Complications Of Internal Fixation Research Articles

Risk factors for nonunion in femoral neck fracture patients with internal fixation: A multicenter (TRON group) retrospective study

IntroductionFemoral neck fractures (FNFs) are common in elderly individuals. When minimally displaced, they are typically treated with internal fixation. Nonunion is a complication of internal fixation of FNF, that sometimes necessitates reoperation. Radiographic parameters, including the Pauwels angle and posterior tilt angle, are risk factors for nonunion. However, these parameters are assessed solely in a two-dimensional context. We developed a novel radiographic parameter named the “Kindex.” This multicenter investigation aimed to identify risk factors for nonunion following FNF fixation and evaluate the validity of this index. MethodsThis retrospective multicenter study collected data from 939 FNF patients who underwent internal fixation between 2016 and 2020 at 11 facilities (TRON group). The following exclusion criteria were applied: age <65, insufficient data, and Garden Stage III or IV fracture. Patient data, including age, sex, BMI, ASA classification, alcohol and smoking history, and comorbidities, were recorded. Radiographic measurements of the Pauwels angle and posterior tilt angle at the time of injury were used to calculate the Kindex. Correlations between the Pauwels angle, posterior tilt angle, Kindex, and nonunion were evaluated. A multivariate logistic regression analysis was performed to investigate independent risk factors for nonunion. A receiver operating characteristic (ROC) analysis was performed to determine the cutoff value of the Kindex, and the area under the curve (AUC) was calculated. ResultsThe study included 594 patients (males, n = 151; females, n = 443; average age, 80.9 years). Nonunion was observed in 13 cases (2.2 %). While the Pauwels angle and posterior tilt angle did not show significant correlations, the Kindex exhibited strong correlations with both parameters. In the multivariate analysis, the Kindex and renal impairment were independent risk factors for nonunion (Kindex: OR 1.06, p = 0.015; renal impairment: OR 1.48, p = 0.021). In the ROC analysis, a Kindex of 50 was identified as the optimal cutoff value (AUC 0.72). ConclusionThe nonunion rate after internal fixation of FNF was 2.2 %. Renal impairment and the Kindex were identified as independent risk factors. The Kindex at the time of injury may serve as a novel radiographic parameter to consider when evaluating the need for internal fixation in FNF cases.

Patient-specific finite element analysis of four different fixation methods for transversely unstable radial head fractures

Plate fixation is a common treatment option for radial head fractures (RHFs). Due to the benefits of less invasiveness and fewer complications of internal fixation, the application of small-diameter headless compression screws (HCSs) to treat RHFs has become a new trend. This study aimed to compare the mechanical stability of four distinct internal fixation protocols for transversely unstable RHFs via finite element analysis. Using computed tomography data from 10 patients, we developed 40 patient-specific FE models of transversely unstable RHFs fixed by parallel, crossed, and tripod HCSs and mini-T plate (MTP). Under simulated physiological loading of the elbow joint, the construct stiffness, displacement, and von Mises stresses were evaluated and verified by a biomechanical experiment. Under shear loading, the MTP group exhibited lower construct stiffness, larger displacement, and higher Von Mises stress than the HCSs group. The stiffness of tripod HCSs was greater than parallel and crossed screw fixation techniques. There was a strong relationship between apparent bone density and construct stiffness (R = 0.98 to 0.99). In the treatment of transversely unstable RHFs, HCSs have superior biomechanical stability than MTP. The tripod technique was also more stable than parallel and crossed fixation.

Biomechanical Properties of Novel Porous Scaffold Core and Hollow Lateral Hole Pedicle Screws: A Comparative Study in Bama Pigs.

