Functional results of unilateral mandibular condylar process fractures after open and closed treatment

BACKGROUND: This retrospective study compared the functional results of unilateral mandibular condylar process fractures treated either by open reduction or by closed treatment. METHODS: Sixty-six patients with unilateral mandibular condylar process fractures were reviewed. Thirty-six patients received open reduction, and the other 30 underwent closed treatment (intermaxillary fixation only). Each group was further divided into condylar and subcondylar subgroups according to fracture level. The functional outcome was evaluated by posttreatment occlusion status, maximal mouth opening, facial symmetry, chin deviation, and temporomandibular joint symptoms. RESULTS: Patients undergoing closed treatment exhibited more condylar motility than those treated by open reduction. Patients in the condylar subgroup with open reduction presented less chin deviation (21.43%) compared with those with closed treatment (56.25%; p = 0.072). Although a greater severity of subcondylar fractures existed in patients treated with open reduction, patients treated with open reduction or closed treatment did not reveal a significantly functional difference. CONCLUSION: The present study revealed that patients with condylar neck or head fractures gained more benefits from open reduction in terms of chin deviation and temporomandibular joint pain. For subcondylar fractures, open reduction provides satisfactory functional results in patients with severely displaced fractures.     

可吸收螺钉治疗儿童肱骨远端T形骨折

目的探讨可吸收螺钉治疗儿童肱骨经髁T形骨折的疗效。方法对7例儿童肱骨经髁T形骨折采用切开复位可吸收螺钉内固定,术后石膏托固定2-4周后进行功能锻炼。结果7例均得到随访,时间14-54个月。骨折全部愈合,时间1-4个月。采用改良的Morrey肘关节功能评分系统进行肘关节功能评价,并结合影像学检查结果,优2例,良4例,可1例。结论可吸收螺钉治疗儿童肱骨经髁T形骨折固定安全牢靠,疗效满意。     

Reverse obliquity fractures of the intertrochanteric region of the femur

BACKGROUND: The reverse obliquity fracture of the proximal part of the femur is a distinct fracture pattern that is mechanically different from most intertrochanteric fractures. The purpose of this retrospective study was to determine the prevalence of these fractures and the results and complications of different types of internal fixation used in their treatment. METHODS: Between 1988 and 1998, 2472 consecutive patients with a hip fracture were treated at our Level-One Trauma Center; 1035 of the fractures were classified as intertrochanteric or subtrochanteric. Clinical and radiographic records were retrospectively reviewed, and fifty-five fractures with a reverse obliquity pattern were identified. Forty-nine patients were followed until the fracture united or a revision operation was performed. The duration of clinical follow-up averaged eighteen months (range, three to sixty-seven months), and the duration of radiographic follow-up averaged fifteen months (range, three to sixty months). Fractures were classified with the Orthopaedic Trauma Association scheme. Results were analyzed according to the fracture pattern, type of implant, quality of the reduction, position of the implant, and use of bone graft at the index operation. Function was assessed on the basis of pain, living situation, need for walking aids, need for analgesics, and walking capacity. RESULTS: Thirty-two (68%) of forty-seven hips treated with internal fixation healed without an additional operation. Fifteen (32%) of the forty-seven failed to heal or had a failure of fixation. The failure rate was nine of sixteen for the sliding hip screws, two of fifteen for the blade-plates, three of ten for the dynamic condylar screws, one of three for the cephalomedullary nails, and zero of three for the intramedullary hip screws. Use of the fixed-angle devices (the blade-plate and the dynamic condylar screw) resulted in fewer failures than did use of the sliding hip screw (p = 0.023). Eleven (46%) of twenty-four nonanatomically reduced fractures and four (17%) of twenty-three anatomically reduced fractures had a failure of treatment (p = 0.060). Eleven (26%) of forty-two fractures with an ideally placed implant and four (80%) of five fractures with a non-ideally placed implant had a failure of treatment (p = 0.023). Of the fifteen fractures that failed to heal or had a failure of fixation, five were treated with revision to a calcar-replacement prosthesis, seven were treated with revision open reduction and internal fixation with bone-grafting, and one was treated with bone-grafting without revision of the fixation. Two patients refused additional surgery because they had limited functional demands. The two-year mortality rate was 33%. Functional results were poor, with many patients requiring walking aids and losing the capacity for independent walking and self-care. CONCLUSIONS: In this series, reverse obliquity fractures accounted for 2% of all hip fractures and 5% of all intertrochanteric and subtrochanteric fractures. Ninety-five-degree fixed-angle internal fixation devices performed significantly better than did sliding hip screws. Results were also worse for fractures with poor reduction and those with a poorly placed implant.     

Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management

BACKGROUND: Avulsion fractures of the posterior cruciate ligament have long been regarded as rare injuries. In the past, it was common practice to use cast immobilization as an external adjunct after open reduction and internal fixation of fractures. METHODS: Sixteen patients with displaced avulsion fractures of the posterior cruciate ligament were treated with open reduction and internal fixation between August 1989 and July 1993. Malleolar screws were chosen as fixation devices in 14 patients. In the other two, pull-through sutures were used because the size of the fractured fragments was too small to obtain purchase of screws. The postoperative management protocol evolved from an initial regimen of 6 weeks' immobilization in a cast with the knee flexed to 40 degrees for the first five patients (group I), to 4 weeks' immobilization in a cast for the next six patients (group II), to the present protocol of immediate postoperative range of motion (40-70 degrees) with muscle-strengthening exercises in a functional brace for the last five patients (group III). The average follow-up period was 36 months (range, 24-58 months). Hughston's criteria were used to assess the clinical results. RESULTS: Overall, there were 12 (75%) good and 4 fair (25%) results. There was no poor result. CONCLUSION: Avulsion fractures of the posterior cruciate ligament should be treated with open reduction and stable internal fixation if any displacement is seen on initial radiographs at presentation. With the use of functional brace and aggressive postoperative rehabilitation program (i.e., immediate range of motion of 40-70 degrees with muscle-strengthening exercises), satisfactory results can be expected and achieved.     

Biodegradable fixation of mandibular fractures in children: stability and early results.

OBJECTIVE: The aim of this study was to assess the safety and efficiency of biodegradable self-reinforced (SR-PLDLA) bone plates and screws in open reduction and internal fixation of mandible fractures in children. STUDY DESIGN: Thirteen patients (5 female, 8 male; mean age 12 years, range 5-16 years) were operated on various fractures of the mandible (2 symphyseal, 6 parasymphyseal, 4 body, 3 angle, 1 ramus, 2 condylar fractures). The mean follow-up time was 26.4 months (range 10.9-43.4 months). Intermaxillary fixation was applied in cases with concomitant condylar fractures up to 3 weeks. RESULTS: Primary healing of the fractured mandible was observed in all patients. Postoperative complications were minor and transient. The outcome of the operations was not endangered. Adverse tissue reactions to the implants, malocclusion, and growth restrictions did not occur during the observation period. CONCLUSIONS: Pediatric patients benefit from the advantages of resorbable materials, especially from faster mobilization and the avoidance of secondary removal operations. Based on these preliminary results, self-reinforced fixation devices are safe and efficient in the treatment of pediatric mandible fractures. However, further clinical investigations are necessary to evaluate the long-term reliability.     

Fractures of the posterior wall of the acetabulum: treatment using cannulated screws

A total of 19 patients (16 males, 3 females) who had fractures of the posterior wall of the acetabulum were treated by open reduction and internal fixation. Their mean age was 40 years. There were five single-fragment fractures and 14 comminuted. Fifteen patients were treated by fixation with cannulated screws only and four were treated with cannulated screws and reconstruction plates. Reduction and fixation of fragments was facilitated, and soft tissue dissection minimized, by the use of cannulated screws. Clinical results were excellent in nine hips, very good in one, good in six, and poor in three after follow-up of more than 2 years. We think that preservation of the blood supply to the fracture fragments and careful placement of the fixation components is as important as rigid fixation of the fragments for the successful treatment of posterior-wall fractures of the acetabulum. The use of cannulated screws may be helpful for this purpose.     

Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction

In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and deviation of the mandible. In the past, closed reduction with concomitant active physical therapy conducted after intermaxillary fixation during the recovery period had been mainly used, but in recent years, open treatment of condylar fractures with rigid internal fixation has become more common. The objective of this review was to evaluate the main variables that determine the choice of an open or closed method for treatment of condylar fractures, identifying their indications, advantages, and disadvantages, and to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.     

股骨远端骨折的外科治疗

目的:探讨股骨远端骨折手术治疗的方法和临床疗效。方法选择股骨远端骨折手术治疗37例,根据AO/A S IF分型,A型8例,B型9例,C型20例,分别采用股骨髁支持钢板、L-梯形钢板、逆行带锁髓内钉、拉力螺钉进行固定,术后随访6个月~8年。结果6例骨折不愈合、3例出现化脓性骨和膝关节感染、3例出现钢板断裂。根据K olm enrt股骨远端功能评定标准,优17例,良14例,一般2例,差4例,优良率83.7%。结论手术治疗股骨远端骨折能最大限度获得骨折复位和膝关节功能的恢复,临床疗效满意,是治疗股骨远端骨折较理想的方法。     

胫骨髁骨折的手术治疗

目的 总结胫骨髁骨折手术治疗的经验。方法 对１９９０年１０月至１９９５年６月９２例（９３个）新鲜闭合性胫骨髁骨折手术治疗情况进行分析。随访８７例,随访时间１２￣３６个月,平均１８．６个月。采用Ｒａｓｍｕｓｓｅｎ评分标准评定临床疗效。结果 优７４例（８４％）,良７例（８％）,差７例（８％）。优良率占９２％。结论 正确掌握和运用内固定技术是使胫骨髁骨折取得满意疗效的关键因素。注意事项有：（１）骨折应解     

Retrograde intramedullary nailing of supracondylar femoral fractures: design and development of a new implant

Since 1992 we have developed an implant in which the distal (condylar) screws have a diagonal configuration so that the screws can be closer to the distal end of the nail, allowing more distal fractures to be fixed. It also utilises the denser bone of the posterior condyles for more secure fixation in osteoporotic patients. The new implant was used for 24 extra-articular fractures from September 1994 to September 1997, and for 14 articular fractures from February 1995 to December 2000. There was no significant difficulty with obtaining fixation in very distal fractures and in osteoporotic bone. Early weightbearing was encouraged in those with extra-articular fractures. All fractures united within 3 months except one which required a bone graft (but no revision of implant) at 6 months. Average knee flexion at final followup was 101 degrees for extra-articular fractures and 106 degrees for articular fractures. Complications included quadriceps adhesions requiring further surgery in two patients who had open fractures, and malunion in one patient who had an early design of the implant and a 4.5mm condylar screw broke. Nine patients required late removal of condylar screws due to local soft tissue irritation.     

Treatment of patellar fractures using bioresorbable forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide cannulated screws and nonabsorbable sutures

BackgroundForged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide (F-u-HA/PLLA) implants are widely used in surgeries because they possess high mechanical strength, bioactivity, and radio-opacity. We previously reported that F-u-HA/PLLA implants were useful for treating lateral tibial condylar, lateral humeral condylar, and ankle fractures. The study aim was to investigate the efficacy of F-u-HA/PLLA cannulated screws and FiberLoop® for treating transverse patellar fractures.MethodsFrom April 2013 to February 2019, 15 patients with transverse patellar fractures were treated with F-u-HA/PLLA cannulated screws and FiberLoop® as follows: Open reduction and internal fixation (ORIF) were performed with two F-u-HA/PLLA cannulated screws and a temporary fixation Kirshner wire (K-wire). Three No. 2 FiberLoops® were inserted into these two screw holes and the K-wire hole for temporary fixation. All patients were allowed to full weight-bearing gaits using a knee brace. Knee range of motion exercise was initiated on postoperative day 1. Knee flexion was restricted to ≤90° for 1 month postoperatively. Radiograph was performed to evaluate fracture healing, screw breakage, reduction loss, and screw radio-opacity. Clinical outcomes and postoperative complications were assessed.ResultsThe average follow-up was 16.0 months. All fractures were successfully united. Screw breakage, reduction loss, osteolysis, and radiolucent zones around the screws were not observed at the final radiographic follow-up. All F-u-HA/PLLA screw shadows were observed during the follow-up. The average range of flexion and extension were 132.0° and −2.7°, respectively. No patients experienced deep infection episodes, late aseptic tissue reactions, or foreign body reactions postoperatively. No patients complained of pain at the final follow-up. All patients returned to their pre-injury work level and activities of daily living.ConclusionOur results strongly suggest that ORIF with F-u-HA/PLLA screws and FiberLoop® could be an alternative treatment option for transverse patellar fractures.     

