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

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

Surgical Treatment of Recent Traumatic Epiphyseal Detachments of the Distal Femur in the Orthopedic and Traumatological Surgery Department of the CHU Bocar Sidy Sall de Kati: About 20 Cases

Introduction: To our knowledge, no scientific study has been conducted at the university hospital of Kati on recent traumatic epiphyseal detachment fractures of the distal femur. However, every day, children present in consultation for knee trauma. Conjugal plate fractures are by definition single to children. Any break in any solution of continuity of this plate is called an epiphyseal fracture or detachment. Objectives: To evaluate the results of surgical treatment of traumatic epiphyseal in detachments of the distal femur recent in children and adolescents. Patients and Method: This was a 13-month prospectively collected longitudinal descriptive study from September 1, 2016 to September 30, 2017. We identified and reviewed 20 medical records of recent traumatic epiphyseal detachments of the distal femur. The parameters studied were sociodemographic, lesion, surgical technique and evolutionary. Results: During the study period, the most affected group age was 12 to 17 years (85%) with an average of 14.65 ± 1.61 years (6 and 20 years). The victims were male (95%). The most frequent etiology was road traffic accident (95%), with a mean time to care of 26.42 ± 10.21 hours and Type II was frequently encountered (85%) with 35% of immediate complications. Cross-bracketing was the most commonly used surgical technique (85%). The result was good (65%). Conclusion: This study allowed us to observe a significant hospital incidence of epiphyseal detachment fractures of the distal femur. Cross pinning was the most commonly used surgical technique with fewer complications (35%) and a satisfactory result in 90% of cases.

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

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

Treatment of distal femur fractures in a regional Australian hospital

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.

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

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

A Novel Method to Fix Type C3 Distal Femur Fractures with Bone Defect Loss Using “Harms Cage”

A case of compound C3 distal femur fracture with 12 cm bone defect. After thorough debridement, the Harms cage was used to reconstruct the medial column and the fracture was fixed with the locking distal femur plate laterally. The Harms cage prevents the cantilever effect and eliminates the need for medial plating. This avoids another medial incision and preserves medial biology. At 18 months’ follow-up, plain radiographs demonstrated full reconstruction of the medial column with good range of motion at the knee joint. This technique avoids the need of dual plating in these fractures with good results.

Distal Radius Fracture: What Does the Patient Want?

Distal radius fractures are common and while historically most have been treated nonoperatively the frequency with which distal radius fractures are treated surgically is increasing. Criteria for considering surgical treatment are often based on radiographic appearance of the fracture. Less often discussed is patient preference: what do patients want. We investigated responses of a general population when presented with various treatment options following a hypothetical distal radius fracture. Many respondents chose nonoperative treatment even when told that surgery might result in a better outcome. This information can help during the shared decision-making process when discussing treatment options with a patient who presents with a distal radius fracture.

Pulmonary thromboembolism after distal ulna and radius fractures surgery: A case report and a literature review

BACKGROUND Pulmonary thromboembolism(PTE)is a serious postoperative complication that can occur after a fracture.Generally,PTE is caused by the falling off of lower extremity deep vein thrombosis(LEDVT)after lower limb fracture surgery.LEDVT and PTE after upper extremity fracture surgery are very rare.PTE is one of the most common clinical causes of sudden death.Venous thromboembolism includes PTE and DVT.We experienced one case of LEDVT and PTE after distal ulna and radius fracture surgery.The purpose of our report is to raise awareness for orthopedic surgeons that PTE can occur after distal ulna and radius fracture surgery,and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.CASE SUMMARY We report a 51-year-old Chinese male who had severe fractures of the left distal ulna,radius and little finger after a motorcycle accident.The patient underwent external fixation,open reduction and internal fixation.On the third post-operative day,computed tomographic pulmonary angiography showed PTE.Doppler ultrasonography showed thrombus formation in the bilateral posterior tibial veins.After a period of anticoagulation therapy,on the 25th d after the PTE,computed tomographic pulmonary angiography showed that thrombus in both sides of the pulmonary artery disappeared.Furthermore,about 4 mo after the PTE,thrombosis in the deep veins of the lower limbs disappeared.About 1 year after the surgery,X-rays showed good fracture healing,and the function of the wrist joint recovered well.CONCLUSION Though rare,PTE can occur after distal ulna and radius fracture surgery and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.

