共查询到20条相似文献,搜索用时 15 毫秒
1.
Peter Reynders 《Injury》2009,40(4):449-454
Aim
To evaluate the Less Invasive Stabilisation System (LISS) in the treatment of segmental tibial fractures.Methods
A prospective series of 23 consecutive open acute segmental tibial fractures were treated with a long LISS plate, in a university hospital. All but three fractures were temporarily fixed with a unilateral external frame. The minimal follow-up was 2 years.Results
Mean age of the casualties was 34 (17-72) years, all but two were male and all were involved in high-energy accidents, had multiple injuries and open fractures. Of the fractures, 4 were grade IIIA, 16 grade IIIB and 3 grade IIIC. It was possible to span the distal fracture with the LISS plate in 20 cases; of these, 3 developed compartment syndrome. Two people with trifocal fractures required additional distal plates, one of which became loose and infected, resulting in a malunion of 8°. Dermatofasciotomy was performed in 13 cases, in 10 of these as a preventive measure and in 3 because of impending compartment syndrome. In five cases a post-fixation neural palsy of the extensor hallucis longus was observed. All except three fractures healed; mean time for union for the proximal fractures was 16 (10-24) weeks and for the distal fractures was 22 (16-44) weeks.Conclusion
Use of the LISS plate in fixing these difficult fractures is commended, but immediate fixation should be avoided. A staged sequential procedure with a temporary spanning external fixation and definitive treatment after soft-tissue healing is preferred. 相似文献2.
Objective
To determine the incidence of rotational malalignment in distal femoral and proximal tibial fractures using computed tomography (CT) scanograms following indirect reduction and internal fixation with the minimally invasive percutaneous osteosynthesis (MIPO) technique.Design
Prospective Cohort.Setting
Level I Trauma Centre.Patients/Participants
A total of 27 consecutive subjects, and 14 proximal tibia and distal femur fractures.Intervention
All patients underwent indirect reduction and internal fixation with a MIPO plating system. A CT scanogram to measure rotational malalignment between the injured and non-injured extremity was then undertaken.Main outcome measure(s)
Femoral anteversion angles and tibial rotation angles between the injured and non-injured extremities were compared. Malrotation was defined as a side-to-side difference of >10°.Results
A total of 14 postoperative tibias and 13 femurs underwent CT scanograms. Three females and 11 males with an average age of 38.1 years sustained proximal tibia fractures and six females and seven males with an average age of 55.8 years sustained distal femur fractures. The difference between tibial rotation in the injured and the non-injured limbs ranged from 2.7 to 40.0° with a mean difference of 16.2° (p = 0.656, paired T-test). Fifty percent of the tibias fixed with MIPO plates were malrotated >10° from the uninjured limbs. The difference between femoral anteversion in the injured and non-injured limbs ranged from 2.0 to 31.3° with a mean difference of 11.5° (p = 0.005, paired T-test). A total of 38.5% of the distal femurs fixed with MIPO plates were malrotated >10° from the uninjured limb.Conclusions
Following fixation of distal femoral and proximal tibial fractures, the incidence of malrotation was 38.5% and 50%, respectively. The difference of the mean measures was significant for femoral malrotation; however, statistical significance could not be demonstrated for tibial malrotation. The incidence of malrotation following MIPO plating in this study is much higher than that quoted in previous studies. 相似文献3.
Objectives
This study aims to assess whether elderly patients (>65 years) with open tibial shaft fractures (OFs) have increased mortality rates than those with closed fractures (CFs).Patients and methods
Patients admitted during 2003-2005 with open/closed diaphyseal (AO 42) fractures of the tibia were eligible to participate.Exclusion criteria
Pathological and peri-prosthetic fractures.Results
A total of 54 patients (38 females) met the inclusion criteria. Twenty-six patients had sustained CF and 28 OF (Gustilo grade I (11), grade II (five), grade IIIa (two) and grade IIIb (10)).The OF group was statistically significantly different with higher injury severity score, secondary procedures and length of hospital stay (p < 0.05). A higher rate of admission/length of stay to intensive care unit and complication rate was noted in the OF group. Mortality rate between the two groups was comparable (CF = 2/26, OF = 3/28).Conclusions
Elderly patients with OFs of the tibial shaft have similar mortality rate to those with CFs. 相似文献4.
