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
{"title":"Minimally invasive treatment of calcaneal fractures of Sanders II&III with subtalar arthroscopy assisted by self-designed retractor and reducer","authors":"Jiali Wang, Feiyuan Song, Zhong-hua Chen, Xiaohui Wang, Yongliang Liu, Xing-guo Wang, Wei Wang","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.004","url":null,"abstract":"Objective \u0000To 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. \u0000 \u0000 \u0000Methods \u0000From 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). \u0000 \u0000 \u0000Results \u0000The 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). \u0000 \u0000 \u0000Conclusion \u0000The 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. \u0000 \u0000 \u0000Key words: \u0000Arthroscopy; Calcaneus; Fractures, bone; Fracture fixation, internal","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"20-26"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41738719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2020.01.005
Y. Huang, Weiming Chen, G. Tang, Bin Huang, Guiquan Chen
Objective To report the treatment effects of open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision on closed calcaneal fractures. Methods A retrospective study was done of the 20 patients (25 feet) who had been treated at Ward One, Department of Orthopaedics, People's Hospital of Yunfu from February 2016 to February of 2019 for closed calcaneal fractures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision. They were 16 males and 4 females, aged from 16 to 60 years. According to the Sanders classification, there were 3 cases of type Ⅱ, 15 cases of type Ⅲ and 2 cases of type Ⅳ. Their fractures were reduced by traction, extruding, prying and direct visualization through the tarsal canal window; the bone plates were inserted through a small incision at the back of the heel and fixated by screws. Postoperative observation was done to address fracture healing, and length, width, height, Bohler angle and Gissane angle of the affected calcaneus, as well as functional recovery of the ankle-hindfoot by the American Orthopaedic Foot and Ankle Society (AOFAS) evaluation. Results The operation time for a single foot ranged from 45 min to 70 min, averaging 64.5 min; the intraoperative fluoroscopy for a single foot ranged from 3 times to 6 times, averaging 4.5 times. Local skin necrosis of about 0.5 cm×0.3 cm appeared in one foot after operation but responded to dressing change. No other wound complications occurred. Their follow up was carried out for 6 to 36 months (average, 17.3 months). The fractures healed well with well-shaped bony callus and flat articular surface after 4 to 6 months. The length (80.5 mm±4.2 mm), width (44.8 mm±5.2 mm), height (44.4 mm±3.0 mm), Bohler angle (25.0°±5.1°) and Gissane angle (113.8°±8.6°) of the calcaneus at the last follow up were significantly improved than the preoperative values (79.4 mm ± 4.5 mm, 50.5 mm ± 6.3 mm, 40.0 mm±4.4 mm, 12.0°±13.8° and 107.0°±13.3°) (all P<0.05). By the AOFAS ankle-hindfoot scale, functional recovery of the foot was excellent in 20, good in 3 and fair in 2 cases, giving an excellent to good rate of 92%. Conclusion In the treatment of closed calcaneal fractures, open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision may lead to fine outcomes due to its advantages of small incision and fine fracture reduction. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal; Tarsal Canal; Small incision
{"title":"Treatment of closed calcaneal fractures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision","authors":"Y. Huang, Weiming Chen, G. Tang, Bin Huang, Guiquan Chen","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.005","url":null,"abstract":"Objective \u0000To report the treatment effects of open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision on closed calcaneal fractures. \u0000 \u0000 \u0000Methods \u0000A retrospective study was done of the 20 patients (25 feet) who had been treated at Ward One, Department of Orthopaedics, People's Hospital of Yunfu from February 2016 to February of 2019 for closed calcaneal fractures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision. They were 16 males and 4 females, aged from 16 to 60 years. According to the Sanders classification, there were 3 cases of type Ⅱ, 15 cases of type Ⅲ and 2 cases of type Ⅳ. Their fractures were reduced by traction, extruding, prying and direct visualization through the tarsal canal window; the bone plates were inserted through a small incision at the back of the heel and fixated by screws. Postoperative observation was done to address fracture healing, and length, width, height, Bohler angle and Gissane angle of the affected calcaneus, as well as functional recovery of the ankle-hindfoot by the American Orthopaedic Foot and Ankle Society (AOFAS) evaluation. \u0000 \u0000 \u0000Results \u0000The operation time for a single foot