桡骨远端C3型骨折不同治疗方法的回顾性研究

目的 探讨C3型桡骨远端骨折有效治疗方法.方法 对2017年6月-2018年7月收治的53例桡骨远端C3型骨折患者,分别采用闭合复位外固定架固定和切开复位锁定加压钢板内固定两种方法进行固定,其中外固定架组34例,内固定组19例,并按照两种治疗方法的复位标准和功能标准对优良率进行比较.结果 53例术后均获得随访,随访时间...     

应用外固定器治疗侧方挤压损伤型骨盆骨折

目的探讨闭合复位外固定器固定治疗侧方挤压损伤型骨盆骨折的效果。方法采用闭合复位,两侧髂嵴各穿放2枚固定针,外固定器挤压固定,早期负重功能康复训练(平均术后14d扶拐下地部分负重行走)。结果所有病例骨盆两侧均获得对称性复位。平均愈合时间8·6周(7~14周)。平均随访4年(3~7年),初始复位后无明显的骨折再分离移位。结论外固定器是一种有效的治疗侧方挤压损伤型骨盆骨折的微创方法。     

外固定架在跗跖关节损伤复位与固定中的应用

目的探讨外固定架在跗跖关节损伤复位与固定中应用的效果。方法外固定架复位固定治疗跗跖关节损伤31例。用外固定架固定针帮助复位,并以外固定架的加压作用纠正残余分离移位。结果获解剖复位27例,功能复位4例。经4~23个月随访,无一例发生再移位,骨折全部骨性愈合。结论应用外固定架进行复位固定是治疗跗跖关节损伤的较好选择。     

Fixation technique influences osteogenesis of comminuted fractures

Comminuted fractures most often are associated with compromised soft tissue conditions and diminished vascularization leading to a reduced osteogenesis. In contrast to stable fixation by compression plating with lag screws, the less stable but also less invasive techniques of external fixation, unreamed nailing, or bridging plates have become increasingly popular. The aim of this study was to compare the bone healing and osteogenesis of these fixation techniques. A triple wedge osteotomy of the sheep tibia was used as a bone healing model. Internal compression plate fixation of all fragments with lag screws was used in one group. In the other three groups, only the main proximal and distal fragments were fixed by external fixation, unreamed interlocking nail, or bridging plate. The sheep with compression plate fixation and lag screws showed the worst results after 12 weeks. The periosteal and endosteal osteogenesis and the apparent density of the newly formed bone in the fracture gaps were significantly lower than those seen in the sheep in the other three technique groups. The best results were found for the bridging plate and external fixator. From these results, it can be concluded that compression plate fixation should be avoided for treatment of comminuted fractures.     

Knee arthrodesis following prosthesis removal. Use of the Wagner apparatus

Arthrodesis after the removal of a knee prosthesis is often hampered by the small area of contact of the bony surfaces and by pre-existing infection. Conventional systems of external fixation and compression frequently fail to achieve stability but the addition of the Wagner leg-lengthening apparatus applied anteriorly and adjusted to give compression ensures rigid external fixation. Four knees in four patients were treated using this technique; the treatment followed the removal of infected prostheses in three knees and painful fibrous ankylosis after the removal of the prosthesis in the other. All obtained a sound arthrodesis.     

