Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We ana...Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We analyzed a case series of patients with open reduction and internal fixation (ORIF) for complex acetabular fractures. Two hundred patients (132 men, 68 women) in four age groups including with a mean age of 43.39 ± 6.18 years (range 20 - 59 years) and a mean follow-up of 82.34 ± 12.48 months (range 18 - 109 months) met the inclusion criteria. Functional outcome at final follow-up was graded assessed according to Harris score. Factors affecting were defined. Results: Anatomic reduction was achieved in 192 hips, imperfect in 8 and poor in none. Radiological outcome revealed excellent results in 128 (64%) hips, good in eight, fair in five and none in poor. Harris score were excellent in 139 (69.5%) hips, good in 43 (21.5%) and fair in 18 (9%) and poor in none. The anatomical reduction results had a favorable final functional outcome. (0.003) However, BMI (P Conclusion: Optimal functional and radiological outcomes have been achieved with anatomic postoperative reduction. Also experience of specialist, on time surgery and good recovery lead to receiving excellent functional outcome with at least complications.展开更多
Mechanical traction and percutaneous reduction by leverage and fixation by a bilateral groove externalfixator were performed on 23 patients with complex tibial plateau fractures involving a depressed and splitfragment...Mechanical traction and percutaneous reduction by leverage and fixation by a bilateral groove externalfixator were performed on 23 patients with complex tibial plateau fractures involving a depressed and splitfragments. The fixator is composed of two long groove frames, three to five nuts, hooked bolts and Stein-manns pins.All fractures united in good position in three months with no incision (only pinpricks), llttle operativetrauma and no significant complications but pintract infection, and the flexion-extension range of kneemovement was excllent in all patients, so that this technique is particularly advisable for complex tibialplateau fractures.展开更多
The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing...The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.展开更多
Complex tibial plateau fractures can seriously affect quality of life and physical and mental health of patients.The anatomical relationship between the proximal tibial bone and soft tissue is complex,resulting in dif...Complex tibial plateau fractures can seriously affect quality of life and physical and mental health of patients.The anatomical relationship between the proximal tibial bone and soft tissue is complex,resulting in different types of tibial plateau fractures.Violent trauma can lead to displaced fracture,serious soft tissue injury,and potentially,dislocation of the knee joint.Therefore,tibial plateau fractures are extremely unstable.AIM To assess the use of locking compression plate(LCP)+T-type steel plate for postoperative weight bearing and functional recovery of complex tibial plateau fractures.METHODS Ninety-seven patients with complex tibial plateau fractures who underwent surgery at our hospital were selected for retrospective study.Forty-nine patients had been treated with LCP+T-type steel plate limited internal fixation(study group),and 48 patients with bilateral ordinary steel plate support(control group).The operation process index,postoperative rehabilitation related index,Rasmussen score of the knee joint,tibial plateau varus angle(TPA),tibial plateau retroversion angle(PA),and surgical complications of the two groups were compared.RESULTS The operation time and intraoperative bone graft volume in the study group were lower than those in the control group(P<0.05).There were no significant differences in surgical bleeding,anterior external incision length,postoperative drainage,hospital stay duration,and fracture healing time between the groups(P>0.05).There was no significant difference in the TPA and PA angle between the groups immediately and 18 mo after surgery(P>0.05).At 12 mo after surgery,the Rasmussen scale score was higher in the study group than in the control group(P<0.05).There was no significant difference in the Rasmussen scale score at 18 mo after surgery,and the radiology score at 12 and 18 mo after surgery,between the two groups(P>0.05).The postoperative complication rate in the study group(3.77%)was lower than that in the control group(15.09%;P<0.05).CONCLUSION LCP+T-type steel plate internal fixation has advantages in terms of minimizing trauma and enabling early postoperative functional exercise,promoting functional recovery and lower limb weight-bearing,and reducing postoperative complications.展开更多
