Fracture of the tibia complicated by acute compartment syndrome

A consecutive series of 32 patients with tibia fractures complicated by compartment syndrome was treated with fasciotomy. One group was also treated with closed reduction of the fracture and cast immobilization and compared with a comparable group treated with internal fixation without case immobilization after fasciotomy. All other patients were treated with fasciotomy and reduction followed with either external skeletal fixation, pins and plaster, or skeletal traction. Care of the open fasciotomy incisions, observation of the neurovascular status of the limb, and rehabilitation of the extremity were facilitated by internal fixation operations without subsequent external cast immobilization. The anatomic and functional results in this group were better than those treated with fasciotomy and cast immobilization. All fractures were united by 20 weeks. Complications in both groups were similar, although one deep infection, which was resolved with appropriate treatment, occurred in the group treated with internal fixation. Six open tibia fractures were treated with external skeletal fixation after fasciotomy; the results were less satisfactory, but the initial injuries were also more severe in this group. Patients with closed tibial fractures complicated by compartment syndromes should be treated expeditiously with fasciotomy, followed by stable internal fixation.     

Supracondylar fracture of the femur after total knee arthroplasty

We reviewed the data on thirty-six supracondylar fractures of the femur (in thirty-four patients) that occurred after total knee arthroplasties that were done between April 1974 and December 1981. Patients who had osteoporosis, rheumatoid arthritis, one or more previous arthroplasties of the knee, or inadvertent breeching of the anterior aspect of the femoral cortex at operation appeared to be particularly at risk for a supracondylar femoral fracture. Malalignment of the component could not be implicated as a cause. Twenty-six fractures (in twenty-five patients) were treated by non-operative methods. Seventeen of them (65.4 per cent) healed and required no surgical treatment. Fourteen of the seventeen were followed for more than two years; they had no significant difference in the knee score and lost less than 10 degrees of motion. The nine remaining knees required revision of the arthroplasty because of non-union in four knees, malunion in two, loosening of the component in two, and extension lag in one. At an average of forty months after revision, the nine knees were rated as having one excellent, four good, three satisfactory, and one failed result. In contrast, only three of the five fractures that were treated by early open reduction and internal fixation had a satisfactory result, and one of them required a second bone-grafting procedure. One patient died perioperatively and another required an above-the-knee amputation because of sepsis. Of the three fractures that were initially treated by external fixation, one had an excellent and two had a good result at an average of forty-five months after fracture. We have found that supracondylar fractures that occur after total knee arthroplasty can be managed by either traction or application of a cast, or both, which usually results in healing of the fracture and a satisfactory outcome of the arthroplasty. Patients who have a poor arthroplasty result after non-operative treatment of the fracture usually can undergo a revision arthroplasty with the expectation of a satisfactory outcome. Operative treatment of the fracture should be reserved for patients who do not have osteopenia and in whom stable fixation can be achieved, for those who demand a highly functional arthroplasty, and for those in whom adequate closed reduction cannot be maintained.     

Supracondylar fracture of the femur following prosthetic knee arthroplasty

Sixty-one supracondylar fractures above prosthetic knee replacements in 58 patients were reviewed with a mean follow-up time of 3.7 years (range, 9 months to ten years). The mean interim between arthroplasty and fracture was 2.9 years (range, intraoperative to ten years). Twenty-seven cases demonstrated notching of the anterior femoral cortex. Seventeen patients suffered from a severe neurologic disorder. Group A consisted of 30 patients with 31 fractures treated by open reduction and internal fixation or revision arthroplasty. Follow-up study revealed 25 unions, three malunions, one nonunion, and two above-knee amputations for deep sepsis. Four of 31 patients had increased pain levels or change in ambulatory status postoperatively. Group B consisted of 30 fractures in 28 patients treated by casting alone or traction followed by cast bracing. Follow-up examination showed 17 unions, seven malunions, and six nonunions. Fifteen of the 30 patients had increased pain levels or change in ambulatory status after treatment. Casting produced significant decreases in motion in both groups. The results indicate that this fracture is associated with anterior notching of the femoral cortex and preexisting neurologic disorders. Patients with a supracondylar fracture following prosthetic knee arthroplasty are best managed by secure internal fixation and early motion.     

