切开复位解剖钢板内固定治疗股骨远端复杂骨折

目的探讨采用切开复位解剖钢板内固定治疗股骨远端复杂骨折的临床疗效。方法2001年1月～2004年6月采用切开复位解剖钢板内固定治疗股骨远端复杂骨折患者67例，25例C3型骨折选用股骨髁上支持钢板，42例A3、c2型骨折选用股骨远端接骨板；其中35例自体髂骨植骨，23例同种异体骨植骨，9例腓骨髓内植骨＋髂骨植骨；全部患者在股四头肌与股骨之间应用生物可吸收医用膜；13例辅助髌骨牵引。术后常规中药熏洗、CPM锻炼等综合方法治疗。结果67例患者获得10．26个月（平均15个月）随访，骨折均获愈合，膝关节功能按Kolment标准评定：优36例，良23例，可5例，差3例，优良率为88．1％。结论切开复位解剖钢板内固定治疗股骨远端复杂骨折，固定可靠，可满足膝关节早期功能锻炼，有效防止股四头肌粘连和膝关节僵硬。辅助局部一期植骨、应用生物可吸收医用膜，部分髌骨牵引、术后中药熏洗、CPM锻炼等综合方法可获得满意疗效。     

拉力螺丝钉配合动力髁螺钉系统治疗股骨远端粉碎性骨折

目的总结拉力螺丝钉配合动力髁螺钉系统(DCS)治疗股骨远端粉碎性骨折的临床效果。方法26例股骨远端粉碎性骨折采用动力髁螺钉系统及拉力螺丝钉内固定,股骨髁间用2～3枚松质骨螺丝做拉力固定,较小骨折块用拉力螺丝钉固定在较大的骨折块上。骨折按AO/ASIF分类:A3型2例,C1型6例,C2型13例,C3型5例。结果平均随访14个月,25例骨折正常愈合,1例延迟愈合,平均骨折愈合时间为5.6个月;按Kolmenrt评定标准:本组优17例,良6例,一般2例,差1例,优良率88.5%。膝关节活动度55°～120°,平均膝关节活动度98.6°。结论拉力螺丝钉配合动力髁螺钉系统可有效治疗股骨远端粉碎性骨折,具有固定牢固、骨折愈合率高、并发症少等优点。     

Treatment of open intraarticular distal femur fractures by Ilizarov fixator; an approach to improve the outcome with mid-term results

PurposeOpen comminuted intraarticular distal femur fracture represents a formidable challenge for the orthopaedic surgeon for the inherent fracture complexity, soft tissue damage, and contamination. The purpose of this study was to evaluate the mid-term outcome results and safety of using the Ilizarov fixator to treat these fractures.Patients and MethodsThe study included 22 fractures treated by debridement with reduction and stabilization by Ilizarov external fixator. The mean age was 35 years. Gustilo grade of open fracture was III-A (19 cases), III-B (2 cases), and III-C (1 case). Six fractures were AO-OTA type 33C2, and 16 cases were type 33C3. Eight patients had associated injuries. Bone and functional results were evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria, and Neer knee score. The statistical analysis was done using the IBM SPSS Statistics for Windows.ResultsSeven cases had autogenous bone grafting. The frame crossed the knee in 8 patients. The fixator was removed after a mean of 7 months with union in all cases, and without any malalignment >5°. Deep infection occurred in two cases. Quadriceps-plasty was needed for 3 cases. After a mean of 44 months, the last follow-up results showed full knee extension and a mean flexion of 107.59°. The ASAMI functional and bone results were good to excellent in all cases. Neer knee score averaged 86.59.ConclusionsIlizarov fixator was an effective treatment modality of open comminuted distal femur fractures with high union rate, adequate alignment and satisfactory functional outcomes.     

应用张力带固定法治疗锁骨远端骨折

目的：评价张力带固定法治疗锁骨远端骨折的临床效果。方法：对20例锁骨远端骨折行切开复位后张力带固定法治疗。术后随诊分析。结果：所有骨折均在半年内愈合。患侧肩关节功能恢复良好。无一例出现伤口感染。结论：张力带固定治疗锁骨远端骨折是一种简单可靠的手术方法。     

解剖型钢板植骨术治疗股骨下端复杂粉碎骨折

目的总结股骨下端复杂粉碎骨折解剖型钢板植骨固定的临床特点、效果。方法20例患者按AO分类，C2型11例，C3型9例，合并髌骨骨折7例。解剖型钢板固定的同时根据骨缺损情况行髂骨、腓骨植骨，观察疗效。结果所有患者随访10～24个月，骨折全部愈合，按schatzker的疗效评定标准，优14例，良5例，可1例，优良率95％。结论解剖型钢板植骨术是治疗股骨下端C2、C3型骨折的理想方法。     