Screw loosening is a common complication of internal fixation of pedicle screw. Therefore, the development of a pedicle screw with low loosening rate and high biosafety is of great clinical significance. This study aimed to investigate whether the application of a porous scaffold structure can improve the stability of pedicle screws by comparing the biomechanical properties of novel porous scaffold core pedicle screws (PSCPSs) with those of hollow lateral hole pedicle screws (HLHPSs) in a porcine lumbar spine. Thirty-two pedicle screws of both types were implanted bilaterally into the L1-4 vertebrae of four Bama pigs, with our newly designed PSCPSs on the right and HLHPSs on the left. All the Bama pigs were sacrificed 16 weeks postoperatively, and the lumbar spine was freed into individual vertebrae. Biomechanical properties of both the pedicle screws were evaluated using pull-out tests, as well as cyclic bending and pull-out tests, while the mechanical properties were assessed using three-point bending tests. The data generated were statistically analyzed using paired-sample t-tests and two independent sample t-tests. We found that the maximal pull-out forces before and after cyclic bending of the PSCPSs (1161.50 ± 337.98 N and 1075.25 ± 223.33 N) were significantly higher than those of the HLHPSs (948.38 ± 194.32 N and 807.13 ± 242.75 N) (p < 0.05, p < 0.05). In 800 cycles of the bending tests, neither PSCPS nor HLHPS showed loosening or visible detachment, but their maximal pull-out forces after cyclic bending tests decreased compared to those in cycles without cyclic bending tests (7.43% and 14.89%, respectively), with no statistical significance (p > 0.05 and p > 0.05, respectively). Additionally, both screws buckled rather than broke in the three-point bending tests, with no statistically significant differences between the maximal bending load and modulus of elasticity of the two screws (p > 0.05 and p > 0.05, respectively). Compared with the HLHPSs, the PSCPSs have greater pull-out resistance and better fatigue tolerance with appropriate mechanical properties. Therefore, PSCPSs theoretically have significant potential for clinical applications in reducing the incidence of loosening after pedicle screw implantation.

Humeral Condylar Fractures in French Bulldogs-Inciting Cause and Factors Influencing Complications of Internal Fixation in 136 Dogs.

To report the inciting cause and configuration of humeral condylar fractures in French Bulldogs, and to identify risk factors for complications associated with their surgical stabilization, as well as their occurrence. Retrospective multicenter clinical cohort study. French bulldogs (n = 136) with humeral condylar fracture. Records from eight United Kingdom referral centers were reviewed for French bulldogs that underwent surgery for humeral condylar fracture between January 2017 and January 2021. Lateral fractures of the humeral condyle represented two-thirds of condylar fractures in this study (95 elbows; 69.8%); medial fractures of the humeral condyle and intracondylar Y or T fractures affected 22 (16.2%) and 19 (14%), respectively. A fall was the inciting cause for 60 elbows (45.6%), with stairs implicated in 27 (20.45%) elbows. Skeletal immaturity was significantly correlated with fracture. Complications affected 30 out of 132 dogs (136 elbows) (22%), of which 10 (33%) were major, and 20 (66%) were minor. Fixation method did not significantly impact complication rate for medial or lateral fractures of the humeral condyle (p = 0.87). Comminution increased the risk of complication for all humeral condylar fracture types (p = 0.02). Fixation method was not found to significantly impact the complication rate of surgically managed fractures of the humeral condyle in French bulldogs. Stair use, falling from low heights, and skeletal immaturity were common inciting reasons for humeral condylar fractures.

Radiological and functional outcomes of anterior bridge plating with minimally invasive plate osteosynthesis technique for humerus diaphyseal fractures in adults

Background: We conducted a study to evaluate radiological, functional outcomes and complications of internal fixation of humerus diaphyseal fractures by anterior bridge plating (ABP) with minimally invasive plate osteosynthesis technique. Methods: 40 patients with humerus diaphyseal fractures operated by ABP with MIPO between August 2017 and January 2020 were included in the study. All patients were evaluated verbally, clinically, and radiologically for a minimum of 1 year. Results: Mean time to radiological union was 13.75 weeks. Disabilities of the arm, shoulder and hand score improved from a mean of 23.45 to a mean of 5.04 at 6 months. All patients except one had an excellent Mayo Elbow Performance Score score at 6 months. The variation of mean shoulder range of motion between normal and operated side was within 5 degrees at 6 months. Visual Analogue Scale score improved from a preoperative mean of 8 to a postoperative mean of 0.5 at 6 months. Mean intraoperative blood loss was 147 ml. Two patients had a superficial wound infection, one patient had a postoperative radial nerve palsy, and one patient had a delayed union, all of which recovered without any surgical intervention. Conclusions: ABP with MIPO technique for humerus diaphyseal fractures is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior patient satisfaction. Therefore, we recommend that ABP with MIPO should be considered as an alternative treatment option in patients with humerus diaphyseal fractures.