Oliver Pieske Felicitas Kaltenhauser Leopold Pichlmaier Nicolai Schramm Heiko Trentzsch Thomas Löffler Axel Greiner Stefan Piltz 《Injury》2010,41(10):1031-1036
Background
The purpose of this study was to determine the clinical benefit of hydroxyapatite (HA)-coated pins compared with standard stainless steel pins in external fixators applied for unstable fractures of the distal radius.Methods
A total of 40 patients (160 pins) with unstable wrist fractures were randomised for uniplanar fixator treatment with the use of identically designed, commercially available pins either composed of stainless steel (steel group) (n = 20) or coated by hydroxyapatite (HA group) (n = 20). Each pin site was clinically evaluated concerning erythema and grade of drainage as well as pain intensity (numeric rating scale (NRS) 0-10) and, additionally, radiological assessment was performed concerning pin-loosening/infection as well as fracture healing at T1 (Ø18 days), T2 (Ø44 days) and T3 (Ø65 days). In case of pin-track complication, the patient was followed continuously. The need for intensified pin-site care, oral or intravenous antibiotic medication, re-admission for additional surgery and premature fixator removal was documented. Bone mineral density (BMD) was determined by dual energy X-ray absorptiometry. At fixator removal (T2), the pin-extraction strength was measured by the use of an electronic torque wrench.Results
Two pin-track infections requiring daily pin-site care and oral antibiotics occurred in the HA group (2.6%) compared with four in the steel group (5.3%) (p = 0.601) and although a trend towards a superior performance of HA pins was detectable, the majority of clinical pin-site-parameters were comparable in both groups. At the end of the fixator therapy, the HA group showed a non-significant lower rate of loose pins (nsteel group = 9; nHA group = 6; p = 0.864) and both hydroxyapatite-coated pins showed at the radius a significantly stronger pin-bone bonding measured by the torque wrench (pproximal radius pin = 0.007; pdistal radius pin = 0.031). Except for elderly patients of the steel group (p = 0.018), all demographic-, health- and injury-related data including BMD were not correlated to any type of pin-site complication in both groups (p > 0.05). Since all fracture healed uneventfully without any type of additional surgery, the number of patients suffering clinically relevant pin-related complications showed no significant difference between both groups (p = 0.707).Conclusions
The use of HA-coated pins compared with standard stainless-steel pins in external fixation for unstable wrist fractures yields only a trend towards a superior clinical outcome. 相似文献5.
Objective
In developing countries, tibial shaft fractures are frequently stabilised using Surgical Implant Generation Network (SIGN) nails. Despite widespread use throughout the world, little is known regarding their biomechanical properties. This study aimed to compare the mechanical stiffness of the SIGN tibial nail with a standard hollow tibial nail.Methods
A fracture gap model was created to simulate a comminuted mid-shaft tibia fracture (AO/OTA42-C3) using synthetic composite bones. The constructs were stabilised with either a 9 mm solid SIGN nail or a 10 mm hollow Russell-Taylor nail. Both nail systems were interlocked proximally and distally. Following fixation, the specimens were loaded in axial, torsional, and cyclical axial modes to calculate construct stiffness and irreversible (plastic) deformation.Results
The mean axial stiffness for the SIGN nail constructs was 47% higher than mean stiffness for the RT nail constructs (p < 0.001). The difference in torsional stiffness was not statistically significant. However, the SIGN group demonstrated 159% more irreversible deformation than the Russell-Taylor group (p = 0.006) for the loading parameters studied.Conclusion
The SIGN tibial nail, despite its slightly smaller diameter, can provide similar construct stiffness and stability, when compared to a larger hollow nail for stabilisation of tibial shaft fractures. 相似文献6.
