锁定钢板治疗肱骨外科颈骨折42例分析

肱骨外科颈骨折好发于中老年人,多伴有骨质疏松,肱骨头脱位及肩袖损伤等,传统治疗方法易导致肩关节僵硬,肱骨头缺血坏死,畸形愈合,肩峰撞击征及二头肌头肌腱炎等并发症。自2008年01月～2010年01月,

Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking cal- caneal plate

Objective：Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate.Methods：In this series,28 patients （26 unilateral and 2 bilateral） with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury.Patients were evaluated in terms of associated injuries and X-rays of anteroposterior,lateral and axial views of the calcaneum.CT scan was done to assess the amount ofcomminution and articular depression.Patients were followed up clinically and radiologically at least for 1 year.Radiological assessment was done by Bohler＇s angle and Gissane＇s angle along with measurement ofcalcaneal height and width.Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society （AOFAS） scale.Results：At average follow-up of 14.5 months,average AOFAS score was 86.3 （range 66 to 97）,with 86% having excellent to good results and 2 （7.7%） and 1 （3.7%） having fair and poor results respectively.All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°.Average subtalar range of motion was 17°.The mean Bohler＇s angle,mean Gissane＇s angle,calcaneal height and width were 25.47°,121.3°,4.32 cm and 3.81cm respectively at final follow-up.Three patients had flap necrosis at incision site and one had superficial and deep infection.Subtalar arthritis was seen in 5 patients,whereas sural nerve hypoaesthesia in 1 patient.None of the patients had compartment syndrome,heel pad problems,peroneal tendinitis,reflex sympathetic dystropy or implant failure.Conclusion：Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome,i.e.restoring anatomically reconstruction of height,width,Bohler＇s and Gissiane＇s angles of the calcaneum,and allowing early mobilization.

Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial frac- tures

Objective： To investigate the efficacy of the locking internal fixator （LIF）, which includes the locking compression plate （LCP） and the less invasive stable system （LISS）, in the proximal and distal tibial fractures. Methods： We did a retrospective study on a total of 98 patients with either proximal or distal tibial fractures from January 2003 to January 2007, who had received the opera- tion with LIF by the minimally invasive plate osteosynthe- sis （MIPO） technique. The data consisted of 43 proximal tibial fractures （type AO41 C3） and 55 distal tibial fractures （type AO43C3）. Results： No complications were observed in all patients after operation. The mean healing time was 8.4 months （range 5-14 months）. Only two cases of delayed union oc- curred at postoperative 10 months. No infections were re- ported after the definitive surgery even in the cases of open fractures. All patients reached a full range of motion at post- operative 6 to 9 months and regained the normal functions of knee and ankle joints. Conclusion： Using LIF in MIPO technique is a reliable approach towards the proximal and distal tibial fractures that are not suitable for intramedullary nailing.

Distal tibial fracture： An ideal indication for external fixation using locking plate

Objective： To evaluate the feasibility and efficiency of one-stage external fixation by using locking plate in distal tibial fractures. Methods： In this non-control prospective study, 28 patients with distal tibial fractures were included and underwent one-stage external fixation by using locking plate. There were 21 males and 7 females, with a mean age of 43 years （19-63）. According to AO/OTA fracture classification, there were 9 cases of Type A1, 9 of Type A2, 10 of Type A3 fractures. There were 21 close and 7 open fractures. The locking plate was placed on the anteromedial aspect of the tibia with 4-5 bicortical screws inserted in both distal metaphysis and diaphysis. The radiographic and clinic results were evaluated. Results： All patients were followed up for the average of 16 months （ranging from 12 to 21 months）. The average surgery duration was 38 （25-60） minutes. The mean time to fracture healing were 14.6 ± 2.67, 17.5 ± 3.66, and 18.4±3.37 （p 〈 0.05） weeks in type A1, A2, and A3 fractures respectively. By the end of the follow-ups, the mean AOFAS score were 96.11 ± 2.32, 92.67 ± 1.80 and 92.00± 2.06 （p 〉 0.05） in type A1, A2, and A3 fractures respectively. None of nonunion, deep infection, or breakage of screw or plate were observed. Conclusions： Distal tibial fracture was the ideal indication for external fixation using locking plate. The external plating is characterized by ease of performance, less invasive, fewer soft tissue impingement, improved cosmesis, and convenient for removal.

