L-shaped Incision Research Articles

Extrapleural cervico-manubriotomy and clavicular swing for the management of a mesenchymal tumour of the middle scalenus: an adapted anterior thoracic inlet approach.

Surgical approach for resection of tumours involving the thoracic inlet has largely been developed in the context of lung cancer of the superior sulcus. Therefore, initial anterior approaches included a thoracotomy associated with a longitudinal cervicotomy. Here, we describe a variation of the previously described anterior surgical approaches of the thoracic inlet that we performed for the resection of a primary mesenchymal tumour of the left middle scalenus muscle secreting fibroblast growth factor-23 responsible for tumour-induced osteomalacia. This approach allowed a safe control of the great vessels phrenic nerve and brachial plexus as well as a comfortable access to the middle scalenus muscle through an L-shaped incision with a cervico-manubriotomy without thoracotomy. The tumour was resected entirely with the middle scalenus. After 3 months of follow-up, the symptoms resolved entirely.

Can medial stability be preserved after open wedge high tibial osteotomy?

PurposeThis study evaluated the medial joint stability after high tibial osteotomy (HTO) releasing the superficial medial collateral ligament (sMCL) without cutting and repairing.MethodsTwenty-one patients who performed HTO were enrolled. After an L-shaped incision was made in the pes anserinus, the sMCL was released from the distal portion during surgery. After plate fixation, the sMCL was reattached and the pes anserinus was repaired underneath the plate. Plate removal was performed after 31.1 ± 14.2 months. Before HTO, a valgus force of 40 N was exerted at extension for reference values. Before and after plate removal, a valgus force of 40 N was exerted at extension and at a flexion position of 20°. Medial stability was evaluated by measuring the joint line convergence angle (JLCA).ResultsThe JLCAs in the extension state before HTO and plate removal were 1.64° ± 1.15° and 1.83° ± 1.36°, respectively; there was no significant difference (p = 0.198). There was also no significant difference in JLCA before HTO and after plate removal (p = 0.835). There was also no significant difference in JLCA before and after plate removal both at a knee extension and flexion position of 20° (p = 0.348 and p = 0.456, respectively).ConclusionsReleasing the sMCL without cutting and repairing the pes anserinus underneath the plate during medial open wedge HTO could facilitate the maintenance of medial joint stability.

Mid-term results of modified L-shaped incision technique for supracardiac total anomalous pulmonary venous connection.

Surgical outcomes of supracardiac total anomalous pulmonary venous connection (TAPVC) repair by the posterior technique (PT) remain unsatisfactory. This study aimed to compare the outcomes of the modified L-shaped incision technique with the PT for supracardiac TAPVC repair. From January 2009 to December 2019, 121 consecutive patients with supracardiac TAPVC undergoing surgical repair in our institution were included (L-group, n = 53; PT group, n = 68). A propensity score-matched analysis was performed. Patients with single-ventricle physiology or atrial isomerism were excluded. All clinical data were retrospectively analysed. In the unmatched cohort, the median follow-up duration was 33 months (interquartile range 26-65 months). There were 5 operative mortalities (4.1%) and 12 late mortalities (9.9%). Postoperative pulmonary venous obstruction (PVO) was documented in 21 patients. After matching (52 pairs), the overall survival rate in the L-group was 88.2% at both 3 and 5 years. For the propensity score-matched patients with preoperative PVO (n = 20), statistically significant differences (P = 0.002) were found by Kaplan-Meier curves with freedom from death and postoperative PVO at 1 and 3 years of 100% and 85.7% [standard deviation (SD): 13.2%] in the L-group and 90% (SD: 9.5%) and 22.9% (SD: 14.1%) in the PT group, respectively. Multivariable analysis revealed that the use of the PT was an independent risk factor for death and postoperative PVO (hazard ratio 4.12, 95% confidence interval 1.12-15.16; P = 0.03). The modified L-shaped incision technique provided an acceptable outcome for supracardiac TAPVC repair. Compared with PT, the modified L-shaped incision technique was significantly associated with decreased death and postoperative PVO in patients with obstructed supracardiac TAPVC.