ranged from 45 min to 70 min, averaging 64.5 min; the intraoperative fluoroscopy for a single foot ranged from 3 times to 6 times, averaging 4.5 times. Local skin necrosis of about 0.5 cm×0.3 cm appeared in one foot after operation but responded to dressing change. No other wound complications occurred. Their follow up was carried out for 6 to 36 months (average, 17.3 months). The fractures healed well with well-shaped bony callus and flat articular surface after 4 to 6 months. The length (80.5 mm±4.2 mm), width (44.8 mm±5.2 mm), height (44.4 mm±3.0 mm), Bohler angle (25.0°±5.1°) and Gissane angle (113.8°±8.6°) of the calcaneus at the last follow up were significantly improved than the preoperative values (79.4 mm ± 4.5 mm, 50.5 mm ± 6.3 mm, 40.0 mm±4.4 mm, 12.0°±13.8° and 107.0°±13.3°) (all P<0.05). By the AOFAS ankle-hindfoot scale, functional recovery of the foot was excellent in 20, good in 3 and fair in 2 cases, giving an excellent to good rate of 92%. \u0000 \u0000 \u0000Conclusion \u0000In the treatment of closed calcaneal fractures, open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision may lead to fine outcomes due to its advantages of small incision and fine fracture reduction. \u0000 \u0000 \u0000Key words: \u0000Calcaneus; Fractures, bone; Fracture fixation, internal; Tarsal Canal; Small incision","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"27-32"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44144479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2020.01.006
L. Shang, Xiangyu Wang, Aiguo Wang, Guanghui Jia, Shi-Zhu Sun, Qi Li, Fuqiang Ma, Xiaolong Zhang, Yalei Wang
Objective To evaluate Evans lateral lengthening calcaneal osteotomy(E-LLCOT) in the treatment of talocalcaneal coalitions (TCCs) with forefoot abduction deformity in the teenagers. Methods From February 2014 to August 2018, 11 teenaged patients (14 feet) were treated at Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital for TCCs with severe forefoot abduction deformity. They were 6 males (8 feet) and 5 females (6 feet), aged from 13 to 17 years (average, 15 years). Their diseases involved bilateral feet in 3 cases and unilateral foot in 8, the left foot in 7 cases and the right in 7. All patients underwent TCCs resection followed by E-LLCOT. Their talonavicular coverage angles (TCA) and talar-second metatarsal angles (T2-MT) on the anteroposterior film and talar horizontal angles (TH) and talar-first metatarsal angles (T1-MT) on the lateral film were measured preoperatively and at the last follow-up. The foot functions were evaluated preoperatively and at the last follow-up using the ankle- hindfoot scores of American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS). Results All the 11 patients were followed up for 12 to 24 months (average, 16.5 months). The mean preoperative TCA (22.3°, from 20° to 26°) was improved to 10.5° (from 8° to 13°) at the last follow-up; the mean T-2MT was improved from preoperative 17.6° (from 16° to 20°) to 6.5° (from 5° to 11°) at the last follow-up; the mean TH on the lateral view was improved from preoperative 35° (from 25° to 40°) to 17.5° (from 16° to 21°) at the last follow-up; the mean T-1MT was improved from preoperative 15.5° (from 10° to 22°) to 3.5° (from 2° to 6°) at the last follow-up; the mean AOFAS score was improved from 56.5 (from 50 to 62) preoperatively to 90.6 (from 75 to 95) at the last follow-up; the mean VAS score was improved from 6.0 (from 5 to 7) preoperatively to 2 (from 0 to 3) at the last follow-up. Conclusion For TCCs with severe forefoot abduction deformity in the geenagers, E-LLCOT after TCCs resection can effectively correct deformity, relieve pain and achieve significant functional and radiographic improvements. Key words: Foot; Talus; Calcaneus; Talocalcaneal coalition; Osteotomy
{"title":"Evans lateral lengthening calcaneal osteotomy for talocalcaneal coalitions with forefoot abduction deformity in the teenagers","authors":"L. Shang, Xiangyu Wang, Aiguo Wang, Guanghui Jia, Shi-Zhu Sun, Qi Li, Fuqiang Ma, Xiaolong Zhang, Yalei Wang","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.006","url":null,"abstract":"Objective \u0000To evaluate Evans lateral lengthening calcaneal osteotomy(E-LLCOT) in the treatment of talocalcaneal coalitions (TCCs) with forefoot abduction deformity in the teenagers. \u0000 \u0000 \u0000Methods \u0000From February 2014 to August 2018, 11 teenaged patients (14 feet) were treated at Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital for TCCs with severe forefoot abduction deformity. They were 6 males (8 feet) and 5 females (6 feet), aged from 13 to 17 years (average, 15 years). Their diseases involved bilateral feet in 3 cases and unilateral foot in 8, the left foot in 7 cases and the right in 7. All patients underwent TCCs resection followed by E-LLCOT. Their talonavicular coverage angles (TCA) and talar-second metatarsal angles (T2-MT) on the anteroposterior film