小夹板固定治疗肱骨髁上骨折321例

肱骨踝上骨折是儿童最常见的肘关节损伤自1989年6月～1993年3月，共收治321例，采用手法整复，小夹板固定，外敷、内服中药，早期功能锻炼等方法治疗，效果良好现小结如下。临床资料321例中，男205例，女116例，年龄最大82岁，最小8个月，10岁以下儿童占73．4％。321例均为新鲜骨折，青枝骨折92例，完全骨折229例（其中开放性骨折1例，多发性骨折1例，为合并同侧桡、尺骨骨干骨折），伸直型215例（其中尺偏型129例；挠偏型86例）；屈曲——尺偏型12例，均为老年患者，年龄在65～82岁之间。治疗方法1．青枝骨折局部采用祖传膏药粘贴。肘关节…     

纸壳夹板治疗小儿肱骨髁上骨折

我们自 1991年 7月～ 1996年 8月用硬纸壳固定治疗小儿单纯肱骨髁上骨折 72例 ,疗效满意。报告如下。1　临床资料本组 72例中男 5 1例 ,女 2 1例 ;年龄 2～ 13岁。左侧 38例 ,右侧 34例。伸直型 6 3例 (其中纯伸直型 2 2例 ,桡偏型 16例 ,尺偏型 2 5例 ) ,屈曲型 9例。伤后就诊时间半小时～ 12天。2　治疗方法2 1　伸直型　整复 :病员坐一方凳 ,下助手在前臂旋前位牵腕关节 ,上助手牵引上臂 ,术者两手在肘关节纠正侧方移位后 ,下助手在牵引的同时进行屈肘 90° ,同时术者两拇指顶住鹰嘴部 ,余指握持近折端 ,来纠正远折端的后方移位。徒手检…     

小儿肱骨髁上骨折的治疗

肱骨髁上骨折是儿童常见的骨关节损伤,以伸直型最为常见。笔者自1989年以来,采用手法复位、屈肘、前臂旋前(或旋后)位、超腕石膏固定治疗肱骨髁上骨折62例,较好地预防了肘内翻的发生率,现报告如下。1　临床资料本组62例,男38例,女24例。年龄最大12岁,最小17个月,其中17个月～4岁9例,5～12岁53例。病程最短1ｈ,最长3ｄ。骨折类型全部为闭合性伸直型,其中左侧骨折23例,右侧骨折39例;桡偏型14例,尺偏型37例,旋转型11例。2　治疗方法21　手法复位　患儿仰卧位,患肘半屈曲,两助手于旋后位对抗牵引3ｍｉｎ,如为尺偏型,术者两拇指抵于骨折近端桡侧,…     

加大屈肘角固定治疗儿童伸直型肱骨髁上骨折

我们自1993年以来,采用加大屈肘角石膏托固定,治疗儿童伸直型肱骨髁上骨折,取得了满意的效果,现报告如下。临床资料本组50例中男29例,女21例;年龄3～15岁;右侧27例,左侧23例;单纯向背侧移位7例,尺偏型32例,桡偏型11例;就诊时间最短半小时,最长1周。治疗方法与结果患者仰卧,麻醉后一助手握住患肢上臂,另一助手握住前臂下端及腕关节,使前臂旋后位沿上臂纵轴方向顺势牵引。首先矫正侧方移位(以尺偏为例),术者以两手拇指置于骨折远端的尺侧用力推按,其余手指置于骨折近端的桡侧与两拇指对抗,同时两助手使肘关节外翻,尺偏即可矫正。(桡偏反之)。…     

拔伸旋转法治疗Galeazzi氏骨折24例

1993～1997年，我们采用拔伸旋转法治疗Galeazzi氏骨折24例，疗效满意，现报告如下。临床资料本组24例中男16例，女8例；年龄7～59岁；受伤距治疗时间1～8天。稳定型10例，不稳定型11例，特殊型3例。有2例合并舟骨骨折，均未合并重要血管、神经损伤。治疗方法采用臂丛神经阻滞或局部浸润麻醉。患者仰卧于整复床上，肩关节外展60°～90°，肘关节屈曲90°。一助手握持患肢前臂近端及肘关节。另一助手一手握患肢大鱼际部，一手握小鱼际部，加大桡侧牵引力量，于患肢前臂中立位拔伸牵引3～5分钟。术者双手环扣下尺桡关节，在牵引下缓缓旋转，…     