L-Shaped Incision in Composite Reduction Labiaplasty

Labia minora hypertrophy, in combination with clitoral hood protrusion, is a common deformity encountered in clinic practice and should be treated as a compound entity. Most targeted surgical procedures are too complex to understand and master. Herein, we introduce a relatively simple method to correct this deformity. In this study, we retrospectively review our experience treating patients with deformity of labia minora hypertrophy combined with clitoral hood protrusion between January 2017 and November 2019. All patients received correction surgery to repair the complex deformity. During the procedures, we divided the complex operation into two parts: clitoral hood reduction using L-shaped incision and then labiaplasty using L-shaped edge resection. We describe the details of the method step-by-step and evaluate the treatment outcomes. A total of 38 sides (14 bilateral procedures and 10 unilateral procedures) of clitoral hood reduction and labiaplasty were performed. There were no wound healing complications in any cases. One patient had a secondary corrective operation for obvious asymmetry of bilateral labia minora. Ultimately, all the patients were satisfied with the cosmetic appearance and did not have complaints. The surgical procedure we describe proved to be an effective, simple method for dealing with the complex situation of hypertrophy of labia minora combined with clitoral hood protrusion. Subsequent L-shaped edge resection of labiaplasty is appropriate for individuals with darker skin, in particular.Level of evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Genital Surgery.

The "FCR" Approach to the Knee for the Management of Posterior Tibial Plateau Fractures.

Three-column fixation of tibial plateau fractures is now an established philosophy. A direct posterior approach with the patient prone affords enhanced exposure of the posterior column and ease of access for fixation using a buttress plate and posterior-to-anterior screws. A "direct posterior" approach through a reverse L-shaped incision to back of the knee is popular, yet complications associated with raising a fascial flap can occur. We present a simple method of conceptualizing a direct posterior approach through a single longitudinal incision, by likening it to a commonly performed orthopedic approach, the flexor carpi radialis approach to the wrist.

Comparison of thoracic paravertebral nerve block and transverse abdominal plane block for multiple costal margins in anal-gesia after open liver surgery

Objective To evaluate the analgesic application of thoracic paravertebral blockade (TPVB) and transverse abdom-inal plane block (TAPB) for multiple costal margins after open liver surgery. Methods A total of sixty patients [American Society Anesthesiologists (ASA) Ⅰ-Ⅲ ]who were scheduled for open liver surgery (with a classical reverse L-shaped incision) were enrolled. The patients were divided into two groups according to the random number table method (n=30): a TPAB group (group TP) and a group of TAPB for multiple costal margins (group TA). Both groups received ultrasound guided nerve block before surgery. Group TP under-went bilateral TPVB at T7-T8 and T8-T9, while group TA underwent TAPB under bilateral costal margins and the classical site between the costal margin and the anterior inferior iliac spine, with a total of four block points. Then, both groups were compared and recorded for the duration of block procedures; the mean arterial pressure (MAP) and heart rate before incision (T0), after incision (T1), and at the times of block of the superior vena cava (T2), liver removal (T3) and stitching (T4); surgical duration, the inflow of liquid during surgery, the consumption of remifentanil, and the length of post-anesthesia care unit (PACU) stay after surgery; the Visual Analogue Scale (VAS) scores at resting and during movement immediately after surgery (when patients were awaken after extubation and able to communicate normally), and 2 h and 6 h after surgery; and the number of patients requiring opioids within 6 h after surgery and the time when opioids were first given after surgery. Results Group TA presented shorter duration of block procedures than group TP (P 0.05). Conclusions During open liver surgery, compared with TAPB for multiple costal margins, TPVB can maintain more stable hemody-namics, require less doses of opioids and improve perioperative analgesia. Key words: Open liver surgery; Thoracic paravertebral nerve block; Transverse abdominal plane block; Postoperative analgesia