Study of Functional Outcomes and Complications of Internal Fixation of Pott's Ankle Fractures in Diabetic Patients

Study of Functional Outcomes and Complications of Internal Fixation of Pott's Ankle Fractures in Diabetic Patients

The Risk of Nerve Injury in Pediatric Forearm Fractures.

This article was updated on July 19, 2023, because of a previous error, which was discovered after the preliminary version of the article was posted online. On page 1080, in the last sentence of the Results section of the Abstract, the text that had read "0.05% (4 of 777)" now reads "0.5% (4 of 777)." The risk of fracture-related nerve injury associated with forearm fractures in children is unknown. The purposes of the present study were to calculate the risk of fracture-related nerve injury and to report the institutional rate of complications of surgical treatment of pediatric forearm fractures. Four thousand, eight hundred and sixty-eight forearm fractures (ICD-10 codes S52.0 to S52.7) that had been treated in our tertiary level pediatric hospital between 2014 and 2021 were identified in our institutional fracture registry. Of these, 3,029 fractures occurred in boys and 53 were open fractures. Sex, age at injury, trauma mechanism and energy, fracture type, treatment method, and cause and type of nerve injury were assessed in 43 patients with 44 registered nerve injuries. Patients with nerve injuries were reevaluated to calculate the recovery time. Univariable and multivariable regression analyses were performed to determine the risk of nerve injury. The risk of a fracture-related nerve injury was 0.7% (33 of 4,868). Only 2 injuries were permanent; thus, the risk of permanent nerve injury associated with a forearm fracture was 0.04% (2 of 4,868). The ulnar nerve was affected in 19 cases; the median nerve, in 8; and the radial nerve, in 7. In cases of open fracture, the risk of nerve injury was 17% (9 of 53). Open fractures had an OR of 33.73 (95% CI, 14.97 to 70.68) on univariate analysis and an OR of 10.73 (95% CI 4.50 to 24.22) on multivariate analysis with adjustment for female sex and both-bone diaphyseal fracture. Both-bone diaphyseal fracture (ICD-10 code S52.4) had an OR of 9.01 (95% CI, 4.86 to 17.37) on univariate analysis and an OR of 9.98 (95% CI 5.32 to 19.47) on multivariate analysis with adjustment for age and female sex. Overall, 777 fractures were internally fixed. The risk of nerve injury as a complication of internal fixation was 1.3% (10 of 777). Four of these iatrogenic injuries (including 2 involving the median nerve, 1 involving the ulnar nerve, and 1 involving the radial nerve) were permanent; thus, the risk of permanent nerve injury as a complication of internal fixation was 0.5% (4 of 777). Nerve injury following a pediatric forearm fracture is rare and has an excellent potential for spontaneous recovery. In the present study, all of the permanent nerve injuries occurred in association with open fractures or as a complication of internal fixation. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Neglected fracture shaft femur presenting with pseudoaneurysm: a case report

A pseudoaneurysm is a collection of blood leaking from a damaged arterial wall. Development of the false aneurysm is due to either initial injury of the vessel or is a complication of internal fixation of the femoral fracture. Femoral artery pseudoaneurysms (FAPs) may close spontaneously if the tear is small enough to allow for clotting and sealing. On the other hand, rupture of the aneurysm can trigger thrombosis, distal embolization and compression of adjacent structures. We present a case of left superficial femoral arterial pseudoaneurysm in a 36-year-old male with fracture of left femoral shaft. A 36-year-old male with history of road traffic accident presented to our institute with pain and swelling in left thigh. Patient was investigated and diagnosed with fracture left femoral shaft with a pseudoaneurysm of the left superficial femoral artery (SFA). Stenting was done for SFA followed by open reduction and internal fixation of the femoral shaft fracture. Such cases require multidisciplinary approach and a proper planning with involvement of different medical specialities to achieve optimal results and to minimise any intraoperative and post operative complications.

