Fixation In Treatment Research Articles

Application of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors

To investigate the surgical characteristics and preliminary effectiveness of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors. Twenty-two patients received Orthofix unilateral external fixator treatment for bone defect after tumor excision or complications after limb salvage surgery between June 2011 and March 2016. There were 11 males and 11 females with a median age of 23.5 years (range, 4-57 years). The bone defect or limb length discrepancy after tumor resection was at proximal femur in 6 cases, distal femur in 8 cases, diaphysis of femur in 3 cases, proximal tibia in 2 cases, and diaphysis of tibia in 3 cases. The external fixation was used for temporary fixation after reconstruction of bone defect in 10 cases [the length of bone defect was 6-19 cm (mean, 12.3 cm); using vascularized fibular graft in 2 cases, allograft bone and free fibular graft in 2 cases, allograft bone and autogenous bone graft in 5 cases, allograft bone reconstruction in 1 case]; bone distraction lengthening for limb length discrepancy in 5 cases [the length of shortening was 6.5-8.5 cm (mean, 7.5 cm)]; temporary fixation after open biopsy in 3 cases; bone transportation over locking plate in 1 case (the length of bone defect was 7.5 cm); fixation for preoperatively pathology fracture in 1 case; and joint distraction for dislocation after tumor ablation in 2 cases. All the patients were followed up 12-72 months (mean, 36 months). In 10 patients with bone defect reconstruction, the wearing external fixator time was 3-8 months (mean, 4.8 months); all got bone union with the healing time of 3-16 months (mean, 6.4 months); the Musculoskeletal Tumor Society 93 (MSTS 93) score was 73.3-93.3 (mean, 87.2); and no complication occurred during wearing external fixator. In 5 patients with bone distraction lengthening for limb length discrepancy, the wearing external fixator time was 7-15 months; 2 patients had axial deviation during distraction and2 had greenstick fracture after apparatus removal; pin site infection was observed in 2 cases with grade 1 and 1 case with grade 2 according to Checketts-Otterburn classification system; the MSTS 93 score was 80.0-96.7 (mean, 89.2). The remaining patients had no complications, the knee and ankle joint movement was normal. Orthofix unilateral external fixator can be used in fixation for complex bone defect after tumor resection and to correct limb length discrepancy after limb salvage surgery.

Clinical application of Acutrak screws in the treatment of fresh scaphoid fractures

Objective To investigate the method and short-term effects of Acutrak screws in the treatment of fresh scaphoid fractures. Methods From January 2011 to January 2015, 11 cases of scaphoid fractures were treated by Acutrak headless compression screws. According to Herbert's classification, one case was type B1, 6 cases were type B2, 2 cases were type B3, and 2 cases were type B4. Volar approach was used in 7 cases, dorsal approach in 3 cases, and combined approach in 1 case. Two cases of type B4 had scapholunate dissociation and were treated by open reduction and fixation with simultaneous repair of scapholunate ligament. After the operation, short arm plaster fixation was used and exercises were gradually carried out after immobilization for 2 to 3 weeks. Results Postoperatively all the patients were follow-up for 12 to 24 months with an average of 16.5 months. The time of fracture healing was 7 to 15 weeks with an average of 11.4 weeks. According to the Mayo scoring system, wrist function at the final follow-up was rated as excellent in 6 cases, good in 3 cases and fair in 2 cases. Conclusion Acutrak headless compression screws can achieve reliable fixation and satisfactory treatment results. Key words: Scaphoid bone; Fractures,bone; Internal fixation; Screw

External fixation combined with delayed internal fixation in treatment of tibial plateau fractures with dislocation.

