Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2020.01.001
Y. Chai
{"title":"How will limb salvage go on for severe trauma of lower extremities","authors":"Y. Chai","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.001","url":null,"abstract":"","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"6-8"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48486223","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.1671-7600.2020.01.012
Jin-ming Zhang, Qiang Huang, Xieyuan Jiang, G. An, Guohui Liu
Objective To evaluate the advantages of reconstructing by mimics software before operation a three-dimensional model of talar posterior process fracture which is to be used in the treatment of talar posterior process fracture through the posteromedial malleolar approach. Methods From May 2015 to February 2019, 7 patients with talar posterior process fracture were treated at Department of Orthopaedic Trauma, Jishuitan Hospital. They were 5 men and 2 women, aged from 20 to 70 years (mean, 39 years). They underwent routine CT examination preoperatively. Their posterior process of talus was reconstructed by Mimics software based on their CT scanning data before operation to determine the size, number and displacement of fracture fragments. Their fractures of posterior process of talus were treated by open reduction and screw fixation in prone position through the posterior ankle approach. The American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scoring system was used to evaluate functional recovery. Results The operation time for this group ranged from 70 min to 105 min, averaging 87.1 min. Early after operation, the wounds healed well with no injury to nerves or tendons. All patients were followed up for 4 to 24 months (average, 12 months). Follow-up by X-ray examination after 10 to 16 weeks revealed fracture union with no complications like screw breakage, nonunion, malunion or traumatic arthritis. Their AOFAS ankle-hindfoot scores at the final follow-up ranged from 80 to 98 points. Conclusion Preoperative three-dimensional reconstruction of talar posterior process fracture based on CT images using Mimics software can accurately determine the entry point and direction of screw insertion, yielding advantages of clear exposure, easy reduction and convenient screwing in the treatment of talar posterior process fracture through the posteromedial malleolar approach. Key words: Talus; Os trigonum; Fractures, bone; Materialise’s interactive medical image control system; Surgical approach
{"title":"Reconstruction of talus model with Mimics software for treatment of talar posterior process fracture through posteromedial malleolar approach","authors":"Jin-ming Zhang, Qiang Huang, Xieyuan Jiang, G. An, Guohui Liu","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.012","url":null,"abstract":"Objective \u0000To evaluate the advantages of reconstructing by mimics software before operation a three-dimensional model of talar posterior process fracture which is to be used in the treatment of talar posterior process fracture through the posteromedial malleolar approach. \u0000 \u0000 \u0000Methods \u0000From May 2015 to February 2019, 7 patients with talar posterior process fracture were treated at Department of Orthopaedic Trauma, Jishuitan Hospital. They were 5 men and 2 women, aged from 20 to 70 years (mean, 39 years). They underwent routine CT examination preoperatively. Their posterior process of talus was reconstructed by Mimics software based on their CT scanning data before operation to determine the size, number and displacement of fracture fragments. Their fractures of posterior process of talus were treated by open reduction and screw fixation in prone position through the posterior ankle approach. The American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scoring system was used to evaluate functional recovery. \u0000 \u0000 \u0000Results \u0000The operation time for this group ranged from 70 min to 105 min, averaging 87.1 min. Early after operation, the wounds healed well with no injury to nerves or tendons. All patients were followed up for 4 to 24 months (average, 12 months). Follow-up by X-ray examination after 10 to 16 weeks revealed fracture union with no complications like screw breakage, nonunion, malunion or traumatic arthritis. Their AOFAS ankle-hindfoot scores at the final follow-up ranged from 80 to 98 points. \u0000 \u0000 \u0000Conclusion \u0000Preoperative three-dimensional reconstruction of talar posterior process fracture based on CT images using Mimics software can accurately determine the entry point and direction of screw insertion, yielding advantages of clear exposure, easy reduction and convenient screwing in the treatment of talar posterior process fracture through the posteromedial malleolar approach. \u0000 \u0000 \u0000Key words: \u0000Talus; Os trigonum; Fractures, bone; Materialise’s interactive medical image control system; Surgical approach","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"67-71"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45818301","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.1671-7600.2020.01.010
Bo Yin, Junlin Zhou, Yuanming He, Qingxian Tian, L. Shan, Meng Guo, K. Leng, Yanrui Zhao