锁定加压接骨板与外固定支架治疗桡骨远端粉碎性骨折的疗效比较

目的 比较锁定加压接骨板与外固定支架治疗桡骨远端粉碎性骨折的临床疗效.方法 对40例桡骨远端粉碎性骨折患者,采用掌侧锁定加压接骨板和外固定支架治疗;其中21例行掌侧锁定加压接骨板,19例行外固定支架.按AO/ASIF分型:C1型10例,C2型15例,C3型15例.随访内容包括测量腕关节活动度,前臂旋转活动度,握力、捏力及相关影像学资料(掌倾角、尺偏角、桡骨高度).按上肢功能评定标准(Disabilities of the Arm,Shoulder and Hand,DASH)和Gartland-Werley腕关节评分标准进行综合评估.对随访数据进行统计学分析,比较两组的治疗效果.结果 术后随访时间为6～48个月,平均18.8个月.根据Gartland-Werley腕关节评分标准评定,锁定加压接骨板治疗组优良率为81.0%,外固定支架治疗组优良率为78.9%.两组在掌曲、背伸、桡偏、旋前、旋后、握力、捏力、掌倾角、尺偏角、桡骨高度等方面,Gartland-Werley腕关节评分和DASH值差异均无统计学意义(P＞0.05);锁定接骨板组的腕尺偏活动度小于外固定支架组,差异有统计学意义(P＜0.05).锁定接骨板治疗组中无并发症出现.外固定支架治疗组中1例反射性交感神经营养不良症,药物治疗和理疗后好转;1例钉道感染,局部换药后治愈.结论 采用掌侧锁定加压接骨板和外固定支架治疗桡骨远端粉碎性骨折具有相同效果,具体可根据骨折类型、患者的功能要求及经济情况选择手术方案.

Abstract：

Objective To compare the treatment outcomes between locking compression plate and external fixator for treating severely comminuted distal radius fracture. Methods Forty patients of severely comminuted distal radius fractures were treated with either locking compression plate fixation via a volar approach or external fixator. Twenty-one patients were treated with locking compression plate fixation, while the other 19 patients were treated with external fixator. According to AO/ASIF classification, there were 10 type C1 fractures,15 type C2 fractures and 15 type C3 fractures.Wrist range of motion, forearm range of motion, grip and pinch strength, radiographic data (palmar tilt, radial inclination, radial height), scores by the Disabilities of the Arm,Shoulder and Hand (DASH) and by Gartland-Werley were collected at follow-up. The data were statistically analyzed to compare the clinical effects. Results Postoperative follow-up ranged from 6 to 48 months with an average of 18.8 months. According to Gartland-Werley wrist score, the excellent and good rate was 81.0% in the locking compression plate group, and 78.9% in the external fixator group. No significantly difference was detected in the ROM of flexion, extension, radial deviation, pronation, supination, grip and pinch strength, the parameter of palmar inclination, ulnar inclination and radial height and in Gartland-Werley score and DASH score between the two groups (P＞0.05). The ROM of unlar deviation in the locking compression plate group was significantly smaller than that in the external fixation group ( P＜0.05). No complication occurred in the locking compression plate group. One patient developed sympathetic reflex dystrophy postoperatively in the external fixation group. After medication and physical therapy the symptoms had resolved. Infection of the external fixator pin tract was note in another patient which was effectively treated by wound care. Conclusion Locking compression plate and external fixator lead to siunilar treatment outcomes for severely cormminuted distal radius fractures. Patient's functional requirement, age and financial status should be taken into consideration while choosing one of these procedures.     

External fixation as an alternative when treating 2nd and 3rd degree open lower leg fractures

Summary The infection rate of open lower leg fracture is extremely high. Surgical treatment guarantees a reduced risk of infection when compared with conservative treatments. But even osteosynthetic methods such as screw or compression plate fixation show unsatisfactory results because of the additional traumatization of the primarily injured soft tissue combined with a reduction of blood circulation. From July 1973 till September 1976 we treated 57 2nd and 3rd degree open shank fractures with osteosynthetic methods: 46 with compression plate osteosynthesis and 11 primarily or secondarily with external fixation. The osteitis-rate was 14%, in addition to that there was a soft-tissue infection rate of 5%. In order to change our therapeutical procedure we stabilized 2nd and 3rd degree open lower limb fractures and lower leg fractures complicated by soft-tissue damages consequently by external fixation.From October 1976 till May 1978 we treated 39 open shank fractures; 25 of them were 2nd and 3rd degree open fractures. They were treated by external fixation. This change in our surgical treatment resulted in an osteitis-rate of 2.6%, there was no case of soft-tissue inflammation.These results underline the superiority of treating 2nd and 3rd degree open lower leg fractures and fractures combined with soft-tissue injuries consequently and chiefly with AO external fixation.     