The aim of this study was to evaluate the clinical efficacy of external fixation, delayed open reduction, and internal fixation in treating tibial plateau fracture with dislocation.Clinical data of 34 patients diagnosed with tibial plateau fracture complicated with dislocation between January 2009 and May 2015 were retrospectively analyzed. Fifteen patients in group A underwent early calcaneus traction combined with open reduction and internal fixation and 19 in group B received early external fixation combined with delayed open reduction and internal fixation. Operation time, postoperative complication, bone healing time, knee joint range of motion, initial weight-bearing time, Rasmussen tibial plateau score, and knee function score (HSS) were statistically compared between 2 groups.The mean follow-up time was 18.6 months (range: 5–24 months). The mean operation time in group A was 96 minutes, significantly longer than 71 minutes in group B (P < .05). In group A, 5 cases had postoperative complications and 1 in group B (P < .05). The mean bone healing time in group A was 6.9 months (range: 5–9 months) and 6.0 months (range: 5–8 months) in group B (P > .05). In group A, initial weight-bearing time in group A was (14.0 ± 3.6) weeks, significantly differing from (12.9 ± 2.8) weeks in group B (P < 0.05). In group A, the mean knee joint range of motion was 122° (range: 95°–150°) and 135° (range: 100°–160°) in group B (P > 0.05). Rasmussen tibial plateau score in group A was slightly lower than that in group B (P > .05). The excellent rate of knee joint function in group A was 80% and 84.21% in group B (P > .05).External fixation combined with delayed open reduction and internal fixation is a safer and more efficacious therapy of tibial plateau fracture complicated with dislocation compared with early calcaneus traction and open reduction and internal fixation.

Conservative management equally effective to new suture anchor technique for acute mallet finger deformity: A prospective randomized clinical trial

Study DesignProspective randomized controlled trial. Purpose of the StudyThis study was designed to compare our new suture anchor technique with conservative management in acute Wehbe-Schneider type I A-B and II A-B mallet fingers. MethodsTwenty nine patients who presented to our clinic between 2013 and 2015 were randomized for surgical or conservative treatment. Wehbe-Schneider subtype C fractures were excluded. Fourteen were treated with surgery, and 15 were treated with conservative treatment. Primary outcomes were visual analog scale score, active distal interphalangeal (DIP) joint flexion, return to work, extension deficit and DIP joint degeneration. Follow-up time was 12 months. ResultsThe mean visual analog scale was 2.0, and return to work was on average in 63.2 days in the surgical group and 1.47 and 53.7 days in the conservative group. Extension deficit was 8.1° in the surgical group and 6.1° in the conservative group. The mean DIP flexion at final follow-up was 54.5° (40-65) in the surgery group and 58.3° (45-70) in the conservative group. DIP joint degeneration was observed with X-rays in 4 patients in surgical group, and none of the patients in the conservative group had DIP degeneration at 1 year after treatment. ConclusionsThe therapeutic effectiveness of suture anchor technique was not statistically different from conservative treatment. Subluxation seen after fixation treatment with suture anchors may be due to inadequate anchor fixation. DIP joint degeneration was seen significantly more in the surgical group. Our study suggests that the new suture anchor technique is not superior to conservative treatment. Level of EvidenceIb.

Clinical efficacy of unilateral percutaneous transfacet screws combined with contralateral pedicle screw versus bilateral pedicle screws fixation in the treatment of the degenerative lumbar disease

To investigate the surgical outcome of unilateral pedicle screw(UPS) after TLIF technique combined with contralateral percutaneous transfacet screw(PTS) fixation vs bilateral pedicle screws(BPS) fixation in treatment of degenerative lumbar disease. From January 2009 to June 2012, 46 patients with degenerative lumbar diseases, including 30 males and 16 females with an average age of 51.5 years old, who were divided into two groups according to different fixation methods. Twenty-two cases underwent UPS after TLIF technique combined with contralateral PTS fixation (group A), while the others underwent BPS fixation(group B). The relative data were analyzed, such as blood loss volume, operative time, fusion rate, ODI score, JOA score and so on. All the patients were followed up for 1 to 3 years with an average of 22 months. Except one case of each group was uncertainty fusion, the rest have obtained bony fusion, and the fusion rates in group A and B were 95.5% and 95.8%, respectively. No displacement and breakage of screw were found during follow-up. Operative time and blood loss volume in group A were better than of group B(P<0.05). ODI and JOA scores had improved obviously than preoperation(P<0.05), but the differences had no statistical significance between two groups(P>0.05). Two approaches had similar clinical outcomes for degenerative lumbar disease with no severe instability. Compared with BPS fixation, the UPS after TLIF technique and contralateral PTS fixation has the advantages of less trauma, shorter operative time and less blood loss, and it is a safe and feasible surgical technique.

