Study on clinical effects of pedicle screw combined with immobilized implantation bone by wirerope and hallow compression screw immobilization in treating spondylolysis of lumbar vertebra of multiple segments of adults

Objective:To observe clinical effects of pedicle screw fixation combined with cable wires and bone graft and cannulated compression screws on adult multi-segment lumbar spondylolysis.Methods:70 cases of patients with multi-segment lumbar spondylolysis were selected in our hospital.According to different surgical schemes,these patients were divided into the observation group(35 cases)and the control group(35 cases).The observation group received pedicle screw fixation combined with cable wires and bone graft and the control group received cannulated compression screw fixation.Macnab criteria were adopted to implement a therapeutic evaluation of two groups of patients to make an observation and comparison of the excellent and good rate of surgery and a series of indicators including perioperative clinical effects,intraoperative blood loss,duration of surgery,hospital length of stay(HLOS),visual analogue scale(VAS),Oswestry disability index and Japanese Orthopaedic Association(JOA)score.Results:The excellent and good rate of the observation group was 97.14%,and that of the control group was 82.86%,the difference between two groups was statistically significant(χ^(2)=6.248,p=0.012).The differences in intraoperative blood loss,duration of surgery and HLOS between two groups were statistically significant(t=-4.55,t=-4.55,t=-4.55;p<0.05).Oswestry index,VAS score and JOA score of the observation group were(2.4±0.9),(28.5±6.4)and(27.1±3.1)respectively,and these of the control group were(3.5±1.2),(37.1±7.8)and(21.3±2.7)respectively,the differences between two groups were statistically significant(t=4.338,t=5.043,t=8.347,p<0.05).Conclusions:Pedicle screw combined with immobilized implantation bone by wirerope has an excellent clinical effect on the treatment of adult multi-segment lumbar spondylolysis,and it has a series of advantages such as fast postoperative recovery,small surgical trauma and so on.In addition,this technique can also restore the stability of spinal segments and relieve pains to a greater degree.

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

Objective： To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods： We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing （n=23）, followed by fall from height （n=20）, road traffic accidents （n-5） and fall from standing height （n=2）. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn＇s criteria. Results： Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn＇s criteria, 90.4% patients showed satisfactory results. Conclusion： Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.

Comparative study on treating complete dislocation of acromioclavicular joint with three different methods

Objective:To comparatively study complete dislo cation of acromioclavicular joint treated with three different methods. Methods:A total of 96 patients (81 males and 15 females, aged 16-59 years, mean=45 years) with complete dislocation of acromioclavicular join t were treated with Dewars operation (Group A, n=32), internal fixation with K irschner tension band wires (Group B, n=44), or internal fixation with Wolter pl ates (Group C, n=20), respectively, in this study. Eighty-five patients suffere d from acute dislocations and eleven from chronic dislocations. Results:The patients were followed up for 50 months on an aver age. According to Karlssons standard, in Group A, 26 patients were assessed as good, 5 as fair and 1 as poor. In Group B, 20 patients were assessed as good, 1 3 as fair and 11 as poor. In Group C, 15 patients were assessed as good, 4 as fa ir and 1 as poor. The good and fair rates were significantly different between G roup A and Group B, and between Group C and Group B, but no statistical differen ce was found between Group A and Group C. The operating time was ( 52.36 ± 7 .24 ) minutes, ( 67.43 ± 8.11 ) minutes and ( 69.73 ± 8.04 ) minutes in Groups A, B and C, respectively. And the hospitalizing fees were ( 2 400 ± 270) yuan, ( 2 100 ±190) yuan and ( 8 450 ±360) yuan in Groups A, B and C, respectively. Conclusions:Dewars operation is a good and safe method with shorter operating time and lower hospitalizing fee for treating complete disloca tion of acromioclavicular joint. The method is simple without the need of a seco nd operation to remove the implants and with few complications.

K-wire and tension band wire fixation in treating sternoclavicular joint dislocation

Objective： To evaluate the feasibility and therapeutic effect of treating sternoclavicular joint dislocation by K-wire and tension band wire fixation, and to improve the safety and stability of this technique.Methods： This study consisted of 9 cases, 6 males and 3 females with the mean age of 25 years （range, 9-62 years）.The causes were traffic accident in 7 cases, falling in 1 case and fight in 1 case. The duration from injury to operation was 2 hours to 7 days. There were 5 left dislocations and 4right dislocations; 8 anterior dislocations and 1 posterior dislocation, including one combined with left scapular fracture and one with left olecranon fracture. Open reduction and internal fixation using K-wires and tension band wires were performed to treat dislocations.Results： All patients were followed up for 6 to 24months, 10 months on average. According to Rockwood＇s rating scale on postoperative sternoclavicular joint, 8 cases achieved excellent outcomes with an average score of 13.88,and the rest case achieved a good outcome with the score of 12. Anatomical reduction was obtained in all cases. There were no such postoperative complications as severe infection, injury to blood vessel and nerve, failure of fixation,etc. Patients were all satisfied with the anatomical reduction and functional recovery.Conclusions： The technique of K-wire and tension band wire fixation is safe, simple, effective, less invasive and has been successfully used in orthopedic surgery. It is effective in treating sternoclavicular joint dislocation though it has some disadvantages.

