Treatment Of Old Fractures Research Articles

Reverse total shoulder arthroplasty for the treatment of old fracture of proximal humerus in elderly patients

To investigate clinical results of reverse total shoulder arthroplasty in treating old fracture of proximal humerus in elderly patients. From January 2012 to December 2017, 12 elderly patients with old proximal humeral fractures were treated with reverse total shoulder arthroplasty. There were 5 males and 7 females with an average age of 70.2 years old (ranged from 63 to 81 years old) and an average course of 12.3 months (ranged from 9 to 18 months). VAS score was used to evaluate the degree of pain relief of shoulder joint, Constant-Murley score was used to evaluate the improvement of shoulder joint function and observe the complications during and after operation. All the 12 patients were followed up with an average duration of 22.3 months (ranged from 15 to 56 months). At the latest follow-up, the VAS score was 1.9±1.4, and Constant-Murley score was 83.4±8.4. Among them, shoulder joint flexion was (92.5±7.7)°, abduction was (90.4±14.3)°, external rotation was(31.9±10.0)°, and internal rotation was(58.9±13.1)°. There was statistical significance before and after treatment(P<0.05). There were 2 cases with glenoid notch. The imaging findings were grade I and grade II respectively. No loosening was found during follow-up. No infection, acromial fracture, prosthesis loosening, axillary nerve injury and other complications occurred. Reverse total shoulder arthroplasty in treating old proximal humeral fractures in elderly patients can achieve satisfactory results, however, indications and complications should be noted.

Open reduction and osteotomy for old pilon fracture

Objective To investigate the efficacy of open reduction and osteotomy combined with internal fixation to reconstruct the distal tibial articular surface in the treatment of old pilon fracture. Methods A retrospective case series study was conducted to analyze the clinical data of 20 patients with old pilon fracture admitted to Zhengzhou Orthopaedic Hospital from July 2014 to February 2018. There were 14 males and six females, aged 21-45 years, with an average of 31.5 years. According to AO classification, there were four patients with C1 type, seven with C2 type and nine with C3 type, all of which were closed fractures. Eleven patients received non-operative treatment while nine patients underwent surgeries. After the surgery, malunion was seen in eight patients, and incomplete union in 12 patients. There were eight patients with posterior articular surface collapse of distal tibia, seven patients with anterior articular surface collapse of distal tibia, three patients with varus deformity and two patients with valgus deformity. All patients were treated with open reduction and osteotomy with internal fixation to reconstruct the articular surface of distal tibia. The time of fracture healing was recorded, and the Visual Analogue Scale (VAS), ankle flexion and extension range of motion, and AOFAS ankle-hind foot function score were compared before and at the last follow-up. The complications were recorded. Results All patients were followed up for 7-36 months, with an average of 26.4 months. Fracture healing time was 3-7 months, with an average of 4.1 months. At the last follow-up, VAS, ankle metatarsal flexion, dorsal extension and AOFAS scores were significantly improved compared with those before operation [(1.9±1.0)points vs. (6.6±1.4)points, (31.6±2.4)° vs. (18.5±4.4)°, (25.7±2.7)° vs. (15.6±2.7)°, (79.6±7.3)points vs. (42.6±5.6)points] (P<0.05). One patient developed severe ankle traumatic arthritis 7 months after operation and underwent fusion of ankle joint. Conclusion For old pilon fracture, open reduction and osteotomy to reconstruct the distal tibial articular surface can effectively relieve pain, improve joint mobility and restore ankle function. Key words: Osteotomy; Foot deformities; Pilon fracture

