胫骨骨折不愈合经胫骨髓内钉开髓点取骨植骨治疗的效果观察

目的 探究胫骨骨折不愈合经胫骨髓内钉开髓点取骨植骨的治疗效果。方法：选取本院收治的74例胫骨骨折不愈合患者，并分为2组，对照组患者接受断端硬化骨去除后胫骨髓内钉固定治疗，观察组患者在断端硬化骨去除后实施胫骨髓内钉开髓点的取骨予以植骨与胫骨髓内钉固定治疗。并对2组患者经过治疗后的骨折愈合时间、治疗效果以及关节功能情况进行对比。结果：全部患者的术后的随访时间10～13个月，平均随访时间12．2±2．1个月。观察组患者的骨折愈合时间30．1±0．3周，明显少于对照组的35．9±0．4周，P〈0．05；2组患者ROM评分优良率与HSS评分优良率的对比P〉0．05。结论：胫骨骨折不愈合经胫骨髓内钉开髓点取骨植骨的治疗效果显著，在临床上值得推广与应用。

胫骨骨折带锁髓内钉加植骨治疗骨不连处理对策

目的:探讨胫骨骨折带锁髓内钉加植骨治疗骨不连效果及预防骨不连对策。方法:收治胫骨骨折术后骨不连患者47例,回顾病例资料及治疗方法等,进行再资料在分析。结果:术后47例患者均痊愈,治愈率100.00%。愈合时间8～24个月,平均14.93±4.88个月。其中6～12个月愈合27例,12～18个月愈合18例,8～24个月愈合2例。均经过X线检查确诊愈合,确定愈合后拆除内固定及外固定。拆除后均可以参加工作,未见并发症出现。结论:对于胫骨骨折患者,手术方式多种,应选择合适手术方式、牢固固定材料、术后加强营养、适当补钙、避免早期运动,都可以预防骨不连发生。已经出现骨不连患者,应早期截骨露出新鲜骨并行带锁髓内钉加植骨治疗,均可以有效治愈。

小切口保护跟骨外侧骨瓣可吸收钉治疗跟骨骨折的临床效果

目的:探讨小切口保护跟骨外侧骨瓣可吸收钉治疗跟骨骨折的临床效果。方法:选取2015年1月-2018年12月100例跟骨骨折患者,随机分为两组。常规治疗组选择普通钢板固定手术,微创手术治疗组选择小切口保护跟骨外侧骨瓣可吸收钉手术。分析两组手术操作中平均出血量、手术实施时间、治疗前后Bohler角和Gissane角、AOFAS评分及并发症情况。结果:微创手术治疗组Bohler角和Gissane角、AOFAS评分、平均出血量、手术实施时间、并发症发生率均优于常规治疗组(P<0.05)。结论:跟骨骨折患者实施小切口保护跟骨外侧骨瓣可吸收钉手术可获得较好效果,可有效缩短手术时间,减少出血量,改善足功能,减少并发症。

胸腰椎陈旧性骨折并后凸畸形后路经椎弓根截骨矫形钉棒固定植骨融合术的疗效观察

目的:分析胸腰椎陈旧性骨折并后凸畸形后路经椎弓根截骨矫形钉棒固定植骨融合术的疗效。方法:2011年1月-2018年12月收治胸腰椎陈旧性骨折并后凸畸形患者46例,随机分为两组,各23例。对照组采用保守治疗;研究组采用后路经椎弓根截骨矫形钉棒固定植骨融合术治疗。比较两组患者治疗效果。结果:研究组治疗6个月后的腰椎段后凸角及Cobb角均低于对照组,腰椎前凸角高于对照组,差异有统计学意义(P<0.05);研究组治疗6个月后的视觉模拟评分(VAS评分)与Oswestry功能障碍指数(ODI)均低于对照组,下腰痛日本骨科协会评估治疗(JOA)评分高于对照组,差异有统计学意义(P<0.05)。结论:后路径椎弓根截骨矫形钉棒固定植骨融合术用于胸腰椎陈旧性骨折并后凸畸形的效果理想,在矫正腰椎畸形与改善椎体功能方面发挥着重要的作用。

闭合复位重建髓内针固定经头钉切口骨泥植骨治疗股骨粗隆下骨折

探讨闭合复位重建髓内针固定经头钉切口骨泥植骨治疗股骨粗隆下骨折的临床效果。方法:选择我院2017年1月-2018年12月期间收治的股骨粗隆下骨折患者88例,随机分为对照组和观察组,分别给予不同的手术方案,对比两组患者术中情况、骨折愈合情况。结果:两组患者手术和术后各项指标对比发现,观察组在X线透视时间、手术时间、术中出血量、骨折愈合时间等方面,均显著优于对照组,经检验,P<0.05。在临床疗效方面,两组患者组间差异不明显(P>0.05)。结论:闭合复位重建髓内针固定经头针切口骨泥植骨治疗股骨粗隆下骨折,疗效确切,术后恢复较好。

