Plaster Fixation Research Articles

Management of mal-united Pilon fractures with joint-sparing osteotomy

Category: Ankle Introduction/Purpose: To explore the effectiveness and operative methods to treat various mal-united Pilon fractures with joint-sparing osteotomy. Methods: Between January 2011 and October 2016, 21 patients with mal-united Pilon fractures were treated with joint-sparing osteotomy. There were 13 males and 8 females with an average age of 38.4 years (range, 22-48 years). 14 were left feet and 7, right. The time from injury to reconstructive operation was 4 months to 10 years. 17 received operative treatment previously, and 4 were treated by plaster fixation. According to Rüedi-Allgöwer classification, 16 were rated as type II (including 6 medial Pilon fractures, 5 anterior, 5 posterior) and 5, type III. All patients received standardized postoperative managements. Results: All patients were followed up for more than 1 year. All the fractures were reunited in an average time of 13.8 weeks (range 9 to 18 weeks). The mean visual analogue scale (VAS) score was 2.42 (range 0 to 5) and the mean ankle and hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) score was 78.81(range 65 to 92) 6 months after operation. The VAS score was 5.27 (range 2 to 7) and the AOFAS score was 57.26 (range 20 to 81) before. Comparing to preoperative data, statistically significant difference was found postoperatively (P<0.05). Conclusion: Results by joint-sparing osteotomy to realign and reconstruct articular surfaces of ankles are acceptable. Functions and symptoms are improved significantly after operation. Joint-sparing osteotomy can be a considerable option for treating mal-united Pilon fractures.

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

Risk factors of cubitus varus in humeral condylar fracture after conservative treatment in child

To further investigate the risk factors of cubitus varus in humeral condylar fracture after conservative treatment in children through Logistic regression analysis, so as to guide the clinical treatment. Children with humeral condylar fracture who were treated by manipulative reduction and plaster fixation in our hospital from March 2008 to December 2014 were studied. The clinical data including age, gender, BMI, time from injury to reduction, direction of displacement, rotation displacement, fixed position, and epiphyseal injury were collected. First, preliminary screen the risk factors through univariate analysis of the above data, then determine the risk factors of cubitus varus through multivariate Logistic regression analysis of the significant factors from univariate analysis. Univariate analysis showed that time from injury to reduction, direction of displacement, rotation displacement and epiphyseal injury were significantly correlated with the cubitus varus. Multivariate Logistic regression analysis showed that time from injury to reduction which was longer than 8 h [P=0.017, OR=3.303(1.243-8.774)], ulnar displacement [P=0.001, OR=11.951(2.895-49.335)], rotation displacement [P=0.003, OR=4.190(1.643-10.685)]and epiphyseal injury [P=0.000, OR=7.092(2.557-19.671)] were independent risk factors of cubitus varus. Time from injury to reduction, ulnar displacement, rotation displacement and epiphyseal injury are independent risk factors of cubitus varus. So it need corresponding treatment according to different risk factors.

Vascularized distal radius graft of 1, 2 intercompartmental supraretinacular artery for scaphoid nonunion