Clinical application of sacral alar screw fixation in surgical treatment of lumbosacral degenerative disease

Objective: To verify the safety and feasibility of sacral alar screw fixation and fusion surgery in lumbosacral area. Methods: The clinical and radiological data of patients receiving L5/S1 single-level cortical bone trajectory screw combined with sacral alar screw decompression fixation and fusion in Beijing Chaoyang Hospital due to lumbar spinal stenosis from January 2019 to January 2020 were retrospectively analyzed. The clinical data included operation duration, intraoperative blood loss, postoperative drainage, pain and function scores during follow-up. The radiological data included preoperative and postoperative follow-up X-rays and three-dimensional reconstruction of lumbar spine CT. The fusion status and complication of internal fixation, such as screw loosening and fixation failure were evaluated by the radiological examination. Results: According to the inclusion and exclusion criteria, a total of 16 patients (7 males and 9 females) were included, with an average age of (69.6±5.2) years. The patients were followed-up for (16.2±1.7) months. The average operation duration was (144±21) min, the intraoperative blood loss was (103±20) ml, and the postoperative drainage was (80±34) ml. The patient's low back pain visual analogue scale (VAS) score was 6.8±1.0 before surgery, and it was improved to 0.9±0.7 at the last follow-up; leg pain VAS score was 6.1±0.9 before the operation and it improved to 0.9±0.7 at the last follow-up; Oswestry disability index (ODI) function score was 66.2%±8.0% before the surgery and it decreased to 26.6%±7.2% at the last follow-up. No neurological complications, surgical site infection, screw loosening, internal fixation failure or cage displacement were observed during the follow-up. The fusion rate was 68.8% (11/16) at 6 months post operation. Conclusion: It is safe, feasible and effective to apply cortical screws combined with sacral alar screws in short-segment decompression, fixation and fusion surgery on the lumbosacral region to treat lumbosacral spinal stenosis.

Outcome Analysis of Dual Plating in Management of Unstable Bicondylar Tibial Plateau Fracture - A Prospective Study.

Introduction:Bicondylar tibial plateau fractures account for 10-30% of tibial plateau fractures. Despite recent advancements in the management of unstable bicondylar tibial plateau fractures, the outcomes are often poor. The present study aimed to evaluate the functional outcomes and complications of internal fixation of bicondylar tibial plateau fractures with the dual plating using two incisions.Materials and methods:The present study included 30 patients (26 males; 4 females, mean age 35.6 years; range, 19 to 65 years) with bicondylar tibial plateau fractures who were treated with dual plating between January 2017 to August 2019. Out of 30 patients, 5 patients had Schatzker type (V) and 25 patients had Schatzker type (VI) bicondylar tibial plateau fracture. All patients were treated with dual plating using two incisions. In all patient’s similar standard physical rehabilitation therapy was followed. All complications including intra and post-operative were assessed and recorded. The patients were followed-up for over 24 months. Functional outcomes were assessed with Rasmussen’s functional grading system, Oxford knee score, and range of motion of knee joint. Radiological outcomes were evaluated using Rasmussen’s radiological scoring system.Result:All fractures united with a mean time of 18 weeks. The average knee range of motion was 1.5° - 130° (range: 0° - 10° for extension lag, range: 100° -135° for flexion). Mean Rasmussen's functional grading score at the final follow-up was 26.75. All patients showed excellent or good radiographic results according to Rasmussen’s radiological scoring with a mean score of 8.5 (range 6-10). The post-operative radiographs showed mean MPTA was 84.3° and the mean PPTA was 6.2°. In the present study, complications were encountered in five patients. However, there were no cases of secondary loss of reduction, failure of the implant, malunion, or non-union.Conclusion:The surgical treatment of bicondylar tibial plateau fractures with dual locking represents a significant treatment option and provides rigid fixation in these fractures with good functional and radiological outcomes.

