Hemiarthroplasty for irreparable distal radius fractures in the elderly:A comprehensive review

BACKGROUND Elderly patients maintaining functional independence can now be candidates for primary wrist hemiarthroplasty to manage acute irreparable distal radius fractures(DRFs).However,further investigation with long-term follow-up is required to validate these initial findings.AIM To review the literature on the outcomes of distal radius hemiarthroplasty with available implants to assess its viability as a treatment option.METHODS A comprehensive review of the literature was conducted using electronic databases,including PubMed,Medline,and Scopus.The search terms employed were"distal radius fracture","hemiarthroplasty","wrist arthroplasty",and related terminology.The search was restricted to articles published in English from 1980 until June 2023.Inclusion criteria encompassed cases or case series of DRF treated with hemiarthroplasty,providing clinical or radiographic outcomes,and published in peer-reviewed journals.RESULTS A total of 2508 articles from PubMed and 883 from Scopus were identified initially.Following screening and removal of duplicates,13 articles met the inclusion criteria.These articles,predominantly clinical retrospective studies,provided insights into hemiarthroplasty outcomes,including functional improvements and complications.Hemiarthroplasty was a treatment option for complex DRF,particularly those cases with severe comminution,intraarticular involvement,or severe osteoporosis.Functional outcomes demonstrated improvements in pain relief,wrist mobility,and grip strength,with variability across studies.Complications included implant loosening,infection,nerve injury,and stiffness,with varying incidence rates influenced by surgical techniques and implant choice.Long-term outcomes were inadequately documented,warranting further research.CONCLUSION Hemiarthroplasty is a promising treatment for irreparable DRF in the elderly.Long-term outcomes and complications require further study.

Progress of systematic psychological interventions in elderly patients with femoral fractures:A comprehensive review

This review aims to gain a deeper understanding of the psychological state of elderly patients with femoral fractures and provide more theoretical and practical support for clinical treatment and care.Through a literature analysis,we found that elderly patients with femoral fractures face various psychological issues such as anxiety,depression,sleep disorders,and social isolation.The application of systematic nursing interventions in clinical practice,including cognitivebehavioral therapy,mindfulness therapy,family therapy,art therapy,interpersonal therapy,emotion-focused therapy,and relaxation training,has yielded significant results.Systematic psychological interventions can improve the psychological state and quality of life of elderly patients with femoral fractures.Therefore,promoting the application and practice of systematic psychological interventions in the clinical care of elderly patients with fractures will provide more effective psychological services to a wider group of patients with fractures in the future.

External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.

Therapeutic Effect of Artificial Femoral Head Replacement and Proximal Femoral Nail Antirotation on Elderly Unstable Intertrochanteric Fractures

Objective: To compare the clinical efficacy of artificial femoral head replacement and Proximal femoral nail antirotation (PFNA) in the treatment of unstable femoral intertrochanteric fractures in the elderly. Methods: This study retrospectively analyzed 60 elderly patients with unstable intertrochanteric fractures treated with PFNA and artificial femoral head replacement from 2015.06 to 2018.06, of which 34 were in the PFNA group (Group A) and 26 in the artificial femoral head replacement group (Group B). Statistical analysis of relevant surgical indicators such as surgical time, intraoperative blood loss, postoperative blood transfusion, postoperative time to landing, postoperative infection rate, hospital stay, number of secondary operations, postoperative VAS score, and postoperative Hip function score comparison. Results: All 60 patients were followed up for 1 - 24 months. Compared with the artificial femoral head replacement group, the operation time of PFNA group was shorter, the blood loss during operation was less, and the difference was statistically significant (P 0.05). Conclusion: The hip joint function and pain scores of the artificial femoral head replacement group in the early and follow-up periods are better than those of the PFNA group. The artificial femoral head replacement is more suitable for the treatment of elderly unstable intertrochanteric fractures.

Managing extremely distal periprosthetic femoral supracondylar fractures of total knee replacements-a new PHILOS-ophy

We report two cases where a proximal humeral locking plate was used for the fixation of an extremely distal, type Ⅲ peri-prosthetic femoral fractures in relation to a total knee replacement(TKR). In each case there was concern regarding the fixation that could be achieved using the available anatomic distal femoral plates due to the size and bone quality of distal fragment. The design of the Proximal Humeral Internal Locking System(PHILOS) allows nine 3.5-mm locking screws to be placed over a small area in multiple directions. This allowed a greater number of fixation points to be achieved in the distal fragment. Clinical and radiological short-term follow-up(6-12 mo) has been satisfactory in both cases with no complications. We suggest the use of this implant for extremely distal femoral fractures arising in relation to the femoral component of a TKR.

