Catastrophic strut collapse with the Taylor Spatial Frame: preventing a disaster

Circular external fixators, and in particular hexapod circular external fixators, are increasingly being used in orthopaedic traumatology and limb reconstruction. Their ability to provide three dimensional stability throughout the treatment period make these external fixators indispensable in the management of complex reconstructive work. This study has identified a unique mode of failure with the use of Taylor Spatial Frame Fast-Fx struts and termed this complication catastrophic strut collapse. In this article a lab model is used to demonstrate the consequences of catastrophic strut collapse and warn users of the importance of using the ID bands and locking nuts to prevent inadvertent fragment displacement.     

镍钛记忆合金环抱器治疗多发性肋骨骨折的临床研究

目的：探讨镍钛记忆合金环抱器治疗多发性肋骨骨折的疗效。方法100例多发性肋骨骨折患者均采用镍钛记忆合金环抱器行手术治疗。结果患者均无感染,骨折不愈合及内固定松动、滑脱等并发症发生;术后5个月~12个月取出内固定,骨折部位无炎症反应,心肺功能恢复较好。结论镍钛记忆合金环抱器呈现出良好的组织相容性,手术操作简便、创伤小、并发症少,是一种较为理想的治疗多发性肋骨骨折的方法。     

Pin tract infection caused by Mycobacterium neoaurum in a 14-year-old child: A case report

Although rapidly growing non-tuberculosis mycobacterium can occasionally cause postoperative infections, Mycobacterium neoaurum is a rare pathogen of surgical site infection. We report a case of pin tract infection caused by M. neoaurum in a 14-year-old girl who was admitted for lengthening of her right fourth metatarsal bone. Pain, redness, and exudate were observed 18 days after external fixator insertion. Repeated exudate cultures revealed M. neoaurum, and she was diagnosed with a mycobacterial pin tract infection. She was initially administered intravenous ciprofloxacin and minocycline, and then was switched to oral trimethoprim-sulfamethoxazole and minocycline for a total of 6 months. Despite the pin tract infection, bone lengthening was completed under antibiotic treatment without removal of the pin; no other complications were noted. There are no prior reports of external fixator pin tract infection by M. neoaurum. While such cases may be rare, this case demonstrates that bone distraction may still be successfully completed using appropriate antibiotic therapy without pin removal.     

金天格胶囊用于手部骨折术后辅助治疗临床评价

目的探讨金天格胶囊用于手部骨折术后辅助治疗的效果及对患者生活质量的影响。方法选取医院2016年1月至2019年1月收治的手部骨折患者92例,按随机数字表法分为观察组和对照组,各46例。两组患者均进行有限内固定结合微型外固定架手术,术后均予抗菌及镇痛常规治疗;观察组患者术后加服金天格胶囊。结果观察组患者愈合时间明显短于对照组,Gartland Werley腕关节功能评分明显低于对照组(P<0.05);治疗后,观察组患者的骨代谢指标包括血清骨钙素(BGP)、血清碱性磷酸酶(ALP)、护骨因子(OPG)水平,以及生活质量包括生理功能、心理功能、日常活动、社会功能评分均明显高于对照组(P<0.05);观察组不良反应发生率为15.22%,与对照组的8.70%相当(P>0.05)。结论金天格胶囊用于手部骨折术后辅助治疗,能促进骨折愈合,改善骨代谢指标水平,提高患者的生活质量。     

外固定支架在严重多发伤合并闭合性长管骨骨折分期治疗中的应用

目的：探讨外固定支架分期治疗严重多发伤合并四肢闭合性长管骨骨折的临床疗效。方法笔者选取2009年1月～2013年8月收治的58例严重多发伤合并闭合性四肢长管骨骨折早期行单臂支架临时外固定的患者,男性39例,女性19例;年龄18～70岁,平均47岁。待全身病情稳定、局部软组织损伤改善后,再根据患者具体情况选择最终确定性内固定治疗。结果平均外固定支架使用时间6d。二期确定性内固定治疗前2例出现钉道感染。内固定术后随访时间3～18个月,平均5．2个月。术后切口3例出现感染,总体感染率为5．2％。结论早期采用临时外固定支架没有增加最终确定性内固定手术后感染率,有利于闭合性长管骨骨折进一步治疗。     

The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan

We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a second visit, we reviewed all patients treated during our first mission. In addition, we treated 13 new patients with complex non-unions. Eight of these patients were deemed to be infected. All patients had previous treatment with monolateral fixators as well as soft tissue coverage procedures, except one patient who had had an IEF applied by another team. All these patients had revision surgery with circular frames. All patients from both groups were allowed to fully weight-bear post-operatively, after a short period of elevation to allow the flaps to take. Overall, all fractures united except one case who eventually had an amputation. Four patients had a corticotomy and lengthening, and three of them had a successful restoration of limb length. The fourth patient was the one with the eventual amputation.     

尺骨延长联合瘤体切除治疗儿童遗传性多发性骨软骨瘤尺骨短缩畸形近期效果观察

目的：探讨尺骨延长联合瘤体切除治疗儿童遗传性多发性骨软骨瘤( hereditary multiple exostoses, HME)尺骨短缩畸形的效果及安全性。方法2011年6月—2014年8月我院收治7例 HME 尺骨短缩畸形,尺骨短缩平均2.6 cm,根据前臂 HME 临床分型标准,4例为Ⅱa 型,3例为Ⅰ1b 型。均采用 Orthofix 外固定器尺骨延长联合瘤体切除治疗,术后患肢按计划进行延长及适当功能锻炼。结果本组平均随访22个月,尺骨延长2.5~4.0 cm,平均3.2 cm,均达骨性愈合。腕关节尺偏畸形得到纠正,前臂旋转功能明显恢复,腕关节及肘关节活动功能明显改善。7例均未出现围术期及远期并发症。结论应用 Orthofix 外固定器尺骨延长联合瘤体切除治疗 HME 尺骨短缩畸形,临床近期疗效显著,具有创伤小、并发症少、操作简便灵活等优点。