153例儿童肱骨髁上骨折的治疗体会

目的探讨儿童肱骨髁上骨折的治疗效果。方法我科自1995年3月至2005年3月对153例肱骨髁上骨折患儿应用手法复位、牵引、小夹板或石膏托固定、手术治疗,随访0.5～5年。结果失访4例,优142例,占95.3%,良7例,占4.7%,愈合时间平均4.5周。结论手法复位、尺骨鹰嘴骨牵引后复位并小夹板或石膏托超肘关节外固定是治疗小儿肱骨髁上骨折较好的方法。     

Supracondylar fractures of the humerus in children: analysis of the results in 142 patients

One hundred forty-two children who had supracondylar humerus fractures and who were treated either by open reduction and internal fixation or by closed methods were reviewed. There were 104 boys and 38 girls. Their ages ranged between 2 and 14 years, with an average age of 8 years. One hundred thirteen of the fractures were of the extension type and 29 were of the flexion type. Sixty-two patients were treated by manipulative reduction and immobilization in a plaster of Paris cast, and 20 were treated by overhead skeletal traction followed by the application of a plaster of Paris cast. The other 60 patients were treated by open reduction and internal fixation. The follow-up period ranged from 4 years to 11 years, with an average of 7.5 years. The results were evaluated based on the range of motion, the subsequent deformity, if any, and the carrying angle. In the overall series we had 72 (50.70%) excellent, 31 (21.83%) good, 13 (9.15%) fair, and 26 (18.30%) poor results.     

The floating knee in the pediatric patient. Nonoperative versus operative stabilization

The results of nonoperative and operative or rigid stabilization of ipsilateral femur and tibia fractures in children and adolescents were evaluated. Twenty-nine consecutive patients with open physes (30 affected extremities) were reviewed. Their mean followup was 8.6 years (range, 1.1-18.6 years). The nonoperative group consisted of 16 patients and 16 extremities treated by skeletal traction of the femoral fracture, closed reduction and splinting or casting of the tibia fractures, and eventual immobilization in a hip spica cast. The operative group, was comprised of 13 patients and 14 extremities in which one or both fractures were treated by open reduction and internal fixation, intramedullary fixation, or external fixation. Despite higher modified injury severity scores and skeletal injury scores, the patients who were treated operatively had a significantly reduced hospital stay, 20.1 days versus 34.9 days, respectively; decreased time to unsupported weightbearing, 16.8 weeks compared with 22.3 weeks, respectively; and fewer complications. Operative stabilization of the femur had a significant effect on decreasing the length of hospital stay and the time to unassisted weightbearing. The patients also were analyzed according to their age at the time of injury: 9 years of age or younger and 10 years of age and older. The younger children who were treated nonoperatively had an increased rate of lower extremity length discrepancy, angular malunion, and need for a secondary surgical procedure as compared with younger children who were treated operatively with rigid fixation. Based on the results of the current study, operative stabilization of at least the femur fracture and, preferably, both fractures in the treatment of a child with a floating knee is recommended, even for younger children.     

Intramedullary nailing with reaming to treat non-union of the tibia

The records of fifty-one patients who were treated by intramedullary nailing with reaming for non-union of the tibia were retrospectively reviewed. The fractures had been treated initially by closed reduction and immobilization in a cast, external fixation followed by immobilization in a cast, fixation by pins incorporated in a plaster cast, minimum internal fixation and immobilization in a cast, dynamic compression plating, or intramedullary nailing with or without reaming. After the initial treatment had failed, intramedullary nailing with reaming was done to gain union. Although closed nailing of the tibia was preferred, in thirty-three patients, the site of the non-union was opened to improve alignment by performing an osteotomy or to remove failed hardware. Bone grafts from the iliac crest were used in ten patients, and a fibular ostectomy or osteotomy was done in thirty-three. Of thirty-four open fractures (fourteen grade I, seven grade II, and thirteen grade III), eight were infected at the time of intramedullary nailing. The average time of the diagnosis of a non-union was 9.6 months; the average length of follow-up after nailing was twenty months. In forty-nine (96 per cent) of the fifty-one patients, tibial union occurred at an average of seven months postoperatively. Complications included persistent infection (three patients), acquired infection after intramedullary nailing with reaming (three patients), fracture of the nail that necessitated an additional operation (two patients), shortening of more than one centimeter (two patients), malrotation of more than 15 degrees (one patient), peroneal palsy (one patient), and amputation (one patient). When used to treat non-union of the tibia, intramedullary nailing with reaming can produce union as effectively as other alternatives, while enabling the patient to function more normally without external immobilization or walking aids.     