Distal femur complex fractures in elderly patients treated with megaprosthesis:Results in a case series of 11 patients

BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques.Recently,several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures.AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85.METHODS Data from 11 consecutive patients(10 females,1 male)presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded.We collected standard demographic data,comorbidities and patient reported outcomes including Visual Analogical Scale(VAS),Oxford Knee Score(OKS)and Barthel’s Index.Post-operative joint range of motion(ROM)and standard radiographic data were also collected.RESULTS At a mean follow-up of 23.2 mo,all of the implants were well-positioned and osteointegrated.Furthermore,all the patients were alive and walking either independently or with walking aids.There was a marked improvement in pain(VAS 4.5 postop vs 1.9 at the last follow-up),OKS score(29.5 postop vs 36.81 at the last follow-up),ROM(96.2°postop vs 102°at the last follow-up)and restoration of pre-injury ambulatory status(average Barthel Index 77.3).The radiographic evaluations showed good restoration of the articular geometry.No deaths and no complications were recorded.CONCLUSION In conclusion,we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice.This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis.It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients

A comparison of three fixations for intertrochanteric femoral fractures in the elderly

Objective To compare the efficacy of 3 internal fixations,locking proximal femoral plate (LPFP),ASI-AN IMHS and InterTAN,for intertrochanteric femoral fractures in elderly patients.Methods A retrospective study was done to analyse

Usage of buttress plate internal fixation associated with autografting of fibula and iliac bone for the treatment of distal femoral C_3 type fracture

To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture using buttress plate associated with antografting of fibula and iliac bone were analyzed retrospectively.Results All cases were followed up for an average of 24 months（8～55 months）.The average time of octets bridge forming were 4 months（3～5 months） while the average time for bone union were 8 months （6～14 months）.According to Shelbourne rating system,result of all 18 cases were excellent and no malunion,infection were found.Conclusion Buttress plate associated with antografting of fibula and iliac bone is an effective alternative for the treatment of distal femoral C3 type fracture.It can provide more stable fixation to the bone and earlier functional exercises can be achieved.5 refs,3 figs,1 tab.

Artificial tiger bone powder for improving the quality of life in elderly patients with fracture

Objective: To investigate the application of artificial tiger bone powder on fracture healing time, wrist functional recovery and quality of life (QOL) in elderly patients with distal radius fracture. Methods: The study was a randomised controlled trials performed from January 2015 to December 2016 in a hospital. Elderly patients with distal radius fracture were divided into the treatment and the control groups by the random sealed envelope method. All patients were given splint or plaster fixation after manipulative reduction, and functional exercise, the treatment group was also given artificial tiger bone powder orally (trade name: Jintiange capsule), the control group was given an oral placebo in their appearance and usage identical with the treatment group. Prior to treatment and 6, 12 months after treatment, the wrist function was assessed by range of motion, including flexion-extension, radial-ulnar and pronation-supination, and the QOL was assessed by the Mos 36-item Short Form Health Survey. Each patient's fracture healing time was recorded. Results: Before treatment, there were no significant differences in wrist function and QOL between the two groups. At 6 and 12 months after treatment, the wrist function and QOL in the treatment group were better than those in the control group, the differences were statistically significant (P < 0.05). The fracture healing time in the treatment group was shorter than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion: The early usage of artificial tiger bone powder for elderly patients with distal radius fracture can promote the healing of fracture, recovery of wrist joint function, and ultimately improve the QOL for elderly patients.

Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: a systematic review and metaanalysis

BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss during the operation.Osteoporosis in elderly patients may cause nonunion of fractures and other complications.Arthroplasty can give patients early weight bearing and reduce financial burden,but whether it can replace PFNs remains controversial.AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODS A search was conducted in the PubMed,Embase,and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN.The search time was limited from January 1,2005 to November 1,2020.Two investigators independently screened studies,extracted data and evaluated the quality according to the inclusion and exclusion criteria.According to the research results,the fixed effect model or random effect model were selected for analysis.The following outcomes were analyzed:Harris Hip score,mortality,complications,operation time,blood loos,hospital stay,weight-bearing time,fracture classification and type of anesthesia.RESULTS We analyzed four randomized controlled trials that met the requirements.A total of 298 patients were included in these studies.According to the AO/OTA classification,there are 20 A1 types,136 A2 types,42 A3 types and 100 unrecorded types.Primary outcome:The Harris Hip Score at the final follow-up of the PFN group was higher[mean difference(MD):9.01,95%confidence interval(CI):16.57 to 1.45),P=0.02].There was no significant difference between the two groups in the rate of overall mortality[risk ratio(RR):1.44,P=0.44]or the number of complications(RR:0.77,P=0.05).Secondary outcomes:blood loss of the arthroplasty group was higher(MD:241.01,95%CI:43.06–438.96,P=0.02);the operation time of the PFN group was shorter(MD:23.12,95%CI:10.46–35.77,P=0.0003);and the length of hospital stay of the arthroplasty group was shorter[MD:0.97,95%CI:1.29 to 0.66),P<0.00001].There was no difference between the two groups in the type of anesthesia(RR:0.99).There were only two studies recording the weight-bearing time,and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSION Compared with PFN,arthroplasty can achieve weight bearing earlier and shorten hospital stay,but it cannot achieve a better clinical outcome.Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.

Comparative study of intertrochanteric fracture fixation using proximal femoral nail with and without distal interlocking screws

BACKGROUND Intertrochanteric(IT)fracture is one of the most common fractures seen in an orthopaedic practice.Proximal femoral nailing(PFN)is a common modality of fixing IT femur fracture.We retrospectively studied whether a PFN with two proximal lag screws can be done without distal interlocking screws in the 31-A1 and 31-A2 fracture patterns according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association(AO/OTA)guidelines for IT femur fractures.AIM To compare the outcomes of IT fractures(AO/OTA 31-A1 and 31-A2)treated by PFN with and without distal interlocking screws.METHODS We carried out a retrospective study of 140 patients in a tertiary care centre who had AO/OTA type 31-A1 and 31-A2 IT fractures.We divided the patients into two groups,in which one of the groups received distal interlocking screws(group 1)and the other group did not(group 2).The subjects were followed up for a mean period of 14 mo and assessed for radiological union time,fracture site collapse,mechanical stability of implant,and complications associated with the PFN with distal interlocking and without distal interlocking.Then,the results were compared.RESULTS PFN without distal interlocking screws has several advantages and gives better results over PFN with distal interlocking screws in the AO/OTA 31-A2 fracture pattern.However,similar results were observed in both groups with the fracture pattern AO/OTA 31-A1.In patients with fracture pattern AO/OTA 31-A2 treated by PFN without distal interlocking screws,there were minimal proximal lockrelated complications and no risk of distal interlock-related complications.The operative time,IITV radiation time and time to radiological union were reduced.These patients also had better rotational alignment of the proximal femur,and the anatomy of the proximal femur was well maintained.It was also noted that in the cases where distal interlocking was performed,there was a gradual decrease in neck shaft angle,which led to varus collapse and failure of bone-implant construct in 21.40%.CONCLUSION In fracture pattern AO/OTA 31-A2,PFN without distal interlocking had better results and less complications than PFN with distal interlocking.

Hybrid External Fixation for Open Severe Comminuted Fractures of the Distal Femur

Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and then fix the condyles to the femoral shaft by minimum handling of the bone and soft tissues. Objectives: To evaluate the treatment of distal femoral open comminuted fractures (type C2 and C3) with hybrid external fixator. Methods: Thirty-four patients with distal femur open comminuted fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. All of the fractures were opened with extension to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72 years). Average follow up period was 36 months. 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by the association for the study and application of the method of Ilizarov (ASAMI) protocol and knee society score. Results: 29 out of 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4 - 19 ms). The average knee range of motion was 87.5 degrees (30 - 115 degrees). The bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%) according to ASAMI protocol. According to the knee society score the functional results were excellent in 9 (26.44%) patients, good in 13 (38.26%), fair in 7 (20.6%), and poor in 5 (14.7%). Conclusion: Hybrid external fixator is an effective method for treatment of distal femoral open comminuted fractures (type C2 and C3) and may be considered as an alternative surgical methods in the management of these fractures.