One stage surgical treatment for scoliosis associated with intraspinal abnormalities

Objective To evaluate the effectiveness and safety of one stage surgical treatment for scoliosis and coexisting intraspinal abnormalities. Methods The data of 6 patients who underwent one stage surgical treatment for scoliosis and coexisting intraspinal abnormalities from October 2016 to January 2017 were retrospectively analyzed. Treatment for intraspinal abnormalities, posterior correction, osteotomy and internal fixation were performed simultaneously. The clinical and radiologic presentations, operative details, complications and postoperative outcomes were evaluated. Results The success rate was 100%. The operating time was (470.83 ± 136.20) min and intraoperative bleeding amount was 1350 (625, 2150) ml. Total fusion segments were 11.00 ± 2.76. Both Cobb angle of scoliosis [postoperation (19.60 ± 5.94)° vs. preoperation (59.40 ± 14.31)°, P = 0.007] and kyphosis [postoperation (25.80 ± 10.87)° vs. preoperation (62.40 ± 21.04)°, P = 0.005] were improved after operation. Tethered cords were released and epidermoid cyst, ganglioglioma and lipoma were excised. Syringomyelia was left untreated. No neurological functional defect or worsening was found. Muscle strength of all patients was improved. Muscular tone of 4 patients and difficulty in urination of 5 patients were also improved. The mean hospital stay was (8.83 ± 3.31) d. No severe complications, such as infection, cerebrospinal fluid (CSF) leakage, failed internal fixation, fractured pedicle screws or rods occurred after operation. None of the patients died, or experienced deterioration of neurological function, delayed infection, pseudoarthrosis, or loss correction during the (7.50 ± 1.22) months follow - up. Conclusions The one stage surgical treatment for scoliosis and intraspinal abnormalities seems to be a safe and effective approach. Neurological functional defect can be improved after operation. Osteotomy can improve correction result. DOI: 10.3969/j.issn.1672-6731.2017.09.011

Primary arthrodesis compared with open reduction and internal fixation for Lisfranc injuries with the first tarsometatarsal joint disolocation

The studies evaluating the outcomes of treatment of purely ligamentous unstable Lisfranc injuries are scarce. This study aimed at comparing outcomes of primary tarso-metatarsal joints fusion versus open reduction and internal fixation in treatment of such condition and determining the possible factors that may alter the outcomes.This study comprised 30 patients; 16 in fusion group and 14 in ORIF group. One column was operated on in 2 patients, two columns in 21, and three columns in 7. The mean follow-up period was 36 months.There was no statistically significant difference between both groups regarding patients or injury characteristics. The mean AOFAS and FFI-Rs scores were 88.9 and 22.7 in the fusion group, compared to 61.7 and 34.5 in the ORIF group (P = .03,.04 respectively). At final follow-up all patients in the primary arthrodesis group were maintaining an anatomical reduction versus 71.5% in the ORIF group. Sixteen patients (53%) reported prominent hardware troubles that required removal. Five patients in ORIF group developed osteoarthritis, and four of them underwent secondary fusion. There was significantly higher incidence of posttraumatic osteoarthritis in patients with non-anatomical reduction and complete injuries. Better mean AOFAS and FFI-Rs scores occurred with non-smokers and with anatomical reduction.Based on this limited case series, purely ligamentous Lisfranc injuries were found to have better outcomes when managed with a primary fusion as compared to ORIF.Achieving and maintaining anatomical reduction was the most important factor that is significantly attributed to improved outcomes. Possible arthritic changes and additional surgeries apart from implant removal could be avoided by primary fusion.level I- prospective comparative case study.