Objective To study the techniques and outcomes of using a retrograde pedicled vascularized radius bone flap based on the 1st, 2nd intercompartmental supraretinacular artery (1, 2ICSRA) for scaphoid nonunion through dorsal and palmar approaches. Methods Between March 2013 and April 2015, 16 patients with scaphoid nonunion were treated by surgery through palmar and dorsal approaches. There were 14 males and 2 females with an average age of 29.1 years (range, 19-51 years). The location of lesion was 6 cases on the left and 10 cases on the right. 5 cases were treated with plaster fixation. 11 cases weren’t treated after wrists injured. The preoperative time was 6-26 months, with an average of 16.5 months. The operation was completed within one incision. The bone flaps based on 1, 2ICSRA were taken through dorsal approach. The broken ends of the scaphoid fracture were cleaned, and the deformity was corrected with bone grafting and internal fixation through palmar approach. Time of fracture union and wrist pain resolution was evaluated. Wrist motion and grip strength were measured and compared. The result of the latest follow-up was used as the criterion for efficacy evaluation. The wrist pain was evaluated using visual analogue scale (VAS) and the postoperative wrist function based on the modified Mayo wrist score was recorded. Results Post-operative follow up ranged from 6-19 months, with an average of 11 months. Bone union was achieved in all the cases, so the healing rate was 100%. 7 cases were healed in 11 weeks. 5 cases were healed in 13 weeks. 3 cases were healed in 15 weeks. 1 case was healed in 17 weeks. The average healing time was 12.5 weeks. The humpback deformity of Scaphoid and DISI of 7 cases were corrected. The bending of wrist could reach 60.2°±3.2°, and the elongation could reach 51.3°± 3.5°. The radial deviation of wrist could reach 13.6°±1.42°, and ulnar deviation could reach 24.4°±1.8°. The range of grip strength was 29-64 kg, with an average of 45 kg. The 16 patients returned to normal work. The pain after wrist movement of 14 cases was completely disappeared, and the VAS was 0. Two cases felt slight pain when wrist was overworked, and the VAS were 0.9 and 1.2. The wrist joint function of patients recovered well. The modified Mayo score was 69-99, with an average of 90.75. The functional results were 12 excellent, 2 good, and 2 fair, and the excellent and good rate was 87.5% (14/16) . No complications such as infection, failure of screws, orthopaedic arthritis or scaphoid necrosis were found during the follow-up period. Conclusion The technique of 1, 2 ICSRA pedicled bone graft and palmar bone grafting for nonunion of scaphoid can provide convenience for us to deal with the broken ends of the scaphoid fracture, correct the malformation and graft bone through dorsal and palmar approaches. This method can protect the blood supply of the scaphoid, and promote scaphoid union. Key words: Scaphoid bone; Fractures, ununited; Bone transplantation

Application of nosting barrier film in the skin nursing of laryngeal carcinoma patients with trachea cannula after surgery

Objective To explore the application effect of nosting barrier film in the skin nursing of laryngeal carcinoma patients with trachea cannula after surgery. Methods Totally 90 cases of laryngeal cancer patients after radiotherapy with tracheal cannula, were randomly divided into three groups, with 28 cases in the control group, 33 cases in the dressing group, and 29 cases in the skin protective film group. Patients in the control group were treated with basic nursing method including using saline to clean plastic casing, cleaning and disinfecting skin, using sterile gauze to cover the field of radiation skin and plaster fixation; dressing group adopted Comfeel hydrocolloid dressings on the basis of basic nursing method; skin protective film group adopted Genetime spray skin protective film to protect skin of radiation field on the basis of basic nursing. After radiotherapy, the incidence of skin injury, severity of skin injury, patient comfort, and the time and times of changing skin dressing everyday were observed and compared among three groups. Results The incidence of radiation skin injury in the skin protective film group (6.89%) and dressing group (15.15%) , were all lower than the control group (50%) (χ2=16.75, P<0.05) ; the times of changing skin dressing everyday in the skin protective film group (4.28±0.53) times/d and the dressing group (4.52±0.76) times/d, were lower than the control group (6.04±1.35) times/d (Hc=32.65, P<0.05) ; patient comfort in the skin protective film group and the dressing group was superior to the control group (Hc=22.42, P<0.05) ; the time of changing skin dressing in the skin protective film group (10.40±1.35) min, was less than the dressing group (14.09±1.27) and the control group (12.35±1.28) min (F=85.87, P<0.05) . Conclusions The skin protective film can effectively reduce the incidence of skin injury in patients with laryngeal cancer and radiotherapy, improve patient comfort, reduce the labor time of nurses, and improve the quality of care and efficiency. Key words: Laryngeal neoplasms; Skin care; Radiotherapy; Tracheal cannula

Implementation and evaluation of objective structured clinical examination for Postgraduate Year 1 surgery residents