OPEN REDUCTION AND CANNULATED SCREW INTERNAL FIXATION OF TALUS FRACTURE-DISLOCATION THROUGH MEDIAL-ANTERIOR APPROACH

Objective To evaluate the role of open reduction through anterior-medial malleolar approachwith cannulated screw internal fixation in the treatment of displaced talus fractures. Methods 16 cases of Hawkin type Ⅱ - Ⅲ displaced talus fractures were treated by open reduction through single anterior medial malleolar approach with cannulated screw internal fixation. Results All the 16 cases of displaced talus fractures achieved bony heal in which 5 cases suffered talus aseptic necrosis. The whole excellence-good ratio reached 62. 5%. Conclusion Open reduction through anterior-medial malleolar approach with cannulated screw internal fixation is a less trauma, easy manipulation, effective method of treatment for displaced talus fractures.

Minimally invasive percutaneous compression plating versus dynamic hip screw for intertrochanteric fractures： a randomized control trial

Objective：Intertrochanteric femur fracture is a common injury in elderly patients.The dynamic hip screw （DHS） has served as the standard choice for fixation; however it has several drawbacks.Studies of the percutaneous compression plate （PCCP） are still inconclusive in regards to its efficacy and safety.By comparing the two methods,we assessed their clinical therapeutic outcome.Methods：Atotal of 121 elderly patients with intertrochanteric femur fractures （type AO/OTA 31.A 1-A2,Evans type 1） were divided randomly into two groups undergoing either a minimally invasive PCCP procedure or a conventional DHS fixation.Results：The mean operation duration was significantly shorter in the PCCP group （55.2 min versus 88.5 min,P＜0.01）.The blood loss was 156.5 ml±18.3 ml in the PCCP group and 513.2 ml±66.2 ml in the DHS group （P＜0.01）.Among the patients treated with PCCP,3.1％ needed blood transfusions,compared with 44.6％ of those that had DHS surgery （P＜0.01）.The PCCP group displayed less postoperative complications （P＜0.05）.The mean American Society of Anesthesiologists score and Harris hip score in the PCCP group were better than those in the DHS group.There were no significant differences in the mean hospital stay,mortality rates,or fracture healing.Conclusion：Due to several advantages,PCCP has the potential to become the ideal choice for treating intertrochanteric fractures （type AO/OTA 31.A1-A2,Evans type 1）,particularly in the elderly.

Treatment of subtrochanteric femoral fracture with long proximal femoral nail antirotation

Objective： Subtrochanteric femoral fractures are severe injuries. Although many treatment methods have been developed, controversy exists regarding the optimal management of these fractures. This study evaluated the clinical outcome of subtrochanteric femoral fractures fixed with long proximal femoral nail antirotation （PFNA-Iong）. Methods： Between October 2006 and February 2008, 25 patients with traumatic subtrochanteric fractures of the femur were treated with PFNA-long. Closed reduction and fixation were performed in 20 cases. In the remaining 5 cases, closed reduction was difficult, so limited open reduction was performed, with bone grafting in 4 cases and circumfer-ential wiring in 4 cases. Results： The average follow-up time was 16.1 months. All subtrochanteric femoral fractures healed uneventfully except one case of delayed union. The mean union time was 26.2 weeks. Technical difficulties with nail insertion were encountered in 3 cases. No implant failure was observed. Conclusion： PFNA-long is effective in treatment of subtrochanteric femoral fractures, with a high rate of bone union, minor soft tissue damage, early return to functional exercise and few implant-related complications.

Treatment of distal femoral nonunion and delayed union by using a retrograde intramedullary interlocking nail