Objective To verify the reliability of novel 3D classification of intertrochanteric fractures by comparing the consistency between conventional and novel classifications. Methods Included for the present study were the preoperative X-ray and CT images of 189 patients with intertrochanteric fracture who had been hospitalized at Department of Orthopaedics, Beijing Chao Yang Hospital, Capital Medical University from 1 January, 2017 to 1 January, 2019. The patients’ intertrochanteric fractures were classified by 6 orthopedic surgeons independently using Evans classification, Jensen classification, AO classification and novel 3D classification, respectively. One month later, the original images of the 189 patients were renumbered and classified again in the same way. The Kappa values between observers and within observers were calculated for the classifications of intertrochanteric fractures based on X-ray and CT images. Results In Evans classification, Jensen classification, AO classification and novel 3D classification, the interobserver Kappa values of X-ray films were 0.54±0.03, 0.53±0.03, 0.45±0.03 and 0.63±0.02, respectively, and the interobserver Kappa values of the CT images were 0.49±0.03, 0.49±0.03, 0.44±0.04 and 0.63±0.03. The intraobserver Kappa values of the X-ray films were 0.53±0.02, 0.54±0.03, 0.44±0.04 and 0.65±0.02, respectively, and the intraobserver Kappa values of the CT images were 0.52±0.03, 0.52±0.03, 0.41±0.02 and 0.64±0.03. In the novel classification based on X-ray and CT images, the interobserver and intraobserver Kappa values were both significantly higher than those in Evans, Jensen and AO classifications (P<0.05). Conclusion The novel 3D classification of intertrochanteric fractures is more reliable than the conventional ones. Key words: Femur; Fractures, bone; Reproducibility of results; Fracture classification
{"title":"Reliability analysis of novel 3D classification of intertrochanteric fractures","authors":"Bo Yin, Junlin Zhou, Yuanming He, Qingxian Tian, L. Shan, Meng Guo, K. Leng, Yanrui Zhao","doi":"10.3760/CMA.J.ISSN.1671-7600.2020.01.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2020.01.010","url":null,"abstract":"Objective \u0000To verify the reliability of novel 3D classification of intertrochanteric fractures by comparing the consistency between conventional and novel classifications. \u0000 \u0000 \u0000Methods \u0000Included for the present study were the preoperative X-ray and CT images of 189 patients with intertrochanteric fracture who had been hospitalized at Department of Orthopaedics, Beijing Chao Yang Hospital, Capital Medical University from 1 January, 2017 to 1 January, 2019. The patients’ intertrochanteric fractures were classified by 6 orthopedic surgeons independently using Evans classification, Jensen classification, AO classification and novel 3D classification, respectively. One month later, the original images of the 189 patients were renumbered and classified again in the same way. The Kappa values between observers and within observers were calculated for the classifications of intertrochanteric fractures based on X-ray and CT images. \u0000 \u0000 \u0000Results \u0000In Evans classification, Jensen classification, AO classification and novel 3D classification, the interobserver Kappa values of X-ray films were 0.54±0.03, 0.53±0.03, 0.45±0.03 and 0.63±0.02, respectively, and the interobserver Kappa values of the CT images were 0.49±0.03, 0.49±0.03, 0.44±0.04 and 0.63±0.03. The intraobserver Kappa values of the X-ray films were 0.53±0.02, 0.54±0.03, 0.44±0.04 and 0.65±0.02, respectively, and the intraobserver Kappa values of the CT images were 0.52±0.03, 0.52±0.03, 0.41±0.02 and 0.64±0.03. In the novel classification based on X-ray and CT images, the interobserver and intraobserver Kappa values were both significantly higher than those in Evans, Jensen and AO classifications (P<0.05). \u0000 \u0000 \u0000Conclusion \u0000The novel 3D classification of intertrochanteric fractures is more reliable than the conventional ones. \u0000 \u0000 \u0000Key words: \u0000Femur; Fractures, bone; Reproducibility of results; Fracture classification","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"22 1","pages":"55-59"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45908332","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}
Objective To evaluate the clinical efficacy of the modified Stoppa approach in the surgical treatment of pelvic fractures of Tile type C combined with acetabular both-column fractures. Methods Between April 2014 and April 2017, a total of 14 patients were treated by open reduction and internal fixation (ORIF) through the modified Stoppa approach at Department of Orthopaedics, Foshan Gaoming Hospital for pelvic fractures of Tile type C combined with acetabular both-column fractures. They were 10 men and 4 women, with an average age of 36.4 years (from 23 to 57 years). The modified Stoppa approach was used exclusively in 4 cases, in combination with the iliac fossa approach in 3 ones, in combination with the Kocher-Langenbeck approach in 4 ones and in combination with the Kocher-Langenbeck and iliac fossa approaches in 3 ones. In all the patients, the pelvic reconstructive plate and screws and lag screws were used. The operation time, intraoperative bleeding volume, postoperative fracture reduction, fracture union time, efficacy and complications were recorded. Results The operation time averaged 170 min (from 110 to 330 min) and the intraoperative bleeding 420 mL (from 240 to 1 100 mL). There were no operative complications. By the Matta evaluation, the postoperative reduction was rated as excellent in the 14 pelvic fractures and 9 acetabular both-column fractures and as good in 5 acetabular both-column fractures. Of this series, 13 patients were followed up for an average of 19 months (from 12 to 29 months) and one was lost to the follow-up. The fractures got united after an average time of 3.4 months (from 2.7 to 4.6 months). Screw loosening was observed in one case and mild limitation to hip flexion in one. Follow-ups found no lateral ventral syndrome or femoral head necrosis. Their Harris hip scores at the last follow-up ranged from 70 to 94 points, averaging 84 points. The function of the affected hip was excellent in 6 cases, good in 5 and fair in 2. Conclusion The modified Stoppa approach may be used exclusively or in combination with other approaches to treat effectively the pelvic fractures of Tile type C combined with acetabular both-column fractures, leading to good short-term clinical outcomes. Key words: Pelvis; Acetabulum; Fractures, bone; Fracture fixation, internal; Surgical approach