Objective To investigate the effectiveness and rationality of objective structured clinical examination (OSCE) used as achievement assessment for Postgraduate Year 1 surgery residents. Then the form and content of training and examination can be improved according to test results. Methods 31 Postgraduate Year 1 surgery residents were involved in the examination. The examination was composed of 5 stations, which were case analysis, wound dressing change, plaster fixation, laparoscopic simulator basic skills and irregular wound debridement suture. Each station was evaluated by centesimal system score and limited in 15 minutes. A questionnaire on their opinion and perception of the examination was given to each resident at the end of examination. A total number of 31 questionnaires were issued and recycled. The difficulty, discrimination and reliability of each station were calculated, and the correlation between each station was analyzed. Results The average OSCE score was (74.66±4.39). The difficulty of total stations was 0.747. The distinction was 0.578 and the reliability was 0.402. The second station was lowest difficulty, and the fifth station was most difficult. Every station's discrimination was larger than 0.400. The reliability of the second and the fourth station was low. There was moderate correlation between the first station and the second station, as well as the first station and the fourth station. But there was no significant correlation between other stations. Residents' questionnaire survey showed that the fourth and the fifth stations were considered as the most difficult, and the second station was the simplest. They thought the fourth was most helpful for clinic. They performed best at the second station and worst at the fifth station. Conclusions OSCE can effectively evaluate the efficacy of the resident training. The residents' practical competency skills can be assessed better by examination simulating complex clinical scenario. Besides, after examination, we need to objectively evaluate the assessment efficiency, and dynamically adjust the training content and examination form according to residents’ subjective opinions. Key words: Objective structured clinical examination (OSCE); The standardized training of residents; Surgery residents; Reliability; Evaluation

Evaluation of minimally invasive laser ablation in children with osteoid osteoma.

The effects between minimally invasive percutaneous laser ablation and open surgery in the treatment of children with osteoid osteoma were compared in the present study. A total of 72 cases of children with osteoid osteoma were divided into control and observational groups, containing 36 cases in each group. The control group underwent conventional open surgery while the observational group underwent minimally invasive CT guided percutaneous laser ablation. Effects of both operations were compared. The operation duration, blood loss and plaster fixation duration of the observational group were significantly less than those of the control group. The postoperative pain score (VAS) at 1 day and 7 days were significantly lower than that of the control group, the differences were statistically significant (P<0.05). The lesion resection rate, effective rate of bone hyperplasia, effective rate of swelling and effusion and total effective rate of the observational group were significantly higher than those of the control group, the differences were statistically significant (P<0.05). Incidence of adverse reactions of observational group was significantly lower (P<0.05) than that of the control group. However, the difference was not significant when comparing 1-year recurrence rate for the two groups. The minimally invasive percutaneous laser ablation has better surgery effects compared with open surgery in the treatment of children with osteoid osteoma.

Comparison of effects of seven treatment methods for distal radius fracture on minimizing complex regional pain syndrome.

IntroductionUsing network meta-analysis, we evaluated the adverse effects of the seven most common treatment methods, i.e., bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating, by their associated risk of developing complex regional pain syndrome (CRPS) in distal radius fracture (DRF) patients.Material and methodsFollowing an exhaustive search of scientific literature databases for high quality studies, randomized controlled trials (RCTs) related to our study topic were screened and selected based on stringent predefined inclusion and exclusion criteria. Data extracted from the selected studies were used for statistical analyses using Stata 12.0 software.ResultsA total of 17 RCTs, including 1658 DRF patients, were enrolled in this network meta-analysis. Among the 1658 DRF patients, 452 received bridging external fixation, 525 received non-bridging external fixation, 154 received K-wire fixation, 84 received plaster fixation, 132 received dorsal plating, 123 received volar plating, and 188 received dorsal and volar plating. When compared to bridging external fixation patients, there was no marked difference in the CRPS risk in DRF patients receiving different treatments (all p > 0.05). However, the surface under the cumulative ranking curves (SUCRA) for plaster fixation (77.0%) and non-bridging external fixation (71.3%) were significantly higher compared with the other five methods.ConclusionsOur findings suggest that compared with bridging external fixation, K-wire fixation, dorsal plating, volar plating, dorsal and volar plating, plaster fixation and non-bridging external fixation might be the better treatment methods to reduce the risk of CRPS in DRF patients.

Timing of internal fixation and effect on Schatzker IV-VI tibial plateau fractures

ObjectiveTo study the effect of internal fixation performed at different times on therapeutic outcomes of Schatzker IV-VI tibial plateau fractures. MethodsThe clinical data of 42 cases of Schatzker IV-VI tibial plateau fractures treated in our department were analyzed retrospectively. Among these 42 patients, 21 received surgical treatment within 12h after injury (Group I), the other 21 were first treated by traction or plaster fixation followed by a delayed internal fixation after soft tissue swelling subsided (Group II). The surgical time, complications, length of hospital stay, cost of hospitalization, and time for fracture union, as well as functional recovery were analyzed and compared between the two groups. ResultsAfter 10-28 months follow-up (mean 16.5 months), except 5 cases who lost to follow-up, no differences were found between the two groups regarding surgical time, preoperative and postoperative complications, healing time or the Hospital for Special Surgery (HSS) score at the end of follow-up, but significant differences were found in the length of hospital stay, cost of hospitalization and HSS score at 3 months after operation (P<0.05). ConclusionUnder certain conditions, early internal fixation for Schatzker IV-VI tibial plateau fracture is feasible, which can shorten the length of hospital stay, decrease the cost of hospitalization and promote early functional rehabilitation.