Management of displaced extension-type supracondylar fractures of the humerus in children

The cases of 230 patients who had a displaced extension-type supracondylar fracture of the humerus were reviewed retrospectively. The results of treatment by four different methods were assessed clinically and compared. The mean length of follow-up was 4.6 years (range, one to nine years). The highest percentages of excellent results were achieved by percutaneous Kirschner-wire fixation (78 per cent), skeletal traction (67 per cent), and open reduction with internal fixation (67 per cent). Closed reduction and application of a cast was associated with a significantly lower percentage of early and late complications, including Volkmann ischemic contracture and cubitus varus. It is recommended that treatment with a cast be reserved for undisplaced fractures only. Percutaneous Kirschner-wire fixation is advocated as the method of choice for the majority of displaced fractures.     

Non-union of fractures of the distal end of the humerus

The records of twenty patients who had been treated for a non-union of the distal end of the humerus at the Massachusetts General Hospital from 1968 to 1984 were reviewed. Thirteen of the fractures were extra-articular and seven were intra-articular. Seven fractures had been open and nine had been associated with multiple trauma. Eight had been initially treated by open reduction and internal fixation; five, by closed reduction and immobilization; four, by skeletal traction; two, by external fixation; and one, by débridement and immobilization. The average time from the original fracture to the treatment of the non-union was twenty months (range, three to 120 months). All but one patient had pain and instability, and fifteen (75 per cent) had limited motion of the elbow. Radiographically, eleven were considered to have a reactive non-union and nine, a non-reactive non-union. Seventeen (94 per cent) of the eighteen non-unions ultimately united. Two patients underwent excision of the distal end of the humerus and replacement with an allograft. At follow-up (average, 3.6 years), function in one patient was rated as excellent; in six, as good; in seven, as fair; and in six, as poor. The patients who had an extra-articular supracondylar non-union had the best over-all results, while those who had a non-union that was associated with an intra-articular component or severe soft-tissue trauma did less well. It should be emphasized, however, that most of the patients in this study continued to have a major long-term disability, despite the fact that union was successful.     

Treatment of physeal fractures in children]

The aim of the study was to determine final clinical and radiological results of epiphyseal fractures treated in our hospital. Thirty-five patients were included in the study (6 girls and 29 boys) aged from 5 to 17 years (mean 12.1 years). Follow up ranged from 2 to 20 years. According to Salter and Harris classification system 15 patients had type I and 20 had type II fracture. According to the Neer-Horowitz classification system of the proximal end of humerus one patient had grade III and three had grade IV fracture. Physeal fractures included: proximal end of humerus (n = 4), distal end of radius (n = 16) (with coexistent distal end of ulna fractures in 6 cases), distal end of femur (n = 4), distal end of tibia (n = 3) and distal end fibula (n = 8). Six patients were treated with open reduction and K-wire fixation, three with skeletal traction and cast, one with closed reduction and K-wire fixation and twenty five with closed reduction and cast. Neurovascular deficit was noted in any of our patients at admission and after reduction. During follow-up we did not notice physeal arrest, changes in limbs axis or limb shortening in any of our patients. All our patients had good clinical results. In 2 cases in early postoperative follow-up limitation of shoulder abduction after physeal fracture of proximal humerus was observed. Restoration of proper anatomical conditions is conducive to restore function of growth plate. Kirschner wire fixation did not increase the risk of growth arrest. Physeal injuries at the end of growth did not cause limb axis changes.     

Long-term results of treatment of fractures of the medial humeral epicondyle in children

