SACRAL FRACTURES

Objective. To delineate the clinical spectrum and treatment choice of sacral fractures. Methods. In this series, 39 sacral fractures were retrospectively reviewed and classified utilizing Denis‘ classification. There were 21 Zone Ⅰ fractures, 6 Zone Ⅱ fractures and 12 Zone Ⅲ fractures. Neurologi-cal deficits were present in seven patients. Thirty seven patients were treated conservatively and two under-went surgical management. Results. Thirty eight patients were followed up for three months to 19 years. Thirty three have recov-ered, four improved, and one remained disabled. Conclusion. The treatment of sacral fractures requires assessment of pelvic stability and existing nerve injury. The patients with pelvic ring instability and neurological deficits should be treated with fracture re-duction and stability reconstruction. When the patients with pelvic fracture are complicated with neurologi-cal deficits, sacral fracture should be first suspected. Once the diagnosis of sacral fracture is made, fracture reduction should be indicated. Conservative treatment usually permits satisfactory results.     

Treatment of hip joint dislocation combined with femoral head fracture

Objective To discuss the treatment of the hip joint dislocation combined with femoral head fracture and its clinical therapeutic effects.Methods From July 2001 to July 2008,19 patients with hip joint dislocation combined with femoral head fracture underwent conservative therapy or surgical treatment.Classification was based on Pipkin’s criteria,type Ⅰ four,type Ⅱ six,type Ⅲ six,type Ⅳ three.Various procedures were taken according to the different types of the fracture,the time of the fracture,and the age of the patients.The clinical therapeutic effects were analyzed.Results In type Ⅰ,four were rated as excellent by Harris Hip Score’s criteria.In type Ⅱ,two rated as excellent,three as good and one as fair.In type Ⅲ,three rated as good,two as fair and one as poor.In type Ⅳ,one rated as excellent,one as good and one as fair,overall rate of excellent and good was 73.7%.Conclusion The treatment of Pipkin fracture should be based on multiple factors such as the type of fracture,the time of fracture,the age of patients and so on.The prognosis is directly related with those factors and the way of the treatment.     

TRAITEMENT DES FRACTURES DE L''''OLECRANE PAR SUTURE PERCUTANEE

The authors devised a method of percutaneous suture for treating fracture of olecranon. There are two operative technics for percutaneous suture: one is the suture through two skin holes and another the suture through four skin holes. 40 cases of fracture of olecranon were resorted to the method of percutaneous suture. Suture with steel wire through two skin holes was used in 3 cases and suture with steel wire through four skin holes in 37 cases. Most of the fractures had satisfactory reduction and all the fractures healed well. 33 cases had been followed for more than one year, the late results were excellent in 20, good in 8, fair in 4 and poor in 1. The operative technic of the percutaneous suture is simple and less traumatic to the local tissues. The late functional recovery is not inferior to that of open reduction with internal fixation.     

Four Pins Assisted Reduction of Complex Segmental Femoral Fractures： a Technique for Closed Reduction

Complex segmental femoral fractures are usually not amenable to closed reduction. The purpose of this study was to evaluate a series of patients who had undergone four pins assisted reduc- tion and intramedullary nail fixation to determine the therapeutic effect of this closed reduction tech- nique. Between December 2010 and January 2013, 15 consecutive patients with segmental femoral fractures were treated with four pins assisted reduction at our hospital. The patient was placed in a supine position on a radiolucent fracture table and a. gentle traction was attempted on the limb. Usu- ally, the proximal fracture segment exhibited the typical deformity of flexion, external rotation, and abduction, the middle segment exhibited adduction and distal fracture segment exhibited flexion. Four Schanz pins were placed percutaneously to fix one cortex and did not penetrate into the me- dullary cavity, and the ＂T＂ sharp handles were fixed on the Schanz pins. The fragments were then re- duced by reversing the deforming forces for segmental fractures by two assistants~ And then, the re- duction could be easily achieved and intramedullary nail fixation was performed. Radiographs were evaluated for the quality of the reduction and fracture union. Closed reduction was achieved in all pa- tients using the four pins technology. All 15 fractures united uneventfully. No patient had a rotational malunion or limb length discrepancy at the time of the last follow-up. Thirteen of the fifteen （86.7%） patients had anatomic reduction and two of them （13.3%） had minor varus alignment of 3° and 5°. Knee stiffness was Observed in 2 patients and no implant failure was observed. Surgical treatment of complex segmental femoral fractures With four pins assisted reduction and intramedullary nail fixation techniques can result in excellent reductions and a high union rate.     

