BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been develo...BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been developed.It is debatable as to which approach is best.AIM To compare triceps reflecting anconeus pedicle(TRAP)and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.METHODS In total,40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C,closed,and Gustilo type I intercondylar humeral fractures were included.Patients ranged in age from 18 years to 70 years.The patients were randomized into two groups:TRAP group and olecranon osteotomy group,with 20 cases in each.All were followed up at 6 wk,3 months,6 months,and 12 months.Functional outcomes were measured in terms of flexion-extension arc,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score.RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group.The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group(119.5 vs 111.5 min and 9.85 vs 5.45 d,respectively).The mean arc of flexion-extension,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up(107.0 vs 106.2,18.3 vs 15.7,and 84.2 vs 86.2,respectively).Ulnar paresthesia and superficial infections were comparable in both groups(2 cases vs 3 cases and 3 cases vs 2 cases,respectively).Hardware prominence was significantly higher in the olecranon osteotomy group,mostly due to tension band wiring.CONCLUSION Both approaches were equivalent,but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.展开更多
BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck,trochanter,and femoral head,that was accompanied by hip dislocation.Currently,there is no established stand...BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck,trochanter,and femoral head,that was accompanied by hip dislocation.Currently,there is no established standard treatment method for this specific type of fracture.Therefore,it is crucial to comprehensively consider factors such as patient age,fracture type,and degree of displacement to achieve a successful outcome.CASE SUMMARY A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident.The injuries included a fracture of the femoral head,a fracture of the femoral neck,an intertrochanteric fracture of the femur,and a posterior dislocation of the hip on the same side.We opted for a treatment approach combining the use of a proximal femoral locking plate,cannulated screws,and Kirschner wires.Following the surgery,we developed an individualized rehabil-itation program to restore patient limb function.CONCLUSION For this complex fracture,we selected appropriate internal fixation and for-mulated individualized rehabilitation,which ultimately achieved good results.展开更多
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
Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to J...Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.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 Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular struct...BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided.展开更多
BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patient...BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patients with medial knee osteoarthritis(OA).However,the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear.We present the case of a patient with a patellar fracture and anteromedial OA.CASE SUMMARY We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA.She also experienced a recent left patellar fracture.ORIF and Oxford UKA were performed in a single stage.The patient showed excellent postoperative clinical results.CONCLUSION ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.展开更多
BACKGROUND Despite recent meta-analyses of randomized controlled trials(RCTs),there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures.The fragility index(FI)is an emerging too...BACKGROUND Despite recent meta-analyses of randomized controlled trials(RCTs),there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures.The fragility index(FI)is an emerging tool used to evaluate the robustness of RCTs by quantifying the number of participants in a study group that would need to switch outcomes in order to reverse the study conclusions.AIM To investigate the fragility index of randomized control trials assessing outcomes of operative fixation in proximal humerus fractures.METHODS We completed a systematic review of RCTs evaluating the surgical treatment of humeral shaft fractures.Inclusion criteria included:articles published in English;patients randomized and allotted in 1:1 ratio to 2 parallel arms;and dichotomous outcome variables.The FI was calculated for total complications,each complication individually,and secondary surgeries using the Fisher exact test,as previously published.RESULTS Fifteen RCTs were included in the analysis comparing open reduction plate osteosynthesis with dynamic compression plate or locking compression plate,intramedullary nail,and minimally invasive plate osteosynthesis.The median FI was 0 for all parameters analyzed.Regarding individual outcomes,the FI was 0 for 81/91(89%)of outcomes.The FI exceeded the number lost to follow up in only 2/91(2%)outcomes.CONCLUSION The FI shows that data from RCTs regarding operative treatment of humeral shaft fractures are fragile and does not demonstrate superiority of any particular surgical technique.展开更多
