内固定治疗C_1型骨盆骨折8例体会

目的 促进C1型骨盆骨折病人早期康复 ,降低死亡率及合并症。方法 采用骶关节脱位前方入路 ,切开复位内固定。结果 平均随访时间 6个月 ,骨折均愈合 ,无下肢不等长 ,亦无跛行和腰骶痛 ,疗效满意。结论 C1型骨盆骨折手术治疗为宜 。

锁定接骨板在老年股骨粗隆间骨折治疗中的应用

目的:总结股骨近端锁定接骨板(locking proximal femoral plate,LPFP)治疗老年股骨粗隆间骨折的临床疗效以及优势。方法:25例采用LPFP做内固定的老年股骨粗隆间骨折,男10例,女12例,年龄65～89岁,平均年龄74.5岁。根据Evans分型,Ⅰ型4例,Ⅱ型6例,Ⅲ型7例,Ⅳ型5例,Ⅴ型3例。结果:25例患者均获得随访,骨折愈合时间10～16周,无不愈合病例,无髋内翻及内固定失败。髋关节功能优良率88%(Harris评分标准)。结论:LPFP治疗老年股骨粗隆间骨折具有创伤小,操作简单,固定可靠,并发症少的优点。

髁支持钢板治疗股骨髁间和髁上骨折24例疗效观察

目的：探讨髁支持钢板治疗股骨髁间、髁上骨折的疗效。方法：回顾性分析2003年1月至2008年1月髁支持钢板内固定治疗股骨髁间、髁上骨折24例。结果：随访7～38个月，7—13个月全部愈合，膝关节功能恢复良好，采用Merchan提出的功能评定标准：优10例，良10例，中2例，差2例，优良率83．3％。结论：采用髁支持钢板治疗股骨髁间髁上骨折，固定牢靠，膝关节功能恢复好，是股骨髁间髁上骨折的理想选择。

Minimally invasive plate internal fixation for calcaneal fractures

Objective： To assess the clinical efficacy of minimally invasive plate internal fixation for the treatment of calcaneal fractures. Methods： Manual reduction, rectification of deformity, and cold compress with traditional Chinese medicine were used preoperatively to relieve swelling and pain. A small incision was made to expose the articular facet and to perform anatomic reduction and plate fixation. Self-made traditional Chinese pharmaceutics were applied postoperatively on the surface of the wound to accelerate bony union. Results： All the 40 patients were followed up for at least 1 year postoperatively. According to the Maryland scoring system, the excellent and good rate was 87.5%. Conclusion： Minimally invasive plate internal fixation has the advantages of relatively mild injury, reliable fixation, good recovery, and rare complications in the treatment of intraarticular fractures.

Internal fixation with headless compression screws and back buttress plate for treatment of old Hoffa fracture

Objective： To analyze the early clinical and radiographic outcomes of Hoffa fractures treated by a standard protocol of open reduction and internal fixation using headless compression screws combined with back buttress plate in a consecutive series of 8 Chinese patients. Methods： Open reduction and internal fixation was performed on all patients. The fractures were anatomical- ly reduced and held temporarily by K-wire. If the ends of fractures were atrophic, autologous bone graft from the ipsilateral iliac crest was packed between the ends. Then the fracture fragments were fixed with AO 6.5 mm headless compression cannulated screws. At least two screws were used to provide rotational stability. One pre-contoured reconstruction plate was placed on the nonarticular surface posteromedially or posterolaterally as back buttress plate. Results： All the patients were followed up for at least 12 months （range 12-25 months）. All fractures achieved anatomical reduction and healed clinically and radiographically. At recent follow-up, the mean flexion degree was 120.6° （range 110°-135°） and the mean extension degree was 2.5° （range 0°-5°）. The average visual analogue scale score was 1.6 points （range 0-3）. Six patients were assessed as excellent and 2 as good according to the hospital for special surgery knee score system. There were no superficial or deep infections, or hardware breakages. No patient had giving way or locking of the knee, though some had intermittent pain and swelling after strenuous exercise. Injury mechanism had significant influence on the functional outcome （P=0.046）. Conclusion： Headless compression screws combined with back buttress plate and/or autologous bone grafting to treat old Hoffa fracture is one of effective measures. It would be conducive to not only fracture healing but also early exercise and functional recovery.

