Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

European Journal of Orthopaedic Surgery & Traumatology - The purpose of this study was to evaluate the clinical and functional outcomes of failed plate fixation in distal tibia fractures...     

骨外固定架结合锁定钢板治疗胫骨开放骨折

2006年7月~2012年7月,我们对28例小腿软组织条件较差的胫骨开放骨折患者早期采用外固定支架固定,待皮肤软组织条件稳定后,采用微创锁定钢板固定治疗,获得良好疗效. 1 材料与方法 1.1 病例资料本组28例,男18例,女10例,年龄18~65岁.均为Ⅱ~Ⅲ度开放骨折,中上1/3段6例,中1/3段10例,中下1/3段12例.     

AO纯钛带锁钢板在颈椎前路固定的初步报告

报告了对１５例颈椎疾患患者行颈前路减压植骨融合并采用ＡＯ颈椎纯钛带锁钢板固定。经６个月～８．２个月的随访，所有病例植骨均完全愈合，无一例发生钢板螺钉松动等并发症。颈椎带锁钢板可使固定节段有高度的内在稳定性，并具有操作简便、安全、并发症少、内固定材料生物相容性良好、无磁性等优点，尤其适用于颈椎外伤、肿瘤及退行性变的治疗。     

Esophageal perforation after anterior cervical plate fixation: a report of two cases.

We report two cases of esophageal complications due to migration of screws after anterior plate fixation of the cervical spine. Close observation for screw back out is needed, particularly in those patients with associated neurologic deficits or osteoporosis.     

Application of locking plate in long-bone atrophic nonunion following external fixation

The treatment of atrophic fracture nonunion continues to represent a therapeutic challenge. Large segmental osteopenia is often seen in patients who received uniplanar or hybrid external fixators as the definitive method of fixation for high-energy fractures, and this adds more difficulties to the treatment of fracture nonunion. This retrospective study was designed to assess the outcome of locking compression plating with autologous bone grafting in patients with long-bone atrophic nonunion following external fixation.From January 2004 to December 2009, a series of consecutive patients with atrophic nonunion of the long bone following external fixation were treated with this method in our institution. The clinical outcomes and complications of these patients were retrospectively analyzed. Twenty-seven patients with 28 fracture nonunions were involved in this study. Mean follow-up was 14.2±3.4 months. Bony union was achieved in all 27 patients within a mean 18.6±4.8 weeks after revision surgery. Two patients developed superficial wound infections. No deep infections were found, and no implant failure was seen. Three patients reported minor pain in the donor site of the bone graft, and no other donor site complications were found.Revision osteosynthesis of long-bone atrophic nonunion following external fixation by locking compression plating with autologous iliac crest bone grafting represents a safe and efficacious modality for the treatment of these challenging conditions.     

Distal tibial fracture: An ideal indication for external fixation using locking plate

Objective: To evaluate the feasibility and efficiency of one-stage external fixation by using locking plate in distal tibial fractures. Methods: In this non-control prospective study, 28 patients with distal tibial fractures were included and underwent one-stage external fixation by using locking plate. There were 21 males and 7 females, with a mean age of 43 years (19-63). According to AO/OTA fracture classification, there were 9 cases of Type A1, 9 of Type A2, 10 of Type A3 fractures. There were 21 close and 7 open fractures. The locking plate was placed on the anteromedial aspect of the tibia with 4e5 bicortical screws inserted in both distal metaphysis and diaphysis. The radiographic and clinic results were evaluated. Results: All patients were followed up for the average of 16 months (ranging from 12 to 21 months). The average surgery duration was 38 (25-60) minutes. The mean time to fracture healing were 14.6±2.67, 17.5 ± 3.66, and 18.4±3.37 (p<0.05) weeks in type A1, A2, and A3 fractures respectively. By the end of the follow-ups, the mean AOFAS score were 96.11±2.32, 92.67±1.80 and 92.00±2.06 (p>0.05) in type A1, A2, and A3 fractures respectively. None of nonunion, deep infection, or breakage of screw or plate were observed. Conclusions: Distal tibial fracture was the ideal indication for external fixation using locking plate. The external plating is characterized by ease of performance, less invasive, fewer soft tissue impingement, improved cosmesis, and convenient for removal.     

