The nail-insertion point in unreamed tibial nailing and its influence on the axial malalignment in proximal tibial fractures

The consequence of choosing a point of insertion for the nail (i.e. medial or lateral of the lig. patellae) in unreamed tibial nailing (AO unreamed tibial nail, UTN) was studied in 22 formaldhyde-fixed tibiae. A lateral osteotomy at the transition from the first to the second fifth of the tibia was used as a model for the fracture. A nail insertion point medial of the lig. patellae caused a valgus deformity, combined with a shift of the distal fragment to the medial side. A lateral point of entry resulted in a varus deformity, together with a lateral shift of the distal fragment. Our results show that the insertion point of the nail is important for the alignment of the axis. Choosing a different point for the insertion of the nail can be useful in operative correction of malalignment of the tibia. Received: 8 December 1999     

The arthroscopic treatment of chondromalacia patellae

Three hundred and nineteen patients who had chondromalacia patellae and persistent patellofemoral pain after six months of conservative management underwent arthroscopy and arthroscopic surgery. The results in four aetiological groups were reviewed at one year and five years after operation. Morbidity was minimal. Lavage produced early remission in all groups. Shaving offered a particular advantage in the post-traumatic group. Lateral release plus shaving and lavage was beneficial in the group with maltracking patellae and in half of the idiopathic group. In the group with unstable patellae, lateral release produced good results in only one in four patients. In conclusion, we consider that arthroscopic surgery has a useful role to play in the management of chondromalacia patellae.     

The part taken by X-ray investigation for closed soft tissue injuries on the extremities (author's transl)]

Special X-ray pictures taken of soft tissues for the treatment of closed soft tissue injuries on the extremities, give valuable diagnostic advises. Rupture on the surface of muscles, the lesion to the tendon Achilles and the lig. patellae proprium, tumours, muscle waisting following plexus or periferial nerve lesions etc. by X-ray investigation can be exactly delineated and the site, extension and type of damage defined.     

Resorbable implants and their use exemplified by fracture of the head of the radius

First a short survey of the variety of experiments concerning absorbable implants is given. The result of those experiments, especially with large implants are still quite unsatisfactory. For small osteosynthesis the development of Polydioxanon-Pins seems to open new perspectives of therapy. Also some selected indications in the field of hand surgery as well as maxillary surgery are mentioned. Promising characteristics of PDS-Pins, such as gentle application, complete absorbability, no late infections and no removal of metal plates, made us implant these pins in eight patients aged 35 to 58 suffering from radial head fractures (type Ib and Ic according to Vogt). Early functional treatment showed very good results. Two exemplary cases are illustrated.     

简易改良法与锁骨钩钢板治疗肩锁关节脱位并锁骨远端骨折的疗效比较

目的 探讨简易改良法(可吸收缝线加钢丝环扎)与锁骨钩钢板内固定治疗肩锁关节脱位并锁骨远端骨折的I临床疗效.方法 1998年7月至2005年12月采用简易改良法(可吸收缝线加钢丝环扎)或锁骨钩钢板治疗48例肩锁关节脱位并锁骨远端骨折患者.简易改良法组23例,男14例,女9例;左侧9例,右侧14例.锁骨钩钢板组25例,男16例,女9例;左侧10例,右侧15例.比较两组患者术后满意率及各种术后并发症的发生情况,按照Lazzcano标准评定术后肩关节功能恢复情况.结果 48例患者术后获6个月～2年1个月(平均1年2个月)随访.简易改良法组1例有肩部轻度疼痛,1例肩部有牵拉感.按照Lazzcano标准评定:优21例,良2例,优良率100%.锁骨钩钢板组1例反复肩关节活动疼痛,1例肩关节上举轻度受限.按照Lazzcano标准评定:优23例,良2例,优良率100%.两组疗效差异无统计学意义(x2=0.008,P=0.93).结论 简易改良法与锁骨钩钢板治疗肩锁关节脱位并锁骨远端骨折固定牢固,符合生物力学要求,肩锁关节功能恢复好,疗效满意;且简易改良法无需二次手术,费用低.     

Immobilisierung und Frühmobilisierung von Malleolarfrakturen nach Osteosynthese mit resorbierbaren Schrauben

71 patients with displaced ankle fracture were treated by using absorbable screws in the fixation of fractures. The follow-up time was 17 (13 to 33) months in average. The fixation devices were SR-PLLA (self-reinforced poly-L-lactide) and SR-PGA (self-reinforced polyglycolide) screws. 38 of the ankle fractures were immobilized with plaster cast and 33 ankle joints were mobilized immediately with a brace. An exact radiological result was achieved in 66 cases, insignificant displacement was observed in four cases and the result was poor in one patient. The result was classified as excellent in 62 patients, as good in eight patients and as poor in one patient. The patients treated postoperatively without plaster healed in a somewhat shorter time, but at one year check-up the differences in the clinical results were almost eliminated. Selected ankle fractures fixed with absorbable screws can be treated postoperatively with early mobilization without plaster.     

