Cannulated Screw Internal Fixation Research Articles

Treatment of unstable pelvic fractures by cannulated screw internal fixation with the assistance of three-dimensional printing insertion template

To evaluate the effectiveness of unstable pelvic fractures treated by cannulated screw internal fixation with the assistance of three-dimensional (3D) printing insertion template. The clinical data of 10 patients who underwent surgical treatment for unstable pelvic fractures by cannulated screw internal fixation with the assistance of 3D printing insertion template between May 2015 and June 2016 were retrospectively analysed. There were 7 males and 3 females with an average age of 37.5 years (range, 20-58 years). The causes of injury included falling from height in 5 cases, crushing from heavy load in 1 case, and traffic accidents in 4 cases. The interval from injury to admission was 1-5 hours (mean, 3.1 hours). The fracture situation included 6 cases of sacral fracture, 1 case of right sacroiliac joint dislocation, and 3 cases of iliac bone fracture. There were 10 cases of superior and inferior pubic rami fracture, including 3 cases on the left side (2 cases of suprapubic fracture adjacent to symphysis pubis), 2 cases on the right side, and 5 cases on the bilateral. All fractures were classified according to the Tile system, there were 4 cases of type B2, 1 of type B3, 4 of type C1, and 1 of type C2. The radiological outcome was evaluated by Matta scale, and the positions of the iliosacral screw and superior pubic ramus screw were evaluated according to 3D reconstruction of CT postoperatively. The functional outcome was evaluated by Majeed function scale. The average time of each screw implantation was 30 minutes, and the average blood loss per screw incision was 50 mL. The time of implantation of each sacroiliac screw was 24-96 seconds (mean, 62 seconds), and the time of implantation of each suprapubic screw was 42-80 seconds (mean, 63.2 seconds). The hospitalization duration was 17-90 days (mean, 43.7 days). All incisions healed by first intention. All patients were followed up 12-22 months (mean, 15.6 months). The radiological outcome was excellent in 8 cases and good in 2 cases according to Matta scale; and 3D reconstruction of CT demonstrated that all the 9 iliosacral screws were placed as type Ⅰ, and all the 13 suprapubic ramus screws were placed as grade 0 on the first postoperative day. No complication such as neurovascular injury, screw back out or rupture, or secondary fracture displacement was observed during the follow-up. At 6 months after operation, the X-ray films showed good fracture healing in all the 10 patients. The functional outcome was excellent in 9 cases and good in 1 case according to Majeed scale at 1 year after operation. One patient sustained Tile C2 pelvic disruption complicated with L 5 nerve root injury achieved complete nervous functional recovery at last follow-up. It has advantages of precise screw insertion and lower risk of neurovascular injury to treat unstable pelvic fractures by cannulated screw internal fixation with the assistance of 3D printing insertion template, which can be a good alternative for the treatment of unstable pelvic fractures.

Posterolateral Approach With Buttress Plates and Cannulated Screw Fixation for Large Posterior Malleolus Fractures

The present study retrospectively reviewed the clinical efficacy of open reduction and internal fixation with buttress plates and cannulated screws via a posterolateral approach for the treatment of large posterior malleolus fractures. From July 2009 to April 2012, 34 patients (15 males and 19 females; mean age 41.2 years) with posterior malleolus fractures involving >25% of the distal articular tibia, were treated by cannulated screw and buttress plate fixation. All the patients were followed for ≥24 months. The outcome measures included the radiographic appearance of the reduction and bone union and the Baird-Jackson score. The average operation time was 105.6 (range 78 to 145) minutes. Radiologic examination showed all fractures achieved anatomic reduction and primary bone union at a mean of 3.8 (range 3 to 7) months after surgery. After an average follow-up period of 32.7 (range 24 to 44) months, no displacement, loosening, or breakage of internal fixation was observed. However, mild posttraumatic arthritis was present in 3 patients. According to the Baird-Jackson scoring system, the outcomes were rated as excellent in 11 cases, good in 17, fair in 5, and poor in only 1 case, for an excellent and good rate of 82.3%. An association analysis indicated age and injury mechanism might be factors influencing the intraoperative and postoperative outcomes. A posterolateral approach with buttress plate and cannulated screw internal fixation could be an effective technique for reduction and fixation of large posterior malleolus fragments.