Minimally invasive treatment of calcaneal fractures of Sanders II&III with subtalar arthroscopy assisted by self-designed retractor and reducer

Objective To evaluate the minimally invasive treatment of calcaneal fractures of Sanders Ⅱ&Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires. Methods From June 2016 to February 2018, 53 patients (60 feet) were treated at Department of Hand and Foot Surgery, Central Hospital of Linyi for closed intra-articular calcaneal fractures. Of them, 24 (28 feet) received the minimally invasive treatment and 29 (32 feet) open surgery via the conventional lateral L-shaped incision. The 2 groups were compared in terms of Bohler angle, Gissane angle, and the width, length and height of the calcaneus before operation, one week after operation and at the final follow-up, as well as in terms of preoperative preparation time, operation time, surgical bleeding volume, incision complications, subtalar joint stiffness, and ankle- hindfoot score of the American Foot and Ankle Surgery Association (AOFAS). Results The 2 groups were comparable because there were no significant differences between them in the preoperative general data (P>0.05). All the patients were followed up for 10 to 22 months (average, 16 months). The Bohler angles, Gissane angles, and the widths, lengths and heights of the calcaneus after operation and at the final follow- up were significantly better than the preoperative values in the minimally invasive group (all P 0.05). Conclusion The minimally invasive treatment of calcaneal fractures of Sanders Ⅱ&Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires can lead to satisfactory clinical results, because this method shortens significantly the time for hospitalization and leads to less invasion, fewer complications, accurate reposition and reliable fixation. Key words: Arthroscopy; Calcaneus; Fractures, bone; Fracture fixation, internal

Effect of Sanders type II to III calcaneal fracture treated by internal fixation of steel plate through Chinese character "八" shaped incision of tarsal sinus approach

Objective To investigate the clinical effect of Sanders type Ⅱ or Ⅲ calcaneal fracture treated by internal fixation of steel plate through Chinese character 八 shaped incision of tarsal sinus approach. Methods The clinical data of 82 patients with Sanders Ⅱ or Ⅲ type calcaneal fractures who were treated by internal fixation was retrospectively analyzed. All patients retained complete clinical operation data and follow-up data at least 12 months after operation. According to different surgical approaches, the patients were divided into minimally invasive group(n=37)and conventional group(n=45). The minimally invasive group received internal fixation of steel plate through Chinese character 八 shaped incision of tarsal sinus approach, and the conventional group received classical open reduction with lateral L-shaped incision approach and plate internal fixation. The operation related indicators, complications and ankle function recovery at 12 months after operation were compared. Results There were no significant differences in operation time and hospitalization time between the two groups(P>0.05). the amount of bleeding in the minimally invasive group was(37.82±10.04)mL, which was less than(62.29±13.20)mL in the conventional group, and the rate of incision-related complications was 10.81%, which was lower than 31.11% in the conventional group, the differences were statistically significant(P 0.05). Conclusion Compared with traditional open reduction with lateral L-shaped incision approach and internal fixation, internal fixation of steel plate through Chinese character 八 shaped incision of tarsal sinus approach can reduce the amount of bleeding and incidence of incision-related complications for Sanders Ⅱ or Ⅲ type calcaneus fracture. The two methods have better efficacy in fracture healing and foot function recovery.

Alternative Management of the Capsule in the Bristow-Latarjet Procedure

The Bristow-Latarjet procedure is considered the current gold standard for the management of anterior glenohumeral joint instability in which significant glenoid bone loss is present, and numerous techniques have been proposed for capsular management after the bony augmentation component of the procedure. These techniques for capsular management include excision of the capsule and labrum, 2-flap elevation, T-capsulotomy, or an L-shaped incision into the capsule. Capsular management during open shoulder procedures may vary among surgeons and may or may not include capsulolabral repair after the Bristow-Latarjet procedure. The purpose of this Technical Note was to illustrate an alternative approach to capsular management, focusing on the elevation of the capsulolabral complex as a sleeve along with augmentation using the coracoacromial ligament during the Bristow-Latarjet procedure in patients with anterior glenohumeral instability. The proposed technique provides the benefit of improvement in visualization to more reliably identify the ideal location for bone block placement and allows for the surgeon to perform a large inferior-to-superior capsular shift to prevent inferior subluxation or instability.