Transperineal repair of rectocele with prosthetic mesh. A prospective study

PURPOSE: To assess the long term results of a transperineal repair of rectocele with a prosthetic mesh and the criteria for selecting the patients. METHODS: Twenty-five consecutive patients (median age: 60 years) with a symptom-giving rectocele have been operated upon. Indication for surgery was: an obstructed defecation (N = 22); a fecal incontinence (N = 1); a pelvic heaviness with dyspareunia (N = 1) or a severe rectal syndrome (N = 1). Patients were evaluated by physical examination and, preoperatively, by defecography and anorectal manometry. The rectovaginal septum was repaired, through a perineal approach, with an absorbable (N = 5) or non absorbable (N = 20) prosthetic mesh. Long term results were assessed after a median follow-up of 45 (range 12-120) months by physical examination and a standardized questionnaire. The presence of the following three symptoms was evaluated: feeling of incomplete emptying, prolonged and unsuccessful straining at stool, digital assistance. Outcome was considered as successful when none of these symptoms were present, as good when minor emptying difficulties persisted, as moderate when emptying difficulties were associated with straining, as a failure when the symptomatic triad was unchanged. A general satisfaction score was established. RESULTS: All the patients had the defect of the rectovaginal septum corrected. Four patients had a low residual rectocele associated, in two cases, with a rectal prolapse subsequently treated by a Delorme's operation. Outcome in patients complaining of obstructed defecation was considered excellent or good in 80% of patients, moderate in 9% and poor in 9%. Subjective scoring showed a significantly better result in cases of success. Among 11 incontinent patients, seven (63.5%) improved or regained full continence. Dyspareunia in three cases was corrected. Age, parity, digital assistance, previous gynecologic surgery, use of laxatives, size of rectocele, type of mesh, anatomical result of repair had no significant prognostic value. On the other hand, in patients with obstructed defecation, clinical and manometric signs of anal hyperactivity of the pelvic floor or anismus (N = 4) were significantly related to a poor result (P < 0.001). CONCLUSION: Surgical repair with a prosthetic mesh is an efficient therapy in patients with obstructed defecation and/or incontinence caused by a rectocele. Clinical and defecographic parameters have no influence on outcome. Preoperative manometric data may help in selecting patients. In case of anal hyperactivity or anismus, given the risk of functional failure, behavioral retraining must be considered as first-line treatment.     

Press-fit metal-backed rotating patella: seven- to 14-year followup

A consecutive series of 80 patients with 110 press-fit metal-backed rotating platform patella resurfacing surgeries were reviewed at an average of 107 months followup (range, 84-167 months). Twenty-eight patients died before followup. Fifty-two patients (70 patellae) were available for clinical and radiographic followups. One patella was revised for failure of the patella component. Four patellae were revised along with revision of the knee replacement. One patella realignment procedure was done for recurrent subluxation of the patella. There were no patellar dislocations in this series, no patella fractures, and no disruption of the quadriceps tendon or infrapatellar ligament. Six patellae had subluxation seen on postoperative radiographs. The incidence of patellar tilt greater than 5 degrees was 13%. No patellae were considered radiographically loose. The incidence of radiolucencies was 37%. Subsidence of the component superiorly was identified in 39% of the patellae, and inferiorly in 36% of the patellae. Of the 49 patients (67 knees) returning for followup, 70% of the knees were rated as excellent, 10% were rated good, 15% were rated fair, and 5% were rated poor. Press-fit metal-backed patella provided good component durability with only one revision because of component failure. Radiographic analyses showed a high incidence of subsidence associated with good clinical results.     

可吸收螺钉联合克氏针固定治疗部分踝关节骨折的疗效评价

目的 探讨可吸收螺钉联合克氏针固定治疗部分踝关节骨折的疗效. 方法 2003年7月至2007年5月.对42例踝关节骨折患者采用可吸收螺钉联合克氏针固定治疗部分踝关节骨折,男27例,女15例;年龄20～70岁,平均39.2岁.术中于可吸收螺钉附近加用1～2枚克氏针,术后4周左右,于门诊拔除克氏针,后逐渐行功能锻炼,分析其治疗效果. 结果 所有患者术后平均随访24个月(14～38个月).骨折全部骨性愈合,无一例出现骨折移位、伤口感染等现象.根据英国足踝外科协会(AOFAS)制定的踝关节评定标准:优35例,良6例,可1例,优良率达97.6%.结论可吸收螺钉联合克氏针固定治疗部分踝关节骨折,骨折愈合率高,踝关节功能恢复良好,并可免除二次手术取内固定,值得推广.     