Evaluation of results of open distal femur fractures with primary fixation and antibiotic impregnated collagen

Purpose:Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1%of all fractures.Open fracture takes 5%-10%of the all distal femoral fractures,which is at an increased risk of complications.There were limited studies which documented the outcomes of such cases.The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in northern India.Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.They were followed for minimum of six months.Patients were followed up monthly for first four months,at six months and one year after surgery.Clinical and radiological signs of healing,any complications,time to union,and functional outcome were assessed.Results:The mean age of patients was 44.33 years(range 20-82 years)with male predominance of 66.7%.According to Gustilo-Anderson classification,there were 5,15 and 10 patients with open grade I,II and IIIA distal femoral fractures respectively.According to orthopaedic trauma association(OTA)classification,majority of patients in our study were of C3 type.The mean time to bony union was 5.6 months(range 4-9 months).Average postoperative knee range of motion(ROM)at the latest follow-up was 98°(range 70°-120°).Lysholm knee scoring scale showed excellent score in 11 patients,good in 9 patients,fair and poor in 5 patients each;however,there was no significant correlation with fracture pattern types(p<0.05).Knee stiffness was the major complications encountered in the study.The knee ROM was<90°in 5 patients and 90°-120°in rest of the patients,while 1 patient had extensor lag of 10°.One patient had implant failure and lost to follow-up;3 patients had deep infection.Conclusion:An approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.

两种治疗方案对老年人桡骨远端骨折的疗效比较

目的:探讨采用保守治疗和切开复位内固定两种方案对65岁以上老年人桡骨远端骨折(DRF)的疗效。方法:选择我院于2020年6月—2022年2月收治的DRF患者81例,分为手法组(46例)与切开组(35例)。手法组采用骨折手法复位高分子聚酯绷带固定治疗;切开组采用切开复位内固定手术治疗。使用X线片对比患者治疗前后的尺偏角、掌偏角和桡骨高度,以评估治疗情况。统计患者末次随访的改良Mayo腕关节评分(MMWS)、DASH-Chinese上肢功能评分以及并发症,对患者预后评价。结果:两组治疗后尺偏角、掌偏角和桡骨高度较治疗前增加(P<0.05);切开组治疗后尺偏角、掌偏角和桡骨高度高于手法组(P<0.05)。两组治疗后MMWS较治疗前增加,而DASH-Chinese上肢功能评分较治疗前降低(P<0.05);切开组治疗后MMWS高于手法组,而DASH-Chinese上肢功能评分低于手法组(P<0.05)。切开组并发症发生率低于手法组(P<0.05)。结论:切开复位内固定术治疗老年人DRF有明显的临床优势,可以促进患者腕关节和上肢功能恢复。

两种方法治疗学龄期儿童股骨下段不稳定型骨折的疗效比较

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。

股骨远端90°锁定钢板与克氏针治疗大龄儿童股骨髁上骨折的疗效比较

目的比较股骨远端90°锁定钢板与克氏针治疗大龄儿童股骨髁上骨折的疗效。方法采用随机数字表法将61例大龄儿童股骨髁上不稳定型骨折患儿分为观察组(31例,采用股骨远端90°锁定钢板治疗)和对照组(30例,采用闭合或切开复位克氏针治疗)。记录两组手术情况、疼痛VAS评分、骨折愈合情况以及骨折再移位率,采用Johner-Wruhs标准评价疗效。结果患儿均获得随访,时间6~24个月。手术时间、术中透视次数观察组短(少)于对照组(P<0.05)。术后1个月疼痛VAS评分观察组低于对照组(P<0.05)。两组骨折均愈合,时间3~5个月。末次随访时采用Johner-Wruhs标准评价的疗效优良率观察组高于对照组(P<0.05)。随访期间观察组1例(3.2%)骨折再移位,对照组8例(26.7%)骨折再移位,骨折再移位率观察组小于对照组(P<0.05)。结论股骨远端90°锁定钢板治疗大龄儿童股骨髁上骨折,无需塑形、固定牢固、符合生物力学特点,效果良好;与克氏针治疗相比,手术时间更短,术中透视次数更少,患儿可以更早功能锻炼,骨折再移位率更低。

钢板内固定治疗股骨下端单髁骨折

2019年3月~2022年3月,我科采用钢板内固定治疗12例股骨下端单髁骨折(Hoffa骨折)患者,疗效满意,报道如下。1材料与方法1.1病例资料本组12例,男10例,女2例,年龄28~67岁。均为闭合Hoffa骨折。左侧4例,右侧8例。致伤原因:交通事故伤9例,高处坠落伤2例,摔伤1例。