Locking plates in distal humerus fractures： study of 43 patients

Objective： The treatment of multi- fragmentary, intraarticular fractures of the distal humerus is difficult, even in young patients with bone of good quality. Small distal fragment, diminished bone mineral quality and increased trauma-associated joint destruction make stable joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal hu- merus fractures. Methods： Forty-three consecutive patients with ar- ticular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. Forty patients were available for the final outcome analysis. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 14 cases of type C1, 7 cases of type C2 and 11 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment,range of motion, and Mayo elbow performance score. Results： Forty patients were available for the final outcome analysis. There were 29 males and 11 females with an average age of 38.4 years （18-73 years）. Clinical and ra- diological consolidation of the fracture was observed in all cases at an average of 11.6 weeks （9-14 weeks）. The average follow-up was 12 months （10-18 months）. Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 33 patients （82.5%）. One pa- tient had superficial infection, and 4 had myositis ossificans. There were no cases of primary malposition or secondary displacement, implant failure or ulnar neuropathy. Conclusion： Anatomically preshaped distal humerus locking plate system is useful in providing stable fixation for complex distal articular fracture and facilitating early post- operative rehabilitation. The low rate of implant failure in the present study indicates that the technique is promising and warrants further investigation.

Sanders II-III calcaneal fractures fixed with locking plate in elderly patients

Purpose： To evaluate the clinical outcomes of locking calcaneal plate in treating calcaneal fracture （Sanders II-IIl） in elderly patients. Methods： From October 2012 to December 2013, 23 elderly patients suffering from calcaneal fracture （Sanders Ⅱ-Ⅲ） were treated and followed up. There were 15 males and 8 females with the mean age of 68.5 years （range： 65-79 years）. According to Sander＇s classification, 16 cases （16 feet） were type II fractures and 7 cases （7 feet） were type llI fractures. Anteroposterior, lateral and axial views of X-ray were taken to detect the calcaneum. CT scan was done to assess the amount of comminution and articular depression. Radiological assessment was performed using Bohler＇s angle and Gissane＇s angle. Functional outcome was assessed using the Maryland foot score. Results： All the patients were followed up for 13.7 months on average （10-20 months）. The mean time of bone union was 3.2 months （3-4 months）. The mean time of complete weight bearing was 3.2 months （3.1-4.0 months）. The soft tissue necrosis was found in 1 case. The mean Bohler＇s angle and Gissane＇s angle were 25.31° and 117.5° respectively. The overall excellent to good rate was 82.6%. Conclusion： Open reduction and internal fixation with locking calcaneal plate can obtain good functional outcome for Sanders II-III calcaneal fractures in elderly patients.

Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates

Fractures of the proximal humerus are uncommon in young patients.Although bilateral fracture of proximal humerus itself is rare,association with epilepsy and electrocution is frequent.Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature.We report a rare case of bilateral traumatic displaced proximal humerus fractures in a 40 years old male patient,which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome.

Role of locking plates in treatment of difficult ununited fractures： a clinical study

Objective： To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods： Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture （3 patients）, supracondylar fracture of femur （gap nonunion）, fracture of clavicle, fracture of both forearm bones （radius and ulna） fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar frac- ture of humerus （one patient each）. Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients. Results： Minimum follow-up was 6 months （range, 6 months to 2.5 years）. Average time for union was 3.4 months （range 2.5 to 6 months）. None of the patients had plate- related complications or postoperative wound infections. Conclusion： Along with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.