Single-stage revision of peri-prosthetic infection following total elbow replacement

This study reviews the predisposing features, the clinical, and laboratory findings at the time of diagnosis and the results of single-stage revision of prosthetic replacement of the elbow for infection. Deep infection occurred in six of 305 (1.9%) primary total elbow replacements. The mean follow-up after revision was 6.8 years (6 months to 16 years) and the mean age at the time of revision was 62.7 years (56 to 74). All six cases with infection had rheumatoid arthritis and had received steroid therapy. The infective organism was Staphylococcus aureus. Four of the six elbows had a developed radiolucency around one component or the other. Successful single-stage exchange arthroplasty was carried out with antibiotic-loaded cement in five of the six cases. In one, the revision prosthesis had to be removed following recurrence of the infection. The functional result was good in three elbows, fair in one, poor in one and fair in the resection arthroplasty.     

可吸收钉固定治疗少儿胫骨远端三平面骨折16例

目的探讨治疗手法复位经皮空心螺钉固定方法治疗少儿胫骨远端三平面骨折的疗效。方法治疗16例胫骨远端三平面骨折患儿,手术在C臂X线机透视下进行,手法复位达到解剖复位后经皮可吸收螺钉固定。术后摄X线片确定骨折解剖复位,石膏托固定8周。结果 16例均获随访,时间7-44（27±1）个月。X线片检查均骨性愈合,未发现骨桥形成及关节面不平整现象,无肢体旋转和短缩畸形。末次随访时按改良W eber评分：优13例,良3例。患儿均能参加正常的体育活动。结论手法复位、经皮空心螺钉固定方法治疗胫骨远端三平面骨折,操作简单,疗效满意。     

可吸收螺钉结合改良外固定支架治疗不稳定性肱骨干骨折

目的探讨外固定支架结合有限切开可吸收螺钉内固定治疗粉碎性长斜形不稳定肱骨干骨折的方法及临床疗效。方法对36例粉碎性长斜形肱骨干骨折患者采用有限切开复位、可吸收螺钉内固定以及结合有羟基磷灰石表面涂层螺钉的外固定架进行治疗。结果36例经6～15个月随访,骨折均获临床愈合,愈合时间3～6个月。肩、肘关节功能评价按Rodriguez-Merchan标准：优28例,良6例,可2例,优良率91.9%,无感染、医源性骨折及周围神经损伤等并发症。结论改良外固定支架结合有限切开可吸收螺钉内固定治疗,损伤小,结合羟基磷灰石表面涂层螺钉,提高了稳定性。     

改良Bosworth法联合应用可吸收防粘连膜治疗陈旧性跟腱断裂

目的探讨改良Bosworth术联合应用可吸收防粘连膜治疗陈旧性跟腱断裂的效果。方法14例陈旧性跟腱断裂病例采用改良Bosworth法重建后，可吸收防粘连膜包绕肌腱的术式予以治疗。跟腱缺损范围3．6～10cm，平均6.3cm。结果平均随访29个月。按Arner-Lindholm疗效评定标准评估，优12例，良2例。结论改良Bosworth法联合应用可吸收防粘连膜治疗陈旧性跟腱断裂临床疗效满意，具有良好的应用前景。     

Subtalar Extra-Articular Fusion in the Treatment of Valgus and Varus Deformities in Children: A Review of 162 Operations in 136 Patients

Sixty knees presenting with chronic anterior pain were investigated. A diffusely increased uptake indicated sympathetically mediated pain provided other diagnoses such as synovitis or widespread arthrosis were excluded. Focal uptake was not specific to any one condition, but could occur in chondromalacia patellae or recent dislocations. However, the commonest appearance found in chondromalacia patellae was a normal scan. A characteristic scintigraphic appearance in symptomatic postpatellectomy knees, which has not been previously reported, was increased uptake in the femoral groove. In all the cases where no clinical or arthroscopic diagnosis was made, the bone scan was normal.

The use of radioisotope scintigraphy is recommended in the problem knee presenting with anterior pain.     

Scintigraphy in the assessment of anterior knee pain

Sixty knees presenting with chronic anterior pain were investigated. A diffusely increased uptake indicated sympathetically mediated pain provided other diagnoses such as synovitis or widespread arthrosis were excluded. Focal uptake was not specific to any one condition, but could occur in chondromalacia patellae or recent dislocations. However, the commonest appearance found in chondromalacia patellae was a normal scan. A characteristic scintigraphic appearance in symptomatic postpatellectomy knees, which has not been previously reported, was increased uptake in the femoral groove. In all the cases where no clinical or arthroscopic diagnosis was made, the bone scan was normal.