Clinical course of treatment of proximal one third ulna fracture by plate osteosynthesis in skeletally mature individuals

Objective: To study the clinical course including radiological union, fracture union time and functional outcome of plate osteosynthesis for proximal one third ulna fracture in skeletally mature individuals.Method: 30 patients of proximal ulna fractures who were treated by plate osteosynthesis were included in this study.Result: 30 patients were followed up for minimum duration of 6 months and the clinical outcomes were assessed according to the Mayo Elbow Performance Score (MEPS). Out of 30, our study included 21 olecranon fractures and 9 monteggia fractures. At final follow up of 6 month, our case series of olecranon fractures resulted mean MEPS of 89.3with 57.1% excellent results and 42.9 % good results, and all patients returning to pre-injury daily activities. For monteggia fractures, resulted mean MEPS score is 93.8 with 88.9% excellent result & 11.1 % good results. All fractures in our study had united by 6 months, both clinically and radiologically. Our study group had reported the complication of delayed union in 6 cases of olecranon fractures. No complications reported in treatment of monteggia fractures.Conclusion: Our study has yielded excellent results in respect of functional outcome, radiological and clinical union without any implant related complications in internal fixation of proximal one third ulna fracture including olecranon fractures and monteggia fractures with plate osteosynthesis. Monteggia fractures treated with plate osteosynthesis yielded slightly better outcome in respect of functional outcome, radiological and clinical union than olecranon fractures. Plate osteosynthesis can be done in comminuted along with non-comminuted proximal one third ulna fractures. We recommend plate osteosynthesis for proximal one third ulna fracture, because of its consistent results with respect to fracture union, stability across the fracture site and early mobilization for better functional results.

Application of the modified internal fixation method of minimally invasive percutaneous plate osteosynthesis in treatment of proximal humeral fracture

To study the clinical outcomes and characteristics of fracture healing of a modified internal fixation method, which was implemented by placing four and two screws respectively at the proximal and distal end of the locking plate in the minimally invasive percutaneous plate osteosynthesis (MIPPO) for patients with proximal humeral fractures. Patients in Peking University Third Hospital from February 2010 to December 2016 were brought into this retrospective study. Based on different operation methods, they were divided into minimally invasive (MI) group and non-minimally invasive (non-MI) group, and the patients in MI group were performed with the modified internal fixation. In order to observe the varying efficacy for different fracture types between the two groups, we further investigated the patients with Neer two-part and three-part fracture, respectively. The follow-up parameters included general physical examination, X-ray, visual analogue scale (VAS) and Constant-Murley score. A total of 117 patients with an average age of (61.5±16.2) years met the inclusion criteria, and MI group included 45 patients, non-MI group included 72 patients. According to the Neer classification, there were 46 cases of two-part fracture, 63 cases of three-part fracture and 8 cases of four-part fracture. In MI group, there were 17 males and 28 males with an average age of (62.2±17.1) years, including 18 cases of two-part fracture, 23 cases of three-part fracture and 4 cases of four-part fracture. In non-MI group, there were 27 males and 45 females with an average age of (60.1±17.7) years, including 28 cases of two-part fracture, 40 cases of three-part fracture and 4 cases of four-part fracture. There were no significant differences between the two groups in terms of gender (P=0.975), age (P=0.545) and fracture type (P=0.756). The average hospital-stay in MI group and non-MI group was (2.8±1.1) days and (4.3±1.3) days (P=0.023), the operation time was (67.8±14.9) min and (102.3±34.1) min (P<0.001), the blood loss was (21.3±6.5) mL and (181.5±55.6) mL (P<0.001), the Constant-Murley score was 6.1±0.9 and 6.5±0.8 (P=0.032) one week after surgery, and the Constant-Murley score was 66.1±4.3 and 63.4±4.9 (P=0.006) three months after surgery, MI group had significant advantages in these aspects. In terms of Neer two-part and three-part fracture, the VAS score (5.9±0.8) one week postoperatively and the Constant-Murley score (66.6±3.7) three months postoperatively were significantly superior in MI group (P<0.05). In MI group, delayed fracture healing occurred in 1 case (2.2%) and abduction was restricted in 1 case (2.2%). In non-MI group, delayed fracture healing occurred in 3 cases (4.2%) and abduction was restricted in 2 cases (2.8%). There were no internal fixation complications and humeral head necrosis in both groups. Applying the modified internal fixation in MIPPO to cure proximal humeral fractures is effective clinically with thick callus formation occurring at the fracture site. The fracture can achieve normal healing and the shoulder functions can restore well, indicating the modified surgical method is a good treatment option.

