双切口接骨板内固定治疗距骨颈粉碎性骨折的临床效果

背景：距骨颈骨折是距骨骨折中最常见的类型,采用切开复位螺钉内固定是经典的手术方式,但总体疗效仍不尽人意,尤其是采用单切口时,内翻畸形愈合率较高,且对于粉碎性骨折,螺钉固定效果也不佳。双切口是目前临床推崇的手术入路,结合接骨板固定,可获得良好的疗效。目的：探讨双切口接骨板内固定治疗距骨颈粉碎性骨折的手术技巧及疗效。方法：2010年5月至2011年5月,我院共收治13例闭合距骨颈粉碎性骨折患者。根据Hawkins分型：II型8例,III型5例。所有患者入院后行常规X线检查及CT扫描以明确骨折类型和粉碎程度,待肿胀消退后择期行双切口接骨板内固定术。术后定期复查X线片,并采用直观模拟量表（VAS）、美国骨科足踝外科协会（AOFAS）踝与后足评分系统及简明健康状况调查表（SF-36）综合评估最终治疗效果,同时记录相关并发症情况。结果：本组11例获得随访,随访时间12-24个月,平均18．7个月。患者术后均无切口感染,边缘和皮瓣坏死及内固定失败等并发症发生。X线结果显示,术后骨折端愈合的时间为8～12周,平均10．4周。末次随访时VAS评分0～5分,平均1．09±1．64分。AOFAS踝与后足评分为72-95分,平均84．55±7．29分。SF．36评分为70-96分,平均85．00±7．84分。未见畸形愈合发生。结论：采用双切口接骨板内固定治疗距骨颈骨折技术要求简单,在获得稳定固定的同时,还可维持距骨颈力线,避免畸形愈合,是治疗距骨颈粉碎性骨折有效的治疗方法。     

Long-term results of displaced talar neck fractures

Of 36 fractures of the talar neck without comminution of the body, eight were undisplaced, treated closed, and 28 were displaced and treated by open reduction. Twenty of the operations were less than 12 hours after injury. Nineteen of 20 were performed through a medial approach, six with a medial malleolar osteotomy. The long-term results were evaluated by a standard rating system based on classification by the fracture. A protective brace was developed for non-weight-bearing in two patients with complete avascular necrosis, and ankle protection with weight-bearing in ten with partial necrosis. Prompt open reduction and internal fixation, malleolar osteotomy, and protected weight-bearing are recommended in selected cases.     

Functional outcomes following displaced talar neck fractures

OBJECTIVES: To determine the outcome of displaced talar neck fractures at long-term follow-up in terms of functional outcome and secondary reconstructive surgery. DESIGN: Retrospective cohort study. SETTING: Academic level 1 trauma center. PATIENTS: Seventy patients with displaced talar neck fractures. INTERVENTION: All patients were treated with open reduction and screw fixation. MAIN OUTCOME MEASUREMENTS: Functional outcome of patients who did not require secondary surgery was assessed using the Short Musculoskeletal Function Assessment, Ankle Osteoarthritis Scale score, and the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. The incidence of secondary reconstructive hindfoot surgery, including arthrodesis or talectomy, was measured using life table analysis. RESULTS: Mean Short Musculoskeletal Function Assessment score was 20 +/- 18 out of 100, with a lower score indicative of better outcome; mean Ankle Osteoarthritis Scale score was 3.8 +/- 2.4 out of 10 (lower score better); and mean Ankle Society Ankle-Hindfoot Score was 71 +/- 19 out of 100 points (higher score better). The incidence of secondary reconstructive surgery increased from 24 +/- 5% at 1 year to 48 +/- 10% at 10 years postinjury. CONCLUSIONS: Functional outcome varied and was most dependent upon the development of complications. The incidence of secondary reconstructive surgery following talar neck fractures increased over time and was most commonly performed to treat subtalar arthritis or misalignment.     

