解剖钢板治疗股骨远端粉碎骨折

目的:介绍应用股骨远端解剖型钢板治疗股骨髁上粉碎骨折。方法:应用股骨远端解剖型钢板治疗股骨髁上粉碎骨折12例。结果:12例中有10例获3~10个月的有效随访,8例骨折对位良好,钢板固定确实,达到优良标准,2例为可,优良率80%。结论:股骨远端解剖型钢板具有良好的生物力学分布,复位准确,固定可靠,值得临床推广使用。     

锁定钢板内固定治疗肱骨近端骨折

目的应用锁定钢板内固定治疗肱骨近端不稳定骨折的初步临床探讨。方法总结我院自2003年8月~2005年11月采用切开复位锁定钢板内固定治疗肱骨近端骨折12例;Neer分类,“二部分”骨折7例,“三部分”骨折5例。结果12例全部获3~15个月随访,参照Neer评分标准,优7例,良4例,可1例,优良率91.6%。结论锁定钢板内固定治疗肱骨近端骨折,固定稳固,允许早期功能煅炼,功能康复满意,是治疗不稳定肱骨近端骨折理想的内固定方法。     

带血管蒂的翻转植入、桡骨茎突切除治疗舟状骨骨不连18例分析

[目的]探讨陈旧性腕舟骨骨折的手术方法及临床疗效。[方法]18例患者均采用带血管蒂的桡骨瓣翻转植入加桡骨茎突切除手术治疗。[结果]所有病例随访时间6个月至3年,平均18个月,骨折全部愈合,腕关节功能恢复大多达健侧标准。疗效评价:优12例,良5例,较差1例,优良率94·5%。[结论]该术式操作简单,舟状骨骨折端植入的带血管蒂骨瓣形成“骨桥”,桡骨茎突切除后减少了撞击,可缩短骨折愈合时间及提高愈合率,是治疗陈旧性腕舟骨骨折的一种有效的手术方法。     

Does an additional antirotation U-Blade (RC) lag screw improve treatment of AO/OTA 31 A1-3 fractures with gamma 3 nail?

IntroductionPoor bone quality and unstable fractures increase the cut-out rate in implants with gliding lag screws. The U-Blade (RC) lag screw for the Gamma3^® nail was introduced to provide monoaxial rotational stability of the femoral head and neck fragment. The purpose of this study was to evaluate whether the use of the U-Blade (RC) lag screw is associated with reduced cut-out in patients with OTA/AO 31A1-3 fractures.Material & methodsBetween 2009 and 2014, 751 patients with OTA/AO 31A1-3 fractures were treated with a Gamma3^® nail at our institution. Out of this sample 199 patients were treated with U-blade (RC) lag screws. A total of 135 patients (117 female, 18 male) with standard lag screw (treatment group A) were matched equally regarding age (±4 years) sex, fracture type and location to 135 patients with U-blade (RC) lag screw (treatment group B). Within a mean follow up of 9.2 months (range 6–18 months) we assessed the cut-out rate, the calTAD, lag screw migration, the Parker's mobility score and the Parker’s ratio at postoperatively, six and 12 months following surgery. Furthermore we recorded all complications, ASA-Score, hospital stay and duration of surgery retrospectively.ResultsThe most common fracture among group B with a cut-out of the lag screw were AO/OTA 2.3 and 3.2 fractures whereas in group A cut-out was most commonly seen in AO/OTA 2.1, 2.2 and 2.3 fractures, there was no significant reduction of the cut-out rate in group B 2.2% (n = 3) compared to group A 3.7% (n = 5). The duration of surgery was significantly shorter in group A (p < 0.05). There was no significant difference in lag screw placement, the Parker’s ratio and mobilization.ConclusionIn our study the U-Blade (RC) lag screw did not reduce the cut-out in treatment of OTA/AO 31A1-3 fractures at all. Considering the longer duration of surgery and the higher costs of the U-Blade (RC) lag screw, our results do not justify its use. However, further prospective randomized studies will be necessary.     