Treatment of old scaphoid fracture by radial approach of wrist

Objective To evaluate the clinical efficacy of the radial styloid process excision combined with bone grafting and internal fixation through radial approach of wrist in the treatment of old scaphoid fracture. Methods From January 2003 to September 2016, 62 cases of old scaphoid fracture nonunion were treated by the radial styloid process excision combined with bone grafting and internal fixation through radial approach of wrist. The wrist joint was immobilized with a plaster cast postoperatively. X-ray examination was performed 3 months after the operation. If the fracture was not healed, the plaster or brace should be used to continue to fix it until the fracture line was blurred, and the recovery of wrist function should be observed. Results All the patients were follow-up for 6 to 24 months with an average of 18 months. Bone healing was achieved in all the patients, with an average healing time of 6 months. The wrist function was evaluated according to the modified Mayo Wrist Function Score. The results were rated as excellent in 40 cases, good in 15 cases and fair in 7 cases, with the excellent and good rate being 88.7%. Conclusion It is simple and effective to treat old scaphoid fracture with the radial styloid process excision combined with bone grafting and internal fixation through radial approach of wrist. The surgical trauma is small. Bone grafting and fixation can be completed in the same incision. Key words: Scaphoid bone; Treatment outcome; Old fracture; Surgical approach

Efficacy comparison of multi-segment and single-segment osteotomy for old osteoporotic vertebral compression fracture combined with kyphosis

Objective To investigate the sagittal correction effect and clinical efficacy of multi-segment Smith-Peterson osteotomy (SPO) and single-segment pedicle subtraction osteotomy (PSO) in the treatment of old osteoporotic vertebral compression fracture (OVCF)combined with kyphosis. Methods A retrospective case control study was conducted to analyze the clinical data of 24 patients with old OVCF combined with kyphosis admitted to Traditional Chinese Medical Hospital of Xiaoshan from February 2014 to July 2016. There were 10 males and 14 females, aged 58-72 years, with an average of 65.6 years. Thirteen patients were treated with multi-segment SPO (Group A), six of whom underwent two-segment SPO and seven underwent three-segment SPO. Eleven patients were treated with single-segment PSO (Group B). The operation time, intraoperative bleeding volume, the number of cases using cement-reinforced nail track, postoperative drainage, hospitalization time and postoperative complications were compared between the two groups. Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis angle (TK) and lumbar lordosis angle (LL) of kyphosis deformity were measured before operation, after operation and at the last follow-up. Oswestry Dysfunction Index (ODI) and Visual Analogue Scale (VAS) were used to evaluate the clinical efficacy at the last follow-up. Results All patients were followed up for 6-24 months, with an average of 15.4 months. The operation time of Group A was (198.1±27.3)minutes, while that of Group B was (237.6±36.1)minutes (P 0.05). Three patients in Group A and one patient in Group B had cerebrospinal fluid leakage (P 0.05). There was no significant difference in SVA, Cobb angle, TK and LL between the two groups at the last follow-up (P>0.05). There was no significant difference in ODI and VAS between the two groups after operation and at the last follow-up (P>0.05). No complications such as spinal cord injury, embolism caused by cement leakage, extraction or rupture of pedicle screw occurred in either group. Conclusion For old osteoporotic vertebrae compressed fractures combined with kyphosis, multi-segment SPO and single-segment PSO can achieve good sagittal correction and clinical efficacy. Single-segment PSO has better correction effect and lower incidence of cerebrospinal fluid leakage, yet accompanied with disadvantages of overcorrection, screw loosening, longer operation time and more blood loss. Key words: Osteoporotic fractures; Thoracic vertebrae; Lumbar vertebrae; Kyphosis; Osteotomy

Treatment of old tibial plateau fracture with tibial plateau osteotomy

Objective To evaluate the surgical efficacy of tibial plateau osteotomy for treatment of old tibial plateau fracture. Methods From March 2007 to March 2018, 18 old tibial plateau fractures were treated by tibial plateau osteotomy at the Department of Orthopedics, Central Hospital of Jilin City. They were 12 males and 6 females with a mean age of 41.2 years (from 19 to 60 years). The fracture healing time, healing rate and the Hospital for Special Surgery (HSS) score for knee function at the last follow-up were recorded. Results This series were followed up for an average of 24 months (from 12 to 36 months). Of them, 17 obtained clinical healing, giving a healing rate of 94.4%. The healing time ranged from 4 to 16 months (average, 10 months). By the HSS score at the last follow-up, 11 cases were rated as excellent, 4 as good, 2 as fair and one as poor. Conclusion Tibial plateau osteotomy is an effective treatment for old tibial plateau fractures. Key words: Knee joint; Fracture fixation, internal; Osteotomy; Tibial plateau fracture

