Objective To evaluate the effectiveness of open reduction and medial-lateral double plate internal fixation for type C distal humeral fractures. Methods Between June 2002 and January 2009, 32 patients with distal humeral intra-articular fractures were treated. There were 19 males and 13 females, aged 19-70 years (mean, 43.3 years). The fracture was caused by fall ing in 7 cases, by traffic accident in 15 cases, by fall ing from height in 5 cases, by crush injury in 4 cases, and by machine injury in 1 case. The time from injury to operation was 8 hours-7 days (mean, 3.3 days). Of 32 patients, 1 had open fracture and 31 had closed fracture; 5 patients compl icated by injury of ular nerve. According to AO/Association for the Study of Internal Fixation (AO/ASIF) classification, there were 9 cases of type C1, 16 of type C2, and 7 of type C3. Open reduction and medial-lateral double plate internal fixation were performed through posterior midl ine approach in 8 cases and through medial-lateral two-incision approaches in 24 cases. Results All incisions healed by first intention. The 32 cases were followed up 11-24 months (mean, 14 months). The X-ray films showed that all fractures healed at 3-6 months (mean, 3.8 months). According to Aitken et al. scoring system, the results were excellent in 22 cases, good in 6 cases, fair in 3 cases, and poor in 1 case with an excellent and good rate of 87.5%. In 5 patients with injury of ular nerve, 4 cases completely recovered at 6 months and 1 case still showed some symptoms after 1 year. Conclusion Treatment of type C distal humeral fractures with open reduction and medial-lateral double plate internal fixation can get good cl inical results.
ObjectiveTo investigate the early-term effectiveness of carpal arthroscopy in the treatment of intra-articular fractures of distal radius.MethodsThe clinical data of 50 cases of intra-articular fractures of distal radius between January 2015 and December 2017 were retrospectively analyzed. According to the different methods of intraoperative assisted treatment, the patients were divided into the trial group (11 cases with carpal arthroscopy assisted treatment) and the control group (39 cases with traditional open reduction). There was no significant difference between the two groups in general data such as gender, age, affected side, cause of injury, time from injury to operation, and preoperative displacement (P>0.05), which were comparable. Six patients in the trial group had triangular fibrocartilage complex (TFCC) injury and received one-stage repair. Postoperative X-ray films were taken to estimate the fracture reduction. Patient-Rated Wrist Evaluation (PRWE) wrist function score and modified Mayo score were used at 3 months after operation to evaluate the function of the wrist. The range of wrist flexion, extension, pronation, and supination motion of the two groups were recorded and compared at 3 months after operation. Patients in the trial group were further divided into the reduction group after arthroscopic exploration (group A, 6 cases) and the simple cleaning group after arthroscopic exploration (group B, 5 cases), and their wrist motions were compared.ResultsThe operation time of the trial group was greater than that of the control group (t=11.08, P=0.00). There was no significant difference in intraoperative blood loss and fracture reduction between the two group (P>0.05). X-ray film at 1 day after operation showed that the degree of fracture displacement was significantly decreased when compared with preoperative one in each group (P<0.05), but no significant difference was found between the two groups at 1 day after operation (t=0.19, P=0.85). Patients in both groups were followed up 8-20 months, with an average of 12 months. There was no significant difference in fracture healing time between the two groups (t=0.52, P=0.60). At 3 months after operation, the PRWE score, modified Mayo score, and wrist motions in the trial group were all better than those in the control group (P<0.05). There was no significant difference in wrist motions between group A and group B (P>0.05). ConclusionCarpal arthroscope assisted treatment of intra-articular fractures of distal radius can achieve good reduction and postoperative function. Meanwhile, TFCC, ligament, articular cartilage, and other injuries can be repaired in one stage.
Objective To compare the effectiveness of open reduction and internal fixation with plate and closed reduction and internal fixation with Kirschner wire (K-wire) in the treatment of intra-articular displaced calcaneal fractures in older children. MethodsA clinical data of 35 older children (37 feet) with intra-articular displaced calcaneal fractures who were admitted between November 2014 and November 2020 and met the selection criteria were retrospectively analyzed. Among them, 19 cases (20 feet) underwent open reduction and internal fixation with plate (plate group), and 16 cases (17 feet) underwent closed reduction and internal fixation with K-wire (K-wire group). There was no significant difference in gender, age, cause of injury, side and type of fracture, and time from injury to admission, and preoperative calcaneal Gissane angle and Böhler angle (P>0.05). The postoperative calcaneal Gissane angle, Böhler angle, complications, and fracture healing were compared between the two groups. The ankle function was evaluated based on the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring system. Results Incision necrosis occurred in 1 foot in the plate group after operation, which healed after symptomatic treatment; the other incisions in the two groups healed by first intention. All children were followed up 12-39 months (mean, 19 months). X-ray films showed that the fractures in both groups healed; the healing time was (2.65±0.71) months in the plate group and (2.24±1.38) months in the K-wire group respectively, with no significant difference (t=1.161, P=0.253). At last follow-up, the calcaneal Gissane angle and Böhler angle returned to normal; and the difference between pre- and post-operation in the two group was significant (P<0.05), but there was no significant difference between the two groups in the difference between before and after operation (P>0.05). In the plate group, the plate was removed at 11-22 months after operation (mean, 16.8 months). At last follow-up, the AOFAS ankle-hindfoot score in the plate group was 91.2±5.1, which was significantly higher than that in the K-wire group (86.9±6.1) (t=2.316, P=0.027). The ankle function was rated as excellent in 15 feet, good in 4 feet, and fair in 1 foot in the plate group, and excellent in 14 feet and good in 3 feet in the K-wire group, and the difference between the two groups was not significant (Z=1.712, P=0.092). ConclusionFor intra-articular displaced calcaneal fracture in older children, the open reduction and internal fixation with plate and closed reduction and internal fixation with K-wire can achieve good effectiveness, but the former has better recovery of ankle function.