Locking plate fixation combined with iliac crest bone autologous graft for proximal humerus comminuted fracture

Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results,the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures.The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.Methods We assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures.Eighteen patients were treated with a locking plate and an autologous crest bone graft （experimental group）,and 22 were treated with only the locking plate and no bone graft （control group）.Postoperative assessments included radiographic imaging,range of motion analysis,pain level based on the visual analogue scale （VAS）,and the SF-36 （Short Form （36） Health Survey）,as well as whether patients could retum to their previous occupation.Results All fractures healed both clinically and radiologically in the experimental group.There was no more than 2 mm collapse of the humeral head,and no osteonecrosis or screw penetration of the articular surface.In contrast,two patients had a nonunion in the control group,and they eventually accepted total shoulder replacements.The average time from surgery to radiographic union was significantly shorter in the experimental group （（4.66±1.63） months） compared with the control group （（5.98±1.57） months） （P ＜0.05）.For the experimental versus controls groups,the mean shoulder active flexion （148.00±18.59 vs.121.73±17.20） degrees,extension （49.00±2.22 vs.42.06±2.06） degrees,internal rotation （45.00±5.61 vs.35.00±3.55）degrees,external rotation （64.00±9.17 vs.52.14±5.73）degrees,and abduction （138.00±28.78 vs.105.95±15.66） degrees were all significantly higher （all P ＜0.001）.The median SF-36 in the experimental group （（88.00±5.71） points） was significantly higher than that of the control group （（69.45±9.45） points; P ＜0.001）.The median VAS pain level （mean rank,10.50） in the experimental group was lower than that （mean rank,47.19） of the control group （P ＜0.001）.All but one patient （17 of 18,94.4％） in the experimental group returned to their previous activities or occupations,and that one patient changed to a different occupation because of slight restrictions to activities.On the other hand,four patients could not return to their previous activities or occupations in the control group.Conclusion Locking plate fixation combined with an iliac crest bone graft is an effective technique for treating proximal humerus comminuted fractures.

Primary Clinical Research of a Patient Specific Implant System for an Old Zygomaticomaxillary Complex Comminuted Fracture

The objective of this study was to expound a novel surgical management technique assisted by patient-specific implants(PSIs)for comminuted fractures of the zygomaticomaxillary complex(ZMC).The aim of this study was to explore the feasibility of using PSIs to accurately restore and fix comminuted fractures.A male patient with an old ZMC comminuted fracture was used to describe the workflow,technique,and method.Computerassisted surgical simulation was used to determine the optimal plan for the reduction of bone segments prior to surgery.The PSIs were used to accurately guide the surgeon’s position of the bone segments,as planned,during the operation.Oral panoramic films and cephalometric films were taken immediately at 1,3,6,and 12 months after the operation,while computed tomography images of the whole skull were taken immediately,half a year,and one year after the operation.The patient’s follow-up showed that the zygomatic symmetry recovered well post-surgery and the patient was satisfied with the outcome.This new surgical method greatly improved the facial symmetry of this patient.

The finite element analysis of cemented long and short stem prosthetic replacement in aged patients with comminuted intertrochanteric fracture

Objective To investigate the stress distribution of the femur after cemented prosthetic replacement in aged patients with comminuted intertrochanteric fracture and to analyze the difference of stress distribution between cemented long

Use of mineralized collagen bone graft substitutes and dorsal locking plate in treatment of elder metaphyseal comminuted distal radius fracture

Bone graft may be needed to fill bone defect in elderly patients with a metaphyseal comminuted distal radius fracture. In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical and radiologic outcomes of using both dorsal locking plates with or without augmentation with mineralized collagen （MC） bone graft for elderly patients with dorsally metaphyseal comminuted radius fractures. Patients in group 1 （n = 12） were treated with dorsal locking plates with MC bone graft application into the metaphyseal bone defect, and those in group 2 （n - 12） only with dorsal locking plates. Clinical and radiologic parameters were determined at three and 12 months after surgery. At final follow-up, no significant difference was noted between the 2 groups in terms of palmar tilt and radial inclination （p - 0.80）; however, ulnar variance increased significantly in the group 2 treated with dorsal locking plates without augmentation （p〈0.05）. Functionally, there was no significant difference between the groups. Our preliminary study suggests that combination of MC as bone-graft substitutes and dorsal locking plates may be a usefully alternative for elderly patients with metaphyseal comminuted distal radius fracture.

Comparative study of perpendicular versus parallel double plating methods for type C distal humeral fractures

Background Double plate osteosynthesis is the standard treatment for intra-articular fractures of the distal humerus.However,there is still controversy concerning dual plate positions in terms of providing optimal stability.The purpose of this retrospective study was to compare the clinical outcomes in patients with type C intra-articular distal humeral fractures using perpendicular and parallel plating methods.Methods Between March 2008 and June 2011,a total of 45 patients with type C distal humerus fractures were treated using two different dual plating methods.Of them,24 patients were treated by perpendicular plating （group Ⅰ） and 21 patients were treated by parallel plating （group Ⅱ）.The surgical time,blood loss,and union time were compared between the two groups.The fiexion-extension arc,the total range of flexion and extension at the end of follow-up were compared between the two groups.The Mayo Elbow Performance Score （MEPS） was used to determine the elbow functional results.Results All patients were followed up.The mean duration of follow-up was 16 months （range 12-25 months） in group Ⅰ and 15.5 months in group Ⅱ （range 12-25 months）.There were no significant differences in the surgical time,blood loss,and the bone union time between the two groups.In group Ⅰ,the mean elbow flexion-extension arc was 101° and the mean MEPS was 85 points.The rate of excellent and good results was 87.5%.In group Ⅱ,the mean flexion-extension arc was 100° and the mean MEPS was 86.1 points.The rate of excellent and good results was 90.5%.There were no significant differences in the MEPS,flexion-extension arc,and the total range of flexion and extension between the two groups.Conclusions Perpendicular and parallel plate configurations with the appropriate surgical techniques can provide anatomical reconstruction and stable fixation of type C intra-articular distal humeral fractures and allow early mobilization of the elbow after an operation.The occurrence of post-operative elbow stiffness can be reduced and good outcomes can be obtained.

科研根植于临床 临床一心为患者——记本刊副总编辑张英泽教授

张英泽,《中国骨与关节杂志》副总编辑。主任医师、教授、博士生导师;美国科罗拉多大学医学院（University of Colorado School of Medicine）客座教授。中华医学会骨科学分会候任主任委员、中国医师协会骨科分会副会长、中国修复重建外科专业委员会副主任委员河北省医师协会会长。