Surgical treatment of old die-punch fractures of distal radius

Objective To report the effects of surgical treatment of old die-punch fractures of the distal radius. Methods A retrospective study of case series was made of the 21 old die-punch fractures of the distal radius which had been surgically treated from January 2012 to January 2017 at Department of Orthopaedics, Shandong Provincial Hospital. There were 13 males and 8 females, aged from 34 to 63 years (average, 46.9 years). According to the preoperative definite diagnoses by the X-ray and CT images, there were 14 metacarpal compression fractures and 7 dorsal compression fractures. The palmar approach was used in 13 cases, the dorsal approach in 7 and the combined approach in one. Autogenous iliac bone grafting was performed for all the cases. Their preoperative and postoperative Cooney scoring and visual analogue scale (VAS) of the wrist, and postoperative complications as well, were observed and recorded. Results This cohort was followed up for 8 to 14 months (average, 9.2 months). All their postoperative wounds healed by the first intention. Their Cooney functional scores of the wrist were, respectively, 58.5±4.2 and 84.0±3.1 points preoperatively and at the final follow-up, and their corresponding VAS scores 7.6±0.9 and 3.4±1.3 points, showing significant differences between preoperation and the final follow-up (P<0.05). Carpal arthritis was observed in one case. Conclusion For old die-punch fractures of the distal radius, surgical treatment can obviously reduce pain, improve function of the wrist and enhance the quality of life of the patients. Key words: Wrist joint; Fracture fixation, internal; Range of motion, articular; Die-punch fractures

Free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis

Objective To evaluate the outcomes of the free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis and review the utility of this procedure. Methods Eleven cases of old scaphoid fracture with bone necrosis were treated with the free medical femoral condyle bone grafting between Feburay, 2013 and May, 2015 (9 males and 2 females) . The average age was 34 years ranged from 27 to 55 years. Six cases were in left wrist, and other 5 cases were in right. Six cases were in waist area, and the other 5 cases were proximal pole nonunion. All cases were evaluated with 3D-CT scan, while humpback deformity were occurred in 6 cases, and avascular necrosis at the proximal pole were occurred in 3 cases. After refreshing the fracture, the free medical femoral condyle bone was transferred to the scaphoid, reduct the scaphoid and fix with the Kirschner wire. An end-to-side anastomosis was performed with the bone flap artery and the radial artery, accompanied by the end to end anastomosis of the flap vein and the vein with the radial artery. The plaster was used for 8 weeks. Bone healing was evaluated with X-ray and 3D CT scan. A functional review was performed after the operation and a Mayo wrist scoring test was taken 6 months after the treatment. Results The average followed-up period was 13.1 months(ranged from 9 to 24 months). Bone union were demonstrated in all cases at 13.4 weeks after the operation(ranged from 11 to 18 weeks). Mayo wrist scoring testing showed excellent in 5 cases, good in 4 cases, and fair in 2 cases. Conclusion Free bone flap of medial femoral condyle is constant in vascular anatomy, and is easy to perform with plenty bone graft and less morbidity at donor site. Medial femoral condyle bone flap transplantation based on the descending gennicular vessels is an effective method for treatment of old scaphoid fracture with bone necrosis. Key words: Scaphoid; Old fracture; Descending genicular artery; Medial femoral condyle bone flap

Treatment of old distal radius fractures through the approach by transection of brachioradialis tendon

