Comparison of Curative Effect of Locking Compression Plate and Retrograde Intramedullary Nails for Distal Femur Fractures
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Objective To compare the clinical curative effect of locking compression plate and retrograde intramedullary nails for distal femur fractures. Methods The clinical data of 58 cases of distal femoral fracture treated in Department of Orthopaedics of Jingzhou City Third People's Hospital from Apr. 2009 to Apr. 2012 was collected,which were divided into steel plate group of 23 cases and intramedullary nail group of 35 cases according to the coin method. The plate group received locking compression plate internal fixation,while the intramedullary nail group underwent retrograde intramedullary nails internal fixation. The operation time,blood loss,fracture healing time,full weight bearing time and the incidence of postoperative complications of the two groups were recorded and the postoperative knee function recovery of two groups was evaluated. Results The operation time,bleeding,full weight bearing time of intramedullary nail group were significantly less than those of the control group[( 381. 3 ± 76. 8) m L vs( 479. 5 ± 89. 3) m L,( 123. 2 ±18. 6) min vs( 164. 7 ± 27. 4) min,( 9. 4 ± 2. 6) weeks vs( 11. 4 ± 3. 9) weeks,P 0. 05]; according to the standard of Kolment assessment of knee joint,the good and excellent rate of intramedullary nail group was significantly higher than the steel plat group( 88. 57% vs 69. 57%,P 0. 05). There was 1 case of postoperative incisional infection occurred,1 case of nonunion of fracture,and 2 cases of varus knee deformity in the steel plate group; there was 1 case of wound infection,1 case of nonunion,and no knee varus deformity in intramedullary nail group; the incidence of postoperative complications of the intramedullary nail group was significantly lower than that in the steel plate group( 14. 29% vs 26. 09%,P 0. 05). Conclusion Retrograde intramedullary nail in the treatment of distal femoral fracture is featured with less blood loss,significantly shortened operation time,better recovery of knee joint function after operation,and significantly lower complication rate.Keywords:
Dynamic compression plate
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Objective To evaluate the clinical outcomes of closed reduction with interlocking intramedullary nails in treatment of femoral shaft fractures.Methods Data of 48 cases with femoral shaft fractures treated with interlocking intramedullary nails were retrospectively analyzed,of whom 32 patients underwent close reduction with interlocking intramedullary nails(group A) and 16 patients underwent conventional open reduction(group B).The outcomes were compared between two groups.Results A total of 32 cases in group A and 16 cases in group B were followed up for averaged 6 months.The blood loss during surgery was less in group A than that in group B [(196±54) ml vs.(480±63) ml](P0.05).So did the time of union after operation [(4.5±2.1) months vs.(5.8±2.9) months](P0.05).The excellence rate of the joint function after operation was higher in group A than that in group B(90.0% vs.86.7%)(P0.05).There were no significant differences in operative time and rotational stability after surgery.Conclusion Closed reduction with interlocking intramedullary nail is better than conventional open reduction in treating femoral shaft fractures.
Interlocking
Femoral shaft
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Objective To study the effect of retrograde intramedullary nail(GSH) in the treatment of distal femoral fractures. Methods A total of 128 patients with distal femoral fracture were randomly divided into treatment group and control group. The patients in treatment group were treated with retrograde interlocking intramedullary nail,while the patients in control group were treated with dynamic condylar screw(DCS). Results The operation time, hospitalization time and healing time in GSH group were all shorter than those in DCS group,and the bleeding volume in GSH group was lower than that in DCS group(P 0.05); The DCS and GSH showed good effect in knee joint recovery function,but there was no statistically difference between two groups. The incidence rate of postoperative complications in GSH group was lower than that in DCS group(P 0.05). Conclusion Retrograde interlocking intramedullary nail has good effect in the treatment of distal femoral fractures,and it is worthy of clinical application.
FEMORAL CONDYLE
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Objective
To compare the effect of proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw fixation in the treatment of ipsilateral femoral neck and shaft fractures.