A novel arthroscopic procedure for fixation of avulsion fracture of tibial attachment of anterior cruciate ligament guided by meniscal stitching needle

Objective： To introduce a novel technique in which meniscal stitching needle is used as a puller to induct steel wire to secure the tibial eminence avulsion under arthroscopic visualization, and evaluate the cfinical results. Methods： From 1999 to 2005, fifteen cases of tibial eminence avulsion were treated with this new technique. Lysholm scoring scale system was used to assess knee function before and after surgery. Regular plain anteroposterior and lateral X-ray flms were undertaken to detect the bony healing of avulsed fragment. Results： The operating time could be controlled within 30 minutes. No complications such as intraarticular infection, iatrogenic injury, fibroarthritis or nonunion of fracture occurred in this group. X-ray film revealed that bony healing in all 15 cases was achieved from 6 weeks to 12 weeks postoperatively. Lysholm score was improved from 19.1 ± 15.2 （ ranging from 10 to 56 ） preoperatively to 97.5 ± 3.7 （ranging from 91 to 100） postoperatively on average in 12-54 months follow up （mean 23 months）. The statistically significant difference was shown in Student＇s t test （t = 18. 483, P =3. 100×10^-11, P 〈 0. 01）. Wire breakage was found in two patients whose wires were removed 8 months and 14 months after initial operation, respectively. Conclusion： This technique has many advantages, such as simplicity, wide indications from type Ⅱ to type Ⅳ fractures, minimal invasion, short operating time and predictable satisfactory results.

Outcome of surgical treatment of type Ⅳ capitellum frac- tures in adults

Objective： Fractures of the capitellum and trochlea constitute less than 1% of all elbow fractures and a shear fracture involving the capitellum and extending medially into most of the trochlea is rarely reported. Type Ⅳ capitellum fracture is still controversial in regard to its ra- diographic appearance, surgical approach and osteosynthesis. We report 10 cases of type Ⅳ capitellum fracture with a view to elucidating its clinical features and treatment outcome. Methods： We treated 10 patients of type Ⅳ capitellum fracture with a mean age of 32 years. A uniform surgical approach and postoperative rehabilitation were followed. Results： Nine patients presented to us after a mean of 4 days of injury and one patient was nonunion after 6 months of injury who had been treated conservatively by a bone setter. Double arc sign was absent in 6 cases. Intraopera- tively 6 capitellotrochlear fragments were devoid of soft tissue attachments. By Mayo Elbow Performance Score evaluation, 7 patients got excellent, 2 good and 1 fair results. One patient with associated elbow dislocation developed heterotopic ossification. There was no case of avascular necrosis, osteoarthrosis or fixation failures. Conclusions： Type Ⅳ capitellum fractures are rare and belong to complex articular injuries. A good functional out- come can only be achieved with open reduction and stable internal fixation followed by early mobilization. Preopera- tive radiographic assessment and computed tomography help surgeons in choosing the right surgical approach and implants. Good surgical technique and stable internal fixa- tion are the keys to early mobilization and good functional outcome.

Unstable mallet fractures： a comparison between three different techniques in a multicenter study

Objective： Management of mallet fractures is still a matter of discussion throughout the literature. For some authors, mallet fractures involving more than 1/3 of the articular surface and palmar subluxation of the distal phalanx require surgical treatment. In this study we retrospectively compared three different techniques for mallet fractures： Kirschner wire fixation with extension block pinning （EBP） of the distal interphalangeal joint, Kirschner wires used as joysticks （KWJ） and interfragmentary miniscrews for open reduction and internal fixation （ORIF）. Methods： Fifty-eight mallet fractures with palmar subluxation in 58 patients were treated with the aforementioned surgical techniques. Twenty mallet fractures in 20 patients 18 to 70 years old （average 42 years） were operated upon by EBP, 16 patients 22 to 56 years old （average 56 years） were operated upon using KWJ and 22 patients 22 to 54 years old （average 36 years） received OR/F. Follow-up time was 6 to 58 months （average 21 months）. The following intraoperative parameters were considered： intraoperative time, number of Kirschner wires/screws and technical problems. Postoperative parameters included work absence and complications. The radiological evaluation was based on A-P and lateral views preoperatively and interviews at follow-up time. Bone union was defined by radiological evidence of bone trabeculae crossing the fracture site on at least one view. Clinical evaluation involved range of motion （ROM） test with a goniometer. Based on these measurements, a functional Crawford score was established. Results： All fractures healed. In the KWJ group, intraoperative time was shorter and total ROM was wider （72° vs 58° and 54 °）; in the ORIF group, return to work was faster （2.7 weeks vs 7.2 weeks and 6 weeks） but a little higher complication rate due to screw positioning has been found. Functional results as to total ROM, distal interphalangeal lag extension and Crawford classification were similar. Conclusions： We demonstrate the advantages of the use of the three techniques and bone consolidation in all cases with no signs ofosteoarthritis. Screw fixation is more technically demanding （longer intraoperative time and more complications） but allows earlier mobilization and faster returning to work. EBP and KWJ techniques are faster to perform with no complications but require a careful management of the pin tracts. There is no statistically significant difference as to functional results.