Objective: To analyze the causes of distal femoral nonunion and delayed union and assess the outcome of the corresponding treatment, retrograde intramedullary interlocking nail (RIIN). Methods: From June 1995 to December 1998, 15 patients (9 males and 6 females) with distal femoral nonunion and delayed union were treated with RIIN. The average age of the patients was 34.5 years (23 46 years). Bone grafting was performed in 10 patients, closed reaming was done in the other 5 patients. Correction osteotomy was performed in 2 patients, and intra articular release of knee adhesion in 11 patients. X ray examination and knee society clinical rating system (KSS) were used to evaluate the results. Results: All fractures were followed up for at least 9 months with average follow up duration of 14.5 months (9 33 months). Solid union was documented in all patients at 6.4 months on average. There were no infections or malunions in this series. Based on the final follow up data, acceptable functional range of motion (ROM) of over 90° was achieved in most patients. The average ROM was 93.5° with significant improvement of 28° ( 42.7 %, P< 0.05 ) compared with the preoperative ROM. The average knee score was 96. Excellent ROM emerged in 13 patients. The knee function score was 90.5 on average. Conclusions: The main causes of distal femoral nonunion and delayed union are improper indications and improper use of the implants. RIIN is an effective alternative for treatment of distal femoral nonunion and delayed union because it can provide a stable and reliable fixation which is beneficial for early functional exercise of knee. Bone grafting, closed reaming and intra articular release of knee adhesion should be considered in order to enhance the bone healing and improve ROM and the knee function.

Surgical factors contributing to nonunion in femoral shaft fracture following intramedullary nailing

Purpose： To explore the possible surgical factors related with nonunion in femoral shaft fracture following intramedullary nailing. Methods： We retrospectively analyzed totally 425 patients with femoral shaft fracture in level I urban trauma center, including 254 males and 171 females, with an average age of 37.6 （ranging from 21 to 56） years old. The inclusion criteria included： （1） traumatically closed fracture of femoral shaft, with preoperative films showing non-comminuted fracture, such as transverse fracture, oblique fracture or spiral fracture; （2） closed reduction and fixation with interlocking intramedullary nail at 3-7 days after trauma; （3） complete follow-up data available. The relationship between the following factors （fracture site, reduction degree, direction of nail insertion and nail size） and nonunion was studied. Results： The incidence of femoral nonunion was 2.8%; in patients with closed simple fracture undergoing interlocking intrameduallary nailing, including 11 cases of hypertrophic nonunion. Nonunion was related significantly to distal fracture, unsatisfactory reduction and unreamed nail （p 〈 0.05）. There was no significant difference between antegrade nail and retrograde nail （p 〉 0.05）. Conclusions： Nonunion in femoral shaft facture following interlocking intramedullary nailing is related to fracture site, fracture reduction and nail diameter. The choice of reamed nails or unreamed nails depends on the fracture site and reduction degree.

Retrograde interlocking intramedullary nailing under arthroscopy for supracondylar femoral fracture

Objective: To evaluate the therapeutic effects of retrograde interlocking intramedullary nailing under arthroscopy on supracondylar femoral fractures. Methods: From June 1999 to December 2000, 17 patients with supracondylar femoral fracture were treated with arthroscopically assisted implantation of retrograde interlocking intramedullary nail and close reduction. Results: More than 6 month follow up study after operation in 11 patients revealed that the average healing time was 3 months. Average range of the knee motion for all the patients was more than 90 degrees. There was no implant breakage and infection. Conclusions: This new method, combining the advantage of arthroscope and retrograde interlocking intramedullary nail, can provide a stable and reliable fixation, and meanwhile is less invasive to the soft tissue and knee, less operative time and blood loss, minimal disruption of the blood supply in fracture site. It is conducive to the fracture healing and the functional recovery of the knee joint and worthwhile to be recommended.

Pseudoaneurysm of profunda femoris artery following dynamic hip screw fixation for intertrochanteric femoral fracture

Dynamic hip screw fixation is a com- monly performed procedure for internal fixation of intertro- chanteric femoral fractures. Arterial injury following the operative fixation is a rare but serious event. We present a patient who developed pseudoaneurysm ofprofunda femo- ris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw. The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization.

Dynamic hip screw with locking side plate： a viable treatment option for intertrochanteric fracture

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.

Research and application of absorbable screw in orthopedics： a clinical review comparing PDLLA screw with metal screw in patients with simple medial malleolus fracture

Objective： To observe the therapeutic effect of absorbable screw in medial malleolus fracture and discuss its clinical application in orthopedics. Methods： A total of 129 patients with simple medial malleolus fracture were studied. Among them, 64 patients were treated with poly-D, L-lactic acid （PDLLA） absorbable screws, while the others were treated with metal screws. All the patients were followed up for 12-20 months （averaged 18.4 months） and the therapeutic effect was evaluated according to the American Orthopaedic Foot and Ankle Society clinical rating systems. Results： In absorbable screw group, we obtained excel- lent and good results in 62 cases （96.88%）; in steel screw group, 61 cases （93.85%） achieved excellent and good results. There was no significant difference between the two groups. Conclusion： In the treatment of malleolus fracture, absorbable screw can achieve the same result compared with metal screw fixation. Absorbable screw is preferred due to its advantages of safety, cleanliness and avoiding the removal procedure associated with metallic implants.