The comparative risk of developing postoperative complications in patients with distal radius fractures following different treatment modalities.

In this study, we performed a network meta-analysis to compare the outcomes of seven most common surgical procedures to fix DRF, including bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. Published studies were retrieved through PubMed, Embase and Cochrane Library databases. The database search terms used were the following keywords and MeSH terms: DRF, bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. The network meta-analysis was performed to rank the probabilities of postoperative complication risks for the seven surgical modalities in DRF patients. This network meta-analysis included data obtained from a total of 19 RCTs. Our results revealed that compared to DRF patients treated with bridging external fixation, marked differences in pin-track infection (PTI) rate were found in patients treated with plaster fixation, volar plating, and dorsal and volar plating. Cluster analysis showed that plaster fixation is associated with the lowest probability of postoperative complication in DRF patients. Plaster fixation is associated with the lowest risk for postoperative complications in DRF patients, when compared to six other common DRF surgical methods examined.

A retrospective analysis of 374 casualties from the Nepal earthquake

Objective To analyze the feature of victims transported from Nepal Pokhara' s earthquake, and summarized the rescuing experiences got by the Chinese government medical team. Methods A total of 374 casualties from the 2015 Nepal ' s earthquake magnitude 8.1 transported to the Field Hospital of the Chinese government medical team were classified into four groups according to different causes of injury, and then retrospectively analyzed the types of injury, vital signs, severity of injury and causes of injury. Results Of 374 casualties, the average age was (30.1 ±12.4) years, and were divided into group A (n =154) in which casualties trapped under ruined buildings, group B (n =123) in which the victims had crushed injury during escaping with their lives, group C (n =58) in which the wounded had injury resulted from fall on the ground during fleeing for their lives and group D (n =39) in which the injury of casualties was caused by fall from high level. Of them, 273 patients (296 parts of body injured) suffered from fracture including 34 patients with severe multiple trauma. The average age in the group D (22.3 ±7.4 years old) was significant younger compared with the others (all P <0.05). The average age in the group C (48.4 ±13.3 years old) was significant older compared to the others (all P <0.05). The injury probability was higher for male in the group D (14.2% vs. 7.1%, χ2 =5.077, P =0.024) and the injury probability was higher for female in the group C (19.7% vs 10.8%, χ2 =5.635, P =0.018). The incidence of limbs fracture was highest (66.6%) in all 296 parts of body injured. The incidence of skull fracture in the group B (31.6%) was higher compared to the others (all P <0.05), and the incidence of spinal fracture in the group D (40.0%) was higher compared to the others (all P <0.05). There was no significant difference in the severe multiple trauma incidence between the group A and the group D (16.9% vs. 12.8%, χ2=0.381, P =0.537), but both group A and group D had significant higher incidence of severe multiple trauma compared to the rest two groups (all P <0.05). The wound debridement was the leading rate of treatment among variety of treatments (57.5%) and the plaster fixation was the second high rate of treatment (30.9%), and the wound infection was found in 25 patients (17.4%) at the first dressing among 144 patients with soft tissue laceration. After active and regular debridement, 72% patients' wound smear tests were negative 3 days later, and 100% were negative 7 days later. Conclusions The casualties treated by Chinese government medical team had relatively young average age, not very severe critical illness, and quite high rate of wound infection. The treatment of all kinds of fractures and open wound was a matter of critical importance. Although facing the challenge of incomplete set of medical equipment, the lacking of medicine and many other unexpected problems, the Chinese government medical team successfully fulfilled the mission with the prior experience accumulated from several domestic earthquake disaster rescue actions. Key words: Earthquake; Trauma; Mountain; Injury reason; Injury mechanism; Rescue; Nepal; Case-analysis