Platzer P Schuster R Luxl M Widhalm HK Eipeldauer S Krusche-Mandl I Ostermann R Blutsch B Vécsei V 《Injury》2011,42(11):1219-1225
Introduction
Interprosthetic femoral fractures following ipsilateral hip and knee arthroplasty are a rare but serious complication in clinical practice. In most cases, adequate management of these injuries might constitute a challenging problem. However, the literature provides only few data regarding the treatment and outcome of interprosthetic femoral fractures, and there are only few classifications available, which might assist in finding an appropriate treatment concept. The purpose of this study was to analyse our experience in the management of interprosthetic femoral fractures following ipsilateral hip and knee joint replacement.Materials and methods
We reviewed the clinical and radiographic records of 23 patients (15 female and eight male, average age: 79.2 years) with an interprosthetic fracture after ipsilateral hip and knee joint replacement between 1992 and 2008. For the classification of interprosthetic femoral fractures, the fractures were divided into three types, depending on the fracture site and the adjacency to the prostheses. All patients underwent operative stabilisation, either by lateral plate fixation (n = 19), by revision arthroplasty using a long stem (n = 2) or by plate fixation and revision arthroplasty (n = 2).Results
Referring to the clinical outcome, 16 patients returned to their pre-injury activity level and were satisfied with their clinical outcome. In six patients, we saw a relevant decrease of hip or knee function and severe limitations in gait and activities of daily living. We had a mean Harris Hip Score (HHS) of 78.4 points, and a mean Knee injury and Osteoarthritis Outcome Score (KOOS) of 71.8 points. Relating to the radiographic outcome, successful fracture healing was achieved in 19 of 22 patients (86%) within 6 months. Failures of reduction and fixation were noted in four (18%) of 22 patients.Conclusion
We had a satisfactory outcome following individualised treatment of interprosthetic femoral fractures following ipsilateral hip and knee joint replacement. Compared to the rare data in current literature, we had promising functional result and high rate of bony fusion. Regarding the complexity and challenges in many of these cases, interprosthetic fractures require an adequate analysis of the fracture aetiology and a suitable transfer into the best possible treatment concept. 相似文献7.
Twenty-seven patients (two women) with segmental tibial fractures (19 open) were treated in our institution with a mean age of 38.9 years (range 22-67 years) and a mean Injury Severity Score of 11.5 (9-34). Sixteen fractures were stabilised initially with an interlocking nail, seven with an external fixator, one with a hybrid external fixator, two cases were plated and one was treated in plaster. The mean size of the segment was 11.5 cm (range 4-20 cm). Soft tissue coverage was required in 17 cases. There were three cases of compartment syndrome, six cases of superficial infection and four deep infection cases (two of which required amputation). In four cases, excision of the non-viable segment was necessary. Overall, 13 patients were subjected to a second operative procedure (OP) (four external fixators were replaced with the AO solid tibial nail, two Ilizarov bone transports following excision of the dead bone segment, 2 below knee amputations, 3 exchange reamed nailings, 1 LISS plate application for stability and 1 ring fixator for compression of a fracture). Five patients underwent third procedure (two Ilizarov for bone transport, two exchange nailing, and one bone grafting). The mean time to union of the proximal segment was 38.8 weeks (range 10-78 weeks) and 41.4 weeks (range 12-65 weeks) for the distal segment, respectively. The treatment of segmental tibial fractures poses many problems to the surgeon due to the precarious blood supply of the intermediate segment. The risk of non-union delayed union, infection and additional procedures is high as seen in this series of patients. 相似文献
8.