闭合复位桡侧3枚克氏针固定治疗幼儿GartlandⅡ型及Ⅲ型肱骨髁上骨折

目的:探讨幼儿期肱骨髁上骨折的特点及闭合复位桡侧穿针固定治疗的效果.方法:自2010年6月至2013年6月就诊幼儿GartlandⅡ型及Ⅲ型肱骨髁上骨折35例,其中男28例,女7例;年龄1岁1个月～2岁6个月,平均2岁1个月.按Gartland分型,Ⅱ型19例,Ⅲ型16例.均为闭合性骨折,其中合并桡神经损伤3例,合并骨间前神经损伤5例,无合并血管损伤.所有患儿采用闭合复位穿针桡侧3枚克氏针固定,后行屈肘90°位石膏外固定,术后第2天复查X线片,术后2～3周后拆除石膏行肘关节屈伸功能锻炼,术后4～5周根据骨折愈合情况拆除克氏针.观察手术时间,神经恢复情况及肘关节功能.结果:患儿均获得随访,骨折均骨性愈合,末次随访采用Flynn肘关节功能评定标准评定疗效,优28例,良4例,一般1例,差2例.结论:幼儿肱骨髁上骨折采用闭合复位桡侧3枚克氏针固定,具有微创、住院时间短、克氏针取出方便及治疗效果可靠的优点.     

手法治疗肱骨髁上骨折168例

肱骨髁上骨折是儿童常见的肘部骨折，好发于10岁以下儿童。我们采用先矫正旋转移位，再矫正其它方向移位，尽量一次整复，尺偏型使其桡侧嵌插方法治疗，获得满意效果，现报告如下。临床资料本组168例中男101例；女67例；年龄1．5～14岁；伸直型118例，尺偏型98例，桡偏型20例；屈曲型50例，新鲜骨折156例，陈旧型骨折12例。治疗方法1，整复方法（以伸直型远端伴有向内侧和旋前移位为例）：患者取坐位，助手甲握上臂上部，助手乙握伤肢前臂，对抗顺势牵拉，充分拔伸牵引。待重叠纠正后，在维持拔伸牵引下，术者一手握近折端，另一手握远折端…     

应用不同入路切开复位交叉克氏针内固定治疗儿重肱骨髁上骨折

[目的]探讨肱骨髁上骨折手术治疗必要性,并比较不同手术入路的治疗效果。[方法]自2004年8月~2006年1月,对32例儿童肱骨髁上骨折患者行切开复位交叉克氏针内固定术治疗,其中20例采用前外侧入路,12例采用肘后正中入路,男24例,女8例;年龄3~12岁,平均8岁。伸直型28例,屈曲型4例,2例合并有正中神经损伤,1例合并有桡神经损伤。其中伸直型依据Gartland的分型方法,Ⅱ型9例,Ⅲ型23例。术后3~4周拔出克氏针,开始功能锻炼。并以Cassebaum等肘关节评分系统评价肘关节功能。[结果]28例获得随访,随访30周~16个月,平均41.3周。随访期内无肘内、外翻发生,肘关节功能评价优18例,良8例,可2例。关节活动范围平均为115°。[结论]对于Ⅱ、Ⅲ型肱骨髁上骨折且肘关节肿胀明显,手法复位困难的患者,手术治疗是一种可靠的治疗方法。而肘关节前外侧手术入路优于肘后正中入路。     

肘关节内骨折脱位48例治疗分析

我们自 1984年至今共收治肘关节内骨折脱位4 8例 ,对不同病例进行手法复位或手术切开复位治疗 ,随访 4 5例 ,疗效较好。现报告如下。1　临床资料1 1　一般资料　 4 8例中男 34例 ,女 14例 ;年龄 2～78岁 ,平均 16 5岁 ;治疗时间为伤后 0 5ｈ～ 6个月 ,平均 14 2ｄ。1 2　致伤原因　跌伤 33例 ,高处坠落伤 10例 ,压砸伤 2例 ,撞击伤 3例。1 3　骨折类型及合并伤　肱骨髁上骨折伸直型 2 2例 (其中新鲜骨折 5例 ,陈旧骨折 17例 ) ,外髁骨折10例 ,内髁骨折 14例 (其中新鲜骨折 6例 ,陈旧骨折8例 )。陈旧性肘关节脱位 5例 ,均为后脱位。尺骨鹰…     

桡骨远端骨折合并同侧肘关节损伤的手术治疗体会

目的探讨桡骨远端骨折合并同侧肘关节周围骨折或脱位的治疗方法,提高临床治疗效果。 方法回顾性分析本院自2012年1月至2016年10月收治的桡骨远端骨折合并同侧肘关节脱位或骨折病例22例。22例桡骨远端骨折中13例伴尺骨茎突骨折,3例伴尺骨远端骨折,2例伴舟状骨骨折。22例肘关节周围损伤中5例为尺桡骨近端骨折,3例为肱骨远端骨折,14例发生肘关节后脱位。 结果所有患者均获得随访,术后平均随访时间为13.6个月（11~26个月）,所有骨折均愈合,未发生感染。Cooney腕关节评分平均为92.5分（55~100分）,其中优13例、良7例、中1例、差1例。Mayo肘关节功能评分平均为87.5分（50~100分）,其中优10例、良8例、中3例,差1例。其中1例就诊时已出现骨筋膜室综合征,尺神经、正中神经、桡神经均损伤,肌肉部分坏死切除,功能恢复较差。 结论桡骨远端骨折合并同侧肘关节损伤多为高能量损伤,早期积极而恰当的处理能为患者二次手术提供良好的条件,结合积极的康复锻炼,能取得良好的治疗效果。     

Trochanteric and Subtrochanteric Fractures: One Year Follow-up of a Prospective Study of Ender and McLaughlin Osteosynthesis

The clinical and social status of 110 patients with trochanteric and subtrochanteric fractures was evaluated in a prospective and comparative study 1 year after Ender or McLaughlin osteosynthesis.

