Background：Subcapital femoral neck fracture in young adults has many complications,and the incidence is increasing year-by-year.The selection of the proper operation method to avoid them is an ambiguous matter.This s...Background：Subcapital femoral neck fracture in young adults has many complications,and the incidence is increasing year-by-year.The selection of the proper operation method to avoid them is an ambiguous matter.This study aimed to evaluate the treatment effect of subcapital femoral neck fracture by the capsulotomy and internal fixation with iliac bone grafting or closed reduction and intemal fixation in young adults.Methods：From March 2003 to February 2010,65 young patients with subcapital femoral neck fractures were treated,including 39 males and 26 females with average age of 34.5 years （range,19-50 years）; 29 cases of the left side and 36 cases of the right side.They were randomly divided into Group A with 34 cases treated by closed reduction and internal fixation and Group B with 31 cases treated by the capsulotomy and internal fixation with iliac bone grafting.The two groups had no significant differences in sex,age,body mass index and preoperative Harris Hip Score.The observation criteria involved the length of the incision,blood loss,operation time,nonunion rate,avascular necrosis of the femoral head （ANFH） rate and Harris Hip Score.Results：Four of 65 patients were lost follow-up,and the follow-up rate was 93.8％,the average follow-up time was 38.7 months （range,33-47 months）.In Group A,the incision length was 5.1 ± 2.2 cm,blood loss was 84.0 ± 13.2 ml,and operation time was 52.9 ± 10.2 min.In Group B,the incision length was 15.4 ± 4.6 cm,blood loss was 396.0 ± 21.3 ml,and operation time was 1 16.5 ± 15.3 min.Nonunion occurred in 8 patients （25.2％） in Group A and 1 patient （3.3％） in Group B.ANFH occurred in 9 patients （29.1％） in Group A and 2 patients （6.7％） in Group B.Postoperative Harris Hip Score was 89.0 ± 5.6 in Group A and 95.0 ± 4.5 in Group B.The above index of two groups was considered statistically significant （P ＜ 0.05）.Conclusions：Capsulotomy and internal fixation with iliac bone grafting can improve fracture healing,reduce ANFH in young adults.It is a safe and effective operation for subcapital femoral neck fracture.展开更多
Background: Since we are very successful in the operation of hallux valgus using a transverse sub-capital osteotomy fixated with an intramedullary angle-stable locking plate, and a tailors bunion is understood as a re...Background: Since we are very successful in the operation of hallux valgus using a transverse sub-capital osteotomy fixated with an intramedullary angle-stable locking plate, and a tailors bunion is understood as a reversed hallux valgus, we have applied the operation also for such indication. Method: The osteotomy was carried out at a straight V. metatarsal subcapitally, and in case of an outwardly curved V. metatarsal at the bending location. The intramedullary plates are available in different designs and the plate and screws disappear completely in the bone, so the soft tissues are not disturbed. The head of the plate is either straight or curved in order to shift the distal fragment sufficiently. Results: 26 patients were operated within a period of 5 years (2008-2012). 21 patients were followed up after an average of 34.4 months. The IM angle IV/V could be improved by an average of 11.76 to an average of 4.10. This is a highliy significant pre- to postoperative difference of 7.66 (t = 15.07, p < 0.001). The AOFAS score was improved by an average of 42.24 points from 55.76 points preoperatively to 98.00 points postoperative. There was no pseudo-arthrosis and no wound healing impairment. All patients were either satisfied or very satisfied with the surgery. Conclusion: This method does not have the disadvantages of the other common operations of the Tailors bunion and is applied now as a standard method in this deformity.展开更多
文摘Background：Subcapital femoral neck fracture in young adults has many complications,and the incidence is increasing year-by-year.The selection of the proper operation method to avoid them is an ambiguous matter.This study aimed to evaluate the treatment effect of subcapital femoral neck fracture by the capsulotomy and internal fixation with iliac bone grafting or closed reduction and intemal fixation in young adults.Methods：From March 2003 to February 2010,65 young patients with subcapital femoral neck fractures were treated,including 39 males and 26 females with average age of 34.5 years （range,19-50 years）; 29 cases of the left side and 36 cases of the right side.They were randomly divided into Group A with 34 cases treated by closed reduction and internal fixation and Group B with 31 cases treated by the capsulotomy and internal fixation with iliac bone grafting.The two groups had no significant differences in sex,age,body mass index and preoperative Harris Hip Score.The observation criteria involved the length of the incision,blood loss,operation time,nonunion rate,avascular necrosis of the femoral head （ANFH） rate and Harris Hip Score.Results：Four of 65 patients were lost follow-up,and the follow-up rate was 93.8％,the average follow-up time was 38.7 months （range,33-47 months）.In Group A,the incision length was 5.1 ± 2.2 cm,blood loss was 84.0 ± 13.2 ml,and operation time was 52.9 ± 10.2 min.In Group B,the incision length was 15.4 ± 4.6 cm,blood loss was 396.0 ± 21.3 ml,and operation time was 1 16.5 ± 15.3 min.Nonunion occurred in 8 patients （25.2％） in Group A and 1 patient （3.3％） in Group B.ANFH occurred in 9 patients （29.1％） in Group A and 2 patients （6.7％） in Group B.Postoperative Harris Hip Score was 89.0 ± 5.6 in Group A and 95.0 ± 4.5 in Group B.The above index of two groups was considered statistically significant （P ＜ 0.05）.Conclusions：Capsulotomy and internal fixation with iliac bone grafting can improve fracture healing,reduce ANFH in young adults.It is a safe and effective operation for subcapital femoral neck fracture.
文摘Background: Since we are very successful in the operation of hallux valgus using a transverse sub-capital osteotomy fixated with an intramedullary angle-stable locking plate, and a tailors bunion is understood as a reversed hallux valgus, we have applied the operation also for such indication. Method: The osteotomy was carried out at a straight V. metatarsal subcapitally, and in case of an outwardly curved V. metatarsal at the bending location. The intramedullary plates are available in different designs and the plate and screws disappear completely in the bone, so the soft tissues are not disturbed. The head of the plate is either straight or curved in order to shift the distal fragment sufficiently. Results: 26 patients were operated within a period of 5 years (2008-2012). 21 patients were followed up after an average of 34.4 months. The IM angle IV/V could be improved by an average of 11.76 to an average of 4.10. This is a highliy significant pre- to postoperative difference of 7.66 (t = 15.07, p < 0.001). The AOFAS score was improved by an average of 42.24 points from 55.76 points preoperatively to 98.00 points postoperative. There was no pseudo-arthrosis and no wound healing impairment. All patients were either satisfied or very satisfied with the surgery. Conclusion: This method does not have the disadvantages of the other common operations of the Tailors bunion and is applied now as a standard method in this deformity.