Working length and proximal screw constructs in plate osteosynthesis of distal femur fractures

BackgroundThe study purpose is to evaluate the working length, proximal screw density, and diaphyseal fixation mode and the correlation to fracture union after locking plate osteosynthesis of distal femoral fractures using bridge-plating technique.MethodsA four-year retrospective review was performed to identify patients undergoing operative fixation of distal femur fractures with a distal femoral locking plate using bridge-plating technique for the metadiaphyseal region. Primary variables included fracture union, secondary surgery for union, plate working length, and diaphyseal screw technique and configuration. Multiple secondary variables including plate metallurgy and coronal plane fracture alignment were also collected.ResultsNinety-six patients with distal femur fractures with a mean age 60 years met inclusion criteria. None of the clinical parameters were statistically significant indicators of union. Likewise, none of the following surgical technique parameters were associated with fracture union: plate metallurgy, the mean working length, screw density and number of proximal screws and screw cortices. However, diaphyseal screw technique did show statistical significance. Hybrid technique had a statistically significant higher chance of union when compared to locking (p = 0.02). All proximal locking screw constructs were 2.9 times more likely to lead to nonunion.ConclusionsPlating constructs with all locking screws used in the diaphysis when bridge-plating distal femur locking plates were 2.9 times more likely to incur a nonunion. However, other factors associated with more flexible fixation constructs such as increased working length, decreased proximal screw number, and decreased proximal screw density were not significantly associated with union in this study.     

切开复位内固定治疗股骨髁间骨折

目的探讨股骨髁间骨折的切开复位内固定临床价值。方法自1995年7月～2001年12月,采用切开复位,普通钢板、95°角钢板、DCS或髁部支撑钢板等内固定治疗股骨髁间骨折32例。根据AO/ASIF分类,C1型13例,C2型10例,C3型9例。根据术前术后X线片及术后膝关节功能恢复情况评价内固定效果。结果27例获得随访,随访时间9个月～7年,根据Sanders评分标准,优14例,良9例,差4例。结论切开复位内固定是治疗股骨髁间骨折的理想选择。     

Primary ilizarov external fixation in open grade III type C distal femur fractures: Our experience

IntroductionOpen comminuted distal femur fractures are notorious for septic or aseptic non-union. The recommended fixed angle distal femur locking plate in such situations can lead to a septic non-union due to its extensive approach and further periosteal stripping. Supracondylar nails, though have a minimally invasive approach, are not suitable for type C2 and C3 (AO/ASIF) fractures. A monolateral fixator as damage control followed by plating may be recommended. But if wound healing is delayed it results in difficult articular reduction, poor alignment and a stiff knee. We therefore used ilizarov circular external fixators (ICEF) for such open fractures (type C1, C2 and C3) and analysed its radiological and functional outcomes.Materials and methods25 male patients, with a mean age of 31.04 ± 6.62 years (range, 22–44 years), with open grade III type C distal femoral fractures were treated with ICEF. There were 7 fractures of type C1and C3 each, 11 were of type C2. Articular reduction and compression was achieved with inter-fragmentary screws through minimal open technique by extending the open wound and then stabilising the fracture with ICEF. The main outcomes evaluated were union, range of motion, final shortening, Knee Society scoring and ASAMI scoring system for radiological and functional outcomes.ResultsThe mean follow-up period was 19.12 ± 1.14 months. All fractures except two united at a mean period of 30 ± 3.02 weeks, without the need of bone grafts. The bony assessment (according to ASAMI score) was excellent in 8 cases (33.33%), good in 9 cases (37.5%) and fair in 5 cases (20.83%), while there were 2 poor clinical end results. The functional results were excellent in 6 cases (25%), good in 9 cases (37.5%) fair in 6 cases (25%) poor in 3 cases (12.5%). The complications included shortening, extension lag and pin tract infections.ConclusionWith the encouraging results, the use of ICEF with minimal internal fixation in grade III open comminuted distal femur fractures as a primary definitive treatment is a valuable alternative.     