小切口撬拨复位外固定支架与切开复位钢板内固定术治疗C3型桡骨远端骨折患者的效果比较

目的:比较小切口撬拨复位外固定支架与切开复位钢板内固定术治疗C3型桡骨远端骨折患者的效果。方法:回顾性分析2022年1月至2023年10月该院收治的80例桡骨远端C3型骨折患者的临床资料,根据手术方法不同将其分为对照组与观察组各40例。对照组采用切开复位钢板内固定术治疗,观察组采用小切口撬拨复位外固定支架治疗。比较两组临床疗效,手术相关指标,术前、术后3个月时骨折复位情况(桡骨高度、掌倾角及关节面台阶高度),术后即刻、术后3个月时腕关节活动度(背伸、掌屈、桡偏及尺偏角度),以及并发症发生率。结果:观察组优良率为95.00%(38/40),高于对照组的77.50%(31/40),差异有统计学意义(P<0.05);观察组手术时间、骨折愈合时间、住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后3个月时,观察组桡骨高度、掌倾角及腕关节背伸、掌屈、桡偏、尺偏角度均大于对照组,关节面台阶小于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:小切口撬拨复位外固定支架治疗桡骨远端C3型骨折患者疗效优良率高于切开复位钢板内固定术,而且能够缩短手术时间、骨折愈合时间、住院时间,减少术中出血量,提高骨折复位效果和腕关节活动度。

抗生素骨水泥柱占位联合植骨治疗股骨远端开放骨折骨缺损的疗效分析

目的:探讨抗生素骨水泥柱占位联合髂骨植骨在股骨远端开放骨折骨缺损治疗中的有效性及初步疗效。方法:回顾性分析2014年10月至2021年3月采用抗生素骨水泥柱占位联合髂骨植骨技术治疗股骨远端开放骨折骨缺损16例,其中男12例,女4例;年龄28~68岁。车祸伤11例,高处坠落伤5例,Gustilo分型Ⅰ型3例,Ⅱ型5例,ⅢA型8例。采用AO分型:C2型9例,C3型7例。从受伤至接受最终植骨手术时间为4~119 d。骨缺长损度2~10 cm。记录患者骨折愈合时间、并发症、膝关节功能Merchan评分。结果:本组16例患者均获得随访,随访时间9~29个月。16例患者切口均Ⅰ期愈合,无术后感染、钢板断裂、肢体短缩及膝内外翻畸形等并发症。骨折愈合时间为4~10个月。膝关节功能根据Merchan评分标准评估,优8例,良4例,可3例,差1例。结论:采用抗生素骨水泥柱占位联合髂骨植骨治疗股骨远端开放复杂骨折骨缺损有助于预防感染、协助骨折复位,增加固定强度,减少植骨量,是一种有效的手术方式。

股骨远端骨折治疗进展

股骨远端骨折是临床上常见的一类骨折。随着内固定器械的发展、治疗理念与技术的提高,股骨远端骨折的治疗有了新的进展。本文就股骨远端的解剖结构,以及股骨远端骨折的发生机制与分型、临床诊断、治疗历史演变与研究方向作一综述。

股骨粗隆间骨折实施髓内钉固定技术的疗效分析

目的探讨股骨粗隆间骨折实施髓内钉固定技术的疗效。方法100例股骨粗隆间骨折患者作为研究样本,按照随机数字表法将其分成研究组、对照组,各50例。两组均实施切开复位内固定术治疗,在内固定材料选择时,对照组选择锁定钢板,研究组选择髓内钉。对比两组手术情况,术后恢复时间,血清炎症因子指标,疼痛评分、髋关节功能评分,生活质量评分。结果研究组手术耗时(74.98±12.15)min较对照组的(92.73±15.62)min短(P<0.05),研究组术中失血量(153.12±31.08)ml少于对照组的(216.69±40.34)ml(P<0.05)。研究组术后初次离床活动、骨折愈合时间及住院天数分别为(4.91±1.03)d、(11.63±1.45)周、(10.04±1.98)d,均较对照组的(6.30±1.24)d、(14.07±1.91)周、(12.89±2.60)d短(P<0.05)。术后1 d,两组血清C反应蛋白和白细胞介素-6水平均较术前显著增高,而研究组血清C反应蛋白(5.89±1.06)mg/L和白细胞介素-6(25.46±3.75)pg/ml均比对照组的(7.02±1.27)mg/L、(29.69±3.83)pg/ml低(P<0.05)。术后3个月,两组疼痛评分均较术前显著降低、髋关节功能评分与术前相比均显著增高,而研究组疼痛评分(2.63±0.61)分较对照组的(3.49±0.72)分低、髋关节功能评分(90.65±7.02)分则较对照组的(81.42±7.38)分高(P<0.05)。术后3个月,两组生活质量中生理、心理、环境、社会关系评分与术前相比均显著增高,而研究组均较对照组高(P<0.05)。结论股骨粗隆间骨折患者行切开复位内固定术治疗时选择髓内钉作为内固定物可取得比锁定钢板更好的手术效果,髓内钉固定不仅可减轻手术创伤,减少术后炎性因子渗出,还可加快患者术后康复进程,促使其骨折更快愈合,有利于更好地改善髋关节功能,减轻疼痛感,提升生活质量。

