克氏针内固定治疗末节指骨撕脱性骨折

2015 年3 月 ～2018 年10 月,我科采用改良切开复位克氏针内固定治疗25 例新鲜闭合末节指骨撕脱性骨折患者,疗效满意,报道如下. 1 材料与方法 1.1 病例资料 本组25 例,男17 例,女8例,年龄21 ～58 岁.损伤指别:环指10例,小指10 例,中指3 例,示指2例.均为新鲜闭合骨性锤状指,表现为...     

克氏针内固定治疗锁骨骨折

我科对锁骨骨折手术治疗的情况,认为克氏针内固定方法符合生物力学原理,值得推广。临床资料我科从１９９０年７月～１９９７年７月共手术治疗３５例锁骨骨折,男２２例,女１３例;年龄１２～５０岁。均为手法复位失败患者。其中开放性骨折２例,粉碎性骨折１０例,陈旧...     

克氏针内固定治疗锁骨骨折

锁骨骨折通常是保守治疗 ,但畸形愈合却很多。对明显移位的锁骨骨折采用手术治疗 ,如钢板螺钉内固定 ,虽然固定比较坚固 ,但手术切口太大 ,局部组织损伤较重 ,其骨膜剥离过多对术后骨折愈合的影响很大。 1996～ 1999年我们采用改良克氏针内固定治疗锁骨骨折 92例 ,疗效满意 ,报道如下。临床资料一、一般资料 :本组 92例 ,其中男性 81例 ,女性 11例 ,年龄为 14～ 5 0岁。所有骨折均为车祸或跌伤所致。单纯锁骨骨折 83例 ,多发性骨折 9例 ,骨折后 1周内行手术治疗 85例 ,2周内行手术治疗 7例 ,无 1例术后出现骨不连 ,骨折愈合率达到 10 0 %。…     

克氏针内固定治疗锁骨骨折

目的观察克氏针内固定治疗锁骨中段骨折的临床效果。方法总结我科58例锁骨中段骨折患者采用克氏针内固定稳定性及愈合情况。结果58例患者解剖复位53例,5例功能复位。经随访均达临床愈合。结论克氏针治疗锁骨中段骨折固定牢固,愈合良好,功能恢复良好,值得临床推广,尤其适用于基层医院。     

改良克氏针内固定治疗锁骨骨折

<正> 自1997年以来,我们采用改良克氏针内固定治疗锁骨骨折22例,报告如下。 1 临床资料 1.1 一般资料:22例中男9例,女12例,其中双侧骨折1例。年龄最小16岁,最大51岁,平均30岁。交通事故伤12例,建筑伤4例,摔伤3例,其它2例。骨折类型:横断骨折10例,斜行5例,粉碎性7例。骨折部位:近1/3骨折5例,中段骨折10例,中外1/3交界处骨折7例。本组全部为新鲜骨折。 1.2 手术方法:从锁骨近折端上翘处始向远侧做一2～3.5cm长切口,显露锁骨近折端。用直径2.5cm克氏针顺骨折端髓腔向近端钻入,于锁骨内侧穿透前方皮质。然后调整克氏针方向,使针尖端指向远端,自内侧向远侧在髓腔内穿出约1mm,然后用复位钳夹持远折端,使骨折复位,将克氏针向远折端钻入,穿出骨皮质约1mm,针尾折弯留于近端皮下。对粉碎性骨折,尽可能不剥离骨膜,用直角钳引线,将骨折块用10号丝线     

克氏针内固定治疗小儿下肢长骨开放性骨折

目的探讨应用克氏针内固定治疗小儿下肢长骨开放性骨折的效果。方法对28例小儿下肢长骨开放性骨折应用克氏针内固定治疗。结果28例全部治愈，随访1～6a，无骨折畸形愈合及肢体短缩，外观及功能满意。结论克氏针内固定是治疗小儿下肢长骨开放性骨折的良好方法。     

克氏针内固定治疗锁骨骨折80例

笔者从1988年10月至1997年3月对80例锁骨骨折采用切开复位,克氏针内固定治疗,获得良好的临床效果。现报告如下:1　临床资料本组80例中男54例,女26例;年龄14岁～61岁。车祸伤40例,摔跌伤23例,打击伤17例。中1/3骨折59例,外1/3骨折21例。斜形骨折48例,横断骨折18例,粉碎性骨...     