Outcomes of Lisfranc Injuries in an Active Duty Military Population

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Traumatic injuries to the tarsometatarsal or Lisfranc joints can be complex problems associated with long-term pain, disability, and deformity. Most current literature advises early open reduction and internal fixation (ORIF) for acute Lisfranc injuries and reserves arthrodesis for chronic injuries, isolated ligamentous injuries, or salvage procedures. There is also a reported association between delayed diagnosis or missed injuries and poor outcomes. The purpose of this study was to evaluate the association between time from injury to treatment and method of fixation with outcome. Methods: A retrospective review of 171 non-battle related closed tarsometatarsal dislocations and fracture dislocations was conducted of patients identified using the Department of Defense Trauma Registry and Military Health System Mart from 2009- 2014 searching by CPT codes. Demographic information, injury characteristics, treatment course, and physical evaluation board results were examined. Return to duty was defined as a patient returning to full duty and passing their service specific physical fitness test. We excluded polytrauma patients, battle injuries, deep infections requiring surgical debridement, those with pre- existing duty limiting conditions, those who separated from the military for unrelated reasons prior to completing their rehabilitation and those with incomplete data. Results: Overall of 107 patients 69% returned to full active duty, 4% returned to limited duty with permanent duty restrictions and 27% underwent a medical evaluation board and were ultimately discharged from service. The ORIF group consisted of 80 patients; the average time from injury to fixation was 2.5 weeks and 63% returned to full duty, 6% returned on permanent profile. Of the arthrodesis group 20 underwent primary arthrodesis with an average time from injury of 15.4 weeks and a return to duty rate of 80%. Seventy-one percent of patients who underwent arthrodesis as a salvage procedure for failed ORIF or post-traumatic osteoarthritis (PTOA) underwent a medical evaluation board and were discharged from service. Conclusion: This represents one of the largest cohorts in the literature and redemonstrates that tarsometatarsal dislocations and fracture-dislocations are serious injuries that can lead to permanent disability. The data also demonstrates very low return to duty rates in those who underwent salvage arthrodesis reinforcing the importance of initial anatomic reduction and the poor outcomes of PTOA. Most notably it demonstrates higher return to duty rates among patients who underwent primary arthrodesis despite the inclusion of more missed/chronic injuries when compared to ORIF. This suggests that primary arthrodesis may be a viable option in a young and active population despite later treatment.

Posterolateral minimal incision, poking reduction, and simple internal fixation in treatment of collapsed fractures of posterolateral tibial plateau

To explore the effectiveness of limited incision, poking reduction, and simple internal fixation in the treatment of collapsed fractures of the posterolateral tibial plateau. Between October 2010 and January 2016, 16 patients with collapsed fractures of the posterolateral tibial plateau underwent posterolateral incision, poking reduction, and simple internal fixation. There were 10 males and 6 females with the age of 22-63 years (mean, 43.5 years). The injury was caused by falling in 5 cases, traffic accident in 7 cases, and falling from height in 4 cases. All cases had closed fractures. The left knee was involved in 9 cases and the right knee in 7 cases. The injury-to-admission time was 2 hours to 3 days (mean, 10 hours). X-ray films showed that the articular surface collapsing was more than 2 mm. According to Schatzker criteria, 6 cases were rated as type II and 10 cases as type III. Twelve cases had fracture of fibular head. The incision length, operation time, intraoperative blood loss, and incision healing were recorded; fracture healing was observed, and tibial plateau angle and posterior slope angle were measured on X-ray films; loss of articular surface reduction was observed by CT scan; and American Hospital for Special Surgery (HSS) score was used to evaluate the knee joint function. The incision length was 7-10 cm (mean, 8.6 cm); operation time was 35-55 minutes (mean, 46 minutes); intraoperative blood loss was 10-35 mL (mean, 28 mL). Primary healing of incision was obtained. Skin pain occurred in 1 case at 2 months because Kirschner wire retracted. Fifteen cases were followed up 8-21 months (mean, 13.5 months). The fracture healing time was from 3 to 6 months (mean, 4.8 months). There was no significant difference in tibial plateau angle and posterior slope angle between at immediate after operation and at last follow-up ( t=-1.500, P=0.156; t=-1.781, P=0.097). The anatomic reduction rate of articular surface was 93.8% (15/16) at immediate after operation. At last follow-up, the recollapse height of articular surface was 0.1-1.2 mm (mean, 0.36 mm). According to the HSS score system, the results were excellent in 12 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 93.3%. The limited incision by posterolateral approach, poking reduction, and simple internal fixation have the advantages of small injury, full exposure, and easy operation in the treatment of simple posterolateral tibial plateau fractures; bone graft support and simple internal fixation can prevent recollapse of the articular surface and achieve satisfactory knee function.