Objective To design the surgical approach by transection of brachioradialis tendon to expose the volar and dorsal side of the distal radius according to the anatomical characteristics of the distal radius adjacent structures, and explore the operative technique of this approach for the treatment of old distal radius fractures. Methods The characteristics and techniques of the surgical approach by transection of brachioradialis tendon were anatomically analyzed using 10 sides of the upper limb specimens of adult cadavers. 15 cases of old distal radius fractures were treated clinically by open reduction and internal fixation through the approach by cutting brachioradialis tendon. The patients' wrist function was evaluated using Fernandez score. Results The incision of brachioradialis tendon provided an adequate surgical exposure of the old distal radius fractures. The postoperative follow-up was 6 to 18 months with an average of 11.6 months. According to the Fernandez score, the results of wrist function at the last follow-up assessment were excellent in 11 cases, good in 3 cases and fair in 1 case. Conclusion Adopting the approach of cutting the brachioradialis tendon in the treatment of the old distal radius fractures has advantages of complete exposure of the surgical sites, clear operation vision and good postoperative recovery, which is worthy of clinical promotion. Key words: Radius fractures; Anatomy; Surgical approach; Brachioradialis tendon

Интраоперационная профилактика синдрома грушевидной мышцы при лечении застарелых переломов задней колонны вертлужной впадины

Интраоперационная профилактика синдрома грушевидной мышцы при лечении застарелых переломов задней колонны вертлужной впадины

Comparison of two kinds of bone flap transplantation for treatment of old scaphoid fracture

Objective To compare surgical procedure and clinical effects of bone flap transplantation vascularized by recurrent branch of the radial artery and by descending genicular artery in the treatment of old scaphoid fracture. Methods From June 2009 to June 2015, a total of 49 patients with old scaphoid fracture were retrospectively reviewed. 22 cases were treated by internal fixation with transplantation of radial styloid bone flap pedicled on the recurrent branch of the radial artery, while the other 27cases by internal fixation with free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery. The operation time, fracture healing time and wrist function were compared between the two groups. Results The operation time of the descending genicular artery bone flap group (186.00±26.48) min was greater than that of the radial styloid bone flap group (107.00±25.18) min (t=10.617,P<0.001). However, the fracture healing time of the radial styloid bone flap group (16.90±3.58) weeks was longer than that of the descending genicular artery bone flap group (13.20±3.10) weeks (t=3.874,P<0.001). Modified Mayo wrist scoring system was used to evaluate the wrist function 6 months after the surgery. In the radial styloid bone flap group, the results were excellent in 12 cases, good in 9 cases, and fair in 1 case with the average score being 87. In the descending genicular artery bone flap group, the results were excellent in 12 cases, good in 13 cases, fair in 1 case, and poor in 1 case with the average score being 81. There was no significant difference between the two groups. Conclusion Both of the surgical procedures are effective methods for treating old scaphoid fracture. The free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery is faster in fracture healing, but more time-consuming and demanding. Key words: Scaphoid bone; Fractures,ununited; Vascularized bone flap

Surgical treatment for 14 patients with old fractures of humeral lateral condyle in children

To study clinical effects of operation for the treatment of old fractures of the humerus lateral condyle in children. From January 2012 to January 2014 in our department, 14 children of old humeral lateral condyle fractures were treated with operation. Ten cases were male, 4 cases were female; age from 2 to 12 years old, average 5.8 years old. The initial diagnosis was type IIfracture according to the Milch ciassification, the loss of treatment in 11 cases, conservative treatment in 3 cases of nonunion after fracture displacement. Two cases had mild cubitus valgus deformity; 10 cases had elbow disorders, and the motion range was limited from 15° to 60°; 6 cases had pain in activity. The time from injury to operation was 32 to 176 days(62 days on average) in 14 cases, the 14 cases were treated with open reduction and internal fixation. According to the Modified An-Morrey elbow function assessment criteria after surgery for curative effect. Fourteen cases were followed up for 1 to 3 years, average 1.8 years. No nonunion, malunion, aseptic necrosis of the epiphysis, cubitus varus or valgus occurred. Five cases had mild protrusion deformity of external condyle, 3 cases still had mild dysfunction. The time of clinical bone union was 4 to 8 weeks in X-ray films. Five cases had bony spur formation, 3 cases had signs of early closure of epiphysis; 2 cases had a increasing volume of humeral lateral condyle; and 2 cases appeared tail deformity. Modified An-Morrey score averaged(95.2±3.6) points, 13 excellent, 1 good. For the old fracture of humeral lateral condyle, operation can effectively restore the appearance and function of elbow joint, and the short-term curative effect is satisfactory, but the long-term effect needs further observation.

