Arthroscopic handlebar technique for the treatment of posterior malleolar fractures

Treating posterior malleolar fractures of the ankle remains a challenge. The arthroscopic handlebar technique is our novel surgical method used for reduction and fixation of posterior malleolar fractures and involves the restoration of posterior malleolar fractures under anterior arthroscopic guidance and the use of Kirschner wires that penetrates the fractured posterior malleolus. Arthroscopy enables visualization of the intra-articular fracture of the posterior malleolus, and a handlebar reduction bar is used to control the fractured posterior malleolus. The arthroscopic handlebar technique is a promising procedure for reduction and internal fixation of the posterior malleolar fractures.     

三踝骨折手术治疗体会

正2010年4月~2012年4月,我们手术治疗35例三踝骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组35例,男23例,女12例,年龄20~58岁。骨折按Lauge-Hansen分型:旋后外旋型16例,旋后内收型4例,旋前外展型7例,旋前外旋型8例。均为新鲜闭合骨折。待肿胀消退后手术,伤后至手术时间5~     

不稳定性股骨转子间骨折的手术治疗进展

随着社会经济发展,人口老龄化日益严重,与之伴随的骨质疏松导致股骨转子间骨折发生率逐年升高,约占髋关节骨折的一半,其中不稳定性股骨转子间骨折占35%-40%,这些老龄患者多合并较多的内科基础病症,使得手术难度增大、风险增加。另一方面,高能量创伤逐渐增多,青壮年不稳定性骨折增加。     

External Fixation for Redislocated Colles' Fractures

Rereduction was carried out in 5% of all treated Colles' fractures and they were externally fixated with a one-bar Hoffmann apparatus. The results of 57 of the first 69 patients treated with a follow-up time of at least 1 year are presented. Using Frykman's criteria, 18 patients were judged as “excellent”, 25 as “good” and 14 patients were judged as “unsatisfactory”. The anatomical analysis showed no increase of deformity during the fixation. The final mean results were a 3.0 mm radial shortening and the articular plane of the radius at a right angle to the long axis. Among the first patients, five cases of pin-loosening were seen, but there were no adverse effects in the final result. There were no pin-tract infections. The results justify using the method as a routine when a redislocated Colles' fracture is rere-duced.     

掌、指骨骨折固定方法的选用

目的探讨如何正确应用微型钢板、螺丝钉、交叉克氏针及张力带钢丝四种内固定方法治疗掌、指骨骨折,以提高治疗效果。方法根据骨折部位、类型及技术条件等有选择的应用上述四种内固定方法治疗掌、指骨骨折87例99处。结果骨折均达到或近似解剖复位,愈合顺利,不伴肌腱损伤的48例;手功能均恢复至正常,伴肌腱损伤的39例。手功能恢复按TAMI标准评价:优16例,良20例,可2例,差1例,优良率92.3%。结论上述四种内固定方法适应症不同,各有优缺点,应根据骨折的部位类型及技术条件等合理选用,才可达到满意的治疗效果。     

Guideline for the management of hip fractures 2020

We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.     

Comparison of algorithms for automated femur fracture reduction

Purpose

We designed an experiment to determine the comparative effectiveness of computer algorithms for performing automated long bone fracture reduction.

Methods

Automated reduction of 10 3D fracture models was performed using two computer algorithms, random sample matching (RANSAM) and Z‐buffering (Z‐Buffer), and one of five options of post‐processing: none; iterative closest point algorithm (ICP); ICP‐X1; ICP‐X2; and ICP‐X3. We measured the final alignment between the two fragments for each algorithm and post‐processing option.

Results

The RANSAM algorithm combined with postprocessing algorithm ICP‐X1 or ICP‐X3 resulted in the most accurate fracture reduction in the translational plane. No discernible difference was observed in the rotational plane. Automated reduction had more accurate translational displacement than telemanipulated manual reductions.

Conclusion

This study supports the use of the RANSAM algorithm for automated fracture reduction procedures. The use of ICP algorithms provides further optimization of the initial reduction.     

Simplified Criteria for Selecting Patients for Vertebral Fracture Assessment

The 2013 Position Development Conference of the International Society for Clinical Densitometry (ISCD) has adopted simplified indications for vertebral fracture assessment (VFA) based on an analysis of the Study of Osteoporotic Fractures (SOF). This showed that a simpler regression model, which included only age, bone mineral density (BMD), and height loss, was able to differentiate women with vertebral fractures from those without vertebral fractures almost as well as more complex models. We aimed to verify these findings in 1228 women referred for BMD testing and determine if the 2013 ISCD indications for VFA would perform as well the 2007 indications. The simple and complex SOF-based models were similar in terms of sensitivity (88.4% vs 89.4%), specificity (44.4% vs 45.5%), positive (25.9% vs 26.5%) and negative (94.5% vs 95.1%) predictive values, and area under the receiver operating characteristics curve (AUROC) (0.664 vs 0.674). The 2013 and 2007 ISCD VFA indications did not differ significantly in terms of sensitivity (88.2% vs 91.3%), specificity (41.3% vs 37.5%), positive (25.3% vs 22.9%) and negative (93.9% vs 95.5%) predictive values, and AUROC (0.648 vs 0.644). Our study provides support for the use of the simplified 2013 ISCD VFA indications as a practical approach to VFA testing.     

