切开复位内固定治疗踝关节B、C型骨折

踝关节骨折的AO分型[1] 方法现已被广大学者所接受。B型和C型骨折 ,若早期处理不当 ,则不可避免会导致创伤性关节炎发生。我科自 1996年 7月至 2 0 0 0年 6月 ,共手术治疗踝关节B型、C型骨折4 4例 ,效果满意 ,现报告如下。1　临床资料本组男 31例 ,女 13例 ;年龄 2 4～ 6 3岁 ,平均 36岁 ;右侧 2 8例 ,左侧 16例。 2例为开放性骨折 ,余均为闭合性骨折。致伤原因 :车祸撞跌伤 17例 ,重物压砸伤 6例 ,滑跌伤 2 1例。按Weber Danis分型[1] :B型 2 6例 ,其中伴下胫腓关节分离 12例 ;C型 18例 ,其中伴下胫腓关节分离 17例。2　治疗方法所有病…     

Complications of open reduction and internal fixation of ankle fractures

This article discusses the complications after open reduction and internal fixation of ankle fractures. Complications are classified as perioperative (malreduction, inadequate fixation, and intra-articular penetration of hardware), early postoperative (wound edge dehiscence, necrosis, infection and compartment syndrome), and late (stiffness, distal tibiofibular synostosis, degenerative osteoarthritis, and hardware related complications). Emphasis is placed on preventive measures to avoid such complications.     

关节镜辅助下切开复位内固定治疗踝关节骨折的临床观察

目的：探讨Lauge-HansenⅣ度踝关节骨折关节镜辅助下手术治疗的临床效结果。方法：自2008年1月至2009年12月,对42例踝关节骨折采用关节镜辅助下切开复位内固定治疗。骨折按Lauge-Hansen分类法：旋后外旋型Ⅳ度26例,女11例,男15例,平均年龄（36.8±11.7）岁;旋前外旋型Ⅳ度16例,女6例,男10例,平均年龄（37.6±11.2）岁。所有患者在关节镜辅助下行骨折切开复位内固定,镜下观察韧带及软骨损伤情况,下胫腓联合分离患者行下胫腓联合螺钉固定,软骨损伤按Cheng-Ferkel分期进行治疗。临床疗效采用AOFAS评分系统进行评价。结果：42例均获随访,时间1年。术后AOFAS评分为（92.00±9.32）分,临床疗效优28例,良11例,可3例,其中31例存在不同程度的软骨损伤。无软骨损伤患者的AOFAS评分高于软骨损伤患者,C级以下软骨损伤患者的AOFAS评分高于C级以上软骨损伤患者,无软骨损伤患者的AOFAS评分高于C级以上软骨损伤患者。下胫腓联合固定患者AOFAS评分低于未固定组患者。结论：Lauge-HansenⅣ度踝关节骨折常合并有关节内软骨及周围韧带损伤,其中下胫腓联合损伤及C级以上的软骨损伤是导致踝关节功能恢复欠佳的重要因素,关节镜辅助下切开复位内固定治疗不仅利于关节面的解剖复位,同时可以对合并的软骨和韧带损伤进行更好的诊治,从而提高手术的临床效果。     

Early mobilization of ankle fractures after open reduction and internal fixation

The effect of early mobilization and unrestricted weight bearing on final ankle motion in 51 operatively stabilized ankle fractures was prospectively investigated. Patients were treated with an ankle-foot orthosis (AFO) or a cast. Full weight bearing was unrestricted in both groups. Thirty-two fractures received an AFO and 19 received a cast. The follow-up period ranged from 2.3 to 66 months, with a median of eight months. At the final follow-up examination, the motion in the AFO-treated group was not functionally different from that of the cast-treated group. However, 72% of the patients treated in an AFO compared with 37% of patients treated in a cast had ankle dorsiflexion greater than 15 degrees (p = 0.014). No complications were directly related to the AFO. No loss of reduction occurred in any patient. The results of this series indicate that early motion of a fractured ankle treated operatively does not affect ankle motion. Early motion was not associated with increased morbidity or loss of reduction.     