BACKGROUND: The treatment of isolated, displaced fractures of the medial humeral epicondyle in children is controversial. Both plaster cast immobilization without reduction and open reduction and internal fixation have been advocated. The purpose of this long-term retrospective study was to analyze the functional and radiographic results of both nonsurgical and surgical management of these injuries. METHODS: Forty-two patients who had had an isolated fracture of the medial humeral epicondyle with displacement of >5 mm at an average age of twelve years (range, eight to fifteen years) were evaluated at an average age of forty-five years (range, thirty to sixty-one years). The patients were divided into three groups that were comparable with regard to the amount of fracture displacement, age at the time of the fracture, age at the time of follow-up, sports activities and occupation, and duration of follow-up. In Group I (nineteen patients), the fracture had been treated with a long-arm plaster cast without reduction of the displaced medial epicondyle. In Group II (seventeen patients), open reduction and internal fixation with either Kirschner wires or a T-nail had been performed. In Group III (six patients), the epicondylar fragment had been excised with suture reattachment of the tendons and the medial collateral ligament. RESULTS: According to a functional grading scale, there were sixteen good and three fair results in Group I. All but two patients were seen to have nonunion of the fragment on follow-up radiographs, but all had a normal result on valgus stress-testing of the elbow. The range of motion of the elbow was either normal or minimally decreased, and the grip strength of the ipsilateral hand was normal. There were fifteen good and two fair results in Group II. All patients had union of the medial epicondyle, with various radiographic deformities of the medial epicondyle, but the functional results were similar to those of the Group-I patients. The Group-III patients had four poor and two fair results. Four had constant pain at the elbow and paresthesias in the distribution of the ulnar nerve. One patient had a restricted range of motion of the elbow, four patients had an unstable elbow, and three patients had decreased grip strength of the ipsilateral hand. CONCLUSIONS: In our study, nonsurgical treatment of isolated fractures of the medial humeral epicondyle with between 5 and 15 mm of displacement yielded good long-term results similar to those obtained with open reduction and internal fixation. The nonunion of the epicondylar fragment that was present in most patients who had been treated only with a cast did not adversely affect the functional results. Surgical excision of the medial epicondylar fragment should be avoided because the long-term results are poor.     

Salter-Harris type II fractures of the capital femoral epiphysis

Salter-Harris type II fractures of the capital femoral epiphysis have not been previously documented. The authors have treated three patients who sustained four such fractures. One child had a recurrent fracture two years after the first had healed satisfactorily. Two fractures were treated by spica cast immobilization, one fracture by closed reduction and internal fixation, and the other fracture healed without treatment. No patient developed avascular necrosis or other complications. Two of the children had an association with idiopathic slipped capital femoral epiphysis. An etiologic relationship with slipped capital femoral epiphysis, if any, is uncertain.     

Cementless acetabular reconstruction after acetabular fracture.

BACKGROUND: Total hip arthroplasty in patients with posttraumatic arthritis has produced results inferior to those in patients with nontraumatic arthritis. The use of cementless acetabular reconstruction, however, has not been extensively studied in this clinical context. Our purpose was to compare the intermediate-term results of total hip arthroplasty with a cementless acetabular component in patients with posttraumatic arthritis with those of the same procedure in patients with nontraumatic arthritis. We also compared the results of arthroplasty in patients who had had prior operative treatment of their acetabular fracture with those in patients who had had prior closed treatment of their acetabular fracture. METHODS: Thirty total hip arthroplasties were performed with use of a cementless hemispheric, fiber-metal-mesh-coated acetabular component for the treatment of posttraumatic osteoarthritis after acetabular fracture. The median interval between the fracture and the arthroplasty was thirty-seven months (range, eight to 444 months). The average age at the time of the arthroplasty was fifty-one years (range, twenty-six to eighty-six years), and the average duration of follow-up was sixty-three months (range, twenty-four to 140 months). Fifteen patients had had prior open reduction and internal fixation of their acetabular fracture (open-reduction group), and fifteen patients had had closed treatment of the acetabular fracture (closed-treatment group). The results of these thirty hip reconstructions were compared with the intermediate-term results of 204 consecutive primary total hip arthroplasties with cementless acetabular reconstruction in patients with nontraumatic arthritis. RESULTS: Operative time (p < 0.001), blood loss (p < 0.001), and perioperative transfusion requirements (p < 0.001) were greater in the patients with posttraumatic arthritis than they were in the patients with nontraumatic arthritis. Of the patients with posttraumatic arthritis, those who had had open reduction and internal fixation of their acetabular fracture had a significantly longer index procedure (p = 0.01), greater blood loss (p = 0.008), and a higher transfusion requirement (p = 0.049) than those in whom the fracture had been treated by closed methods. Eight of the fifteen patients with a previous open reduction and internal fixation required an elevated acetabular liner compared with one of the fifteen patients who had been treated by closed means (p = 0.005). Two of the fifteen patients with a previous open reduction and internal fixation required bone-grafting of acetabular defects compared with seven of the fifteen patients treated by closed means (p = 0.04). The thirty patients treated for posttraumatic arthritis had an average preoperative Harris hip score of 41 points, which increased to 88 points at the time of follow-up; there was no significant difference between the open-reduction and closed-treatment groups (p = 0.39). Twenty-seven patients (90%) had a good or excellent result. There were no dislocations or deep infections. The Kaplan-Meier ten-year survival rate, with revision or radiographic loosening as the end point, was 97%. These results were similar to those of the patients who underwent primary total hip arthroplasty for nontraumatic arthritis. CONCLUSIONS: The intermediate-term clinical results of total hip arthroplasty with cementless acetabular reconstruction for posttraumatic osteoarthritis after acetabular fracture were similar to those after the same procedure for nontraumatic arthritis, regardless of whether the acetabular fracture had been internally fixed initially. However, total hip arthroplasty after acetabular fracture was a longer procedure with greater blood loss, especially in patients with previous open reduction and internal fixation. Previous open reduction and internal fixation predisposed the hip to more intraoperative instability but less bone deficiency.     

