaging and the clinical function at regular intervals to observe the callus growth and the recovery condition of the affected limb function, and clinical curative effectiveness was evaluated by Tohner-Wrnch standard. Results The operation time, intraoperative bleeding volume, and intraoperative erythrocyte-transported volume in group A were significantly higher than those in group B (P lt; 0.05). There was no significant difference in postoperative drainage volume and hospitalization days between 2 groups (P gt; 0.05). All the incisions healed by first intention, and no nerve and blood vessel injury occurred. All patients were followed up 18.6 months on average (range, 12-36 months). All cases obtained bone union, and time of clinical and radiological bone healing in group B was significantly shorter than those in group A (P lt; 0.05). During follow-up, no following complication occurred: deep incision infection, injuries of blood vessels and nerves, loosening and breakage of internal fixation, loss of reduction, angulated and rotational malunion. According to Tohner-Wrnch standard at last follow-up, the results were excellent in 6 cases, good in 3 cases, and poor in 2 cases, with an excellent and good rate of 81.8% in group A; the results were excellent in 12 cases, good in 5 cases, with an excellent and good rate of 100% in group B; and difference was significant between 2 groups (Z= — 2.623, P=0.021). Conclusion Augmentation plating with a retained intramedullary nail is an ideal treatment for aseptic nonunion of femoral shaft fractures after femoral nailing and can achieve satisfactory clinical outcomes because it has simpler operation, shorter operation time, less blood loss, and less trauma than intramedullary nail change.
Objective To investigate the feasibility and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using unilateral incision and internal fixation of pedicle screws and a translaminar facet screw for dural-level lumbar degenerative disease. Methods Between January 2010 and January 2012, 19 patients with dural-level lumbar degenerative disease was treated, including 7 males and 12 females with an average age of 50.4 years (range, 22-68 years) and a median disease duration of 37 months (range, 8 months to 15 years). The operated segments included L3-5 in 6 cases and L4-S1 in 13 cases. MIS-TLIF was performed by unilateral incision, and then pedicle screws and a translaminar facet screw were used for internal fixation. Results Operations were successfully performed in all cases. The mean operation time was 158 minutes; the mean intraoperative blood loss was 156 mL; the mean length of incision was 42 mm; the mean postoperative ambulation time was 35 hours; the mean hospitalization time was 4.1 days; and the mean length of translaminar facet screw was 51 mm. All the wounds healed by first intention. No complication occurred in the others except 1 case of dural tear. The patients were followed up 12-24 months (mean, 17.1 months). The visual analogue scale (VAS) scores for back and leg pain and Oswestry disability index (ODI) scores at postoperation were significantly improved when compared with preoperative ones (P lt; 0.05). The symptom disappeared gradually. The postoperative X-ray images showed that the internal fixations were in good position; all facets screws penetrated through the base of spinous process, laminar, and facets joint; of the screws, 2 (5.3%) facets screws penetrated lateral laminar, and 1 (1.8%) pedicle screw penetrated out of pedicle of vertebral arch, but no symptom of nerve injury was seen. The CT scan and three-dimensional reconstruction at postoperative 12th month showed good interbody fusion; and based on the Bridwell’s interbody fusion grading system, 11 cases were rated as grade I, and 8 cases as grade II. Conclusions MIS-TLIF by unilateral incision and internal fixation is a safe and reliable method to treat dural-level lumbar degenerative disease, and it has the advantages of short operation time, less invasion, less blood loss, and fast recovery.