Objective To explore the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and locking compression plate (LCP) for open tibial shaft fractures.Methods From March 2005 to May 2009,16 ca...Objective To explore the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and locking compression plate (LCP) for open tibial shaft fractures.Methods From March 2005 to May 2009,16 cases with open tibial展开更多
BACKGROUND The tibial stop of anterior cruciate ligament(ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine,which is located between the anterior horn of the medial and lateral me...BACKGROUND The tibial stop of anterior cruciate ligament(ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine,which is located between the anterior horn of the medial and lateral meniscus.The incidence of this fracture is low previously reported,which is common in children and adolescents.With the increase of sports injury and traffic injury and the deepening of understanding,it is found that the incidence of the disease is high at present.AIM To explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.METHODS Seventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People’s Hospital from April 2018 to June 2020 were retrospectively analyzed.According to the surgical methods,they were divided into group A(40 cases) and group B(36 cases).Patients in group A were treated with arthroscopic high-strength non-absorbable suture,and patients in group B were treated with small incision open reduction and internal fixation.The operation time,fracture healing time,knee joint activity and functional score before and after operation,and surgical complications of the two groups were compared.RESULTS The operation time of group A was higher than that of group B,and the difference was statistically significant(P < 0.05);the fracture healing time of group A was compared with that of group B,and the difference was not statistically significant(P > 0.05);The knee joint function activity was compared between two groups before operation,3 mo and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation(P < 0.05);the limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm score were compared between the two groups before and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the scores of limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm in group A and group B at 6 mo after operation were significantly higher than those before operation(P > 0.05);the surgical complication rate of group A was 2.63%,which was lower than 18.42% of group B,and the difference was statistically significant(P > 0.05).CONCLUSION Both small incision open reduction and internal fixation and arthroscopic high-strength nonabsorbable sutures can achieve good results in the treatment of anterior cruciate ligament tibial avulsion fractures.The operation time of arthroscopic high-strength non-absorbable sutures is slightly longer,but the complication rate is lower.展开更多
Purpose: To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation. Methods: This retrospective review was condu...Purpose: To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation. Methods: This retrospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov external fixation between July 2006 and December 2015 with the minimum follow-up duration of one year. There were 30 patients: 24 males and 6 females, mean age 43.33 years, and mean follow-up 3.6 years. Three of them were open fractures;15 cases were Schatzkertype V fractures and the other 15 type VI. According to AO/OTA classification, there were 11 type C1, 12 C2 and 7 type C3 fractures. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final follow-up. Results: Out of the 30 cases, mini-open reduction was performed in 7, bone graft in 4, minimal internal fixation in 10 and knee temporary immobilisation in 11 patients. Mean duration of external fixation was 11.8 weeks. All fractures united. Pin tract infections in 7 and common peroneal neuropathy in 2 patients were self-limiting. Two patients had axial misalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS 81.5 and mean RRS 16.7. On statistical analysis, Schatzker type of fractures, use of minimal internal fixation and knee-spanning did not influence the final outcome. Conclusion: Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.展开更多
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...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.展开更多