非手术方法治疗胸腰椎压缩性骨折的疗效观察

目的 探讨非手术方法治疗胸腰椎压缩性骨折的临床效果。方法 ７１例胸腰椎压缩性骨折患者,分为石膏外固定法、垫枕练功法、弹性支架外固定法３组治疗。均测量治疗前、后Ｘ线片上的椎体前高度,并进行比较分析。结果 随访５６例,时间１～５年。经３种非手术方法治疗后,压缩椎体的椎前高度明显恢复（Ｐ〈０．０１）。但难以恢复至正常高度,弹性外固定治疗法疗效明显优于石膏外固定（Ｐ〈０．０５）。结论 过伸体位复位法能明显     

Use of a locking compression plate as an external fixator for repair of a tarsometatarsal fracture in a bald eagle (Haliaeetus leucocephalus)

We describe the successful treatment of a tarsometatarsal fracture in a mature bald eagle (Haliaeetus leucocephalus) using a locking compression plate as an external fixator. The anatomy of the area (inelastic dermis and minimal subcutaneous space) and the high forces placed on a fracture at that site necessitated a unique approach to fixation. The unconventional use of a locking compression plate as an external fixator was minimally invasive, well tolerated by the eagle, and provided adequate stability in opposing fracture forces. This technique may serve as a method of fixation for tarsometatarsal fractures in other large avian species.     

Ist die Behandlung der instabilen distalen Radiusfraktur beim älteren Menschen mittels Fixateur externe nicht mehr indiziert?

BACKGROUND: In recent years there has been an increasingly marked shift in the operative treatment of unstable fractures of the distal radius. The introduction of locking compression plates has made it possible to extend the indications for palmar stabilisation according to the principles of internal fixation to extension fractures even in osteoporotic bone, and since then the new design has been used more and more widely. First clinical results show very good and good clinical and radiological outcomes in over 80% of cases after locking compression plate osteosynthesis. All this raises the question of whether external fixation is no longer indicated for distal radius fractures in the elderly, or is now no more than a second-line treatment. PATIENTS AND METHODS: Within a 5-year period, 67 patients over 65 years of age were identified among 220 who had had unstable fractures of the distal radius in our hospital with external fixation. The average follow-up period (clinical and radiological examinations) was 37 months. We devoted particular attention to the analysis of complications and problems during the treatment. RESULTS: Complete bone healing was observed in all patients treated with external fixation. In most cases, complications were minor pin-track infections (10%). The radiological follow-up examination revealed radial shortening by an average of 2 mm and an average radial shift of 0.2 mm. The joint angle was 2.5 degrees with lateral irradiation and 18 degrees with dorso-palmar irradiation. According to the Gartland and Werley score, the functional, radiological and subjective outcome was excellent or good in 87% of these patients. CONCLUSIONS: Overall, internal fixation with angular fixed plates has definite benefits. The medium- and long-term follow-up and functional outcome still show no benefits over external fixation, however. External fixation is a genuine option, even if as second-line treatment.     

A new external fixation device for treatment of complicated fractures of the leg

An external fixation device has been designed for rigid fixation of fragments of bone. It can be used in operations to lengthen the tibia and can be adapted to the compression fixation of fractures. This paper describes the apparatus and its use in the treatment of 10 complicated fractures.     

