平行双接骨板内固定治疗老年肱骨远端粉碎性骨折

Objective To summarize our experience of treating distal humeral fractures of AO/OTA type C with parallel-plate fixation in the aged. Methods From January 2007 to September 2008, we treated 22 cases of type C distal humeral fractures by parallel-plating. They were 6 males and 16 females, with a mean age of 70. 2 (range, 60 to 81 ) years, including 3 open fractures (Gustilo type Ⅰ) and 19 close fractures. According to AO classification, there were 5 cases of type C1, 10 cases of type C2 and 7 cases of type C3. The posterior midline approach was selected. After the articular surface of the distal humerus was exposed through the olecranon osteotomy or the liguliform flap of triceps brachii muscle, parallel-plate fixation was performed to fix fractures internally. All patients began functional exercise of the elbow joint from 3 days after operation. Results All patients were followed up for a mean of 18 (range, 13 to 35) months. All fractures achieved complete union. The mean degrees of the elbow movement were as follows: extension was 16°(range, 0 to 50°), flexion 125° (range, 95° to 140°), supination 65° (range, 40° to 90°) and pronation 67°(range, 40° to 90°). According to Mayo elbow performance score (MEPS), 11 cases were graded as excellent, 8 as good, 2 as fair and one as poor. 86. 4% of the patients had an excellent or good functional result. Two cases reported transient ulnar nerve paralysis, 2 heterotopic ossification, one delayed union and elbow stiffness,3 slight symptoms of traumatic arthritis, and 2 slight malformation of cubitus varus. Conclusions Parallel-plate fixation is a preferred treatment for AO type C distal humeral fractures in the aged because of satisfactory bone healing, early mobilization and recovery of joint function. However, more attention should be paid to the complexity of the fracture which may influence the therapeutic effects of the operation.     

肱骨远端解剖型锁定接骨板的初步应用

Objective To investigate surgical techniques and effects of AO distal humeral plate used as a treatment alternative for distal humerus fractures. Methods From April 2008 to July 2009, 22 cases of distal humerus fracture were treated with open reduction and internal fixation with AO distal humeral plate (DHP). They were 10 males and 12 females. Their ages ranged from 14 to 65 years (average, 40 years). According to AO classification, one case was Type A, 6 were Type B and 15 were Type C. Their elbows were not immobilized postoperatively. The mean follow-up was 15 months. Functional results were evaluated according to the Mayo elbow performance score (MEPS). Results Fractures healed in all cases. There was no hardware failure or loss of reduction. No patient complained of pain. They had an average elbow flexion of 108° (range, 60° to 130°) and an average full extension to 25° (range 0 to 80°) . The average ulnohumeral motion was 79° (range, 10° to 130°). The average MEPS was 91 points (range, 60 to 100 points). Fifteen cases scored excellent, 5 good and 2 fair. Conclusions DHP has advantages of an anatomically preshaped locking plate which may enhance anchorage in fractures difficult to manage, such as metaphyseal comminuted supra-intercondylar fractures, lower fractures with relatively small distal fragments and osteoporotic fractures, and allow early postoperative rehabilitation. However, in order to achieve an optimal result,precise location and pre-bending of the plate should be ensured.     

肱骨远端解剖型锁定接骨板的初步应用

Objective To investigate surgical techniques and effects of AO distal humeral plate used as a treatment alternative for distal humerus fractures. Methods From April 2008 to July 2009, 22 cases of distal humerus fracture were treated with open reduction and internal fixation with AO distal humeral plate (DHP). They were 10 males and 12 females. Their ages ranged from 14 to 65 years (average, 40 years). According to AO classification, one case was Type A, 6 were Type B and 15 were Type C. Their elbows were not immobilized postoperatively. The mean follow-up was 15 months. Functional results were evaluated according to the Mayo elbow performance score (MEPS). Results Fractures healed in all cases. There was no hardware failure or loss of reduction. No patient complained of pain. They had an average elbow flexion of 108° (range, 60° to 130°) and an average full extension to 25° (range 0 to 80°) . The average ulnohumeral motion was 79° (range, 10° to 130°). The average MEPS was 91 points (range, 60 to 100 points). Fifteen cases scored excellent, 5 good and 2 fair. Conclusions DHP has advantages of an anatomically preshaped locking plate which may enhance anchorage in fractures difficult to manage, such as metaphyseal comminuted supra-intercondylar fractures, lower fractures with relatively small distal fragments and osteoporotic fractures, and allow early postoperative rehabilitation. However, in order to achieve an optimal result,precise location and pre-bending of the plate should be ensured.     