交锁髓内钉治疗股胫骨骨折110例分析

目的　探讨交锁髓内钉治疗股、胫骨骨折的疗效 ,分析并发症发生原因 ,提出防治措施。方法　 110例股、胫骨骨折 (闭合骨折 83例 ,开放骨折 2 7例 ) ,除 2例股骨和 5例胫骨闭合复位未扩髓外 ,余均采用开放复位并有限扩髓 ,应用交锁髓内钉固定。随访 3～ 2 4个月 ,平均随访 14个月。结果　 110例骨折全部愈合 ,其中髓内钉折断 5例 ,锁钉折断或松动退出 4例 ,骨折成角畸形 4例 ,骨折延期愈合 8例 (股骨 3例 ,胫骨 5例 ) ,无感染病例。按Johner -Wruh法功能评定 :优 83例 ,良 2 3例 ,中 3例 ,差 1例。结论　只要掌握好手术指征及正确处理所遇问题 ,交锁髓内钉治疗股、胫骨骨折是一种较好的内固定方式     

股骨远端骨折常见内固定临床应用评价

目的: 评价股骨远端骨折常见内固定临床应用效果。方法: 1998~2003年共收治股骨远端骨折 215例,骨折按AO/ASIF标准分型, A型 112例, B型 20例, C型 83例。分别采用AO角钢板、松质骨拉力螺钉、DCS、GSH及AO股骨髁钢板内固定, 合并股骨内侧骨质压缩粉碎较重者, Ⅰ期大块自体髂骨植骨。结果: 经平均 10 6个月随访, AO角钢板固定组 (12例): 2例内固定折断骨不连, 1例骨畸形愈合; 松质骨拉力螺钉固定组 (20例 ): 骨折全部愈合; DCS固定组 (96例): 2例骨不连, 1例内固定折断; GSH固定组 (20例 ): 1例骨不连、锁钉折断; AO股骨髁钢板固定组 (67例): 2例骨不连。膝关节功能按Merchan评分标准评分, 总优良率 93%。结论: 股骨远端骨折的常见内固定器械, 均不具包容性, 术前应正确判定骨折的类型并选用合适的内固定, 合并股骨内侧骨质压缩粉碎较重者, Ⅰ期大块自体髂骨植骨。这样, 才能有效提高此类骨折的优良率。     

动力髁螺钉内固定并一期植骨治疗股骨远端严重粉碎骨折

目的探讨股骨远端严重粉碎骨折的治疗方法。方法应用动力髁螺钉(dynamic condylar scrow，DCS)内固定并一期植骨治疗股骨远端严重粉碎骨折21例，对术后膝关节功能进行评价。结果21例病人均获随访，膝关节功能：优7例、良9例、可4例、差1例，优良率近80％。结论动力髁螺钉内固定并一期植骨是治疗股骨远端严重粉碎骨折的一种有效方法。     

Outcome of delayed primary internal fixation of distal radius fractures: A comparative study

Introduction and aim

Operative fixation of distal radius fractures using fixed-angle devices has become increasingly common. Although good to excellent results have been reported in acute fractures, little is currently known regarding the fixation of healing displaced distal radius fractures that were presented late. The aim of this study was to evaluate the results of internal fixation of distal radius fractures presented late (>21 days) as compared with an acute-care control group.

Methods

Forty patients operated on for displaced distal radius fractures, presenting more than 21 days after injury (delayed treatment (DT) group), were compared with 75 age-matched controls with acute fracture repair (≤21 days). The same surgical approach was used in both groups, together with dorsal soft-tissue and brachioradialis release. No osteotomy was required. Direct and indirect reduction aids were used. A fixed-angle device (DVR; Biomet Inc., Warsaw, IN, USA) was used in both groups. Mean follow-up was 3.4 years. Quick DASH (Disabilities of the Arm, Shoulder and Hand) and Short Form 12 scores were used to evaluate outcome, as well as radiographic analysis for Arbeitsgemeinschaft für Osteosynthesefragen(AO)/Orthopaedic Trauma Association(OTA) classification, volar tilt, radial inclination and radial length.

Results

Average age was 53 years in both groups and male to female (M/F) ratio was similar in the study groups. Mean time to surgery was 30 days in the DT group and 8 days in the control group. There were significantly more type C (91.5% vs. 67.5%) fractures in the control group. The average quick DASH score was 27.1 in the DT group as compared with 6.3 in the control group (p < 0.03); however, when controlling for two outlier cases with complications (hardware irritation and a sensory neuropathy) there was no significant difference. Volar tilt, radial inclination and length were similar in both groups and were within normal anatomical values.

Conclusions

Delayed primary operative fixation of displaced unstable distal radial fractures is a viable option for cases that were presented late, with predictable, favourable results. Neither extensile approaches nor formal osteotomies are required.     