and talar horizontal angles (TH) and talar-first metatarsal angles (T1-MT) on the lateral film were measured preoperatively and at the last follow-up. The foot functions were evaluated preoperatively and at the last follow-up using the ankle- hindfoot scores of American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS). \u0000 \u0000 \u0000Results \u0000All the 11 patients were followed up for 12 to 24 months (average, 16.5 months). The mean preoperative TCA (22.3°, from 20° to 26°) was improved to 10.5° (from 8° to 13°) at the last follow-up; the mean T-2MT was improved from preoperative 17.6° (from 16° to 20°) to 6.5° (from 5° to 11°) at the last follow-up; the mean TH on the lateral view was improved from preoperative 35° (from 25° to 40°) to 17.5° (from 16° to 21°) at the last follow-up; the mean T-1MT was improved from preoperative 15.5° (from 10° to 22°) to 3.5° (from 2° to 6°) at the last follow-up; the mean AOFAS score was improved from 56.5 (from 50 to 62) preoperatively to 90.6 (from 75 to 95) at the last follow-up; the mean VAS score was improved from 6.0 (from 5 to 7) preoperatively to 2 (from 0 to 3) at the last follow-up. \u0000 \u0000 \u0000Conclusion \u0000For TCCs with severe forefoot abduction deformity in the geenagers, E-LLCOT after TCCs resection can effectively correct deformity, relieve pain and achieve significant functional and radiographic improvements. \u0000 \u0000 \u0000Key words: \u0000Foot; Talus; Calcaneus; Talocalcaneal coalition; Osteotomy","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"33-37"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45458356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2020.01.014
Bo-yuan Su, Yong-xiong Pan, Jinsong Hong, Qinmeng Yang
Objective To compare the effects of arthroscopic surgery plus one or more posterior small incisions and the sinus tarsi approach in the treatment of calcaneal fracture. Methods A retrospective analysis was conducted of the 85 patients with calcaneal fracture who had been treated from January 2017 to June 2017 at Department of Foot & Ankle Surgery, Guangzhou Orthopaedic Hospital. They were 43 men and 42 women, 32 to 58 years of age (average, 46.0 years). Arthroscopic surgery plus one or more posterior small incisions was performed in 40 of them while the sinus tarsi approach was used in the other 45 cases. The 2 groups were compared in terms of operation time, fracture healing time, incision complications and functions of the affected foot by the American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot scores. Results There were no significant differences in the preoperative general data between the 2 groups, showing they were comparable (P>0.05). The average follow-up period for all the patients was 8 months (from 6 to 12 months). For the arthroscopic surgery group and sinus tarsi approach group, the fracture healing time was 8.6±2.4 weeks and 8.9±1.8 weeks, and the AOFAS ankle-hindfoot scores were 82.5±5.6 and 85.1±4.0, respectively, showing no significant differences between them (P>0.05). The operation time in the arthroscopic surgery group (43.6±5.4 min) was significantly less than in the sinus tarsi approach group (56.5±6.4 minutes), and the rate of complications in the former[2.5%(1/40)] significantly lower than in the latter[15.6%(7/45)] (P< 0.05). Conclusion Arthroscopic surgery plus one or more posterior small incisions may be a fine treatment for calcaneal fractures because postoperative incision complications can be reduced. Key words: Arthroscopy; Calcaneus; Fracture, bone; Posterior
{"title":"Arthroscopic surgery plus one or more posterior small incisions for calcaneal fractures","authors":"Bo-yuan Su, Yong-xiong Pan, Jinsong Hong, Qinmeng Yang","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.014","url":null,"abstract":"Objective \u0000To compare the effects of arthroscopic surgery plus one or more posterior small incisions and the sinus tarsi approach in the treatment of calcaneal fracture. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted of the 85 patients with calcaneal fracture who had been treated from January 2017 to June 2017 at Department of Foot & Ankle Surgery, Guangzhou Orthopaedic Hospital. They were 43 men and 42 women, 32 to 58 years of age (average, 46.0 years). Arthroscopic surgery plus one or more posterior small incisions was performed in 40 of them while the sinus tarsi approach was used in the other 45 cases. The 2 groups were compared in terms of operation time, fracture healing time, incision complications and functions of the affected foot by the American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot scores. \u0000 \u0000 \u0000Results \u0000There were no significant differences in the preoperative general data between the 2 groups, showing they were comparable (P>0.05). The average follow-up period for all the patients was 8 months (from 6 to 12 months). For the arthroscopic surgery group and sinus tarsi