Effect of early surgery in high surgical risk geriatric patients with femoral neck fracture and taking antiplatelet agents

AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery(ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics(45 cases) who had delayed surgery(DS group) after 72 h during an earlier 3-year period. Postoperative outcomeswere followed for one year and compared. RESULTS: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality(P > 0.05 all). There were 2 patients(4%) in the DS group who died after surgery(P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome(P < 0.05 all).CONCLUSION: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.

A comparative analysis of distal locked and unlocked long proximal femoral nail antirotation (PFNA-II) in the fixation of stable intertrochanteric fractures

Purpose:Long proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures,especially in osteoporotic patients.The purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric fractures.Methods:A total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017–2019 by distal locked or unlocked long PFNA-II fixation were included in this study.Patients who had multiple injuries or open fractures were excluded.There were 40 female and 18 male patients,with 33 affecting the left side and 25 the right side.Of them,31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B).Surgical procedures and implants used in both groups were similar except for the distal locking of the nails.General data (age,gender,fracture side,etc.) showed no significant difference between two groups (allp > 0.05).The intraoperative parameters like operative time,radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and compared.Statistical tests like the independent samplest-test Fischer’’s exact and Chi-square test were used to analyze association.Results:The distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our study.All the included fractures united and the average functional outcome in both groups were good and comparable at the end of one year.The operative time (mL,107.1 ± 12.6vs.77.0 ± 12.0,p < 0.001) and radiation exposure (s,78.6 ± 11.0vs.40.3 ± 9.3,p < 0.001) were significantly less among the patients in group B.Fracture consolidation,three months after the operative procedures,was seen in a significantly greater proportion of patients in group B (92.6%vs.67.7%,p = 0.025).Hardware irritation because of distal locking bolt was exclusively seen in group A,however this was not statistically significant (p = 0.241).Conclusion:We conclude that,in fixation of stable intertrochanteric fractures by long PFNA-II nail,distal locking not only increases the operative time and radiation exposure but also delays the fracture consolidation and increases the chances of hardware irritation,and hence is not required.

Bone three-dimensional microstructural features of the common osteoporotic fracture sites

Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fractures are of global health and socioeconomic importance. The three-dimensional microstructural information of the common osteoporosis-related fracture sites, including vertebra, femoral neck and distal radius, is a key for fully understanding osteoporosis pathogenesis and predicting the fracture risk. Low vertebral bone mineral density(BMD) is correlated with increased fracture of the spine. Vertebral BMD decreases from cervical to lumbar spine, with the lowest BMD at the third lumbar vertebra. Trabecular bone mass of the vertebrae is much lower than that of the peripheral bone. Cancellous bone of the vertebral body has a complex heterogeneous three-dimensional microstructure, with lower bone volume in the central and anterior superior regions. Trabecular bone quality is a key element to maintain the vertebral strength. The increased fragility of osteoporotic femoral neck is attributed to low cancellous bone volume and high compact porosity. Compared with age-matched controls, increased cortical porosity is observed at the femoral neck in osteoporoticfracture patients. Distal radius demonstrates spatial inhomogeneous characteristic in cortical microstructure. The medial region of the distal radius displays the highest cortical porosity compared with the lateral, anterior and posterior regions. Bone strength of the distal radius is mainly determined by cortical porosity, which deteriorates with advancing age.

Modified fixation for periprosthetic supracondylar femur fractures:Two case reports and review of the literature

BACKGROUND Periprosthetic supracondylar femoral fractures(PSFs)present a challenge in terms of optimizing fixation in patients with poor bone quality.Surgical treatment and peri-operative management of PSFs in the elderly remain a burden for orthopedic surgeons.Among different treatment options,locking plate(LP)and retrograde intramedullary nail(RIMN)have shown favorable results.However,reduced mobility and protected weight-bearing are often present in the postoperative older population.With a purpose of allowing for early weight-bearing,a modified nail plate combination(NPC)was redesigned for PSF management.CASE SUMMARY In our cases,two elderly osteoporotic female underwent total knee arthroplasty(TKA),and then suffered from low energy trauma onto their knees after falling to the floor.Plain radiographs or computed tomography scans demonstrated oblique or transverse PSFs,both of which occurred at the distal femur above TKA.The modified NPC technique was performed for treatment of PSFs.The patient was made foot flat weight bearing in 1 wk.At 6-mo follow-up,the union was ultimately achieved using modified NPC with satisfactory implant outcomes.CONCLUSION Neither LP nor RIMN alone may provide adequate support to allow for union in circumstances where the patient has severely osteopenic bone.Therefore,developing a modified implant offer an alternative choice for treating PSFs.These two cases revealed that this technique is a viable option for the geriatric osteoporotic PSFs,offering safe,early weight bearing and favorable clinical outcomes.