Selection of approach and fixation in the treatment of type C fracture of distal humerus in adults

Objective：To study the surgical treatment for distal humeral fractures in adults according to the follow-up results.Methods： Twenty-one cases （16 males and 5 females）of distal humeral fracture were included in this study. The average age was 42.5 years （range： 37-52 years）. Fractures were classified according to the AO classification system.Nine cases of C1,8 C2 and 4 C3-type fractures were identified.Open reduction and internal fixation were performed in all cases. A tricep-reflecting approach was adopted, and either the AO orthogonal plating or parallel plating technique was chosen,based on the fracture type. The plaster cast was removed 3 weeks after operation. Rehabilitation was encouraged during this period and afterwards. The average follow-up time was 12.2 months （range： 8-28 months）. The outcome was scored according to Aitken and Rorabeek system.Results：No nerve injury,nonunion or failure of fixation was encountered during the operation and follow-up.However, ossifying myosifis occurred in one case.Conclusions：A triceps-reflecting approach can provide adequate exposure to the joint. The use of AO orthogohal plating or parallel plating techniques based on the type of fractures can provide rigid fixation for the fracture.     

重度开放性Pilon骨折的治疗

Objective To discuss the operative methods, timing and outcomes of severe open Pilon fractures. Methods From April 2003 to July 2008, 21 patients with open Pilon fractures were admitted. All the patients were type C fracture according to AO/OTA classification, including 17 cases of type C2 and 4 cases of type C3. According to Gustilo classification, there were 18 cases of type Ⅱ, 2 cases of type ⅢA, 1 case of type ⅢB. The patients were treated in two different ways: one-stage minimally invasive osteosynthesis for reconstruction of the articular surface with transarticular external fixation of the ankle (19 cases),which included 16 cases of Gustilo Ⅱ AO/OTA C2, 2 cases of type Gustilo Ⅱ AO/OTA C3 and 1 case of type Gustilo ⅢA AO/OTA C2. Formal open reconstruction of the articular surface by plating and external fixation was performed when the condition of soft tissue had improved (2 cases), which included 1 cases of type Gustilo ⅢA AO/OTA C3 and 1 cases of type Gustilo Ⅲ B AO/OTA C3. Results All the patients were followed up from 6 to 48 months, with the mean of 24 months. The outcome of reduction was evaluated by the Burwell-Charnley score. Anatomical reduction was found in 6 cases, function reduction was in 14 cases and poor reduction was 1 case. The heal-time ranged from 2.5 to 11 months, with the mean of 4.7 months. The delayed union occurred in 2 cases. The rate of delayed union was 9.5%. Two patients experienced skin superficial necrosis. There were superficial infection in 2 cases and deep infection in 1 case. The infection rate was 14.3%. Eight cases experienced early traumatic arthritis. The incidence of this complication was 38.1%.According to American Orthopedic Foot Ankle Society (AOFAS) scale for ankle joint, the result of the treatment was 66-94, with an average of 85.2. Conclusion It is important to have the optimal timing of surgery and reliable fixation according to fracture classification, the condition of soft tissue and time after injury. It is the key to evaluate the condition of soft tissue and protect the blood supply.     

全关节镜下交换棒技术治疗尺骨冠状突骨折

Objective To investigate the feasibility and methods of arthroscopic reduction and fixation of coronoid fractures. Methods During 2008 and 2009, 6 patients (4 male and 2 female) with coronoid fractures of Regan and Morrey Types Ⅰ and Ⅱ underwent arthroscopic treatment in our department. Their ages ranged from 19 to 34 years, averaging 26. 6 years. Two fractures involved the left side and 4 the right side. By Regan-Morrey classification, 2 were of type Ⅰ and 4 of type Ⅱ. Standard elbow approaches and the exchange rod technique were applied. Compression screws were used to directly fixate the fracture via the anterior median approach. Results One patient was lost to the follow-up. A mean follow-up of 11 months (7 to 24 months) showed that the other 5 patients achieved a functional range of motion with an average flexion/extension of -2°( - 10° to 140°) and full pronation and supination. No patient had elbow instability and neurovascular complications. All the 5 patients had excellent Mayo elbow performance scores. Conclusion Arthroscopic management of coronoid fractures can provide excellent visual fields for anatomic repair without extensive soft tissue dissection and may thus facilitate early rehabilitation.     

全关节镜下交换棒技术治疗尺骨冠状突骨折

Objective To investigate the feasibility and methods of arthroscopic reduction and fixation of coronoid fractures. Methods During 2008 and 2009, 6 patients (4 male and 2 female) with coronoid fractures of Regan and Morrey Types Ⅰ and Ⅱ underwent arthroscopic treatment in our department. Their ages ranged from 19 to 34 years, averaging 26. 6 years. Two fractures involved the left side and 4 the right side. By Regan-Morrey classification, 2 were of type Ⅰ and 4 of type Ⅱ. Standard elbow approaches and the exchange rod technique were applied. Compression screws were used to directly fixate the fracture via the anterior median approach. Results One patient was lost to the follow-up. A mean follow-up of 11 months (7 to 24 months) showed that the other 5 patients achieved a functional range of motion with an average flexion/extension of -2°( - 10° to 140°) and full pronation and supination. No patient had elbow instability and neurovascular complications. All the 5 patients had excellent Mayo elbow performance scores. Conclusion Arthroscopic management of coronoid fractures can provide excellent visual fields for anatomic repair without extensive soft tissue dissection and may thus facilitate early rehabilitation.     