approach group, the fracture healing time was 8.6±2.4 weeks and 8.9±1.8 weeks, and the AOFAS ankle-hindfoot scores were 82.5±5.6 and 85.1±4.0, respectively, showing no significant differences between them (P>0.05). The operation time in the arthroscopic surgery group (43.6±5.4 min) was significantly less than in the sinus tarsi approach group (56.5±6.4 minutes), and the rate of complications in the former[2.5%(1/40)] significantly lower than in the latter[15.6%(7/45)] (P< 0.05). \u0000 \u0000 \u0000Conclusion \u0000Arthroscopic surgery plus one or more posterior small incisions may be a fine treatment for calcaneal fractures because postoperative incision complications can be reduced. \u0000 \u0000 \u0000Key words: \u0000Arthroscopy; Calcaneus; Fracture, bone; Posterior","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"79-83"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49464884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2020.01.008
Wenlai Fang, Mochuan Chen, Liao-Jun Sun, J. Kong
Objective To observe the clinical efficacy of internal fixation through a modified posterolateral approach in the treatment of lateral and posterior malleolar fractures. Methods From January 2015 to January 2018, 25 patients with fracture involving the lateral and posterior malleolus were treated at Department of Orthopedics, The Second Affiliated Hospital to Wenzhou Medical University. They were 13 males and 12 females, aged from 18 to 70 years (mean, 43.1 years). By the Lauge-Hansen classification for ankle injury, 9 cases belonged to supination-supination type of degree Ⅲ, 11 to supination-supination type of degree Ⅳ, and 5 to pronation-supination type of degree Ⅳ. By the Haraguchi classification, all the posterior malleolar fractures in this series belonged to type Ⅰ. Internal fixation through a modified posterolateral approach was performed for all the lateral and posterior malleolar fractures. Their operation time, fracture healing time and postoperative complications were observed. At the last follow-up, ankle joint function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. Results In the 25 patients, the operation time ranged from 50 to 100 min (mean, 70 min). Of this group, 21 patients were followed up for 12 to 18 months (mean, 14 months). Bony union was achieved after 3 to 5 months after operation. Superficial wound infection was observed in 3 cases. No such complications occurred like postoperative adhesion, deep infection, contracture of flexor hallucis longus tendon, or loosening or breakage of implants. By the AOFAS ankle-hindfoot scale at the last follow-up, the ankle function was excellent in 13 cases, good in 6 and fair in 2. Conclusion The modified posterolateral approach is worth popularizing in clinic because it provides possibilities of fixating the lateral and posterior malleolar fractures by the same incision, not stripping the muscular origins of the flexor hallucis longus and reducing postoperative adhesion of the flexor hallucis longus. Key words: Fractures, bone; Ankle joint; Fracture fixation, internal; Approach
{"title":"A modified posterolateral approach for lateral and posterior malleolar fractures: a preliminary report","authors":"Wenlai Fang, Mochuan Chen, Liao-Jun Sun, J. Kong","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.008","url":null,"abstract":"Objective \u0000To observe the clinical efficacy of internal fixation through a modified posterolateral approach in the treatment of lateral and posterior malleolar fractures. \u0000 \u0000 \u0000Methods \u0000From January 2015 to January 2018, 25 patients with fracture involving the lateral and posterior malleolus were treated at Department of Orthopedics, The Second Affiliated Hospital to Wenzhou Medical University. They were 13 males and 12 females, aged from 18 to 70 years (mean, 43.1 years). By the Lauge-Hansen classification for ankle injury, 9 cases belonged to supination-supination type of degree Ⅲ, 11 to supination-supination type of degree Ⅳ, and 5 to pronation-supination type of degree Ⅳ. By the Haraguchi classification, all the posterior malleolar fractures in this series belonged to type Ⅰ. Internal fixation through a modified posterolateral approach was performed for all the lateral and posterior malleolar fractures. Their operation time, fracture healing time and postoperative complications were observed. At the last follow-up, ankle joint function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. \u0000 \u0000 \u0000Results \u0000In the 25 patients, the operation time ranged from 50 to 100 min (mean, 70 min). Of this group, 21 patients were followed up for 12 to 18 months (mean, 14 months). Bony union was achieved after 3 to 5 months after operation. Superficial wound infection was observed in 3 cases. No such complications occurred like postoperative adhesion, deep infection, contracture of flexor hallucis longus tendon, or loosening or breakage of implants. By the