三种固定方法治疗儿童肱骨髁上骨折的临床对照试验

目的:探讨不同固定方法治疗儿童移位肱骨髁上骨折临床疗效及其临床适应证。方法:137例儿童移位肱骨髁上骨折患者,男85例,女52例;年龄3~12岁。分别采用交叉克氏针内固定(A组)38例,小夹板外固定(B组)67例,石膏托外固定(C组)32例。观察3组骨折愈合时间、肘内翻的发生率及肘关节伸屈功能并进行比较。结果:本组随访6个月~5年,平均29个月,参照Flynn疗效评价标准:A组,优29例,良7例,差2例,优良率为94.74%;B组,优12例,良49例,差6例,优良率为91.04%;C组,优9例,良16例,差7例,优良率为78.13%。A组疗效分别与B、C组比较,差异有统计学意义(P<0.05);B组与C组疗效比较,差异无统计学意义(P>0.05)。结论:三种固定方法以闭合克氏针固定疗效最佳,但三种固定方法各有其适应证:对无移位或轻度移位的肱骨髁上骨折可采用石膏托固定或小夹板固定;对严重移位或旋转,极不稳定型骨折可采用闭合交叉克氏针穿针固定或小夹板固定。临床应根据骨折类型、皮肤条件以及是否合并有神经血管损伤来合理选择最佳治疗方案。     

Open Gustilo 1 and 2 midshaft fractures of the radius and ulna in children: is there a role for cast immobilization after wound debridement?

INTRODUCTION: Open fractures of the forearm in children are one of the indications for open reduction and internal fixation. Fixation allows for soft tissue management and maintenance of reduction. This study compares the outcome of open Gustilo 1 and 2 midshaft forearm fractures treated with cast immobilization versus the outcome of those treated with internal fixation after wound debridement. METHODS: This is a retrospective study of the cases of 31 children treated in Kandang Kerbau Women's and Children's Hospital from 1998 to 2005. All had wound debridement, followed by cast immobilization in 15 patients and implant stabilization in 16 others, using plates and screws or intramedullary K-wires. The patients were assessed at final follow-up using the classification by Price. RESULTS: Both treatment groups had 100% excellent or good results. There was no significant difference in time to union. However, there was a higher incidence rate of delayed union and infection when treated with implant stabilization. The main complication associated with cast immobilization was loss of reduction (4 cases), of which 1 case required a second manipulation. DISCUSSION: Despite the trend toward implant stabilization of all open forearm fractures, this study shows that there is still a role for cast immobilization in its treatment of Gustilo 1 and 2 open forearm fractures as long as proper casting technique and close follow-up is achieved. However, internal fixation should be considered in cases where the fracture is noted intraoperatively to be unstable or if attempted reduction fails, bearing in mind the possible complications associated with internal fixation.     

Treatment of femoral fracture above a knee prosthesis: 18 cases followed 0.5-14 years

We reviewed 16 patients who sustained 18 fractures above a total knee prosthesis. 5 fractures were undisplaced and were treated with either skeletal traction or a plaster cylinder. 3 did well, 1 patient suffered a cerebral vascular accident while still in plaster and 1 patient died of heart failure while on skeletal traction. 7 displaced fractures were treated initially with skeletal traction. 1 patient had a nonunion of the fracture and 2 a malunion and malfunction of the knee. 4 underwent various operations later because of malalignment and nonunion of the fracture with poor functional results. 6 displaced fractures were treated with immediate internal fixation. 5 recovered well and returned to pre-fracture activities. 1 patient's plate broke and further surgery was needed.

