Purpose： Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation （ExFix） and open reduction and internal fixation （ORIF） are two widely used methods for repairing tibial ...Purpose： Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation （ExFix） and open reduction and internal fixation （ORIF） are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications. Methods： A computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library （before December 2014） for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference （WMD）, risk ratio （RR） and corresponding 95% confidence intervals （Cl） were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2. Results： Ten cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection （p = 0.13）, reduction （p = 0.11）, clinical evaluation （p = 0.82）, post-traumatic arthrosis Cp = 0.87）, and union time （p = 0.35）. Besides, ExFix group was found to have a higher rate of superficial infection （p = 0.001）, malunion （p = 0.01） and nonunion （p= 0.02）, but have a lower risk of unplanned hardware removal （p = 0.0002）. Conclusions： We suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, hut a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation. ~ost-traumatic arthrosis and union time.展开更多
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 fro...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.展开更多
文摘Purpose： Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation （ExFix） and open reduction and internal fixation （ORIF） are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications. Methods： A computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library （before December 2014） for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference （WMD）, risk ratio （RR） and corresponding 95% confidence intervals （Cl） were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2. Results： Ten cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection （p = 0.13）, reduction （p = 0.11）, clinical evaluation （p = 0.82）, post-traumatic arthrosis Cp = 0.87）, and union time （p = 0.35）. Besides, ExFix group was found to have a higher rate of superficial infection （p = 0.001）, malunion （p = 0.01） and nonunion （p= 0.02）, but have a lower risk of unplanned hardware removal （p = 0.0002）. Conclusions： We suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, hut a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation. ~ost-traumatic arthrosis and union time.
文摘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.