Methods
Data of 42 patients with ipsilateral femoral neck and shaft fractures who were admitted in our hospital from January 2007 to January 2016 were retrospectively analyzed. According to different fixation methods, the patients were divided into two groups: single intramedullary nail group (SIN group) (20 cases, treated with single proximal femoral intramedullary nail, 15 males and 5 females with an average age of 39.4); combined internal fixation group (CIF group) (22 cases, treated with femoral distal intramedullary nail combined with femoral neck hollow lag screw, 17 males and 5 females with an average age of 42.2 years). In the SIN group, 4 cases were type A, 9 cases type B, 7 cases type C according to AO classification. And 14 cases belonged to I or II (stable fracture), 6 cases of type III or IV (unstable fracture) according to Garden classification. In the CIF group, 3 cases were type A, 10 cases type B, 9 cases type C according to AO classification. And 16 cases belonged to type I or type II, 6 cases type III or IV according to Garden classification. The incision length, operation time, intraoperative blood loss, fracture healing time, postoperative weight time, stability of internal fixation, hip function score, pain in the knee and postoperative complication rate were compared between the two groups.
Results
There was no significant difference in gender, age and fracture classification between the two groups. The operation time (75.0±10.2 min), intraoperative blood loss (150.6±80.4 ml), hip Harris score excellent rate (80%) of incidence of knee pain in postoperative 3 months (10.0%) of the SIN group were significantly lower than those of the CIF group (105.2±18.4 min, 180.0±56.8 ml, 86.4% and 31.8%). The length of incision (8.3±1.4 cm) in the SIN group was significantly longer than that in the CIF group (4.0±0.6 cm). There was no significant difference in fracture healing time (SIN group 20.0±4.0 weeks, CIF group 19.6±4.2 weeks) and postoperative weight time (SIN group 8.2±4.0 weeks, CIF group 8.0±4.2 weeks) between the two groups. The main complications of the two groups were delayed union (3 cases of SIN group and 1 case of CIF group), nonunion of fracture (1 case of SIN group) and, coxa vara (1 case of SIN group). The complication of SIN group (30%) was significantly higher than that of CIF group (4.5%), which occurred mainly in unstable femoral neck fracture cases.
Conclusion
Both proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw can effectively treat femoral ipsilateral femoral neck and shaft fracture. Femoral retrograde intramedullary nail combined with hollow lga screw has more therapeutic advantages for unstable femoral neck fractures (Garden III and IV).
Key words:
Femoral fractures; Femoral neck fractures; Fracture fixation, intramedullary; Bone screws
Femoral shaft
Lag screw
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To explore the efficacy and advantages of the lower extremity axial distractor assisted closed reduction and retrograde intramedullary nail internal fixation in the treatment of distal femoral fractures.The clinical data of 49 patients with distal femoral fractures treated with retrograde intramedullary nail internal fixation between April 2016 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative reduction, the patients were divided into trial group (29 cases, using lower extremity axial distractor to assist closed reduction) and control group (20 cases, using free-hand retraction reduction). There was no significant difference in general information between the two groups ( P>0.05), such as gender, age, side of injury, cause of injury, and fracture classification. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, and callus formation time were recorded and compared between the two groups. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation.All patients successfully completed the operation. In the control group, there was 1 case with open reduction and internal fixation, and the rest of the two groups were closed reduction. There was no significant difference in operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency between the two groups ( P>0.05). There was no complication such as vascular or nerve injury and iatrogenic fracture, etc. during and after operation, and the incisions healed by first intention. Except for 2 patients in the trial group who were lost to follow-up at 3 months after operation, the rest of the patients were followed up 12-36 months, with an average of 16.0 months. There was no significant difference in the callus formation time between the two groups ( t=2.195, P=0.145). During the follow-up, postoperative knee joint stiffness occurred in 1 case in the control group, which improved by strengthening the knee joint function exercise and removing the internal fixator; the rest were not found to be associated with delayed or nonunion fractures, knee stiffness, and internal fixation complication. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation, the trial group achieved excellent results in 22 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 96.3%; in the control group, the results were excellent in 16 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate was 95.0%; showing no significant difference in the excellent and good rate between the two groups ( χ2=0.451, P=0.502).The lower extremity axial distractor assisted closed reduction and retrograde intramedullary nailing for the treatment of distal femoral fractures is convenient, which has satisfactory efficacy.探讨下肢轴向牵引器辅助闭合复位逆行髓内钉内固定治疗股骨远端骨折的疗效及优势。.回顾性分析 2016 年 4 月—2018 年 12 月行逆行髓内钉内固定治疗的 49 例股骨远端骨折患者临床资料。根据术中复位方式不同将患者分为试验组（29 例，使用下肢轴向牵引器辅助闭合复位）与对照组（20 例，采用徒手牵开复位）。两组患者性别、年龄、受伤侧别、致伤原因、骨折分型等一般资料比较差异均无统计学意义（ P>0.05）。记录并比较两组患者手术时间、术中出血量、术中透视次数、骨痂形成时间；术后 1 年根据 Schatzker-Lambert 标准对患肢功能进行评估。.所有患者均顺利完成手术，对照组有 1 例中转切开复位内固定，两组其余患者均闭合复位。两组手术时间、术中出血量、术中透视次数比较差异均无统计学意义（ P>0.05）。两组术中、术后均未发生血管及神经损伤、医源性骨折等并发症，切口均Ⅰ期愈合。除试验组 2 例患者于术后 3 个月失访外，其余患者均获随访，随访时间 12～36 个月，平均 16.0 个月。两组患者骨痂形成时间比较差异无统计学意义（ t=2.195， P=0.145）。随访期间对照组 1 例发生术后膝关节僵硬，通过加强膝关节功能锻炼并取出内固定物后得到改善；两组其余患者均未发现骨折延迟愈合或不愈合、膝关节僵硬及内固定相关并发症。术后 1 年根据 Schatzker-Lambert 标准对患肢功能进行评估，试验组获优 22 例、良 4 例、中 1 例，优良率 96.3%；对照组获优 16 例、良 3 例、中 1 例，优良率 95.0%；两组优良率比较差异无统计学意义（ χ2=0.451， P=0.502）。.下肢轴向牵引器辅助闭合复位逆行髓内钉内固定治疗股骨远端骨折术中操作方便，临床效果满意。.
Closed Fracture
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Objective To compare the clinical efficacy of locking compression plate (LCP) versus intramedullary nail in staged treatment of complex compound tibial fractures.Methods From February 2008 to January 2013,55 cases of complex tibial open fracture were treated at our department.They were 39 men and 16 women,with an average age of 32.5 years (from 17 to 72 years).The fractures were on the left side in 24 patients,on the right side in 28 and both sides in 3.By Gustilo classification,18 fractures were type Ⅰ,24 type Ⅱ and 16 type ⅢA; by AO classification,6 fractures were type 42-A,32 type 42-B,and 20 type 42-C.They were treated by external fixation and vacuun sealing drainage (VSD) at the primary stage followed by fixation with LCP or intramedullary nail at the secondary stage.Locking intramedullary nail was used in 32 patients (34 fractures) and LCP in 23 patients (24 ffractures).The 2 groups were compared in terms of fracture healing time,functional recovery of the affected limbs,and postoperative complications.Results The 55 patients were followed up for 12 to 34 months (average,18 months).All the fractures were healed from 16 to 48 weeks after the staged treatment,with an average of 24.2±5.3 weeks in the intramedullary nail group and 26.1 ± 7.2 weeks in the LCP group.There was no significant difference in the healing time between the 2 groups (P ＞ 0.05).According to the functional assessment by the Johner-Wruhs system,the intramedullary nail group had 13 excellent cases,18 good ones and 3 fair ones (the excellent to good rate,91.2％) while the LCP group had 9 excellent,12 good and 3 fair ones (the excellent to good rate,87.5％),showing no significant between-group difference (P ＞ 0.05).There was no significant difference either between the 2 groups regarding the postoperative complication rate [20.6％ (7/34) for the intramedullary nail group versus 12.5％ (3/24) for the LCP group] (P ＞ 0.05).Conclusion In the staged treatment of complex open tibia fractures,both intramedullary nail and LCP can result in reliable fixation of the fracture ends,a low complication rate and thus satisfactory clinical efficacy.
