One-stage emergency treatment of open grade IIIB tibial shaft fractures with bone loss

The purpose of this study was to report the authors' experience with emergency reconstruction of severe tibial shaft fractures. Five male patients were admitted to the emergency room with a grade IIIB open tibial shaft fracture with bone loss (average age, 33 years; age range, 18-65 years). Injuries were the result of motorcycle accidents (N = 2), pedestrian accidents (N = 1), gunshot wound (N = 1), and paragliding fall (N = 1). Primary emergent one-stage management for all patients consisted of administration of antibiotics, debridement, stabilization by locked intramedullary nailing, bone grafting from the iliac crest, and coverage using free muscle flaps (four latissimus dorsi and one gracilis). The average follow-up was 21 months (range, 8 months-3.5 years). Partial weight bearing with no immobilization was started at 3 months, and full weight bearing began 5 months after trauma. No angular complications and no nonunions were observed. There was one case of superficial infection without osteitis. All fractures healed within 6 months in 4 patients and within 10 months in 1 patient. At the last follow-up examination, ankle and knee motion was normal and no pain was noted, except for 1 patient who had associated lesions (ankle motion reduced by 50%). Aggressive emergency management of severe open tibial fractures provides good results. It improves end results markedly, not only by reducing tissue loss from infection, but also reducing healing and rehabilitation times.     

One-stage emergency treatment of open tibial shaft fractures with bone loss. Specifics and indications

OBJECTIVES: The purpose of this study was to report our experience in the reconstruction of severe tibial shaft fractures in emergency treatment. PATIENTS: Five male patients were admitted to the emergency room with a grade IIIB open tibial shaft fracture with bone loss, one patient with a grade IIIA open tibial fracture with massive articular bone loss and one patient with a grade IIIC open tibial fracture. INTERVENTION: Primary one-stage management was the same for the five patients with a grade IIIB: debridement, stabilization by locked intramedullary nailing, bone grafting from iliac crest. Skin loss was covered in the same operative time using free muscle flaps (four latissimus dorsi, one gracilis). For the patient with massive articular and diaphyseal bone loss, a vascularized fibula transfer with arthrodesis was performed one day after the trauma. For the patient with grade IIIC open tibial fracture, a shortening was performed in emergency treatment. RESULTS: The average follow-up was 21 months (range: eight months to 3.5 years). Partial weight-bearing was started at three months and the time of full weight-bearing was five months after the trauma. No angular complication and no non-union were observed. We noted one superficial infection without osteitis. All fractures healed within five to ten months (mean: 8.5 months). At the last follow-up, ankle and knee motion was normal and no pain was noted, except for the patient who had an arthrodesis and another who had associated lesions. CONCLUSION: We think that "aggressive" emergency management for severe open tibial fractures gives good results. It significantly reduces tissue loss from infection and improves healing and rehabilitation times.     

股骨近端解剖型钢板治疗股骨粗隆下不稳定性骨折

目的:探讨股骨近端解剖型钢板治疗股骨粗隆下不稳定骨折的临床价值.方法:自2001年1月～2003年6月采用切开复位、股骨近端解剖型钢板内固定治疗股骨粗隆下不稳定骨折23例.根据术前术后X线片及术后髋关节功能、站立及行走等恢复情况评价内固定效果.结果:17例获得随访,随访时间6个月～3年,根据黄公怡评定标准,优9例,良6例,差2例.结论:股骨近端解剖型钢板治疗高位股骨粗隆下不稳定骨折具有安全可靠、能允许术后早期部分负重等特点,是治疗高位股骨粗隆下骨折的理想选择.     

The treatment of femoral neck fractures with an isoelastic endoprosthesis implanted without bone Cement

Summary We report about our first experiences inserting an isoelastic femoral endoprosthesis in cases of a fractured femoral neck. 28 patients have been observed for a period of more than 1 year after surgery. We did not find loosening or incompatibility of the polyacetal-resin material. We believe the implantation of this prosthesis type without cement fixation is especially advantageous. The histologic result of a patient who died 6 weeks after surgery did not reveal any tissue incompatibility. We observed an excellent fixation of the prosthesis by bone growth into the surface indentations of the stem.