Intra-articular injection of hyaluronic acid for the reduction in joint adhesion formation in a rabbit model of knee injury

PurposeOur purpose was to evaluate the effectiveness of intra-articular injections of hyaluronic acid (HA) into immobilized joints for reducing rigidity and formation of joint adhesions following surgery and prolonged joint immobilization.MethodsTwenty-four New Zealand white rabbits were randomly divided into experimental (n = 12) and control groups (n = 12). A model of knee injury was created in the right hind leg, and external plaster fixation was performed for 8 weeks. The experimental and control groups received weekly intra-articular injections of 0.3 mL HA solution or normal saline, respectively, in the knee joint. The degree of adhesions, range of motion (ROM), and collagen content of the synovium of the knee joint were observed after 8 weeks.ResultsAt the end of 8 weeks, the experimental compared with control group had significantly higher mean ROM (70.3° ± 11.1° vs. 54.6° ± 11.2°, respectively; P = 0.002) and mean adhesion score. The experimental group compared with the control group had significantly lower mean adhesion score (2.2 ± 0.9 vs. 3.1 ± 0.7, respectively; P = 0.012) and collagen content (32.4 ± 4.7 vs. 39.0 ± 4.2 μg/mg, P = 0.001).ConclusionsIn a rabbit model of knee injury, intra-articular injection of HA decreased adhesion formation and collagen content and increased ROM after prolonged immobilization. These results indicate that HA may be clinically useful to prevent adhesions and improve joint mobility in patients who require joint immobilization for up to 8 weeks.

Analysis of the effect of conservative treatment of distal radius fracture by telephone follow-up with clinic patients

Objective To investigate the effect of the telephone visit for conservative treatment of distal radius fracture.Methods The clinical data were retrospectively analyzed from the patients with distal radius fractures treating with manual reduction and plaster fixation or small splintfixation from January 2007 to December 2008 (No telephone follow-up,group A,n =64) and from January 2009 to December 2010 (Telephone follow-up,group B,n =71).And group B received the telephone follow-up during the first week after discharge,then,follow-up was taken by the condition of patients.Then,the fracture healing situation and Gartland-Werley wrist score were observed.Results All patients were followed up 19 months on average.There were 9 cases in group A and 2 cases in group B who had loss of fracture reduction,but showed no significant difference (x2 =5.688,P =0.017) between two groups in incidence.Fracture healing was achieved.There were no significant differences(t =1.396,P =0.165)in fracture healing time between group A [(10.4-± 1.8)weeks] and group B [(10.9 ±2.8) weeks].Significant differences was found in the palmar tilt angle,the radial inclination angle and the radial length between the two group (t =3.268,2.216,2.692,respectively;P ＜0.05).At last follow-up,According to the Gartland-Werley score,the results were excellent in group B than that in group A (Z =-1.994,P =0.046) between two groups.Conclusions Distal radial fracture patients by telephone follow-up can prevent loss of reduction and guide the rehabilitation training for patients with satisfactory results. Key words: Rehabilitation; Telephone follow-up; Distal radius fracture; Conservative treatment; Loss of reduction

Development of a New Device Implementing Standardized Closed Fracture in the Rat

The objective of the study was to produce a user-friendly device for creating standardized close fracture in an experimental animal. We describe a device that takes advantage of the elastic and plastic nature of the bone for producing a closed fracture with reproducible location and structure. Fractures were p roduced by a pendulum-like device applying an external blo w directly over the tibiae of female Wistar rats fixed to a platform by dynamic holders. The tibiae were immed iately stabilized by plaster fixation that was covered by dental wa x. Rad iographically, this method resulted in a highly reproducible bi -cortical transverse fracture. M inimal soft tissue damage was noticed around the fracture site. Creatine phosphokinase activity in the seru m and in the gastrocnemius muscle of the posterior calf compart ment was analy zed in order to evaluate the standardization of the soft tissue damage. The device is simp le to build and can be modulated and adapted to different sizes of animals. By using this device, a highly reproducible closed fracture system can be imp lemented with minimal damage to local soft tissues, but still with the local hematoma that is essential for the fracture healing process.