Internal fixation for coronal shear fracture of the distal end of the humerus by the anterolateral approach

Six patients with a displaced coronal shear fracture of the distal end of the humerus were treated surgically with the anterolateral approach to the elbow, in which the capitulum and trochlea could be exposed widely. All underwent open reduction and internal fixation to reduce anatomically and mobilize the joint at an early stage. The mean duration of follow-up was 40 months (range, 24-54 months). All fractures healed with an acceptable functional result. In no case did we observe collapse of the capitulum or trochlea. We recommend open reduction by the anterolateral approach, which provides good exposure of the fracture sites and allows internal fixation to be accomplished with the use of Herbert screws, resulting in good fixation and compression of the bone fragments.     

PDLLA可吸收螺钉治疗踝关节骨折的临床研究

目的 探讨使用可吸收螺钉治疗踝关节骨折的适应证和经验教训。方法 使用超高分子聚-DL-乳酸(PDLLA)制成的自膨胀可吸收螺钉治疗踝关节骨折58例。切开复位后1—4枚螺钉固定，术中检查稳定性是否良好；术后定期随访，检查踝关节功能和X线检查。结果随访54例147枚螺钉。全部骨折无移位，均愈合良好，无细菌感染。患术后平均随访16月(3—28月)，根据国内王栋梁等综合功能评估标准，优良率达96.3％。结论 PDLLA自膨胀可吸收螺钉治疗踝关节骨折，操作简单，效果理想。只要手术时机恰当，术中精细操作，术中术后处理得当，并发症也是可以预防的。     

36例桡骨头骨折的治疗体会

目的探讨桡骨头骨折的治疗方法、手术技术及治疗效果。方法对36例桡骨头骨折患者中7例（Ⅰ型）采用非手术治疗,29例（Ⅰ～Ⅳ型）采用切开复位微型接骨板螺钉或单用螺钉固定。结果患者均获随访,时间2～36个月。肘关节屈曲幅度为100°～145°,前臂旋转幅度为65°～160°。按Broberg-Morrey评估标准进行功能评定：优21例,良14例,可1例。结论对桡骨头骨折大部分Ⅰ型患者可采用非手术治疗,对部分Ⅰ型和Ⅱ～Ⅳ型者采用切开复位微型接骨板、螺钉内固定治疗,疗效均满意。     

Treatment of fractures of the humeral capitellum using herbert screws

Isolated fractures of the capitellum are rare injuries and account for 1% of all elbow injuries. The purpose of this study is to evaluate the clinical outcomes of 11 Type I capitellum fractures treated by open reduction and internal fixation using at least two standard Herbert screws between 1998 and 2003. The average age of the patients was 27.5 years. The mean follow-up time was 23.4 months. The final postoperative assessment was made at the 12th month. The results were evaluated according to the Mayo Elbow Performance Index. We obtained excellent result in eight patients and good result in three patients. We recommend open reduction and fixation with Herbert screws inserted from the posterior surface of the lateral epicondyle and early mobilization in Type I fractures of the capitellum.     

Tibial condylar fractures fixed with totally absorbable, self-reinforced polyglycolide screws

Six patients with displaced split-depression-type tibial condylar fractures were treated with absorbable, self-reinforced polyglycolide screws. One patient underwent reoperation because of an unacceptable primary fracture reduction unrelated to the implant material. The others healed well, with good functional and anatomical results despite one slight redisplacement in a medial condylar fracture treated without plaster cast immobilisation. Absorbable polyglycolide screws seem to be suitable for the fixation of selected tibial condylar fractures. The implant removal operation is thus avoided.     