{"title":"Open reduction and internal fixation via modified Stoppa approach for pelvic fractures of Tile type C combined with acetabular both-column fractures","authors":"X. Xia, Wei Liu, Weiwen Lin, Bei Li, Zhiqiang Yan, Qiang Liu, Hao Xiong","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.12.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.12.010","url":null,"abstract":"Objective \u0000To evaluate the clinical efficacy of the modified Stoppa approach in the surgical treatment of pelvic fractures of Tile type C combined with acetabular both-column fractures. \u0000 \u0000 \u0000Methods \u0000Between April 2014 and April 2017, a total of 14 patients were treated by open reduction and internal fixation (ORIF) through the modified Stoppa approach at Department of Orthopaedics, Foshan Gaoming Hospital for pelvic fractures of Tile type C combined with acetabular both-column fractures. They were 10 men and 4 women, with an average age of 36.4 years (from 23 to 57 years). The modified Stoppa approach was used exclusively in 4 cases, in combination with the iliac fossa approach in 3 ones, in combination with the Kocher-Langenbeck approach in 4 ones and in combination with the Kocher-Langenbeck and iliac fossa approaches in 3 ones. In all the patients, the pelvic reconstructive plate and screws and lag screws were used. The operation time, intraoperative bleeding volume, postoperative fracture reduction, fracture union time, efficacy and complications were recorded. \u0000 \u0000 \u0000Results \u0000The operation time averaged 170 min (from 110 to 330 min) and the intraoperative bleeding 420 mL (from 240 to 1 100 mL). There were no operative complications. By the Matta evaluation, the postoperative reduction was rated as excellent in the 14 pelvic fractures and 9 acetabular both-column fractures and as good in 5 acetabular both-column fractures. Of this series, 13 patients were followed up for an average of 19 months (from 12 to 29 months) and one was lost to the follow-up. The fractures got united after an average time of 3.4 months (from 2.7 to 4.6 months). Screw loosening was observed in one case and mild limitation to hip flexion in one. Follow-ups found no lateral ventral syndrome or femoral head necrosis. Their Harris hip scores at the last follow-up ranged from 70 to 94 points, averaging 84 points. The function of the affected hip was excellent in 6 cases, good in 5 and fair in 2. \u0000 \u0000 \u0000Conclusion \u0000The modified Stoppa approach may be used exclusively or in combination with other approaches to treat effectively the pelvic fractures of Tile type C combined with acetabular both-column fractures, leading to good short-term clinical outcomes. \u0000 \u0000 \u0000Key words: \u0000Pelvis; Acetabulum; Fractures, bone; Fracture fixation, internal; Surgical approach","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"1069-1072"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46061509","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 : 2019-12-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.12.012
Yan Q Sun, Li Xiao, Zhifeng Chen, Y. Qin
Objective To evaluate the composite external fixation in the treatment of children with fracture of lower extremity metaphysis. Methods A retrospective analysis was conducted of the 42 children with fracture of lower extremity metaphysis who had been admitted to Zhengda Shaoyang Orthopaedic Hospital between September 2016 and September 2018. They were 24 boys and 18 girls, aged from 3 to 14 years (mean, 8.3 years). Open injury occurred in 10 cases, with type Ⅰ in 2, type Ⅱ in 7 and type Ⅲ in one according to the Gustilo-Anderson classification, and closed injury in the other 32 ones. The fracture happened at distal femur in 12, at proximal tibia in 9 and at distal tibia in 21 cases. All the patients were fixated with composite external brackets. Fracture healing, functional recovery of the knee and ankle joints, and complications were recorded. Results All the 42 patients were followed up for 12 to 18 months (mean, 15.8 months). All fractures healed well by the first intention with no malunion or no alignment change on the full length X-ray films of both lower limbs. Irritant growth within 1.5 cm was observed in 2 cases. No loosening occurred in the external fixation which was removed 3 to 5 months after surgery (mean, 3.8 months). Functional recovery of the knee and ankle joints was good at the last follow-up. For the patients with distal femoral metaphysis fracture, the knee function by the Merchan scoring was excellent in 3 cases, good in 7 cases, fair in one and poor in one; for the patients with proximal tibial metaphysis fracture, the knee function by the Merchan scoring was excellent in 3, good in 4 and fair in 2 cases; for the patients with distal tibial metaphysis fracture, the ankle function by the Kofoed scoring was excellent in 11, good in 7 and fair in 3 cases, giving an excellent and good rate of 83.3%. Of a total of 228 needle channels in the 42 patients, 58 were infected mildly or moderately, giving an infection rate of 25.4%. All the infections responded to active dressing change. Conclusion The composite external fixation brackets are a good choice for the treatment of children with fracture of lower extremity metaphysis, because they are easy in manipulation and stable in configuration, and can reduce the iatrogenic injury to the epiphyseal plate, spare cross-articular fixation and allow early functional exercise. Key words: Lower extremity; Fractures, bone; Fracture fixation; External fixator; Child