Outcomes of Pin and Plaster Versus Locking Plate in Distal Radius Intraarticular Fractures

BackgroundDistal radius fractures are among the most prevalent fractures predictive of probable occurrence of other osteoporotic fractures. They are treated via a variety of methods, but the best treatment has not been defined yet.ObjectivesThis study was performed to compare the results of open reduction and internal fixation with locking plates versus the pin and plaster method.Materials and MethodsIn this prospective study, 114 patients aged 40 to 60 years with Fernandez type III fracture referring to Imam-Reza and Mehr hospitals of Mashhad from 2009 to 2011, were selected randomly; after obtaining informed consent, they were treated with pin and plaster fixation (n = 57) or internal fixation with the volar locking plate (n = 57). They were compared at the one year follow up. Demographic features and standard radiographic indices were recorded and MAYO, DASH and SF - 36 tests were performed. Data was analyzed by SPSS software version 13, with descriptive indices, Mann-Whitney and Chi-square tests.ResultsSF-36 test demonstrated a better general health (P < 0.001), mental health (P = 0.006), physical functioning (P < 0.001), social functioning (P < 0.001) and energy/fatigue (P < 0.001) in LCP group. However, pain (P = 0.647) was not significantly different between the groups. Physical limitation (P < 0.001) and emotional limitation (P < 0.001) were greater in the pin and plaster group. Also, in the LCP group mean MAYO score (P < 0.001) was more than pin and plaster group. Mean DASH score was not different between the groups (P = 0.218). The rate of acceptable results of radiographic indices (P < 0.001), grip strength (P < 0.001) and range of motion in supination-pronation (P < 0.001) in LCP method were better than the pin and plaster method.ConclusionsIn treatment of intra-articular distal radius fractures in middle-aged patients internal fixation with locking plates may be prefered to pin and plaster as the treatment of choice.

Application of early rehabilitation treatment for patients with anterior cruciate ligament injury of knee undergoing artbroscopic reconstruction

A total of 74 patients undergoing arthroscopic reconstruction for anterior cruciate ligament (ACL) injury from January 2007 to September 2009 were randomly divided into the treatment and control groups.The treated patients started training at day 1 post-operation while the controls had initial external plaster fixation for 4 - 6 weeks followed by supporting devices with active and passive functional exercises of knee flexion and extension.All Lysholm scores in two groups were better at Month 12 than those at Month 3 [(93.8±2.7)vs.(81.8±4.2),(80.0±7.6) vs.(75.2±4.2); t=2.85,P＜0.0l,t=2.16,P＜0.05,respectively].The scores in the treatment group achieved better curative effects than those in the control group at Months 3,6 and 12 (P ＜0.01 ) ; Early and standard rehabilitation training for the patients with ACL injury of knee after reconstruction will facilitate the recovery of knee joint fumction. Key words: Exercise therapy; Anterior cruciate ligament

Treatments for acute and old distal radius fracture with lunate dislocation

Our study was undertaken to determine the correct treatment protocol for distal radius fracture with lunate anterior dislocation. From 2000 to 2007, 58 patients (36 with acute injury and 22 with old injury) with distal radius fracture with lunate anterior dislocation were enrolled in the study. Among acute injury patients, 15 were treated through manipulative reduction and plaster fixation and 21 were treated through minimal invasive poking reduction followed by Kirschner wire and plaster fixation. Among old injury patients, 8 underwent operative reduction of lunate dislocation through the palmar approach and Kirschner wire and plaster fixation, whereas 14 patients underwent operative reduction and fixation through the dorsal approach combined with reparation of the dorsal radiolunate ligament. Lidstrom wrist function scores and the morbidity of lunate necrosis and osteoarthritis were documented and evaluated. Lidstrom wrist function scores revealed that the rate of excellent and good scores was higher in acute injury patients than in old injury patients (91.7 versus 54.5%, respectively; P=0.018). The lunate necrosis rate was lower in acute injury patients than in old injury patients (0 versus 27.2%, respectively; P=0.027). For old injury patients, the lunate necrosis rate was higher in those treated with the palmar approach than in those treated with the dorsal approach (50 versus 14.3%, respectively; P=0.033). The key points for resolving distal radius fracture with lunate dislocation are prompt and precise diagnosis and treatment of lunate dislocation to prevent old lunate dislocation. We recommend that the surgical procedure is performed through the dorsal approach with reparation of the dorsal radiolunate ligament.