手术治疗肩胛骨骨折

正2012年1月~2015年1月,我科手术治疗14例肩胛骨骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组14例,男11例,女3例,年龄19~55岁。左侧8例,右侧6例。肩峰喙突骨折1例,体部骨折12例,颈部骨折1例。受伤至手术时间7~14 d。1.2治疗方法全身麻醉下手术。患侧上肢消毒包扎放置于手术台上,以便     

Two-stage reconstruction with free vascularized soft tissue transfer and conventional bone graft for infected nonunions of the tibia: 6 patients followed for 1.5 to 5 years

Background?Vascularized soft tissue transfer may give better results of treatment of infected nonunions of the tibia.

Methods?6 patients with infected nonunion of the tibia and combined soft tissue (70–170?cm²) and bony (5–8?cm) defects underwent staged reconstruction. Initial surgery consisted of soft tissue and bone debridement, external fixation, filling of the bony defect with a gentamicin-impregnated cement spacer, and reconstruction of the soft tissue with a free microsurgical muscle flap and skin graft. Second-stage surgery consisted of removal of the cement spacer and osseous reconstruction with nonvascularized bone graft.

Results?All patients except 1 achieved full weight-bearing and radiographic consolidation after 7–10 months. This patient required repeated bone grafting and internal plate fixation to heal. There were no cases of recurrence of infection at the latest follow-up, after a mean of 3 (1.5–5) years.

Interpretation?Staged reconstruction with free vascularized soft tissue transfer and conventional bone grafting within a cement-induced membrane is a low-risk surgical strategy resulting in a high rate of bone healing.

?     

聚髌器结合克氏针治疗髌骨粉碎性骨折

2007年1月-2010年8月,我院对髌骨粉碎性骨折以聚髌器结合克氏针手术治疗34例,疗效满意。     

8例Hoffa骨折手术治疗临床疗效分析

目的探讨手术治疗Hoffa骨折的临床疗效。方法自2011-01—2015-10共诊治8例Hoffa骨折。对于LetenneurⅠ、Ⅱ型骨折采用2或3枚空心拉力螺钉固定;对于LetenneurⅢ型骨折,3例用2枚空心拉力螺钉外加锁定钢板支撑固定,2例用2枚空心拉力螺钉外加横向2枚空心拉力螺钉固定。结果本组8例均获得随访8~37个月,平均20.3月,术后切口均一期愈合,术后3个月骨折均骨性愈合,随访过程未见骨折移位、内固定物失效、骨折不愈合、骨折畸形愈合等并发症。末次随访疗效用Letenneur评估系统进行评定:优4例,良3例,差1例。结论 Hoffa骨折行手术治疗时,对于LetenneurⅠ、Ⅱ型骨折行2或3枚空心拉力螺钉固定,对于LetenneurⅢ型骨折、粉碎性Hoffa骨折或伴有严重骨质疏松症患者加用锁定钢板支撑固定或横向2枚空心拉力螺钉固定,可达到固定牢固、能早期功能练习、术后并发症少、术后效果满意的疗效。     

Fixation versus hemiarthroplasty for undisplaced intracapsular hip fractures

The conventional treatment for an undisplaced intracapsular hip fracture is internal fixation. A possible alternative treatment is replacement hemiarthroplasty. We have compared the outcomes of an age, sex and co-morbidity matched cohort of 346 patients who have had their undisplaced intracapsular hip fracture treated using cannulated screws with a group of 346 patients who have had a displaced intracapsular fracture treated using a hemiarthroplasty. Patients treated by internal fixation had a shorter operation time (43 versus 67 min), reduced orthopaedic ward stay (11 versus 15 days), lower incidence of peri-operative complications (24 versus 81), and a lower 1-year mortality (19% versus 26%). Additional benefits for the fixation group were less pain at 1 year, less reduction in mobility and lower dependence on walking aids. All these differences were statistically significant. Hemiarthroplasty had a lower re-admission rate (43 versus 14 cases) and re-operation rate (59 versus 22 cases). These results support the use of internal fixation for undisplaced intracapsular fractures and confirm that the final outcome for an undisplaced intracapsular hip fracture is significantly better than for a displaced intracapsular fracture, despite a higher re-operation rate after internal fixation.     