钢丝加克氏针内固定治疗手指末节撕脱骨折

手指末节撕脱骨折引起的锤状指较为常见。撕脱骨块若较大，可用细不锈钢针将骨折块固定在原位，但用细不锈钢针容易引起骨块碎裂；而保守治疗的效果不能令人满意。1998年10月～2002年3月，我们采用钢丝捆扎加克氏针内固定治疗手指末节撕脱骨折21例，疗效满意。     

克氏针及钢板内固定治疗锁骨骨折

<正> 锁骨骨折是骨科临床中的常见病,多因间接暴力所致,骨折后多有不同程度的移位。骨折类型可分为横形、斜形、粉碎性骨折,以往大多采用手法复位八字绷带固定。近年来切开复位内固定的手术治疗方法也被临床所采用。我们自在1998年以来,采用克氏针及钢板内固定治疗有移位的锁骨骨折40例,     

Trimed钩钢板固定外踝骨折

[目的]探讨Trimed钩钢板在Danis-Weber A型外踝骨折中的临床疗效.[方法]2019年7月-2021年1月,共收治Weber A型踝关节骨折患者20例,按医患沟通结果分为两组.10例采用Trimed钩形钢板固定外踝骨折(钩钢板组),10例采用无钩钢板固定外踝骨折(无钩钢板组).比较两组临床与影像资料.[结...     

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.     

Application of a Ni-Ti arched shape-memory connector in unstable lateral malleolus fractures: A retrospective study

Purpose

To compare the outcomes of the arched shape-memory connector (ASC) only fixation and the lateral one-third tubular plate fixation in managing unstable Type A or B lateral malleolus fractures according to the Weber (AO) classification, and to evaluate the feasibility and reliability of ASC only fixation in treating these fractures.

针丝钉改良张力带治疗尺骨鹰咀及内外踝骨折

[目的]探讨张力带内固定治疗尺骨鹰咀及内外踝骨折的改良术式。[方法]用针丝钉方法改良替代针丝或针针丝传统张力带手术方法。治疗89例尺骨鹰咀骨折,63例内外踝骨折。[结果]随访68／55例（80．9％）,最长5a,最短6个月,平均2．5a。按Wolfgang后期疗效标准,优良：65／53例（95．9％）,一般：3＋2例（4．1％）,无差者。骨折平均愈合时间1．5个月。[结论]针丝钉改良张力带治疗尺骨鹰咀、内外踝骨折：（1）简化了手术操作;（2）减少了钢针数量;（3）保持了张力带生物力学原理和稳定的AO内固定优势;（4）加用螺钉代替钻骨孔改良方法减少了钢丝穿骨孔所出现骨坏死吸收而增大所产生的“失张力”现象,避免了内固定松脱并发症。缺点是仍然需再次手术取出内固定。     

带线锚钉技术治疗外踝撕脱骨折的疗效观察

目的探讨采用带线锚钉技术内固定治疗外踝撕脱骨折的临床疗效。方法自2009-01—2013-07采用带线锚钉技术内固定治疗外踝撕脱骨折13例,采用AOFAS踝-后足功能评分系统评定术后疗效。结果 13例均获得随访6~12个月,平均10月。术后X线片显示13例均达到骨性愈合,骨折愈合时间8~12周,平均10周。末次随访时AOFAS评分：优7例,良4例,可2例。结论采用带线锚钉技术内固定治疗外踝撕脱骨折具有手术操作简单、固定可靠、能早期功能锻炼、术后功能恢复快的优点。     

自制克氏针钩固定治疗严重移位儿童肱骨近端骨折

目的：探讨自制克氏针钩治疗严重移位的儿童肱骨近端骨折的临床疗效。方法：2007年1月至2012年2月,应用自制克氏针钩治疗严重移位的儿童肱骨近端骨折35例,男25例,女10例;年龄5～17岁,平均13.2岁;伤后至手术时间1～10 d,平均4.5 d.骨折移位根据Neer-Horwitz分型,Ⅲ型26例,Ⅳ型9例。均为闭合性骨折,无神经血管损伤。手术均行切开复位,复位满意后行自制克氏针钩固定。观测记录术中及术后并发症、术后放射学检查结果、上肢长度及肩关节活动度,并以Neer肩关节功能评分标准对肩关节功能进行评分。结果：35例获得随访,时间6～18个月,平均12.1个月。末次随访时肩关节功能Neer评分84～99分,平均（94.2±4.8）分,优30例,良5例;X线片显示所有病例骨性愈合,未发现内固定物松动断裂等并发症,无骨骺早闭现象,无肢体短缩畸形。除外展外患侧肩关节各方向活动度与正常侧肩关节相同（P>0.05）.所有患者能参加正常的体育活动。结论：自制克氏针钩固定是一种安全、有效的治疗严重移位的儿童肱骨近端骨折的方法。     