Coracoid process fractures are relatively rare and few cases have been reported in the orthopedic literature. In this article, we report the case of an active, thirty years old, male patient with isolated, displaced f...Coracoid process fractures are relatively rare and few cases have been reported in the orthopedic literature. In this article, we report the case of an active, thirty years old, male patient with isolated, displaced fracture of the coracoid process, associated with a blunt injury to the shoulder, during a motor vehicle accident. We describe the incidence, mechanism of injury, and surgical treatment. Although rare, a high index of suspicion, special radiographic views, can detect an isolated coracoid process. Knowledge of the associated injuries will help the clinician to order further imaging and treat them accordingly. We recommend that a displaced, isolated fracture of the coracoid be treated with open reduction and osteosynthesis, to achieve early use of the extremity, good radiological union and clinical function.展开更多
In proximal humeral fracture except AO classification 11A1, fixations with a locking plate and nails are recommended. We performed mechanical tests to investigate whether retrograde intramedullary nailing has fixation...In proximal humeral fracture except AO classification 11A1, fixations with a locking plate and nails are recommended. We performed mechanical tests to investigate whether retrograde intramedullary nailing has fixation stability comparable to those of anterograde intramedullary nailing and locking plate which achieve clinically favorable outcomes. In retrograde intramedullary nailing, a nail entry point is made in the diaphysis, for which reduction of stiffness of the humerus is of concern. Thus, we investigated the influence of a nail entry point made in the diaphysis on humeral strength. Retrograde intramedullary nailing had fixation stability against bending and a force loaded in the rotation direction comparable to those of anterograde intramedullary nail and locking plate. Displacement by the main external force loaded on the humerus, compressive load, was less than half in the bone fixed by retrograde intramedullary nailing compared with that in the bone fixed with a locking plate, showing favorable fixation stability. It was clarified that stiffness of the humerus against rotation and a load in the compression direction is not reduced by a nail entry point made by retrograde intramedullary nailing.展开更多
At present,effective fixation and anti-infection implant materials represent the mainstay for the treatment of open fractures.However,external fixation can cause nail tract infections and is ineffective for fixing sma...At present,effective fixation and anti-infection implant materials represent the mainstay for the treatment of open fractures.However,external fixation can cause nail tract infections and is ineffective for fixing small fracture fragments.Moreover,closed reduction and internal fixation during the early stage of injury can lead to potential bone infection,conducive to bone nonunion and delayed healing.Herein,we designed a bone adhesive with anti-infection,osteogenic and bone adhesion fixation properties to promote reduction and fixation of open fractures and subsequent soft tissue repair.It was prepared by the reaction of gelatin(Gel)and oxidized starch(OS)with vancomycin(VAN)-loaded mesoporous bioactive glass nanoparticles(MBGNs)covalently cross-linked with Schiff bases.Characterization and adhesion experiments were conducted to validate the successful preparation of the Gel-OS/VAN@MBGNs(GOVM-gel)adhesive.Meanwhile,in vitro cell experiments demonstrated its good antibacterial effects with the ability to stimulate bone marrow mesenchymal stem cell(BMSCs)proliferation,upregulate the expression of alkaline phosphatase(ALP)and osteogenic proteins(RunX2 and OPN)and enhance the deposition of calcium nodules.Additionally,we established a rat skull fracture model and a subcutaneous infection model.The histological analysis showed that bone adhesive enhanced osteogenesis,and in vivo experiments demonstrated that the number of inflammatory cells and bacteria was significantly reduced.Overall,the adhesive could promote early reduction of fractures and antibacterial and osteogenic effects,providing the foothold for treatment of this patient population.展开更多
Background For some specific comminuted unstable intra-articular fracture,the plaster cast can not maintain the alignment of the articular surface effectively.The aim of this study was to evaluate the clinical effects...Background For some specific comminuted unstable intra-articular fracture,the plaster cast can not maintain the alignment of the articular surface effectively.The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.Methods From January 2002 to March 2010,539 cases of distal radius fracture were treated with open reduction and internal fixation,including 184 males and 355 females aging 21-72 years (mean 57 years).Fractures were caused by falling to the ground in 459 cases,by traffic accident in 62 cases and by athletic injuries in 18 cases.Of 539 cases,there were 523 cases of closed fracture and 16 cases of open fracture.According to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) standards of classification,there were 14 cases of A2 type,22 of A3 type,18 of B1 type,24 of B2 type,62 of B3 type,91 of C1 type,162 of C2 type and 146 of C3 type.The time from injury to operation was 1-16 days (mean 5 days).All patitents received open reduction and internal plate screw fixation.Forty-seven patients with bone defect were given 6-15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.Results All incisions healed by first intention after operation.Patients were followed up for 15 to 32 months postoperatively (mean 22 months).The fractures healed within 10-18 weeks after operation (mean 12 weeks).During the last follow-up,the mean palmar tilt was (7.0±0.9)° and the mean ulnar variance was (21.0±4.2)°,showing significant difference when compared with preoperation ((-5.0±1.2)° and (8.0±3.8)°).The radial heights were not abbreviated.According to Gartland and Werley assessment system,the results were excellent in 314 cases,good in 163 cases,fair in 46 cases,and poor in 16 cases 12 weeks after operation,the excellent and good rate was 88.5%.Conclusions The clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory.Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.展开更多