{"title":"Composite external fixation for children with fracture of lower extremity metaphysis","authors":"Yan Q Sun, Li Xiao, Zhifeng Chen, Y. Qin","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.12.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.12.012","url":null,"abstract":"Objective \u0000To evaluate the composite external fixation in the treatment of children with fracture of lower extremity metaphysis. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted of the 42 children with fracture of lower extremity metaphysis who had been admitted to Zhengda Shaoyang Orthopaedic Hospital between September 2016 and September 2018. They were 24 boys and 18 girls, aged from 3 to 14 years (mean, 8.3 years). Open injury occurred in 10 cases, with type Ⅰ in 2, type Ⅱ in 7 and type Ⅲ in one according to the Gustilo-Anderson classification, and closed injury in the other 32 ones. The fracture happened at distal femur in 12, at proximal tibia in 9 and at distal tibia in 21 cases. All the patients were fixated with composite external brackets. Fracture healing, functional recovery of the knee and ankle joints, and complications were recorded. \u0000 \u0000 \u0000Results \u0000All the 42 patients were followed up for 12 to 18 months (mean, 15.8 months). All fractures healed well by the first intention with no malunion or no alignment change on the full length X-ray films of both lower limbs. Irritant growth within 1.5 cm was observed in 2 cases. No loosening occurred in the external fixation which was removed 3 to 5 months after surgery (mean, 3.8 months). Functional recovery of the knee and ankle joints was good at the last follow-up. For the patients with distal femoral metaphysis fracture, the knee function by the Merchan scoring was excellent in 3 cases, good in 7 cases, fair in one and poor in one; for the patients with proximal tibial metaphysis fracture, the knee function by the Merchan scoring was excellent in 3, good in 4 and fair in 2 cases; for the patients with distal tibial metaphysis fracture, the ankle function by the Kofoed scoring was excellent in 11, good in 7 and fair in 3 cases, giving an excellent and good rate of 83.3%. Of a total of 228 needle channels in the 42 patients, 58 were infected mildly or moderately, giving an infection rate of 25.4%. All the infections responded to active dressing change. \u0000 \u0000 \u0000Conclusion \u0000The composite external fixation brackets are a good choice for the treatment of children with fracture of lower extremity metaphysis, because they are easy in manipulation and stable in configuration, and can reduce the iatrogenic injury to the epiphyseal plate, spare cross-articular fixation and allow early functional exercise. \u0000 \u0000 \u0000Key words: \u0000Lower extremity; Fractures, bone; Fracture fixation; External fixator; Child","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"1077-1080"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47161663","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 : 2019-12-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.12.014
Junfeng Zhan, Jialiu Fang, J. Jing, N. Zhu, Wang Fang, Yun Zhou
Objective To explore the clinical efficacy of plate fixation via the lateral transverse incisions and double-window approaches for the treatment of intra-articular calcaneal fractures. Methods A retrospective analysis was performed on the data of 21 intra-articular calcaneal fractures (22 feet) which had been treated at Department of Orthopaedics, The Second Affiliated Hospital to Anhui Medical University from May 2014 to April 2016. There were 19 males and 2 females, aged from 20 to 60 years (average, 38.3 years). The fracture affected 13 left feet and 9 right feet. According to the Sanders classification, 10 feet were type Ⅱ, 11 type Ⅲ and one type Ⅳ. They were treated by plate fixation via the lateral transverse incisions and double-window approaches. Early complications within 3 months after operation, the length, width, height, Bohler angle and Gissane angle of the calcaneus one year after operation, functional recovery of the affected feet at the last follow-up, and complications were recorded. Results The 21 patients were followed up for 21 to 44 months (mean, 36.7 months). Incisions were all healed at the first postoperative stage with no serious skin or soft tissue complications like superficial infection, deep infection or wound dehiscence. At the early stage, one patient suffered epidermal necrosis at the margin of incision, which was cured after dressing change. None of the patients developed subtalar arthritis by the last follow-up. The preoperative length, width, height, Bohler angle and Gissane angle of the calcaneus (respectively, 68.6±1.2 mm, 46.7±0.8 mm, 39.1±2.0 mm, 5.4°±12.1° and 104.3°±10.2°) were significantly improved to 71.7±1.6 mm, 48.8±2.0 mm, 32.8±1.3 mm, 29.2°±6.8°, and 120.8°±6.2° one year after operation(P<0.05). At the last follow-up, their AOFAS ankle-hind foot scores averaged 92.7 points (from 73 to 98 points); 17 feet were rated as excellent, 3 as good and 2 as moderate, giving an excellent and good rate of 90.1%. Conclusion Plate fixation via the lateral transverse incisions and double-window approaches can reduce incidences of postoperative soft tissue complications and subtalar arthritis, leading to good clinical results in the treatment of intra-articular calcaneal fractures. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal; Surgical approach