Treatment with external fixation of displaced talar fractures

This article presents a case report on a 17-year-old girl who sustained a dislocation fracture of the talus, and was treated with external fixation. The fracture healed with a good result. After a 1-year follow-up, the patient had completely normal, pain-free mobility in the ankle joint. There were no radiographic signs of osteonecrosis.     

切开复位内固定治疗移位的桡骨头骨折

[目的]探讨切开复位内固定治疗成人移位桡骨头骨折的手术技术。[方法]本组移位桡骨头骨折26例,MasonⅡ型16例,Ⅲ型6例,Ⅳ型4例。22例用肘后外侧Kocher切口,另外4例用肘后正中切口以便同时处理合并的尺骨近端骨折。复位后用微型钢板螺钉固定,并使内固定物不妨碍关节活动。[结果]随访平均32个月,无骨间后神经损伤及感染发生,26例骨折均顺利愈合。按照Broberg和Morrey肘部评分标准,优17例,良9例。[结论]切开复位内固定治疗移位桡骨头骨折可取得满意疗效,术中应注意以下方面：（1）保护、修复尺骨外侧副韧带;（2）防止损伤骨间后神经;（3）努力达到解剖复位;（4）固定既要坚强可靠,又要不阻碍关节的运动。     

切开复位内固定治疗移位的跟骨关节内骨折的疗效分析

目的 评定切开复位内固定治疗移位的跟骨关节内骨折的疗效,并分析其影响因素.方法 回顾性分析2004年3月至2006年7月收治的采用切开复位内固定治疗的移位跟骨关节内骨折40例(46足).按照Sanders分型:Ⅱ型16足,Ⅲ型19足,Ⅳ型11足,总结评定其临床疗效并分析影响疗效的相关因素. 结果 所有患者均得到随访,平均随访18个月(13～28个月).根据Maryland足部评分系统评价术后疗效:优21足,良16足,可6足,差3足,优良率82.6%.优良率在不同骨折类型中分别为:Ⅱ型93.8%(15/16),Ⅲ型84.2%(16/19),1V型54.5%(6/11);伤后至手术时间≤14 d组和＞14d组分别为87.2%(34/38)和42.9%(3/8);在术后B0hler角＜15°组和≥15°组分别为37.5%(2/9)和89.5%(35/37);关节面复位质量≤2 mm组和＞2 mm组分别为91.2%(32/33)和45.5%(5/13).对各因素的优良率比较,差异有统计学意义(P＜0.05). 结论 切开复位内固定治疗移位的跟骨关节内骨折,治疗效果好.骨折类型、伤后至手术时间、术后Bohler角的恢复程度、关节内骨折的复位质量为影响其术后疗效的重要因素.     

Open reduction and internal fixation in displaced juvenile Tillaux fractures

BACKGROUND: Juvenile Tillaux fracture is relatively an uncommon injury for which there appears no established treatment protocol. MATERIALS AND METHODS: Ten patients with juvenile Tillaux fractures were treated by open reduction and internal fixation and the results were evaluated by an objective scoring system. RESULTS: At the latest follow-up (32-75 months) mean score was 99.3 (97-100) by the score of American Orthopaedic Foot and Ankle Society. Radiographically all fractures had healed in anatomical position. CONCLUSION: Treatment of juvenile Tillaux fractures with 2mm or more displacement by internal fixation without any attempt of closed reduction gives excellent results.     

切开复位内固定治疗移位的跟骨关节内骨折

目的探讨切开复位可塑跟骨钢板内固定治疗移位的跟骨关节内骨折的疗效。方法对76例（82足）复杂跟骨关节内骨折行切开复位可塑跟骨钢板内固定治疗,其中39足予自体髂骨植骨。结果76例均获随访,时间12-35（22.3±3.7）个月。B hler角术前9.3°±3.2°,术后恢复到26.7°±6.8°;Gissane角术前101.6°±13.3°,术后恢复到120.1°±14.2°。根据Maryland足部评分系统：优39足,良31足,可8足,差4足。结论切开复位可塑跟骨钢板内固定治疗复杂的跟骨关节内骨折,固定牢固,能早期功能锻炼,可减少并发症。     

