Chinese Journal of Traumatology最新文献

Endoscopic techniques have been widely used in orthopedic surgery, such as arthroscopy and transforaminal endoscopy, but the application in fracture is rarely reported. We reported a case of a 69-year-old male with pelvic fracture (AO/OTA type B2.1) who underwent successful laparoscopy-assisted pubic ramus plate fixation without auxiliary incision. We designed and applied a separate custom-made lengthening surgical instrument for internal fixation installation suitable for laparoscopic surgery, and the entire reduction and internal fixation installation were performed under laparoscopy. The patient could sit up 1 day after surgery, and the reported pain visual analogue scale score decreased from 5 points before surgery to 1 point. At 2 weeks after surgery, the patient could walk with a single crutch. At 4 weeks after surgery, the Majeed score was 73 points, and at 10 weeks after surgery, the Majeed score increased to 81 points. Twelve weeks after surgery, the patient was able to walk independently without pain, defecation and urination function, and the Majeed score was 87. Laparoscopic surgery is a new strategy for treating pelvic ring fractures. The case proves that full laparoscopic-assisted closed reduction and internal fixation of pelvic fractures is feasible.

Purpose: Femur fractures are among the most common fractures treated surgically, representing a significant challenge for the orthopedic surgeon. Peri-implant femoral fractures (PIFFs) represent a rare complication of the surgical treatment. It is necessary to pay attention during osteosynthesis, evaluating not only the fracture site but the entire femoral skeletal structure, the characteristics of the fracture, the health comorbidities, and the risk of malunion and pseudarthrosis. There are few studies on the incidence, treatment, and outcomes of PIFFs near osteosynthesis. This study aimed to investigate PIFF after osteosynthesis of femoral fractures and evaluate the mortality after surgery and the morbidity associated with these types of fractures.

Methods: A retrospective cohort study was carried out at the IRCCS Galeazzi Orthopedic Institute, Milan, Italy, between January, 2017 and December, 2022. Inclusion criteria were the presence of a femur fracture around an intramedullary nail to treat a previous fracture, follow-up ≥ 12 months, and patient age ≥ 65 years. Exclusion criterion was intraoperative periprosthetic fractures. The data were expressed as frequency and percentage. Continuous variables were expressed as mean ± standard deviation or median and range.

Results: Overall, 25 patients were enrolled (88.0% female) and the mean age was 84.5 years (range of 70 - 92 years). There were 20 patients having type B PIFF and 5 having type C. In 22 patients, multiple comorbidities were found with an average Charlson comorbidity score of 5.5 and the mean time to peri-implant fracture was 38 months. After surgery, 1 patient (4.0%) presented renal failure, 1 (4.0%) needed removal surgery for their loosening, and 2 (8.0%) presented surgical site infection. Nine patients (36.0%) died within 1 year with a mortality rate of 20. 0% at 30 days, 8.0% at 3 months, and 8.0% at 12 months.

Conclusions: PIFFs in elderly patients are associated with high short-term mortality and morbidity, so careful planning for primary fracture surgery and patient awareness to ensure prolonged compliance and a healthy lifestyle are essential for prevention.

Purpose: The management of irreducible, sagittally unstable peritrochanteric fractures presents a significant challenge due to the inability to achieve closed reduction using conventional techniques. This study introduces a novel minimally invasive technique leveraging the mechanical advantage principle with long, angled hemostatic clamps.

Methods: A retrospective review was performed on 16 patients who sustained sagittally unstable peritrochanteric fractures and underwent a percutaneous hemostatic clamp leverage reduction procedure.

Inclusion criteria: (1) Preoperative confirmation of fracture type as peritrochanteric fracture; (2) Intraoperative imaging confirms the presence of sagittal plane displacement at the fracture site; (3) Age > 18 years.

Exclusion criteria: (1) Open fractures, pathological fractures, and diabetes; (2) Long-term use of corticosteroids; (3) Patients with local skin or systemic conditions not suitable for surgery. Regular follow-ups at intervals of 6 - 8 weeks continued until evidence of bone consolidation was apparent in radiographic assessments. Evaluation of the alignment quality considered factors such as the re-establishment of the neck-shaft angle, the integrity of all cortical bone edges, and the rectification of any translational displacement, while the assessment of hip functionality was performed using the Harris scoring system. Statistical analysis of the relevant data was performed using SPSS 25.0 software.

Results: The average age of these 16 patients was 56.8 years (ranging from 25 to 81 years), consisting of 8 males and 8 females. According to the AO/OTA fracture classification, the cohort included 13 cases of type 31A, 2 cases of type 32A, and 1 case of type 32C. The time from hospital admission to the day of surgery ranged from 3 to 11 days, with an average of 5.1 days. Closed reduction was successfully implemented in all 10 instances, negating the necessity for transition to open reduction procedures. The mean operative duration was 105.8 min (range 80 - 180 min). Satisfactory results of the quality of reduction were determined by comparison with the normal side. The average Harris hip score was 94.1 (range 87 - 99), and the fracture healing time was 4.2 months (3 - 6 months). Implant failure and malunion were not observed.

Conclusions: This study provides an alternative, minimally invasive technique for reducing sagittally unstable, irreducible peritrochanteric fractures. This technique holds the potential to manage complex fractures with the same efficacy as is typically reserved for simple and easily reducible fractures.