{"title":"Treatment of intra-articular calcaneal fractures by plate fixation via lateral transverse incisions and double-window approaches","authors":"Junfeng Zhan, Jialiu Fang, J. Jing, N. Zhu, Wang Fang, Yun Zhou","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.12.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.12.014","url":null,"abstract":"Objective \u0000To explore the clinical efficacy of plate fixation via the lateral transverse incisions and double-window approaches for the treatment of intra-articular calcaneal fractures. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed on the data of 21 intra-articular calcaneal fractures (22 feet) which had been treated at Department of Orthopaedics, The Second Affiliated Hospital to Anhui Medical University from May 2014 to April 2016. There were 19 males and 2 females, aged from 20 to 60 years (average, 38.3 years). The fracture affected 13 left feet and 9 right feet. According to the Sanders classification, 10 feet were type Ⅱ, 11 type Ⅲ and one type Ⅳ. They were treated by plate fixation via the lateral transverse incisions and double-window approaches. Early complications within 3 months after operation, the length, width, height, Bohler angle and Gissane angle of the calcaneus one year after operation, functional recovery of the affected feet at the last follow-up, and complications were recorded. \u0000 \u0000 \u0000Results \u0000The 21 patients were followed up for 21 to 44 months (mean, 36.7 months). Incisions were all healed at the first postoperative stage with no serious skin or soft tissue complications like superficial infection, deep infection or wound dehiscence. At the early stage, one patient suffered epidermal necrosis at the margin of incision, which was cured after dressing change. None of the patients developed subtalar arthritis by the last follow-up. The preoperative length, width, height, Bohler angle and Gissane angle of the calcaneus (respectively, 68.6±1.2 mm, 46.7±0.8 mm, 39.1±2.0 mm, 5.4°±12.1° and 104.3°±10.2°) were significantly improved to 71.7±1.6 mm, 48.8±2.0 mm, 32.8±1.3 mm, 29.2°±6.8°, and 120.8°±6.2° one year after operation(P<0.05). At the last follow-up, their AOFAS ankle-hind foot scores averaged 92.7 points (from 73 to 98 points); 17 feet were rated as excellent, 3 as good and 2 as moderate, giving an excellent and good rate of 90.1%. \u0000 \u0000 \u0000Conclusion \u0000Plate fixation via the lateral transverse incisions and double-window approaches can reduce incidences of postoperative soft tissue complications and subtalar arthritis, leading to good clinical results in the treatment of intra-articular calcaneal fractures. \u0000 \u0000 \u0000Key words: \u0000Calcaneus; Fractures, bone; Fracture fixation, internal; Surgical approach","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"1085-1089"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47681441","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 : 2019-12-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.12.013
Hong-Wei Ma, Yueming Guo, Chong-da Zhao
Objective To compare the clinical efficacy between arthroscopic riveting with line and lateral retinacular release plus medial patellofemoral ligament reconstruction in the treatment of habitual patellar dislocation. Methods A retrospective study was conducted of the 40 children with habitual patellar dislocation who had been treated at Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine from January 2016 to December 2016. They were divided evenly into an observation group and a control group according to the treatment methods (n=20). In the observation group which was treated by lateral retinacular release plus medial patellofemoral ligament reconstruction, there were 14 boys and 6 girls, with an age of 14.2±1.2 years and an average number of dislocations of 5.3±1.1 times. In the control group which was treated by arthroscopic riveting with line, there were 13 boys and 7 girls, with an age of 13.8±1.3 years and an average number of dislocations of 5.5±1.2 times. The 2 groups were compared in terms of visual analogue score (VAS), Q-angle, knee motion, Lysholm score and Kujala score of the knee at the last follow-ups. Results The 2 groups were comparable due to insignificant differences in preoperative general data between them (P>0.05). The observation and control groups were followed up for 13.3±1.2 months and 12.9±1.2 months, respectively, showing no significant difference between them(P>0.05). At the last follow-ups, the observation group had a significantly lower VAS score (2.2±0.8 pints), a significantly smaller Q-angle (14.5°±1.2°), significantly larger knee motion (30.3°±3.8°), and significantly higher Lysholm (91.6±5.3 points) and Kujala scores (93.2±2.8 points) than the control group (4.3±1.1 points, 17.8°±1.6°, 23.4°±3.4°, 81.4±4.4 points and 82.0±5.4 points, respectively) (all P<0.05). Conclusion In the treatment of habitual patellar dislocation, lateral retinacular release plus medial patellofemoral ligament reconstruction can lead to improvements in knee function and clinical symptoms and better clinical outcomes than arthroscopic riveting with line. Key words: Patellar dislocation; Arthroscopy; Bone nails; Lateral retinaculum; Medial patellofemoral ligament