Effect of three-layer close suture and Allgöwer-Donati suture on incision healing after calcaneal fracture surgery

Objective To compare the efficacy between three-layer suture and Allgower-Donati suture on wound healing. Methods From September 2016 to June 2018, patients with Sanders type III calcaneal fracture were randomly divided into two groups: three-layer close suture group (26 cases, 18 males and 8 females, aged 19-48 years, with an average age of 33.69±8.84 years) and Allgower-Donati group (26 cases, 19 males and 7 females, aged 19-49 years, with an average age of 32.38±8.45 years). The traditional L-shaped incision was used in all patients. The inflammatory reaction area of incision, skin temperature change at the corner of L-shaped incision line and the healing grade of incision were compared between the two groups. Results 52 pa-tients were followed up for 6 months. At 2 weeks after operation, the inflammatory reaction area of incision skin in the three-layer close skin suture group (26.46±9.37 mm2) was smaller than that in Allgower-Donati suture group (33.16±9.33 mm2). There was a significant difference between the two groups (t=2.584, P=0.013). There was no difference in skin temperature at the corner of L-shaped incision between the two groups before and on the first day after operation. However, the incision skin temperature of the three-layer close suture group on the 2nd and 3rd day after operation[ (36.47±0.33) ℃ and (36.54±0.22) ℃]was higher than that of Allgower-Donati group[ (36.20±0.42) ℃ and (36.22±0.43) ℃]. The difference was statistically significant (t=2.61, P=0.01; t= 3.48, P=0.001). There were 25 cases of Class A healing and 1 case of Class B healing in three-layer close suture group, with Class A healing rate of 96.15% (25/26). In Allgower-Donati group, there were 22 cases of Class A healing, 1 case of Class B healing, and 3 cases of Class C healing, with Class A healing rate of 84.62% (22/26). Among all grade B healing incisions, 1 case had a small amount of local hemorrhagic exudation in the three-layer close suture group, while 1 case had a black necrosis at the edge of the in-cision, 3 cases had a purulent incision and exposed steel plate in the Allgower-Donati group. Conclusion In the treatment of L-shaped incision of calcaneal fracture, three-layer close suture is a better method than Allgower-Donati suture because of smaller in-flammatory reaction area of incision, higher skin temperature change at the corner of L-shaped incision on the 2nd and 3rd day af-ter operation, higher rate of first-degree healing of incision and slighter incision complications. Key words: Calcaneus; Fractures, bone; Wound closure techniques; Wound healing

A Comparison of Wound Complications With Surgical Treatment of Achilles Tendon Conditions Using 2 Surgical Approaches.

Background:Wound complications are a concern with the open treatment of Achilles tendon conditions. The location of the incision may impact the risk of wound complications because of its relationship to the blood supply to the skin. There is no consensus as to the safest incision location. The purpose of this study was to evaluate and compare the rates of sural nerve injury and wound complications including superficial or deep infections and wound dehiscence between posterior midline and posteromedial surgical incision locations.Methods:125 patients with Achilles tendon rupture or Achilles tendinopathy were treated with open surgery through a longitudinal posterior midline or posteromedial incision. An L-shaped incision was used in the posteromedial group for cases of insertional repair. Postoperative complications including sural nerve injuries, superficial wound complications, superficial infections, deep wound infections, return to the operating room, and need for soft tissue coverage were recorded and rates were compared between the groups.Results:No significant differences were detected between the posteromedial and posterior incision groups in rates of sural nerve injuries, superficial infection, or deep wound infection. The posterior incision group had significantly fewer wound complications. The wound complications in the posteromedial group primarily occurred when an L-shaped incision was used for insertional repair. No patients in either group required debridement or soft tissue/flap coverage.Conclusion:The posterior incision location had significantly fewer wound complications. The use of an L-shaped incision was likely responsible for the wound complications in this group rather than the location of the incision. The use of a medial incision was not found to decrease the rate of sural nerve injury.Level of Evidence:Level III.

