Scapular fractures and concomitant injuries

Objective: The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized.Few studies have investigated this presumed association...     

肩胛骨骨折与其合并伤关系的探讨

目的 分析115例肩胛骨骨折病例的临床资料,探讨肩胛骨骨折粉碎程度和涉及部位与合并伤之间的关系.方法 回顾性分析2006年8月至2008年3月115例肩胛骨骨折患者的病史及其影像学资料,分为单部分骨折组(83例)和多部分骨折组(32例),比较两组合并伤的发生率及特点.将单部分肩胛骨骨折组按Nordqvist与Petersson方法分成3组:肌肉覆盖部分(64例)、骨突起部分(11例)及肩胛盂部分(8例),并比较3组合并伤的发生率及特点.结果 绝大部分肩胛骨骨折是严重多发伤的一部分,致伤原因与高能量损伤有关.最常见的致伤原因是车祸伤(70.4%).损伤严重程度评分值(injury severity Scale,ISS)平均14.0,42例(36.5%)患者ISS>16.98例(85.2%)患者伴有不同程度和类型的合并伤,其中又以胸部合并伤的发生率最高(85/115,73.9%).多部分肩胛骨骨折组胸部简明损伤定级法评分值(abbreviated injury score,AIS)和总体ISS值均高于单部分肩胛骨骨折组.在单部分肩胛骨骨折组中,肌肉覆盖部骨折组较骨突起部和肩胛盂部骨折组的胸部AIS值和总体ISS值更高.结论 肩胛骨骨折尤其是骨折涉及多部分或肌肉覆盖部时更容易并发严重的胸部损伤.多部分肩胛骨骨折致伤原因多为高能量损伤,常伴发严重的胸部合并伤,可作为胸部严重损伤存在的一项骨性指标.     

Ankle fractures and alcoholism. The influence of alcoholism on morbidity after malleolar fractures.

The postoperative morbidity after osteosynthesis of malleolar fractures was investigated retrospectively by comparing 90 alcohol abusers with 90 controls. The two groups were selected from 626 male patients and were matched regarding trauma, treatment for cardiovascular, pulmonary and endocrine diseases, age, weight, smoking habits, anaesthesia and duration of surgery. The alcohol abusers developed significantly more early complications, especially infections, after surgery. Follow-up at six, nine and 12 weeks after surgery also revealed a significantly higher morbidity among the alcoholics.     

The long-term functional outcome of operatively treated tibial plateau fractures.

OBJECTIVES: To review the long-term functional results of the surgical treatment of tibial plateau fractures using standard techniques of open reduction and internal fixation. DESIGN: Retrospective study. SETTING: University hospital. METHODS: Forty-seven displaced fractures of the tibial plateau in forty-six patients were treated with open reduction, interfragmental screw fixation of the articular fragments, and buttress plate fixation and had a minimum of five years of follow-up. All aspects of their care, including tibial plateau fracture type, operative management and associated injuries, were documented. Preoperative and postoperative follow-up radiographs were analyzed for fracture classification and adequacy of reduction. All patients were contacted and given functional outcome questionnaires using both a generic health status scale (Short Form 36 [SF-36]) (18) and a disability scale relating to knee osteoarthritis (Western Ontario and McMaster Universities Osteoarthritis index [WOMAC]) (1). Data were also collected regarding return to work and sporting activities. Assessment scores were analyzed with respect to age, fracture type and severity, and were compared to standardized age and sex-matched scores for the healthy population. The average age of the patients at the time of injury was forty years and the average follow-up period was 8.3 years. Of the forty-seven fractures studied, twenty-five were classified as Schatzker types I, II, or III, and the remaining twenty-two were types IV, V, or VI (15). All fractures received operative treatment within forty-eight hours and all but five fractures were acceptably reduced. RESULTS: Compared to the standardized SF-36 categorical and aggregate scores, there was no statistically significant difference between the healthy age-matched population and twenty-four of twenty-six of the under-age-forty group regardless of fracture type. With regard to the over-age-forty group, scores statistically similar to the control population were found in only twelve of twenty-one patients. Although there was a large variance in WOMAC scores for all groups resulting in no statistically significant difference being found, a trend toward higher categorical and aggregate scores was seen with increasing age at presentation. There was no correlation between WOMAC scores and fracture type. Multiple-classifications analysis of all data revealed that presentation age was the most significant source of variation with respect to functional outcome. Fracture type had much less influence and adequacy of reduction had no significant influence on outcome, although the group of patients having an inadequate reduction by the authors' criteria was too small in number to reasonably comment upon. CONCLUSIONS: Open reduction and internal fixation is a satisfactory technique for the treatment of displaced fractures of the tibial plateau, particularly for patients younger than forty years.     

Unrecognized injuries of the lateral ligaments associated with lateral malleolar fractures of the ankle

Of four patients who were treated between May 1985 and November 1987 and who had both a lateral malleolar fracture and a tear of the lateral ligaments of the ipsilateral ankle, three could be followed. The fractured malleolus was treated with rigid internal fixation, but the injury to the lateral ligaments was not diagnosed until the ankle was stressed to test for stability after the internal fixation. We believe that if disruption of the lateral ligaments is noted at operation, repair is indicated. This involves only a slight prolongation of time under anesthesia and markedly increases the chances for a stable ankle. It is important to check intraoperatively for a possible tear of the lateral ligaments in a patient who has a fracture of the ankle, especially when the injury was caused by high-energy trauma.     

The effect of minimally displaced posterior malleolar fractures on decision making in minimally displaced lateral malleolus fractures

Purpose

Despite the high incidence of cases of minimally displaced lateral or posterior malleolus ankle fractures, treatment guidelines are still an issue of controversy. The purpose of this study was to delineate treatment preferences among orthopaedic surgeons in these fractures with and without concomitant posterior malleolus fractures. We hypothesized that concomitant minimally displaced fractures of the posterior malleolus can shift treatment preference towards operative intervention.