Background
The challenges of managing Gustilo IIIB tibial fractures in children are unique. A multi-disciplinary, evidence based approach is needed. We aimed to evaluate the evidence for the ortho-plastic management of Gustilo grade IIIB open tibial shaft fractures in children based on a review of all published data in order to rationalise the orthopaedic and plastic surgical approach to these complex injuries.Method
A systematic review of the literature was performed. Gustilo grade IIIB tibial shaft fractures in pre-adolescent and adolescent children were identified and evaluated with regard to both the skeletal and soft tissue management, and the outcome.Results
Of 54 children with grade IIIB tibial fractures, a mean union time of 31 weeks included 33 weeks for 42 adolescents and 23 weeks for 12 pre-adolescents. Faster union time in pre-adolescents tended towards significance. Delayed union occurred in 22%, nonunion in 13%, mostly in adolescents. Two of 45 covered by vascularised flaps and 3 of 9 treated without flaps developed deep infection (p = 0.028). There was no correlation between method of skeletal fixation and union time.Conclusion
Gustilo IIIB tibial shaft fractures in pre-adolescents tended towards faster healing with fewer complications, irrespective of the method of skeletal fixation. In adolescents, healing times were similar to adults. Soft tissue closure without flaps was associated with deep infection in one-third of patients, requiring debridement and flap cover. Adequate debridement and flap cover is suggested in all cases, irrespective of age. 相似文献9.
Rausch S Klos K Stephan H Hoffmeier K Gras F Windolf M Gueorguiev B Hofmann GO Mückley T 《Injury》2011,42(11):1248-1252
Introduction
Polyaxial angle-stable plating is thought to be particularly beneficial in the management of complex intra-articular fractures of the distal radius. The purpose of the present study was to investigate whether the technique provides stability to match that of conventional (fixed-angle) angle-stable constructs.Material and methods
In seven pairs of human cadaver radii, an Arbeitsgemeinschaft für Osteosynthese (AO) 23 C2.1 intra-articular fracture was created. One radius of each pair received a juxta-articular 2.4-mm locking compression plate (LCP) Volar Distal Radius Plate, whilst the contralateral one received a 2.4-mm Variable Angle Locking Compression Plate (LCP) Two-Column Volar Distal Radius Plate (both plates: Synthes, Oberdorf, Switzerland). Parameters tested were construct stiffness (static axial loading with 150 N), range of motion and secondary loss of reduction (dynamic 150 N axial loading over 5000 cycles). Stiffness and range of motion were measured both pre- and post-cycling.Results
The polyaxial constructs were significantly stiffer, both before and after cyclic testing. However, the two-column plates showed a significant loss of stiffness during cyclic testing. The range of motion was significantly greater, both initially and at the end of cyclic testing, in the fixed-angle constructs. The conventional constructs had significantly greater secondary loss of reduction.Conclusion
The polyaxial two-column plate tested in this study provides a biomechanically sound construct for the management of intra-articular fractures of the distal radius. 相似文献10.
Objective
Distal radial fractures are common. Modern trends favour operative treatment in many instances, providing stable fixation and early functional recovery. Recent biomechanical evidence suggests that volar locking plates (VLPs) enable adequate stability for dorsally displaced fractures, both in dorsally intact (DI) and in dorsally comminuted (DC) fractures. The aim of the study was to compare the clinical outcome of these two fracture groups treated with a VLP.Methods
Retrospective case-control analysis of 91 distal radial fractures treated surgically using VLP by a single surgeon between the years 2006 and 2008 was carried out. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthes/Orthopaedic Trauma Association (AO/OTA) classification. Based on initial pre-reduction X-rays and computed tomography (CT) scans, fractures were classified into two groups of DI and DC fractures. The patients were re-evaluated at 2 and 6 weeks, 3 and 6 months and 1 year.Results
Forty-one fractures (45%) were dorsally comminuted. Patients in the DC group were significantly older (mean 59 vs. 46 years, p < 0.01) and included more female patients, as well as significantly more C3 type fractures than the DI group (p < 0.04). The mean Disabilities of the Arm, Shoulder and Hand (DASH) score at 1 year postoperatively was 6.3 ± 2.3 for the DC group, as compared with 6.6 ± 2.02 for the DI group (p = 0.64). Average time to return to work was longer in the DC group (81.2 vs. 63.6 days, p = 0.05). Range of motion, volar tilt, and radial inclination were within clinically acceptable values and did not differ significantly among the two groups.Conclusions
VLP fixation of DC distal radial fractures results in the maintenance of reduction and comparable functional and radiographical outcome with respect to DI fractures. 相似文献11.