Complications after open reduction and internal fixation of ankle fractures in the elderly

BackgroundOpen reduction with internal fixation for unstable ankle fractures is relatively predictable with excellent outcomes. However, the management of ankle fractures in the elderly remains less predictable secondary to the various co-morbidities associated with advanced age.MethodsA retrospective chart review of 216 patients over the age of 60 that sustained an ankle fracture, was performed to determine the incidence of complications after ORIF of ankle fractures in an elderly population in the perioperative course. Secondly, the incidence of complications in patients that had locking plate fixation compared to those that had non-locking plate fixation was determined. Lastly, the effect of early weight bearing on the incidence of complications was analyzed.ResultsThere was not a statistically significant difference in the complication rates between the group with co-morbidities (19.01%) and those without (11.96%). The postoperative complication with the highest incidence was wound dehiscence (9.7%), and only diabetes significantly predicted wound dehiscence. The fixation construct and weight-bearing protocol failed to significantly predict any of the indexed complications.ConclusionsOverall, the results suggest that surgical treatment of unstable ankle fractures in the elderly is fairly predictable with an acceptable complication rate. The complication rates are higher with increased age and diabetes, but they failed to reach statistical significance. Conventional plating appears to provide adequate stability without increased risk of hardware failure. In addition patients that were allowed to walk within the first 2 weeks postoperatively did not experience a higher rate of hardware failure.     

后外侧入路切开复位内固定治疗三踝骨折

目的评价采用后外侧入路切开复位内固定治疗三踝骨折的价值。方法自2009-03—2012—06采用后外侧入路切开复位内固定治疗三踝骨折23例,处理外踝骨折时钢板放置于腓骨后侧或外侧,对后踝骨折行钢板或螺钉固定。观察术后切口及骨折愈合情况,术后3、12个月采用AOFAS踝一后足评分标准评价踝关节功能。结果术后3个月23例均获得随访,术后12个月2例失访。术后7d2例外侧和内侧切口周围同时出现张力性水泡．2例外侧切口周围出现张力性水泡,未出现切口感染。1例出现足背外侧麻木,术后3个月复诊时症状消失。术后3个月X线片显示23例骨折线均模糊,AOFAS评分：优12例,良8例,可2例,差1例,优良率86．96％。术后12个月X线片显示骨折线均消失,AOFAS评分：优17例,良2例,可2例,优良率90．48％。结论采用后外侧入路行切开复位内固定术治疗三踝骨折可以一次性复位固定外踝和后踝骨折,联合内侧切口可以一个体位下完成三踝骨折的治疗,对软组织破坏少,骨折可获得解剖复位,术后踝关节功能恢复佳、并发症少。     

Operative costs associated with arthroscopic assisted open reduction and internal fixation of acute ankle fractures

BackgroundAnkle fractures are a common orthopedic injury that frequently involves associated cartilage lesions, soft tissue damage, and a significant inflammatory burden. Despite studies revealing intra-articular pathology in up to 79% of ankle fractures, only 1% of open reduction and internal fixation (ORIF) procedures undergo arthroscopic evaluation. The primary purpose of this study was to determine the cost effectiveness of ankle arthroscopy performed at time of ORIF for ankle fracture.MethodsAn IRB approved retrospective review of patients who sustained ankle fractures and underwent ORIF with and without concomitant arthroscopic surgery between 2015 and 2020 were investigated. Patient demographics, fracture characteristics, outcomes, and cost data were collected and analyzed.ResultsThere were 567 total ORIF and 28 ORIF and scope included for cost analysis purposes. Total surgical costs averaged $6,537.62 and $6,886.46 for the ORIF only and ORIF and scope procedures respectively. Total direct costs, including operating room time, for the same procedures were found to average $6,212.34 and $7,312.10 for the ORIF only and ORIF and scope procedures respectively. The cost difference between the ORIF only and with arthroscopy was not statistically significant (p = 0.1174). Twelve of the 28 arthroscopic patients (42.86%) had grade 3 or full thickness chondral lesions, and 11/28 (39.28%) arthroscopic patients were found to have grade 1–2 cartilage changes.ConclusionIn the acute treatment of ankle fractures, concurrent arthroscopic evaluation does not add a significant cost to the procedure and may result in improved short and long term benefits for the patient. With improved arthroscopic efficiency, the cost differential can be further reduced.LOEIV.     