Evaluation and comparison of the complications of internal fixation by TENS method and plate and screws method for clavicle fracture

Background: Fractures of clavicle are common injuries with incidence of 2.6% of all fractures and 44% of all shoulder injuries. Better operative technique; improve metallurgy and availability of image intensifiers made the operative techniques as a method of first choice by more and more surgeons. So the study was conducted to evaluate and compare the complications of these two methods of fixation. Methodology: The study was conducted on 62 patients with fracture of clavicle. Selected patients were treated by, closed/open reduction & internal fixation by TENS and Group II by open reduction & internal fixation by plate& screws. Patients were followed periodically at 2weeks, 6 weeks, 3, 6, 12 months, 18 months and 24 months. Results were evaluated by Constant scoring system given by Murley (1987). Results: Overall plate had more intra op and post op complications like more blood loss, more operative time, superficial infections, deep infections, implant protuberance, ugly scar, difficult implant removal than TENS fixation. In this study nonunion was equal in both TENS and plate fixation groups. Conclusion: In our study no significant difference was found in function and nonunion rate in both the groups but major complications and union time are more in plate fixation group than TENS group so, TENS fixation is the preferred treatment of choice for fracture middle 1/3rd clavicle.

Internal fixation of low energy pilon fractures: Prospective study of two treatment options (ORIF/MIPO)

Objective: Pilon fractures are intra articular distal tibia fractures involving articular surface or tibial plafond. Various options of treatments are open reduction and internal fixation (ORIF), external fixation, arthroscopic assisted fixation, minimally invasive plate osteosynthes (MIPO). MIPO is an option for extra articular and few undisplaced type B fractures. It may not be suitable in complete articular fractures (43 C) type injuries unless severe soft tissue injury is involved. Type C fractures need accurate articular reduction which may need open reduction and internal fixation. This is a prospective study comparing functional outcome and complications of internal fixation of different types of low energy pilon fractures treated in our hospital with MIPO and ORIF technique. Methods: This prospective study was conducted in our trauma centre from 2012 to 2015 on pilon fractures. We included all low energy pilon fractures (OTA A, B, and C) both open and closed fractures treated by internal fixation with MIPO or ORIF. Group 1 subjects were treated by distal tibia locking plates by MIPO technique. Group 2 by open reduction and internal fixation by different approaches as required depending on fracture fragments. AOFAS ankle hind foot scale was used to assess outcome and was done at the end of follow-up. Results: Pilon fractures type A and B were mainly treated by MIPO while type C was mainly treated by ORIF. Delayed union more frequently seen in MIPO and flap necrosis and delayed wound healing in ORIF group. There was no significant difference in functional outcome by the end of two year as shown by AOFAS scoring (p value 0.851). Conclusion: Internal fixation is an effective method of treatment for pilon fractures. MIPO and ORIF are equally effective provided articular congruity is maintained.