Clinical and Patient reported outcomes following open reduction and internal fixation for distal tibial intra-articular fractures

IntroductionIntra-articular distal tibial plafond fractures are rare injuries, provide a challenge for the surgeon and can often have poor outcomes. The aim of this paper was to report long term patient reported functional outcomes, health related quality of life (QoL) scores and rates of complications in order to fully counsel the patient on likely outcomes and set realistic post-operative expectations for the patient.MethodsWe conducted a retrospective review of 20 patients with distal tibial intra-articular fractures that presented to our institution between September 2014 and September 2020. All patients underwent open reduction and internal fixation (ORIF). Clinical, radiological and patient reported outcome measures (PROMS), quality of life (QoL) scores and complications were collected.ResultsThe mean age of the patients at the time of surgery was 50.6 years (24−71). There were 7 males and 13 females. There were 4 open and 16 closed fractures. There were 7 Rüedi and Allgöwer (RA) Type 1, 9 Type 2 and 4 Type 3 fractures. The mean follow-up was 3.8 years [1–7]. The mean OMAS score was 54.3, reaching a peak at 2 years from injury. The mean QoL score (EQ5D5L) was 0.602, representing only 70 % of aged matched, UK population based norms.ConclusionsWhilst clinical outcomes are comparable with other studies, this report highlights this is a devastating injury, with most people taking 2 years to reach peak recovery. QoL outcome scores only reach 70 % normal and only 35 % of patients return to within 10 % of age matched population based norms.     

经关节入路微创钢板固定技术治疗股骨远端C型骨折

目的探讨经关节入路微创钢板固定(MIPPO)技术治疗股骨远端C型骨折的临床疗效。方法2002年4月～2005年2月,应用MIPPO技术治疗股骨远端C型骨折14例,按AO/ASIF分类：C1型3例,C2型6例,C3型5例。先行关节内骨折切开复位、松质骨螺钉固定,再行髁上部分骨折间接复位、经关节内切口插入髁支撑钢板或LISS钢板桥接固定骨折。结果12例患者获得10～32个月(平均18．4个月)随访,骨折均获愈合,愈合时间10周～12个月,平均4．6个月。按Kolmert和Wulff的评价标准：优4例,良5例,可2例,差1例,优良率为75%。结论应用MIPPO技术治疗股骨远端C型骨折实现了微创操作,具有创伤小、软组织干扰少、骨折愈合快等优点,疗效满意。     

Swashbuckler approach for distal femur fractures: A systematic review

PurposeThe review aims to reach a common consensus regarding the swashbuckler approach for distal femur fractures by a systematic review of the available literature and to evaluate the complications, union, and outcomes.MethodsElectronic database search engines like Cochrane Library, PubMed, Google Scholar, and Scopus were searched until May 2021. Studies comparing the clinical complications, and functional outcome scores of Swashbuckler approach for distal femur were considered. The quality of the articles were evaluated using Methodological Index for Non-Randomized Studies score.ResultsEleven studies were included for the final analysis. An anterior midline incision was used in the majority of studies. Superficial infection was the most common complication seen followed by knee stiffness and deep infections. 66.45% of the patients had excellent/good outcomes. 1.08% had a painful implant and 1.89% had deep infection.ConclusionSwashbuckler approach offers itself as a viable option in cases of distal femur fractures, especially in AO type C. The quadriceps sparing approach provides excellent/good outcomes in approximately 66.45% of the patients.     

桥接组合式内固定系统治疗股骨干骨折合并同侧股骨近端、股骨远端骨折

目的 探讨桥接组合式内固定系统治疗股骨干骨折合并同侧股骨近端、股骨远端骨折的临床疗效.方法 回顾性分析2013年1月至2016年12月于我院骨科接受手术治疗的4例股骨干骨折合并同侧股骨近端及远端骨折病人的临床资料,其中男3例,女1例,年龄为(33.5±9.3)岁(23～44岁),闭合性骨折3例,开放性骨折1例.3例病人...     

Management of distal tibial intra-articular fractures with circular external fixation

The treatment of tibial plafond fractures requires careful management of the soft tissue envelope, reconstruction of the articular surface and stable fixation with minimal additional damage. Thirty cases of AO type 43 C tibial fractures were treated by transosseous osteosynthesis (Ilizarov technique). The external fixator constructs used were Ilizarov (Transosseous osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tissue, Springer, Berlin, 1992) and Sheffield (Classification AO des fractures, Springer, Berlin, 1987) circular fixator systems. All tibial plafond fractures healed. Using radiological criteria for assessment of reduction of the articular fragments and the clinical scoring system described by Teeny and Wiss, there were excellent and good restoration of articular structure in 27 cases and good clinical results in 14. This treatment method compares well with previous published series and is to be recommended for this group of difficult fractures.     