外固定支架结合锁定加压钢板在不稳定骨盆骨折治疗中的应用

目的 探讨外固定支架结合锁定加压钢板技术在不稳定骨盆骨折治疗中的应用及效果.方法 对2007年6月至2008年7月获得随访的12例不稳定骨盆骨折患者进行回顾性分析,男9例,女3例;年龄22～51岁,平均36.2岁.均采用髋臼上方外固定架固定前环骨折,锁定加压钢板固定后环骨折的技术.按照Tile分型:B1型5例,B2型3例,B3型2例;C1型2例.合并直肠或膀胱损伤3例,血气胸、颅脑损伤3例,腰骶神经损伤2例,多发骨折8例. 结果 12例患者术后获3～12个月(平均6.3个月)随访.手术时间40～120 min(平均70 min).支架保留时间6～16周(平均11周).骨盆骨折或脱位的愈合时间为12～19周(平均14周).骨折复位按照Tornetta评估标准:优7例,良4例,可1例.术后功能评定按Majeed评分标准:优6例,良4例,可2例.并发症包括2例早期负重行走时后方疼痛,经卧床休息延迟负重后缓解;6例有不同程度钉道感染,2例腰骶神经损伤患者3个月后神经功能部分恢复,无严重医源性并发症和合并症发生. 结论髋臼上方置钉外同定支架技术可有效恢复骨盆前方稳定性,通过股骨牵引还可以达到对骶髂关节的加压.跨骶骨髂骨间锁定加压钢板对骨盆后方的固定有一定优势.两种技术结合应用,创伤较小、手术操作简单,能达到不稳定骨盆骨折微创治疗的目的 .     

桡骨远端骨折的治疗

近年来,对于桡骨远端骨折的治疗观念不断更新,针对各种类型的桡骨远端骨折出现了不同的治疗方法,治疗手段不断完善。本文对桡骨远端的解剖、分类方法、治疗方法(包括闭合复位外固定、经皮穿针术、外固定架技术、切开复位内固定术、腕关节镜技术以及植骨技术的应用等)进行了综述。并对当前的治疗方法提出了几点看法:A型(AO分型)骨折首选闭合复位石膏外固定;对B型和C1型骨折在手法复位不满意的情况下首选切开复位斜T形钛板内固定;对C2和C3型骨折首选切开复位斜T形钛板内固定,干骺端粉碎无法进行钛板内固定时,采用切开复位外固定架固定术,并视术中情况决定是否使用克氏针内固定;对骨质疏松的老年患者采用LCP内固定,具体视骨折的骨缺损情况及骨质情况决定是否进行骨移植。     

Application of locking plate in long-bone atrophic nonunion following external fixation

The treatment of atrophic fracture nonunion continues to represent a therapeutic challenge. Large segmental osteopenia is often seen in patients who received uniplanar or hybrid external fixators as the definitive method of fixation for high-energy fractures, and this adds more difficulties to the treatment of fracture nonunion. This retrospective study was designed to assess the outcome of locking compression plating with autologous bone grafting in patients with long-bone atrophic nonunion following external fixation.From January 2004 to December 2009, a series of consecutive patients with atrophic nonunion of the long bone following external fixation were treated with this method in our institution. The clinical outcomes and complications of these patients were retrospectively analyzed. Twenty-seven patients with 28 fracture nonunions were involved in this study. Mean follow-up was 14.2±3.4 months. Bony union was achieved in all 27 patients within a mean 18.6±4.8 weeks after revision surgery. Two patients developed superficial wound infections. No deep infections were found, and no implant failure was seen. Three patients reported minor pain in the donor site of the bone graft, and no other donor site complications were found.Revision osteosynthesis of long-bone atrophic nonunion following external fixation by locking compression plating with autologous iliac crest bone grafting represents a safe and efficacious modality for the treatment of these challenging conditions.     

External fixation in trauma of the foot and ankle

External fixation as a modality is a versatile and minimally invasive stabilization option that should not be forgotten even as new and specially designed implants for nearly each bone become more fashionable. As a temporary traction device, the external fixator can help condition the soft tissues and, if closed reduction was sufficient, it can stay in place for definitive treatment. The external fixator can be used as an intraoperative distraction device and as a helpful tool for reduction, which can stay in place as a temporary immobilization. External fixation instead of plaster cast allows for better care of skin and soft tissues. External fixation also has its advantages as a minimally invasive external compression device in specific indications for arthrodesis, especially in infected cases.     

The role of external fixation in pelvic disruptions

External fixation has a definite role in the management of pelvic fractures. Biomechanically, it is not useful for maintaining reduction of the unstable, vertically migrating pelvis and must be used with some other form of treatment, such as traction, spica cast, or internal fixation. In vertically stable fractures, that is, rotationally unstable fractures, the anteroposterior and lateral compression injuries, the external fixator should probably be the first course of treatment.     

