[Application of anterior subcutaneous internal fixator combined with posterior plate in treatment of unstable pelvic fractures].
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Abstract:
To investigate the effectiveness of anterior subcutaneous internal fixator combined with posterior plate in the treatment of unstable pelvic fractures.Keywords:
Pelvic fracture
Nerve Injury
Despite advances in science and technology, the success rate for the treatment of displaced intracapsular femoral neck fractures in high-energy injuries remains disappointing. The blood supply system in the femoral head of humans does not favor recovery from these fractures. Once these fractures occur, osteonecrosis and nonunion rates may be as high as 30%, even if the newest technique is used. There are some surgical techniques used to supplement internal fixation to reestablish the blood supply in the femoral head, but none have been evidently successful. After analysis of related studies, the author concludes that immediate surgical treatment using improved techniques incorporating the principles of biomechanics can improve the success rate of treatment of these fractures. Using these principles, the fracture site can achieve sufficient stability. Consequently, the blood supply in the femoral head and neck can be reestablished earlier and loss of reduction of fragments during treatment can be minimized. Thus, the chance of full recovery from these complicated fractures can be maximized. In this study, the biomechanical characteristics of these fractures and the principles associated with the surgical techniques used for treating them are reviewed and clarified. Finally, a surgical technique which is ideal from the author's viewpoint is presented. The author believes that the recommended surgical technique may become the best method for treating these complicated fractures.
Blood supply
Biomechanics
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Thirty-one patients with fracture-dislocations of the tarsometatarsal joint were examined to assess the functional end results after a mean follow-up of 2.9 years (range 20 to 56 months). Sixty-one percent were polytrauma patients; 39% suffered isolated fractures. Forty-five percent had associated lesions of the tarsal joint complex (Chopart and subtalar joint). According to the Baltimore Painful Foot Scoring System (PFS), 52% achieved an excellent or good result and 48% a fair or poor result. Of the four different treatment modalities, open reduction and temporary screw or K-wire fixation yielded the best results. The major determinants of acceptable results were the type of treatment, type of lesions, the quality of initial reduction and associated involvement of the tarsal joint complex. The extent of the initial injury was the determining factor in the development of late degenerative arthritis. Degenerative changes of the tarsal joint were seen in almost all cases (94%). Such changes were more frequent after temporary screw fixation but did not seem to influence the final results. An initial anatomical reduction did not guarantee excellent results but minimized the chance of late degenerative arthritis. Primary arthrodesis demonstrated no advantage in our series. Although partial arthrodesis may be necessary in severely comminuted joints, it cannot be routinely advocated and should be used as a salvage procedure.
Tarsometatarsal joints
Polytrauma
Degenerative arthritis
Tarsal Joint
Subtalar joint
Tarsal Bone
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When hardware used to repair calcaneus fractures must be removed, the exposure using the original incision can be tedious due to scarring. The technique described here facilitates relatively easy and safe implant removal without the risk of wound complications.
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Fracture reduction
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To investigate the effect of decalicified dental matrix (DDM) on healing of traumatic fracture and its side-effect.From June 1997 to December 1998, 42 patients with closed traumatic long bone fracture (36 males and 6 females, aged from 18 to 57 years with an average of 32 years) were divided into two groups randomly; open reduction and internal fixation were carried out in all patients, but the DDM was used only in experimental group. After operation, the body temperature, ALT, and bone union time were observed and recorded.Following-up 1 to 3 years, the bone union time of experimental group was significantly shorter than that of control group (P < 0.01), there was no significant difference in the temperature and ALT changes between two groups(P > 0.05). No infection occurred.DDM can promote the growth of bony callus and enhance the healing of fracture. There is no side-effect.
Delayed union
Bone matrix
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Malunion
Avascular Necrosis
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We evaluated the radiologic and functional outcomes of patients with radial head fractures managed with open reduction and internal fixation.Between 1998-2003, 15 patients (7 males, 8 females; mean age 34.1; range 18 to 49 years) with radial head fracture were treated with open reduction and internal fixation. Follow-up time was 54.6 months (42-78). Three fractures were Mason type II, 8 were III and 4 were IV. They were evaluated by anteroposterior and lateral radiographs and functionally by Broberg and Morrey criteria.All the fractures except in 1 patient with Mason type III had united. The mean range of motion of the elbow was 20 degrees to 145 degrees with 71.9 degrees of pronation and 83.2 degrees of supination. According to Broberg and Morrey criteria, the outcome was excellent in 8, good in 4, fair in 1 and bad in 2. Excision and prosthetic replacement were performed in 1 patient because of implant failure.We suggest open reduction and internal fixation even in comminuted cases because it gives satisfactory elbow function and avoids radial shortening, loss of motion and wrist joint dysfunction as a result of radial head excision. When it fails, excision and prosthetic replacement can be done later.