跨腕关节外固定器治疗不稳定性桡骨远端骨折

目的 回顾分析闭合复位、单侧外固定器跨腕关节固定治疗不稳定性桡骨远端骨折的效果。方法 2000年6月～2005年3月，利用外固定器跨腕关节固定治疗45例50侧不稳定性桡骨远端骨折，年龄15～78岁（平均44．8岁）。骨折按AO分型：A3型5例5侧，B3型4例4侧，C1型3例3侧，C2型9例9侧，C3型24例29侧。手法或外固定器协助复位，外固定器静力性固定，骨折愈合后拆除外固定器。随访8～48个月（平均20个月）。结果 骨折愈合时间6～8周，平均7．6周。4例4侧出现针道表浅感染，经口服抗生素及局部换药后好转。最后一次随访时，影像学评估（Stewan改良的Sarmiento评分）：优39例42侧，良6例8侧。腕关节功能按Garland与Werley功能评分标准：优34例37侧，良8例9侧，可3例4侧，优良率为92％。结论 闭合复位、单侧外固定器跨腕关节静力性固定桡骨远端骨折，通过选择合适的外固定针置入部位，可以避免桡神经损伤及第二掌骨医源性骨折，减少针道感染及松动等并发症的发生，并有利于术后早期行手部功能锻炼；无需辅助性植骨促进骨折愈合，是不稳定性桡骨远端骨折的有效治疗方法。     

Additional fixation of medial plate over the unstable lateral locked plating of distal femur fractures: A biomechanical study

IntroductionLateral locked plating is a standard treatment option for distal femur fractures. However, the unstable conditions after lateral locked plating are increasing. The objective of this study was to investigate the biomechanical strength of additional medial plate fixation over the unstable lateral locked plating of distal femur fractures.Materials and methodsA distal femur fracture model (AO/OTA 33-A3) was created with osteotomies in the composite femur. Three study groups consisting of 6 specimens each were created for single-side lateral locked plating with 6 distal locking screws (LP-6), single-side lateral locked plating with 4 distal locking screws (LP-4), and additional medial locked plating on LP-4 construct (DP-4). A compressive axial load (10 mm/min) was applied in the failure test. Mode of failure, load to failure, and ultimate displacement were documented.ResultsAll single-side lateral locked plating (LP-4 and LP-6) showed plate bending at the fracture gap, while none of the DP-4 showed plate bending at the fracture gap. Load to failure of DP-4 (mean 5522 N) was 17.1% greater than that of LP-6 (mean 4713.3 N, p < 0.05) and 29.2% greater than that of LP-4 (mean 4273.2 N, p < 0.05). Ultimate displacement of DP-4 (mean 5.6 mm) was significantly lower than that of LP-6 (mean 8.8 mm, p < 0.05) and LP-4 (mean 9.1 mm, p < 0.05).ConclusionsAdditional fixation of medial plate significantly increased the fracture stability in distal femur fractures fixed with the lateral locked plating. Especially in the clinical situations where sufficient stability cannot be provided at the distal segment, the medial plate may be considered as a useful biomechanical solution to obtain adequate stability for fracture healing.     

Functional outcome of arthroscopic assisted fixation of distal radius fractures

Background:

Many studies in literature have supported the role of wrist arthroscopy as an adjunct to the stable fixation of unstable intraarticular distal radial fractures. This article focuses on the surgical technique, indications, advantages, and results using wrist arthroscopy to assess articular reduction and evaluates the treatment of carpal ligament injuries and triangular fibrocartilage complex (TFCC) injuries in conjunction with the stable fixation of distal radial fractures.

Materials and Methods:

We retrospectively evaluated 27 patients (16 males and 11 females), who underwent stable fixation of intraarticular distal radial fractures with arthroscopic evaluation of the articular reduction and repair of associated carpal injuries. As per the AO classification, they were 9 C 1, 12 C2, 2 C3, 3 B 1, and 1 B2 fractures. The final results were evaluated by modified Mayo wrist scoring system. The average age was 41 years (range: 18-68 years). The average followup was of 26 months (range 24-52 months).

Results:

Five patients needed modification of the reduction and fixation after arthroscopic joint evaluation. Associated ligament lesions found during the wrist arthroscopy were TFCC tears (n=17), scapholunate ligament injury (n=8), and luno-triquetral ligament injury (n=1). Five patients had combined injuries i.e. included TFCC tear, scapholunate and/or lunotriquetral ligament tear. There were 20 excellent, 3 good, and 4 fair results using this score.

Conclusion:

The radiocarpal and mid carpal arthroscopy is a useful adjunct to stable fixation of distal radial fractures.