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Zusammenfassung Es wird über die ersten Erfahrungen mit einer isoelastischen Femurkopfprothese bei Schenkelhalsfrakturen berichtet. 28 Patienten mit einer Beobachtungsdauer von mehr als 1 Jahr wurden nachuntersucht. Es zeigten sich keine Fälle von Lockerung oder Unverträglichkeit der aus Polyacetalharz mit Metallarmierung und auswechselbarem Metallkopf geschaffenen Hüftkopfprothesen. Der Verzicht auf die Verwendung von Knochenzement wird als besonderer Vorteil hervorgehoben. Die histologische Untersuchung bei einem Fall einer Patientin, die 6 Wochen nach der Operation verstorben war, zeigt gute Gewebeverträglichkeit des Polyacetalharzes and bereits gute Fixation der Prothese im Femurschaft durch Einwachsen von Knochengewebe in die Vertiefungen der Prothesenoberfläche.

     

应用股骨牵开器有限切开复位治疗胫骨平台骨折

<正>2009年1月~2012年6月,我科对25例胫骨平台骨折患者应用股骨牵开器有限切开复位及内固定治疗,取得了满意疗效,报道如下。1材料与方法1.1病例资料本组25例,男21例,女4例,年龄23~66岁。骨折按Schatz-     

The epidemiology of open long bone fractures

Open long bone fractures occur with a frequency of 11.5 per 100,000 persons per year. They are more common in males and they have a bimodal age distribution. Open fractures of the tibial diaphysis are the commonest, but open femoral diaphyseal, distal femoral and proximal tibial fractures tend to occur in the most seriously injured patients. Lower limb open fractures are more severe than open fractures of the upper limbs. Not only is the soft tissue damage less in open upper limb fractures, but there are fewer associated musculoskeletal injuries.     

开放性股骨髁上骨折28例手术治疗临床分析

目的回顾性分析开放性股骨髁上骨折治疗的临床资料,评价其治疗效果。方法对28例开放性股骨髁上骨折术中彻底清创,Anderson-GustiloⅠ型骨折采用内固定治疗;Anderson-GustiloⅡ、ⅢA型骨折视软组织情况,采用内固定或外固定架固定;Anderson-GustiloⅢB、C型骨折均采用外固定架固定治疗。一期或延迟封闭创面。结果 28例获6~24个月(平均12.7个月)随访。3例发生浅表感染,无骨髓炎发生,2例因骨折不愈合再次行手术治疗,3例发生创伤性膝关节炎。末次随访时膝关节Merchant评分:优10例,良14例,可3例,差1例,优良率85.7%。结论开放性股骨髁上骨折损伤重、处理难度大,选择合适的固定方式、正确处理骨折及软组织损伤、减少感染等并发症的发生是治疗的关键。     

Stress fractures of the femoral neck in child with open capital femoral epiphysis

Stress fracture of the femoral neck has been considered a typical injury of two age groups: active youths and elderly people with osteoporosis. Its occurrence in children with an open capital femoral epiphysis is rare, and only 11 cases have been reported. Here we report two cases, in a 12-year-old boy and a 5-year-old girl (among the youngest patients on record). This fracture can be classified as a compression fracture or a tension fracture. Although tension fractures are not uncommon in military recruits and young athletes, all 13 cases (including our two cases) of femoral neck stress fracture associated with an open capital epiphysis were compression fractures that were treated conservatively.     

