Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft w...Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases （16 sides） with intra-articular calcaneal fractures including 13 males （14 feet） and 2 females （2 feet） ,with average age of 36. 6 years （24-61 years）. All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ （3 type Ⅱa, 3 type Ⅱb and 8 type Ⅱc） and 2 feet of type Illac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results： All patients were followed up for an average of 18.4 months （ranged, 12 to 34 months）. No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group （86.5±4.4） was better than in joint depression type group （81.2±1.7, P〈0.05）. Radiography showed basic restoration of Bohler＇s angle, Gissane＇s angle and calcaneal shape. Conclusion： The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures, with advantages of simple operation, fewer complications and good clinical results.展开更多
Six tibias removed from 30-40 years old males, who died in an accident for in less than 12 hours, were osteotomized at one-third supra-medium segment. They were fixed by an unilateral adjustable external fixer (UAEF),...Six tibias removed from 30-40 years old males, who died in an accident for in less than 12 hours, were osteotomized at one-third supra-medium segment. They were fixed by an unilateral adjustable external fixer (UAEF), to be used as a model of external fixation of tibial fracture (MEFTF). The compression. tension, torsion, antero-posterior and lateral bending strength, and the strength for vertically extracting the pins from the tibia were determined in the MEFTF. Within a certain range of load, the correlation of strain to stress was basically a linear relationship. These data provide a theoretical basis of biomechanics for the improvement of UAEF and for early exercises of fracture patients, such as extend-bending of the joint.raising the limb and walking with a walking stick.展开更多
Objective： To investigate risks and clinical effects of operative treatment for cervical vertebral fracture and dislocation associated with unilateral vertebral artery injury. Methods： This group consisted of 76 ca...Objective： To investigate risks and clinical effects of operative treatment for cervical vertebral fracture and dislocation associated with unilateral vertebral artery injury. Methods： This group consisted of 76 cases of closed cervical spine trauma combined with unilateral vertebral artery injury （23 cases of bilateral facet dislocation, 28 unilateral facet dislocation and 25 fracture）. All patients underwent prospective examination of cervical spine MRI and vertebral artery two-dimensional time-of-flight （2D TOF） magnetic resonance angiography （MRA）, and anterior cervical decompression. The healthy vertebral artery paths were evaluated before the surgery, and were protected during the surgery according to the anatomical signs. Results： There were no acute or chronic clinical dam- age symptoms in 76 cases after surgery. No neural damage symptoms were observed in patients with normal neural functions. The neural functions of incomplete paralyzed patients were improved in different grades. Conclusions： Reliable anterior operation can produce good results for cervical fracture and dislocation with unilateral vertebral artery injury. Detecting the course of uninjured vertebral artery before operation and locating the anatomical site during operation are effective to avoid damaging vertebral artery of uninjured side.展开更多
Objective： Dynamic hip screw （DHS） is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from I% to 6%. In osteoporotic bone, normal screws in DHS blade provid...Objective： Dynamic hip screw （DHS） is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from I% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate. Methods： Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS （group A） and locking DHS （Combi plate, group B）. We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score. Results： Coxa valga was found more frequently in group A than in group B （12% vs. 0%, P=0.42）. Coxa vara showed the same trend （12% vs. 8%, P=0.81）. Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B （8% cases） than in group A （4% cases, P=0.98）. The rate of anteversion angle restoration within 10° of sound side was also higher in group B （100% vs. 88%, P=0.85）. The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications. Conclusion： The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.展开更多
文摘Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases （16 sides） with intra-articular calcaneal fractures including 13 males （14 feet） and 2 females （2 feet） ,with average age of 36. 6 years （24-61 years）. All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ （3 type Ⅱa, 3 type Ⅱb and 8 type Ⅱc） and 2 feet of type Illac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results： All patients were followed up for an average of 18.4 months （ranged, 12 to 34 months）. No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group （86.5±4.4） was better than in joint depression type group （81.2±1.7, P〈0.05）. Radiography showed basic restoration of Bohler＇s angle, Gissane＇s angle and calcaneal shape. Conclusion： The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures, with advantages of simple operation, fewer complications and good clinical results.
文摘Six tibias removed from 30-40 years old males, who died in an accident for in less than 12 hours, were osteotomized at one-third supra-medium segment. They were fixed by an unilateral adjustable external fixer (UAEF), to be used as a model of external fixation of tibial fracture (MEFTF). The compression. tension, torsion, antero-posterior and lateral bending strength, and the strength for vertically extracting the pins from the tibia were determined in the MEFTF. Within a certain range of load, the correlation of strain to stress was basically a linear relationship. These data provide a theoretical basis of biomechanics for the improvement of UAEF and for early exercises of fracture patients, such as extend-bending of the joint.raising the limb and walking with a walking stick.
基金This was supported by Natural Science Foundation Project of Chongqing （CSTC, 2007BB5071）.
文摘Objective： To investigate risks and clinical effects of operative treatment for cervical vertebral fracture and dislocation associated with unilateral vertebral artery injury. Methods： This group consisted of 76 cases of closed cervical spine trauma combined with unilateral vertebral artery injury （23 cases of bilateral facet dislocation, 28 unilateral facet dislocation and 25 fracture）. All patients underwent prospective examination of cervical spine MRI and vertebral artery two-dimensional time-of-flight （2D TOF） magnetic resonance angiography （MRA）, and anterior cervical decompression. The healthy vertebral artery paths were evaluated before the surgery, and were protected during the surgery according to the anatomical signs. Results： There were no acute or chronic clinical dam- age symptoms in 76 cases after surgery. No neural damage symptoms were observed in patients with normal neural functions. The neural functions of incomplete paralyzed patients were improved in different grades. Conclusions： Reliable anterior operation can produce good results for cervical fracture and dislocation with unilateral vertebral artery injury. Detecting the course of uninjured vertebral artery before operation and locating the anatomical site during operation are effective to avoid damaging vertebral artery of uninjured side.
文摘Objective： Dynamic hip screw （DHS） is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from I% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate. Methods： Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS （group A） and locking DHS （Combi plate, group B）. We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score. Results： Coxa valga was found more frequently in group A than in group B （12% vs. 0%, P=0.42）. Coxa vara showed the same trend （12% vs. 8%, P=0.81）. Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B （8% cases） than in group A （4% cases, P=0.98）. The rate of anteversion angle restoration within 10° of sound side was also higher in group B （100% vs. 88%, P=0.85）. The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications. Conclusion： The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.