AOFAS ankle-hindfoot scale at the last follow-up, the ankle function was excellent in 13 cases, good in 6 and fair in 2. \u0000 \u0000 \u0000Conclusion \u0000The modified posterolateral approach is worth popularizing in clinic because it provides possibilities of fixating the lateral and posterior malleolar fractures by the same incision, not stripping the muscular origins of the flexor hallucis longus and reducing postoperative adhesion of the flexor hallucis longus. \u0000 \u0000 \u0000Key words: \u0000Fractures, bone; Ankle joint; Fracture fixation, internal; Approach","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"45-48"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46226724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2020.01.013
Kai Xu, Kainan Li
Objective To explore the significance of proximal femoral medial wall plating by finite element analysis of the stability after medial wall fixation of the proximal femur in all types of 6-part classification of femoral intertrochanteric fractures. Methods Finite element method was used to establish models of 7 types of 6-part classification of femoral intertrochanteric fractures which were fixated with proximal femoral nail anti-rotation (PFNA), medial wall plating (bi-cortex), PFNA+medial wall plating (uni-cortex). The boundary conditions and material properties were defined according to the data published in literature. A load of the peak hip stress was applied in simulation of a normal adult of 70 kg in weight walking. The conditions above produced the Von Mises stress diagrams and Min Principal stress distributions of the normal femur for 21 groups of internal fixation models. The stability of the model was assessed by analyzing the peak stress value of the key part and fragmental displacements in each group. Results In 7 types of fractures fixated with PFNA, the changes in stress and fragmental displacement were small for all major femoral parts while the fragmental displacement increased in the greater trochanter. In the medial wall plating, the stress increased obviously with the increase in bone fragments, especially the lateral ones, for the significant femoral parts and internal fixation, and the fragmental displacements increased greatly but the displacement was always limited for the medial fragments. In the fixation with PFNA+medial wall plating, the stress changes and fragmental displacements for significant femoral parts were the smallest of the 3 fixation methods. Conclusions Proximal femoral plating can effectively reduce stress concentration at the proximal femur and provide better support for the medial wall of the proximal femur. For unstable fractures, PFNA plus medial plating may provide rigid fixation because it better reduces stress on the femur than simple PFNA, does not increase fragmental displacements and leads to no significant abnormal changes in internal fixation structure. Key words: Femur; Fractures, bone; Fracture fixation, internal; Proximal femoral medial wall
{"title":"Finite element analysis of medial wall fixation of proximal femur","authors":"Kai Xu, Kainan Li","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.013","url":null,"abstract":"Objective \u0000To explore the significance of proximal femoral medial wall plating by finite element analysis of the stability after medial wall fixation of the proximal femur in all types of 6-part classification of femoral intertrochanteric fractures. \u0000 \u0000 \u0000Methods \u0000Finite element method was used to establish models of 7 types of 6-part classification of femoral intertrochanteric fractures which were fixated with proximal femoral nail anti-rotation (PFNA), medial wall plating (bi-cortex), PFNA+medial wall plating (uni-cortex). The boundary conditions and material properties were defined according to the data published in literature. A load of the peak hip stress was applied in simulation of a normal adult of 70 kg in weight walking. The conditions above produced the Von Mises stress diagrams and Min Principal stress distributions of the normal femur for 21 groups of internal fixation models. The stability of the model was assessed by analyzing the peak stress value of the key part and fragmental displacements in each group. \u0000 \u0000 \u0000Results \u0000In 7 types of fractures fixated with PFNA, the changes in stress and fragmental displacement were small for all major femoral parts while the fragmental displacement increased in the greater trochanter. In the medial wall plating, the stress increased obviously with the increase in bone fragments, especially the lateral ones, for the significant femoral parts and internal fixation, and the fragmental displacements increased greatly but the displacement was always limited for the medial fragments. In the fixation with PFNA+medial wall plating, the stress changes and fragmental displacements for significant femoral parts were the smallest of the 3 fixation