The use of radioisotope scintigraphy is recommended in the problem knee presenting with anterior pain.     

Scintigraphy in the assessment of anterior knee pain

Sixty knees presenting with chronic anterior pain were investigated. A diffusely increased uptake indicated sympathetically mediated pain provided other diagnoses such as synovitis or widespread arthrosis were excluded. Focal uptake was not specific to any one condition, but could occur in chondromalacia patellae or recent dislocations. However, the commonest appearance found in chondromalacia patellae was a normal scan. A characteristic scintigraphic appearance in symptomatic postpatellectomy knees, which has not been previously reported, was increased uptake in the femoral groove. In all the cases where no clinical or arthroscopic diagnosis was made, the bone scan was normal. The use of radioisotope scintigraphy is recommended in the problem knee presenting with anterior pain.     

Treatment of displaced radial head fractures by internal fixation with absorbable pins

Objective: To study the effect of internal fixation with absorbable pins on treatment of displaced radial head fractures. Methods: From May 1999 to May 2004, 16 patients with displaced radial head fractures (Mason typesⅡandⅢ) were treated with internal fixation by absorbable pins. The duration of follow-up averaged 22.6 months (12-58 months). The outcome was assessed on the basis of elbow motion, radiographic findings and the functional rating score delineated by Broberg and Morrey. Results:All fractures healed within 10 months without avascular necrosis of radial head. The mean elbow flexion loss was 15°(0°-35°), and pronation and supination decreased by 10°(0°-30°) on average compared with those of the contralateral elbow. Five patients had an excellent result, 6 a good result, and 3 a fair result according to the criteria of Borberg and Morrey. Conclusions: Internal fixation with absorbable pins is an effective method in treating displaced radial head fractures. It can maintain the biomechanical stability of forearm, improve the elbow function and avoid second operation.     

浮肩损伤的分类与治疗

目的 :探讨浮肩损伤的分类与治疗。方法 :回顾性分析自 1995年 5月～ 2 0 0 3年 2月共收治的 14例浮肩损伤病例 ,将浮肩损伤分为 3型。A型 :同侧肩胛颈骨折 锁骨干骨折 ;B型 :同侧肩胛颈骨折 锁骨外侧端骨折 ;C型 :同侧肩胛颈骨折 肩锁关节脱位。本组A型 9例 ,B型 3例 ,C型 2例。本组非手术治疗 6例。手术治疗 8例 ,其中A型损伤 4例 ,B型损伤 3例 ,C型损伤 1例。均只手术固定锁骨或肩锁关节。采用AO重建钢板 3例 ,AO锁骨钩钢板 3例 ,克氏针 2例。结果 :14例均得到随访 ,时间 6～ 3 6个月 ,平均 18个月 ,肩关节功能根据Herscovici标准进行评定。本组非手术 6例 ,优 1例 ,良 5例。手术 8例 ,优 3例 ,良 4例 ,可 1例。结论 :对于浮肩损伤进行分类 ,有利于浮肩损伤的诊断和选择治疗方法 ,手术中仅牢固固定锁骨可达到肩关节上部悬吊复合体稳定。     

可吸收螺钉治疗儿童肱骨远端T形骨折

目的探讨可吸收螺钉治疗儿童肱骨经髁T形骨折的疗效。方法对7例儿童肱骨经髁T形骨折采用切开复位可吸收螺钉内固定,术后石膏托固定2-4周后进行功能锻炼。结果7例均得到随访,时间14-54个月。骨折全部愈合,时间1-4个月。采用改良的Morrey肘关节功能评分系统进行肘关节功能评价,并结合影像学检查结果,优2例,良4例,可1例。结论可吸收螺钉治疗儿童肱骨经髁T形骨折固定安全牢靠,疗效满意。     

可吸收软骨钉治疗MasonⅡ、Ⅲ型桡骨小头骨折的疗效观察

目的探讨MasonⅡ、Ⅲ型桡骨小头骨折切开复位可吸收软骨钉手术治疗的临床疗效。方法自2010年3月至2012年9月采用切开复位、可吸收软骨钉内固定治疗MasonⅡ、Ⅲ型桡骨小头骨折28例,其中MasonⅡ型17例,MasonⅢ型11例,术后早期行功能锻炼,观察肘关节及前臂的屈伸旋转活动度、肌肉力量、稳定性及主观疼痛情况。结果所有患者均获得随访,随访时间6~18个月,平均8.3个月。疗效评定:优16例,良10例,可2例(Mayo标准),优良率92.86%。结论可吸收软骨钉内固定治疗MasonⅡ、Ⅲ型桡骨小头骨折手术时间短,手术创伤小,功能康复快,临床效果良好。