Purpose
In the Fracture Prevention Trial, the risks of any nonvertebral fracture (relative risk [RR] 0.65, P = 0.04) and any fragility nonvertebral fracture (RR 0.47, P = 0.02) were significantly reduced in the teriparatide 20 μg/day (teriparatide) versus placebo group. The purpose of this analysis was to examine the efficacy of teriparatide versus placebo on a variety of other nonvertebral fracture outcomes.Materials and methods
The Fracture Prevention Trial was a double-blind trial of postmenopausal women with osteoporosis and vertebral fractures randomly assigned to teriparatide (N = 541) or placebo (N = 544) administered by daily self-injection for a median of 19 months and a median follow-up of 21 months. All patients received calcium and vitamin D supplementation. Reports of nonvertebral fractures were collected from patients at each visit and confirmed by review of a radiograph or written radiology report. Nonvertebral fractures were recorded for the following sites: distal radius/wrist, humerus, rib/clavicle, hip, ankle, distal foot, pelvis, or other. Pathological fractures and fractures of the face, skull, metacarpals, fingers and toes were excluded. Fractures were classified by investigators as fragility or traumatic fractures. The three endpoints considered were six nonvertebral sites (nonvert-6), a set of common nonvertebral fractures described in a Food and Drug Administration Guidance document for the treatment and prevention of postmenopausal osteoporosis (FDA), and a European Union major set (major) of nonvertebral fractures.Results
For teriparatide versus placebo, the point estimates for the RR of nonvert-6 (RR 0.54, P = 0.06; fragility RR 0.32, P = 0.014), FDA (RR 0.60, P = 0.15; fragility RR 0.38, P = 0.05), and major (RR 0.52, P = 0.02; fragility RR 0.38, P = 0.02) nonvertebral fracture endpoints were smaller than for the all nonvertebral fracture endpoint. Lower RRs were observed when the outcomes were limited to fragility fractures, and significant reductions in traumatic nonvertebral fractures were not observed.Conclusion
In the Fracture Prevention Trial, the risk reduction for nonvertebral fracture in patients treated with teriparatide versus placebo depended on the set of nonvertebral fractures included in the analysis; lower RRs were observed for nonvertebral fractures most likely to be of osteoporotic origin. No significant reductions in traumatic nonvertebral fractures were observed. 相似文献12.
Kamal El-Gafary Wael El-adly Osama Farouk Mohamed Khaled Marwa Mahmoud Abdelaziz 《European orthopaedics and traumatology》2014,5(1):9-14
Background
Despite the evolution of surgical techniques and implants, high energy tibial plateau fractures remain a challenging problem. The goals of treatment are to obtain a well-aligned stable joint with a painless functional range of motion and prevention of posttraumatic arthritis. Indirect reduction techniques and other soft tissue preservation methods safeguard the vascularity and emphasize restoring both joint congruity and the mechanical axis of the limb. The aim of this study was to evaluate the clinical outcome of using Ilizarov external fixator in the treatment of Schatzker type V–VI tibial plateau fracture.Methods
This study was done during the period 2009–2011 for the treatment of 30 patients with high energy tibial plateau fractures (Schatzker type V in 17 and type VI in 13 patients) by Ilizarov external fixator. The mean age was 36 years .There were 23 males. The right limb was affected in 17 patients. There were 10 open fractures and other associated injuries in 9 patients.Results
The mean of follow up period was 18 months. All the fractures were united in an average time of 15 weeks. There were pin track infection in 20 patients and other few complications in 8 patients. According to knee society score, there was an excellent result in 16.7 %, good in 60 %, fair in 20 %, and poor in 3.3 %.Conclusion
Ilizarov external fixation is a safe and effective treatment option for high energy tibial plateau fractures with good functional results. 相似文献13.