Effectiveness comparison of flexible fixation and rigid fixation in treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis

To compare the effectiveness of flexible fixation and rigid fixation in the treatment of ankle pronation-external rotation fractures with distal tibiofibular syndesmosis. A retrospective analysis was made on the clinical data of 50 patients with ankle pronation-external rotation fractures and distal tibiofibular syndesmosis treated between January 2013 and December 2015. Suture-button fixation was used in 23 patients (flexible fixation group) and cortical screw fixation in 27 patients (rigid fixation group). There was no significant difference in age, gender, weight, side, fracture type, and time from trauma to surgery between 2 groups ( P>0.05). The operation time, medial clear space (MCS), tibiofibular clear space (TFCS), tibiofibular overlap (TFO), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Disability Index (FADI) score were compared between 2 groups. The operation time was (83.0±9.1) minutes in the flexible fixation group and was (79.6±13.1) minutes in the rigid fixation group, showing no significant difference ( t=1.052, P=0.265). All patients achieved healing of incision by first intention. The patients were followed up 12-20 months (mean, 14 months). The X-ray films showed good healing of fracture in 2 groups. There was no screw fracture, delayed union or nounion. The fracture healing time was (12.1±2.5) months in the flexible fixation group and was (11.3±3.2) months in the rigid fixation group, showing no significant difference between 2 groups ( t=1.024, P=0.192). Reduction loss occurred after removal of screw in 2 cases of the rigid fixation group. At last follow-up, there was no significant difference in MCS, TFCS, TFO, AOFAS score and FADI score between 2 groups ( P>0.05). Suture-button fixation has similar effectiveness to screw fixation in ankle function and imaging findings, and flexible fixation has lower risk of reduction loss of distal tibiofibular syndesmosis than rigid fixation.

Comparison of three internal fixation methods for treatment of patellar fractures

Objective To compare patellar ring, Kirschner wire tension band and patellar ring plus Kirschner wire in fixation for treatment of patella fractures. Methods A retrospective analysis was conducted on the 285 patients with patellar fracture who had been treated between September 2009 and January 2016. They were 155 men and 130 women, with an average age of 45.5 years (from 18 to 70 years). Their fractures included 176 transverse, 28 longitudinal split and 81 comminuted ones. They were divided into 3 groups according to their different internal fixation methods: patellar ring fixation (98 cases), Kirschner wire tension band (92 cases), patellar ring plus Kirschner wire fixation (95 cases). The 3 groups were compared in terms of operative time, intraoperative bleeding, fracture healing time, knee function by Bostman score at the last follow-up and postoperative complications. Results The operative time in the patellar ring group(58.9±6.4 min) was significantly shorter than in the Kirschner wire group (71.8±7.8 min) and in the patellar ring plus Kirschner wire group (74.4±8.0 min) (P 0.05). The good to excellent rate of knee function at the last follow-up in the Kirschner wire tension band group was 100.0% (92/92), significantly higher than in the patellar ring group (90.8%, 89/98) and in the patellar ring plus Kirschner wire group (91.6%, 87/95) (P 0.05). Conclusion Internal fixation with Kirschner wire tension band has definite curative effect on patellar fractures, showing the advantages of less operative invasion, fewer postoperative complications, better functional recovery of the affected knee joint, and lower price over the other 2 internal fixation methods. Key words: Patella; Fractures, bone; Fracture fixation, internal; Internal fixators; Case-control studies

Nonunion of greater trochanter following total hip arthroplasty: Treated by an articulated hook plate and bone grafting.

Background:Trochanteric osteotomy still has an important role in hip arthroplasty in cases of (1) preexisting developmental hip dysplasia with superior subluxation, (2) revision arthroplasty, specifically with acetabular component revision in the face of well-fixed femoral component, and (3) recurrent dislocation without component loosening or malalignment, in treatment of complicated trochanteric fixation in osteoporotic bone and nonunions may be difficult. This study reports the clinical outcomes of trochanteric fixation following total hip arthroplasty (THA) utilizing a hook plate construct in a cohort of ten patients.Materials and Methods:The Arbeitsgemeinschaft für Osteosynthesefragen (AO) articulated hook plate was used in nine cases of established approach related nonunion following THA and in one case of osteopenic bone during primary THA. All ten patients returned for interviews and clinical examination. The average time for clinical followup was 35 months (range 5–48 months). The mean age of the study cohort was 65 years (range 56–74 years). Time to union and incidence of postoperative complications were assessed.Results:Union occurred in all ten cases at an average of 3.3 months postoperatively. One patient developed symptomatic trochanteric bursitis and required plate removal. Another patient developed a superficial infection which was successfully treated with local wound debridement and antibiotics. A third patient developed a symptomatic neuroma at the site of the iliac crest bone harvest and was successfully treated with excision of the neuroma. No catastrophic implant failures occurred.Conclusions:The articulated design of the plate allows for ease in application and functional construct stability. The articulated hook plate is an option for fixation of osteopenic bone fragments and established nonunions of the greater trochanter.