Methods

A questionnaire-based study was conducted among orthopaedic surgeons attending the 2012 European Federation of National Associations of Orthopaedics and Traumatology Conference (EFORT) in Berlin, Germany. Treatment preferences were reported for minimally displaced lateral malleolus fractures seen on radiographs and were then compared with treatment preferences when computed tomography (CT) was added revealing a concomitant minimally displaced posterolateral fracture of the posterior malleolus.

Results

The cohort comprised 177 surgeons from all six continents. When radiographs showing a minimally displaced lateral malleolus fracture were presented, nonoperative management was indicated by 35 % (62) of participants, whereas 65 % (115) preferred operative intervention. After CT views were added showing an accompanying minimally displaced posterolateral posterior malleolus fracture, 79 % (140) suggested operative intervention and only 21 % (37) advocated nonoperative management (p = 0.03).

Conclusions

Most surgeons prefer open reduction with internal fixation for minimally displaced lateral malleolar fractures. The presence of concomitant posterior malleolus fractures in these cases shifts treatment preference further towards open reduction with internal fixation. Because the posterior malleolus fragment might not be well delineated on standard ankle radiographs, a high index of suspicion is warranted, and the use of CT should be considered in these cases.     

66例踝关节骨折的AO分型和治疗

目的 探讨和总结踝关节骨折的分型和治疗。方法 按AO组织原则治疗踝关节骨折。结果 随访4月～6年,优良率达97％。结论 踝关节骨折,应尽量达到解剖复位,韧带损伤应同时处理。AO组织的分型对确定踝关节骨折的治疗方案有更好的指导意义。     

Posterior malleolar fractures of the ankle associated with external rotation-abduction injuries. Results with and without internal fixation

Thirty-eight patients in whom a fracture of the posterior malleolus was shown to comprise 25 per cent or more of the articular surface on the lateral radiograph were followed for an average of forty-four months (range, twenty-four to ninety-nine months). All injuries were judged to be a result of external rotation or abduction of the talus. Fifteen patients had fixation of the posterior malleolus, and twenty-three did not. Open reduction and internal fixation was carried out on all associated fractures of the medial and lateral malleoli. Satisfactory reduction of the posterior malleolus was often achieved when the fibula was reduced, and frequently this was maintained despite the absence of fixation. No posterior subluxation of the talus occurred in either group. No statistically significant difference was noted between the clinical results with and without fixation.     

Early weight bearing of malleolar fractures

A prospective randomized investigation of early versus late weight bearing in 46 patients with fracture of the lateral malleolus was performed. In 43/46 patients an exact operative reconstruction of the ankle mortise could be achieved using pins, staples and cerclage (Cedell, 1967). Radiographic and stereophotogrammetric analysis of the ankles after 3 months showed no significant differences, nor did the clinical follow-up.     

The surgical treatment of malleolar fractures: long-term results

The retrospective study concerns use of the AO method for the treatment of 75 ankle fractures between 1990 and 1995. After a mean follow-up of 5 years and 7 months the Cedell criteria were used for a subjective evaluation of results. Good results were obtained in 53 out of 75 patients submitted to surgery (70%), with a significant difference between uni-malleolar fractures and bi- and tri-malleolar fractures. Dorsal flexion measured an average of 24 degrees (80% of the healthy contralateral side), plantar flexion 36 degrees (90% of the healthy side). The presence of a fracture-dislocation considerably worsens prognosis because of the cartilaginous damage produced. The risk of poor results increases considerably when reduction of fracture is insufficient or absent. Post-traumatic arthrosis constitutes a common complication (25%) and it particularly affects females aged between 45 and 65 years, as a result of the presence of post-menopausal osteoporosis. Accurate reduction, fracture stabilization, sex and age constitute essential elements for satisfactory final results.     

Early weight bearing of malleolar fractures

A prospective randomized investigation of early versus late weight bearing in 46 patients with fracture of the lateral malleolus was performed. In 43/46 patients an exact operative reconstruction of the ankle mortise could be achieved using pins, staples and cerclage (Cedell, 1967). Radiographic and stereophotogrammetric analysis of the ankles after 3 months showed no significant differences, nor did the clinical follow-up.     

Early weight bearing of malleolar fractures

A prospective randomized investigation of early versus late weight bearing in 46 patients with fracture of the lateral malleolus was performed. In 43/46 patients an exact operative reconstruction of the ankle mortise could be achieved using pins, staples and cerclage (Cedell, 1967). Radiographic and stereophotogrammetric analysis of the ankles after 3 months showed no significant differences, nor did the clinical follow-up.     

Early active rehabilitation for operatively stabilized distal radius fractures.

From the young to the elderly, distal radius fractures are very common. Extensive literature has been written regarding surgical management of distal radius fractures, but the same degree of attention has not been given to the critical rehabilitation that follows. Successful functional outcomes for distal radius fractures are a result of appropriate surgical treatment as well as timely and specific rehabilitation. Surgical treatment strategies available for unstable distal radius fractures include percutaneous pinning, external fixation, dorsal plating, and volar fixed-angle plating. Arthroscopically assisted as well as other minimally invasive techniques are now gaining acceptance. The ideal surgical treatment would provide stable fixed-angle fragment-specific support with minimal soft tissue disturbance and allow safe, early active wrist rehabilitation. This article reviews the normal anatomy of the region, the pathoanatomy created by the different stabilization strategies, and specific therapy techniques, including static and static progressive splints, that correlate with each of the surgical procedures.