Delayed open reduction and fixation of ankle fractures

Because of clinical circumstances in the period from 1970-1980, 26 consecutive ankle fractures were treated by delayed (14-31 days after injury) open reduction and internal fixation. Follow-up examination (two to 12 years) was obtained in 25 patients. Based on clinical performance index, outcome was judged satisfactory in 17 patients (68%). Seventeen (68%) had an anatomic reduction, and 15 (88%) of these 17 had a satisfactory result. Compared to a group of 26 similar patients treated within 24 hours after injury, the major effect of delay was an adverse influence on the probability of achieving an anatomic reduction (p less than 0.08). When anatomic reduction was obtained, the performance index in the delayed-treatment group (78.8) was comparable to that in the immediate-treatment group (78.4%). Thus, when immediate fixation is not possible, delayed reduction and fixation of displaced ankle fractures is a reasonable option in some instances and can be seriously considered by the surgeon. Displaced fractures should not be left in a malreduced position because this provides virtually no opportunity for a satisfactory result.     

踝关节骨折切开复位内固定术后踝关节镜手术的临床结果

目的研究踝关节骨折切开复位内固定(ORIF)手术后再次踝关节镜的疗效。 方法回顾性分析2011年1月至2014年12月在解放军第81集团军医院骨科因踝关节骨折ORIF手术后各种原因行踝关节镜手术66例患者,平均年龄(40±13)岁。纳入踝关节骨折ORIF术后因残余痛及其他各种原因行踝关节镜手术的患者,排除炎症性关节炎及下肢神经病变、合并精神疾病者。记录术前、术后4周、6月的疼痛视觉模拟评分(VAS)及美国足踝骨科协会踝－后足(AOFAS)评分,记录并发症及处理方法。组间比较采用单因素ANOVA方差分析。 结果术后早期无关节镜相关并发症发生。术后4周、6月VAS评分比术前显著改善(t＝2.783, P<0.05), AOFAS评分与术前相比明显升高(t＝6.271, P <0.01)。术后4年再次手术率为19.7%。 结论踝关节骨折ORIF手术后因各种原因行踝关节镜手术早期可以减轻疼痛、改善功能,但中期再手术率高。     

切开复位内固定手术治疗66例老年踝关节骨折临床观察

[目的]通过对老年性旋后-外旋型踝关节骨折的手术治疗,分析其疗效,探讨有效手术技巧。[方法]2008年1月²012年12月,依据Lauge-Hansen分型,对66例60岁以上老年旋后-外旋型踝关节骨折患者行切开复位内固定术,其中男20例,女46例;年龄602012年12月,依据Lauge-Hansen分型,对66例60岁以上老年旋后-外旋型踝关节骨折患者行切开复位内固定术,其中男20例,女46例;年龄60⁸9岁,平均67.4岁;旋后-外旋Ⅰ度3例,Ⅱ度8例,Ⅲ度37例,Ⅳ度18例。观察术后骨折愈合和切口愈合及并发症情况,并用美国足踝外科协会(AOFAS)踝与后足评分进行评估。[结果]66例均获随访,随访时间1289岁,平均67.4岁;旋后-外旋Ⅰ度3例,Ⅱ度8例,Ⅲ度37例,Ⅳ度18例。观察术后骨折愈合和切口愈合及并发症情况,并用美国足踝外科协会(AOFAS)踝与后足评分进行评估。[结果]66例均获随访,随访时间12³6个月,平均20个月。伤口延迟愈合9例;2例轻度腓骨肌腱疼痛;1例内踝骨折延迟愈合;无深部感染、内固定松动、断裂发生;AOFAS疼痛评分(34.3±5.1)分,功能活动评分(41.4±6.9)分,后足排列(10.0±0.0)分,总分(83.6±6.3)分。[结论]手术治疗老年性旋后-外旋型踝关节骨折的并发症少,是治疗的首选。但因骨质疏松、软组织条件差,手术难度增大。提高手术技巧,在确切固定的基础上尽量简化手术过程更为可行。     