Is there a place for external fixation in humeral shaft fractures?

There is a good indication for unilateral axial dynamic external fixation in fractures of the humeral shaft when the fracture appears in the distal third or in cases of bilateral fractures. A non-union or a posttraumatic paralysis of the radial nerve may be indications for external fixation as well as fractures associated with multiple injuries. Further indications include osteitis, infected non-union and comminuted fracture. There is maximum protection of the soft tissue with this method of treatment. External fixation combines the advantages of conservative and operative treatment by influencing callus formation by dynamizing, distraction or compression. Minimizing soft tissue damage facilitates the decision for early exploration of the radial nerve in cases of palsy. A safer positioning technique of the distal screws of the fixator is described.     

Tibiocalcaneal Arthrodesis Using a Simple External Fixator

Tibiocalcaneal arthrodesis has been a salvage option for conditions with extensive loss of the talar body. In conditions that preclude the use of internal fixation, external compression arthrodesis has been the preferred technique to achieve fusion about the hindfoot. Since Sir John Charnley elucidated the technique of compression arthrodesis using compression clamps, various modifications and techniques of external compression arthrodesis have been described. Various clinical and biomechanical studies have established the superiority of triangular transfixation in external compression arthrodesis. We have described a simple technique of compression arthrodesis after the principle of triangular transfixation using easily available hardware from Ilizarov instrumentation. This technique is relatively inexpensive in terms of the cost of the materials, uses a modular construct, and allows multiplanar correction of the hindfoot. It can be used intraoperatively to distract the hindfoot joints, especially in the presence of fibrosis and poor skin conditions. We believe this device can be a reasonable alternative to the conventional external fixation techniques for tibiocalcaneal arthrodesis.     

Similar patient reported outcomes at long-term follow-up after external fixation versus internal fixation of the anterior ring component of APC injuries

Purpose: Unstable pelvic ring injuries produced by external rotation of the hemipelvis and a symphyseal disruption are most often treated with internal fixation of the anterior ring, with percutaneous treatment of the posterior ring as needed. In some clinical situations, patients are treated with external fixation for their anterior injuries and the long-term functional outcomes associated with external fixation are not well understood. We ask if there is a difference in functional outcome, between treatment of these injuries with internal versus external fixation, when measured at a minimum of three years after injury.Method: This was a retrospective cohort study performed at a level one regional trauma center. Trauma database review identified 128 patients, with 70 subsequently excluded, with unstable anterior posterior compression (APC) pelvic ring injuries (OTA 61B2.3 & 61C1.2) treated with surgery with minimum three years of follow-up. An intervention of internal fixation versus external fixation of anterior pelvic ring was performed, and depending on the injury, supplemented with posterior iliosacral screw fixation. Main outcome was measured with the Majeed functional outcome score (0-100).Results: Patients treated with external fixation reported a Majeed score of 70 (95% CI 28-100) compared to 79 (95% CI 36-100) in those with internal fixation (p-value 0.28). Subgroups of the Majeed score were not significantly different (p value > 0.05). Open fractures, severity of injury, and ISS were worse in those treated with external fixation. There was no differential loss to follow-up.Conclusion Patients with unstable pelvic ring injuries with symphyseal disruptions treated with external fixation as definitive treatment versus internal fixation may fare no different in the long term.     

影响骨外固定刚度和应力分布因素的实验研究

本实验通过体外力学测试研究固定钢针数目，针直径和骨断端加压固定等因素对骨外固定刚度和应力分布的影响，实验结果表明：增多固定针数，增大针直径能显著提高骨外固定刚度，同时也非常显著地增大了应力遮挡率；骨断端加压固定既能显著提高骨外固定刚度，又能非常显著地降低应力遮挡率，说明可以通过调整固定钢针数目，针直径和骨断端加压量，使骨外固定刚度和应力分布最适宜骨折愈合。