股骨远端骨折手术治疗的回顾性研究

目的探讨采用切开复位内固定术治疗股骨远端骨折的临床效果。方法对1999年1月至2009年1月收治的采用切开复位内固定治疗且获得完整随访资料的19例股骨远端骨折患者进行回顾性分析,男10例,女9例;年龄23～83岁,平均59岁;左侧6例,右侧13例。按照AO分型：A型9例,B型5例,C型5例;根据Neer分型：I型5例,Ⅱ型9例,Ⅲ型5例。闭合性骨折16例,开放性骨折3例,合并其他部位骨折6例,其中合并同侧胫骨平台骨折2例,同侧髌骨骨折1例,同时合并同侧胫骨平台及髌骨骨折1例。受伤至入院时间1 h～6 d,平均22.6 h。对术后患者的膝关节活动度、功能及患者满意度进行评定。结果随访时间4～76个月,平均35.9个月。无一例患者出现伤口感染,内固定松动、断裂。1例患者出现骨折延迟愈合,经二次手术植骨后好转。所有患膝关节伸直均达0度,屈曲平均达122.4度,无内外翻畸形,关节内骨折患者无明显创伤性关节炎表现。膝关节功能HSS评分平均85.1分,优良率94.7%;Lysholm评分83.6分,优良率89.5%。患者对治疗的满意率平均为82.1%。结论采用切开复位内固定结合植骨并早期功能锻炼治疗股骨远端骨折,有利于膝关节功能的早期恢复,结果满意。     

开放性胫腓骨骨折合并胫骨骨缺损的手术治疗

目的探讨开放性胫腓骨骨折伴有大段骨缺损的手术治疗方法。方法自2003—09-2012—04对51例开放性胫腓骨骨折伴骨缺损者根据骨缺损长度进行分组,其中24例一期行外固定架结合腓骨钢板固定骨折端,二期骨缺损处行髂骨植骨;27例一期行Ihzamv骨搬移技术治疗胫骨大段骨缺损。结果骨缺损均得以重建,患者肢体长度完全恢复,患者肢体长度与健侧之差均〈2cm,无一例出现畸形,皮肤软组织得到修复。结论外固定架结合钢板固定是治疗合并胫骨骨缺损的开放性胫腓骨骨折的有效方法,骨缺损6em以内患者肢体功能及长度得以重建。IHzamv骨搬移技术也是治疗胫骨大段骨缺损合并软组织缺损的有效方法,尤其适用于骨缺损长度大于6cm的患者。     

Masquelet技术治疗开放性pilon骨折骨缺损

目的 探讨Masquelet技术治疗开放性pilon骨折骨缺损的疗效. 方法 对2005年8月至2010年6月采用Masquelet技术治疗的16例开放性pilon骨折骨缺损患者的临床资料进行回顾性研究,男11例,女5例;年龄20 ～67岁,平均36.5岁;右侧10例,左侧6例;骨折按AO/ASIF分型:C2型7例,C3型9例.长段缺损5例,腔隙性缺损11例.开放性损伤按Gustilo分型:ⅢA型10例,ⅢB型6例.所有患者先进行清创,将带抗生素的骨水泥植入骨缺损处,并用外固定支架临时固定,6～8周后待软组织肿胀消退无明显感染迹象后拆除外固定支架,并行切开复位钢板内固定及植骨术. 结果 所有患者术后获6 ～48个月(平均24个月)随访,均未出现伤口深部感染和皮肤坏死.骨折复位影像学评估按照Burwell-Charnley标准:解剖复位6例,功能复位9例,复位差1例.骨折均获骨性愈合,愈合时间为13～58周,平均21周.踝关节功能按美国足踝外科协会的踝-后足功能评分标准评定,评分为62 ～98分,平均85.6分. 结论 采用Masquelet技术治疗开放性pilon骨折骨缺损可以取得良好的疗效,且手术方法简便.     

带锁髓内钉治疗股骨干骨折合并股骨颈及转子间骨折或转子下粉碎骨折

目的应用带锁髓内钉治疗股骨干骨折合并同侧股骨颈骨折及转子间骨折或转子下粉碎骨折。方法在1996年7月～1998年11月收治的16例复杂股骨骨折中,股骨干骨折合并同侧股骨颈骨折3例,合并转手间骨折4例,转子下粉碎骨折9例。其中10例应用国产加长型Gamma钉,6例使用Russell－Taylor股骨重建钉固定。结果所有病例随访6～22个月,平均11个月。除1例股骨干骨折合并同侧股骨颈骨折患者术后7个月出现股骨头坏死外,其余15例骨折均愈合,平均愈合时间5．5个月,患肢关节功能优良。经此方法治疗后可早期活动关节及功能锻炼、手术创伤小、切口小、固定可靠、骨折愈合率高。结论　　对股骨干骨折合并同侧股骨颈骨折及转手间骨折或转子下粉碎骨折的治疗,带锁髓内钉具有明显优势。     