Redisplacement of Diaphyseal Fractures of the Forearm After Closed Reduction in Children: A Retrospective Analysis of Risk Factors

Manipulation and plaster fixation is the primary management for diaphyseal fractures of the radius and/or ulna in children. This study was designed to evaluate risk factors of fracture redisplacement after closed reduction and cast immobilization. Retrospective study. Tertiary hospital. Fifty-seven children with fractures of the radius were included. The medical records of patients with/without ulna treated with closed reduction and casting were reviewed. Data analyzed were age, sex, dominant hand, fracture pattern, reduction quality, experience of the surgeon, and type of anesthesia. Logistic regression was used for multivariate analysis. There were 41 (71.9%) males and 16 (28.1%) females with a mean age of 9.74 ± 3.07 years. There were 53 radius fractures and 54 ulna fractures, and 22 subjects experienced redisplacement. The redisplacement rate of radius fractures was 34% and of ulnar fractures was 27.8%. Multivariate analysis showed that the factors associated with redisplacement of radius fractures were fair reduction quality [odds ratio (OR), 8.45] and complete fracture (OR 9.62) and those for redisplacement of ulna fractures were fair reduction quality (OR 8.10) and complete fracture (OR 8.43). Poorer reduction and complete fracture are more likely to result in redisplacement, and surgical management may be considered in these cases.

Combined injuries to the upper and lower cervical vertebrae

Objective To investigate the treatment of combined injuries tu the upper and lower cervical vertebrae. Methods Nine consecutive patients (4 females and 5 males) with combined injuries to the upper and lower cervical vertebrae underwent different treatments in our department from March 2000 to March 2008. Their mean age was 39.3 years, ranging from 18 to 67 years. Six cases had neurological deficits. Two cases received conservative management (4 weeks of cervical traction followed by Dick splint or plaster fixation). Seven cases received different kinds of operation (upper cervical fixation in one case, lower cervical fixation in 3 cases and upper plus lower cervical fixation in the other 3 cases) followed by postoperative immobilization with Dick splint or neck support. Results One case died of respiratory infection 6 months after operation. The other 8 cases were followed up from 6 to 32 moths, with an average of 19 months.There were no neurological or vascular complications during surgery or traction. There were no cases of implant failure. Neurological symptoms were improved significantly in 5 cases. At the final follow-up, all patients demonstrated evidence of solid fusion on radiographs. Conclusions The stability of the upper and lower cervical spine and the severity of nerve injury determine whether conservative treatment or open surgery should be indicated for combined injuries to the upper and lower cervical vertebrae. In surgery, the lower cervical vertebra should be stabilized first of all. Key words: Cervical vertebrae; Spinal injuries; Fracture fixation

Greenstick Fractures of the Middle Third of the Forearm. A Prospective Multi-Centre Study

Greenstick fractures suffered during growth have a high risk for refracture and posttraumatic deformity, particularly at the forearm diaphysis. The use of a preemptive completion of the fracture by manipulation of the concave cortex is controversial and data supporting this approach are few. Aim of this study was to determine the factors which predispose to refracture and deformities, and to define therapeutic strategies. We prospectively gathered clinical and radiographic data over a period of one year on greenstick fractures of the middle third of the forearm in children as part of a multi-centre study. Endpoint was a follow-up visit at one year. Radiographic deformity, state of consolidation at resumption of physical activities and refracture rate were analysed statistically (ANOVA, Student's t-test and Pearson's chi-square test) with regard to patient age, gender, fracture type, therapy and time in plaster. We collected the data of 103 patients (63 boys, 40 girls), average age 6.6 years (1.3-14.5 years), the vast majority of whom had a combined greenstick fracture of the radius and ulna. 6.7% of the patients sustained a refracture within 49 days (29-76) after plaster removal. They were significantly older (p=0.017) with a significantly higher incidence of manual completion of the fracture with radiographic signs of partial consolidation (p=0.025). Residual deformities were significantly smaller after completion of the fracture compared to reduction without completion (p=0.019) or plaster fixation alone (p<0.005). Completion of a greenstick fracture does not prevent refracture. Nevertheless, it diminishes the extent of secondary deformities in cases where the primary angulation exceeds the remodelling capacity. Prevention of refracture should include a routine radiographic follow-up 4-6 weeks after injury with continuation of plaster fixation in cases of partial consolidation.