Correction outcomes of the postoperative malalignment salvaged by the temporary application of the hexapod external fixator in tibial diaphyseal fractures treated by monolateral external fixation

BackgroundPostoperative malalignment in fractures treated by monolateral external fixation is not uncommon in clinical practice. Accurate reduction without excessive tissue disruption caused by surgical intervention and sequentially manage the fractures using monolateral external fixation for definitive treatment is still a challenge for surgeons. The purpose of our study was to evaluate the feasibility and effectiveness of the temporary application of the hexapod external fixator (HEF) for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation.MethodsWe carried out a retrospective analysis of 23 trauma patients with tibial diaphyseal fracture treated by the monolateral external fixation at our institution from January 2016 to May 2019. There were 21 males and 2 females with a mean age of 38 years (range 18-60 years). The hexapod external fixator was temporarily applied due to postoperative malalignment within two weeks and who unwilling to undergo a secondary surgical intervention. For patients with postoperative malalignment requiring correction, the HEF components were installed on the original existing half pins of the monolateral external fixator after removing the connecting rod. The standard anteroposterior and lateral X-rays of the injured limb combined with the temporary HEF were conducted to measure the hexapod external fixator parameters. Any residual deformities were corrected by gradual struts adjustment with the aid of computer-based software. When satisfactory alignment was achieved, the HEF was removed, and the monolateral external fixator was sequentially used as the definitive structure.ResultsAll patients acquired functional reduction, which was evaluated by radiographs. The mean correction time was 4 days (range 2 to 8 days). The mean coronal plane translation (1.3±1.0 mm), coronal plane angulation (0.9±0.7°), sagittal plane translation (1.4±1.1 mm), and sagittal plane angulation (0.7±0.7°) after correction were all less than those (7.0±4.9 mm, 4.7±2.3°, 5.6±3.6 mm, 3.2±2.5°) before correction.ConclusionsThe temporary application of the hexapod external fixator is an alternative and feasible method for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation.     

Knee arthrodesis with circular external fixation

Knee arthrodesis can enable limb salvage in patients with disability secondary to trauma, infected total knee arthroplasty, pyarthrosis, and other complications. Historically, intramedullary nailing has resulted in the highest overall knee fusion rates. However, intramedullary nailing is relatively contraindicated in the presence of active infection. Nineteen patients who underwent knee arthrodesis with circular external fixation were studied retrospectively. Postoperative radiographs were evaluated for evidence of bony fusion, which was defined as trabecular bridging between the femur and tibia. Patients were interviewed and graded using the functional assessment portion of the Knee Society clinical rating system. Fusion was successful in 13 of 19 (68%) patients. Overall, patients spent an average of 4 months 8 days wearing the circular external fixator. Average time to radiographic and clinical evidence of arthrodesis (defined as lack of motion across the fusion site) was 4 months 18 days. No patient with successful fusion considered himself or herself housebound. All but one of these patients require some form of assistive device for ambulation. Complications occurred in 16 of 19 (84%) patients overall. Superficial pin tract infection (55%) and nonunion (32%) were the most common. Circular external fixation is an effective method for obtaining knee arthrodesis in patients who are not good candidates for intramedullary nailing.     

Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis

The aim of this study was to compare bridging external fixation with volar locked plating in patients with unstable distal radial fractures regarding functional outcome. A systematic search was performed in the Cochrane Central Register of Controlled Trials, Medline and EMBASE. All randomized controlled trials that compared bridging external fixation directly with volar locked plating in patients with distal radial fractures were considered. Three reviewers extracted data independently from eligible studies using a data collection form. Studies in which the primary endpoint was measured on the disabilities of the arm shoulder and hand (DASH) score at 3, 6 and 12 months were included in the analysis. To this end, mean scores and standard deviations were extracted. The software package Revman 5 provided by the Cochrane Collaboration was used for data analysis. Three studies involving 174 patients were analyzed. Ninety patients were treated with an (augmented) bridging external fixator and 84 with a volar locking plate. Data were analyzed with the random effects model. The robustness of the results was explored using a sensitivity analysis. Patients treated with a volar locking plate showed significantly lower DASH scores at all times. A difference of 16 (p = 0.006), six (p = 0.008) and eight points (p = 0.06) was found at 3, 6 and 12 months follow-up, respectively. Patients treated with a volar locking plate showed significantly better functional outcome throughout the entire follow-up. However, this difference was only clinically relevant during the early postoperative period (3 months).     