股骨逆行髓内钉与微创内固定系统锁定钢板治疗骨质疏松性股骨远端骨折的临床疗效

目的探讨股骨逆行髓内钉与微创内固定系统(LISS)锁定钢板治疗骨质疏松性股骨远端骨折的临床效果。方法选取2015年7月至2021年7月北京市垂杨柳医院收治的49例骨质疏松性股骨远端骨折患者作为研究对象,根据不同内固定方法分为逆行髓内钉组(n=24)和LISS锁定钢板组(n=25)。逆行髓内钉组术中使用股骨逆行交锁髓内钉,LISS锁定钢板组术中使用LISS锁定钢板。比较两组手术相关指标、术后1年疗效、术后并发症发生率。结果逆行髓内钉组手术切口、手术时间、骨折愈合时间均短于LISS锁定钢板组,术中出血量少于LISS锁定钢板组,术中透视次数多于LISS锁定钢板组,差异有统计学意义(P<0.05)。两组术后1年优良率、术后并发症发生率比较差异无统计学意义。结论逆行髓内钉及LISS锁定钢板治疗在治疗骨质疏松性股骨远端骨折患者疗效相当,但两种内固定方法各有利弊,临床医师可根据患者情况进行选择。

单一切口双钢板治疗股骨远端粉碎性骨折的疗效

目的探讨单一切口双钢板治疗股骨远端粉碎性骨折的疗效。方法采用单一切口双钢板治疗30例股骨远端粉碎性骨折患者。记录骨折复位及愈合情况、负重行走情况、术后并发症发生情况、膝关节活动度,采用New KSS评分系统评价膝关节功能。结果患者均获得随访,时间6~24个月。术后均无感染、肢体短缩或旋转、关节半脱位等情况发生。术后X线片显示:28例骨折对位对线良好,关节面平整,达到解剖复位;2例轻度膝内翻。患者术后1~2周开始拄拐患肢不负重功能锻炼,术后4~6个月逐渐弃拐负重行走。除1例因过早负重术后12个月骨折延期愈合外,其余患者术后4~6个月骨折愈合。末次随访时,患者均可弃拐行走,断端无疼痛感,X线片显示骨折端无移位、内固定无松动或折断;膝关节屈曲105°~120°,伸直0°~10°;采用New KSS评分系统评价膝关节功能:优14例,良12例,可3例,差1例,优良率26/30。结论单一切口双钢板治疗股骨远端粉碎性骨折,可达到骨折解剖复位、坚强固定效果,患者可进行早期功能锻炼,疗效满意。

改良前内侧支撑钢板联合外侧锁定钢板固定治疗股骨远端骨折

目的探讨改良前内侧支撑钢板联合外侧锁定钢板固定治疗股骨远端骨折的疗效。方法将46例股骨远端骨折患者按照内固定方式不同分为对照组(采用单纯外侧锁定钢板固定治疗,28例)和观察组(采用改良前内侧支撑钢板联合外侧锁定钢板固定治疗,18例)。比较两组术中出血量、手术时间、骨折愈合时间、膝关节屈曲活动度。结果患者均获得随访,时间5~16个月。术中出血量两组比较差异无统计学意义(P>0.05);手术时间对照组短于观察组(P<0.01)。骨折愈合时间、术后5个月膝关节屈曲活动度观察组短(大)于对照组(P<0.01)。结论改良前内侧支撑钢板联合外侧锁定钢板固定治疗股骨远端骨折,可充分显露骨折断端,复位及固定效果可靠,具有缩短骨折愈合时间、利于患者早期进行膝关节功能锻炼的优势,但存在手术时间长的不足。