FLS模式康复护理对老年股骨粗隆间骨折切开复位内固定术后患者生活质量的影响分析

目的分析FLS模式康复护理在老年股骨粗隆间骨折切开复位内固定术后的应用效果。方法采用随机数字表法将2022年7月至2023年7月期间在我院接受老年股骨粗隆间骨折切开复位内固定术治疗的131例患者分为两组,对照组(65例)接受常规护理,观察组(66例)接受FLS模式康复护理,对比两组功能评定优良率、护理满意度和遵医行为、生活质量。结果观察组功能评定优良率高于对照组(P<0.05),遵医行为评分在用药、饮食、功能锻炼、并发症预防及遵医行为总分方面均高于对照组(P<0.05),生活质量评分在躯体功能、心理功能、物质生活及社会功能方面均高于对照组(P<0.05),护理满意度均高于对照组(P<0.05)。结论老年股骨粗隆间骨折切开复位内固定术后应用FLS模式康复护理,有助于提升患者遵医行为,可以促进患者肢体功能尽快恢复,改善患者生活质量,患者对护理也更加满意度。

老年桡骨远端不稳定骨折不同治疗方式的成本效益分析

目的 比较老年桡骨远端不稳定骨折手术和保守治疗的临床疗效和总费用,为临床医师选择有效的治疗方式提供依据。方法 将2019年12月—2023年3月于浙江中医药大学附属富阳中医骨伤医院就诊的88例老年不稳定型桡骨远端骨折患者纳入研究。按治疗方式不同分为手术组(n=44)和夹板组(n=44)。记录患者住院期间和治疗后1年门诊复查费用、腕关节功能评分量表(gartland-werlery,GW)、腕关节患者自行评估量表(patient-ratedwristevaluation,PRWE)、影像学检查、并发症,从卫生经济学角度进行成本-效果比(costeffectivenessratio,CER)和增量成本-效果比(incrementalcost-effectivenessratio,ICER)。结果 2组腕关节功能恢复优良率及PRWE评分比较,差异无统计学意义(P>0.05)。术后1年随访,2组影像学参数均有改善;2组影像学参数比较,差异有统计学意义(P<0.05)。手术组并发症总发生率低于夹板组(P<0.05)。手术组总体费用和住院费用分别为(23080.71±2180.37)、(23728.35±2246.57)元,均高于夹板组(5333.80±1843.87)、(6614.61±1763.00)元(P<0.05),但门诊费用则低于夹板组(P<0.05)。手术组和夹板组CER分别为1383.51元/分和331.89元/分;与夹板组比较,手术组PRWE评分每降低1分需多花费5648.10元。结论 >60岁老年不稳定型桡骨远端骨折患者中,夹板固定与切开复位内固定术均具有良好的疗效,但前者可能是一种更为经济有效的治疗方案。

微创经皮钢板内固定联合锁定加压钢板治疗胫骨远端骨折的效果分析

目的:分析微创经皮钢板内固定(MIPPO)联合锁定加压钢板(LCP)治疗胫骨远端骨折的效果。方法:选取2019年9月—2021年9月肥城市人民医院收治的胫骨远端骨折患者81例作为研究对象,依据随机数字表法分为对照组(n=41)与观察组(n=40)。对照组行切开复位克氏针钢板内固定治疗,观察组行MTPPO联合LCP治疗。比较两组治疗效果。结果:观察组患者手术时间、术中透视时间、骨折愈合时间、住院时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.001)。术后6个月,观察组膝关节功能总优良率高于对照组,差异有统计学意义(P=0.021)。术后6个月,观察组踝关节功能及足功能评分高于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P=0.014)。结论:MIPPO联合LCP治疗胫骨远端骨折的效果显著,患者膝、踝关节功能及足功能明显改善,并发症发生率低。