Orthopaedic surgeon＇s nightmare： iatrogenic fractures of talus and medial malleolus following tibial nailing

Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures. The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical practice. Despite adequate surgeon experience, tibial nailing is not without complications if proper techniques are not followed. A case of iatrogenic talar neck and medial malleolus frac- tures during intramedullary nailing of tibia in a 24-year-old male is reported. It is believed to be caused by forceful hammering of insertion zig with foot dorsiflexed. To the best of our knowledge, no such case has been reported in the literature. It is possible to reduce the risk of this complication by adoption of preventive measures.

Early intramedullary nailing for femoral fractures in patients with severe thoracic trauma： A systemic review and meta-analysis

Purpose： Early intramedullary nailing （IMN） within the first 24 h for multiply injured patients with femoral fracture and concomitant thoracic trauma is controversial. Previously published studies have been limited in size and their outcomes have been inconclusive. A meta-analysis was conducted to evaluate the available data in order to guide care and help improve the outcomes for these patients. Methods： We searched the literature up to December 2011 in the main medical search engines and identified 6 retrospective cohort studies that explored the safety of early IMN in patients with both femoral fracture and chest injury. Our primary outcome was the rates of pulmonary complication （pneumonia, adult respiratory distress syndrome, fat embolism syndrome）, multiple organ failure （MOF） and mortality. Results： We found no statistically significant difference in the rate of pulmonary complications, MOF or mortality in the patients treated with early IMN. Conclusion： Early 1MN for femoral fractures does not increase the mortality and morbidity in chest- iniured patients in the studies anah/zed.

Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail

Objective： Studies showed elastic stable intramedullary nailing （ESIN） of displaced midclavicular fractures has excellent outcomes, as well as high complication rates and specific problems. The aim was to discuss ESIN of midshaft clavicular fractures.Methods： Totally 60 eligible patients （aged 18-63 years） were randomized to either ESIN group or non-operative group between January 2007 and May 2008. Clavicular shortening was measured after trauma and osseous consolidation.Radiographic union and complications were assessed. Function analysis including Constant shoulder scores and disabilities of the arm, shoulder and hand （DASH） scores were performed after a 15-month follow-up.Results： ESIN led to a signifcantly shorter time to union, especially for simple fractures. In ESIN group, all patients got fracture union, of which 5 cases had medial skin irritation and 1 patient needed revision surgery because of implant failure. In the nonoperative group, there were 3 nonunion cases and 2 symptomatic malunions developed requiring corrective osteotomy. At 15 months after intramedullary stabilization, patients in the ESIN group were more satisfied with the appearance of the shoulder and overall outcome, and they benefited a lot from the great improvement of post-traumatic clavicular shortening. Furthermore,DASH scores were lower and Constant scores were significantly higher in contrast to the non-operative group.Conclusion： ESIN is a safe minimally invasive surgical technique with lower complication rate, faster return to daily activities, excellent cosmetic and better functional results,restoration of clavicular length for treating mid-shaft clavicular fractures, resulting in high overall satisfaction, which can be regard as an alternative to plate fixation or nonoperative treatment of mid-shaft clavicular 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.

Outcome of bone marrow instillation at fracture site in intracapsular fracture of femoral neck treated by head preserving surgery

Purpose： The aim of present study is to evaluate the outcome of bone marrow instillation at the fracture site in fracture of intracapsular neck femur treated by head preserving surgery. Methods： This study included 32 patients of age group 18e50 years with closed fracture of intracapsular neck femur. Patients were randomized into two groups as per the plan generated via www.randomization.com. The two groups were Group A （control）, in which the fracture of intracapsular neck femur was treated by closed reduction and cannulated cancellous screw fixation, and Group B （intervention）, in which additional percutaneous autologous bone marrow aspirate instillation at fracture site was done along with cannulated cancellous screw fixation. Postoperatively the union at fracture site and avascular necrosis of the femoral head were assessed on serial plain radiographs at final follow-up. Functional outcome was evaluated by Harris hip score. Results： The average follow-up was 19.6 months. Twelve patients in each group had union and 4 patients had signs of nonunion. One patient from each group had avascular necrosis of the femoral head. The average Harris hip score at final follow-up in Group A was 80.50 and in Group B was 75.73, which was found to be not significant. Conclusion： There is no significant role of adding on bone marrow aspirate instillation at the fracture site in cases of fresh fracture of intracapsular neck femur treated by head preserving surgery in terms of accelerating the bone healing and reducing the incidence of femoral head necrosis.