Fibula physeal fracture causing syndesmotic diastasis

We report an unusual physeal fibula fracture seen in a 12 year old child. The fragment was rotated and incarcerated in the distal tibiofibular joint causing syndesmotic diastasis. The fragment required open reduction and the fibula was stabilised with k-wires. The patient made an excellent recovery.     

不可吸收缝线治疗髂前上棘撕脱性骨折

正2012年7月~2015年10月,我们采用不可吸收缝线治疗11例髂前上棘撕脱骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组11例,均为男性,年龄11~16岁。就诊时可见患者轻度屈髋体位,髂前上棘处肿胀、压痛。受伤至手术时间4 h~5 d。1.2治疗方法全身麻醉下手术。患者仰卧,患肢稍屈髋屈膝外旋位。以髂     

Intraconal gauze mass: An unusual complication of orbital fracture repair – a case report

Gossypiboma and textiloma are terms used to describe tumor-like masses caused by retained gauze or surgical sponges after any operation. It is a rare surgical complication, usually difficult to diagnose due to its variable clinical presentation and nonstandard radiological appearance. We describe here a rare case of orbital gossypiboma in a child after surgical correction of an orbital blowout fracture.     

Transient retrograde interfragmentary compression technique in AO/OTA type 33-C distal femur fractures: A surgical technique and short-term radiographic follow up results

Surgical treatment of AO/OTA type 33-C fractures is a therapeutic challenge despite advances in surgical instruments and techniques. We introduce a novel surgical technique named transient retrograde interfragmentary compression (TRIC) to help intraarticular fragment reduction in AO/OTA type 33-C fracture. We inserted a partial threaded 7.0-cannulated screw with a washer along the transepicondylar axis from the medial femoral epicondyle during the articular block reduction process of AO/OTA type 33-C fractures to strengthen the compressive force between the condylar fragments and to enhance the handling of the articular block fragment in the alignmental correction stage. Following the provisional reduction and fixation using lateral distal femur locking compression plate, TRIC screw was removed. Fifteen AO/OTA type 33-C distal femoral intraarticular fractures of thirteen patients were surgically treated using the TRIC technique. We analyzed the radiographic result of the patients by measuring the horizontal gap and vertical step-off in the postoperative radiographs. Mean horizontal fracture gap was 0.34 mm and mean vertical step-off between bicondylar fragments was 0.63 mm. The median value of the horizontal fracture gap and vertical step off was 0 and 0.46 mm, respectively. Mean time to union in the bicondylar fracture fragment was 9 week. TRIC is considered to be a valuable surgical reduction technique in the treatment of the AO/OTA 33-C type fractures.     

Infection after fracture fixation: Current surgical and microbiological concepts

One of the most challenging complications in trauma surgery is infection after fracture fixation (IAFF). IAFF may result in permanent functional loss or even amputation of the affected limb in patients who may otherwise be expected to achieve complete, uneventful healing. Over the past decades, the problem of implant related bone infections has garnered increasing attention both in the clinical as well as preclinical arenas; however this has primarily been focused upon prosthetic joint infection (PJI), rather than on IAFF. Although IAFF shares many similarities with PJI, there are numerous critical differences in many facets including prevention, diagnosis and treatment. Admittedly, extrapolating data from PJI research to IAFF has been of value to the trauma surgeon, but we should also be aware of the unique challenges posed by IAFF that may not be accounted for in the PJI literature.This review summarizes the clinical approaches towards the diagnosis and treatment of IAFF with an emphasis on the unique aspects of fracture care that distinguish IAFF from PJI. Finally, recent developments in anti-infective technologies that may be particularly suitable or applicable for trauma patients in the future will be briefly discussed.     

A mathematical simulation of the tip-apex distance and the calcar-referenced tip-apex distance for intertrochanteric fractures reduced with lag screws

BackgroundAs a predictor of the risk of lag screw cutout, it was recommended that keeping tip-apex distance (TAD) < 25 mm and placing the screw centrally or inferiorly, but positioning the lag screw too inferiorly in the head would produce TAD > 25 mm. We aim to simulate various positions of the lag screw in the femoral head and identify whether 25 mm is a suitable cut-off value that favours all sizes of femoral heads with intertrochanteric fractures of the hip.MethodsUsing a general mathematical software, the positions of the screw tip points were simulated. The virtual anterior–posterior and lateral views were then visualised, and the locus of the screw tips was projected into a Cartesian coordinate system according to the TAD and calcar-referenced tip-apex distance (CalTAD) formulas. Each original virtual anterior–posterior and lateral image was zoomed and compiled to match a calculated average image. The screw tip points were recorded, traced and compiled into volumes which could be used to visualise the screw's movements and positioning within the femoral head. The extracted volumes were calculated when 10 mm < TAD < 25 mm and 10 mm < CalTAD < 25 mm, and the region where these two volumes overlapped was also calculated. Suitable positions for the screw tip were then assessed.ResultsFor the TAD calculation, the shape of the traced screw tip points had a pancake-like appearance, while the CalTAD plot produced a teardrop-shaped region. The volume ratios of TAD, CalTAD and overlapping region relative to the femoral head volume were respectively 3.51 ± 1.30%, 5.19 ± 1.62% and 2.64 ± 1.32%. The volumes of the traced TAD, CalTAD and overlapping regions increased slower than the volume of an idealised sphere.ConclusionPositioning the lag screw should address geometrical effects of both tip-apex distance and femoral head size, with an emphasis on measuring the position of the screw tip for the suitable zone by volume ratio. The previous 25 mm TAD cut-off value should be adjusted according to the individual femoral head size.     

