<b><span>Purpose</span></b><b><span>: </span></b><span>The purpose </span><span>of </span><span>this study was to define a treatment protoc...<b><span>Purpose</span></b><b><span>: </span></b><span>The purpose </span><span>of </span><span>this study was to define a treatment protocol in which a non-vascularized endosteal fibular strut graft, a corticocancellous grafts and a locking plate construct </span><span>are</span><span> used for stabilization of the delayed and neglected proximal humerus fractures and to report its outcome. </span><b><span>Patients & Methods</span></b><b><span>:</span></b><b><span> </span></b><span>Eleven patients (6 females and 5 males) with delayed, neglected proximal humerus fractures were included in this study,</span><span> </span><span>conducted between March 2015 </span><span>and </span><span>December 2019.</span><span> </span><span>Average age of the patients was 57 years (range: 41 to 67 yrs). All patients were treated with the debridement, decortication and shingling of the bone at the site of the fracture followed by using an endosteal fibular strut graft, corticocancellous bone grafts and stabilization with locking plate. The patients were followed</span><span> </span><span>up for a mean time of 16.3 months (range: 13 </span><span>to </span><span>40 months). The patient outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand Questionnaire, and the modified scoring system of Constant and Murley. </span><b><span>Results</span></b><b><span>:</span></b><b><span> </span></b><span>Union at the fracture site was achieved in all patients at a mean </span><span>of </span><span>8.5 months (range: 6 to 11 months). The DASH score improved from an average pre-operative score of 71.1 (range: 64 to 78) to an average post-operative score of 25.2 (range: 21 to 35) at the final follow-up. Albeit with a small sample size of n</span><span> </span><span>=</span><span> </span><span>11, this difference was found to be statistically significant (p</span><span> </span><span><</span><span> </span><span>0.05). The CM score improved from an average pre-operative score of 33.2 (range: 20 to 48) to an average post-operative score of 66.8 (range: 59 to 72) at the final follow-up. This difference was also found to be statistically significant in this patient cohort (p</span><span> </span><span><</span><span> </span><span>0.05). The results were excellent in 3 patients, good in 6 and moderate in 2. </span><b><span>Conclusions</span></b><b><span>:</span></b><b><span> </span></b><span>An endosteal fibular strut, subperiosteally placed cortico-cancellous grafts with a locking plate fixation helps in biological healing of neglected fractures of proximal humerus.</span>展开更多
Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated...Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results:The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion:The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.展开更多
Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated...Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.展开更多
BACKGROUND Ipsilateral femoral neck and intertrochanteric fractures in young patients are extremely rare,and there is no reference for fracture classification and treatment options.CASE SUMMARY We report a 27-year-old...BACKGROUND Ipsilateral femoral neck and intertrochanteric fractures in young patients are extremely rare,and there is no reference for fracture classification and treatment options.CASE SUMMARY We report a 27-year-old male patient who sustained ipsilateral femoral neck and intertrochanteric fractures and was treated with a proximal femoral locking compression plate(PFLCP).The literature on these fractures was also reviewed.At the last follow-up three years after surgery,the patient had no obvious pain in the hip,and the range of motion in the hip joint was slightly limited,but met the normal life and work needs.There were no complications such as necrosis of the femoral head.CONCLUSION The PFLCP can be used to treat these complex proximal femoral fractures,and selection should be based on the patient's specific fractures.展开更多
Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with...Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results,the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures.The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.Methods We assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures.Eighteen patients were treated with a locking plate and an autologous crest bone graft （experimental group）,and 22 were treated with only the locking plate and no bone graft （control group）.Postoperative assessments included radiographic imaging,range of motion analysis,pain level based on the visual analogue scale （VAS）,and the SF-36 （Short Form （36） Health Survey）,as well as whether patients could retum to their previous occupation.Results All fractures healed both clinically and radiologically in the experimental group.There was no more than 2 mm collapse of the humeral head,and no osteonecrosis or screw penetration of the articular surface.In contrast,two patients had a nonunion in the control group,and they eventually accepted total shoulder replacements.The average time from surgery to radiographic union was significantly shorter in the experimental group （（4.66±1.63） months） compared with the control group （（5.98±1.57） months） （P ＜0.05）.For the experimental versus controls groups,the mean shoulder active flexion （148.00±18.59 vs.121.73±17.20） degrees,extension （49.00±2.22 vs.42.06±2.06） degrees,internal rotation （45.00±5.61 vs.35.00±3.55）degrees,external rotation （64.00±9.17 vs.52.14±5.73）degrees,and abduction （138.00±28.78 vs.105.95±15.66） degrees were all significantly higher （all P ＜0.001）.The median SF-36 in the experimental group （（88.00±5.71） points） was significantly higher than that of the control group （（69.45±9.45） points; P ＜0.001）.The median VAS pain level （mean rank,10.50） in the experimental group was lower than that （mean rank,47.19） of the control group （P ＜0.001）.All but one patient （17 of 18,94.4％） in the experimental group returned to their previous activities or occupations,and that one patient changed to a different occupation because of slight restrictions to activities.On the other hand,four patients could not return to their previous activities or occupations in the control group.Conclusion Locking plate fixation combined with an iliac crest bone graft is an effective technique for treating proximal humerus comminuted fractures.展开更多
目的:探讨锁定钢板内固定治疗股骨近端外侧壁骨折块后的效果。方法:2021年1月至2022年6月收治31例合并外侧壁骨折的股骨转子间骨折患者,其中15例单纯采用股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)固定,男3例,女12例...目的:探讨锁定钢板内固定治疗股骨近端外侧壁骨折块后的效果。方法:2021年1月至2022年6月收治31例合并外侧壁骨折的股骨转子间骨折患者,其中15例单纯采用股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)固定,男3例,女12例;年龄(75.87±7.46)岁;另16例采用PFNA内固定后再应用预弯好的3.5 mm螺孔锁定钢板内固定外侧壁骨折,男4例,女12例;年龄(76.15±9.47)岁。术后随访观察记录比较两组手术指标、尖顶距(tip-apical distance,TAD)、术后负重站立时间、骨折复位情况。术后6个月根据Harris髋关节评分评价术后髋关节功能。结果:两组患者均获得随访,时间7~17(12±5)个月。两组术后即刻颈干角为111°~132°(119.3±8.3)°。骨折复位效果:PFNA组,优11例,可2例,差1例;PFNA+锁定钢板组,优12例,可3例,差1例。PFNA组1例发生螺旋刀片经股骨头切出。两组手术时间、术中出血量及手术切口长度比较,差异有统计学意义(P<0.05);两组TAD及术后负重站立时间比较,差异无统计学意义(P>0.05)。两组术后6个月Harris各项评分和总分比较,差异有统计学意义(P<0.05)。结论:应用PFNA辅助锁定钢板内固定合并外侧壁骨折的股骨转子间骨折疗效确切,可较好恢复外侧壁完整性,提高PFNA内固定的稳定性,术后并发症少。展开更多
文摘<b><span>Purpose</span></b><b><span>: </span></b><span>The purpose </span><span>of </span><span>this study was to define a treatment protocol in which a non-vascularized endosteal fibular strut graft, a corticocancellous grafts and a locking plate construct </span><span>are</span><span> used for stabilization of the delayed and neglected proximal humerus fractures and to report its outcome. </span><b><span>Patients & Methods</span></b><b><span>:</span></b><b><span> </span></b><span>Eleven patients (6 females and 5 males) with delayed, neglected proximal humerus fractures were included in this study,</span><span> </span><span>conducted between March 2015 </span><span>and </span><span>December 2019.</span><span> </span><span>Average age of the patients was 57 years (range: 41 to 67 yrs). All patients were treated with the debridement, decortication and shingling of the bone at the site of the fracture followed by using an endosteal fibular strut graft, corticocancellous bone grafts and stabilization with locking plate. The patients were followed</span><span> </span><span>up for a mean time of 16.3 months (range: 13 </span><span>to </span><span>40 months). The patient outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand Questionnaire, and the modified scoring system of Constant and Murley. </span><b><span>Results</span></b><b><span>:</span></b><b><span> </span></b><span>Union at the fracture site was achieved in all patients at a mean </span><span>of </span><span>8.5 months (range: 6 to 11 months). The DASH score improved