Surgical treatment of proximal humerus fractures using PHILOS plate

Objective：To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system （PHILOS） plate for proximal humerus fractures.Methods：We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012.There were 35 men and 16 women with a mean age of 38 years （range 24-68）.There were 41 patients in the age group of ＜60 years and 10 patients in the age group of ＞60 years.According to Neer classification system,8,15 and 23 patients had 2-part,3-part,and 4-part fractures,respectively and 5 patients had 4-part fracture dislocation.All surgeries were carried out at our tertiary care trauma centre.Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score.Results：The mean follow-up period was 30 months （range 12-44 months）.Two patients were lost to followup.Of the remaining 49 patients,all fractures were united clinically and radiologically.The mean time for radiological union was 12 weeks （range 8-20 weeks）.At the final follow-up the mean Constant-Murley score was 79 （range 50-100）.The results were excellent in 25 patients,good in 13 patients,fair in 6 patients and poor in 5 patients.During the follow-up,four cases of varus malunion,one case of subacromial impingement,one case of deep infection,one case of intraarticular screw penetration and one case of failure of fixation were noted.No cases of avascular necrosis,hardware failure,locking screw loosening or nonunion were noted.Conclusion：PHILOS provides stable fixation in proximal humerus fractures.To prevent potential complications like avascular necrosis,meticulous surgical dissection to preserve vascularity of humeral head is necessary.

Twenty-seven-year nonunion of a Hoffa fracture in a 46-year-old patient

A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion ofa Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion ofa Hoffa fracture have been documented in the literature to date, including two children and one adult. This article presents a case of an adult who had nonunion of a Hoffa fracture for 27 years and was treated by open reduction and internal fixation, and the varus deformity corrected with xenogenous bone graft. An excellent result has been achieved to date. This unusual case reminds us that we cannot neglect the possibility of nonunion of a cancellous hone fracture, especially the Hoffa fractures of the medial femoral condyle if they are treated nonoperatively. It also demonstrates that internal fixation with bone graft is effective, even for the 27-year Hoffa fracture.

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

Objective： To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods： We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing （n=23）, followed by fall from height （n=20）, road traffic accidents （n-5） and fall from standing height （n=2）. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn＇s criteria. Results： Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn＇s criteria, 90.4% patients showed satisfactory results. Conclusion： Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.

Subciliary incision and lateral cantholysis in rigid internal fixation of zygomatic complex fractures

Objective: To introduce the technique of subciliary incision and lateral cantholysis with tri-dimension reduction and rigid internal fixation to treat zygomatic complex fractures. Methods: The subciliary incision and lateral cantholysis combined with tri-dimension reduction and rigid internal fixation of zygomatic complex fractures with titanium microplates were applied in 56 patients with zygomatic complex fractures. Another lateral eyebrow incision or sublabial incision was used to simplify the operation. Results: The postoperative follow-up period ranged from 6 months to 5 years. During the follow-up period, all the patients had satisfying postoperative results. All clinical symptoms disappeared except the numbness in the infraorbital region in 2 patients. In 94.6% patients no complications such as obvious scar, ectropion, entropion or blepharoedema were found, only 5.4% of the patients had slight ectropion 6 months after operation. Conclusions: The subciliary incision and lateral cantholysis have many advantages such as invisible scar, sufficient exposure, minimal injury, and few complications and combined with rigid internal fixation with titanium microplates this technique could be used as one of the routine operation methods to treat zygomatic complex fractures.

Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail

Objective: To evaluate the results of reconstructive intramedullary interlocking nail in the treatment of ipsilateral hip and femoral shaft fractures. Methods: From August 1997 to November 2001, 13 patients were treated with the reconstructive intramedullary interlocking nail. Nine patients were associated with ipsilateral femoral neck fractures, three with ipsilateral intertrochanteric fractures, and one with subtrochanteric fracture. Results: The follow up time was from 6 to 38 months with an average of 14 months. All the femoral shaft and hip fractures healed up well. There was no nonunion of the femoral neck, and only one varus malunion. No patient had avascular necrosis of the femoral head. The average healing time for femoral neck fracture was 4.6 months and for shaft fracture 5.8 months. The joint movement and other functions were fairly resumed. Conclusions: The reconstructive intramedullary interlocking nail, with less trauma, reliable fixation, and high rate of fracture healing, is an ideal method of choice in the treatment of ipsilateral hip and femoral shaft fractures.