Objective: To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods: We prospecti...Objective: To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods: We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing (n=23), followed by fall from height (n=20), road traffic accidents (n-5) and fall from standing height (n=2). In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn's criteria. Results: Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn's criteria, 90.4% patients showed satisfactory results. Conclusion: Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.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:This meta-analysis compared the clinical outcome of three-dimensional(3D)printing combined with open reduction and internal fixation(ORIF)to traditional ORIF in the treatment of acetabular fractures.Methods:We...Purpose:This meta-analysis compared the clinical outcome of three-dimensional(3D)printing combined with open reduction and internal fixation(ORIF)to traditional ORIF in the treatment of acetabular fractures.Methods:We searched the Cochrane Library,PubMed,Embase,VIP database,CNKI,and Wanfang data-base with keywords"acetabular fracture","3D printing","three-dimensional printing","open reduction and internal fixation","Acetabulum","Acetabula"from January 2000 to March 2020.Two reviewers independently selected articles,extracted data,assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’s tools and/or Newcastle-Ottawa scale.When the two analysts had different opinions,they would ask the third analyst for opinion.Randomized controlled trials or retrospective comparative studies of 3D printing combined with ORIF(3D printing group)versus traditional ORIF(conventional group)in the treatment of acetabular fractures were selected.The data of operation time,intraoperative blood loss,intraoperative fluoroscopy times,incidence of complications,excellent and good rate of Matta score for reduction,and excellent and good rate of hip function score were extracted.Stata14.0 statistical software was used for data analysis.Results:Altogether 9 articles were selected,including 5 randomized controlled trials and 4 retrospective studies.A total of 467 patients were analyzed,250 in the conventional group,and 217 in the 3D printing group.The operation time in the 3D printing group was less than that in the conventional group and the difference was statistically significant(standardized mean difference(SMD)=-1.19,95%CI:-1.55 to-0.82,p<0.05).The intraoperative bleeding volume of the 3D printing group was significantly lower than that of the conventional group(SMD=-1.08,95%CI:-1.65 to-0.51,p<0.05).The fluoroscopy times were less in the 3D printing group than in the conventional group and the difference was statistically significant(SMD=-1.64,95%CI:-2.35 to-0.93,p<0.05).The total incidence of complications in the 3D printing group was significantly lower than that in the conventional group(OR=0.43,95%CI:0.24-0.79,p<0.05).There was no significant difference in the excellent and good rate of Matta score for reduction between the two groups(OR=0.60,95%CI:0.34-1.06,p>0.05).There was no significant difference in the excellent and good rate of hip function score at the end of postoperative follow-up between the two groups(OR=0.84,95%CI:0.46-1.56,p>0.05),but the follow-up time varies from 6 months to 40 months.Conclusion:Compared with traditional ORIF,3D printing combined with ORIF has certain advantages in terms that 3D printing not only helps surgeons to understand acetabular fractures more intuitively,but also effectively reduces operation time,intraoperative blood loss,intraoperative fluoroscopy times,and postoperative complications.However,there were no significant differences in the excellent and good rate of Matta score for reduction and the excellent and good rate of hip function score at the end of follow-up.展开更多
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 w...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.展开更多
BACKGROUND Hoffa fracture is rare,especially in adolescents,and has a high rate of complications such as avascular necrosis and osteoarthritis;moreover,there are no definitive guidelines for its treatment.This report ...BACKGROUND Hoffa fracture is rare,especially in adolescents,and has a high rate of complications such as avascular necrosis and osteoarthritis;moreover,there are no definitive guidelines for its treatment.This report could provide a new potential treatment for Hoffa fracture.CASE SUMMARY A 16-year-old girl presented to the orthopedic emergency department of No.2 People’s Hospital of Yibin City with persistent pain following a right knee injury sustained during a sprint race.Her knee was swollen and tender,and the range of motion was restricted by the pain.X-ray and computed tomography revealed a Hoffa fracture in the right knee.After consultation,surgical treatment was performed,and the fracture was fixed with three 3.5-mm cannulated cancellous screws;osteochondral plugs that were harvested from the screw insertion site were re-implanted to cover the screw head.The patient’s fracture and osteochondral plug healed 6 mo postoperatively,and she presented a knee range of motion of 0–135 without pain,and was walking without support with a normal gait.CONCLUSION Here,we describe an innovative surgical procedure for Hoffa fracture that could provide a new possibility for the treatment of similar fractures,and further improve their management.展开更多