Application of functional neck dissection with preservation of cervical plexus in differentiated thyroid carcinoma

Objective Investigate application of functional neck dissection with preservation of cervical plexus in differentiated thyroid cancer. Methods In the current hospital, 39 cases of patients with differentiated thyroid cancer and lymph nodes metastases were treated with selective neck dissection through a low-collar incision while preserving cervical plexus. The distribution of the lymph nodes, complications, recurrence rate, and clinical effect are studied. Results In the 39 cases, the cervical lymph node metastases were mainly distributed at Level Ⅳ (76.9%), Level Ⅲ (64.1%), Level Ⅱa (38.4%), Ⅱb(2.6%) and Ⅴb (12.8%). Three cases of complications were found after surgeries: one case of neck swelling, one case of bleeding, and one case of chyle leakage. No impairment in the sensation of ears, lower neck, shoulders, and the subclavian skin was found. No local relapse was found during the 5-60 months’ follow-ups. Compared with L-shape incision, the Low-collar incision is cosmetically desirable. Conclusion Neck dissection through a low-collar incision with preservation of cervical plexus results in a small incision and preserves cervical plexus while not increasing the recurrence rate. Key words: Differentiated thyroid cancer; Neck dissection; Low-collar incision; Cervical plexus

Anterior transhepatic approach for caudate lobectomy

: A solitary liver tumor was found in a 64-year-old female. Magnetic resonance imaging (MRI) showed the tumor was located in the caudate lobe of the liver (6 cm diameter); almost all caudate lobe was occupied by the tumor. Anterior transhepatic approach was used for isolated complete resection of the caudate lobe through a reversed L-shaped incision, without sacrificing other part of the liver. The postoperative course of the patient was uneventful. The final pathological result showed a cholangiocarcinoma with a part of inferior vena cava (IVC) wall involved.

Case-control study on self-setting calcium phosphate cement and allograft for Sanders II-IV fractures of calcaneus

To compare clinical results of Sanders II-IV fractures of calcaneus treated by self-setting calcium phosphate cement and allograft with locking reconstruction bone plate internal fixation. From March 2012 to December 2015, 48 patients with Sanders II-IV fractures of calcaneus were treated by open reduction and internal fixation through L-shape incision, bone grafting were performed on reserved bone defect of calcaneal fracture. The patients were divided into self-setting calcium phosphate cement and allograft group according to different materials. Twenty-eight patients in self-setting calcium phosphate cement group, including 23 males and 5 females aged from 22 to 52 years old with an average of (34.46±7.33) years old; 8 cases were type II, 11 cases were type III and 7 cases were type IV according to Sanders classification. Twenty patients in allograft group, including 17 males and 3 females aged from 24 to 55 years old with an average of(36.40±7.93) years old; 6 cases were type II, 7 cases were type III and 9 cases were type IV according to Sanders classification. Postoperative wound complications, Böhler angle before and after operation and 12 months, Maryland functional score were evaluated. All patients obtained bone union, and were followed up from 12 to 42 months with an average of 25 months. There were no statistical significance in Böhler angle and Manyland score before and after operation and 12 months between two groups. Five patients occurred wound complications in allograft group and 2 cases occurred wound complications in self-setting calcium phosphate cement and allograft group. Both of open reduction bone grafting and reconstructive plate internal fixation have good effective results for calcaneal fracture. Compared with allograft, self-setting calcium phosphate cement, which has no rejection response and less complications, has equal effects for calcaneal fracture and deserves to be popularized.