Timing of internal fixation and effect on Schatzker IV-VI tibial plateau fractures

Objective： To study the effect of internal fixation performed at different times on therapeutic outcomes of Schatzker IV-VI tibial plateau fractureS. Methods： The clinical data of 42 cases ofSehatzker IV- VI tibial plateau fractures treated in our department were analyzed retrospectively. Among these 42 patients, 21 re- ceived surgical treatment within 12 h after injury, （Group I）, the other 2 [ were first treated by traction or piaster fixation followed by a delayed internal fixation after soft tissue swell- i ing subsided （Group II）. The surgical time, comPlications, length of hospital stay, cost of hospitalization, and time for i fracture union, as well as functional recovery were analyzed and compared between the two groups. Results： After 10-28 months follow-up （mean 16.5 months）, except 5 cases who lost to follow-upl no differ-ences were found between the two groups regarding surgi- cal time, preoperative and postoperative complications, heal- ing time or the Hospital for Special Surgery （HSS） score at the end of follow-up, but significant differences were found in the length of hospital stay, cost of hospitalization and HSS score at 3 months after operation （P〈0.05）. Conclusion： Under certain conditions, early internal fixation for Schatzker IV-VI tibial plateau fracture is feasible, which can shorten the length of hospital stay, decrease the cost of hospitalization and promote early functional rehabilitation.

Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures

Purpose： To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis （MIPPO） of tibial shaft fractures with the use of a distraction support. Methods： Between March 2011 and October 2014, 52 patients with a mean age of 48 years （16-72 years） sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goniometer measurement on preoperative and postoperative images. Results： Preoperative radiographs revealed a mean of 7.6°（1.2°-28°） angulation in coronal plane and a mean of 6.8°（0.5°-19°） angulation in sagittal plane. Postoperative anteroposterior and lateral radio graphs showed a mean of 0.8°（0°-4.0°） and 0.6°00-3.6°） of varusvalgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. Conclusions： This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.

Use of gentamicin-loaded collagen sponge in internal fixation of open fractures

Objective： To assess the outcome of immediate plate osteosynthesis via application of antibiotic impregnated collagen fleeces （gentamicin-collagen and an- tibiotic sponge） which gradually release antibiotic locally in the surgical treatment of open fractures presented to us 6 hours after injury. Methods： All cases were treated in our tertiary level trauma center and teaching hospital including 35 patients with open fractures who were treated by immediate open reduction and plate fixation from January 2008 to August 2010. Among them, 31 patients were available for adequate follow-up and assessment. All fractures were treated by irri- gation and debridement, immediate open reduction and plate fixation along with placement of antibiotic-releasing collagen fleeces around the plate just before closure of wound. Pa- tients were assessed to determine postoperative infection, delayed union or nonunion and development of other post- operative complications. It was hypothesized that immedi- ate plate osteosynthesis after thorough debridement and local antibiotics would give safe and acceptable clinical results in treatment of open fractures. Results： The 31 patients with adequate final follow-up were assessed at a mean time of 40 weeks （15-160 weeks）.Most fractures united primarily in an acceptable time period according to area of involvement. Local wound complica- tions （superficial infection and skin loss） were found in 3 patients （9.67%）. Deep infection was noted in 2 patients （6.45%）. None of these patients needed implant removal and both fractures united in due time. Delayed union was noted in 5 patients （16.13%）. No patient progressed to non- union or implant failure in long term follow-up. Excessive scarring was developed in 2 patients （6.45%）. Conclusions： Immediate plate osteosynthesis after adequate debridement and placement of collagen film eluting antibiotics locally produces excellent results regarding bone union and absence of deep infections and is a safe technique in the management of open bone injuries. These sponges can be used easily with any form of internal fixa- tion and there is no need of second surgery for the removal of these antibiotic carriers since they are bioabsorbable. Local antibiotic-impregnated collagen sponges along with systemic antibiotics for 3 to 5 days offer promising results in open fracture management.