锁定钢板用于胫骨远端骨折外固定的有限元分析

目的探讨锁定钢板用于胫骨远端骨折外固定的生物力学特性。方法利用三维有限元技术,创建胫骨远端骨折锁定钢板外固定模型。将股骨LISS钢板放置于胫骨前内侧,钢板与骨面距离设定为1、10、20、30 mm 4个组,在骨折远近端各锁定4枚双皮质螺钉。对骨折固定模型分别施加垂直负荷及旋转外力,观察在不同外力作用下,骨折固定模型的稳定性变化。结果骨折固定模型的稳定性随着钢板与骨面距离的增加而下降。在单一垂直载荷下,30 mm组的刚度接近正常胫骨,1、10、20 mm组的刚度高于正常胫骨。在垂直及内旋载荷下,1 mm和10 mm组的刚度接近正常胫骨,20 mm和30 mm组的刚度低于正常胫骨。在垂直及外旋载荷下,4组的刚度均低于正常胫骨。钢板峰值应力集中在最靠远端的2枚螺钉,在10 mm组最高,在1 mm组最低。结论采用锁定钢板外固定胫骨远端骨折时,为了获得良好的稳定性,钢板与骨面的距离宜保持在30 mm以内。在完全负重站立位时,要避免旋转动作,以降低固定失败的风险。     

外固定支架与锁定加压钢板治疗桡骨远端关节内骨折的比较研究

[目的]比较外固定支架与锁定加压钢板在治疗桡骨远端关节内骨折的疗效。[方法]自2006年5月~2008年9月收治62例桡骨远端关节内骨折,外固定支架组27例,锁定钢板组35例。外固定支架手术在必要时可作小切口行有限内固定,锁定钢板组根据骨折块位置采用掌侧或背侧入路。[结果]62例患者随访时间13~40个月,平均17个月。两组术后1年腕关节Sarmiento[2]标准评定的优良率和腕关节活动范围无统计学差异,外固定支架组术后1年握力的恢复显著优于锁定钢板组。外固定支架组出现2例钉道感染,锁定钢板组有1例发生肌腱激惹。[结论]外固定支架和锁定加压钢板对于桡骨远端骨折没有一种方法具有明显的优势,外固定支架应在桡骨远端骨折的治疗上拥有一席之地。     

Four-corner arthrodesis with a radiolucent locking dorsal circular plate: technique and outcomes

Background

Scaphoid excision and four-corner arthrodesis (FCA) is an acceptable motion sparing procedure used to treat wrist arthritis. Recently, a locking dorsal circular plate composed of polyether-ether-ketone has been introduced (Xpode®; TriMed Inc.). The purpose of this study is to assess the efficacy of this specific plate design with regard to FCA.

Methods

A retrospective chart review of all patients who underwent FCA with an Xpode® between January 1, 2008 and December 31, 2012 was conducted. Patients were contacted and asked to return to clinic for clinical and radiographic follow-up. Patient demographics, range of motion, grip strength, and complications were collected from medical records. Patients completed a patient-rated wrist evaluation (PRWE). A paired t test was used to compare means, and p values <0.05 were considered statistically significant.

Results

Twenty-six procedures (24 patients) were identified. One patient required full wrist fusion following the initial procedure. Of the 25 remaining wrists, arthrodesis was successfully achieved in 20 (80 %). Eleven patients (13 wrists, 52 %) returned to clinic for an average follow-up of 28 months. Mean wrist extension improved from 30 to 47°, and flexion decreased from 33 to 23°. Average grip strength was 77 % of the uninjured side. The mean PRWE scores for pain and function were 19.7 and 17.1, respectively. Five patients underwent additional operations (two hardware removals, two contracture releases, and one distal radial ulnar joint arthroplasty).