Correction of posttraumatic thoracolumbar kyphosis with modified pedicle subtraction osteotomy

To evaluate the efficacy and safety of modified pedicle subtraction osteotomy for treatment of thoracolumbar old fracture with kyphosis. Methods: From January 2003 to January 2013, 58 patients of thoracolumbar kyphosis, who underwent modified pedicle subtraction osteotomy, were reviewed. Among them, 45 cases underwent initial operation and 13 cases underwent revision surgery. Preoperative and postoperative kyphotic Cobb's angle, score of back pain, as well as the incidence of complication were accessed by using visual analogue scale (VAS) and Oswestry disability index (ODI). Results: Mean follow-up duration was 42 months (range, 24-60 months). Average operative time was 258 min (range, 190-430 min), while average bleeding was 950 mL (range, 600-1 600 mL). All the patients were significantly improved in function and self-image, and achieved kyphosis correction with 17.9°± 4.3°. VAS of low back pain was decreased by 3.1±0.6; ODI was dropped by 25.3%±5.5%. 3 patients (5.2%) suffered anterior thigh numbness and got recovery after 3 months of follow-up. Complications happened in 19 patients, including 12 with cerebrospinal fluid leak, 4 with superficial wound infection, and 3 with urinary tract infection. All these complications were managed properly and none of them underwent reoperation. Conclusion: Modified pedicle subtraction osteotomy is a safe and effective technique for the treatment of old fracture with kyphosis.

Atlantoaxial pedicle screw fixation for old odontoid fracture combined with atlantoaxial instability

Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability.Methods The study involved 48 patients with old odontoid fractures combined with atlantoaxial instability treated with trans-atlantoaxial pedicle screw-rod internal fixation and fusion from January 2005 to January 2010.There were 30 males and 18 females,at average age of 45.1 years old(19-56 years).All the patients underwent the skull traction preoperatively.Results A total of 192 pedicle screws(96 screws for the atlas and another 96 for the axis)were implanted in all the 48 patients who obtained satisfactory atlantoaxial reduction,with no spinal cord injuries.The operation lasted for average 155 min,with blood loss for average 370 ml.There were three patients with vertebral artery injury and three with inferior posterior arch fracture of the atlas during operation.All the patients were followed up for average of 46.6 months(range,9-64 months),which showed bone fusion at 6 months after operation,with no loosening,displacement,instability or breakage of the screws.The JOA score was improved from preoperative 7.1 ±2.8 to postoperative 13.3 ± 2.1(P ＜ 0.05).Conclusion Atlantoaxial pedicle screw fixation is a reliable and effective method for the treatment of the atlantoaxial instability. Key words: Atlas; Axis; Spinal fractures; Old odontoid fracture