The influence of local bone quality on fracture pattern in proximal humerus fractures

IntroductionBone mineral density and fracture morphology are widely discussed and relevant factors when considering the different treatment options for proximal humerus fractures. It was the aim of this study to investigate the influence of local bone quality on fracture patterns of the Neer classification as well as on fracture impaction angle in these injuries.Materials and methodsAll acute, isolated and non-pathological proximal humerus fractures admitted to our emergency department were included. The fractures were classified according to Neer and the humeral head impaction angle was measured. Local bone quality was assessed using the Deltoid Tuberosity Index (DTI). The distribution between DTI and fracture pattern was analysed.Results191 proximal humerus fractures were included (61 men, mean age 59 years; 130 women, mean age 69.5). 77 fractures (40%) were classified as one-part, 72 (38%) were two-part, 24 (13%) were three- and four-part and 18 (9%) were fracture dislocations. 30 fractures (16%) were varus impacted, whereas 45 fractures (24%) were classified as valgus impacted. The mean DTI was 1.48. Valgus impaction significantly correlated with good bone quality (DTI ≥ 1.4; p = 0.047) whereas no such statistical significance was found for the Neer fracture types.DiscussionWe found that valgus impaction significantly depended on good bone quality. However, neither varus impaction nor any of the Neer fracture types correlated with bone quality. We conclude that the better bone quality of valgus impacted fractures may be a reason for their historically benign amenability to ORIF. On the other hand, good local bone quality does not prevent fracture comminution.     

Traitement d’une fracture-luxation chronique de l’interphalangienne proximale par un greffon d’hémi-hamatum

Fracture-dislocations of the proximal interphalangeal (PIP) joint are complex and challenging to manage once they become chronic. We report a case of PIP joint fracture-dislocation treated by hemi-hamate arthroplasty. An 18-year-old male polytrauma patient presented with a neglected PIP joint fracture-dislocation in the third finger of the left hand. After four months of follow-up, he remained disabled due to clinodactyly and stiffness. After performing a cadaver study to evaluate the feasibility of grafting, we resurfaced the bone-cartilage defect with a hemi-hamate arthroplasty. The range of motion at the last follow-up was 65° without pain; the DASH score was 2.27. The patient was able to return to heavy manual labour work at 5 months postoperative.     

Apport d’une évaluation biomécanique dans la prise en charge des tendinopathies proximales des ischiojambiers : discussion à partir de deux cas cliniques

IntroductionThe purpose of this study was to illustrate the benefits of static and dynamic biomechanical assessment, in addition to the conventional diagnostic approach in the management of patients with proximal hamstring tendinopathy.MethodTwo women, 30 years old, practicing intensive running (8–10 hours per week), presenting a proximal hamstring tendinopathy, were seen in consultation of biomechanical assessment. This multidisciplinary consultation includes a global static and dynamic assessment of the patient; dynamic assessment including video analysis and plantar pressure during walking and running on platform pressure plate.Cases reportEither 2 patients had pain in the buttock radiating to the posterior thigh, occurring during running and acceleration phases of sprint. Clinical examination showed just a pain in the ischium. Biomechanical assessment showed deficiency of the hip abductors and external rotators only for involved side for the 2 patients, responsible of a “sag” of the lower limb. Each of the 2 patients received a “conventional” rehabilitation, including stretching and eccentric exercises of the hamstring, associated with a specific care, according to the weaknesses identified in the biomechanical assessment, including hip external rotators. Full recovery of running was obtained at 4–6 weeks without subsequent recurrence.ConclusionProximal hamstring tendinopathy could be favoured by a deficiency of hip external rotators during walking or running only. It therefore seems appropriate to propose a static and dynamic biomechanical assessment in patients with proximal hamstring tendinopathy, looking for possible contributing/risks factors, such as dynamic hip internal rotation. Biomechanical assessment helps to target and adapt rehabilitation and could prevent the use of more invasive treatments.