Objective To explore the relative prognostic factors of Tile C pelvic injury after iliolumbar fixation. Methods Between March 2007 and March 2010, 60 patients with Tile C pelvic injuries were surgically treated with iliolumbar fixation, including 39 males and 21 females with an average age of 37 years (range, 17-66 years). Of them, 27 cases were classified as Tile C1, 20 as Tile C2, and 13 as Tile C3. The preoperative injury severity score (ISS) was 12-66 (mean, 29.4). The time from injury to surgery was 2-25 days (mean, 8.1 days). Iliolumbar fixation was performed in all patients. Unconditional logistic analysis was used to analyze the relationship between the age, sex, body mass index (BMI), operation opportunity, the preoperative combined injury, classification of fracture, the postoperative complication, reduction outcome, sacral nerve injury, and the time of physical exercise and the prognosis. Results All 60 patients were followed up 12-56 months (mean, 27.3 months). Infection of incisions occurred in 12 cases and were cured after dressing change; healing of incision by first intention was obtained in the other patients. Delay sacral nerve injury was found in 15 patients, 6 patients underwent nerve decompression, and 9 underwent conservative treatment. Ten patients had nail protrusion of Schanz screws at the posterior superior illac spine, and 3 patients had pain, which was relieved after removal of the internal fixator. One patient had bone-grafting nonunion of sacroiliac joint, which was improved by pressured bone graft. Five patients had the beam breakage without significant effect. Six patients had deep vein thrombosis, among them 4 underwent filter and 2 underwent nonsurgical treatment. The healing time of fracture was 3-6 months (mean, 3.9 months). According to the Matta function score, the results were excellent in 31 cases, good in 24 cases, fair in 3 cases, and poor in 2 cases with an excellent and good rate of 91.7% at last follow-up. Majeed score was 58-100 (mean, 86), 28 were rated as excellent, 12 as good, 16 as fair, and 4 as poor with an excellent and good rate of 66.7%. The logistic analysis showed that the age, sex, BMI, and postoperative complications were not prognostic factors; early operation (within 10 days), early function exercises (within 7 days), the better reduction quality, and the less sacral nerve injury were in favor of prognosis; and the worse preoperative combined injury and pelvic injury were, the worse the prognosis was. Conclusion Operation opportunity, the preoperative combined injury, reduction outcome, sacral nerve injury, and the time of physical exercise are all significantly prognostic factors of Tile C pelvic injuries
Objective To discuss the improved method and effectiveness of posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae for treating thoracolumbar burst fracture. Methods Between March 2008 and September 2010, 21 patients with thoracolumbar burst fracture were treated by posterior pedicle-screw fixationcombined with restoring and grafting through the injured vertebrae. Of 21 cases, 15 were male and 6 were female with an age range of 20-61 years (mean, 38.4 years). Affected segments included T12 in 5 cases, L1 in 7 cases, L2 in 5 cases, and T12-L1 in 4 cases. According to Frankel classification for neurological function, 2 cases were rated as grade A, 4 cases as grade B, 6 cases as grade C, 5 cases as grade D, and 4 cases as grade E; based on Denis classification, all 21 cases were burst fractures, including 7 cases of type A, 11 cases of type B, and 3 cases of type C. The X-ray film was taken to measure the relative height of fractured vertebrae and Cobb’s angle, and the function of the spinal cord was evaluated at preoperation, postoperation, and last followup. Results All the incisions healed primarily. The 21 patients were followed up 12-30 months (mean, 26 months). No loosening or breakage of screws and rods occurred. X-ray films showed good bone heal ing with the heal ing time from 12 to 23 months (mean, 16 months). The Cobb’s angles at 1 week and 1 year postoperatively were (3.4 ± 2.4)° and (5.2 ± 3.2)° respectively, showing significant differences when compared with preoperative angle (22.1 ± 1.2)° (P lt; 0.05), while no significant difference between 1 week and 1 year after operation (P gt; 0.05). The anterior height of injured vertebrae recovered from (14.6 ± 2.1) mm (40.2% ± 1.5% of the normal) at preoperation to (36.0 ± 2.0) mm (95.3% ± 1.3% of the normal) at 1 week, and to (35.0 ± 2.4) mm (94.4% ± 2.5% of the normal) at 1 year; significant differences were found between preoperation and postoperation (P lt; 0.05), while no significant difference between 1 week and 1 year after operation (P gt; 0.05). At 1 year after operation, the Frankel neurological function grade was improved in varying degrees, showing significant difference when compared with preoperative grade (χ2=11.140, P=0.025). Conclusion Improved method of posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae in treatment of thoracolumbar burst fracture can reconstructthe anterior and middle column stabil ity and prevent loss of Cobb’s angle and height of vertebrae.