文摘BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been developed.It is debatable as to which approach is best.AIM To compare triceps reflecting anconeus pedicle(TRAP)and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.METHODS In total,40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C,closed,and Gustilo type I intercondylar humeral fractures were included.Patients ranged in age from 18 years to 70 years.The patients were randomized into two groups:TRAP group and olecranon osteotomy group,with 20 cases in each.All were followed up at 6 wk,3 months,6 months,and 12 months.Functional outcomes were measured in terms of flexion-extension arc,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score.RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group.The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group(119.5 vs 111.5 min and 9.85 vs 5.45 d,respectively).The mean arc of flexion-extension,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up(107.0 vs 106.2,18.3 vs 15.7,and 84.2 vs 86.2,respectively).Ulnar paresthesia and superficial infections were comparable in both groups(2 cases vs 3 cases and 3 cases vs 2 cases,respectively).Hardware prominence was significantly higher in the olecranon osteotomy group,mostly due to tension band wiring.CONCLUSION Both approaches were equivalent,but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.
基金Supported by the Peak Discipline of Traditional Chinese Medicine(Orthopedics and Traumatology Integrated Traditional Chinese and Western Medicine),No.YC-2023-0601.
文摘BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck,trochanter,and femoral head,that was accompanied by hip dislocation.Currently,there is no established standard treatment method for this specific type of fracture.Therefore,it is crucial to comprehensively consider factors such as patient age,fracture type,and degree of displacement to achieve a successful outcome.CASE SUMMARY A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident.The injuries included a fracture of the femoral head,a fracture of the femoral neck,an intertrochanteric fracture of the femur,and a posterior dislocation of the hip on the same side.We opted for a treatment approach combining the use of a proximal femoral locking plate,cannulated screws,and Kirschner wires.Following the surgery,we developed an individualized rehabil-itation program to restore patient limb function.CONCLUSION For this complex fracture,we selected appropriate internal fixation and for-mulated individualized rehabilitation,which ultimately achieved good results.
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Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.
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 Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided.
文摘BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patients with medial knee osteoarthritis(OA).However,the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear.We present the case of a patient with a patellar fracture and anteromedial OA.CASE SUMMARY We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA.She also experienced a recent left patellar fracture.ORIF and Oxford UKA were performed in a single stage.The patient showed excellent postoperative clinical results.CONCLUSION ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.
文摘BACKGROUND Despite recent meta-analyses of randomized controlled trials(RCTs),there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures.The fragility index(FI)is an emerging tool used to evaluate the robustness of RCTs by quantifying the number of participants in a study group that would need to switch outcomes in order to reverse the study conclusions.AIM To investigate the fragility index of randomized control trials assessing outcomes of operative fixation in proximal humerus fractures.METHODS We completed a systematic review of RCTs evaluating the surgical treatment of humeral shaft fractures.Inclusion criteria included:articles published in English;patients randomized and allotted in 1:1 ratio to 2 parallel arms;and dichotomous outcome variables.The FI was calculated for total complications,each complication individually,and secondary surgeries using the Fisher exact test,as previously published.RESULTS Fifteen RCTs were included in the analysis comparing open reduction plate osteosynthesis with dynamic compression plate or locking compression plate,intramedullary nail,and minimally invasive plate osteosynthesis.The median FI was 0 for all parameters analyzed.Regarding individual outcomes,the FI was 0 for 81/91(89%)of outcomes.The FI exceeded the number lost to follow up in only 2/91(2%)outcomes.CONCLUSION The FI shows that data from RCTs regarding operative treatment of humeral shaft fractures are fragile and does not demonstrate superiority of any particular surgical technique.