Comparative study on effect of coronoid fixation with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability

Objective To compare the effect of coronoid fixation combined with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability. Methods This retrospective cohort research included 34 patients with elbow varus posteromedial rotational instability operated between January 2011 and June 2015. All patients had coronoid process fractures of O' Driscoll type Ⅱ (six with subtype 1, 24 with subtype 2 and four with subtype 3). Fifteen of the 34 patients were operated by coronoid fixation combined with lateral collateral ligament repair (Group A) and other 19 patients were operated by coronoid fixation combined with placing hinged external fixator (Group B). Interval between injury and operation, operation time and blood loss were recorded. At final follow-up, elbow range of motion, Mayo elbow performance score (MEPS) and Hastings and Graham heterotopic ossification classification were measured. Results There were no significant differences in the interval between injury and operation, operation time and blood loss between the two groups (P>0.05). Median period of follow-up was 30 months in Group A and 40 months in Group B. Last follow-up showed flexion of the affected elbow in Group B [145° (135°-150°)] was better than that in Group A [140° (130°-145°)] (P 0.05). MEPS in Group A scored 100 in 10 patients, 90 in three, 85 in one and 70 in one; MEPS in Group B scored 100 in 13 patients, 90 in one, 85 in four and 80 in one. There was no significant difference in MEPS between the two groups (P>0.05). Conclusion For treating elbow varus posteromedial rotational instability, either lateral collateral ligament repair or hinged external fixation after anatomic reduction and coronoid fixation can achieve good results. Key words: Elbow joint; Intra-articular fractures; Coronoid process

Curative effect of anatomic plate internal fixation for complex proximal humeral fractures combined with humeral shaft fractures

Objective To investigate the efficacy of anatomic plate internal fixation in treatment of complex proximal humeral fractures combined with humeral shaft fractures. Methods This retrospective case series study included 58 patients with complex proximal humeral fractures combined with humeral shaft fractures admitted from July 1998 to July 2015. There were 31 males and 27 females, with a mean age of 63 years (range, 18-86 years). According to the Neer classification of proximal humeral fractures, three-part fractures were noted in 42 patients and four-part fractures in 16 patients. Four patients were combined with compressed or splitting fractures of the head of humerus and 38 patients with dislocation of the shoulder. According to the site classification of femoral shaft fractures, proximal 1/3 shaft fractures were noted in 36 patients, middle and distal 1/3 shaft fractures in 19, and multisegmental shaft fractures in three. All patients underwent anatomic reduction and anatomic plate internal fixation. Bone healing, Neer score of function outcome and complications were evaluated after operation. Results Mean duration of follow-up was 8.6 years (range, 1-18 years). Bone union was observed in all patients after 10 to 24 weeks (mean, 14.5 weeks). According to the Neer score, the outcomes were excellent in 23 patients, good in 25, fair in eight and poor in two, with the excellent rate of 83%. Complications such as infection, nerve injury and vascular injury were not observed after operation. Six patients suffered from limitations of shoulder anterior flexion and rise, one patient had humeral head necrosis and treated by shock wave treatment, and one patient had poor incision healing with hemorrhagic effusion and cured after dressing. Conclusion Anatomic plate internal fixation can contribute to fast functional recovery and few complications in treatment of complex proximal humeral fractures combined with humeral shaft fractures. Key words: Humeral fractures; Fracture fixation, internal; Reduction

Modular S-ROM prosthesis for failed internal fixation of intertrochanteric fracture