Treatment of osteoporotic vertebral body compression fractures by percutaneous vertebroplasty

Objective: To explore the effect of percutaneous vertebroplasty to treat osteoporotic vertebral body compression fractures. Methods: Seventeen patients with compression fractures at 27 different levels came in for percutaneous vertebroplasty. Under the guidance of C-ann image intensifier, bone needle was inserted into the fracture vertebral bodies via a unilateral transpedicular approach.Polymethyl methacrylate (PMMA) was injected slowly under continuous fluoroscopic control. Then the effect was evaluated after operation.Results: Follow-up results among 15 patients were studied, other two patients lost contact. The follow-up period was from three to seven months. No patient had relapse of compression fracture. Leakage of the cement outside the vertebral body was seen in four bodies. All patients had a complete relief after Percutaneous vertebroplasty(PVP). Conclusion: PVP is an efficient minimally invasive technique to treat osteoporotic vertebral body compression fractures.     

Clinical classification and treatment strategy of hamate hook fracture

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures,12 patients who suffered from hamate hook fractures were followed up retrospectively.According to the fracture sites and the prognosis,we classified the hamate hook fractures into 3 types.Type Ⅰ referred to an avulsion fracture at the tip of hamate hook,type Ⅱ was a fracture in the middle part of hamate hook,and type Ⅲ represented a fracture at the base of hamate hook.By the classification,in our series,only 1 fell into type Ⅰ,7 type Ⅱ,and 4 type Ⅲ.The results were evaluated with respect to the functional recovery,recovery time and the association among the clinical classification,pre-operative complications and treatment results.The average follow-up time of this group was 8.4±3.9 months.Two cases were found to have fracture non-union and both of them were type Ⅱ fractures.Six patients had complications before operation.Five cases were type Ⅱ fractures and 1 case type Ⅲ fracture.All the patients were satisfied with the results at the time of the last follow-up.Their pain scale and grip strength improved significantly after treatment.All the pre-operative complications were relieved.The recovery time of hamate hook excision was significantly shorter than that of the other two treatments.The incidences of both pre-operative complications and non-union in type Ⅱ fractures were higher than those in type Ⅰ and type Ⅲ fractures.It was concluded that,generally,the treatment effects with hamate hook fracture are quite good.The complication incidence and prognosis of the fracture are closely related to the clinical classification.Early intervention is critical for type Ⅱ fractures.     

Clinical effect of Sidong Wubu method in treatment of closed fracture of upper limbs

OBJECTIVE:To objectively evaluate the clinically curative effect of sidong wubu method on closed fracture of upper limbs.METHODS:A single-blind randomized controlled trial was used to divide 654 patients with closed fracture of upper limbs at early stage into two groups.298 patients in the surgical group were treated with open reduction and internal fixation and 356 patients in the treatment group with sidong wubu method for 6 months as a course of treatment.RESULTS:As for short-term curative effect(after 6 courses of treatment),the total effective rate was 97.7% in the treatment group and 92.9% in the control group,and the excellent and good rate was 83.7% and 76.5% respectively.Fracture-healing time,treatment cost,function-recovering time,scores of symptoms and signs obviously declined in both groups with remarkable difference between the two groups.As to long-term curative effect(after follow-up visit for one year to 5 years and 2 months),there was still noticeable difference(χ 2 = 7.536,P<0.05) in total curative effect and in excellent and good rate between the two groups.CONCLUSION:With low cost,short treatment course,good function and other advantages,sidong wubu method can be first used to treat closed fracture of upper limbs.     

PERCUTANEOUS REDUCTION AND STABILIZATION OF COMPLEX TIBIAL PLATEAU FRACTURES

Mechanical traction and percutaneous reduction by leverage and fixation by a bilateral groove external fixator were performed on 23 patients with complex tibial plateau fractures involving a depressed and split fragments. The fixator is composed of two long groove frames, three to five nuts. hooked bolts and Steinmanns pins. All fractures united in good position in three months with no incision (only pinpricks), little operative trauma and no significant complications but pinrract infection, and the flexlon-extension range of knce movement was excllent in all patients, so that this technique is particularly advisable for complex tibial plateau fractures.     