methods. \u0000 \u0000 \u0000Conclusions \u0000Proximal femoral plating can effectively reduce stress concentration at the proximal femur and provide better support for the medial wall of the proximal femur. For unstable fractures, PFNA plus medial plating may provide rigid fixation because it better reduces stress on the femur than simple PFNA, does not increase fragmental displacements and leads to no significant abnormal changes in internal fixation structure. \u0000 \u0000 \u0000Key words: \u0000Femur; Fractures, bone; Fracture fixation, internal; Proximal femoral medial wall","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"72-78"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44248569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2020.01.016
Yangli Xie, Q. Tan, F. Luo, Can Li, Junlan Huang, Xiaolan Du, Lin Chen
Growth plate, the developmental center of endochondral osteogenesis, can be divided morphologically and functionally into a resting zone, a proliferative zone, a prehypertrophic zone and a hypertrophic zone. Injuries to growth plate often lead to bone growth defects including limb length discrepancy and angulation deformity in children. Currently, their orthopedic corrective surgeries are invasive and limitedly effective and no effective biotherapy has been available. Previous studies on animal models of growth plate damage have investigated the related cellular and molecular events in the repair of damaged growth plates in the 4 distinct inflammatory, fibrogenic, osteogenic and remodeling phases. Related molecules involved in the regulation of the above processes, such as inflammatory cytokines tumor necrosis factor alpha, mitogenic platelet-derived growth factor and bone morphogenetic protein, are found to participate in the regulation of growth plate injury. Exploration of the mechanisms may provide new targets for biotherapy. In addition, development of cartilage tissue engineering, especially application of mesenchymal stem cells, also provides potential interventions for growth plate injury. Key words: Tissue engineering; Wounds and injuries; Bone marrow cells; Growth plate; Chondrogenesis
{"title":"Research advances in repair of growth plate injury","authors":"Yangli Xie, Q. Tan, F. Luo, Can Li, Junlan Huang, Xiaolan Du, Lin Chen","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.016","url":null,"abstract":"Growth plate, the developmental center of endochondral osteogenesis, can be divided morphologically and functionally into a resting zone, a proliferative zone, a prehypertrophic zone and a hypertrophic zone. Injuries to growth plate often lead to bone growth defects including limb length discrepancy and angulation deformity in children. Currently, their orthopedic corrective surgeries are invasive and limitedly effective and no effective biotherapy has been available. Previous studies on animal models of growth plate damage have investigated the related cellular and molecular events in the repair of damaged growth plates in the 4 distinct inflammatory, fibrogenic, osteogenic and remodeling phases. Related molecules involved in the regulation of the above processes, such as inflammatory cytokines tumor necrosis factor alpha, mitogenic platelet-derived growth factor and bone morphogenetic protein, are found to participate in the regulation of growth plate injury. Exploration of the mechanisms may provide new targets for biotherapy. In addition, development of cartilage tissue engineering, especially application of mesenchymal stem cells, also provides potential interventions for growth plate injury. \u0000 \u0000Key words: \u0000Tissue engineering; Wounds and injuries; Bone marrow cells; Growth plate; Chondrogenesis","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"88-92"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43335534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2020.01.011
X. An, Baoshan Xu, Xiao-jian Wang, Jie Wei, Baoguo Chang, F. Chang, Jie-fu Song, Yun-xing Su
Objective To evaluate the factors related to contralateral hip fracture in the elderly patients with hip fracture by meta analysis. Methods Pubmed, Cochrane, CBMdisc, CNKI Chinese Journal Full Text Database and Wan Fang Database were searched for publications at home and abroad from January 2005 to April 2018 on factors related to contralateral hip fracture after hip fractures in the elderly. The publication quality was strictly evaluated before the data were extracted concerning gender and age(>65 years) of the patients, concomitant osteoporosis (Singh sign ≥4), primary fracture type, concomitant Parkinson disease, concomitant stroke, concomitant senile dementia, concomitant cataract, concomitant rheumatoid arthritis, concomitant diabetes, type of internal fixation for primary fracture and therapeutic compliance. Revman5.0 was used to perform the statistical analysis and the OR value and 95% CI were calculated fore each index. Results A total of 17 studies