{"title":"Arthroscopic riveting with line versus lateral retinacular release plus medial patellofemoral ligament re-construction for habitual patellar dislocation","authors":"Hong-Wei Ma, Yueming Guo, Chong-da Zhao","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.12.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.12.013","url":null,"abstract":"Objective \u0000To compare the clinical efficacy between arthroscopic riveting with line and lateral retinacular release plus medial patellofemoral ligament reconstruction in the treatment of habitual patellar dislocation. \u0000 \u0000 \u0000Methods \u0000A retrospective study was conducted of the 40 children with habitual patellar dislocation who had been treated at Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine from January 2016 to December 2016. They were divided evenly into an observation group and a control group according to the treatment methods (n=20). In the observation group which was treated by lateral retinacular release plus medial patellofemoral ligament reconstruction, there were 14 boys and 6 girls, with an age of 14.2±1.2 years and an average number of dislocations of 5.3±1.1 times. In the control group which was treated by arthroscopic riveting with line, there were 13 boys and 7 girls, with an age of 13.8±1.3 years and an average number of dislocations of 5.5±1.2 times. The 2 groups were compared in terms of visual analogue score (VAS), Q-angle, knee motion, Lysholm score and Kujala score of the knee at the last follow-ups. \u0000 \u0000 \u0000Results \u0000The 2 groups were comparable due to insignificant differences in preoperative general data between them (P>0.05). The observation and control groups were followed up for 13.3±1.2 months and 12.9±1.2 months, respectively, showing no significant difference between them(P>0.05). At the last follow-ups, the observation group had a significantly lower VAS score (2.2±0.8 pints), a significantly smaller Q-angle (14.5°±1.2°), significantly larger knee motion (30.3°±3.8°), and significantly higher Lysholm (91.6±5.3 points) and Kujala scores (93.2±2.8 points) than the control group (4.3±1.1 points, 17.8°±1.6°, 23.4°±3.4°, 81.4±4.4 points and 82.0±5.4 points, respectively) (all P<0.05). \u0000 \u0000 \u0000Conclusion \u0000In the treatment of habitual patellar dislocation, lateral retinacular release plus medial patellofemoral ligament reconstruction can lead to improvements in knee function and clinical symptoms and better clinical outcomes than arthroscopic riveting with line. \u0000 \u0000 \u0000Key words: \u0000Patellar dislocation; Arthroscopy; Bone nails; Lateral retinaculum; Medial patellofemoral ligament","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"1081-1084"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42226520","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 : 2019-12-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.12.005
Jianchao Wang, Song Gao, Jijun Liu
Objective To compare pedicle screw internal fixation (PSIF) and subcutaneous anterior pelvic internal fixation (APIF) in the treatment of pelvic anterior ring fractures. Methods A retrospective study was conducted of a consecutive series of 46 patients who had undergone surgery for anterior ring pelvic fractures at Department of Orthopaedic Surgery, The People’s Hospital of Henan Province from January 2014 to September 2018. Of them, 20 were treated by PSIF and 26 by APIF. In the PSIF group, there were 12 males and 8 females with an age of 47.8±2.4 years, and 6 cases of B1, 9 cases of type B2, 4 cases of type B3 and one case of type C1 by the Tile’s classification; in the APIF group, there were 16 males and 10 females with an age of 49.6±1.2 years, and 9 cases of B1, 8 cases of type B2, 5 cases of type B3, 2 cases of type C1 and 2 cases of type C2 by the Tile’s classification. The 2 groups were compared in terms of surgical or postoperative complications (including iatrogenic nerve injury, infection, implant failure and fracture nonunion), fracture reduction and therapeutic efficacy at the final follow-up. Results There were no significant differences between the 2 groups of patients in their preoperative general data, indicating they were compatible(P>0.05). The 46 patients were followed up for 9 to 18 months (mean, 13.5 months). In the PSIF and APIF groups, the incidences of injury to the lateral femoral cutaneous nerve were 5.0%(1/20) and 7.7%(2/26), those of infection 5.0%(1/20) and 3.8%(1/26), and those of skin discomfort 5.0% (1/20) and 7.7%(2/26), respectively. According to the Matta criteria, the fracture reduction at the last follow-up was evaluated as excellent in 7, as good in 11 and as fair in 2 in the PSIF group, giving an excellent and good rate of 90.0%, and as excellent in 9, as good in 13 and as fair in 4 in the APIF group, giving an excellent and good rate of 84.6%. According to the Majeed criteria, the pelvic function at the final follow-up was evaluated as excellent in 10, as good in 7, as fair in 2 and as poor in one in the PSIF group, giving an excellent and good rate of 85.0%, and as excellent in 13, as good in 10, and as fair in 3 in the APIF group, giving an excellent and good rate of 88.5%. There were no significant differences between the 2 groups in all the comparisons above (P>0.05). The incidence of femoral nerve parasthesia was 0(0/20) for the PSIF group, significantly lower than that for the APIF groups (3.8%, 1/26) (P<0.05). Conclusion As both PSIF and APIF lead to similar clinical efficacy in the treatment of pelvic anterior ring fracture, either of them can be selected as an appropriate surgical procedure depending on the patient’s situation and surgeon’s experience. Key words: Pelvis; Fractures, bone; Fracture fixation, internal; Bone plates; Surgical procedures, minimally invasive