开放性踝关节骨折内固定术后并发症的防治

自 1995 - 2 0 0 0年间我院 182例开放性踝关节骨折行不同方法内固定 ,发生多种并发症 35例报告如下。1　临床资料男 30例 ,女 5例 ;年龄 2 1～ 6 1岁 ,平均 4 3 5岁。发病原因 :车祸伤 12例、坠落伤 18例、挤压伤 5例。骨折类型 (Danis weber) :A型 3例、B型 8例、C型 2 4例。软组织损伤情况按朱通伯分度[1] :Ⅰ度开放 5例 ,Ⅱ度开放 2 1例 ,Ⅲ度开放 9例。其中伴内踝骨折18例 ,外踝骨折 30例 ,后踝骨折 8例。2　治疗方法伤口彻底清创 ,内踝 :1枚螺钉固定 10例 ,2枚螺钉固定 5例 ,张力钢丝固定 3例 ;后踝 :骨折 1枚螺钉固定 2例 ,2枚螺钉…     

Three-dimensional printing combined with open reduction and internal fixation versus open reduction and internal fixation in the treatment of acetabular fractures: A systematic review and meta-analysis

Purpose: This meta-analysis compared the clinical outcome of three-dimensional (3D) printing combined with open reduction and internal fixation (ORIF) to traditional ORIF in the treatment of acetabular fractures.Methods: We searched the Cochrane Library, PubMed, Embase, VIP database, CNKI, and Wanfang database with keywords “acetabular fracture”, “3D printing”, “three-dimensional printing”, “open reduction and internal fixation”, “Acetabulum”, “Acetabula” from January 2000 to March 2020. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’s tools and/or NewcastleeOttawa scale. When the two analysts had different opinions, they would ask the third analyst for opinion. Randomized controlled trials or retrospective comparative studies of 3D printing combined with ORIF (3D printing group) versus traditional ORIF (conventional group) in the treatment of acetabular fractures were selected. The data of operation time, intraoperative blood loss, intraoperative fluoroscopy times, incidence of complications, excellent and good rate of Matta score for reduction, and excellent and good rate of hip function score were extracted. Stata14.0 statistical software was used for data analysis.Results: Altogether 9 articles were selected, including 5 randomized controlled trials and 4 retrospective studies. A total of 467 patients were analyzed, 250 in the conventional group, and 217 in the 3D printing group. The operation time in the 3D printing group was less than that in the conventional group and the difference was statistically significant (standardized mean difference (SMD) = 1.19, 95% CI: 1.55 to 0.82, p < 0.05). The intraoperative bleeding volume of the 3D printing group was significantly lower than that of the conventional group (SMD = 1.08, 95% CI: 1.65 to 0.51, p < 0.05). The fluoroscopy times were less in the 3D printing group than in the conventional group and the difference was statistically significant (SMD = 1.64, 95% CI: 2.35 to 0.93, p < 0.05). The total incidence of complications in the 3D printing group was significantly lower than that in the conventional group (OR = 0.43, 95% CI: 0.24-0.79, p < 0.05). There was no significant difference in the excellent and good rate of Matta score for reduction between the two groups (OR = 0.60, 95% CI: 0.34-1.06, p > 0.05). There was no significant difference in the excellent and good rate of hip function score at the end of postoperative follow-up between the two groups (OR = 0.84, 95% CI: 0.46-1.56, p > 0.05), but the follow-up time varies from 6 months to 40 months.Conclusion: Compared with traditional ORIF, 3D printing combined with ORIF has certain advantages in terms that 3D printing not only helps surgeons to understand acetabular fractures more intuitively, but also effectively reduces operation time, intraoperative blood loss, intraoperative fluoroscopy times, and postoperative complications. However, there were no significant differences in the excellent and good rate of Matta score for reduction and the excellent and good rate of hip function score at the end of follow-up.     

