Treatment of distal clavicle fracture with distal radius volar locking compression plate

Objective: To observe the early clinical outcomes of the internal fixation with distal radius volar locking compression plate (LCP) in treatment of distal clavicle fracture.Methods: Six patients with unilateral distal clavicle fractures, identified as type Ⅱ according to Neer classification system, including 4 males and 2 females, were treated with open reduction and internal fixation using a distal radius volar LCP. Bone union was evaluated by routine X-ray radiography, and shoulder joint function were assessed by Constant score system.Results: All fractures achieved bone union at 6 to 8 weeks postoperatively, and Constant scores ranged from 95 to 100 at the postoperative 10 to 12 weeks.Conclusion: Fixation of distal clavicle fracture with distal radius volar LCP demonstrates excellent effects of bone union with rarely early complications, thus providing a new technique to treat distal clavicle fracture.     

Bone splint technique and plating application in adolescent high,energy comminuted fracture of distal femur with bone defects

Comminuted fracture of distal femur is a common lower limb injury from traffic accidents, especially from motor accidents. Routine dynamic condylar screw （DCS） or 95-degree condylar plate （CP） sometimes cannot solve the bone defect in the center of alignment and contralateral diaphysis for the reason of absent screw anchor point, especially for AO C2.2-2.3 types. Many authors recommended open reduction and fixation with less invasive stabilization system （LISS） as the treatment of choice, but there are still problems in fusion and alignment. In this study, we reported our experiences with the use of bone splint technique in the high-energy commimuted fracture of distal femur with central and medial bone defect in adolescents.     

《手外科杂志》(美国卷)2000年25卷第1期目录的中英文对照

[l]Outcome following nonoperative treatment of displaced distal radius fractures in low-demand Pa-tients older than 60 years 老年患者采取非手术疗法治疗桡骨远端骨折伴移位的预后。[2]Comparison of three different plating tech-niques for the dorsum of the distal radius: a bio-mechanical study桡骨远端背侧三种钢板固定方法的生物力学比较。[3]Experimental carpal reversefloW Pedicle vascu-larized bone grafts. Part Ⅰ: the anatomical basis of vasclarized Pedicle bone grafts based on the canine distal radius and ulna腕部逆行带血管蒂的骨移植的实验研究。I:关于犬尺桡骨远端带血管蒂骨移植的解剖学研究。     

Scaphoid fracture associated with distal radius fracture in children:a case report

Te forearm distal bone fracture is the most com-mon fracture in children. Scaphoid frac-ture is rare because the scaphoid is largely car-tilaginous in children. Some cases associating both distal radius and scaphoid fractures were reported in the literature. Scaphoid fracture often occurs without displacement and can be easily overlooked. We re-ported a case of children wrist injury combining scaphoid fracture with ipsilateral distal fracture.     

Managing extremely distal periprosthetic femoral supracondylar fractures of total knee replacements-a new PHILOS-ophy

We report two cases where a proximal humeral locking plate was used for the fixation of an extremely distal, type Ⅲ peri-prosthetic femoral fractures in relation to a total knee replacement(TKR). In each case there was concern regarding the fixation that could be achieved using the available anatomic distal femoral plates due to the size and bone quality of distal fragment. The design of the Proximal Humeral Internal Locking System(PHILOS) allows nine 3.5-mm locking screws to be placed over a small area in multiple directions. This allowed a greater number of fixation points to be achieved in the distal fragment. Clinical and radiological short-term follow-up(6-12 mo) has been satisfactory in both cases with no complications. We suggest the use of this implant for extremely distal femoral fractures arising in relation to the femoral component of a TKR.     

Implanting hydroxyapatite-coated porous titanium with bone morphogenetic protein-2 and hyaluronic acid into distal femoral metaphysis of rabbits

Objective： To assess the osseointegration capability of hydroxyapatite-coated porous titanium with bone morphogenetic protein-2 （BMP-2） and hyaluronic acid to repair defects in the distal femur metaphysis in rabbits.
Methods： Porous titanium implants were made by sintering titanium powder at high temperature, which were coated with hydroxyapatite by alkali and heat treatment and with BMP-2 combined with bone regeneration materials. And hyaluronic acid was further used as delivery system to prolong the effect of BMP-2. The implants were inserted into the metaphysis of the distal femur of rabbits. The animals were killed at 6, 12 and 24 weeks to accomplish histological and biomechanical analyses.
Results： According to the result of histological analysis, the osseointegration in BMP-2 group was better than that of the HA-coated porous titanium group. In push-out test, all the samples had bigger shear stress as time passed by. There was statistical difference between the two groups in 6 and 12 weeks but not in 24 weeks.
Conclusion： Hydroxyapatite-coated porous titanium with BMP-2 and hyaluronic acid has a good effect in repairing defects of distal fumur in rabbits, which is a fine biotechnology for future clinical application.     