A Posterior Approach to Open Reduction and Internal Fixation of Displaced Posterior Cruciate Ligament Tibial Osseous Avulsions.

The true prevalence of displaced tibial-sided avulsion injuries of the posterior cruciate ligament (PCL; Video 1) is unknown, and the majority of data regarding management has been published in areas other than the Western world, such as China and India (perhaps due to the higher prevalence of two-wheeler motorcycle accidents in these areas). Despite the rarity of data, a better understanding of the approach, fixation techniques, and outcomes is necessary to provide quality patient care. These injuries generally require surgical intervention as nonoperative management leads to complications-specifically, knee arthrofibrosis1,2. There is no consensus regarding the optimal surgical approach for these injuries. A recent systematic review demonstrated that both open and arthroscopic surgical treatment provide satisfactory complication rates and outcomes in the majority of cases3. However, the arthroscopic approach can be performed by only a highly skilled arthroscopist; thus, in this article we focus on the open approach to reach a broader audience of capable surgeons. The principal steps for open reduction and internal fixation of the tibial avulsion fracture include the following:Place the patient in a prone position and utilize a curvilinear L-shaped incision with the longitudinal portion over the medial head of the gastrocnemius muscle and the transverse portion starting distal to the joint line and extending laterally past the midline.Develop the interval between the semimembranosus and medial gastrocnemius muscles, as originally described by Burks and Schaffer4. Lateral retraction of the gastrocnemius muscle exposes the posterior aspect of the capsule, allowing for a vertical capsular incision to adequately visualize the avulsed osseous fragment.Prepare the osseous bed and remove hematoma and/or debris.Reduce the avulsed fragment and obtain provisional fixation with Kirschner wires.Confirm reduction under fluoroscopy with emphasis on sagittal plane alignment.Obtain definitive fixation with the method dictated by the fracture orientation. Options include screw(s) with or without a washer, sutures, Kirschner wires, staples, and toothed plates2,5-7. An arthroscopic approach can be performed, with results that are similar to those of an open procedure, but considerable expertise is required to perform this procedure arthroscopically. Nonsurgical management is not recommended as it frequently leads to loss of knee motion. The exact operative indications for PCL injuries remain in question, but we believe that displaced tibial avulsion injuries at the PCL attachment always require operative treatment.

Percutaneous reduction and Kirschner pin flxation through sinus tarsi approach for the treatment of Sanders type III calcaneal fracture

To investigate clinical effect of percutaneous reduction and Kirschner pin flxation through sinus tarsi approach in treating Sanders type III calcaneal fracture. Totally 22 patients (22 feet) with Sanders III calcaneal fracture were treated with percutaneous reduction and Kirschner pin flxation through sinus tarsi approach form September 2013 to December 2015. Among them, including 18 males and 4 females; aged from 20 to 65 years old with an average of (41.73±12.46) years old. Böhler angle, Gissane angle and calcaneal width before and after operation were observed and compared, Maryland scoring system was used to evaluate curative effect; postoperative complications were recorded. All patients were followed up from 18 to 36 months with an average of (27.05±4.92) months. All fractures healed well with an average of (10.73±1.24) weeks. Böhler angle before operation (11.36±5.92) improved to (33.36±3.99) after operation, and had significant differences(P<0.05); there was significant difference of Gissane angle between preoperation (99.23±8.61) and postoperation (114.64±6.93); calcaneal width was improved from (46.59±1.40) mm before operation to (42.15±0.75) mm at 3 months after operation (P<0.05). Maryland score was (95.05±6.86) points, 16 patients obtained excellent results, 5 patients moderate, and 1 patient poor. No inflammation, flap margin necrosis and osteomyelitis occurred. Compared with conventional internal fixation through L-shape incision, percutaneous reduction and Kirschner pin flxation through sinus tarsi approach in treating Sanders type III calcaneal fracture obtained satisfied clinical effects, and has advantages of invasive trauma, simple operation, easy to remove and less complication. Meanwhile, careful operation and identification should be done during sinus tarsi approach operation to protect sural nerve and tendon.