Bone joint

<正>209364 Clinical observation on the different treatments targeted at different types of radial head fracture and radial neck fracture/Zhang Yingze(张英泽,Emergency Center Traumatic Orthop,3rd Hosp Hebei Med Univ,Shijiazhuang 050051)…∥Chin J Surg.-2009,47(12).-896～898Objective To assess the effect of the different treatments targeted at different types of radial head fracture and radial neck fracture.Methods A retrospective study was performed in 87 patients from February 2006 to March 2007.Fifty(four patients with radial head fractures included 36 males and 18 females,aged from 18 to 65 years (the average age was 33);Forty of them resulted from crashing,8 from traffic injury and 6 from falling injury.According to Mason classification system,there were 15 type Ⅰ,23 type Ⅱ and 16 type Ⅲ.Thirty-three patients with radial neck fractures included 21 males and 12 females,aged from 9 to 17 years (the average age was 13),29 of them resulted from crashing,1 from traffic injury and 3 from falling injury.According to O’brien classification system,there were 8 type Ⅰ,14 type Ⅱ and 11 type Ⅲ.Type Ⅰ of radial head fractures and tadial neck fractures were immobilizated with cast,the patients with type Ⅱ of radial head fractures were treated with open reduction and micro-screw or T-trapezoid and bridge-shaped plate fixation and type Ⅲ had operations to fix with bridge-shaped locked plated and repair the broken annular ligament,or replace heads with prosthesis.All patients with type Ⅱ and type Ⅲ of radial neck fractures were treated with closed reduction by leverage and percutaneous intra-medullary nailing.Results The patients were followed up for 4-12 months (mean 7.2 months).The functional recovery degrees were evaluated with Wheeler’s evaluation system.In group of radial head fractures,the results were excellent in 26 patients,good in 20,fair in 6 and poor in 2,the excellent and good rate was 85.2%.In group of radial neck fractures,the results were excellent in 20 patients,goo     

Loss of bone mass after Colles’ fracture: a follow-up study

Background Colles’ fracture usually associated with osteoporosis is regarded as the predictor of subsequent osteoporotic fracture. However, it is not clear how the local changes of bone mass take place during the course of treatment and whether the changes are related to clinical practice. The objective of the current study was to investigate the local changes of bone mass in patients with Colles’ fracture and their possible clinical relevance in a follow-up study.Methods The radiograms of the second metacarpal in 64 patients with Colles’ fracture were assessed for bone density immediately after fracture, 6 weeks, 6 months and 1 year after fracture, respectively. Functional results were evaluated at one year.Results Bone mass six weeks after Colles’ fracture was significantly decreased without returning to normal at one year though increased bone mass had been identified 6 months after fracture (P&lt; 0.05), (P&lt; 0.01). At one year significant (P&lt; 0.05) or highly significant (P&lt; 0.01) correlations were observed between bone mass indices of metacarpal and functional results, indicating that poor function is associated with lower bone density. Significant differences (P&lt; 0.05) between fracture patterns also suggested that patients with more severe fractures have a more pronounced bone loss.Conclusions Bone loss during the course of treatment will have a direct effect upon the prognosis, so different treatment should be proposed for different patterns of fractures. Active exercise should be made to improve the recovery of bone mass.     

闭合整骨复位外固定器治疗锁骨骨折

目的：探讨锁骨骨折的治疗方法.方法：局部麻醉下闭合正骨复位,经皮刺入锁骨外固定器的抓持爪,旋紧抓持爪紧固螺钉,固定骨折近端,同法固定骨折远端,锁紧万向节紧固螺钉及调节螺杆的螺母,无菌敷料包扎.结果：18例患者接受锁骨外固定器（中国专利号：200320107735.1）固定治疗,术后28d骨折愈合,肩节功能优良.结论：闭合正复经皮外固定器固定术创伤轻微,固定可靠,有利于术后早期进行患肢功能锻炼,促进骨折愈合与节功能恢复,避免了传统外固定法的不稳定性和并发症以及切开复位内固定手术医源性创伤.     

形状记忆合金环抱接骨板治疗人工髋关节置换术后股骨干骨折

目的 探讨形状记忆合金环抱接骨板治疗人工髋关节置换术后股骨干骨折的手术方法及疗效.方法 采用西脉记忆合金环状接骨板治疗人工髋关节置换术后股骨干骨折患者7例.结果 7例均获随访6个月以上,骨折均愈合,关节功能恢复术前水平.结论 形状记忆合金环抱接骨板治疗人工髋关节置换术后股骨干骨折具有操作简单、固定牢靠、创伤小、手术时间短等优点,是一种简便有效的方法.     

记忆合金环抱器治疗髋关节置换并发假体周围骨折

目的:探讨记忆合金环抱器治疗髋关节置换并发假体周围骨折的方法及疗效。方法:回顾性分析采用记忆合金环抱器手术治疗髋关节置换并发假体周围骨折11例,术后复查X线片并随访,对疗效评价。结果:11例均获随访,患者均获骨性愈合,假体稳定,无X线松动表现,髋关节活动功能恢复较好,Harris评分平均82.4分(74～87分)。结论:髋关节置换术中、术后的股骨柄假体周围骨折采用记忆合金环抱器内固定,操作简便、安全、固定牢固且骨折愈合好。     