同侧股骨干合并股骨颈骨折的处理

目的 分析同侧股骨干合并股骨颈骨折的临床特点和诊断要点，探讨不同治疗方法的疗效。方法 1998年3月－2001年6月收治的18例19个同侧股骨干合并股骨颈骨折病人中，早期诊断12例，2例用多针固定。2例行缝匠肌带肌蒂植骨，3例行带旋髂深血管植骨术。结果 术后随访8－40个月，平均16个月。股骨干骨折除1例钢板固定不愈合外其余均愈合。股骨颈骨折1例不愈合，其余均愈合。结论 对股骨干骨折合并同侧股骨颈骨折早期推荐使用逆行带锁髓内钉和空心螺钉固定，对漏诊病例使用多针在股骨髓内钉前方固定股骨颈是一种有效的补救方法，晚期漏诊采用带肌蒂、血管蒂植骨术仍可取得较高愈合率。     

髋关节后脱位伴股骨头骨折的治疗

目的探讨髋关节后脱位合并股骨头骨折的治疗方法与愈后。方法分析29例髋关节后脱位合并股骨头骨折患者的分型、治疗时间及治疗方式。27例获得随访(93.1%),随访时间1～15年(平均7年)。以X光平片及髋关节功能恢复情况评价其愈后。结果29例髋关节后脱位合并股骨头骨折患者按Pipkin分类法分型,Ⅰ型13例(占44.8%),Ⅱ型9例(占31%),Ⅲ型3例(占10%),Ⅳ型4例(占14.2%),对27例获得随访者按HHS(HarrisHipScore)功能评价标准,Ⅰ型中优为9例(占33.3%),良2例(占7.4%),可1例(占3.7%),差0例(占0%),Ⅱ型中优为0例(占0%),良2例(占7.4%),可4例(占14.9%),差2例(占7.4%),Ⅲ型中优1例(占3.7%),良0例(占0%),可1例(占3.7%),差1例(占3.7%),Ⅳ型中优0例(占0%),良2例(占7.4%),可1例(占3.7%),差1例(占3.7%),其中行人工全髋关节置换者4例(占总例数13.7%)。结论髋关节后脱位合并股骨头骨折的治疗方法应根据损伤机制、骨折脱位类型确定。其愈后取决于患者的年龄、治疗时间、骨折脱位类型、治疗方法以及预防并...     

The surgical choice strategies in the treatment of femoral bone fractures in injured persons with combined trauma

In 1990-1999 years osteosynthesis of the hip bone was performed in 500 injured persons with combined trauma. In 63.1% patients the plates were used, in 19.6%--pivots, in 17.3%--apparatuses of external fixation. The choice of the method and optimal terms of performance of the surgical stabilization procedure of fracture were determined by the trauma severity in accordance with anatomo-functional model. In 12-18 months after the operation 198 patients were examined. Good result was noted in 79.6% of patients, satisfactory--in 17.3%, bad--in 3.1%.     

带血管蒂大转子骨瓣移位修复青壮年股骨颈骨折

目的 观察带血管蒂大转子骨瓣移位治疗青壮年股骨颈严重骨折的疗效. 方法 青壮年股骨颈严重骨折29例.其中GardenⅢ型10例,Ⅳ型19例.新鲜骨折12例,陈旧性骨折17例.陈旧性骨折病例中,合并股骨头坏死者7例.人院后即行胫骨结节牵引.手术方式均为开放复位空心拉力螺钉固定同时行带血管蒂大转子骨瓣移位. 结果 随访39～84个月.新鲜股骨颈骨折和陈旧性骨折病例均在4.5个月全部愈合.但合并有股骨头坏死者修复时间明显延长,平均12.5个月.未合并股骨头坏死的陈旧性骨折病例10例中,出现股骨头坏死3例.髋关节功能完全恢复正常15例,部分受限12例,髋关节屈曲严重受限2例.新鲜骨折术后的髋关节功能明显优于陈旧性骨折.依Harris髋关节评分标准,术后平均89.2分.股骨颈短缩得到较好纠正. 结论 带血管蒂大转子骨瓣移位可有效治疗青壮年股骨颈严重骨折.