Biplane osteotomy and bone transport combined external locking plating for sequential treatment of massive tibial bone defects北大核心CSCD

Objective To evaluate biplane osteotomy and bone transport combined external locking plating for sequential treatment of massive tibial bone defects. Methods Twenty-eight patients with massive tibial bone defects were reviewed who had been treated at Department of Repair and Reconstruction, Wuhan Puai Hospital from October 2013 to October 2019. They were divided into a bone transport group and a combined bone transport group (bone transport combined external locking plating) according to their surgical methods. In the bone transport group of 14 cases, there were 10 males and 4 females with an age of (38. 6 ±3. 2) years and a bone defect of (8. 0 ± 0. 5) cm; in the combined bone transport group of 14 cases, there were 9 males and 5 females with an age of (39. 1 ± 3. 9) years and a bone defect of (8. 3 ± 0. 3) cm. The time for wearing external fixator, fracture healing time, dock-in-site healing time, postoperative function assessment and complications were observed and compared between the 2 groups. Results There was no significant difference between the 2 groups in their preoperative general data, showing they were comparable (P > 0. 05). The bone transport group were followed up for 12 to 28 months (average, 18. 4 months) and the combined bone transport group for 12 to 26 months (average, 16. 8 months) . The time for wearing external fixator in the combined bone transport group [(8.4±0.7) months] was significantly shorter than that [(13.3±1.4) months ] in the bone transport group (P< 0. 05). No significant difference was observed between the 2 groups in either the fracture healing time [ (8. 4 土1.3) months versus (7. 4 ± 1. 2) months] or the dock-in-site healing time [(210. 2 ±9.1) months versus (206. 2 ± 9. 8) months ] (P > 0. 05). By the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring, the bone healing was excellent in 6, good in 5 and fair in 3 cases in the bone transport group while excellent in 8, good in 4 and fair in 2 cases in the combined bone transport group, showing no significant difference between the 2 groups in the excellent to good rate (P > 0. 05). By the postoperative functional assessment of the lower extremity, there were 7 excellent, 3 good, 3 fair and one poor cases in the bone transport group while 8 excellent, 5 good and one poor cases in the combined bone transport group, showing no significant difference between the 2 groups in the excellent to good rate (P > 0. 05). In the bone transport group, there were 3 cases of pin track infection, one case of dock-in-site nonunion, 2 cases of poor alignment of lower extremities, 2 cases of skin depression, one case of nail loosening, 5 cases of joint stiffness and 3 cases of delayed union of the distracted bone; in the combined bone transport group, there were one case of pin track infection, 2 cases of poor alignment of lower extremities, 3 cases of skin depression, 3 cases of joint stiffness, 2 cases of delayed union of the distracted bone and one case of refracture. Conclusion In the sequential treatment of massive tibial bone defects, biplane osteotomy and bone transport combined external locking plating can reduce the time for wearing external fixator and increase the satisfaction of patients. © The Author(s) 2022.     

肘关节脱位与肱骨远端关节内骨折

Objective To describe dislocation of the elbow with articular fracture of the distal humerus,a type of elbow fracture-dislocation about which little has been written.Methods Four patients with a dislocation of the elbow and fracture of the distal humerus were identified.Three had dislocation and complex intraarticular fracture of the capitellum,trochlea,and lateral epicondyle.Results Two patients(one treated with a second operation to address avascular necrosis of the capitellum)achieved a functional arc of elbow motion and one patient was lost after removal of the implants 3 months after fracture with documented healing.The fourth patient had a complex open fracture dislocation involving the entire articular surface.An attempt to salvage the articular surface resulted in deep infection.Extensive heterotopic bone led to arthrodesis of the elbow.Conclusions Dislocations of the elbow with articular fracture of the humerus are uncommon.Most injuries involve the capitellum,lateral trochlea,and lateral epicondyle.Open reduction and internal fixation of the distal humerus fracture can restore stability without repairing the medial collateral ligament.     

背侧双板固定治疗桡骨远端粉碎性骨折

目的 探讨采用背侧入路复位、双板固定治疗桡骨远端粉碎性骨折的手术指征及疗效.方法 采用背侧人路行骨折复位、植骨、双板固定治疗C型桡骨远端粉碎性骨折10例,其中男2例,女8例;患者平均年龄72岁.结果 术后随访时间6～26个月,平均14个月,按照改良的Garland-Werley评分标准评定:平均为2分(0～12分),其中优5例、良4例、可1例.结论 背侧双板固定治疗桡骨远端粉碎性骨折手术操作难度较高,但是背侧复位、植骨、固定更符合局部的解剖学特点和骨折的受伤机制,是治疗桡骨远端粉碎性骨折的有效方法之一.

Abstract：

Objective To discuss the indications, methods and treatment outcomes of double plate internal fixation of comminuted distal radius fractures via a dorsal approach. Methods Ten patients of type C comminuted distal radius fractures were treated by dorsal approach reduction, bone graft and double plate internal fixation. Among them, 2 were male and 8 were female. The average age of the patients was 72 years. Results Postoperatively the patients were followed up for 6 to 26 month, with an average of 14 months. The mean Garland and Werley score was 2 (range 0 to 12). Results were considered excellent in 5 cases, good in 4 cases and fair in 1 case. Conclusion Dorsal double plate fixation for comminuted distal radius fracture is technically challenging. However dorsal reduction, bone grafting and fixation is more in line with the anatomy of distal radius and the injury mechanism. It is one of the most effective methods for treating this type of complex fractures.     