Internal fixation and hemiarthroplasty for the treatment of displaced femoral neck fracture: a cost-utility analysis

Objective: To compare the cannulated screw internal fixation (IF) and hemiarthroplasty (HA) for displaced femoral neck fracture with cost-utility analysis (CUA). Methods: From January 2014 to August 2015, a total of 87 patients above 60 years old with displaced femoral neck fracture were admitted into the study and divided into 2 groups according to surgery type. There were 41 cases in IF group and 46 cases in HA group. During 1 year follow-up we collected the total cost due to fracture and applied EQ-5D index to evaluate the clinical effects. The value of EQ-5D index will be transformed to quality adjusted life year (QALY). Eventually the data including cost and QALY were used to calculate the cost utility ratio (CUR) for patients in each group. Results: All the patients completed the operation successfully. The total cost of IF and HA was 45 796 yuan and 56 657 yuan (P<0.05), while the QALY was 0.79 and 0.83 respectively (P>0.05). The CUR showed that patients in IF and HA group spent 57 970 yuan and 68 261 yuan for each QALY which means patients in HA group spent more 10 292 yuan for each QALY than that in IF group. Conclusions: Both IF and HA can provide satisfactory clinical outcome in 1 year follow-up, however the total cost of IF was obviously less than HA. Therefore IF may be more cost-effective for the treatment of displaced femoral neck fracture in terms of health economics.

Effect of Xugu-Huoxue decoction for the patients with femoral neck fracture after internal fixation with hollow screw fixation

Objective To evaluate effect of Xugu-Huoxue decoction on the treatment of patients with femoral neck fracture after internal fixation with hollow screw fixation. Methods A total of 120 patients with femoral neck fracture were randomly divided into the treatment group and the control group according to the inclusion criteria, 60 patients in each group. The control group was treated with cannulated screw internal fixation; the observation group was treated with Xugu-Huoxue decoction at the second day after the operation. Both groups were assessed with the Harris hip function score at the end of 12 months after operation. The SF-36 scale was used to evaluate the quality of life of the patients. Results The total effect rate of the observation group was 88.3% (53/60) and the control group was 71.7% (43/60). The difference between the 2 groups was statistically significant (χ2=5.208, P=0.022). At 12 months after surgery, the pain (41.4 ± 7.3 vs. 32.2 ± 5.7, t=7.738), the joint function (45.7 ± 6.2 vs. 36.3 ± 7.2, t=7.701), joint mobility (5.0 ± 0.8 vs. 3.1 ± 0.8, t=13.115), and the total score of Harris (87.7 ± 4.6 vs. 65.4 ± 5.4, t=24.461) in the observation group were significantly higher than those in the control group (P<0.001). The physical function (83.1 ± 7.2 vs. 78.8 ±14.2, t=2.095), body pain (82.1 ± 9.9 vs. 67.7 ± 11.1, t=7.524), the overall health (76.6 ± 10.3 vs. 68.8 ± 14.4, t=3.401) and activity (81.1 ± 7.9 vs. 76.6 ± 11.2, t=2.549) in the observation group were higher than those in the control group (P<0.05 or P<0.01). Conclusions The Xugu-Huoxue decoction could improve the prognosis of patients with femoral neck fractures after cannulated screw fixation, promote the recovery of hip function and improve the quality of life. Key words: Femoral neck fractures; Fracture fixation, internal; Bone screws; Xugu-Huoxue decoction; Quality of life; Clinical study

Clinical application of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures

To investigate the clinical efficacy of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures. A retrospective analysis was made on the clinical data of 20 femoral neck fracture patients treated by computer-assisted cannulated screw internal fixation system based on error correction method between January 2014 and October 2015 (trial group), and 36 femoral neck fracture patients undergoing traditional manual surgery with closed reduction by cannulated screw fixation in the same period (the control group). There was no significant difference in gender, age, injury cause, side of fracture, types of fracture, and time from injury to operation between 2 groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion, fracture healing time, fracture healing rate, and Harris hip score were compared between 2 groups. All incisions healed by first intention after operation, and no complication of blood vessel and nerve injury occurred. The operation time of trial group was significantly longer than that of control group ( t=2.290, P=0.026), however, the intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion of trial group were significantly less than those of control group ( t=-10.650, P=0.000; t=18.320, P=0.000; t=-16.625, P=0.000). All patients were followed up 12-18 months (mean, 14.7 months). X-ray films showed that fracture healing was obtained in 2 groups, showing no significant difference in fracture healing time between 2 groups ( t=0.208, P=0.836). No complication of ischemic necrosis of femoral head occurred during follow-up period. At last follow-up, the Harris hip score was 87.05±3.12 in trial group and was 86.78±2.83 in control group, showing no significant difference ( t=0.333, P=0.741). Computer-assisted cannulated screw internal fixation surgery based on error correction method for femoral neck fractures is better than traditional manual surgery in decreasing intraoperative radiation and surgical trauma during operation.