Objective To observe the outcomes of hip arthroplasty with modular S-ROM prosthesis for failed internal fixation of intertrochanteric fracture. Methods Fifteen patients who had been admitted for failed internal fixation of intertrochanteric fracture from January 2013 to May 2015 were reviewed retrospectively in this study. They were 9 men and 6 women, aged from 55 to 86 years (average, 72 years). Their primary internal fixation methods included dynamic hip screw (DHS) in 7 patients, proximal femoral nail anti-rotation (PFNA) in 5 and proximal femoral locking plate in 3. The causes for internal fixation failure were implant loosening in 5 patients, screw breakage in 6, and cutting-out of screws in 4. All the patients received hip arthroplasty with modular S-ROM prosthesis to treat their fracture nonunion or displacement. Harris hip scores were measured before operation and at the final follow-up. Results Their average operative time was 156 min (from 118 to 180 min) and average intraoperative blood loss 432 mL (from 230 to 700 mL). No fracture or neurovascular damage occurred during operation. The 15 patients were followed up for 13 to 35 months (mean, 24 months). Postoperative dislocation of the artificial joint happened in one patient and nonunion of the greater trochanter due to massive bone defects was observed in 2 patients. Follow-ups showed none of the patients had such severe complications as infection, deep vein thrombosis or peri-prosthesis fracture. At the last follow-up, 15 patients obtained Harris hip score of 90.6 (from 78 to 95), with 11 excellent, 3 good and one fair cases. Conclusion Hip arthroplasty with modular S-ROM prosthesis is a safe and effective treatment for failed internal fixation of intertrochanteric fracture. Key words: Arthroplasty, replacement, hip; Hip fractures; Fracture fixation, internal; Treatment failure

Intramedullary nail versus volar locking plate fixation for the treatment of extra-articular or simple intra-articular distal radius fractures: systematic review and meta-analysis.

This study aims to compare the outcomes of intramedullary nail (IMN) and volar locking plate (VLP) fixation for treatment of extra-articular or simple intra-articular distal radius fractures. PubMed, Embase, Medline and Cochrane Collaboration Central databases were searched for studies that compared the results of IMN and VLP fixation for the treatment of distal radius fractures up to March 2016. Stata 11.0 was used to perform the meta-analysis. Six randomized controlled trials (RCT) and two retrospective studies were included in this review, including 463 patients. No significant differences were found between two treatment methods in terms of any functional score, radiographic parameters and motion range in the late post-operative period (6, 12 and 24months). However, IMN did better than VLP at the post-operative sixweeks and threemonths, no matter which functional scoring system was used. The incidence of carpal tunnel syndrome (CTS) was 8.7% in the VLP group, significantly higher than that (0.8%) in the IMN group (OR, 0.183; 95%CI, 0.045-0.74). But for other complications, such as infection (OR, 0.449; 95%CI, 0.095-2.114), tendious damage (OR, 0.931; 95%CI, 0.238-3.648), tenosynovitis (OR, 0.806; 95%CI, 0.209-3.108), algodystrophy (pain) (OR, 0.795; 95%CI, 0.291-2.173) and radial nerve paraesthesia (OR, 1.8143; 95%CI, 0.834-3.942), no significant differences were found (P > 0.05). Compared to VLP, IMN could provide better early postoperative functional outcomes and reduce the incidence of carpal tunnel syndrome, which could be of particular help in restoring confidence for workers with specialized manual skills to return to their prior jobs. Additionally, the conclusion should be cautiously treated, because it was reached in the context of limited amount of studies and relatively small sample size. Therefore, future studies with good design and large samples are required to verify this conclusion.