Complications of implant removal in ankle fractures

BackgroundAlthough the complications of internal fixation in ankle fractures are well-known in a number of reports, there have been few reports revealing the complications of implant removal in ankle fractures. The aim of this study was to investigate the perioperative complications of implant removal in ankle fractures and analyze the associated factors of such complications. MethodsPatients who underwent open reduction and internal fixation using metal implants for ankle fractures and had their implants removed between 2010 and 2015 were enrolled in the study. We investigated the rate and details of perioperative complications and collected information on the possible risk factors including the age, comorbidities, fracture type, number of skin incisions, operative time, and surgeon's grade from the medical charts. ResultsA total of 80 patients were included for analysis. Perioperative complications occurred in 11 patients (14%) including arterial injury in one patient, blistering in three, nerve injuries in three, skin necrosis in two, and infection in two. In patients with perioperative complications, the rate of patients with peripheral vascular disease and multiple skin incision was significantly higher (18% vs 3%, p = 0.031 and 64% vs 32%, p = 0.042, respectively) and the operative time was significantly longer (102 min vs 57 min, p < 0.001) than those without perioperative complications. ConclusionThe indication of implant removal in ankle fractures should be considered carefully, especially in patients with possible risk factors and without implant-related symptoms, due to the high incidence of perioperative complications.

Evaluation of clinical results and complications of internal fixation of intertrochanteric femur fracture with proximal femoral nail antirotation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The purpose of the present study was to evaluate the theoretical advantages of the proximal femoral nail antirotation in cases of intertrochanteric fractures and also whether it actually alters the eventual functional outcome of the patient.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study includes a total 30 patients with intertrochanteric femur fractures managed with proximal femoral nail antirotation between December 2014 to November 2016. In all patients similar standard physical rehabilitation therapy were followed. All complications including intra and postoperative were assessed and recorded. The patients were followed up for over 24 months. Functional outcome was assessed using the Harris hip score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All of 30 cases of intertrochanteric fracture got united with good anatomical position and average time of fracture union was 14 weeks. Postoperative complications included 2 degree varus deformity (n=1, 3%), calcification at tip of greater trochanter (n=4, 13%), sensitivity over TFL (n=2, 7%), medial thigh pain (n=3, 10%). 10 patients developed femoral shortness (mean=0.22 cm, range from 0-1 cm). Average harris hip score at the end of study showed mean value of 87, ranged from 65 to 94 with almost 22 (73%) patients showing excellent or good outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Proximal femoral nail antirotation (PFNA) represents a significant treatment option in management of intertrochanteric fractures with low complication rate.&lt;/p&gt;

Risk factors for cut-out after internal fixation of trochanteric fractures in elderly subjects

IntroductionProximal femoral fracture is associated with severe morbidity and mortality and high socioeconomic costs. The main mechanical complication of internal fixation in trochanteric fracture is lag-screw cut-out through the femoral head. Several factors are involved, but remain controversial. The aim of the present study was to determine risk factors for cut-out in internal fixation of extracapsular proximal femoral fracture. MethodsA single-center retrospective study was conducted on a continuous series of 228 patients aged over 75 years, operated on for trochanteric fracture by gamma3 nail or DHS screw plate between July 2009 and December 2014. ResultsThirteen patients experienced mechanical failure of the internal fixation (5.7%). Tip-apex distance (TAD) differed significantly between the group with cut-out (32.69mm) and the group with consolidation (23.70mm; p-value=0.003052). Cut-out rate was 0.89% in good reduction, versus 9.64% in moderate and 12.12% in poor reduction (p-value=0.002693). In contrast, there were no significant differences according to age, type of fracture, or severity of osteoporosis. ConclusionTo minimize mechanical complications exacerbating morbidity and mortality, great attention should be paid to fracture reduction and lag-screw positioning. Level of evidenceIV, retrospective study.

Three-step Reduction Therapy of Integrated Chinese and Western Medicine for Thoracolumbar Burst Fracture

ABSTRACTObjective: To investigate and compare the efficacy of three-step reduction (TSR) therapy of integrated Chinese and Western Medicine and posterior open (PO) surgery for thoracolumbar burst fracture. Methods: We selected 60 patients diagnosed with thoracolumbar burst fracture and received treatment in our hospital from December 2014 to March 2017. According to randomized digital table, they were randomly divided into TSR and PO groups. VAS pain grade, Oswestry disability index, height of centrum front, Cobb's angle of spine, bleeding, and complication of internal fixation of the two groups were compared. Results: Postoperative reduction of injured centrum, regained volume of canalis vertebralis, volume of bleeding, and early functional rehabilitation of TSR group were better than that of PO groups (P < 0.05). Conclusion: Through three-step reduction combined pedicle screw fixation surgery, we can achieve satisfied reduction of thoracolumbar burst fracture, rebuild the height of centrum, recover the biomechanics function of spine, and reduce bleeding. Three-step reduction therapy is an effective therapy for thoracolumbar burst fracture.