Cannulated compression screw with platelet rich plasma injection for the treatment of femoral neck fracture in mid-age patients

Objective To discuss the effect of the cannulated compression screw internal fixation combined with platelet rich plasma(PRP) injection by the fracture for the treatment of femoral neck fracture in mid-age patients. Methods The fracture healing and complications after the operation of 25 mid-age patients who suffered from femoral neck fracture and received the cannulated compression screw internal fixation combined with autologous PRP injection were analyzed. Results 12-40 months after operation, 3 patients developed osteonecrosis of the femoral head and 2 patients with fracture nonunion. Conclusion The cannulated compression screw internal fixation combined with autologous PRP injection is an effective method to treat femoral neck fracture in mid-age patients.The operation is minimal invasive, relatively easy technique, low expense and short length of hospitalization, etc. Key words: Bone nails; Fracture fixation, internal; Platelet-rich plasma; Femoral neck fracture

Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures.

The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation.One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head.Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH.There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications.

Comparison of kirschner wires and cannulated screw internal fixation for displaced lateral humeral condyle fracture in skeletally immature patients

Comparison of kirschner wires and cannulated screw internal fixation for displaced lateral humeral condyle fracture in skeletally immature patients

Neglected neck femur fractures in adolescents and young adults: factors predicting the surgical outcome

BackgroundNeglected femoral neck fracture in young adults is an intriguing problem. This retrospective study tried to solve that challenge through open reduction, cannulated screw internal fixation, autogenous iliac bone and bone marrow grafting. MethodsThirty-six cases were studied; they were classified according to Sandhu et al.'s classification. Twenty cases were type I and 16 cases were type II fractures; the mean age was 26.8years; fracture neglect averaged 44.6days. Twenty cases had posterior comminution and 16 cases had anterior comminution. All cases had open reduction, cannulated screw internal fixation, autogenous iliac bone and bone marrow grafting. The Harris hip score and Matta et al. grading system were applied for functional and radiological evaluation, respectively. ResultsThe average postoperative follow-up was 25.3months; 94.4% of the cases had solid union in a mean of 19.6weeks. Functionally, the Harris hip score averaged 87.8 points. Nonunion, avascular necrosis and coxa vara complicated two, two and four cases, respectively. Fair and poor radiological results were related to coxa vara and avascular necrosis, respectively. Nonunion was significantly related to posterior comminution, type II neglected fracture, and a neglect of more than 45days. Age groups more than 30years old and postoperative neck-shaft angles <140° were significantly associated with late-onset radiological healing and nonunion. ConclusionsCannulated screw osteosynthesis augmented by autogenous bone and bone marrow grafting is a simple, easy-to-perform surgical procedure with encouraging clinical outcomes for selected patients complaining of that difficult problem.

Comparison of Kirschner wires and AO cannulated screw internal fixation for displaced lateral humeral condyle fracture in children

This retrospective study compares Kirschner wires versus 3.5-mm diameter AO cannulated screw internal fixation in treatment for the displaced lateral humeral condyle fractures. The study included 62 patients (42 boys, 20 girls; mean age 6.93years; age range two to 14years) with displaced lateral humeral condyle fractures. All patients were treated by open reduction and Kirschner wires or cannulated screw fixation. The clinical outcomes were evaluated according to the criteria of Hardacre et al. The mean follow-up period was 39.4months (range 21-95months). There was no statistically significant difference in clinical outcome between these two groups (P > 0.05). Five patients (16.7%) developed skin infection around K-wires, while no infection occurred in fracture with screws. An obvious lateral prominence occurred in 11 (36.7%) patients with K-wires and four (12.5%) patients with screws. Nine (30%) patients with K-wires and two (6.3%) patients with screws had a lack of 10° of extension of the elbow compared with the other side. Both K-wires and cannulated screw fixation are effective in treatment for displaced lateral humeral condyle fracture. K-wires can pass through the ossific nucleus of capitulum without damaging it, but a longer period of external fixation and local skin care will be required. The screws can reduce the possibility of lateral prominence and promote the function of elbow by continuously stabilising the fracture, but a second operation is need for screw removal.