梅花针结合记忆合金环抱钢板治疗股骨严重粉碎性骨折

目的探讨梅花针结合记忆合金环抱钢板固定治疗股骨严重粉碎性骨折的临床疗效。方法2003年1月—2008年1月,我院采用梅花针结合记忆合金环抱钢板固定治疗股骨严重粉碎性骨折患者36例,手术采用切开复位,先逆行打出梅花针,复位股骨主干及大骨折块,顺行打入梅花针,再复位小骨块,用记忆合金环抱钢板固定。若骨块间隙〉5 mm,采用自体骨条一期植骨。结果术后随访6～36个月,平均随访时间13.4个月,骨折全部愈合,平均愈合时间为5.3个月,所有患者关节功能恢复良好,无感染及医源性神经血管损伤发生。结论梅花针结合记忆合金环抱钢板固定是治疗股骨严重粉碎性骨折行之有效的方法。     

股骨粗隆间骨折几种手术方法的评估

目的评价股骨粗隆间骨折的手术治疗效果。方法对股骨粗隆间骨折采用动力髋螺钉、动力髁螺钉、股骨近端外侧解剖钢板、Oamma钉、PFN及人工股骨头置换等6种方法固定后其疗效分析。结果比较以上六种治疗股骨粗隆间骨折的方法，各有利弊，其结果与与选择的骨折类型、年龄、手术熟练程度均有联系。结论以上六种方法对治疗股骨粗隆间骨折均有其适应证，关键是选择合适的病例，即个性化治疗。     

形状记忆合金环抱器治疗锁骨骨折不愈合的体会

目的 探讨形状记忆合金环抱器治疗锁骨骨折不愈合的疗效。方法 使用形状记忆合金环抱器治疗锁骨骨折不愈合13例,其中内固定术后失败12例,非手术治疗1例,均采用植骨。结果 13例均获随访,平均12．7个月,X线片显示术后平均2．4个月骨折愈合。结论 形状记忆合金环抱器治疗锁骨骨折不愈合固定坚强,操作安全,愈合率高。     

应用记忆合金环抱式固定器治疗多发性肋骨骨折47例临床分析

目的 探讨记忆合金环抱式固定器治疗多发性肋骨骨折的临床应用价值.方法 对采用记忆合金环抱式肋骨固定器进行手术内固定的47例多发性肋骨骨折患者的临床资料进行分析总结,并与既往传统外固定非手术治疗的多发性肋骨骨折47例患者比较.结果 本组病例手术均顺利,全部临床愈合出院.与传统非手术治疗组比较,内固定手术组胸痛明显减轻、下床活动时间提前,住院时间及骨折愈合时间明显缩短,肺部并发症(肺部感染、肺不张)明显减少(P<0.05).结论 应用记忆合金环抱式肋骨固定器治疗多发性肋骨骨折,是一种比较理想治疗方法,具有创伤小、恢复快、安全、固定可靠、并发症少等多项优点.     

记忆合金环抱钢板结合克氏针治疗锁骨长节段粉碎骨折

目的探讨记忆合金环抱钢板结合克氏针治疗锁骨长节段粉碎骨折的临床疗效。方法采用记忆合金环抱钢板结合克氏针治疗锁骨长节段粉碎骨折28例，其中锁骨外侧1／3骨折17例，中1／3骨折8例，内侧1／3骨折3例。结果28例患者术后随访13个月，骨折全部临床愈合，平均临床愈合时间10周。结论记忆合金环抱钢板结合克氏针治疗锁骨长节段粉碎骨折具有手术简单、固定牢靠、骨折端血运破坏少、手术安全、并发症少等优点，疗效满意。     

天鹅记忆接骨器治疗兔肱骨干骨折

目的 观察天鹅记忆接骨器(SMC)治疗动物肱骨干骨折的疗效。方法 选用新西兰大白兔30只建立肱骨干骨折模型，一侧用SMC固定，对侧以4孔动力加压接骨板(DCP)作为对照。术后2、4、8、12周拍片观察骨愈合情况。结果 术后动物全部成活，前肢负重明显少于后肢。SMC侧骨折端直接由板层骨替代连接，既不出现外骨痂，也无板下皮质骨疏松，对照侧骨折愈合速度慢，且部分骨断端有骨痂生成，所有骨干局部出现骨质疏松。结论 兔肱骨干的生物力学特性和解剖形态与人肱骨干非常接近，其骨折内固定模型是研究SMC促进骨折愈合的机制的理想实验工具。     

人工股骨头置换术治疗高龄患者股骨粗隆部骨折疗效观察

目的探讨人工股骨头置换术治疗高龄患者股骨粗隆部骨折疗效观察,总结护理经验,提高治疗质量。方法回顾性分析21例人股骨粗隆间骨折人工股骨头置换术的疗效观察,均给予认真细致的术前、术中及术后观察。结果临床效果满意,术后关节功能恢复良好。结论有效的护理措施对老年人股骨粗隆间骨折人工股骨头置换术后康复具有重要作用。