Radial head fracture
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This case report illustrates a subcapital femoral neck fracture following application of a compression screw and side plate to treat an intertrochanteric hip fracture. This is an uncommon complication in the management of intertrochanteric hip fractures. The authors describe steps in this surgical technique that minimize the possibility of this complication.
Dynamic hip screw
Intertrochanteric fracture
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To evaluate the surgical efficiency of treating the intertrochanteric hip fracture with the Gamma nail fixation and to compare two operating methods of the Gamma nail fixation.From August 2000 to August 2006, 69 patients (32 males, 37 females; age, 43-98 years;average, 72.3 years) with the intertrochanteric hip fracture but with no associated injury were treated with the Gamma nail fixation. The patients' average illness course was 5. 6 days (range, 3-14 days). Among the 69 patients, 36 were treated with the traditional method of the Gamma nail fixation (Group A) and 33 were treated with an improved method of the Gamma nail fixation (Group B). According to the Association for the Study of Internal Fixation (AO-ASIF) classification, in Group A, 5 patients had a disease of Type A1, 23 of Type A2, and 8 of Type A3; in Group B, 8 patients had a disease of Type A1, 21 of Type A2, and 4 of Type A3. The data from the two groups were analyzed, and the statistical analysis was made on the following aspects: incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, blood transfusion volume, postoperative infection of the lungs, superficial infection of the incision, duration of antibiotic use, standing with the walking stick after operation, complication due to internal fixation, healing time for the fracture, and the hip function recovery half a year after operation assessed with the Harris scoring system.All the 69 patients were followed up for 8-80 months (average, 42 months). We studied the indexes such as incision length, operating time, intraoperative bleeding, X-ray exposure frequency, drainage amount, and blood transfusion volum; above indexes in Group A were 9.5 +/- 4.7 cm, 85 +/- 35 min, 186.0 +/- 87.3 ml, 9.0 +/- 5.1 times, 102.7 +/- 49.8 ml, 325.0 +/- 169.5 ml; and those were 5.3 +/- 1.2 cm, 46 +/- 10 min, 65.0 +/- 26.0 ml, 3.0 +/- 2.1 times, 52.5 +/- 16.2 ml, 203.0 +/- 61.2 ml in Group B. The above indexes showed that the surgical efficiency in Group B was significantly better than that in Group A (P < 0. 05). The postoperative recovery indexes such as infection of the lungs, infection of the incision, duration of antibiotic use, standing time after operation, union time of fracture, and function score, were studied. There was a statistically significiant difference in lung infection, incision infection, duration of antibiotic use, and standing time after operation between Group A and Group B (P < 0.05).The improved method of the Gamma nail fixation for treating the intertrochanteric hip fracture can increase the surgical efficiency and improve the patient's early recovery after operation, especially suitable for the elderly patients who have more complications. This kind of method can shorten the operating time and the anesthesia duration, reducing the incision infection and the blood loss during operation, and decrease the frequency of the X-ray use.
Dynamic hip screw
Intertrochanteric fracture
Hip Fracture
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Anterior instrumentation in the treatment of thoracolumbar fractures has progressed significantly during the past 2 decades. These fixation systems have evolved to meet the anatomic, biomechanical, and imaging challenges associated with internal fixation of the thoracolumbar spine. The evolution of these devices will be reviewed, and from this, the indications and surgical techniques necessary for the safe and effective use of the device will be discussed. This study also reports the authors' initial clinical experience using the Z plate anterior thoracolumbar plating system in the treatment of thoracolumbar burst fractures. The study consists of 12 consecutive adult patients who underwent a 1-stage anterolateral decompressive and stabilization procedure for burst fractures from T9–L3. The indications for surgery included neurologic deficits, deformity, progressive kyphosis, and late pain. Ten of the 12 patients maintained their postoperative sagittal alignment or a significant portion of their kyphosis reduction. Two patients with severe kyphotic deformities greater than 50° lost 10° and 20° of their reduction at last followup. All 3 patients with neurologic deficits recovered. There were no neurologic or perioperative complications. Eleven of the 12 patients obtained a good or excellent functional outcome. Anterior arthrodesis using instrumentation stabilization after a 1-stage anterolateral decompression and reduction procedure can yield successful clinical results in the treatment of thoracolumbar burst fractures.
Kyphosis
Burst fracture
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