{"title":"Pedicle screw internal fixation versus subcutaneous anterior pelvic internal fixation in treatment of pelvic anterior ring fractures","authors":"Jianchao Wang, Song Gao, Jijun Liu","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.12.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.12.005","url":null,"abstract":"Objective \u0000To compare pedicle screw internal fixation (PSIF) and subcutaneous anterior pelvic internal fixation (APIF) in the treatment of pelvic anterior ring fractures. \u0000 \u0000 \u0000Methods \u0000A retrospective study was conducted of a consecutive series of 46 patients who had undergone surgery for anterior ring pelvic fractures at Department of Orthopaedic Surgery, The People’s Hospital of Henan Province from January 2014 to September 2018. Of them, 20 were treated by PSIF and 26 by APIF. In the PSIF group, there were 12 males and 8 females with an age of 47.8±2.4 years, and 6 cases of B1, 9 cases of type B2, 4 cases of type B3 and one case of type C1 by the Tile’s classification; in the APIF group, there were 16 males and 10 females with an age of 49.6±1.2 years, and 9 cases of B1, 8 cases of type B2, 5 cases of type B3, 2 cases of type C1 and 2 cases of type C2 by the Tile’s classification. The 2 groups were compared in terms of surgical or postoperative complications (including iatrogenic nerve injury, infection, implant failure and fracture nonunion), fracture reduction and therapeutic efficacy at the final follow-up. \u0000 \u0000 \u0000Results \u0000There were no significant differences between the 2 groups of patients in their preoperative general data, indicating they were compatible(P>0.05). The 46 patients were followed up for 9 to 18 months (mean, 13.5 months). In the PSIF and APIF groups, the incidences of injury to the lateral femoral cutaneous nerve were 5.0%(1/20) and 7.7%(2/26), those of infection 5.0%(1/20) and 3.8%(1/26), and those of skin discomfort 5.0% (1/20) and 7.7%(2/26), respectively. According to the Matta criteria, the fracture reduction at the last follow-up was evaluated as excellent in 7, as good in 11 and as fair in 2 in the PSIF group, giving an excellent and good rate of 90.0%, and as excellent in 9, as good in 13 and as fair in 4 in the APIF group, giving an excellent and good rate of 84.6%. According to the Majeed criteria, the pelvic function at the final follow-up was evaluated as excellent in 10, as good in 7, as fair in 2 and as poor in one in the PSIF group, giving an excellent and good rate of 85.0%, and as excellent in 13, as good in 10, and as fair in 3 in the APIF group, giving an excellent and good rate of 88.5%. There were no significant differences between the 2 groups in all the comparisons above (P>0.05). The incidence of femoral nerve parasthesia was 0(0/20) for the PSIF group, significantly lower than that for the APIF groups (3.8%, 1/26) (P<0.05). \u0000 \u0000 \u0000Conclusion \u0000As both PSIF and APIF lead to similar clinical efficacy in the treatment of pelvic anterior ring fracture, either of them can be selected as an appropriate surgical procedure depending on the patient’s situation and surgeon’s experience. \u0000 \u0000 \u0000Key words: \u0000Pelvis; Fractures, bone; Fracture fixation, internal; Bone plates; Surgical procedures, minimally invasive","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"1041-1046"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46301139","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 : 2019-12-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.12.003
F. Yao, Yu-jie Wu, Huidong Wang, Zhiyi Fu
Objective To investigate the effect of a modified puncture cannula on prevention of bone cement leakage in percutaneous vertebroplasty (PVP). Methods From January 2014 to February 2018, 243 patients with single-segmental osteoporotic vertebral fracture were treated with PVP at Department of Orthopedics, Shanghai Ninth People's Hospital. Their clinical data were retrospectively analyzed. Of them, a common puncture cannula was used in 169 cases (control group) and a modified puncture cannula in 74 (modified group). In the control group, there were 41 men and 128 women with an age of 71.6±9.5 years, and the fracture was distributed from T5 to T10 in 7 cases, from T11 to L2 in 132 and from L3 to L5 in 30. In the modified group, there were 20 men and 54 women with an age of 73.6±9.3 years, and the fracture was distributed from T5 to T10 in 3 cases, from T11 to L2 in 63 and from L3 to L5 in 8. The 2 groups were compared in terms of postoperative recovery of vertebral height, reduction in visual analogue scale(VAS) and bone cement leakage. Results There were no significant differences between the 2 groups in age, gender, distribution of fractured vertebral bodies, compression degree, condition of vertebral posterior wall, or bone cement volume injected (P>0.05). There were no significant differences either between the control and modified groups in the postoperative recovery of vertebral height (7.43%±7.82% versus 6.20%±7.84%) or reduction in VAS score (5.83±0.99 versus 5.81±0.89) (P>0.05). Bone cement leakage occurred in 93 cases (55.0%) in the control group but in 26 cases (35.1%) in the modified group, showing a significant difference (P<0.05). The incidences of bone cement leakage in the paravertebral vessels [13.5% (10/74)], paravertebral soft tissue [9.5%(7/74)] and spinal canal [4.1%(3/74)] in the modified group were all significantly lower than those in the control group [25.4%(43/169), 20.1%(34/169) and 15.4%(26/169)](P<0.05). Conclusion Application of the modified end-to-side puncture cannula is an optional scheme to prevent bone cement leakage in PVP, because it can reduce the incidence of bone cement leakage without compromising postoperative short-term outcomes, especially in the spinal canal, paraspinal vessels and paraspinal soft tissue. Key words: Osteoporosis; Vertebroplasty; Spinal fractures; Bone cement; Puncture cannula