from an average pre-operative score of 71.1 (range: 64 to 78) to an average post-operative score of 25.2 (range: 21 to 35) at the final follow-up. Albeit with a small sample size of n</span><span> </span><span>=</span><span> </span><span>11, this difference was found to be statistically significant (p</span><span> </span><span><</span><span> </span><span>0.05). The CM score improved from an average pre-operative score of 33.2 (range: 20 to 48) to an average post-operative score of 66.8 (range: 59 to 72) at the final follow-up. This difference was also found to be statistically significant in this patient cohort (p</span><span> </span><span><</span><span> </span><span>0.05). The results were excellent in 3 patients, good in 6 and moderate in 2. </span><b><span>Conclusions</span></b><b><span>:</span></b><b><span> </span></b><span>An endosteal fibular strut, subperiosteally placed cortico-cancellous grafts with a locking plate fixation helps in biological healing of neglected fractures of proximal humerus.</span>
文摘Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results:The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion:The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.
文摘Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.
文摘BACKGROUND Ipsilateral femoral neck and intertrochanteric fractures in young patients are extremely rare,and there is no reference for fracture classification and treatment options.CASE SUMMARY We report a 27-year-old male patient who sustained ipsilateral femoral neck and intertrochanteric fractures and was treated with a proximal femoral locking compression plate(PFLCP).The literature on these fractures was also reviewed.At the last follow-up three years after surgery,the patient had no obvious pain in the hip,and the range of motion in the hip joint was slightly limited,but met the normal life and work needs.There were no complications such as necrosis of the femoral head.CONCLUSION The PFLCP can be used to treat these complex proximal femoral fractures,and selection should be based on the patient's specific fractures.
文摘Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results,the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures.The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.Methods We assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures.Eighteen patients were treated with a locking plate and an autologous crest bone graft （experimental group）,and 22 were treated with only the locking plate and no bone graft （control group）.Postoperative assessments included radiographic imaging,range of motion analysis,pain level based on the visual analogue scale （VAS）,and the SF-36 （Short Form （36） Health Survey）,as well as whether patients could retum to their previous occupation.Results All fractures healed both clinically and radiologically in the experimental group.There was no more than 2 mm collapse of the humeral head,and no osteonecrosis or screw penetration of the articular surface.In contrast,two patients had a nonunion in the control group,and they eventually accepted total shoulder replacements.The average time from surgery to radiographic union was significantly shorter in the experimental group （（4.66±1.63） months） compared with the control group （（5.98±1.57） months） （P ＜0.05）.For the experimental versus controls groups,the mean shoulder active flexion （148.00±18.59 vs.121.73±17.20） degrees,extension （49.00±2.22 vs.42.06±2.06） degrees,internal rotation （45.00±5.61 vs.35.00±3.55）degrees,external rotation （64.00±9.17 vs.52.14±5.73）degrees,and abduction （138.00±28.78 vs.105.95±15.66） degrees were all significantly higher （all P ＜0.001）.The median SF-36 in the experimental group （（88.00±5.71） points） was significantly higher than that of the control group （（69.45±9.45） points; P ＜0.001）.The median VAS pain level （mean rank,10.50） in the experimental group was lower than that （mean rank,47.19） of the control group （P ＜0.001）.All but one patient （17 of 18,94.4％） in the experimental group returned to their previous activities or occupations,and that one patient changed to a different occupation because of slight restrictions to activities.On the other hand,four patients could not return to their previous activities or occupations in the control group.Conclusion Locking plate fixation combined with an iliac crest bone graft is an effective technique for treating proximal humerus comminuted fractures.