Open reduction and internal fixation of acute displaced scaphoid waist fractures

Fourteen consecutive patients with acute displaced scaphoid waist fractures were treated with open reduction and internal fixation. The operative technique consisted of anatomic reduction of the displaced scaphoid waist fracture, correction of carpal instability, radial bone grafting for comminution, and internal fixation with K-wires or Herbert screw. The patients were evaluated an average of 26 months (range, 4-48 months) after surgery. Thirteen of the 14 (93%) fractures united. The average time to union was 11.5 weeks (range, 8-20 weeks). Fracture union was confirmed with trispiral tomography. Final radiographic assessment consistently revealed a healed scaphoid fracture, restored intrascaphoid alignment, and no evidence of carpal instability. All patients regained functional wrist range of motion (wrist extension, 57 degrees; wrist flexion, 52 degrees ) and grip strength. Open reduction and internal fixation of acute displaced scaphoid waist fractures restores scaphoid alignment and leads to predictable union. Early operative intervention avoids malunion and carpal instability that often occurs with closed management of these complex fractures.     

Open reduction and internal fixation of two- and three-part displaced surgical neck fractures of the proximal humerus

Twenty-two patients aged 20 to 82 years (average 56 years) were followed for 1.1 to 8.9 years (average 3.3 years) after open reduction and internal fixation of two- and three-part displaced surgical neck fractures of the proximal humerus. There were 14 two-part displaced surgical neck fractures, seven three-part displaced greater tuberosity and surgical neck fractures, and one three-part displaced lesser tuberosity and surgical neck fracture. Fixation was achieved with heavy nonabsorbable sutures or wire that incorporated the rotator cuff tendons, tuberosities, and shaft. In cases with significant surgical neck comminution, humeral Enders nails were incorporated in a tension-band construct to provide longitudinal stability. Eighteen (82%) of the 22 patients had good or excellent results. Three (14%) of the 22 had satisfactory results, and one (5%) had an unsatisfactory result. The use of a technique of limited internal fixation for these displaced fractures without the use of plates and screws achieved fracture stability and a high percentage of acceptable results.     

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches

Purpose

Treatment of talar neck fractures is challenging. Various surgical approaches and fixation methods have been documented. Clinical outcomes are often dissatisfying due to inadequate reduction and fixation with high rates of complications. Obtaining satisfactory clinical outcomes with minimum complications remains a hard task for orthopaedic surgeons.

Methods

In the period from May 2007 to September 2010, a total of 31 cases with closed displaced talar neck fractures were treated surgically in our department. Injuries were classified according to the Hawkins classification modified by Canale and Kelly. Under general anaesthesia with sufficient muscle relaxation, urgent closed reduction was initiated once the patients were admitted; if the procedure failed, open reduction and provisional stabilisation with Kirschner wires through an anteromedial approach with tibiometatarsal external fixation were performed. When the soft tissue had recovered, definitive fixation was performed with plate and screws through dual approaches. The final follow-up examination included radiological analysis, clinical evaluation and functional outcomes which were carried out according to the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS), patient satisfaction and SF-36.

Results

Twenty-eight patients were followed up for an average of 25 months (range 18–50 months) after the injury. Only two patients had soft tissue complications, and recovery was satisfactory with conservative treatment. All of the fractures healed anatomically without malunion and nonunion, and the average union time was 14 weeks (range 12–24 weeks). Post-traumatic arthritis developed in ten cases, while six patients suffered from avascular necrosis of the talus. Secondary procedures included three cases of subtalar arthrodesis, one case of ankle arthrodesis and one case of total ankle replacement. The mean AOFAS hindfoot score was 78 (range 65–91). According to the SF-36, the average score of the physical component summary was 68 (range 59–81), and the average score of the mental component summary was 74 (range 63–85).

Conclusions

Talar neck fractures are associated with a high incidence of long-term disability and complications. Urgent reduction of the fracture-dislocation and delayed plate fixation through a dual approach when the soft tissue has recovered may minimise the complications and provide good clinical outcomes.     