We conclude that displaced fractures above a knee prosthesis should be treated with immediate stable internal fixation and early mobilization. Nonoperative treatment was satisfactory only for minor undisplaced fractures.     

Acute tibial tubercle avulsion fractures

A retrospective analysis of 18 patients with 19 acute tibial tubercle avulsion fractures was performed. Mean age at injury was 13 years 8 months. Mean follow-up time was 2 years 8 months. A group of four preadolescent patients ages 9 to 12 years at injury was identified. Participation in athletics, particularly basketball, resulted in 77% of fractures. There were one type IA, three type IB, two type IIA, six type IIB, two type IIIA, four type IIIB, and one type IV fractures. Fifteen fractures were treated with open reduction and internal fixation and four by closed reduction and cylinder cast immobilization. Three cases (15.7%) of extensor mechanism disruption were noted, two patellar tendon avulsions and one quadriceps avulsion. Final outcome was good in all patients regardless of fracture type or treatment. There were no complications.     

Clinical significance and treatment concept of Lisfranc dislocation and dislocation fracture

Dislocations and fracture dislocations of the tarsometotarsal joint are uncommon (only 30 cases have been treated in our hospital in a 20-year period). The late results of tarsometotarsal injuries in 20 patients have been reviewed. The average follow-up was 3.8 years (range 8 months to 20 years). Methods of treatment were either open (n = 15) or closed (n = 5) reduction with (n = 18) or without (n = 2) internal fixation and cast immobilization (n = 10). Late results clearly correlate with the quality of reduction. An open procedure is usually necessary to achieve anatomical reduction. Diagnostic and operative problems are discussed.     

跖跗关节骨折脱位89例

目的：探讨跖跗关节骨折脱位治疗方法和疗效分析。方法：对89例跖跗关节骨折脱位者根据分型分类法进行闭合复位石膏外固定、切开复位内固定和闭合复位内固定治疗。按跖行、稳定、疼痛、外形和X线五项标准评定临床疗效。结果：随访6个月－3年，平均2年。闭合复位治疗29例，优12例，良13例，差4例，优良率86％。切开复位内固定治疗45例，优24例，良16例，差5例，优良率89％。闭合复位内固定治疗15例，按分型统计取得满意疗效。结论：保守治疗可获得满意疗效，手术较保守治疗并无多大优势。目前应用的分类方法，需进一步完善，对临床治疗和预后判断具有一定的指导作用。     

顺势复位技术微创治疗FraserⅡ型浮膝损伤的疗效

目的探讨顺势复位技术微创治疗FraserⅡ型浮膝损伤的临床疗效。方法回顾性分析2016年11月至2018年7月河北医科大学第三医院创伤急救中心采用顺势复位技术微创治疗的7例FraserⅡ型浮膝损伤患者资料。男5例,女2例;年龄30~82岁,平均52岁;7例患者均为浮膝损伤合并胫骨平台骨折,其中FraserⅡA型(胫骨平台骨折伴有股骨干骨折)5例,ⅡC型(胫骨平台骨折伴有股骨髁骨折)2例。应用顺势双反牵引复位器分别闭合复位股骨及胫骨平台骨折,微创置入内固定物。记录手术时间、单个切口平均长度、失血量、透视次数等数据。随访拍摄患者下肢正、侧位X线片,记录骨折愈合时间;末次随访时采用美国特种外科医院膝关节评分(HSS)评估膝关节功能。结果7例患者手术时间平均为87.2 min,单个切口长度平均为2.8 cm,失血量平均为471 mL,透视次数平均为37次。所有患者术后X线均显示骨折对位及力线良好,关节面平整。7例患者切口均为甲级愈合。7例患者术后随访时间为12~21个月(平均15.6个月),骨折愈合时间平均为12.8周。末次随访时患者HSS评分结果显示:优6例,良1例。结论采用顺势双反牵引复位器可分别闭合复位微创固定股骨侧骨折及胫骨侧骨折,可获得较好的膝关节功能。