Posterior screw-plate system for treating old fracture of the odontoid process

To assess the efficacy of a screw-plate system for the treatment of old fracture of the odontoid process. Twenty-six patients with old fracture of the odontoid process were treated by a posterior screw-plate system. There were 17 men and 9 women ranging in age from 17 to 58 years (mean, 32.8 years). According to the Anderson-D'Alonzo classification, 19 patients were classified as type II, and 7 as type III. According to the Frankel classification, there were 3 patients of grade C, 21 of grade D and 2 of grade E. All operations were successfully performed. The operation time was 75-120 min (mean, 90 min) and the intraoperative blood loss 50-200 ml (mean, 125 ml). There were no postoperative complications. All patients were followed up for 24-36 months. At the final follow-up, one patient had improved from grade C to grade D, two from grade C to grade E, and 15 from grade D to grade E. The other cases had remained stable. There was no breakage of nails or failure of internal fixation during follow-up. Stable bone union was observed in all cases, the average healing time being 7.8 months. Posterior screw-plate system is a safe and effective method for treating old fracture of the odontoid process.

The application of wrist-spanning external fixators in the treatment of old distal radius fractures

Objective To analyze the results of distal radius limited open reduction and trans-articular fixation with external fixators for treatment of old distal radius fractures.Methods From March 2006 to March2008,16 patients with 18 old distal radius fractures were treated with open reduction and trans-articular fixation with wrist spanning external fixators.Their average age was 52.6 years(29 to 72 years).There were 15 Colles fractures in 13 patients and 3 Smith fractures in 3 patients.The external fixation was used after distal radius fracture reduction and bone grafting for reduction maintenance and static immobilization.Results All the patients were followed up for 4 to 30 months(average 16 months).The time to achieve bone healing ranged from6 to 12 weeks(average 8.7 weeks).According to Cartland and Werley wrist scores,the functional results were rated as excellent in 11 cases,good in 4 cases and fair in 3 cases,with an overall 83.3% excellent and good rate.Conclusion Distal radius limited open reduction and trans-articular fixation with external fixators is an effective method to treat old distal radius fractures.This is a simple procedure with minimal soft tissue damage,which can facilitate early postoperative rehabilitation and promote bone healing. Key words: Fractures,bone; External fixators; Radius

Treatment of old thoracolumbar fractures combined with paraparesis through anterior decompression plus posterior intradural release

Objective To explore the effect of anterior decompression plus posterior intradural release in treatment of old thoracolumbar fractures with paraparesis. Methods A total of 22 patients with old thoracolumbar fractures with paraparesis were admitted to our hospital since January 2004 to Jan-uary 2008. Before admission, all patients were treated with decompression and internal fixation with pos-terior pedicle system, with bony compression to the spinal cord found through CT scanning and intact spi-nal cord found by MRI but without obvious neurofunction recovery. Of all, 20 patients were kept with the original posterior fixation except for two patients that were fixed with Z-plate after removal of posterior hardware. Autologous bone grafts from iliac were utilized in all patients. Intradural release was done 3-6 months after anterior decompression. Results Of all, 19 patients were followed up for 17-49 months (average 28 months). Twenty patients obtained varied recovery of neurofunction after anterior decompres-sion, with ASIA motor scores increasing from average 59.4 points before decompression to 71.3 after de-compression. The followed-up patients won further recovery after secondary posterior intradural release, with ASIA motor scores further increasing to average 80.6 points. Conclusion For patients with old thoracolumbar fractures combined with paraparesis, the release of intradural sear and fibrocompression is also important besides anterior decompression. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Paraparesis; Decompression

Treatment of old osteoporotic vertebral compression fractures with Sky bone expander percutane-ous kyphoplasty

