Objective To investigate mechanism involved i n knee joint rehabilition by compreh ensive rehabilitation therapy foll owing com-minuted fracture of patella surgery.Method25patients suffered from comminute d fracture o...Objective To investigate mechanism involved i n knee joint rehabilition by compreh ensive rehabilitation therapy foll owing com-minuted fracture of patella surgery.Method25patients suffered from comminute d fracture of patella received rehabilitation training,drugs administration and physical therapy.Results Knee joint function was evaluated,e xcellent 22cases,good 2cases,favo rable 1case,good rate was 96%.Conclusion Rehabilitation of knee joint is satisfying in patients underwent compre hensive rehabilitation treatment.So,comprehensive rehabilitation treatment is valuable in clinic.展开更多
Objective To investigate the stress distribution of the femur after cemented prosthetic replacement in aged patients with comminuted intertrochanteric fracture and to analyze the difference of stress distribution betw...Objective To investigate the stress distribution of the femur after cemented prosthetic replacement in aged patients with comminuted intertrochanteric fracture and to analyze the difference of stress distribution between cemented long展开更多
The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters fol...The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.展开更多
Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and inter...Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation(ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty(TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.展开更多
Introduction: Proximal femoral nail is a better choice of implant for the treatment of an unstable trochanteric fracture, however it is associated with screw migration and cutout because of greater trochanteric commin...Introduction: Proximal femoral nail is a better choice of implant for the treatment of an unstable trochanteric fracture, however it is associated with screw migration and cutout because of greater trochanteric comminution and coronal split. This study is to evaluate the results of Trochanteric Buttress Plate (TBP) combined with PFN in an unstable IT fractures for buttressing lateral wall and reinforcing fixation. Materials and Methods: We carried out a consecutive study of 32 patients of Unstable intertrochanteric fracture femur with lateral wall comminution. It was studied at Ashwini Sahakari Rugnalaya and Sanshodhan Kendra Solapur India and Government medical college Chandrapur India from April-2015 to December-2017 using innovative Trochanteric buttress plate along with PFN. Eighteen male and fourteen female in the age group of 55 to 80 years were included in the study. There were 26 cases of A3 and six cases of A2 were fixed by PFN combined with trochanteric buttress plate to augment the comminuted lateral wall. Results: The bone healing is observed in all the cases in the mean period of 12.6 weeks. Four patients developed complications, including lateral migration of neck screws (n = 2), superficial infection (n = 2). Patients were followed up for a mean of 10.6 months. At the end of follow-up the Salvati and Wilson hip function was 36 (out of 40) in 87.5% of patients [twenty eight patients]. The clinical, radiological and functional outcomes were found to be satisfactory. Conclusion: The stabilization of lateral trochanteric wall with trochanteric buttress plate restores anatomy, increases the stability of construct and prevents inherent complication of screw migration and cutout.展开更多
AIM： To investigate clinical efficacy of displaced intra-articular calcaneal fracture （DIACF） following operation and nonoperation. METHODS： Literature search was performed of PubMed and Cochrane Library by two in...AIM： To investigate clinical efficacy of displaced intra-articular calcaneal fracture （DIACF） following operation and nonoperation. METHODS： Literature search was performed of PubMed and Cochrane Library by two independent authors to identify randomized controlled trials （RCTs） comparing operative vs nonoperative treatment of DIACF from inception to December 31st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or random-effects models were adopted with P 〉 0.05 or P ≤ 0.05 for heterogeneity tests, respectively.RESULTS： Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job （P = 0.006）. No statistical differences were found between the two groups in residual pain （P = 0.33）, shoe fitting problems （P = 0.07）, limited walking distance （P = 0.56） or secondary late arthrodesis （P = 0.38）. However, operative treatment was associated with a higher complication rate （P = 0.003）. Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems （P 〈 0.0001） in operative group, the two groups had similar complication rate in deep wound infection （ P = 0.34）,CONCLUSION： Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.展开更多
Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic...Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76°and 64°, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.展开更多
目的:外固定支架和钢板内固定作为桡骨远端粉碎性骨折的常用治疗方法,在临床上各有利弊。系统评价外固定支架与钢板内固定治疗粉碎性桡骨远端骨折的临床疗效及安全性,为桡骨远端骨折中西医结合诊疗指南研制提供论证依据。方法:系统检索P...目的:外固定支架和钢板内固定作为桡骨远端粉碎性骨折的常用治疗方法,在临床上各有利弊。系统评价外固定支架与钢板内固定治疗粉碎性桡骨远端骨折的临床疗效及安全性,为桡骨远端骨折中西医结合诊疗指南研制提供论证依据。方法:系统检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、中国生物医学文献数据库、维普和万方数据库,纳入2013年10月至2023年10月发表的关于外固定支架和钢板内固定治疗粉碎性桡骨远端骨折的随机对照试验文献,按照纳入标准和排除标准筛选文献,使用Review Manager进行文献质量评价和Meta分析。结果:(1)纳入8篇文献,其中中文文献4篇,英文文献4篇、总样本量648例,外固定支架组328例,钢板内固定组320例;(2)术后3个月,钢板内固定组的背伸、掌屈、旋后范围优于外固定支架组;术后12个月,钢板内固定组的握力、掌倾角、掌屈、旋前和旋后范围优于外固定支架组;钢板内固定组在术后感染方面优于外固定支架组,其余结局指标两组差异均无显著性意义。结论:现有8项证据表明,在粉碎性桡骨远端骨折的治疗方式选择上,外固定支架与切开钢板内固定都有良好的治疗效果,综合其他因素钢板内固定更胜一筹,但是对于一些高度严重的粉碎性桡骨远端骨折、骨质较差、严重污染的开放性骨折以及软组织肿胀而无法进行切开手术的特殊患者,外固定支架才是首选。此次研究结果具有局限性,未来还需要开展更多高质量、大样本、多中心的随机对照试验研究,另外需重视远期疗效、其他次要指标的观察,补充优化当前研究结果。展开更多
文摘Objective To investigate mechanism involved i n knee joint rehabilition by compreh ensive rehabilitation therapy foll owing com-minuted fracture of patella surgery.Method25patients suffered from comminute d fracture of patella received rehabilitation training,drugs administration and physical therapy.Results Knee joint function was evaluated,e xcellent 22cases,good 2cases,favo rable 1case,good rate was 96%.Conclusion Rehabilitation of knee joint is satisfying in patients underwent compre hensive rehabilitation treatment.So,comprehensive rehabilitation treatment is valuable in clinic.