BACKGROUND Lisfranc injuries have not received much attention by orthopedic doctors in the past,and there is little related research on the diagnosis and treatment of these injuries.In recent years with the rise in fo...BACKGROUND Lisfranc injuries have not received much attention by orthopedic doctors in the past,and there is little related research on the diagnosis and treatment of these injuries.In recent years with the rise in foot and ankle surgery,doctors are now paying more attention to this type of injury.However,there is still a high rate of missed diagnosis due to insufficient attention causing treatment delays or inadequate treatments,which eventually result in greater sequelae;including long-term pain,arthritis,foot deformity etc.In particular,for cases with a mild Lisfranc joint complex injury,the incidence of sequelae is higher.AIM To select an active surgical treatment for an atypical Lisfranc joint complex injury and to evaluate the clinical efficacy of the surgical treatment.METHODS The clinical data of 18 patients,including 10 males and 8 females aged 20-64 years with Lisfranc injuries treated in our department from January 2017 to September 2019 were retrospectively analyzed.All patients were treated with an open reduction and internal fixation method using locking titanium mini-plates and hollow screws or Kirschner wires.X-ray images were taken and follow-up was performed monthly after the operation;the internal fixation was then removed 4-5 mo after the operation;and the American Orthopedic Foot and Ankle Society(AOFAS)score was used for evaluation on the last follow-up.RESULTS All patients were followed up for 6-12 mo.A good/excellent AOFAS score was observed in 88.9%of patients.CONCLUSION For atypical Lisfranc joint complex injuries,active open reduction and internal fixation can be performed to enable patients to obtain a good prognosis and satisfactory functional recovery.展开更多
背景:治疗后交叉韧带胫骨附着点撕脱骨折的最佳手术技术仍值得商榷。随着关节镜手术的应用与成熟,它在后交叉韧带胫骨附着点撕脱骨折的诊疗中有很大前景。目的:综述关节镜技术在后交叉韧带胫骨附着点撕脱骨折治疗中的应用与进展,包括不...背景:治疗后交叉韧带胫骨附着点撕脱骨折的最佳手术技术仍值得商榷。随着关节镜手术的应用与成熟,它在后交叉韧带胫骨附着点撕脱骨折的诊疗中有很大前景。目的:综述关节镜技术在后交叉韧带胫骨附着点撕脱骨折治疗中的应用与进展,包括不同关节镜治疗方法、手术入路、胫骨隧道设计、缝合材料选择以及内固定植入物选择等。方法:通过计算机对中国知网、PubMed、Web of Science及ScienceDirect等数据库中的相关文献进行检索,检索时间为2003年1月至2023年11月,中文检索词为“后交叉韧带,后十字韧带,撕脱骨折,关节镜”;英文检索词为“posterior cruciate ligament,avulsion,fracture,tibia,arthroscopic,operation,fixation,treatment”。共纳入97篇文献进行综述。结果与结论:关节镜技术提供了一种可靠的治疗方式来治疗后交叉韧带胫骨附着点撕脱骨折。根据入路、缝合材料类型以及用于缝合的入路和胫骨隧道数量等不同,关节镜技术可以分为关节镜下缝线固定结合自体移植物增强重建、关节镜下多交叉带缝合桥固定、关节镜下高强度缝线固定以及关节镜下直接前后缝合悬吊固定等几类。在各种研究中,常用的临床结果评估指标包括关节活动度、Lysholm评分、国际膝关节文献委员会评分及KT-2000关节测量仪差等,研究显示关节镜手术后末次随访时上述指标检测结果较术前显著改善,影像学随访结果显示关节镜手术都取得了令人满意的结果。在随访过程中,接受关节镜技术治疗后的各类交叉韧带胫骨附着点撕脱骨折患者都未出现严重并发症,例如创伤性关节炎、神经血管损伤、围手术期伤口感染、血栓形成以及骨折不愈合等。展开更多
Objective: To explore a classification method which can provide the clinical guidance for internal fixation of tibial fracture. Methods: The different fractures were fixed according to their mechanical classificatio...Objective: To explore a classification method which can provide the clinical guidance for internal fixation of tibial fracture. Methods: The different fractures were fixed according to their mechanical classification. Totally, 71 cases of tibial plateau fracture, tibial proximal fracture, tibial distal fracture and Pilon fracture were analyzed to test this selective principle. Results: All 71 patients were followed up for 6-32 months. The displacement was seldomly observed in cases treated acccording to the classification principle, while some cases against the principle had postoperative displacement.The difference was statistically significant (P〈0.05). It was proved that there was remarkable correlation between tibial fracture classification, internal fixator and fixation methods. Conclusion: Types Ⅲa3, Ⅲb 1 and Ⅲb2 fractures without eccentric moment should be fixed with double plates or angle-stable materials combined with locking structure, otherwise displacement may occur.展开更多
Purpose: To compare the outcomes of closed reduction and expert tibial nailing (ETN) versus open reduction and plate and screw fixation in treating two segmental tibial fractures. Methods: This study included 53 c...Purpose: To compare the outcomes of closed reduction and expert tibial nailing (ETN) versus open reduction and plate and screw fixation in treating two segmental tibial fractures. Methods: This study included 53 cases of two segmental fractures of the tihial shaft. They were admitted to our department between March 2010 and June 2013 and treated respectively by closed reduction and ETN (ETN group, n = 31 ) or open reduction fixation with plate and screws (PS group, n = 22). The general data of two groups including gender, age, injury cause, fracture type, etc showed no significant difference (p 〉 0.05). To compare the therapeutic effects between two groups, the intraoperative condition, post- operative function and related complications were investigated. Results: All the patients were successfully followed up. The period was 19.2 months for ETN group and 20.5 months for PS group. All the fractures in ETN group had union without complications such as malunion, infection, or osteofascial compartment syndrome; whereas there were 3 cases of superficial infection cured by repeated dressing change and 2 cases of delayed union in PS group. The total incidence of complication in PS group was 22.7% (5/22), much higher than that in ETN group (p 〈 0.05). Moreover, ETN group showed a better result in terms of intraoperative blood loss, operation time, postoperative weight bearing time and