文摘Coracoid process fractures are relatively rare and few cases have been reported in the orthopedic literature. In this article, we report the case of an active, thirty years old, male patient with isolated, displaced fracture of the coracoid process, associated with a blunt injury to the shoulder, during a motor vehicle accident. We describe the incidence, mechanism of injury, and surgical treatment. Although rare, a high index of suspicion, special radiographic views, can detect an isolated coracoid process. Knowledge of the associated injuries will help the clinician to order further imaging and treat them accordingly. We recommend that a displaced, isolated fracture of the coracoid be treated with open reduction and osteosynthesis, to achieve early use of the extremity, good radiological union and clinical function.
文摘In proximal humeral fracture except AO classification 11A1, fixations with a locking plate and nails are recommended. We performed mechanical tests to investigate whether retrograde intramedullary nailing has fixation stability comparable to those of anterograde intramedullary nailing and locking plate which achieve clinically favorable outcomes. In retrograde intramedullary nailing, a nail entry point is made in the diaphysis, for which reduction of stiffness of the humerus is of concern. Thus, we investigated the influence of a nail entry point made in the diaphysis on humeral strength. Retrograde intramedullary nailing had fixation stability against bending and a force loaded in the rotation direction comparable to those of anterograde intramedullary nail and locking plate. Displacement by the main external force loaded on the humerus, compressive load, was less than half in the bone fixed by retrograde intramedullary nailing compared with that in the bone fixed with a locking plate, showing favorable fixation stability. It was clarified that stiffness of the humerus against rotation and a load in the compression direction is not reduced by a nail entry point made by retrograde intramedullary nailing.
基金This work was supported by the Guangzhou Science and Technology Program Key Projects(No.202002020001)Science and Technology Planning Project of Guangdong Province(No.2020A0505100039)+1 种基金Autonomous region science and technology branch Xinjiang project plan(No.2022E02040)Clinical Key Specialty in Ningde City,Fujian Province.
文摘At present,effective fixation and anti-infection implant materials represent the mainstay for the treatment of open fractures.However,external fixation can cause nail tract infections and is ineffective for fixing small fracture fragments.Moreover,closed reduction and internal fixation during the early stage of injury can lead to potential bone infection,conducive to bone nonunion and delayed healing.Herein,we designed a bone adhesive with anti-infection,osteogenic and bone adhesion fixation properties to promote reduction and fixation of open fractures and subsequent soft tissue repair.It was prepared by the reaction of gelatin(Gel)and oxidized starch(OS)with vancomycin(VAN)-loaded mesoporous bioactive glass nanoparticles(MBGNs)covalently cross-linked with Schiff bases.Characterization and adhesion experiments were conducted to validate the successful preparation of the Gel-OS/VAN@MBGNs(GOVM-gel)adhesive.Meanwhile,in vitro cell experiments demonstrated its good antibacterial effects with the ability to stimulate bone marrow mesenchymal stem cell(BMSCs)proliferation,upregulate the expression of alkaline phosphatase(ALP)and osteogenic proteins(RunX2 and OPN)and enhance the deposition of calcium nodules.Additionally,we established a rat skull fracture model and a subcutaneous infection model.The histological analysis showed that bone adhesive enhanced osteogenesis,and in vivo experiments demonstrated that the number of inflammatory cells and bacteria was significantly reduced.Overall,the adhesive could promote early reduction of fractures and antibacterial and osteogenic effects,providing the foothold for treatment of this patient population.
文摘Background For some specific comminuted unstable intra-articular fracture,the plaster cast can not maintain the alignment of the articular surface effectively.The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.Methods From January 2002 to March 2010,539 cases of distal radius fracture were treated with open reduction and internal fixation,including 184 males and 355 females aging 21-72 years (mean 57 years).Fractures were caused by falling to the ground in 459 cases,by traffic accident in 62 cases and by athletic injuries in 18 cases.Of 539 cases,there were 523 cases of closed fracture and 16 cases of open fracture.According to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) standards of classification,there were 14 cases of A2 type,22 of A3 type,18 of B1 type,24 of B2 type,62 of B3 type,91 of C1 type,162 of C2 type and 146 of C3 type.The time from injury to operation was 1-16 days (mean 5 days).All patitents received open reduction and internal plate screw fixation.Forty-seven patients with bone defect were given 6-15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.Results All incisions healed by first intention after operation.Patients were followed up for 15 to 32 months postoperatively (mean 22 months).The fractures healed within 10-18 weeks after operation (mean 12 weeks).During the last follow-up,the mean palmar tilt was (7.0±0.9)° and the mean ulnar variance was (21.0±4.2)°,showing significant difference when compared with preoperation ((-5.0±1.2)° and (8.0±3.8)°).The radial heights were not abbreviated.According to Gartland and Werley assessment system,the results were excellent in 314 cases,good in 163 cases,fair in 46 cases,and poor in 16 cases 12 weeks after operation,the excellent and good rate was 88.5%.Conclusions The clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory.Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.