Factors influencing functional outcomes following open reduction internal fixation of acetabular fractures

IntroductionRecent large series of patient-reported outcomes after acetabulum fracture are limited, and potentially modifiable risk factors may be unidentified. The goal of this study was to describe patient and injury factors which negatively influence functional outcomes following operative management of acetabular fractures.Methods699 patients with acetabular fractures were treated with open reduction and internal fixation (ORIF). Musculoskeletal Function Assessment (MFA) questionnaire was completed after a minimum 12 months post-injury by 283 adults. MFA scores range from 1 to 100 and higher scores represent greater dysfunction. Factors were assessed for potential association with MFA scores, and univariate and multiple linear regression analyses were performed.ResultsSurvey respondents were more severely injured than non-respondents, with more chest injury (38% vs 22%, p<0.001) and higher Injury Severity Score (19.3 vs 16.8, p=0.003). Patients were 69% male with mean age 44.0 years. Approximately one-third were smokers (31%), while 14% had comorbid diabetes mellitus type II. The majority of injuries occurred during a motor vehicle collision (65%); low-energy mechanisms were rare (4.2%). The most common fracture pattern was isolated posterior wall (23%), followed by transverse/posterior wall (21%). Heterotopic ossification (HO) was noted in 22%: Brooker 1: 29.5%, 2: 23.0%, 3: 32.8%, and 4: 14.8%. Tobacco use (β = 18.4, p<0.001), obesity (β = 0.39, p=0.009), diabetes (β = 8.2, p=0.029), post-traumatic arthrosis (PTA) (β = 5.94 p=0.035), and increasing HO severity (β = 8.93, p<0.001) were independently associated with worse MFA scores. Tobacco use had the strongest association, followed by the severity of HO.ConclusionIn a large series of patient-reported functional outcomes following fixation of acetabular fractures, tobacco use, obesity, comorbid diabetes, PTA, and HO were associated with worse MFA scores. Further study to mitigate HO should be considered.Level of EvidenceIII     

Midshaft metatarsal segmental osteotomy with open reduction and internal fixation

BACKGROUND: Metatarsalgia is a common source of patient discomfort and has multiple etiologies. Lesser metatarsal osteotomy is a recognized treatment modality for persistent symptoms after conservative care, yet the location and type of osteotomy remain highly debated topics. The current investigation reports the initial results regarding midshaft, segmental osteotomy of the lesser metatarsals with open reduction and internal fixation. METHODS: Ninety-five consecutive patients had lesser metatarsal midshaft, segmental osteotomy with open reduction and internal fixation from June, 1999, to October, 2001, representing 102 feet and 126 osteotomies. Patient records were retrospectively reviewed for osteotomy union, symptomatic relief, and complications associated with this procedure. Followup ranged from 5 months to 18 months with an average of 8.8 months. Fixation was achieved with a four-hole, 1/4-tubular, minifragment, plate and four 2.7-mm cortical screws. RESULTS: Five patients had transfer lesions, (five feet, five osteotomies) within the followup period. One patient (one foot, one osteotomy, 0.8%) developed a nonunion. After hardware removal this patient's osteotomy united. This technique produced excellent metatarsal union rates (125 of 126 osteotomies, 99.2%). CONCLUSIONS: Although further clinical investigation regarding patient outcome from this procedure needs to be carried out, the data from this preliminary study indicate that midshaft segmental osteotomy of a lesser metatarsal is a useful technique for metatarsal shortening with a high rate of bony union.     

Open reduction of lateral ankle fractures and internal fixation with the gripper plate

Surgical Principles Internal fixation and stabilization of lateral malleolus fractures of Type A and B according to Weber are achieved with a contoured plate adapting to the anatomical configuration of that bone even in the presence of osteoporosis. Revised Version from: Operat. Orthop. Traumatol. 5 (1993), 16–23 (German Edition).     

关节镜辅助复位内固定与切开复位内固定治疗胫骨平台骨折的疗效比较

目的:比较关节镜辅助复位内固定（ARIF）和切开复位内固定（ORIF）治疗胫骨平台骨折的疗效。方法:回顾性分析2016年1月至2018年8月华中科技大学附属协和医院骨科收治的75例胫骨平台骨折患者的资料。男58例,女17例;年龄20~54岁,平均47岁。左侧42例,右侧33例。骨折根据Schatzker分型：Ⅰ型23例...