The effects of stress- relaxation plate on disorganization and repair of regional bone structure: an experimental study

Objective:To study the influence of stress-relaxation plate on disorganization and repair of the cortex beneath the plate.Methods:A washer made of viscoelastic polyethylene was placed between the screw and the screw hole of conventional stainless rigid plate (RP) to produce a stressrelaxation plate (SRP).Both SRP and RP were applied to osteotomized tibia in 48 New Zealand rabbits.Healing process of the fracture with either SRP or RP fixation (control) was comparatively studied with polarized light microscopy,in situ hybridization of collagen mRNA and immunohistochemical technique from 2 to 36 weeks postoperatively.Results:The study of plated bone remodeling showed that the degree of cortex osteoporosis beneath the plate was similar between the SRP and RP group within 12 weeks postoperatively.In comparison,the disorganization of bone structure in SRP group happened later and milder than that of RP group,and the repair process began at 12 weeks after implantation.As a consequence,the absorption cavities became smaller and the structure of collagen fibers became well oriented along with these changes by polarized light microscopy.In addition to these,the in situ hybridization analysis of collagen genes and the immunohistochemical study of type I,Ⅲ collagen at 8 to 12 weeks after implantation.from this time on ,the changes above became more evident significantly before most of cavities were repaired by 36 weeks.In contrast to the changes in the SRP group,no expression and synthesis of any kind of collagen could be observed during 12 to 36 weeks after implantation in RP group.Conclusions:Without removal of the bone plate,the SRP fixation not only reduces the degree of plated bone osteoporosis,but also makes the disorganized bone structure restored to normal in terms of the expression and synthesis of type I collagen mRNA of osteoblasts lying on the surface of absorption cavities.     

Role of locking plates in treatment of difficult ununited fractures: a clinical study

Objective:To present our experience in treatment of difficult ununited long bone fractures with locking plate.Methods:Retrospective evaluation of locking plate fixation in 10 difficult nonunions of lon...     

Dsteosynthesis with long volar locking plates for meta- physeal-diaphyseal fractures of the distal radius

Objective：Metaphyseal-diaphyseal fractures of the distal radius are a major treatment dilemma and orthopaedic surgeons have to pay due consideration to restoration of anatomy of distal radius together with rotation of the radial shaft and maintenance of radial bow and interosseous space.We performed this study to evaluate the clinic-radiological outcome of metaphyseal-diaphyseal fractures of the distal radius treated with long volar locking plates.Methods：This prospective study involved 27 patients （22 males and 5 females） with metaphyseal-diaphyseal fracture of the distal radius.Their mean age was （30.12±11.48） years （range 19-52 years） and the follow-up was 26.8 months （range 22-34 months）.All patients underwent open reduction and internal fixation with a long volar locking plate.According to AO/OTA classification,there were 7 type A3,13 type C2 and 7 type C3 fractures.Subjective assessment was done based on the disabilities of the arm,shoulder and hand （DASH） questionnaire.Functional evaluation was done by measuring grip strength and range of motion around the wrist and the radiological determinants included radial angle,radial length,volar angle and ulnar variance.The final assessment was done according to Gartland and Werley scoring system.Results：Postoperative radiological parameters were well maintained throughout the trial,and there was significant improvement in the functional parameters from 6 weeks to final follow-up.The average DASH scores improved from 37.5 at 6 weeks to 4.2 at final follow-up.Final assessment using Gartland and Werley scoring system revealed 66.67%（n=l8） excellent and 33.33% （n=9） good results.There was one case of superficial infection which responded to antibiotics and another carpel tunnel syndrome which was managed conservatively.Conclusion：Volar locking plate fixation for metaphyseal-diaphyseal fractures of distal radius is associated with excellent to good functional outcome,early rehabilitation and minimal complications.     

Variations in mineral apposition rate of trabecular bone within the beagle skeleton

Summary The mineral apposition rate of trabecular bone was determined in several skeletal sites of young adult beagles. Tetracycline derivatives were administered intravenously or orally on 2 separate occasions preceding the day of sacrifice in order to label actively mineralizing bone surfaces. The rate of mineral apposition was calculated by dividing the distance between the 2 tetracycline markers by the time interval between their administration. The lumbar vertebra, proximal humerus, and pelvis, each of which contains red marrow, were found to have a significantly higher (P<0.001) rate of mineral apposition in trabecular bone than the skeletal sites containing yellow marrow—the proximal ulna and distal humerus. The mean apposition rate in the former 3 sites was 1.3±0.3μm/day, while that in the latter 2 was 0.9±0.2μm/day (uncorrected for plane of sectioning). It is tempting to speculate that this finding may be a consequence of differences in vascularity between red and yellow marrow.     

A modified preauricular-temporal approach for fixing comminuted and redisplaced zygomatic arch fractures with the resorbable bone plate

Objective: To evaluate the effectiveness of the rigid internal fixation for comminuted and redisplaced zygomatic arch fractures by modified preauricular-temporal approach with the resorbable bone fixat...     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.