In spite of advances in techniques and improvements in surgical implants, confusion still prevails regarding use of specific implants in distal femur fracture. Fractures in the distal femur have posed considerable the...In spite of advances in techniques and improvements in surgical implants, confusion still prevails regarding use of specific implants in distal femur fracture. Fractures in the distal femur have posed considerable therapeutic challenges throughout the history of fracture treatment. Most of these surgical failures were due to inadequate fixation of the fracture fragments. The Aim of the study is to determine whether distal femur locking plates are superior implants than dynamic condylar screw and distal femur nail. A prospective and observational study was done in Department of Orthopaedics and Traumatology, Sri Ramachandra Medical Collage, Chennai between Jan. 2011 and Jan. 2015. Patients with distal femoral fractures, admitted into the hospital, were treated using various modes of internal fixation and followed up over a period of six months to one year and their functional outcome was evaluated. The functional and radiological assessment of patients during follow-up was done using Neer’s criteria. The use of any one of the implant, i.e. distal femur locking plates, dynamic condylar screw or distal femur nailing for internal fixation, depends on the type of fracture and the pre operative planning and intra operate decision of the surgeon. In our study, 38% of fractures treated by Dynamic condylar screw, 72% of fractures treated by distal femur locking plate and 42% of fractures treated by Distal femur supracondylar nail had excellent/satisfactory results. Locking plates had better outcome in both extra-articular and intra-articular group. They also had better outcome in both younger and older age groups.展开更多
Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated...Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results:The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion:The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.展开更多
Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic...Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76°and 64°, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.展开更多
Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated...Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.展开更多
AIM:To review our outcomes and compare the results of the Less Invasive Stabilization System(LISS)to other implants for distal femur fracture management at a regional Australian hospital.METHODS:The LISS is a novel im...AIM:To review our outcomes and compare the results of the Less Invasive Stabilization System(LISS)to other implants for distal femur fracture management at a regional Australian hospital.METHODS:The LISS is a novel implant for the management of distal femur fractures.It is,however,technically demanding and treatment results have not yet been assessed outside tertiary centres.Twenty-seven patients with 28 distal femur fractures who had been managed surgically at the Mackay Base Hospital from January 2004 to December 2010 were retrospectively enrolled and assessed clinically and radiologically.Outcomes were union,pain,Lysholm score,knee range of motion,and complication rates.RESULTS:Twenty fractures were managed with the LISS and eight fractures were managed with alternative implants.Analysis of the surgical techniques re-vealed that 11 fractures managed with the LISS were performed according to the recommended principles(LISS-R)and 9 were not(LISS-N).Union occurred in67.9%of fractures overall:9/11(82%)in the LISS-R group vs 5/9(56%)in the LISS-N group and 5/8(62.5%)in the alternative implant group.There was no statistically significant difference between pain,Lysholm score,and complication rates between the groups.However,there was a trend towards the LISS-R group having superior outcomes which were clinically significant.There was a statistically significant greater range of median knee flexion in the LISS-R group with compared to the LISS-N group(P=0.0143)and compared with the alternative implant group(P=0.0454).CONCLUSION:The trends towards the benefits of the LISS procedure when correctly applied would suggest that not only should the LISS procedure be performed for distal femur fractures,but the correct principle of insertion is important in improving the patient’s outcome.展开更多