可吸收钉棒治疗粉碎性桡骨头骨折

目的探讨可吸收钉棒治疗粉碎性桡骨头骨折的疗效。方法对21例MasonⅢ、Ⅳ型桡骨头骨折患者施行切开复位可吸收钉棒内固定。结果 21例均获随访,时间5～35（20.5±9.6）个月,按B roberg和Morrey的肘部评分标准评判：优6例,良13例,可2例。结论可吸收钉棒治疗粉碎性桡骨头骨折操作简便,疗效确切,不需二次手术,具有临床优势。     

Functional outcome after operative treatment of eight type III coronoid process fractures

BACKGROUND: There have been few reports about surgical outcomes of coronoid process fractures. Eight cases of clinical results of type III coronoid process fractures were reviewed. METHODS: Eight patients with coronoid type III fracture were retrospectively reviewed. All were men with an average age of 33 years. There were three isolated fractures, two elbow dislocations, two radial head and neck fractures, and one medial collateral ligament rupture. An open reduction and internal fixation through an anterior approach with cannulated screws was used. The patients were followed up for a mean of 31 months (range, 24-60 months). RESULTS: Average active elbow joint motion at the most recent follow-up was 105 degrees. The average Mayo Elbow Performance Score was 76.9 (range, 50-95). Of the results, there was one excellent, four good, two fair, and one poor. CONCLUSION: Early open reduction and stable internal fixation provided a reliable method for the treatment of type III coronoid process fractures. Any associated injuries to the elbow and fracture comminution were considered as important prognostic factors.     

Results of operative treatment of avulsion fractures of the iliac crest apophysis in adolescents

Background

Avulsion fracture of the iliac crest apophysis is a rare condition that commonly occurs in adolescent athletes. Conservative treatment for this injury can produce excellent functional outcomes. However, the rehabilitation process requires a rather long immobilisation period. This study aimed to evaluate the use of cannulated screws for fixation of avulsion fractures of iliac crest apophysis.

Methods

Ten patients with avulsion fractures of iliac crest apophysis were treated by open reduction and internal fixation using cannulated screws.

Results

The mean age of patients was 14.6 years (range, 13–15 years). The mean intraoperative blood loss was 14.9 ml (range, 10–25 ml). The mean operative time was 40.3 min (range, 33–52 min). The mean follow-up period was 11.2 months (range, 6–20 months). At the 4-week follow-up, all patients returned to previously normal activity without pain and had no evidence of lower extremity muscle weakness. At the final follow-up, all patients resumed their athletic activity without any complications.

Conclusion

Open reduction and internal fixation for the treatment of avulsion fracture of iliac crest apophysis can be recommended for patients requiring rapid rehabilitation.     

Rigid internal fixation with miniplates and screws: a cost-effective technique for treating mandible fractures?

Traditional methods of fixation for stabilization of mandible fractures primarily center around intermaxillary fixation with or without open reduction. During the past decade, rigid internal fixation with miniplates and screws has attained widespread acceptance in the management of acute traumatic injuries to the mandible. With continuing emphasis on cost containment in health care delivery, plastic surgeons will be expected to justify their therapeutic methods as beneficial as well as cost-effective. This is particularly important when a number of acceptable procedures are readily available. The purpose of our investigation was retrospectively to compare treatment with intermaxillary fixation alone, interosseous wire osteosynthesis, and rigid internal fixation with miniplates and screws. We analyzed the hospital records of three such treatment groups, each consisting of 25 patients. Despite initial purchase costs, increased operating time, and the need to develop the skills required to apply the hardware, our study clearly demonstrated that miniplates and screws remain a cost-effective approach to caring for fractures of the mandible. Associated advantages include a quicker return to a preinjury life-style, decreased weight loss, improved oral hygiene and wound care, and protection of the airway, thereby eliminating monitored intensive care unit admissions.