Introduction
In distal radial fractures in adults, factors affecting instability have been investigated in many studies in an effort to shorten the preoperative waiting period for the fractures requiring surgery. Numerous factors, aside from the alignment-related indices, have been searched to predict redisplacement. Unlike as in paediatric counterparts, the casting technique and casting-related indices have not been appropriately considered in adults. The aim of this study was to determine the impact of the various previously investigated factors in addition to casting technique-related indices such as three-point index, cast index, padding index and gap index, in predicting the risk of redisplacement of extra-articular distal radial fractures in adults and the presence of the ulnar deviation of the cast.Patients and methods
Seventy-five patients over 18 years who were treated with a cast in our emergency department within 24 h after a displaced distal radial fracture, were recruited into the study. Age, alignment-related indices, cast-related indices, extent of the ulnar deviation of the cast, having a non-anatomical reduction, co-existing ulnar fracture, dorsal comminution and obliquity of the fracture line were investigated. Casting technique according to three-point index, obliquity of the fracture line, degree of the ulnar deviation of the cast, and reduction accuracy were the significant factors affecting redisplacement.Results
The three-point index had a sensitivity of 95.8%, specificity of 96.1%, positive predictive value of 92%, and negative predictive value of 98% in predicting redisplacement. Logistic regression revealed that having an inadequate cast according to the three-point index (p < 0.001), degree of obliquity of the fracture line (p = 0.018), decreased ulnar deviation of the cast (p = 0.002), and having a non-anatomical reduction (p = 0.029) were the significant predictive factors in redisplacement.Conclusions
Our results suggest that the casting technique plays a major role in the success of conservative treatment, which can best be examined with the three-point index. Ulnar deviation of the cast and fracture obliquity are the other dominant factors affecting redisplacement. 相似文献14.
Introduction
External fixation of distal radius fractures may be static (wrist-bridging) or dynamic (wrist-bridging with mobile hinge or non-bridging). The aim of this systematic review is to investigate the effectiveness of different methods of external fixation for unstable distal radius fractures.Methods
A Medline database search was performed with strict eligibility criteria to obtain the highest quality evidence from meta-analyses, RCTs and comparative studies. Eligible studies were critically appraised using levels of evidence and RCTs were further appraised using a validated scoring tool.Results
Fifty-four studies were identified of which eight were included. There were six RCTs and two retrospective comparative studies. Three RCTs compared non-bridging with static wrist-bridging fixation. Two RCTs compared dynamic wrist-bridging with static wrist-bridging fixation. One study compared dynamic wrist-bridging with non-bridging fixation. The RCTs varied in quality and scored between 12 and 23 out of a maximum of 33 points.The evidence suggests that there are no functional or radiological benefits for a dynamic wrist-bridging external fixator with a mobile hinge joint over a static wrist-bridging external fixator. The evidence also suggests that there are no benefits for non-bridging over static wrist-bridging external fixation in older patients but there do appear to be clear benefits both functionally and radiologically when considering patients of all ages.Conclusion
Dynamic and static external fixators both achieve good outcomes for patients with unstable distal radius fractures with comparable complication rates. Non-bridging fixation may result in better functional and radiological results than static wrist-bridging fixation when considering patients of all ages with earlier return of function. This benefit does not seem apparent when considering older patients. Although a benefit was not seen in this group, the technique may have practical advantages over wrist-bridging fixation by allowing increased mobility and use of the limb during the fixation period and enabling such patients to maintain their independence. Cost effective analyses are required to assess whether this would be an economically viable option for this group of patients. 相似文献15.