Clinical application of modified inverted L-shape incision by extraperitoneal approach to lumbosacral tuberculosis

To explore the clinical effects of one-stage posterior transpedicular screw system internal fixation combined with anterior debridement and bone grafting with modified inverted L-shape incision by extraperitoneal approach in treating multiple lumbosacral tuberculosis. The clinical data of 15 patients with multiple lumbosacral tuberculosis underwent operation from February 2008 to December 2014 were retrospectively analyzed. There were 9 males and 6 females with an average of (47.0±13.9) years old. The lesions involved L₄-S₁ in 12 cases, L₄-S₂ in 1 case, L₃-S₁ in 2 cases. Five cases complicated with nerve root symptoms and 2 cases with cauda equina symptoms. All patients were treated with posterior transpedicular screw system internal fixation combined with anterior L₄,₅, L₅S₁ debridement and bone grafting with modified inverted L-shape incision by extraperitoneal approach. Operation time, blood loss, incision length, first passage of gas by anus were recorded. The condition of bone fusion and focus absorption were observed by lumbar CT and MRI; and ESR and CRP were regularly rechecked. Fifteen patients were followed up for 18-24 months with an average of (20.0±2.73) months. All lumbosacral pain obtained improvement, and no hardware loosening, breaking, or bone graft block loosening was found. The operative time of anterior-posterior approach surgery was 210-250 min with an average of (231.0±12.1) min; the blood loss was 320-705 ml with an average of(495.0±130.3) ml; the incision length was 15-21 cm with an average of (16.4±3.4) cm, and the extended length of inverted L-shape incision was 6 to 9 cm with an average of (7.1±2.6) cm. The time of first passage of gas by anus was 14 to 40 h with an average of (24.1±7.4) h after operation. All bone graft obtained fusion at final follow-up, and spinal cord symptoms got recovery, ESR and CRP restored normal level with no recurred at 3 months after drug withdrawal. The treatment of multiple lumbosacral tuberculosis with posterior transpedicular screw system internal fixation combined with anterior debridement and bone fusion with modified inverted L-shape incision by extraperitoneal approach is feasible and practical. This method has advantages of little trauma, good exposure, less complications and high security.

The Clinical Comparison of Extensile Lateral Approach and Sinus Tarsi Approach Combined with Medial Distraction Technique for Intra-Articular Calcaneal Fractures

Category: Hindfoot Introduction/Purpose: To study and compare the clinical outcomes of open reduction and internal fixation via extensile L-shape incision and limited open reduction via sinus tarsi approach using medial distraction technique for intra-articular calcaneal fractures. Methods: We performed a retrospective review of 65 intra-articular calcaneal fractures treated operatively between March 2012 and February 2015, including 32 cases of Sanders type? and 33 of Sanders type?. There were 49 men and 16 women. The mean age was 43.7 years old. They were divided into two groups: sinus tarsi approach group and extensile lateral approach group. No significant difference was found in gender, age, injury pattern, fracture classification between two groups (P&gt;0.05). The Böhler angle, Gissane angle and calcaneal varus angle were measured before surgery, 1 week after surgery and at each follow-up visit respectively. The postoperative function was evaluated by the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS). Results: All of the fractures were healed at about 10 weeks postoperatively. Böhler angle, Gissane angle and calcaneal varus angle were restored obviously, while there was no significant statistically difference between the two groups. Only the corrected value of calcaneal varus angle is statistically significant.At the last follow-up, the average AOFAS ankle and hind-foot score of minimal group was 88.4±6.6, and the VAS score was 1.9±0.7, while of extensile lateral approach group was 83.2±5.6 and 2.3±1.0 respectively. Conclusion: Limited open reduction via sinus tarsi approach for intra-articular calcaneal fractures could reduce the incidence of wound complications effectively, and the medial distraction technique is helpful to correct the calcaneus varus deformity.