Meta-analysis of open reduction internal fixation and non-operative treatment of multiple rib fractures

Objective To compare the efficacy between open reduction internal fixation and non-operative treatment of multiple rib fractures. Methods Pubmed, Embase, Chinese National Knowledge Infrastructure database (CNKI), Chinese Biological Medical Literature database (CBM), Wanfang database and VIP database were searched for relevant studies comparing the effect of open reduction internal fixation and non-operative treatment of multiple rib fractures during 1990 and 2016. RevMan 5.3 software was used for the meta-analysis to compare differences of the two treatments concerning hospital stay, total ICU stay, duration of mechanical ventilation, proportion of pneumonia and atelectasis and pulmonary function. Results Eleven studies containing 799 patients met the inclusion criteria, including 431 patients in internal fixation group and 368 patients in non-operative group. Two groups had significant differences in hospital stay (95%CI -11.00--3.34, P<-0.05), total ICU stay (95%CI -4.48--1.29, P<0.05), duration of mechanical ventilation (95%CI-7.52--1.54, P<0.05), proportion of pneumonia (95%CI 0.19-0.42, P<0.05), proportion of atelectasis (95%CI 0.24-0.57, P<0.05) and total lung capacity (95%CI 1.57-1.97, P<0.05), forced vital capacity (FVC) (95%CI 0.98-1.27, P<0.05) and forced expiratory volume in one second (FEV1) (95%CI 0.68-0.95, P<0.05). Conclusion Open reduction internal fixation of multiple rib fractures can significantly improve rehabilitation rate, reduce incidence of pulmonary complications during hospitalization, and facilitate recovery of lung function. Key words: Rib fractures; Flail chest; Surgical procedures, operative; Meta-analysis

Emerging Techniques in Degenerative Thoracolumbar Surgery.

There continue to be incremental advances in thoracolumbar spine surgery techniques in attempts to achieve more predictable outcomes, minimize risk of complications, speed recovery, and minimize the costs of these interventions. This paper reviews recent literature with regard to emerging techniques of interest in the surgical treatment of lumbar spinal stenosis, fusion fixation and graft material, degenerative lumbar spondylolisthesis, and thoracolumbar deformity and sacroiliac joint degeneration. There continue to be advances in minimal access options in these areas, although robust outcome data are heterogeneous in its support. The evidence in support of sacroiliac fusion appears to be growing more robust in the properly selected patient.

Minimally invasive internal fixation combined with external fixator for treatment of intra-articular fracture of the base of the first metacarpal

Objective To investigate the method and clinical outcomes of minimally invasive internal fixation combined with external fixator for treatment of intra-articular fracture of the first metacarpal base. Methods From September 2014 to April 2016, eleven patients with intra-articular fractures of the base of the first metacarpal were treated. All the fractures were preliminarily fixed with Kirschner wire using minimally invasive technique to avoid open reduction. Small incision was made for these that could not be fixed with closed reduction. Then an external fixator was applied to distract the first carpometacarpal joint for 2 to 3 mm and maintain the reduction. The forearm was immobilized with a plaster cast. Results The time of fracture healing was 7 to 9 weeks, the average being 7.6 weeks. The external fixator was removed at 5 to 6 weeks postoperatively when functional exercise was resumed. Postoperative follow-up ranged from 4 to 18 months with an average of 10.5 months. Functions of the involved thumb were evaluated by the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association at final follow-up, which revealed excellent results in 8 cases, good in 2 cases, and fair in 1 case. Conclusion For intra-articular especially comminuted fractures of the base of the first metacarpal, application of external fixator combined with Kirschner wire to fix the fracture and distract the MP joint gives rise to satisfactory results. Key words: Metacarpal bones; External fixators; Intra-articular fracture; Comminuted fracture

Interfragmentary compression and pull-out properties of 6.5-mm AO cancellous lag screws in a uniform synthetic material during tightening procedures

AO lag screws are widely used in surgical intra-articular fracture treatment for anatomical reduction and rigid fixation. Interfragmentary compressive force (IFCF) and pull-out strength (POS) are two critical parameters generated by AO lag screws during tightening, and both of these parameters could be used to estimate screw insert conditions to prevent screw stripping. The aim of this study is to evaluate the IFCF and POS of AO cancellous screws inserted into uniform synthetic cancellous bone during tightening procedures. Seven synthetic cancellous bone blocks were used for this research. Each test contained two continuous portions as follows: the rotation test portion and the pull-out test portion. IFCF and POS were captured by the pressure transducer and the sensor of the test machine. The properties of IFCF and POS based on tightening degrees were obtained in this study. The ideal balance between POS and IFCF during screw tightening exists, and the peak values of these parameters cannot be simultaneously achieved. Moreover, rotation angles of 100–150° appear to serve as the optimum balance between IFCF and POS in the present study.