Objective Supracondylar closing wedge osteotomy is a standard operation for the management of post-traumatic cubitus varus deformity. There are many fixation methods for the broken ends of bone. However, most of these fixation methods are fraught with various complications. To evaluate the methods and functional results of double volume internal fixation for correction of adult post-traumatic cubitus varus deformity. Methods The cl inical data were retrospectively reviewed, from 22 cases of adults post-traumatic cubitus varus deformity between June 2007 and December 2010.There were 16 males and 6 females, aged 18-29 years (mean, 21 years) and they all had a history of supracondylar fracture. The deformities of cubitus varus appeared at 6 months (range, 3 months to 1 year) after fracture, and the operations were carried out at 4-17 years (mean, 8 years) after deformity occurrence. The valgus angle were 16-25° (mean, 20.6°) and the Flynn functional scores were all poor before operation. Supracondylar closing wedge osteotomies were performed. Two reconstruction plates were moulded and placed to the media and lateral volumes of the humerus to fix the broken ends of the osteotomy surfaces. External fixation was not needed and early rehabil itation was performed postoperatively in all cases. Results Incisions healed by first intention. All cases were followed up 6 to 24 months (mean, 13 months). At last follow-up, the valgus angle was 0-10° (mean, 7.5°). All cases got bone union at 8-13 weeks (mean, 10 weeks) after operation. No related complications occurred, such as infection, nervous or vein injury, and loosening or breakage of internal fixator; and no cubitus varus recurred. The Flynn scores were excellent in 17 cases, good in 3 cases, and fair in 2 cases; the excellent and good rate was 91%. Conclusion The operation of supracondylar osteotomy with double plates internal fixation for the correction of adult post-traumatic cubitus varus deformity can rigidly stabil ize distal humerus, which is helpful to functional training just after operation and satisfactory restoration of the elbow function.
Objective To investigate the treatment methods and the cl inical therapeutic effects of symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy. Methods A retrospective analysis was performed in 18 patients (10 males and 8 females, aged 30-62 years with an average age of 45.3 years) with cervical vertebral hemangioma associated with cervical spondylotic myelopathy between January 2006 and September 2008. The disease duration was 10-26 months (mean, 15.6 months). All patients had single vertebral hemangioma, including 2 cases at C3, 3 cases at C4, 5 cases at C5, 5 cases at C6, and 3 cases at C7. The X-ray films showed a typical “pal isade” change. According to the cl inical and imaging features, there were 13 cases of type II and 5 cases of type IV of cervical hemangioma. The standard anterior cervical decompression and fusion with internal fixation were performed and then percutaneous vertebroplasty (PVP) was used. The cervical X-ray films were taken to observe bone cement distribution and the internal fixation after operation. The recovery of neurological function and the neck pain rel ief were measured by Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) score. Results All operations were successful with no spinal cord and nerves injury, and the incisions healed well. Anterior bone cement leakage occurred in 2 cases without any symptoms. All cases were followed up 24-28 months (mean, 26 months) and the symptoms were improved at different degrees without fracture and collapse of vertebra or recurrence of hemangioma. During the follow-up, there was no implant loosening, breakage and displacement, and the mean fusion time was 4 months (range, 3-4.5 months). The JOA score and VAS score had a significant recovery at 3 months and at last follow-up when compared with preoperative values (P lt; 0.05). Based on JOA score at last follow-up, the results were excellent in 9 cases, good in 6 cases, fair in 2 cases, and poor in 1 case. Conclusion The anterior cervical decompression and fusion with internalfixation combined with PVP treatment is one of the ideal ways to treat symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy, which could completely decompress the spinal cord and effectively alleviate the cl inical symptoms caused by vertebral hemangioma.
Objective To compare the effectiveness of arthroscopy assisted percutaneous internal fixation and open reduction and internal fixation for Schatzker types II and III tibial plateau fractures. Methods Between August 2006 and April 2010, 58 patients with tibial plateau fractures of Schatzker types II and III were treated with arthroscopy assisted percutaneous internal fixation (arthroscopy group, n=38), and with open reduction and internal fixation (control group, n=20). There was no significant difference in gender, age, disease duration, fracture type, and compl ication between 2 groups (P gt; 0.05). The operation time, incision length, fracture heal ing time, and compl ications were compared between 2 groups. Knee function score and the range of motion were measured according to American Hospital for Special Surgery (HSS) scorestandard. Results All patients achieved primary incision heal ing. The arthroscopy group had smaller incision length andlonger operation time than the control group, showing significant differences (P lt; 0.05). The patients of 2 groups were followed up 12 to 14 months. At 6 months, the HSS score and the range of motion of the arthroscopy group were significantly greater than those of the control group (P lt; 0.05). The X-ray films showed bony union in 2 groups. The fracture heal ing time of the arthroscopy group was shorter than that of the control group, but no significant difference was found (t=2.14, P=0.41). Morning stiffness occurred in 2 cases (5.3%) of the arthroscopy group, joint pain in 6 cases (30.0%) of the control group (3 cases had joint stiffness) at 1 week, which were cured after symptomatic treatment. There was significant difference in the incidence of compl ications between 2 groups (χ2=6.743, P=0.016). Conclusion The arthroscopy assisted percutaneous internal fixation is better than open reduction and internal fixation in the treatment of tibial plateau fractures of Schatzker types II and III, because it has smaller incision length and shorter fracture heal ing time.