Objectives: This study compared the clinical and radiological outcomes of two different methods for the treatment of distal radial intra-articular fractures. Patients and Methods: Forty-six patients with distal radius...Objectives: This study compared the clinical and radiological outcomes of two different methods for the treatment of distal radial intra-articular fractures. Patients and Methods: Forty-six patients with distal radius intra-arti-cular fractures were divided into two groups. Group I included 24 patients with type C fracture treated by external fixator augmented by percutaneous K-wires. Group II included 22 patients with type C fracture treated by volar locked distal radial plate augmented by K-wires. Two patients had complex injuries necessitating double plating (sandwich). All patients were evaluated clinically by Mayo Wrist Score and radiologically by Sarmiento’s radiological score. Results: Both groups reported good personal satisfaction according to Mayo Wrist Score, and the results were not statistically different between the two groups. In Group I, 19 patients (79.2%) had excellent radiological outcome and five patients (20.9%) had good radiological outcome according to Sarmiento’s radiological score. In Group II, 20 patients (90.9%) had excellent outcome, and two (9.1%) had good radiological outcome;there was no or insignificant deformity. Conclusions: Complex distal radial fractures can be treated either by external fixation (ligamentotaxis) or by locked pre-contoured plating. The clinical outcome of plating and external fixator in our study did not show any statistically significant difference. The radiological outcome had no correlation with the clinical outcome.展开更多
Complications and shortcomings of volar plating, which is very widely used for surgical treatment of distal radius fractures, are well known. Thus, there is scope for alternative innovative surgical methods. In the pr...Complications and shortcomings of volar plating, which is very widely used for surgical treatment of distal radius fractures, are well known. Thus, there is scope for alternative innovative surgical methods. In the present work, we used the finite element analysis method to compare the biomechanical performance of a model of a construct comprising a simulated distal radius fracture considered fixated using a notional intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis system (“fixator”) versus using a commercially-available volar locking plate (VP). The biomechanical parameters determined were longitudinal stiffness and factor of safety under each of the applied loads.?For the fixator model, 1) each of the biomechanical parameters was markedly influenced by fracture gap fill ratio (FGFR) (defined as the proportion of the volume of the fracture gap that is considered occupied by the expanded polymer-filled balloon)?but not by modulus of elasticity assigned to the polymer;2) with FGFR = 100%, stiffness was comparable to that of the Ti-6Al-4V alloy VP construct model;and 3) stiffness was within the range of literature values for stiffness of constructs comprising simulated fractures in fresh cadaveric distal radii fixated using metal volar locking plate. These results suggest that the fixator may be an alternative modality to metal volar plating and, as such, deserves further evaluation.展开更多
目的比较股骨远端90°锁定钢板与弹性髓内钉治疗学龄期儿童股骨下段不稳定型骨折的疗效。方法采用随机数字表法将75例学龄期股骨下段不稳定型骨折患儿分成观察组(采用股骨远端90°锁定钢板治疗,38例)与对照组(采用闭合或切开复...目的比较股骨远端90°锁定钢板与弹性髓内钉治疗学龄期儿童股骨下段不稳定型骨折的疗效。方法采用随机数字表法将75例学龄期股骨下段不稳定型骨折患儿分成观察组(采用股骨远端90°锁定钢板治疗,38例)与对照组(采用闭合或切开复位弹性髓内钉治疗,37例)。记录手术情况、骨折复位及愈合情况、术后再移位发生率。采用HSS评分评价膝关节功能。结果患儿均获得随访,时间6~24个月。术中出血量、术中透视次数观察组均少于对照组(P<0.05)。术后3 d X线片显示两组骨折均复位良好。两组骨折愈合时间2.5~5个月。末次随访时,HSS评分优良率观察组高于对照组(P<0.05)。术后再移位发生率观察组低于对照组(P<0.05)。结论与弹性髓内钉相比,股骨远端90°锁定钢板治疗学龄期儿童股骨下段不稳定型骨折,术中出血量、透视次数更少,术后骨折再移位率更低,疗效更好。展开更多
文摘In spite of advances in techniques and improvements in surgical implants, confusion still prevails regarding use of specific implants in distal femur fracture. Fractures in the distal femur have posed considerable therapeutic challenges throughout the history of fracture treatment. Most of these surgical failures were due to inadequate fixation of the fracture fragments. The Aim of the study is to determine whether distal femur locking plates are superior implants than dynamic condylar screw and distal femur nail. A prospective and observational study was done in Department of Orthopaedics and Traumatology, Sri Ramachandra Medical Collage, Chennai between Jan. 2011 and Jan. 2015. Patients with distal femoral fractures, admitted into the hospital, were treated using various modes of internal fixation and followed up over a period of six months to one year and their functional outcome was evaluated. The functional and radiological assessment of patients during follow-up was done using Neer’s criteria. The use of any one of the implant, i.e. distal femur locking plates, dynamic condylar screw or distal femur nailing for internal fixation, depends on the type of fracture and the pre operative planning and intra operate decision of the surgeon. In our study, 38% of fractures treated by Dynamic condylar screw, 72% of fractures treated by distal femur locking plate and 42% of fractures treated by Distal femur supracondylar nail had excellent/satisfactory results. Locking plates had better outcome in both extra-articular and intra-articular group. They also had better outcome in both younger and older age groups.
文摘Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results:The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion:The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.
文摘Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76°and 64°, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.
文摘Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.