Conclusions

FCA with the Xpode® yielded reasonable results for pain and function and demonstrated a fusion rate of 80 %.     

骨外固定加压治疗胫骨开放性骨折(附107例报道)

目的评估骨外固定治疗胫骨开放性骨折的疗效。方法107例胫骨开放性骨折骨外固定加压治疗。将伤口彻底清创后，交叉穿针骨外固定。稳定性骨折复位后可直接加压固定。对不稳定骨端和粉碎骨块(片)整复后先用1～3枚螺钉固定，不剥离骨膜，使分离的骨折端和骨块互相靠拢以增强骨折端的稳定性。小腿中上段软组织缺损选用腓肠肌内侧头或腓肠肌肌皮瓣转位修复，中下段用邻近筋膜皮瓣覆盖。结果107例中94例伤口一期愈合(87．8％)。骨折愈合时间4．5～6．5个月，平均5个月。结论骨外固定加压是治疗胫骨开放性骨折较为理想的方法，其固定确切、操作简单，对骨生长的生物学及生物力学环境影响小，有利于骨折愈合：钢针远离骨折端，对骨端的血循环干扰小。     

锁定加压钢板外置在胫骨感染性骨不连治疗中的应用

目的 探讨锁定加压钢板(LCP)外置技术在胫骨感染性骨不连治疗中的应用效果.方法 2005年2月至2011年11月应用LCP外置技术治疗11例胫骨感染性骨不连患者;男7例,女4例;年龄20～55岁,平均35.6岁.感染性胫骨骨不连根据Jain-Sinha分类方法分类:A型7例,B型4例.骨不连部位:胫骨下1/3段8例,中段2例,上段1例.7例患者采取清创植骨LCP外固定一期手术治疗,另外4例经一期清创LCP外固定并行软组织重建、待感染控制后二期植骨.术后定期复查X线片,并根据Olerud-Molander评分评定踝关节功能.结果 所有患者术后获10～26个月(平均14.3个月)随访.9例植骨术后正常愈合,2例出现延迟愈合;术后15～36周(平均22.0周)拆除外置的LCP和螺钉.术后原手术切口无感染,无神经、血管及肌腱损伤并发症;3例出现不同程度钉道感染;1例因钉道感染出现螺钉松动,并于术后2个月提前拔出近端松动的螺钉1枚.根据Olerud-Molander评分评定踝关节功能:优8例,良3例.结论 LCP外置治疗胫骨感染性骨不连简单、方便、稳定性好、患者易耐受,是其有效的治疗方法之一.     

32例股骨远端严重粉碎性骨折解剖钢板内固定的治疗探讨

[目的]探讨股骨远端严重粉碎性骨折的治疗方法。[方法]应用股骨远端型解剖钢板内固定治疗股骨远端严重粉碎性骨折并进行回顾性调查,分析骨折愈合及膝关节功能恢复情况。[结果]所有患者骨折均在5～12个月内愈合,膝关节功能:优12例、良16例、可3例、差l例,优良率87.5%。[结论]良好的复位,可靠的内固定,仔细的软组织修复及早期有效的功能锻炼是促进骨折愈合及恢复膝关节功能的基本要求。     

锁定钢板内固定治疗跟骨骨折

<正>2012年6月~2013年9月,我院行切开复位锁定钢板内固定治疗28例跟骨骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组28例(29足),男21例,女7例,年龄18~75岁。双侧跟骨骨折1例。骨折按Sanders骨折分型:Ⅱ型8足,Ⅲ型12足,Ⅳ型9足。其中合并腰椎骨折1例。     

锁定钢板治疗锁骨粉碎性骨折

<正>2010年9月~2012年12月,我科采用锁定加压钢板治疗66例粉碎性骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组66例,男55例,女11例,年龄22~67岁。骨折类型:锁骨中段37例,中外1/3处29例。66例均系粉碎性闭合性。患者均未合并血管神经损伤。1.2治疗方法臂丛麻醉。以锁骨骨折为中心,沿锁骨上缘做6~8 cm的横切口,骨折断端略作剥离,尽量保留碎骨