Risk factors analysis on wound complications after closed calcaneal frature operation using lateral extensive L-shaped incision

To investigate the risk factors of wound complications after closed calcaneal fracture operation using a lateral extensive L-shaped incision and to explore the effective interventions to reduce the complications after incision. Retrospective analysis of clinical data of 285 patients(315 calcaneal fractures) who underwent open reduction and internal fixation by using the lateral extensive L-shaped incision from January 2011 to January 2015. Eighteen factors which might cause the complications of calcaneal incision were compared by univariate analysis, and multiple Logistic regression analysis was performed for factors with statistically significances. Twenty-nine patients(30 calcaneus) had wound complications among all the 285 patients(315 calcaneus) after surgery, including 9 patients with incision redness, swelling, oozing or nonunion;16 patients with skin necrosis or incision rupture, 3 patients with soft tissue superficial infection, and 2 patients with osteomyelitis. Univariate analysis showed that fall height(P=0.017), diabetes (P=0.026), smoking(P=0.001), and operative time(P=0.003) were correlated with incision complications after surgery. Multivariate analysis showed that diabetes(P=0.029), smoking(P<0.001), and operative time(P=0.018) were risk factors for incision complications after operation. Preoperative smoking cessation, actively control of blood glucose and shortening the operation time by practicing can effectively reduce the incision complication after fracture surgery with the lateral extensive L-shaped incision.

Posterior medial approach inverted L-shaped incision combined with reconstruction plate for posterior condylar fracture of tibial plateau

To study the clinical therapeutic effects of posterior medial approach inverted L-shaped incision combined with reconstruction plate fixation in treating posterior tibial plateau condylar fracture. From February 2011 to February 2015, 19 patients that were clearly diagnosed with combined posterior tibial plateau condylar fracture were treated with internal fixation of reconstruction plate through the posterior medial approach L-shaped incision under direct vision, involved 14 males and 5 females with an average age of 45.5 years ranging from 28 to 71 years. The intervals between injury and operation ranged from 6 to 15 days with a mean of 9.2 days. According to Schatzker Classification, there were 6 cases in type II, 2 in type IV, 7 in type V, 4 in type VI In accordance with the three-column theory proposed by Luo Congfeng, 2 cases were medial column combined with posterior column fracture, 6 were lateral column combined with posterior column fracture, and 11 were three-column fracture. The major clinical symptoms before treatment were swelling and deformity of the knee, as well as limitation of motion. X-ray and CT examination were completed. The American Hospital for Special Surgery score(HSS) was used to evaluate clinical effect. One case developed skin infection in the posteromedial incision postoperatively, but other complications, such as neurovascular injury, deep venous thrombosis of lower limb, cracking and failure of internal fixation, and fracture re-displacement were not seen. The patients were followed up for an average of 12.5 months (10 to 24 months). The fracture healing time ranged from 5 to 11 months with a mean of 8.2 months. According to HSS, the total score was 82.1±7.3, 9 patients got an excellent result, 7 good, 2 poor and 1 bad. Regular postoperative re-check X-ray indicated that all fracture showed stage I healing. The difference was not significant on varus angle, post-dip angle and femorotibial angle between 3 days and 1 year after operaiton. Treating the posterior tibial plateau condylar fracture through the posterior medial approach L-shaped incision of the knee rendered sufficient exposure, little injury, as well as convenient and effective installation of internal fixation. Reconstruction plate possessed the advantages of good plasticity, strong supportability, small implant volume, together with low cost;and the structural and functional recovery of the knee could achieve satisfying clinical therapeutic effects as combined with appropriate postoperative rehabilitation training.