In both groups the mortality rate during the first year was 21 per cent. There were no significant differences between the two groups concerning pain, hip movement, walking ability or the social status of the patients. Of the 110 patients surviving the first year, 35 per cent were unable to walk, 20 per cent walked with a cane or crutches and 30 per cent had periodic pains in the hip or knee. About 20 per cent of the patients admitted from their own home now lived in nursing homes.     

Decision-making in burst fractures of the thoracolumbar and lumbar spine

The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding management. A detailed understanding of the mechanism of injury and their unique biomechanical propensities following various forms of treatment can help the spinal surgeon manage such patients effectively and prevent devastating complications.     

Fractures of the thumb and finger metacarpals in athletes

Most metacarpal fractures are minimally displaced and are treated without surgery. Markedly displaced fractures, fractures causing finger rotation, and displaced intra-articular fractures require surgical intervention. The challenge with the elite athlete is achieving an early return to play without compromising fracture position. Casts, splints, and surgery each have a role in getting the athlete back into action as soon as possible.     

不稳定骨盆骨折合并髋臼骨折的手术治疗

目的探讨手术治疗不稳定骨盆骨折合并髋臼骨折的临床疗效。方法对15例不稳定骨盆骨折合并髋臼骨折患者进行手术复位内固定,术后早期功能锻炼。结果患者均获随访,时间12～38个月。术中无血管神经损伤发生,无切口感染、内固定松动及断裂、骨不愈合、明显双下肢不等长。髋臼骨折复位效果按MattaX线评估标准：优8例,良5例,一般2例。功能恢复根据Majeed评分标准：优5例,良8例,可2例。结论手术治疗不稳定骨盆骨折合并髋臼骨折可获得满意的临床疗效。     

Unusual combined scaphoid and lunate fracture of the wrist: a case report

All perilunate fracture-dislocations combine ligament ruptures, bone avulsions, and fractures in a variety of clinical forms. The most frequent is the dorsal trans-scaphoid perilunate dislocation. In rare cases, however, these dislocations also have been associated with capitate fractures, triquetral fractures, or lunate fracture. We report a combined scaphoid and lunate fracture of the wrist that was not associated with perilunate dislocation.     

Hoffa骨折的临床特点及治疗

目的探讨Hoffa骨折的临床特点及治疗方法。方法对5例Hoffa骨折患者1例保守治疗、4例切开复位内固定治疗。结果5例均获随访，时间13—31个月。功能恢复参照Letenneur方法进行评估：优良3例，可2例。结论Hoffa骨折的临床特点以膝关节屈曲外翻位损伤多见，外髁发生率较高。X线对诊断价值有限，多借助CT检查。治疗原则是解剖复位，坚强内固定，早期功能康复锻炼。     

Surgical Management Navicular and Cuboid Fractures

Cuboid fractures are not uncommonly associated with concurrent fractures or injuries of the midfoot or medial column. The mechanism of injury resulting in a cuboid fracture may be a direct impact to the cuboid or from indirect force acting on the cuboid from the foot and ankle. Typically the mechanism in an indirect injury is a rotational force in a plantarflexed position and abduction, causing the cuboid to get crushed between its adjacent articulations with the calcaneus and metatarsals.²⁰ A

Cuboid Intra-Articular Fracture

The patient is placed supine on the operating room table with an ipsilateral hip bump. The lower extremity is exsanguinated and a thigh tourniquet is inflated. A 6-cm longitudinal incision is made directly over the cuboid at the dorsolateral foot. Dissection is carried deep to the extensor digitorum brevis and then the muscle belly is reflected off the periosteum and retracted dorsally. The cuboid is visualized and the calcaneocuboid and tarsometatarsal joints are inspected. A Freer elevator is

     

Co-existing ipsilateral subcapital and subtrochanteric fracture of the proximal femur

Background  Co-existing subcapital and subtrochanteric fracture on the same side of the hip is rare. We are not aware of a similar case reported in the literature. Case study  We present a rare case of co-existing ipsilateral subcapital and subtrochanteric fracture in a 67-year-old woman. The mechanism of injury was low energy. Therapeutic implication  The outcome of internal fixation using a Proximal Femoral Nail was satisfactory. This work was carried out in the Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, UK.