文摘Objective To investigate the stress distribution of the femur after cemented prosthetic replacement in aged patients with comminuted intertrochanteric fracture and to analyze the difference of stress distribution between cemented long
基金supported by National Natural Science Foundation of China Grant 81560350
文摘The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.
文摘Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation(ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty(TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.
文摘Introduction: Proximal femoral nail is a better choice of implant for the treatment of an unstable trochanteric fracture, however it is associated with screw migration and cutout because of greater trochanteric comminution and coronal split. This study is to evaluate the results of Trochanteric Buttress Plate (TBP) combined with PFN in an unstable IT fractures for buttressing lateral wall and reinforcing fixation. Materials and Methods: We carried out a consecutive study of 32 patients of Unstable intertrochanteric fracture femur with lateral wall comminution. It was studied at Ashwini Sahakari Rugnalaya and Sanshodhan Kendra Solapur India and Government medical college Chandrapur India from April-2015 to December-2017 using innovative Trochanteric buttress plate along with PFN. Eighteen male and fourteen female in the age group of 55 to 80 years were included in the study. There were 26 cases of A3 and six cases of A2 were fixed by PFN combined with trochanteric buttress plate to augment the comminuted lateral wall. Results: The bone healing is observed in all the cases in the mean period of 12.6 weeks. Four patients developed complications, including lateral migration of neck screws (n = 2), superficial infection (n = 2). Patients were followed up for a mean of 10.6 months. At the end of follow-up the Salvati and Wilson hip function was 36 (out of 40) in 87.5% of patients [twenty eight patients]. The clinical, radiological and functional outcomes were found to be satisfactory. Conclusion: The stabilization of lateral trochanteric wall with trochanteric buttress plate restores anatomy, increases the stability of construct and prevents inherent complication of screw migration and cutout.
文摘AIM： To investigate clinical efficacy of displaced intra-articular calcaneal fracture （DIACF） following operation and nonoperation. METHODS： Literature search was performed of PubMed and Cochrane Library by two independent authors to identify randomized controlled trials （RCTs） comparing operative vs nonoperative treatment of DIACF from inception to December 31st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or random-effects models were adopted with P 〉 0.05 or P ≤ 0.05 for heterogeneity tests, respectively.RESULTS： Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job （P = 0.006）. No statistical differences were found between the two groups in residual pain （P = 0.33）, shoe fitting problems （P = 0.07）, limited walking distance （P = 0.56） or secondary late arthrodesis （P = 0.38）. However, operative treatment was associated with a higher complication rate （P = 0.003）. Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems （P 〈 0.0001） in operative group, the two groups had similar complication rate in deep wound infection （ P = 0.34）,CONCLUSION： Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.
文摘Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76°and 64°, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.
文摘目的:外固定支架和钢板内固定作为桡骨远端粉碎性骨折的常用治疗方法,在临床上各有利弊。系统评价外固定支架与钢板内固定治疗粉碎性桡骨远端骨折的临床疗效及安全性,为桡骨远端骨折中西医结合诊疗指南研制提供论证依据。方法:系统检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、中国生物医学文献数据库、维普和万方数据库,纳入2013年10月至2023年10月发表的关于外固定支架和钢板内固定治疗粉碎性桡骨远端骨折的随机对照试验文献,按照纳入标准和排除标准筛选文献,使用Review Manager进行文献质量评价和Meta分析。结果:(1)纳入8篇文献,其中中文文献4篇,英文文献4篇、总样本量648例,外固定支架组328例,钢板内固定组320例;(2)术后3个月,钢板内固定组的背伸、掌屈、旋后范围优于外固定支架组;术后12个月,钢板内固定组的握力、掌倾角、掌屈、旋前和旋后范围优于外固定支架组;钢板内固定组在术后感染方面优于外固定支架组,其余结局指标两组差异均无显著性意义。结论:现有8项证据表明,在粉碎性桡骨远端骨折的治疗方式选择上,外固定支架与切开钢板内固定都有良好的治疗效果,综合其他因素钢板内固定更胜一筹,但是对于一些高度严重的粉碎性桡骨远端骨折、骨质较差、严重污染的开放性骨折以及软组织肿胀而无法进行切开手术的特殊患者,外固定支架才是首选。此次研究结果具有局限性,未来还需要开展更多高质量、大样本、多中心的随机对照试验研究,另外需重视远期疗效、其他次要指标的观察,补充优化当前研究结果。