Cannulated screws internal fixation plus three-column reconstruction for treatment of Lisfranc' s joint injuries

Objective To evaluate the preliminary outcome of cannulated screw internal fixation in treatment of the tarsometatarsal joint injuries.Methods From January 2005 to October 2010,21 patients(14 males and 7 females)with the tarsometatarsal joint injuries were treated.Their age ranged from 21 to 62 years(average 38.2 years).According to anatomical three-column classification,there were four patients with single medial column injury,four with medial and middle column injuries,three with middle and lateral column injuries,two with single lateral column injury and eight with three column injuries.The injury causes included traffic injury in nine patients,machine injury in eight and fall from height injury in four.The period from injury to admission was 2-15 hours(mean 5 hours).During operation,open reduction was performed,followed by internal fixation with the cannulated screw.X-ray examination was done in the regular follow-up and function was evaluated by using Maryland scoring system.Results Of all,19 patients were followed up for 4-47 months(mean 20 months),which showed no infection,loosing or breakage of the internal fixation.According to the Maryland scoring system,the clinical outcome was rated as excellent in eight patients,good in seven,fair in two and poor in two,with excellence rate of 79％.Conclusions The three-column theory plays an important role in clinical diagnosis and therapy of the tarsometatarsal joint injuries.Open reduction and cannulated screw internal fixation may attain satisfactory clinical results in treatment of the tarsometatarsal joint injuries. Key words: Tarsometatarsal joint; Fracture fixation, internal; Cannulated screws

Arthroscopic cannulated screw fixation for nonunion after tibial eminence fracture in children

Objective To discuss arthmscopic treatment of nonunion after avulsed fracture of tibial intercondylar eminence in children.Methods From January 2003 to June 2008,we treated 11 pediatric cases of old avulsed fracture of tihial intercondylar eminence.Reduction of bone fragments was conducted arthroscopically.The tension of anterior cruciate ligament was recovered by slightly excessive debridement of the fracture ends.The bone fragments were fixed with 2 cannulated screws respectively.Results The 11patients were followed up from 12 to 42 months,with an average of 18 months.Slight limitation of knee extension was found in 3 cases,and at one year after operation limitation of knee flexion was found in 2 cases which responded to removal of internal fixation and arthroscopic lysis.The preoperative and postoperative Lachman and drawer tests were negative in all the 11 cases.The postoperative Ⅹ-ray showed that all fractures healed at one stage 3 months after operation.The average Lysbolm score was 73.51 ±6.38 before operation and98.32 ± 1.21 at the last follow-up(t = 15.165,P =0.000).The average International Knee Documentation Committee(IKDC)score was 71.15±5.51 before operation and 96.85±1.21 at the last follow-up(t=20.712,P = 0.000).Conclusions Arthroscopic treatment of nonunion after avulsed fracture of tibial intercondylar eminence in children has advantages of minimal trauma,simplicity and early rehabilitation.In addition,the cannulated screw internal fixation can provide stability and higher pressure to prevent nonunion. Key words: Tibial fractures; Fracture fixation,internal; Bone nails; Arthroscopy; Child

Treatment of posterior malleolar fractures by means of limited open reduction, poking reduction and QWIX cannulated screw internal fixation

Objective To evaluate the clinical effect of limited open reduction, poking reduction and QWIX cannulated screw internal fixation in treatment of posterior malleolar fracture. Methods A total of 14 patients with posterior malleolar fracture were treated by limited open reduction, poking reduction and QWIX cannulated screw internal fixation. Injury causes included traffic accidents in five patients, fall from height injury in four and inversion sprain in five. According to fracture type classification methods of Weber and Danis, there were two patients with type A3, seven with type B3 and five with type C3. Func-tional exercise was carried out based on postoperative exercise plan. Regular follow-up was performed to e-valuate the functional recovery of the ankle joint. Results All patients were followed up for 6-18 months (average 9.5 months). One patient with sural nerve injury returned to normal after six months. Twelve pa-tients showed excellent range of motion of the ankle joint and normal gait three months after operation. In 12 patients, dorsiflexion of the ankle joint was > 20° and plantar flexion > 40° six months after operation, which was approximately similar to contralateral normal ankle joint. The ankle joint function of all patients returned to normal six months after operation. According to Baird-Jackson ankle joint function evaluation, the result was excellent in 12 patients, good in one and fair in one, with excellence rate of 93%. Con-clusion The limited open reduction, poking reduction and internal fixation of QWIX caunulated screw are effective method for treatment of posterior malleolar fractures. Key words: Hind limb; Ankle injuries; Fracture fixation, internal