Observation of curative effect of external fixator combined with limited internal fixation in the treatment of complex ankle fractures

Objective To observe the effect of external fixator combined with limited internal fixation in the treatment of complex ankle fractures. Methods According to the digital table, 65 patients with complex ankle fracture were randomly divided into treatment group(33 cases) and control group(32 cases). The treatment group was treated with external fixator combined with limited internal fixation, the control group was treated with internal fixation.All patients were followed up for 5 to 20 months. The curative effect and incidence rate of complication of the two groups were observed. Results The excellent rate of the treatment group was 84.85%, which was higher than 62.50% of the control group, the difference was statistically significant(χ2=4.20, P<0.05). The incidence rate of complications in the treatment group was 3.03%, which was lower than 18.75% of the control group, the difference was statistically significant(χ2=4.18, P<0.05). Conclusion External fixator combined with limited internal fixation can effectively treat complex ankle fractures, the method can not only make patients satisfied with the reduction effect, but also the internal fixation complications such as infection are minimized, the clinical value is extremely high, it is worthy of wide application. Key words: Fractures, Bone; Ankle Joint; Fracture Fixation, Internal; External Fixators

Effectiveness comparison between cervical plate internal fixation and Zero profile interboby fixation system for the treatment of cervical spondylotic myelopathy

Objective Compare the clinical efficacy between anterior cervical decompressions, internal fixation with steel plate and zero profile interbody fusion system(Zero-P) in the treatment of cervical spondylotic myelopathy. Methods From October 2010 to May 2013, a total of 47 patients with cervical myelopathy were included in prospective randomized controlled study. All patients were randomly divided into two groups, respectively using plate fixation(screw plate system group, 26 cases) and Zero-P(Zero-P group, 21 cases). Compared operation time, intraoperative blood loss, postoperation flow and the incidence of postoperative discomfort swallowing. Evaluated the Japanese Orthopaedic Association(JOA) score of nerve function and calculated improvement rate; measured cervical Cobb Angle on X-ray film, observed abnormal activity of surgical clearance, evaluated degree of bone graft fusion and related internal fixation complications. Results The average operation time of screw plate system group was 71.2±26.8 min, which was 53.4±28.6 min in Zero-P group, significant difference was found in two groups. The average bleeding volume was 78.1±46.7 ml, and average volume of postoperation drainage was 63.3±37.7 ml in screw plate system group; the average bleeding volume was 77.5±50.4 ml, and the average volume of postoperation drainage was 60.7±28.6 ml in Zero-P group, no significant difference was found. 5 cases in screw plate system group remained swallowing discomfort 3 weeks after operation, but non in Zero-P group. Followed-up lasted for 24-42 months, an average of 23±2.16 months, nerve function were significantly improved at the end of the follow-up of both two groups, the JOA score of screw plate system group was 14.28±2.96, the improvement rate was 68.91%±7.9%, and Zero-P group was 14.32±2.87, the improvement rate was 69.79%±11.2%, there were no significant difference; curvature of cervical vertebrae of screw plate system group was 15.2°±5.7° at the end of follow-up; Zero-P group was 18.1°±7.9°, which with significant difference. Bone graft fusion were found in all patients at the end of follow-up, and no abnormal activities and fixation loosening was found during follow-up period. Conclusion Zero-P compared with traditional fracture-fixation techniques in treating single or double segments of cervical spondylotic myelopathy, can shorten operation time, reduce the incidence of postoperative chronic discomfort swallowing, and maintain in favour of cervical curvature. Key words: Cervical vertebrae; Spinal cord compression; Spinal fusion; Treatment outcome