Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic ...Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic aspects of PSA of the diaphysis of long bones. Method: This retrospective work concerns 30 cases of non-union of the diaphysis of long bones treated in the orthopedic and trauma surgery department at Donka National Hospital, during a period of 18 months from January 1, 2019 to June 30, 2020. Results: We recruited 30 patients, 80% of whom were male, with an average age of 39.9 years. Public road accidents (AVP) represented the main cause of fractures of the diaphysis of long bones 87%, they were open in 25 cases or 83%. The fractures were located in the middle 1/3 of the diaphysis of the long bones in 50% of cases. Treatment of initial fractures was traditional in 21 cases, orthopedic in 2 cases and surgical in 7 cases. It was aseptic nonunion in 28 cases (93%) and septic nonunion in 2 cases. They were hypertrophic in 7 cases, slightly hypertrophic in 5 cases, oligotrophic in 11 cases, atrophic in 6 cases and with bone defect in 1 case. The treatment was based on osteosynthesis including 16 cases of screwed “PV” plate: 7 cases of centromedullary “ECM” nailing, 2 cases of external fixator, 1 case of broaching and 4 cases of Plastering. The results according to ASAMI criteria on an anatomical level were excellent in 19 cases, good in 3 cases and poor in 3 cases, with a union rate of 76%. And 5 patients undergoing consolidation. Conclusion: Based on the literature data and the experience of our department, the true treatment of PSA requires correct management of the initial fracture without forgetting the interest in preventing AVP which appears to be an element essential, making it possible to reduce the incidence of fractures of the diaphysis.展开更多
The locking compression plates (LCP) are efficient tools in open reduction and internal fixation (ORIF), especially in osteoporotic bones. Two important factors of screw density and screw position can affect the funct...The locking compression plates (LCP) are efficient tools in open reduction and internal fixation (ORIF), especially in osteoporotic bones. Two important factors of screw density and screw position can affect the functionality of the bone plate. Several studies have assessed the influence of the screw configurations on the bone-plate stiffness, but the effects of screw positions on the interfragmentary strain, εIF of LCP construct have not been investigated yet. In this study, finite element method was used to investigate the influence of screws number and position on the interfragmentary strain of LCP-femur system for a mid-shaft fracture. Results of this study showed that by insertion of screws closer to the fracture site, εIF decreases by 2nd degree polynomial function versus screw position, but by adding the screws from the ends of the plate, or by moving and placing the screws towards the fracture site, the reduction of εIF will be linear. Results of this study were compared and are in agreement with some studies in the literature, even though their scope was mostly stability of the bone-implant system, whereas our scope was focused on the interfragmentary strain.展开更多
AIM: To demonstrate that long head of the biceps tendon(LHBT) tenodesis is possible more than 3 mo after rupture. METHODS: From September 2009 to January 2012 we performed tenodesis of the LHBT in 11 individuals(avera...AIM: To demonstrate that long head of the biceps tendon(LHBT) tenodesis is possible more than 3 mo after rupture. METHODS: From September 2009 to January 2012 we performed tenodesis of the LHBT in 11 individuals(average age 56.9 years, range 42 to 73) more than 3 mo after rupture. All patients were evaluated by Disabilites of the Arm Shoulder and Hand(DASH) and Mayo outcome scores at an average follow-up of 19.1 mo. We similarly evaluated 5 patients(average age 58.2 years, range 45 to 64) over the same time treated within 3 mo of rupture with an average follow-up of 22.5 mo.RESULTS: Tenodesis with an interference screw was possible in all patients more than 3 mo after rupture and 90% had good to excellent outcomes but two had recurrent rupture. All of those who had tenodesis less than 3 mo after rupture had good to excellent outcomes and none had recurrent rupture. No statistical difference was found for DASH and Mayo outcome scores between the two groups(P <0.05). CONCLUSION: Tenodesis of LHBT more than 3 mo following rupture had outcomes similar to tenodesis done within 3 mo of rupture but recurrent rupture occurred in 20%.展开更多
目的比较短节段骨水泥强化椎弓根螺钉与长节段普通椎弓根螺钉固定治疗老年胸腰椎爆裂骨折的临床效果。方法将80例老年胸腰椎爆裂骨折患者根据固定方式不同分为A组(40例,采用短节段骨水泥强化椎弓根螺钉固定治疗)和B组(40例,采用长节段...目的比较短节段骨水泥强化椎弓根螺钉与长节段普通椎弓根螺钉固定治疗老年胸腰椎爆裂骨折的临床效果。方法将80例老年胸腰椎爆裂骨折患者根据固定方式不同分为A组(40例,采用短节段骨水泥强化椎弓根螺钉固定治疗)和B组(40例,采用长节段普通椎弓根螺钉固定治疗)。记录两组手术情况、伤椎前缘高度丢失率、伤椎Cobb角、疼痛VAS评分及并发症发生情况。结果患者均获得随访,时间10~35个月。手术时间、切口长度、术中出血量A组均短(少)于B组(P<0.01)。疼痛VAS评分:术后4 d B组低于A组(P<0.01);末次随访两组比较差异无统计学意义(P>0.05)。伤椎前缘高度丢失率、伤椎Cobb角:两组术后、末次随访均较术前改善(P<0.05);两组末次随访与术后比较均有所丢失,但A组比较差异无统计学意义(P>0.05),而B组比较差异有统计学意义(P<0.05);两组术后比较差异均无统计学意义(P>0.05);末次随访A组均优于B组(P<0.05)。并发症发生率A组低于B组(P<0.05)。结论与长节段普通椎弓根螺钉相比,后路短节段骨水泥强化椎弓根螺钉固定治疗老年胸腰椎爆裂骨折具有手术切口小、术中出血少、手术时间短、术后椎体高度维持较好、并发症少等优点,但需注意骨水泥渗漏风险。展开更多