Open reduction and internal fixation of displaced supracondylar fractures of the humerus

The results of open reduction and internal fixation were analysed in 200 displaced supracondylar fractures of the humerus in children. Overall, excellent results were obtained in 65% of cases, good in 15% and unsatisfactory in 20%. Delay in surgery was found to lead to unsatisfactory results. The operation was performed within 48 hours of injury in 140 cases and gave an excellent result in 120 cases, whereas delayed surgery, in 60 cases, gave an excellent result in only 10 cases. Open reduction provides an accurate, stable reduction, is easy to perform and has been found to give consistently good results.     

Open reduction and internal fixation of displaced intra-articular fractures of the calcaneus

BACKGROUND: Thirty-two displaced intra-articular fractures of the calcaneus in 30 patients were treated with open reduction and internal fixation. Fracture classification was based on Sanders computed tomographic classification. There were 18 type II fractures, 10 type III fractures, and 4 type IV fractures. METHODS: The operations were performed using a standard extended lateral approach, and the fractures were fixed with small-fragment AO T-plates without bone grafting. Average follow-up was 35.4 months (range, 24-53 months). The Creighton-Nebraska Health Foundation Assessment score for fractures of the calcaneus was used for evaluation. RESULTS: The average score was 86.7 for type II, 82.3 for type III, and 59.2 for type IV fractures. There was a clear statistically significant superiority with type II and type III fractures treated with open reduction when compared with type IV fractures (p < 0.0001). CONCLUSION: On the basis of our result, we recommend that type II and type III fractures be treated with open reduction and internal fixation. Despite the results of type IV fractures being significantly worse than that of type II and type III fractures, we recommend open reduction and internal fixation for type IV fractures to restore the hindfoot architecture and the subtalar joint, if possible. When the disrupted subtalar joint is so comminuted that it is beyond the surgeon's ability to reconstruct, primary subtalar arthrodesis should be performed in addition to open reduction and internal fixation.     

切开复位内固定治疗移位的跟骨关节内骨折

目的探讨切开复位跟骨钢板内固定治疗跟骨关节内骨折的效果。方法自2001年8月至2003年4月,采用切开复位内固定治疗移位的跟骨关节内骨折34例35足。所有骨折均采用Sanders分型,应用广泛外侧入路,AO跟骨钢板内固定。对有选择的病例进行了植骨。应用影像学检查和美国足踝协会的后足评分系统进行结果评价,患者全部获得随访。平均随访时间18.3个月(12～32个月)。结果共完整随访Ⅱ型骨折30足,Ⅲ型骨折5足。术前平均Bhler角是5.6°,随访时平均Bhler角是28.2°。X线测量表明在单侧跟骨骨折患者跟骨高度恢复为健侧的97.7%。80%的患者取得关节面的解剖复位或近解剖复位。平均评分在SandersⅡ型骨折为88分,Ⅲ型骨折为79分。优良率在SandersⅡ型骨折为83%,Ⅲ型骨折为60%。总的优良率为79%。结论对于SandersⅡ型和Ⅲ型骨折患者采用切开复位内固定治疗,效果较好。     

Open reduction internal fixation of displaced sacral fractures: technique and results

Pelvic ring disruption with an associated sacral fracture is typically a result of high-energy injury. Due to significant local soft tissue trauma and the complex neurovascular anatomy in the region, exposure and reduction of sacral fractures has proven to be difficult, hazardous, and fraught with complications. We describe a modified reduction technique to address displacement in sacral fractures to show that it can be safe and effective through evaluation of radiographic, clinical, and functional outcomes. We retrospectively reviewed the radiographic and clinical results of consecutive patients treated at a single institution by the senior surgeon (K.F.D.) with open reduction for displaced sacral fractures. Radiographic follow-up was available on all patients. Complete clinical follow-up was available on 19 of 20 patients. The average duration of follow-up was 3.7 years. All fractures united with no additional surgery. There were no infections or additional neurologic deficits or vascular injuries. There was 1 asymptomatic hardware failure 2 years postoperatively with no further displacement. Average preoperative displacement on the anteroposterior (AP) radiograph was 14.72 mm with a long-term follow-up displacement of 3.25 mm. Iowa Pelvic Score questionnaires demonstrated an average score of 92.2. Eighty-nine percent of patients returned to full time work or their previous activity level. The technique of open reduction and fixation of displaced sacral fractures described in this review is safe and effective with a low complication rate and clinical results comparable to or exceeding that of previously published series.     