were included involving 1,504 patients with contralateral hip fracture among 13,717 elderly patients with hip fracture. The factors related to the refracture of the contralateral hip were the age of the patients (OR=-3.55, 95% CI:-5.60~-1.50, P<0.001), osteoporosis (OR=2.38, 95% CI: 1.36~4.17, P=0.002), Parkinson disease (OR=4.54, 95% CI: 2.74~7.53, P<0.001), stroke (OR=0.33, 95% CI: 0.18~0.59, P<0.001), senile dementia (OR=0.43, 95% CI: 0.29~0.62, P<0.001), cataract (OR=0.37, 95% CI: 0.22~0.63, P< 0.001), rheumatoid arthritis (OR=0.32, 95% CI: 0.21~0.50, P<0.001), diabetes (OR=0.65, 95% CI: 0.47~0.91, P=0.01), type of internal fixation for primary fracture (OR=0.51, 95% CI: 0.30~0.85, P=0.01), and therapeutic compliance (OR=0.36, 95% CI: 0.21~0.64, P<0.001). However, the refracture of the contralateral hip was not related to gender (OR=1.07, 95% CI: 0.45~2.56, P=0.88), smoking (OR=0.86, 95% CI: 0.40~1.86, P=0.70), fracture type (OR=0.97, 95% CI: 0.60~1.57, P=0.90), or hypertension (OR=0.70, 95% CI: 0.41~1.21, P=0.20). Conclusions In elderly patients with hip fracture, the risks for contralateral hip fracture may be advanced age, concomitant osteoporosis, Parkinson disease, stroke, senile dementia, cataract, rheumatoid arthritis and diabetes, type of internal fixation for primary fracture, and poor therapeutic compliance. However, no sufficient evidence has suggested that gender, smoking, type of hip fracture or concomitant hypertension might be associated with the contralateral hip fracture. Key words: Elderly; Hip fracture; Meta-analysis; Contralateral hip fracture; Related factors
{"title":"Risk factors related to contralateral hip fracture following hip fracture in elderly patients: a meta analysis and review","authors":"X. An, Baoshan Xu, Xiao-jian Wang, Jie Wei, Baoguo Chang, F. Chang, Jie-fu Song, Yun-xing Su","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.011","url":null,"abstract":"Objective \u0000To evaluate the factors related to contralateral hip fracture in the elderly patients with hip fracture by meta analysis. \u0000 \u0000 \u0000Methods \u0000Pubmed, Cochrane, CBMdisc, CNKI Chinese Journal Full Text Database and Wan Fang Database were searched for publications at home and abroad from January 2005 to April 2018 on factors related to contralateral hip fracture after hip fractures in the elderly. The publication quality was strictly evaluated before the data were extracted concerning gender and age(>65 years) of the patients, concomitant osteoporosis (Singh sign ≥4), primary fracture type, concomitant Parkinson disease, concomitant stroke, concomitant senile dementia, concomitant cataract, concomitant rheumatoid arthritis, concomitant diabetes, type of internal fixation for primary fracture and therapeutic compliance. Revman5.0 was used to perform the statistical analysis and the OR value and 95% CI were calculated fore each index. \u0000 \u0000 \u0000Results \u0000A total of 17 studies were included involving 1,504 patients with contralateral hip fracture among 13,717 elderly patients with hip fracture. The factors related to the refracture of the contralateral hip were the age of the patients (OR=-3.55, 95% CI:-5.60~-1.50, P<0.001), osteoporosis (OR=2.38, 95% CI: 1.36~4.17, P=0.002), Parkinson disease (OR=4.54, 95% CI: 2.74~7.53, P<0.001), stroke (OR=0.33, 95% CI: 0.18~0.59, P<0.001), senile dementia (OR=0.43, 95% CI: 0.29~0.62, P<0.001), cataract (OR=0.37, 95% CI: 0.22~0.63, P< 0.001), rheumatoid arthritis (OR=0.32, 95% CI: 0.21~0.50, P<0.001), diabetes (OR=0.65, 95% CI: 0.47~0.91, P=0.01), type of internal fixation for primary fracture (OR=0.51, 95% CI: 0.30~0.85, P=0.01), and therapeutic compliance (OR=0.36, 95% CI: 0.21~0.64, P<0.001). However, the refracture of the contralateral hip was not related to gender (OR=1.07, 95% CI: 0.45~2.56, P=0.88), smoking (OR=0.86, 95% CI: 0.40~1.86, P=0.70), fracture type (OR=0.97, 95% CI: 0.60~1.57, P=0.90), or hypertension (OR=0.70, 95% CI: 0.41~1.21, P=0.20). \u0000 \u0000 \u0000Conclusions \u0000In elderly patients with hip fracture, the risks for contralateral hip fracture may be advanced age, concomitant osteoporosis, Parkinson disease, stroke, senile dementia, cataract, rheumatoid arthritis and diabetes, type of internal fixation for primary fracture, and poor therapeutic compliance. However, no sufficient evidence has suggested that gender, smoking, type of hip fracture or concomitant hypertension might be associated with the contralateral hip fracture. \u0000 \u0000 \u0000Key words: \u0000Elderly; Hip fracture; Meta-analysis; Contralateral hip fracture; Related factors","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"60-66"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42649997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2020.01.003
Yun-Feng Zhou, Zheng-Zheng Zhang, Zhong Chen, Chuan Jiang, Yue Xu, H. Zhang, Weiping Li, Bin Song