Key words:
Tibial fractures; Fractures, open; External fixator; Bone nails; Bone plates
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[Objective] To analyze the treatment of humeral fracture fixed with the plate or the intramedullary nail.[Method] Seventy-five cases of humeral fractures fixed with the plate or intramedullary nail were observed.The type of humeral fractures,the amount of operative time,the amount of bleeding during operation and from the wound after operation,complications,the recovery of the shoulder and elbow function and the time of the union were caculated.The results were analyzed with t test and Kolmogorov-Smirnov test.[Result]All kinds of humeral fractures could be fixed with the plate or the intramedullary nail,and there was no difference in the average amount of operative time which was 162.11 minutes in plate group and 143.5 minutes in nail group.The average amount of bleeding during operation and the blood from the wound after operation were 541.73ml and 130.4ml in the plate group and 225.67 ml and 67.22 ml in the nail group,which had difference between two groups.All fractures united and the union time were 13.58 weeks in plate group and 12.97 weeks in nail group.The score of the recovered shoulder and elbow were 90.89 and 89.69 in the plate group,and 89.70 and 90.10 in the nail group,there were no difference between two groups.There were 12 cases(26.67%) injuried the radial nevers and 1 case(2.22%) infected in the plate group,and there was no complication in the nail group.[Conclusion]All kinds of humeral fractures were fixed with the plate or the intramedullary nail.The radial nerve might be injuried and the amount of bleeding during operation and after operation were more in the plate group.The operation in which the humeral fracture was fixed with the nail by closed manipulation is safer.The operative time,the rate of union,and the recovery of shoulder and elbow function are similar between two methods.
Humeral fracture
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Objective: To compare the clinical efficacy and safety of interlocking intramedullary nail with locking plate in the treatment of proximal humeral fracture.Methods: 90 patients with proximal humeral fracture hospitalized from January 2010 to December 2011were selected and randomly divided into 2 groups according to the operation method: interlocking intramedullary nail group and locking plate group,45 cases in each group.The operation time,intraoperative blood loss,healing time of fracture,hospital stays,constant shoulder score,Mayo elbow score and incidence rate of complications were observed and compared between the two groups.Results: All patients were followed up from 6 to 24 months,with an average of 13 months.The total effective rates in elocking plate group and interlocking intramedullary nail group were respectively 88.89% and 93.33%,no significant difference was found between the two groups(P0.05).The operation time,intraoperative blood loss,healing time of fracture,hospital stays,constant shoulder score in interlocking intramedullary nail group were all significantly lower or shorter than those in locking plate group(P0.05 or 0.01),while no significant difference of the Mayo elbow score was observed between two groups(P0.05).The incidence rate of complications was 24.44% in locking plate group,which was significantly higher than that in interlocking intramedullary nail group(6.67%,P0.05).Conclusion: The efficacy of interlocking intramedullary nailing on proximal humeral fracture was close to locking plate,and the interlocking intramedullary nail had the merits of smaller wound,earlier recovery and fewer complications,while the lock plate had fewer impact on the shoulder function.
