Weight-bearing in ankle fractures: An audit of UK practice

IntroductionThe purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures.MethodsA multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, “early” weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and “delayed” weight-bearing as unrestricted weight-bearing permitted after 3 weeks.Results251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing.DiscussionThe majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures.ConclusionThis study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible.     

外固定架治疗桡骨远端粉碎性骨折的疗效分析

目的:探讨闭合手法复位外固定架治疗桡骨远端粉碎性关节内骨折的临床疗效。方法:对29例桡骨远端粉碎性关节内骨折,通过外固定架的牵伸辅助复位,矫正桡骨的短缩、成角移位,恢复关节面的解剖关系,利用外固定架维持复位后的位置并进行功能练习。术后定期进行X线和腕关节功能的评价。结果:29例均获得随访,随访时间3~12个月,平均6.5个月。根据Aro功能评价:优9例,良17例,可2例,差1例,优良率89.66%。结论:外固定架能很好维持复位后的位置,恢复桡尺骨的相对长度和关节面的平整,使腕关节功能得到良好的恢复,因此是治疗桡骨远端粉碎性关节内骨折的有效方法。     

人工骨椎体成形术治疗胸腰椎爆裂骨折

目的:探讨经椎弓根人工骨植入椎体成形术治疗胸腰椎爆裂性骨折的方法和效果。方法:胸腰椎爆裂骨折12例,男8例,女4例;年龄28～61岁,平均47.5岁;受伤时间4～12d;术前Frankel分级:C级1例,D级3例,E级8例;受伤椎体:T112例,T122例,L15例,L23例;术前后突角11°～35°,平均24°;术前椎管占位率39%～85%,平均64.5%;术前伤椎椎体前缘高度平均为正常的47%。行后路切开复位短节段椎弓根钉内固定后,人工骨经伤椎椎弓根植入椎体成形术。结果:所有患者均获随访,时间3～19个月,平均13个月。脊柱后突角平均恢复20°,椎体高度平均恢复96%,椎管占位率平均恢复至7%。2例人工骨椎体内充填不足;无内固定松动、断裂、椎体高度变低及生理弧度丢失。神经功能恢复:1例术前Frankel分级C级及2例D级患者术后均恢复至E级。结论:经椎弓根人工骨植入椎体成形术重建了椎体高度,增加了脊椎前柱的抗压稳定性,使患者能早期活动,减少内固定物因应力过大造成的断钉、松动、椎体再压缩等并发症。     

腕舟状骨疲劳骨折3例

疲劳骨折亦称行军骨折，多发生在下肢骨骼，发生在第2、3跖骨、胫骨、股骨颈等部位的疲劳骨折已不少见，但是发生在上肢的疲劳骨折尚不多见。自2002年以来，发现3例腕舟骨疲劳骨折，现报告如下。     

前踝骨折诊治分析5例

踝部骨折是最常见的关节内骨折,约占全身骨折的3.9%[1]。自1998年4月至2004年3月收治单纯前踝骨折5例,现报告如下。1临床资料本组5例,均为男性;年龄18～24岁;左侧3例,右侧2例。受伤至住院时间为2h～1d,均为训练时从高处跳下垂直暴力所致。按Lauge-Hansen分类系统踝关节骨折分为     

The impact of cystic fibrosis on recovery from orthopedic trauma: A case study

Cystic Fibrosis has effects on many body systems, including the skeletal system. In this case, we describe the impact of respiratory and endocrine disease on bone healing following orthopedic trauma in a 22-year-old woman. Limitations to mobility resulting from trauma complicated her respiratory condition. Disease-related effects on bone health and healing delayed her recovery from the trauma. It is important to recognize the multisystemic nature of CF, even when managing acute orthopedic injuries.     

经Lister结节穿针多针阶梯形排列髓内弹性固定的3D有限元分析

目的：考察经Lister结节穿针多针阶梯形排列髓内弹性固定的力学效应。方法：采用CT扫描与计算机图象处理相结合的建模方法，进行尺桡骨受力的3D有限元分析，对比无克氏针固定、多针固定、传统针固定3种状态下，尺桡骨干在压缩和弯曲两种外载荷条件下的受力状态。结果：受压缩载荷作用时，桡骨在产生压缩变形的同时，横向（X轴方向）也产生一定的位移，且随着压缩载荷的增大，横向位移（绝对值）增加；尺骨压缩时横向位移很小。未植入克氏针与植入不同数量克氏针的尺桡骨压缩时，横向位移差异明显。传统针固定和多针固定时，受压缩载荷的尺骨受力较均匀，且等效应力低；而桡骨的等效应力分布不均匀，在桡曲的中间段内外侧应力明显集中；植入克氏针后骨干受力有所变化，尤其是尺骨的等效应力值明显下降。在受到横向的弯曲载荷时，尺桡骨同时产生横向弯曲，其中间部分的最大桡曲位移量随着弯曲载荷的增加而增大。在相同外载荷作用下，无克氏针固定和植入克氏针固定的尺桡骨的最大横向位移有一定差别，并且弯曲载荷越大，无克氏针固定、多针固定、传统针固定的差别越明显。克氏针固定后，其最大等效应力下降明显，尤以多针固定下降最明显。随着横向弯曲载荷的增加，尺桡骨横向弯曲变形越来越严重，外侧表现出纵向拉应力。植入克氏针尤其是多针后，桡骨内侧最大的压应力（绝对值）和外侧的最大拉应力值均明显降低，桡骨承载能力明显提高。结论：经Lister结节穿针多针阶梯形排列髓内弹性固定能有效分担外来载荷对尺桡骨的力学影响，提高固定的稳定性，维持桡骨的生理曲度，从而提高疗效。