切开复位钢板螺钉内固定治疗跟骨骨折

跟骨骨折以往主要采用保守治疗为主，但病残率高。2005年7月-2006年3月，我科对47例跟骨骨折患者采用手术切开复位钢板螺钉内固定治疗，笔者对其效果进行分析。     

轴向牵伸复位对胸腰椎爆裂骨折的治疗基础

根据作者17年中观察和对近年141例中获随访的39例胸腰椎爆裂骨折的治疗分析,对胸腰椎爆裂骨折的复位和稳定,有赖于伤椎的椎间盘纤维环和前后纵韧带基本完好,提供与致伤暴力方向相反的轴向牵伸力,是使脊椎爆裂骨折复位、恢复椎管容积、促进脊髓神经功能和脊柱稳定的力学和生物学基础。     

Lacking evidence for performance of implants used for proximal femoral fractures – A systematic review

IntroductionEvaluation of the long-term performance of implants used in trauma surgery relies on post-marked clinical studies since no registry based implant assessment exists. The purpose of this study was to evaluate the evidence of performance of implants currently used for treating proximal femoral fractures (PFF) in Denmark.MethodPubMed was searched for clinical studies on primary PFF with follow-up ≥12 months, reporting implant-related failure and evaluating one of following: DHS, CHS, HipLoc, Gamma3, IMHS, InterTan, PFN, PFNA or PTN. Limits: English language and publication date after 1st of January 1990.ResultsAll studies were evidence level II or III. 30 publications for SHS were found: 13 of CHS, 15 of DHS and 2 of HipLoc. In total CHS was evaluated in 1110 patients (900 prospectively), DHS in 2486 (567 prospectively) and HipLoc in 251 (all prospectively). Fifty-four publications for nails were found: 13 of Gamma3, 7 of IMHS, 5 of InterTan, 10 of PFN, 24 of PFNA and 0 of PTN. In total Gamma3 was evaluated in 1088 patients (829 prospectively), IMHS in 1543 (210 prospectively), InterTan in 595 (585 prospectively), PFN in 716 (557 prospectively), PFNA in 1762 (1018 prospectively) and PTN in 0.ConclusionsThe clinical evidence behind the current implants used for proximal femoral fractures is weak considering the number of implants used worldwide. Sporadic evaluation is not sufficient to identify long term problems. A systematic post market surveillance of implants used for fracture treatment, preferable by a national register, is necessary in the future.     

距骨骨折的手术治疗

目的探讨距骨骨折的特点、类型、手术方法及影响疗效的相关因素。方法1998年12月至2004年12月,共治疗距骨骨折39例,根据Hawkins分型方法,型骨折5例,型骨折25例,型骨折9例。型骨折采用松质骨拉力螺钉内固定;、型骨折行急诊手术,其中型骨折采用前外侧切口暴露,解剖复位,2枚松质骨拉力螺钉交叉内固定;型骨折采用踝前内侧切口暴露,解剖复位,松质骨拉力螺钉内固定,伴有内踝骨折时同时复位内固定,并以自体髂骨块跨骨折线嵌入植骨。术后短腿管形石膏外固定12~24周,X线片示骨折线模糊后拆石膏行不负重下踝关节活动,骨折线消失后恢复伤前活动。结果除2例失访外,37例获得随访。随访时间1.5~6年,平均3年。根据Hawkins疗效标准判定,优12例(32.4%),良17例(45.9%),可6例(16.2%),差2例(5.4%),优良率为78.4%。结论距骨骨折虽然并发症多且后果严重,但是通过急诊手术、解剖复位、有效内固定、自体髂骨块嵌入植骨、局部封闭、理疗等综合治疗,可降低病残率。     

Timing of operation for blowout fractures with extraocular muscle entrapment

Abstract

Many authors have advocated early surgical intervention to avoid muscle degeneration in patients with blowout fractures with evidence of extraocular muscle entrapment imaged under computed tomography. However, there is still no golden standard with regard to the target timing of operations for releasing extraocular muscle. Between January 2002 and December 2011, the authors treated eight cases of blowout fracture with extraocular muscle entrapment. Notes from presumed cases of blowout fracture were retrospectively reviewed for information relating to surgical treatment and prognosis. In this series, a patient who was operated on 7 hours after injury showed the quickest recovery from diplopia. In contrast, a patient who was operated on 18 days after injury showed persistent diplopia for 2 years. Nevertheless, in patients who were operated on 3–11 days after injury, there was no obvious correlation between the outcome and the number of days between injury and the operation. It is concluded that, when emergency surgical intervention within several hours is not possible, it should be performed as soon after the injury as possible in order to prevent the increase of predictive fibrosis around the extraocular muscle.     

腰-骶-髂固定术治疗严重骨盆骨折脱位1例

骨盆环的连续性是骨盆力学稳定的基础,骨盆前环和后环同时损伤,可造成骨盆垂直及旋转不稳和腰、骶神经损伤,处理十分棘手。笔者采用腰-骶-髂固定术固定骨盆后环,同时固定骨盆前环,治疗严重骨盆骨折脱位并腰骶神经损伤1例,疗效满意。1病例资料患者,男,18岁。2005年3月26日因车祸