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S.L. Ezekiel Tan 《Injury》2009,40(7):683-691
The goal of fracture fixation is to achieve bone healing and restore the function of the injured limb in the shortest possible time without compromising safety. Newer technologies such as the locking compression plate (LCP) and its derivatives are valuable additions to the orthopaedic traumatologist's armamentarium. As with any emerging technology, the indications will be extended until a threshold is reached and the limitations of the technology are seen. It is vital that surgeons involved in fracture care are aware of when locked plating is superior to other methods and also when they should use another treatment modality.This paper reviews the use of locked plating as a fixation method. Five topics covered in this review are: a historical perspective on locked plating, general indications, specific modes and techniques, patterns of failure, and an anatomical overview of current indications for locked plating. 相似文献
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We followed all consecutive hip fracture patients admitted between 2004 and 2006, identified cases in which the intention was to treat non-operative and compared their functional outcome and mortality with a similar cohort treated surgically over the same period. We recorded length of hospital stay, place of discharge, pre and post-fracture mobility and residence, 30 days and 1 year mortality, re-admission due to same fracture and delayed surgery. The group treated surgically was recruited and matched for age, gender, pre and post-fracture mobility, mental confusion and independence. 25 patients were treated non-operative. 22 patients treated surgically over the same time period matched the patient characteristics of the non-operative arm. The mean hospital stay was 13 days in both groups. There were 4 extra-capsular fractures (3 displaced) and 21 intra-capsular fractures (5 displaced) in the non-operative arm and 11 extra-capsular fractures and 9 intra-capsular fractures in the surgically treated arm. 4 patients from the non-operative treatment group underwent late surgery because of persisting hip pain 20 days-2 months after the index event (2 cannulated screws, 1 hemiarthroplasty, 1 total hip arthroplasty). 11 patients in the surgical treatment arm underwent dynamic screw fixation, 1 had cannulated screw, 1 had total hip replacement and 7 had hemiarthroplasty. 14 of the non-operative treated patients were mobile independently or with aid before fracture but only 9 patients retained their pre-fracture mobility following treatment, compared to 16 patients pre-fracture and 11 patients post-fracture after surgery. 16 patients treated non-operative were living independently prior to injury but only 7 went back to their own residence. Of the operatively treated patients 14 patients were living independently and 10 patients went back to their previous residence. 1 month and 1 year mortality in the non-operative treated group was 4/21 and 7/21 respectively compared to 1/20 and 5/20 in the operative fixation group. There was no statistically significant difference in mobility, residence or mortality between the two groups (Fisher exact test, p > 0.05). Non-operative management after hip fracture is suitable for medically unfit patients and does not result in statistically significant difference in functional outcome or mortality compared to patients treated surgically. 相似文献
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目的:探讨髋臼骨折合并同侧下肢骨折的创伤机制和治疗方法。方法:髋臼骨折并同侧下肢骨折14例,男9例,女5例;年龄18~65岁,平均35岁。髋臼骨折按Letournel分型,后壁伴后柱骨折11例,单纯后柱骨折3例,均行钢板内固定。伴同侧股骨转子间骨折3例,1例行起重机架外固定,2例行DHS固定;伴同侧股骨颈骨折3例,均行空心钉加压固定;伴同侧股骨干骨折6例,1例行钢板固定,余5例行带锁髓内钉固定;伴同侧胫骨平台骨折2例,行钢板内固定。结果:1例半年后死亡,余13例获得随访,随访时间18个月~5年,平均30个月。按照美国矫形外科研究院髋关节疗效评定标准,优9例,良3例,差1例。结论:髋臼骨折合并同侧下肢骨折受伤暴力大、机制复杂、合并创伤多、易漏诊,应早期明确诊断,合理内固定。 相似文献
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Torsion of noncircular beams results in warping of each cross section. When noncircular cross sections are constrained to remain plane, the resulting shear stress distribution is different from what Saint Venant torsion (with warping) would predict. This has practical implications to the stress analysis of plated long bones subjected to torsional loadings. Analyses in which warping is not allowed predict incorrect stress fields in the plate and bone and overpredict the amount of stress shielding associated with fracture plate fixation. 相似文献
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双头加压螺纹钉贴股骨距内固定治疗股骨颈骨折 总被引:8,自引:0,他引:8
在X光电视下采用双头加压螺纹钉贴股骨距内固定治疗新鲜股骨颈骨折42例,随访平均2.5年,其中16例随访3年以上,骨折愈合率95.2%,骨折不愈合并股骨头缺血性坏死率4.76%。认为加压螺纹钉贴股骨距内固定可使钉的受力由较大剪应力变为较大轴向力承受,减少骨折处的剪应力,并加压于骨折端能促进骨折愈合。具有操作简单、进钉准确、创伤小、固定牢靠、并发症少等优点。 相似文献
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