文摘AIM:To review our outcomes and compare the results of the Less Invasive Stabilization System(LISS)to other implants for distal femur fracture management at a regional Australian hospital.METHODS:The LISS is a novel implant for the management of distal femur fractures.It is,however,technically demanding and treatment results have not yet been assessed outside tertiary centres.Twenty-seven patients with 28 distal femur fractures who had been managed surgically at the Mackay Base Hospital from January 2004 to December 2010 were retrospectively enrolled and assessed clinically and radiologically.Outcomes were union,pain,Lysholm score,knee range of motion,and complication rates.RESULTS:Twenty fractures were managed with the LISS and eight fractures were managed with alternative implants.Analysis of the surgical techniques re-vealed that 11 fractures managed with the LISS were performed according to the recommended principles(LISS-R)and 9 were not(LISS-N).Union occurred in67.9%of fractures overall:9/11(82%)in the LISS-R group vs 5/9(56%)in the LISS-N group and 5/8(62.5%)in the alternative implant group.There was no statistically significant difference between pain,Lysholm score,and complication rates between the groups.However,there was a trend towards the LISS-R group having superior outcomes which were clinically significant.There was a statistically significant greater range of median knee flexion in the LISS-R group with compared to the LISS-N group(P=0.0143)and compared with the alternative implant group(P=0.0454).CONCLUSION:The trends towards the benefits of the LISS procedure when correctly applied would suggest that not only should the LISS procedure be performed for distal femur fractures,but the correct principle of insertion is important in improving the patient’s outcome.
文摘Objectives: This study compared the clinical and radiological outcomes of two different methods for the treatment of distal radial intra-articular fractures. Patients and Methods: Forty-six patients with distal radius intra-arti-cular fractures were divided into two groups. Group I included 24 patients with type C fracture treated by external fixator augmented by percutaneous K-wires. Group II included 22 patients with type C fracture treated by volar locked distal radial plate augmented by K-wires. Two patients had complex injuries necessitating double plating (sandwich). All patients were evaluated clinically by Mayo Wrist Score and radiologically by Sarmiento’s radiological score. Results: Both groups reported good personal satisfaction according to Mayo Wrist Score, and the results were not statistically different between the two groups. In Group I, 19 patients (79.2%) had excellent radiological outcome and five patients (20.9%) had good radiological outcome according to Sarmiento’s radiological score. In Group II, 20 patients (90.9%) had excellent outcome, and two (9.1%) had good radiological outcome;there was no or insignificant deformity. Conclusions: Complex distal radial fractures can be treated either by external fixation (ligamentotaxis) or by locked pre-contoured plating. The clinical outcome of plating and external fixator in our study did not show any statistically significant difference. The radiological outcome had no correlation with the clinical outcome.
文摘Complications and shortcomings of volar plating, which is very widely used for surgical treatment of distal radius fractures, are well known. Thus, there is scope for alternative innovative surgical methods. In the present work, we used the finite element analysis method to compare the biomechanical performance of a model of a construct comprising a simulated distal radius fracture considered fixated using a notional intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis system (“fixator”) versus using a commercially-available volar locking plate (VP). The biomechanical parameters determined were longitudinal stiffness and factor of safety under each of the applied loads.?For the fixator model, 1) each of the biomechanical parameters was markedly influenced by fracture gap fill ratio (FGFR) (defined as the proportion of the volume of the fracture gap that is considered occupied by the expanded polymer-filled balloon)?but not by modulus of elasticity assigned to the polymer;2) with FGFR = 100%, stiffness was comparable to that of the Ti-6Al-4V alloy VP construct model;and 3) stiffness was within the range of literature values for stiffness of constructs comprising simulated fractures in fresh cadaveric distal radii fixated using metal volar locking plate. These results suggest that the fixator may be an alternative modality to metal volar plating and, as such, deserves further evaluation.
文摘目的比较股骨远端90°锁定钢板与弹性髓内钉治疗学龄期儿童股骨下段不稳定型骨折的疗效。方法采用随机数字表法将75例学龄期股骨下段不稳定型骨折患儿分成观察组(采用股骨远端90°锁定钢板治疗,38例)与对照组(采用闭合或切开复位弹性髓内钉治疗,37例)。记录手术情况、骨折复位及愈合情况、术后再移位发生率。采用HSS评分评价膝关节功能。结果患儿均获得随访,时间6~24个月。术中出血量、术中透视次数观察组均少于对照组(P<0.05)。术后3 d X线片显示两组骨折均复位良好。两组骨折愈合时间2.5~5个月。末次随访时,HSS评分优良率观察组高于对照组(P<0.05)。术后再移位发生率观察组低于对照组(P<0.05)。结论与弹性髓内钉相比,股骨远端90°锁定钢板治疗学龄期儿童股骨下段不稳定型骨折,术中出血量、透视次数更少,术后骨折再移位率更低,疗效更好。