Surgical treatment of proximal humerus fractures using PHILOS plate

Objective：To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system （PHILOS） plate for proximal humerus fractures.Methods：We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012.There were 35 men and 16 women with a mean age of 38 years （range 24-68）.There were 41 patients in the age group of ＜60 years and 10 patients in the age group of ＞60 years.According to Neer classification system,8,15 and 23 patients had 2-part,3-part,and 4-part fractures,respectively and 5 patients had 4-part fracture dislocation.All surgeries were carried out at our tertiary care trauma centre.Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score.Results：The mean follow-up period was 30 months （range 12-44 months）.Two patients were lost to followup.Of the remaining 49 patients,all fractures were united clinically and radiologically.The mean time for radiological union was 12 weeks （range 8-20 weeks）.At the final follow-up the mean Constant-Murley score was 79 （range 50-100）.The results were excellent in 25 patients,good in 13 patients,fair in 6 patients and poor in 5 patients.During the follow-up,four cases of varus malunion,one case of subacromial impingement,one case of deep infection,one case of intraarticular screw penetration and one case of failure of fixation were noted.No cases of avascular necrosis,hardware failure,locking screw loosening or nonunion were noted.Conclusion：PHILOS provides stable fixation in proximal humerus fractures.To prevent potential complications like avascular necrosis,meticulous surgical dissection to preserve vascularity of humeral head is necessary.     

克氏针固定治疗儿童肱骨髁上骨折不同进针方式的比较

Objective To compare the treatment outcomes of techniques of K-wire fixation for treatment of supracondylar humeral fractures in children and provide guidelines for selection of internal fixation methods for humeral supracondylar fractures in children.Methods Sixty-four cases d humeral supracondlylar fractures in children were treated by K-wire internal fixation from January 2004 to January 2009.They were divided into 2 groups, with similar fracure types distributed to each group.Group one (crisscross K-wire fixation) contained 38 cases among which 21 were Gartlad Ⅱ fractures and 17 were Gartland Ⅲ fractures.Group two (lateral parallel K-wire fixation) cases contained 26 cases among which 18 cases were Gartland Ⅱ fractures and 8 cases were Garland Ⅲ fractures.Postoperative elbow functions were evaluated and compared between the two groups.Statistical analysis of the excellent-good rate was carried out.Results Postoperatively all 64 patients were follow-up for 6 to 54 moths (average 26 months).The excellent-good rate of elbow fiuctions in group one and two was 92.1% and 84.6%, respectively.There was no significant difference in functional recovery between the two fixation methods (P＞ 0.05).However ulnar nerve injury occurred in 4 cases of the crisscross K-wire insertion group, while none occurred in the lateral parallel K-wire insertion group.Conclusion Crisscross and lateral parallel K-wire fixation have similar clinical outcomes in treating humeral supracondylar fiactures in children.Lateral parallel K-wire fixation technique is simpler and can avoid the risk of iatrogenic ulnar nerve injury.It therefore is an effective method to treat Gartland Ⅱ and Ⅲ supracondylar humerus fractures.     

克氏针固定治疗儿童肱骨髁上骨折不同进针方式的比较

Objective To compare the treatment outcomes of techniques of K-wire fixation for treatment of supracondylar humeral fractures in children and provide guidelines for selection of internal fixation methods for humeral supracondylar fractures in children.Methods Sixty-four cases d humeral supracondlylar fractures in children were treated by K-wire internal fixation from January 2004 to January 2009.They were divided into 2 groups, with similar fracure types distributed to each group.Group one (crisscross K-wire fixation) contained 38 cases among which 21 were Gartlad Ⅱ fractures and 17 were Gartland Ⅲ fractures.Group two (lateral parallel K-wire fixation) cases contained 26 cases among which 18 cases were Gartland Ⅱ fractures and 8 cases were Garland Ⅲ fractures.Postoperative elbow functions were evaluated and compared between the two groups.Statistical analysis of the excellent-good rate was carried out.Results Postoperatively all 64 patients were follow-up for 6 to 54 moths (average 26 months).The excellent-good rate of elbow fiuctions in group one and two was 92.1% and 84.6%, respectively.There was no significant difference in functional recovery between the two fixation methods (P＞ 0.05).However ulnar nerve injury occurred in 4 cases of the crisscross K-wire insertion group, while none occurred in the lateral parallel K-wire insertion group.Conclusion Crisscross and lateral parallel K-wire fixation have similar clinical outcomes in treating humeral supracondylar fiactures in children.Lateral parallel K-wire fixation technique is simpler and can avoid the risk of iatrogenic ulnar nerve injury.It therefore is an effective method to treat Gartland Ⅱ and Ⅲ supracondylar humerus fractures.