Objective To compare the outcomes of bone marrow stimulation techniques -- drilling by a Kirschner needle versus microfracturing technique in the treatment of small osteochondral lesions of the talus. Methods From February 2014 to June 2017, 57 patients were treated at Department of Orthopaedics, Sun Yat-sen Memorial Hospital for small osteochondral lesions of the talus. Of them, 26 were treated by arthroscopic drilling with a Kirschner needle. They were 15 males and 11 females, aged from 20 to 57 years. The areas of osteochondral lesion ranged from 0.6 to 1.4 cm2. By the Berndt & Harty classification of ankle osteochondral lesions based on X-ray films, there were 9 cases of stage Ⅰ, 8 cases of stage Ⅱ, 6 cases of stage Ⅲ and 3 cases of stage Ⅳ. The other 31 patients of them were treated by arthroscopic microfracturing technique. They were 17 males and 14 females, aged from 24 to 55 years. The areas of osteochondral lesion ranged from 0.5 to 1.5 cm2. By the Berndt & Harty classification of ankle osteochondral lesions based on X-ray films, there were 10 cases of stage Ⅰ, 11 cases of stage Ⅱ, 8 cases of stage Ⅲ and 2 cases of stage Ⅳ. The 2 groups were compared in terms of visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the ankle activity score (AAS) and the Berndt & Harty staging of osteochondral lesions based on ankle X-ray films at the final follow-up. Results All the 57 patients were followed up for 13 to 27 months. The VAS, AOFAS and AAS scores and Berndt & Harty stages at the final follow-up were significantly improved in all the patients compared with their preoperative values (P 0.05). There was no significant difference between the 2 groups either in the excellent and good rate by the AOFAS ankle-hindfoot scoring [88.5% (23/26) versus 90.3% (28/31)] at the final follow-up (χ2=0.052, P=0.820). Conclusion In the treatment of small osteochondral lesions of the talus, both arthroscopic drilling with a Kirschner needle and microfracturing technique can achieve satisfactory short-term curative effects, but the long-term effects need to be further studied. Key words: Ankle joint; Cartilage; Wounds and injuries; Arthroscopy, subchondral
{"title":"A comparison between arthroscopic drilling and microfracturing technique in treatment of osteochondral lesions of the talus","authors":"Yun-Feng Zhou, Zheng-Zheng Zhang, Zhong Chen, Chuan Jiang, Yue Xu, H. Zhang, Weiping Li, Bin Song","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.003","url":null,"abstract":"Objective \u0000To compare the outcomes of bone marrow stimulation techniques -- drilling by a Kirschner needle versus microfracturing technique in the treatment of small osteochondral lesions of the talus. \u0000 \u0000 \u0000Methods \u0000From February 2014 to June 2017, 57 patients were treated at Department of Orthopaedics, Sun Yat-sen Memorial Hospital for small osteochondral lesions of the talus. Of them, 26 were treated by arthroscopic drilling with a Kirschner needle. They were 15 males and 11 females, aged from 20 to 57 years. The areas of osteochondral lesion ranged from 0.6 to 1.4 cm2. By the Berndt & Harty classification of ankle osteochondral lesions based on X-ray films, there were 9 cases of stage Ⅰ, 8 cases of stage Ⅱ, 6 cases of stage Ⅲ and 3 cases of stage Ⅳ. The other 31 patients of them were treated by arthroscopic microfracturing technique. They were 17 males and 14 females, aged from 24 to 55 years. The areas of osteochondral lesion ranged from 0.5 to 1.5 cm2. By the Berndt & Harty classification of ankle osteochondral lesions based on X-ray films, there were 10 cases of stage Ⅰ, 11 cases of stage Ⅱ, 8 cases of stage Ⅲ and 2 cases of stage Ⅳ. The 2 groups were compared in terms of visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the ankle activity score (AAS) and the Berndt & Harty staging of osteochondral lesions based on ankle X-ray films at the final follow-up. \u0000 \u0000 \u0000Results \u0000All the 57 patients were followed up for 13 to 27 months. The VAS, AOFAS and AAS scores and Berndt & Harty stages at the final follow-up were significantly improved in all the patients compared with their preoperative values (P 0.05). There was no significant difference between the 2 groups either in the excellent and good rate by the AOFAS ankle-hindfoot scoring [88.5% (23/26) versus 90.3% (28/31)] at the final follow-up (χ2=0.052, P=0.820). \u0000 \u0000 \u0000Conclusion \u0000In the treatment of small osteochondral lesions of the talus, both arthroscopic drilling with a Kirschner needle and microfracturing technique can achieve satisfactory short-term curative effects, but the long-term effects need to be further studied. \u0000 \u0000 \u0000Key words: \u0000Ankle joint; Cartilage; Wounds and injuries; Arthroscopy, subchondral","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"13-19"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45909423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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