Treatment of irreducible femoral intertrochanteric fractures using a wire-guided device

Purpose:Treatment of irreducible femoral intertrochanteric fractures often requires open reduction.However,the technique unavoidably causes patients to suffer greater trauma.As such,minimally invasive techniques should be employed to reduce the surgical-related trauma on these patients and maintain a stable reduction of the fractures.Herein,a minimally invasive wire introducer was designed and used for the treatment of femoral intertrochanteric fractures.The effectiveness of using a wireguided device to treat irreducible femoral intertrochanteric fractures was evaluated.Methods:Between 2013 and 2018,patients with femoral intertrochanteric fractures who were initially treated by intramedullary nail fixation but had difficult reduction using the traction beds were retrospectively reviewed.Decision for an additional surgery was based on the displacement of the fracture.The patients were then divided into two groups:those in the control group received an open reduction surgery while those in the observation group received a closed reduction surgery using a minimally invasive wire introducer to guide the wire that could assist in fracture reduction.The operation time,blood loss,visual analogue scale scores,angulation,reduction,neck-shaft angle,re-displacement,limb length discrepancy,and union time were then recorded and analyzed to determine the efficiency of the wire introducer technique.Categorical variables were analyzed by using Chi-square test,while continuous variables by independent t-test and the Mann-Whitney test accordingly.Results:There were 92 patients included in this study:61 in the control group and 31 in the observation group.There were no significant differences in baseline demographic factors between the two groups.All surgeries were successful with no deaths within the perioperative period.The average follow-up time for the patients was 23.8 months.However,the observation group had a significantly shorter operation time,lower visual analogue scale score,less intraoperative bleeding,and shorter fracture healing time.There were no significant differences in the angulation,reduction,neck-shaft angle,and limb length discrepancy between the two groups.Conclusion:The minimally invasive wire guide achieved a similar effect to that of open reduction in the treatment of intertrochanteric fractures with difficult reduction.Moreover,the minimally invasive wire introducer is a good technology that accurately guides the wire during reduction.Indeed,it is an effective technique and achieves good clinical outcomes in restoration of irreducible femoral intertrochanteric fractures.

Kirschner wire migration from subcapital humeral fracture site, causing hydropneumothorax

Migration of wires or pins around the shoulder is a known complication, though their migration within the chest is uncommon. We report an unusual case of hydropneumothorax due to migration of a bent Kirschner wire from the right proximal humerus in a 63 year-old man. We reviewed his clinical history, physical examination, imaging findings, surgical method and outcome. We also reviewed the literature on orthopaedic wire migration and latest technique in removal of the wires. Chest radiographs and chest computerized tomography are useful in detection and diagnosis of this disorder. Regular radiographic follow-up is needed for patients with internal fixation devices; any fractured or migrated pins or wires must be removed immediately to prevent dangerous complications. It is always important to remove the wires at the end of the treatment. Early removal of fixation wires and regular follow-up if wires are retained are essential to prevent serious complications.

Kirschner wire migration from the right second rib to the right ventricle： a case report

Migrations of orthopedic wires to car- diovascular system are uncommon and rarely reported. We report a case of right ventricle embolization with the Kirschner wire that was used for right 2nd rib osteosynthesis 2 years and 8 months previously in a 50-year-old man. The patient was asymptomatic and migration of the Kirschner wire was discovered by routine chest X-ray. An 8 cm-long Kirschner wire was successfully retrieved from the right ventricle. The treatment strategy for Kirschner wire removal from right ventricle is discussed.

Removal of a broken guide wire entrapped in a fractured femoral neck

Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw （DHS）. Breakage of a guide wire during operation is a very rare condition. We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type IV frac- ture of the right femoral neck. The distal end of the guide wire broke and was entrapped in the fractured femoral neck. We tried to get the broken part out by a cannulated drill. Reaming was started with the cannulated drill slowly rotat- ing arotmd the guide K-wire until the reamer fully contained the target under fluoroscope. A bone curette was used to get the broken wire out but failed, so we had to use the cannuated drill to dredge this bone tunnel. Finally the bro-ken wire end was taken out, mixed with blood and bone fragments. Through the existing drilling channel, DHS fixa- tion was easily finished. The patient had an uneventful re- covery without avascular necrosis of femoral head or non- union of the fracture at one year＇s follow-up. A few methods can be adopted to deal with the broken guide wire. The way used in our case is less invasive but technically challenging. When the guide wire is properly positioned, this method is very practical and useful.