Positional change of hyoid bone after anesthesia in anterior surgery of upper cervical spine

Background contextThe hyoid bone is used as a landmark in anterior upper cervical spine operations and is supposed to represent the level of C3 body. However, this correspondence between hyoid bone position and cervical level is not static and changes during surgery (extension after anesthesia).PurposeTo find the cervical level corresponding to the position of hyoid bone before and after anesthesia and to evaluate the adequacy of its usage as a surgical landmark.Study designA retrospective study.Patient sampleOne hundred twenty-eight patients with degenerative cervical diseases who had undergone anterior cervical discectomy and fusion.Outcome measureRadiologic measure.MethodsFor each patient, preanesthesia neutral, preanesthesia extension, and postanesthesia induction extension C-spine lateral image were obtained. The level of cervical vertebra that midline of hyoid bone indicated was measured by radiological method. A cervical vertebra was divided into three segments, consisting of upper half, lower half, and disc space, and each of these segments was considered as one level. The differences between pre- and postanesthesia induction hyoid positions were classified as minimal change (one level or less) and significant change (two levels or greater). Relationship between positional change of hyoid bone to gender, obesity, and age were respectively investigated.ResultsThere were 20 cases of one-level distal displacement of the hyoid bone, 40 cases of two-level distal displacement, 34 cases of three-level distal displacement, 16 cases of 4-level distal displacement, and two cases of five-level distal displacement. In eight cases, there was no level change, and in the remaining 8 cases, the hyoid bone had been displaced proximally. There were 34 cases of minimal change. The remaining 94 cases (73.4%) had significant changes. No respective relationship was found between sex, obesity, age and pre-and postanesthesia induction positional change of hyoid bone.ConclusionsAmong the 128 cases studied, 73.4% hyoid bone positions had changed by more than one cervical vertebra body between the pre- to postanesthesia induction X-ray images. Sex, age, and body mass index were not associated with statistically significant differences in these positions. The hyoid bone should not be trusted as a landmark for upper cervical operations, and the cervical level to be operated should be confirmed by a radiological method before a skin incision is made.     

股骨近端抗旋髓内钉治疗老年股骨转子间骨折

正2014年6月~2015年6月,我科采用股骨近端抗旋髓内钉(PFNA)治疗24例老年股骨转子间骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组24例,男9例,女15例,年龄60~85(69.6±5.7)岁。骨折按Evans-Jensen分型:Ⅰ型2例,Ⅱ型5例,Ⅲ型11例,Ⅳ型6例。入院至手术时间2~10(6±2.3)d。1.2治疗方法患者入院后予以患肢股骨髁上牵引,早期行低分子肝素皮下注射结合患肢主动踝泵锻炼,高血压、高血糖患者术前调整血压、血糖等。手术采用全身麻醉或腰硬联合麻醉。在C     

个体化护理干预对颈椎骨折伴高位截瘫患者压疮预防管理的影响

目的探讨个体化护理干预对颈椎骨折伴高位截瘫患者压疮预防的作用。方法将84例颈椎骨折伴高位截瘫患者随机分成观察组和对照组,每组各42例。对照组给予常规压疮护理,观察组在常规护理基础上以整体护理模式为理论框架,采用"Barden压疮风险评估表"进行评估,并对评分结果给予个体化针对性护理干预。出院前评价两组患者压疮发生情况。结果对照组42例患者中发生压疮8例,压疮发生率为19%,观察组发生压疮2例,压疮发生率为4.8%,差异有统计学意义(x~2=4.725,P0.05)。结论个体化护理干预能有效降低颈椎骨折伴高位截瘫患者的压疮发生,改善患者生活质量。     

中西医结合治疗开放性胫腓骨骨折的疗效及术后感染分析

目的分析中西医结合治疗开放性胫腓骨骨折的临床疗效及术后感染等并发症。方法选取开放性胫腓骨骨折患者164例,随机分为观察组和对照组各82例,观察组予中西医结合治疗,对照组仅予抗菌药物等西药治疗,比较两组患者骨痂生长情况、治疗优良率及并发症发生率。结果观察组术后10周内骨痂出现率为91.46%,对照组为67.07%,观察组患者术后10周内骨痂出现率明显高于对照组;观察组患者临床疗效优良率为92.68%,明显高于对照组的78.05%;观察组并发症总发生率为12.41%;明显高于对照组的25.61%,差异均有统计学意义(P<0.05)。结论中西医结合方法治疗开放性胫腓骨骨折,骨痂生长快,疗效优良率高,术后并发症少,较少出现术后感染。