Interlocking
Clinical efficacy
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Objective: To compare the functional and radiological results of locking plate versus shortened interlocking nail for treating extra-articular distal tibia fractures.Methods: This randomized trial was conducted in Department of Orthopaedics, Lahore General Hospital from 25th June 2017 to 25th July 2019.All patients of distal tibia fractures fulfilling the inclusion criteria were randomly and equally divided into group A(shortened interlocking nail) and group B(anatomically contoured distal tibial locking plate). Post operatively functional outcome was determined by assessing ankle and knee range of motion. Radiological union was assessed through callus formation on X ray AP and Lateral view. The time of radiological union and range of motion in both groups were compared and chi square test was applied to note any statistical significance with P value of < 0.05 was considered significant.Results: Total 24 patients were equally divided into two groups A and B with 12 patients in each group. The mean age of group A was 22.5 years(range 20 to 34.5 years) while group B had mean age 31 years(range 22 to 35 years).In group A all the patients were male. Group B had 1(8.3%) female patient. Majority(91.6%,n=11) of patients in group A regained normal range of motion of ankle and knee at final follow up. In group B the normal ankle range of motion was noted in 8(66.6%) patients. Non union was documented in 1(8.3%) patient in group A and 3(25%) patients in group B. The functional and radiological outcome was significantly better in interlocking nail group than locking plate group(P value of < 0.05).Conclusion: Extra articular distal tibia fractures treated with shortened intramedullary nail produced better functional and radiological results than locking plate. Shortened intramedullary nail should be the treatment of first choice to treat these fractures.
Distal tibia
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Objective To compare the efficacy and indication of the two different kinds of internal fixation treatment modes for the complex distal femoral fractures.Methods Reviewing the clinical data of 46 cases used two kinds of internal surgical treatment of complex distal femoral fracture during Jan 2006 to Mar 2009.These cases including 28 males and 18 females with an average age of 42.9-year-old ranging from age 26~71 years were divided into 2 groups:retrograde intramedullary nail group(A-Group,20 cases);pressure locking plate fixation group(B-Group,26 cases).There were all complex fracture types according X-ray film by AO/ASIF classification(A3、C2、C3).Results All patients were followed up for 16~36 months(average 24 months)and obtained first intention incisions healing and satisfied replacement without complications such as postoperative infection,implant rupture,nonunion of bone,deep vein thrombosis,limb shortening,varus deformity.Fracture healing time was 15~20 weeks,the A-Group in average 18.18 weeks and the B-Group in average 18.38 weeks,between the two groups showed no significant difference(P0.05).Postoperative knee scoring according to merchan system.A-Group:excellent in 11 cases,better in 6 cases,good in 2 cases and poor in 1 case,fine rate was 85.0%.B-Group:excellent in 15 cases,better in 8 cases,good in 2 cases and poor in 1 case,fine rate was 88.5%.Difference between the two groups was statistically significant(P0.05).Conclusion For the complex distal femur fractures,retrograde intramedullary locking nail and compression plate could achieve good results.However,the results of our observations,using locking compression plate system could to minimize soft tissue damage,the recovery of knee function seems better than using retrograde intramedullary nail system.
Varus deformity
Femoral fracture
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To analyze and compare the hidden blood loss of minimally invasive percutaneous plate osteosynthesis(MIPPO) combined with locking plate fixation and intramedullary nail fixation in the treatment of tibial shaft fracture.One hundred and ninety-one cases of tibial shaft fracture treated from January 2017 to January 2019 were analyzed retrospectively. The patients were all treated with closed reduction and divided into two groups:group A (110 cases) and group B (81 cases). In group A, 78 males and 32 females were treated with MIPPO combined with locking plate. The age ranged from 19 to 74 (45.32±11.79) years old. According to AO classification, 42cases were type 42-A, 45 were type 42-B and 23 were type 42-C fractures. Group B was treated with intramedullary nail, including 65 males and 16 females, aged 19 to 84 (45.44± 14.32) years old. According to AO classification, there were 39 cases of type 42-A, 29 cases of type 42-B and 13 cases of type 42-C. The operation time, intraoperative blood loss and hidden blood loss were observed and compared between the two groups.On the first day, the hidden blood loss was (155.27±47.89) ml in group A and (160.43±131.42) ml in group B, the difference was statistically significant (P<0.001);on the third day, the hidden blood loss was (102.70±94.79) ml in group A and (338.23±85.24) ml in group B, the difference was statistically significant (P<0.001). There was no significant difference between the two groups in gender, age, height, weight, fracture type and preoperative Hct (P>0.05).In the treatment of tibial shaft fracture with intramedullary nail, there is obvious hidden blood loss, which is much higher than expected.
Group B
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