Aims and objectives
To measure long-term functional outcome and health-related quality of life following tibial fracture in association with the full spectrum of soft tissue injury.Methods
One hundred and thirty patients with different types of tibial injury were selected from our trauma database. This included 33 patients with compartment syndrome (no underlying fracture), 30 with closed diaphyseal tibial fractures, 45 with grade IIIB/IIIC open fractures and 22 requiring below knee amputation. Mean time to final follow-up was 37.4 months. The EQ-5D (EuroQol) questionnaire was used to assess these patients at this point. Patients had been treated according to standard unit protocols. Open fractures were jointly managed under the care of local plastic and orthopaedic surgeons using a policy of obtaining early soft tissue cover.Results
Patients with reconstructed IIIB fractures reported problems with pain and carrying out their normal activities more frequently than amputees whilst still reporting problems with mobility just as frequently. Anxiety and depression were more common in the patients with open fractures and amputees as were problems with self-care, though the latter were unusual overall. Stepwise logistic regression revealed that tibial injury type was significantly predictive of all measured outcomes except self-care (p < 0.0001). Age, ISS, sex and time to follow-up were not significant predictors of response.Conclusions
These results show that patients with these injuries still report long-term problems with their health-related quality of life, though to varying degrees. This information is useful when determining the treatment options for these patients and it is important that it is shared with the patient prior to surgery where possible. 相似文献16.
Praveen Mereddy Sri Kamath Muthukrishnan Ramakrishnan Hamad Malik Nigel Donnachie 《Injury》2009,40(4):428-432
Introduction
PFNA design compacts the cancellous bone to provide increased stability and has been bio-mechanically proven to retard rotation and varus collapse.Methods
Between 2006 and 2007, 62 consecutive patients with unstable proximal femoral fractures were treated with the PFNA.Results
Twenty males and 42 females with a mean age of 78 years (44-94) were reviewed. In 48 patients, the fracture resulted from a low energy injury. The majority of the fractures belonged to AO/ASIF types 31A2.3 (22) and 31A3.2 (29). Twelve patients required open reduction. The PFNA blade position was central in 52 patients with a mean tip-apex distance (TAD) of 12 mm (range 4-34 mm). Post-operatively, five patients died within 3 months and two patients were lost to follow-up. Forty-nine fractures united between 3 and 4 months. Four patients had delayed union. The PFNA blade cut out rate was 3.6%.Conclusions
Unstable proximal femoral fractures were treated successfully with the PFNA. The PFNA blade appears to provide additional anchoring in osteoporotic bone. No results have been published on this new design. 相似文献17.
Introduction
The aim of the study was to compare radiological and functional outcomes between volar and dorsal surgical fixation of distal radius fractures using low-profile, fixed-angle implants.Patients and methods
A total of 305 distal radius fracture patients were treated with Synthes locking compression plate (LCP) 2.4- or 3.5-mm fixation using either a volar (n = 266) or dorsal (n = 39) approach. The patients were examined at 6 months, 1 and 2 years for radiological assessment of fracture healing, alignment, reduction and arthritis, as well as the determination of various functional outcome scores.Results
Both groups were comparable with respect to baseline and injury characteristics. The complication rate was higher for the volar approach (15%). No significant differences were observed for Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form (36) Health Survey (SF-36) scores, pain, arthritis grade, grip strength and radiological measurements. However, a significantly better functional outcome represented by a low mean Gartland and Werley score was observed for the volar approach after 6 and 12 months. Significantly higher percentages of dorsal extension, palmar flexion, ulnar deviation and supination angle (relative to the mean contralateral healthy wrist) were also reported for volar approach patients at the 6-month follow-up.Conclusions
Volar internal fixation of distal radius fractures with LCP DR implants can result in earlier and better functional outcome compared with the dorsal approach, yet is associated with a higher incidence of complications. After 2 years, these differences are no longer observed between the two surgical methods. 相似文献18.