文摘Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic aspects of PSA of the diaphysis of long bones. Method: This retrospective work concerns 30 cases of non-union of the diaphysis of long bones treated in the orthopedic and trauma surgery department at Donka National Hospital, during a period of 18 months from January 1, 2019 to June 30, 2020. Results: We recruited 30 patients, 80% of whom were male, with an average age of 39.9 years. Public road accidents (AVP) represented the main cause of fractures of the diaphysis of long bones 87%, they were open in 25 cases or 83%. The fractures were located in the middle 1/3 of the diaphysis of the long bones in 50% of cases. Treatment of initial fractures was traditional in 21 cases, orthopedic in 2 cases and surgical in 7 cases. It was aseptic nonunion in 28 cases (93%) and septic nonunion in 2 cases. They were hypertrophic in 7 cases, slightly hypertrophic in 5 cases, oligotrophic in 11 cases, atrophic in 6 cases and with bone defect in 1 case. The treatment was based on osteosynthesis including 16 cases of screwed “PV” plate: 7 cases of centromedullary “ECM” nailing, 2 cases of external fixator, 1 case of broaching and 4 cases of Plastering. The results according to ASAMI criteria on an anatomical level were excellent in 19 cases, good in 3 cases and poor in 3 cases, with a union rate of 76%. And 5 patients undergoing consolidation. Conclusion: Based on the literature data and the experience of our department, the true treatment of PSA requires correct management of the initial fracture without forgetting the interest in preventing AVP which appears to be an element essential, making it possible to reduce the incidence of fractures of the diaphysis.
文摘The locking compression plates (LCP) are efficient tools in open reduction and internal fixation (ORIF), especially in osteoporotic bones. Two important factors of screw density and screw position can affect the functionality of the bone plate. Several studies have assessed the influence of the screw configurations on the bone-plate stiffness, but the effects of screw positions on the interfragmentary strain, εIF of LCP construct have not been investigated yet. In this study, finite element method was used to investigate the influence of screws number and position on the interfragmentary strain of LCP-femur system for a mid-shaft fracture. Results of this study showed that by insertion of screws closer to the fracture site, εIF decreases by 2nd degree polynomial function versus screw position, but by adding the screws from the ends of the plate, or by moving and placing the screws towards the fracture site, the reduction of εIF will be linear. Results of this study were compared and are in agreement with some studies in the literature, even though their scope was mostly stability of the bone-implant system, whereas our scope was focused on the interfragmentary strain.
文摘AIM: To demonstrate that long head of the biceps tendon(LHBT) tenodesis is possible more than 3 mo after rupture. METHODS: From September 2009 to January 2012 we performed tenodesis of the LHBT in 11 individuals(average age 56.9 years, range 42 to 73) more than 3 mo after rupture. All patients were evaluated by Disabilites of the Arm Shoulder and Hand(DASH) and Mayo outcome scores at an average follow-up of 19.1 mo. We similarly evaluated 5 patients(average age 58.2 years, range 45 to 64) over the same time treated within 3 mo of rupture with an average follow-up of 22.5 mo.RESULTS: Tenodesis with an interference screw was possible in all patients more than 3 mo after rupture and 90% had good to excellent outcomes but two had recurrent rupture. All of those who had tenodesis less than 3 mo after rupture had good to excellent outcomes and none had recurrent rupture. No statistical difference was found for DASH and Mayo outcome scores between the two groups(P <0.05). CONCLUSION: Tenodesis of LHBT more than 3 mo following rupture had outcomes similar to tenodesis done within 3 mo of rupture but recurrent rupture occurred in 20%.
文摘目的比较短节段骨水泥强化椎弓根螺钉与长节段普通椎弓根螺钉固定治疗老年胸腰椎爆裂骨折的临床效果。方法将80例老年胸腰椎爆裂骨折患者根据固定方式不同分为A组(40例,采用短节段骨水泥强化椎弓根螺钉固定治疗)和B组(40例,采用长节段普通椎弓根螺钉固定治疗)。记录两组手术情况、伤椎前缘高度丢失率、伤椎Cobb角、疼痛VAS评分及并发症发生情况。结果患者均获得随访,时间10~35个月。手术时间、切口长度、术中出血量A组均短(少)于B组(P<0.01)。疼痛VAS评分:术后4 d B组低于A组(P<0.01);末次随访两组比较差异无统计学意义(P>0.05)。伤椎前缘高度丢失率、伤椎Cobb角:两组术后、末次随访均较术前改善(P<0.05);两组末次随访与术后比较均有所丢失,但A组比较差异无统计学意义(P>0.05),而B组比较差异有统计学意义(P<0.05);两组术后比较差异均无统计学意义(P>0.05);末次随访A组均优于B组(P<0.05)。并发症发生率A组低于B组(P<0.05)。结论与长节段普通椎弓根螺钉相比,后路短节段骨水泥强化椎弓根螺钉固定治疗老年胸腰椎爆裂骨折具有手术切口小、术中出血少、手术时间短、术后椎体高度维持较好、并发症少等优点,但需注意骨水泥渗漏风险。