fracture union time. In ETN group, at one-year follow-up, Johner-Wruhs' criteria was adopted to assess the postoperative function, which was reported as excellent in 18 cases, good in 10 cases and fair in 3 cases in ETN group (100% excellent-good rate). While in PS group, the result was excellent in 10 cases, good in 7 cases, fair in 3 cases and poor in 2 cases (77.3% excellent-good rate). The comparison was insignificant (p 〉 0.05). Conclusion: Compared with plate and screw fixation, ETN fixation has the advantages of fewer complications, shorter operation time, being less invasive, earlier postoperative rehabilitation and weight bearing, quicker fracture union and better functional recovery, thus being an effective way to treat two segmental tibial fractures.展开更多
文摘Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We analyzed a case series of patients with open reduction and internal fixation (ORIF) for complex acetabular fractures. Two hundred patients (132 men, 68 women) in four age groups including with a mean age of 43.39 ± 6.18 years (range 20 - 59 years) and a mean follow-up of 82.34 ± 12.48 months (range 18 - 109 months) met the inclusion criteria. Functional outcome at final follow-up was graded assessed according to Harris score. Factors affecting were defined. Results: Anatomic reduction was achieved in 192 hips, imperfect in 8 and poor in none. Radiological outcome revealed excellent results in 128 (64%) hips, good in eight, fair in five and none in poor. Harris score were excellent in 139 (69.5%) hips, good in 43 (21.5%) and fair in 18 (9%) and poor in none. The anatomical reduction results had a favorable final functional outcome. (0.003) However, BMI (P Conclusion: Optimal functional and radiological outcomes have been achieved with anatomic postoperative reduction. Also experience of specialist, on time surgery and good recovery lead to receiving excellent functional outcome with at least complications.
文摘Mechanical traction and percutaneous reduction by leverage and fixation by a bilateral groove externalfixator were performed on 23 patients with complex tibial plateau fractures involving a depressed and splitfragments. The fixator is composed of two long groove frames, three to five nuts, hooked bolts and Stein-manns pins.All fractures united in good position in three months with no incision (only pinpricks), llttle operativetrauma and no significant complications but pintract infection, and the flexion-extension range of kneemovement was excllent in all patients, so that this technique is particularly advisable for complex tibialplateau fractures.
文摘The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.
文摘Complex tibial plateau fractures can seriously affect quality of life and physical and mental health of patients.The anatomical relationship between the proximal tibial bone and soft tissue is complex,resulting in different types of tibial plateau fractures.Violent trauma can lead to displaced fracture,serious soft tissue injury,and potentially,dislocation of the knee joint.Therefore,tibial plateau fractures are extremely unstable.AIM To assess the use of locking compression plate(LCP)+T-type steel plate for postoperative weight bearing and functional recovery of complex tibial plateau fractures.METHODS Ninety-seven patients with complex tibial plateau fractures who underwent surgery at our hospital were selected for retrospective study.Forty-nine patients had been treated with LCP+T-type steel plate limited internal fixation(study group),and 48 patients with bilateral ordinary steel plate support(control group).The operation process index,postoperative rehabilitation related index,Rasmussen score of the knee joint,tibial plateau varus angle(TPA),tibial plateau retroversion angle(PA),and surgical complications of the two groups were compared.RESULTS The operation time and intraoperative bone graft volume in the study group were lower than those in the control group(P<0.05).There were no significant differences in surgical bleeding,anterior external incision length,postoperative drainage,hospital stay duration,and fracture healing time between the groups(P>0.05).There was no significant difference in the TPA and PA angle between the groups immediately and 18 mo after surgery(P>0.05).At 12 mo after surgery,the Rasmussen scale score was higher in the study group than in the control group(P<0.05).There was no significant difference in the Rasmussen scale score at 18 mo after surgery,and the radiology score at 12 and 18 mo after surgery,between the two groups(P>0.05).The postoperative complication rate in the study group(3.77%)was lower than that in the control group(15.09%;P<0.05).CONCLUSION LCP+T-type steel plate internal fixation has advantages in terms of minimizing trauma and enabling early postoperative functional exercise,promoting functional recovery and lower limb weight-bearing,and reducing postoperative complications.