文摘Objective: To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods: We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing (n=23), followed by fall from height (n=20), road traffic accidents (n-5) and fall from standing height (n=2). In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn's criteria. Results: Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn's criteria, 90.4% patients showed satisfactory results. Conclusion: Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.
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:This meta-analysis compared the clinical outcome of three-dimensional(3D)printing combined with open reduction and internal fixation(ORIF)to traditional ORIF in the treatment of acetabular fractures.Methods:We searched the Cochrane Library,PubMed,Embase,VIP database,CNKI,and Wanfang data-base with keywords"acetabular fracture","3D printing","three-dimensional printing","open reduction and internal fixation","Acetabulum","Acetabula"from January 2000 to March 2020.Two reviewers independently selected articles,extracted data,assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’s tools and/or Newcastle-Ottawa scale.When the two analysts had different opinions,they would ask the third analyst for opinion.Randomized controlled trials or retrospective comparative studies of 3D printing combined with ORIF(3D printing group)versus traditional ORIF(conventional group)in the treatment of acetabular fractures were selected.The data of operation time,intraoperative blood loss,intraoperative fluoroscopy times,incidence of complications,excellent and good rate of Matta score for reduction,and excellent and good rate of hip function score were extracted.Stata14.0 statistical software was used for data analysis.Results:Altogether 9 articles were selected,including 5 randomized controlled trials and 4 retrospective studies.A total of 467 patients were analyzed,250 in the conventional group,and 217 in the 3D printing group.The operation time in the 3D printing group was less than that in the conventional group and the difference was statistically significant(standardized mean difference(SMD)=-1.19,95%CI:-1.55 to-0.82,p<0.05).The intraoperative bleeding volume of the 3D printing group was significantly lower than that of the conventional group(SMD=-1.08,95%CI:-1.65 to-0.51,p<0.05).The fluoroscopy times were less in the 3D printing group than in the conventional group and the difference was statistically significant(SMD=-1.64,95%CI:-2.35 to-0.93,p<0.05).The total incidence of complications in the 3D printing group was significantly lower than that in the conventional group(OR=0.43,95%CI:0.24-0.79,p<0.05).There was no significant difference in the excellent and good rate of Matta score for reduction between the two groups(OR=0.60,95%CI:0.34-1.06,p>0.05).There was no significant difference in the excellent and good rate of hip function score at the end of postoperative follow-up between the two groups(OR=0.84,95%CI:0.46-1.56,p>0.05),but the follow-up time varies from 6 months to 40 months.Conclusion:Compared with traditional ORIF,3D printing combined with ORIF has certain advantages in terms that 3D printing not only helps surgeons to understand acetabular fractures more intuitively,but also effectively reduces operation time,intraoperative blood loss,intraoperative fluoroscopy times,and postoperative complications.However,there were no significant differences in the excellent and good rate of Matta score for reduction and the excellent and good rate of hip function score at the end of follow-up.
文摘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.
文摘BACKGROUND Hoffa fracture is rare,especially in adolescents,and has a high rate of complications such as avascular necrosis and osteoarthritis;moreover,there are no definitive guidelines for its treatment.This report could provide a new potential treatment for Hoffa fracture.CASE SUMMARY A 16-year-old girl presented to the orthopedic emergency department of No.2 People’s Hospital of Yibin City with persistent pain following a right knee injury sustained during a sprint race.Her knee was swollen and tender,and the range of motion was restricted by the pain.X-ray and computed tomography revealed a Hoffa fracture in the right knee.After consultation,surgical treatment was performed,and the fracture was fixed with three 3.5-mm cannulated cancellous screws;osteochondral plugs that were harvested from the screw insertion site were re-implanted to cover the screw head.The patient’s fracture and osteochondral plug healed 6 mo postoperatively,and she presented a knee range of motion of 0–135 without pain,and was walking without support with a normal gait.CONCLUSION Here,we describe an innovative surgical procedure for Hoffa fracture that could provide a new possibility for the treatment of similar fractures,and further improve their management.