Background
Management of comminuted bicondylar tibial plateau fractures remains a challenge to orthopedic surgeons. Studies of long-term outcomes of treatment of the tibial plateau have included a mixture of fracture types, including low-energy split and split-depressed fractures. Thus, the middle- to long-term results of management of high-energy fractures are still lacking. The aim of this study was to evaluate the knee function and development of arthrosis after a minimum of 3 years in high-energy tibial plateau fractures treated by the Ilizarov external fixator.Methods
This is a retrospective study performed at an academically supervised level III, trauma center, in which percutaneous and/or limited open internal fixation and an Ilizarov frame were applied for displaced bicondylar high-energy tibial plateau fractures (Schatzker types V and VI, and Orthopedic Trauma Association types C1, C2, and C3). There were 55 patients in this study and they were followed for a minimum of 3 years. Completion of the Iowa knee score, and the Short Form-36 (SF-36) General Health Survey, was a must.Results
After healing, none of the studied patients needed a secondary reconstructive procedure. The knee motion ranged between 15° of extension and 155° of flexion, with an average of 88 % of the total arc of the contralateral knee. The average Iowa knee score was 94 points (range, 65 to 100 points), at the final follow-up visit. Twenty-eight patients rated their outcome as excellent; 17, as good; and 10, as fair. All the studied patients returned to their previous original works. Thirty-five of them were performing strenuous labor. At the final follow-up visit, there were arthrosis grade 1 in the X-rays of 25 patient, grade 2 in 10, grade 3 in 2, and no evidence of arthrosis was found in 18 X-rays (grade 0). Compared with the radiographic appearance 3 years after surgery, there was no evidence of progression of arthrosis in 42 patients, while arthrosis progressed for one grade in 13 patients. The SF-36 subscale scores were similar to those of age-matched controls.Conclusion
Patients suffering from high-energy bicondylar tibial plateau fractures could be safely treated by minimal internal fixation and Ilizarov external fixation. This procedure has good prognosis for satisfactory knee function for up to 16 years of follow-up. The intra-articular displacement should be reduced properly, and only very minimal displacements are accepted. This leads to a better knee function and low arthrosis rate. 相似文献19.
Background
Controversy persists concerning the preferred treatment of peritrochanteric femoral fractures. The purpose of the present study was to evaluate the mid-term outcomes of the newly developed implants - proximal femoral nail antirotation (PFNA) for the stabilisation of this type of fracture.Methods
Between April 2006 and March 2008, 169 patients with peritrochanteric femoral fractures were treated with PFNA. As many as 26 patients were excluded from the study. According to the Orthopaedic Trauma Association (OTA) classification system, the remaining 143 fractures were classified as 19 cases of AO/OTA 31A1 fractures, 83 cases of 31A2 fractures, 28 cases of 31A3 fractures and 13 cases of 31A combined with proximal 32 fracture or separate proximal 32 fracture. The mean age of these patients was 67 years (range, 20-93 years). The operative time, the overall fluoroscopy time, the duration of hospitalisation and the surgical complications were noted. Patients were followed up for a mean of 21 months (range, 12-36 months). Functional outcomes were assessed according to the Harris hip scoring system.Results
Fifteen patients (10%) required open reduction. The mean duration of surgery (from the beginning of close reduction to wound closure) was 72 min with a range between 45 and 170 min. The mean fluoroscopy time was 164 s with a range between 92 and 396 s. The mean time of hospital stay was 15 days. Postoperative X-rays showed a good or acceptable reduction in 134 cases (94%), and an ideal implant position in 131 cases (92%). There were 12 (8%) postoperative complications. All patients except one healed their fractures without any implant-specific complication (bending, breaking of the implant, cut out of the PFNA blade, femoral head penetration of the blade or ipsilateral fractures of the femoral shaft at the tip of the implant). The average time to bone healing was 16 weeks (range, 12-25 weeks). At the time of the latest follow-up, 106 patients (74%) were restored to their preoperative mobility. The mean Harris hip score was 84 points (range, 46-100 points). A total of 106 patients (74%) had an excellent or good outcome. According to the patients and/or their caregivers, outcome was described as satisfactory in 120(84%) of the 143 patients, and 36(90%) of the 40 patients, who were more than 80 years old.Conclusion
The results suggest that PFNA is a very effective and safe method in the treatment of different patterns of peritrochanteric femoral fractures. The fixation is adequate to maintain reduction over time even in osteoporotic bones. 相似文献20.
Mahmound A El-Rosasy 《Indian Journal of Orthopaedics》2008,42(4):420-425