文摘Objective To explore the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and locking compression plate (LCP) for open tibial shaft fractures.Methods From March 2005 to May 2009,16 cases with open tibial
文摘BACKGROUND The tibial stop of anterior cruciate ligament(ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine,which is located between the anterior horn of the medial and lateral meniscus.The incidence of this fracture is low previously reported,which is common in children and adolescents.With the increase of sports injury and traffic injury and the deepening of understanding,it is found that the incidence of the disease is high at present.AIM To explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.METHODS Seventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People’s Hospital from April 2018 to June 2020 were retrospectively analyzed.According to the surgical methods,they were divided into group A(40 cases) and group B(36 cases).Patients in group A were treated with arthroscopic high-strength non-absorbable suture,and patients in group B were treated with small incision open reduction and internal fixation.The operation time,fracture healing time,knee joint activity and functional score before and after operation,and surgical complications of the two groups were compared.RESULTS The operation time of group A was higher than that of group B,and the difference was statistically significant(P < 0.05);the fracture healing time of group A was compared with that of group B,and the difference was not statistically significant(P > 0.05);The knee joint function activity was compared between two groups before operation,3 mo and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation(P < 0.05);the limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm score were compared between the two groups before and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the scores of limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm in group A and group B at 6 mo after operation were significantly higher than those before operation(P > 0.05);the surgical complication rate of group A was 2.63%,which was lower than 18.42% of group B,and the difference was statistically significant(P > 0.05).CONCLUSION Both small incision open reduction and internal fixation and arthroscopic high-strength nonabsorbable sutures can achieve good results in the treatment of anterior cruciate ligament tibial avulsion fractures.The operation time of arthroscopic high-strength non-absorbable sutures is slightly longer,but the complication rate is lower.
文摘Purpose: To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation. Methods: This retrospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov external fixation between July 2006 and December 2015 with the minimum follow-up duration of one year. There were 30 patients: 24 males and 6 females, mean age 43.33 years, and mean follow-up 3.6 years. Three of them were open fractures;15 cases were Schatzkertype V fractures and the other 15 type VI. According to AO/OTA classification, there were 11 type C1, 12 C2 and 7 type C3 fractures. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final follow-up. Results: Out of the 30 cases, mini-open reduction was performed in 7, bone graft in 4, minimal internal fixation in 10 and knee temporary immobilisation in 11 patients. Mean duration of external fixation was 11.8 weeks. All fractures united. Pin tract infections in 7 and common peroneal neuropathy in 2 patients were self-limiting. Two patients had axial misalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS 81.5 and mean RRS 16.7. On statistical analysis, Schatzker type of fractures, use of minimal internal fixation and knee-spanning did not influence the final outcome. Conclusion: Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.
文摘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.
基金Science Foundation of Shenyang Medical College,No.20187076.
文摘BACKGROUND Lisfranc injuries have not received much attention by orthopedic doctors in the past,and there is little related research on the diagnosis and treatment of these injuries.In recent years with the rise in foot and ankle surgery,doctors are now paying more attention to this type of injury.However,there is still a high rate of missed diagnosis due to insufficient attention causing treatment delays or inadequate treatments,which eventually result in greater sequelae;including long-term pain,arthritis,foot deformity etc.In particular,for cases with a mild Lisfranc joint complex injury,the incidence of sequelae is higher.AIM To select an active surgical treatment for an atypical Lisfranc joint complex injury and to evaluate the clinical efficacy of the surgical treatment.METHODS The clinical data of 18 patients,including 10 males and 8 females aged 20-64 years with Lisfranc injuries treated in our department from January 2017 to September 2019 were retrospectively analyzed.All patients were treated with an open reduction and internal fixation method using locking titanium mini-plates and hollow screws or Kirschner wires.X-ray images were taken and follow-up was performed monthly after the operation;the internal fixation was then removed 4-5 mo after the operation;and the American Orthopedic Foot and Ankle Society(AOFAS)score was used for evaluation on the last follow-up.RESULTS All patients were followed up for 6-12 mo.A good/excellent AOFAS score was observed in 88.9%of patients.CONCLUSION For atypical Lisfranc joint complex injuries,active open reduction and internal fixation can be performed to enable patients to obtain a good prognosis and satisfactory functional recovery.