{"title":"Application of a modified puncture cannula to prevent bone cement leakage during percutaneous vertebroplasty","authors":"F. Yao, Yu-jie Wu, Huidong Wang, Zhiyi Fu","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.12.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.12.003","url":null,"abstract":"Objective \u0000To investigate the effect of a modified puncture cannula on prevention of bone cement leakage in percutaneous vertebroplasty (PVP). \u0000 \u0000 \u0000Methods \u0000From January 2014 to February 2018, 243 patients with single-segmental osteoporotic vertebral fracture were treated with PVP at Department of Orthopedics, Shanghai Ninth People's Hospital. Their clinical data were retrospectively analyzed. Of them, a common puncture cannula was used in 169 cases (control group) and a modified puncture cannula in 74 (modified group). In the control group, there were 41 men and 128 women with an age of 71.6±9.5 years, and the fracture was distributed from T5 to T10 in 7 cases, from T11 to L2 in 132 and from L3 to L5 in 30. In the modified group, there were 20 men and 54 women with an age of 73.6±9.3 years, and the fracture was distributed from T5 to T10 in 3 cases, from T11 to L2 in 63 and from L3 to L5 in 8. The 2 groups were compared in terms of postoperative recovery of vertebral height, reduction in visual analogue scale(VAS) and bone cement leakage. \u0000 \u0000 \u0000Results \u0000There were no significant differences between the 2 groups in age, gender, distribution of fractured vertebral bodies, compression degree, condition of vertebral posterior wall, or bone cement volume injected (P>0.05). There were no significant differences either between the control and modified groups in the postoperative recovery of vertebral height (7.43%±7.82% versus 6.20%±7.84%) or reduction in VAS score (5.83±0.99 versus 5.81±0.89) (P>0.05). Bone cement leakage occurred in 93 cases (55.0%) in the control group but in 26 cases (35.1%) in the modified group, showing a significant difference (P<0.05). The incidences of bone cement leakage in the paravertebral vessels [13.5% (10/74)], paravertebral soft tissue [9.5%(7/74)] and spinal canal [4.1%(3/74)] in the modified group were all significantly lower than those in the control group [25.4%(43/169), 20.1%(34/169) and 15.4%(26/169)](P<0.05). \u0000 \u0000 \u0000Conclusion \u0000Application of the modified end-to-side puncture cannula is an optional scheme to prevent bone cement leakage in PVP, because it can reduce the incidence of bone cement leakage without compromising postoperative short-term outcomes, especially in the spinal canal, paraspinal vessels and paraspinal soft tissue. \u0000 \u0000 \u0000Key words: \u0000Osteoporosis; Vertebroplasty; Spinal fractures; Bone cement; Puncture cannula","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"1029-1035"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43863386","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 : 2019-12-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.12.016
Yang Xiao
Of all the knee ligaments, anterior cruciate ligament (ACL) is the most likely injured and thus a hot spot in sports medicine research. Complexity of the anatomical structures and motion mechanisms of the knee joint poses a great challenge to the study into the accurate biomechanics of the knee. As finite element analysis can evaluate a variety of variables effectively, such as graft type, surgical design and material properties, it can predict injury mechanisms, optimize surgical techniques and makes up for the deficiencies of biomechanical experiments. It is an important tool to evaluate the mechanical behavior of ACL. This paper summarizes the research progress in finite element analysis of ACL sports injury, discusses its significance in clinical application, and points out the insufficiencies of finite element analysis in simulating knee joint flexion-extension activity. This review may help clinicians to make better use of finite element simulation in the research of ACL sports injury. Key words: Finite element analysis; Anterior cruciate ligament; Knee joint; Wounds and injuries
{"title":"Progress in finite element analysis of sports injury to anterior cruciate ligament","authors":"Yang Xiao","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.12.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.12.016","url":null,"abstract":"Of all the knee ligaments, anterior cruciate ligament (ACL) is the most likely injured and thus a hot spot in sports medicine research. Complexity of the anatomical structures and motion mechanisms of the knee joint poses a great challenge to the study into the accurate biomechanics of the knee. As finite element analysis can evaluate a variety of variables effectively, such as graft type, surgical design and material properties, it can predict injury mechanisms, optimize surgical techniques and makes up for the deficiencies of biomechanical experiments. It is an important tool to evaluate the mechanical behavior of ACL. This paper summarizes the research progress in finite element analysis of ACL sports injury, discusses its significance in clinical application, and points out the insufficiencies of finite element analysis in simulating knee joint flexion-extension activity. This review may help clinicians to make better use of finite element simulation in the research of ACL sports injury. \u0000 \u0000 \u0000Key words: \u0000Finite element analysis; Anterior cruciate ligament; Knee joint; Wounds and injuries","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"1093-1096"},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46171210","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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