Objective To discuss the clinical effect of Sky bone expander percutaneous ky-pbeplasty (Sky-PKP) in treatment of old osteoperotic vertebral compression fractures. Methods The study involved 27 patients (27 vertebrae) with old osteoporotic vertebral compression fractures treated by Sky-PKP from March 2005 to June 2007. Normotopia, lateral and dynamia radiographs, CT scanning and MRI were performed preoperatively to verify fluid collection in the vertebral body, vacuum phenomenon and open-close phenomenon. Visual analog scale (VAS), Oswestry disability index (ODI), anterior body height, middle line body height, posterior body height and kyphotic angle changes were measured on a lateral radiograph before and after treatment. Results All patients were followed up for mean 6.2 months, which showed no severe complications. VAS score was decresed from preoperative 7.8 to postop-erative 3.1 and ODI from 65% to 37%. However, The anterior vertebral height and middle line vertebral height were recovered for 4.6 nun and 5.7 mm respectively compared with preoperation. Correction of ky-photic angle was mean 5.6°postoperatively. There was no sitatistical changes in regard to posterior body height before and after operation. Conclusions Sky-PKP is a reasonable procedure for treatment of old osteoporotic vertebral compression fractures under strict control of indications, especially with vacuum phenomenon, open-close phenomenon and fluid collection. While high degree of difficulty in puncturation results in insignificant correction of kyphotic angle and body height. Key words: Spinal fractures; Percutaneoas kyphoplasty; Osteoporosis; Fraetures, old

Treatment of old Barton's fracture

Objective To analyze the etiology of old Barton's fractures and discuss the diagnostis strategies and treatment options. Methods Sixteen cases of old Barton's fracture(11 cases of volar fractures and 5 cases of dorsal fractures) were involved.Plain X-ray examines were combined with CT scan to determine type of the fractures.displacement of ioint surfaces and the severity of wrist joint dislocation.Eleven cases of volar Barton's fractures were fixed with T-shaped metallic plate via a volar-radial approach.Five cases of dorsal Barton fractures were treated with limited intemal fixation combined with external fixator via a distal dorsolateral incision. Results All 16 patients were followed-up for 10 to 36 months postoperatively.Bone union was seen in all cases.The volar tilting angle was 10°～15°(average 11.3°).The ulnar inclining angle Was 16°～25°(average 20°).There was no shortening of the radius.According to Mehara's evaluation for volar Barton's fractures.15 cases(93.8%)had obtained sarisfying results(excellent in 13 cases.good in 2 cases,fare in 1 case). Conclusions Open reduction and intemal fixation is an effective method to treat old Barton's fractures.CT scan is helpful in revealing fracture details.displaying joint surface displacement,and judging the accuracy of surgical reduction and fixation. Key words: Fractures.bone; Fracture fixation; Treatment outcome

Interlocking intramedullary nailing and bone grafting in treatment of old fractures of femoral shaft

目的 评价带锁髓内钉并植骨治疗股骨干陈旧性骨折的临床疗效和优点.方法对1996年2月～2003年11月收治的47例陈旧性殷骨干骨折患者进行回顾性分析.其中植骨组28例,非植骨组19例.采用切开复位,带锁髓内钉扩髓,静力型固定,根据骨折部位生长情况改为动力型固定.结果术后随访39例,随访10～25个月,平均随访时间14.2个月.植骨组骨折愈合率为95.6%(22/23),感染率为4.3%(1/23),骨折平均愈合时间为6.3个月,非植骨组则分别为62.5%(10/16),6.25%(1/16)和9.7个月.临近关节功能达正常,无感染、断钉等并发症.结论带锁髓内钉静力固定能有效控制有害的剪应力,同时对骨折有一定的加压作用,可提供早期坚强的内固定,同时,植骨后骨折愈合快,并发症少,是治疗陈旧性骨折的理想方法。

Operative treatment of old fractures of pelvis

目的 探讨陈旧性骨盆骨折的手术治疗.方法自2000年2月起,对本院14例陈旧性骨盆骨折患者行手术清理瘢痕或骨痂,牵引复位,然后内固定治疗.结果本组病例全部获得随访,时间6个月～3年6个月.根据骨盆形态、双下肢长度差异、步态、X线片测量等指标判断疗效,优8例,良4例,差2例,优良率为85.7%.结论陈旧性骨盆骨折可进行手术复位治疗.只要设计合理、方法得当,通过积极的手术可避免发生严重的残废,极大地提高伤者的生存质量。