文摘背景:治疗后交叉韧带胫骨附着点撕脱骨折的最佳手术技术仍值得商榷。随着关节镜手术的应用与成熟,它在后交叉韧带胫骨附着点撕脱骨折的诊疗中有很大前景。目的:综述关节镜技术在后交叉韧带胫骨附着点撕脱骨折治疗中的应用与进展,包括不同关节镜治疗方法、手术入路、胫骨隧道设计、缝合材料选择以及内固定植入物选择等。方法:通过计算机对中国知网、PubMed、Web of Science及ScienceDirect等数据库中的相关文献进行检索,检索时间为2003年1月至2023年11月,中文检索词为“后交叉韧带,后十字韧带,撕脱骨折,关节镜”;英文检索词为“posterior cruciate ligament,avulsion,fracture,tibia,arthroscopic,operation,fixation,treatment”。共纳入97篇文献进行综述。结果与结论:关节镜技术提供了一种可靠的治疗方式来治疗后交叉韧带胫骨附着点撕脱骨折。根据入路、缝合材料类型以及用于缝合的入路和胫骨隧道数量等不同,关节镜技术可以分为关节镜下缝线固定结合自体移植物增强重建、关节镜下多交叉带缝合桥固定、关节镜下高强度缝线固定以及关节镜下直接前后缝合悬吊固定等几类。在各种研究中,常用的临床结果评估指标包括关节活动度、Lysholm评分、国际膝关节文献委员会评分及KT-2000关节测量仪差等,研究显示关节镜手术后末次随访时上述指标检测结果较术前显著改善,影像学随访结果显示关节镜手术都取得了令人满意的结果。在随访过程中,接受关节镜技术治疗后的各类交叉韧带胫骨附着点撕脱骨折患者都未出现严重并发症,例如创伤性关节炎、神经血管损伤、围手术期伤口感染、血栓形成以及骨折不愈合等。
文摘Objective: To explore a classification method which can provide the clinical guidance for internal fixation of tibial fracture. Methods: The different fractures were fixed according to their mechanical classification. Totally, 71 cases of tibial plateau fracture, tibial proximal fracture, tibial distal fracture and Pilon fracture were analyzed to test this selective principle. Results: All 71 patients were followed up for 6-32 months. The displacement was seldomly observed in cases treated acccording to the classification principle, while some cases against the principle had postoperative displacement.The difference was statistically significant (P〈0.05). It was proved that there was remarkable correlation between tibial fracture classification, internal fixator and fixation methods. Conclusion: Types Ⅲa3, Ⅲb 1 and Ⅲb2 fractures without eccentric moment should be fixed with double plates or angle-stable materials combined with locking structure, otherwise displacement may occur.
文摘Purpose: To compare the outcomes of closed reduction and expert tibial nailing (ETN) versus open reduction and plate and screw fixation in treating two segmental tibial fractures. Methods: This study included 53 cases of two segmental fractures of the tihial shaft. They were admitted to our department between March 2010 and June 2013 and treated respectively by closed reduction and ETN (ETN group, n = 31 ) or open reduction fixation with plate and screws (PS group, n = 22). The general data of two groups including gender, age, injury cause, fracture type, etc showed no significant difference (p 〉 0.05). To compare the therapeutic effects between two groups, the intraoperative condition, post- operative function and related complications were investigated. Results: All the patients were successfully followed up. The period was 19.2 months for ETN group and 20.5 months for PS group. All the fractures in ETN group had union without complications such as malunion, infection, or osteofascial compartment syndrome; whereas there were 3 cases of superficial infection cured by repeated dressing change and 2 cases of delayed union in PS group. The total incidence of complication in PS group was 22.7% (5/22), much higher than that in ETN group (p 〈 0.05). Moreover, ETN group showed a better result in terms of intraoperative blood loss, operation time, postoperative weight bearing time and fracture union time. In ETN group, at one-year follow-up, Johner-Wruhs' criteria was adopted to assess the postoperative function, which was reported as excellent in 18 cases, good in 10 cases and fair in 3 cases in ETN group (100% excellent-good rate). While in PS group, the result was excellent in 10 cases, good in 7 cases, fair in 3 cases and poor in 2 cases (77.3% excellent-good rate). The comparison was insignificant (p 〉 0.05). Conclusion: Compared with plate and screw fixation, ETN fixation has the advantages of fewer complications, shorter operation time, being less invasive, earlier postoperative rehabilitation and weight bearing, quicker fracture union and better functional recovery, thus being an effective way to treat two segmental tibial fractures.