距骨体与距骨颈骨折手术疗效分析

目的探讨距骨体与距骨颈骨折患者采用切开复位内固定术在治疗和预后上的差异。方法通过对1996年4月～2003年9月间17例SneppenⅡ型距骨体骨折患者与19例HawkinsⅠ、Ⅱ型距骨颈骨折患者均采用切开复位内固定,将Hawkins评分优良率、距骨缺血坏死率、胫距关节创伤性关节炎发生率和距下关节创伤性关节炎发生率进行对比,使用χ2检验确切概率法分析。结果SneppenⅡ型距骨体骨折患者Hawkins评分优良率为64.7%(11/17),距骨缺血坏死率17.6%(3/17),胫距关节创伤性关节炎发生率41.2%(7/17),距下关节创伤性关节炎发生率64.7%(11/17)。HawkinsⅠ、Ⅱ型距骨颈骨折患者Hawkins评分优良率为73.7%(14/19),距骨缺血坏死率15.8%(3/19),胫距关节创伤性关节炎发生率15.8%(3/19),距下关节创伤性关节炎发生率36.8%(7/19)。四种评价指标两组之间比较,差异无显著性意义(P>0.05)。结论距骨体和距骨颈骨折仅是解剖学上的概念,目前对于两种骨折的预后没有区分意义。对有移位(≥2mm)的距骨体或距骨颈骨折患者均应视软组织条件行切开复位内固定,保护残存血运,解剖复位,减少创伤性关节炎和距骨缺血坏死的发生。     

Radiographic analysis of the Canale view for displaced talar neck fractures

Fractures of the talar neck comprise almost 50% of fractures of the talus and may result in significant long-term morbidity. It is of paramount importance to ensure anatomic reduction of the fracture not only for fracture healing but also for minimizing future posttraumatic arthritic sequelae. In addition to conventional radiographs and computed tomography scans, the Canale view has proven to be beneficial, especially when evaluating for varus displacement. This study investigated whether the original method of performing the Canale view could be modified for improved evaluation for varus displacement. Simulated talar neck fractures were created in 6 cadaveric specimens. These were placed into varying amounts of varus displacement; the Canale view was performed with progressive degrees of eversion, from 0° to 25°, resulting in 108 total views. Blinded evaluation was performed, and a ranking system was used to determine the most beneficial degree(s) of eversion for evaluating varus malalignment. Multiple statistical analyses were performed. A significant difference was seen between the high and low range of values of eversion. A significantly lower ranking was achieved with 10° of eversion. As opposed to a single view taken at 15° of eversion, a range of angles may be most beneficial in evaluating varus displacement in talar neck fractures.     

重建钢板内固定治疗移位肩胛骨体部骨折

1998年2月～2003年6月,我们对14例移位明显的肩胛骨体部骨折采取手术复位重建钢板内固定治疗,取得满意疗效。1材料与方法1.1病例资料本组14例,男11例,女3例,年龄25～58岁。左侧6例,右侧8例。新鲜骨折13例,陈旧性骨折1例,均为肩胛骨体部闭合骨折。1.2治疗方法全麻下侧卧位。取后侧弧形入路2例,肩胛骨外侧缘入路12例,充分暴露骨折端,重建钢板塑形后行复位固定。见图1。术中C臂X线机透视复位满意后,放置引流片,关闭切口。术后24～48h后开始钟摆式功能锻炼,6周开始主动活动锻炼,3个月后开始肌肉强度和耐久力的训练。图1肩胛体骨折X线片A.术前;…