带筋膜外踝前动脉蒂外踝骨膜骨瓣治疗距骨病损

目的探讨带筋膜外踝前动脉蒂外踝骨膜骨瓣的解剖学特点和治疗距骨病损的临床应用价值.方法采用成人尸体动脉灌注标本15具30侧小腿,观测外踝前动脉的起源、走行、外径、主干长度等.根据解剖学特点设计带筋膜外踝前动脉蒂外踝骨膜骨瓣临床应用于12例距骨骨折或坏死病例.结果随访6个月～7年,12例术后3～8个月均获满意愈合,按Kenwright疗效标准,优6例,良3例,可2例,差1例.结论该骨瓣血供丰富,蒂长易于转位,手术创伤小,操作简单,为修复距骨骨折、骨不连、骨坏死提供了一个新而可靠的供区.     

手术治疗涉及后踝的踝关节骨折

目的 探讨涉及后踝的踝关节骨折的手术方法及临床疗效.方法手术治疗36例涉及后踝骨折的踝关节骨折患者.结果 36例均获随访,时间12～21个月.骨折愈合时间10～16周.根据美国足与踝关节协会（AOFAS）评分：优19例,良13例,可4例,优良率为88.9%.结论 根据骨折类型选择手术方式和固定方法,切开复位内固定治疗涉及后踝的踝关节骨折,可保证踝关节获得解剖复位,最大限度地恢复踝关节功能.     

腓骨远端爪型钢板治疗外踝骨折的疗效观察

<正>2010年1月~2013年10月,我科对35例外踝粉碎性骨折患者采用腓骨远端爪型支持钢板进行治疗,取得满意疗效,现报道如下。1材料与方法1.1病例资料本组35例,男22例,女13例,年龄18~73岁。单纯外踝骨折6例,双踝骨折16例,三踝骨折13例。其中6例合并下胫腓分离。按照踝关节骨折Lauge-Hansen分型:旋后内收     

Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study

Background:

The goal of managing the comminuted fracture of lateral malleolus is to restore length, rotation and alignment which might be more challenging with extensive comminution around the area of the distal tip. The common osteosynthesis techniques such as the one-third tubular plate, tension band wiring, K-wires, screws, or intramedullary nail may be insufficient in cases with a comminuted lateral malleolus. The anatomical hook plate is an alternative implant in such cases. We present our results of the comminuted lateral malleolar fractures (Weber A, B), managed by open reduction and internal fixation (ORIF) with an anatomical hook plate of lateral malleolus (Königsee Implant Company, Germany).

Materials and Methods:

We retrospectively reviewed 20 patients of comminuted fracture of distal lateral malleolus between 2008 and 2010. There were 12 males and 8 females, right side was involved in 18 patients and left in 2. The mean age was 51.9 years (range 18-75 years). The fractures were categorized by Denis-Weber classification type A (n=1), B1 (n=1), B2 (n=13) and B3 (n=5). Nineteen cases were of closed injury and one of open injury (Gustilo Anderson type II). These patients underwent ORIF with a lateral malleolus anatomical hook plate. Followup including radiographs and clinical examinations were performed. The American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores were documented at followups.

Results:

The mean followup was 21.4 months (range 16-27 months). The average AOFAS score was 94.3 (range 78-100) points. A stable anatomic reduction and bony union were obtained in all the cases. The average time was 3.1 months (range 2.5-4 months). Four cases had complications like posttraumatic osteoarthritis, hardware impingement and superficial wound infection.

Conclusion:

A reasonably good stability can be obtained in distal most comminuted fractures of lateral malleolus with a lateral malleolus anatomical hook plate. We believe this method to be a reasonable treatment option for a distal lateral comminuted malleolar fracture when other common fixations are insufficient to fix the fragments.