Construct failure after open reduction and plate fixation of displaced midshaft clavicular fractures

IntroductionWorldwide, implants mostly used for fixation of displaced midshaft clavicular fractures (DMCF) are the easily to bend reconstruction plate and the stiffer small fragment locking compression plate. Construct failure rates after plate fixation of DMCF are reported around 5 percent. Possible risk factors for construct failure are implant type and fracture type. However, little is known about the influence of fracture fixation method on construct failure. The aim of this study was to assess construct failure in plate fixation of DMCF and to identify possible risk factors.MethodsAll consecutive patients treated in a level 1 trauma centre with open reduction and fixation of DMCF using a 3.5-mm reconstruction plate or 3.5-mm small fragment locking compression plate between 2007 and 2015 were evaluated. Potential risk factors for construct failure were analysed using univariate analysis.ResultsTwo hundred and fifty-nine patients were analysed. Fifty DMCF (19%) were fixated with a reconstruction plate and 209 (81%) with a small fragment locking compression plate. Construct failure was seen in 18 patients (6.9%), including 5 broken plates and 13 with screw loosening. Eight percent of all reconstruction plates broke in contrast to 0.5 percent of all small fragment locking compression plates (p = 0.001). All broken implants were used as a bridging plate. Loosening of screws was seen in older patients and when the plate was fixated with less than three bicortical screws on one side of the fracture (p = 0.002).ConclusionsOverall construct failure after open reduction and plate fixation of DMCF occurred in 6.9 percent. Risk factors for plate breakage were the use of a reconstruction plate and a bridging method for fracture fixation. Risk factors for screw loosening were an increasing patient age and plate fixation with less than three bicortical screws on one side of the fracture.RecommendationsBased on the results of this study our recommendation is to use a small fragment locking compression plate for open reduction and internal fixation of DMCF. The surgeon should always strive to fixate the plate on both sides of the fracture with at least three bicortical screws.     

关节镜治疗34例胫骨平台骨折的临床体会

目的:探讨关节镜治疗胫骨平台骨折的应用价值及方法。方法:回顾分析2003年6月至2009年6月用关节镜治疗胫骨平台骨折34例患者的临床资料。结果:34例经6个月～6年随访,骨折复位良好,无感染和严重骨关节炎发生,Hohl评分:优27例,良4例,中3例,优良率91.2%。结论:SchatzkerⅠ～Ⅳ型胫骨平台骨折于关节镜监视下复位,固定可靠,可避免遗留关节内的伴随损伤,具有患者创伤小,康复快,并发症少等优势。     

掌侧型Barton骨折的治疗

目的探讨提高Barton骨折疗效的方法和疗效。方法采用开放复位解剖型锁定钢板内固定治疗15例Bar-ton骨折患者,进行早期功能锻炼。结果 15例患者术后获6~18个月的随访,骨折均获骨性愈合,愈合时间平均为3.5个月;按照M erchant标准,优良率达93.3%。结论掌侧型Barton骨折早期手术治疗效果好。     

Functional bracing of humeral shaft fractures. A review of clinical studies

Functional bracing has been widely accepted as the gold standard for treating humeral shaft fractures conservatively. We conducted a literature review to verify the efficacy of this treatment method. Sixteen case series and two comparative studies fulfilled the criteria set. Analysis of these clinical studies showed that humeral shaft fractures when treated with functional bracing heal in an average of 10.7 weeks. Union rate is high (94.5%). Statistical analysis showed that proximal third fractures and AO type A fractures have a higher non-union rate although this is not statistical significant. Residual deformity and joint stiffness are considered the main drawbacks of conservative treatment. Angulation - usually varus - rarely exceeded 10°, while full shoulder and elbow motion was achieved in 80% and 85% of the patients, respectively. Nevertheless, in the few studies that subjective parameters such as functional scores, pain and quality of life were assessed results were not so promising.     

Kyphoplasty for the treatment of malignant vertebral compression fractures caused by metastases

Despite the literature supporting the efficacy of kyphoplasty for treatment of osteoporotic vertebral compression fractures in multiple myeloma, few reports exist documenting its use in the treatment of malignant vertebral compression fractures (MVCF) caused by metastases. Accordingly, we sought to evaluate the feasibility, efficacy and safety of kyphoplasty in the treatment of MVCF without epidural involvement. We performed a retrospective review of clinical outcome data for 48 patients with multiple spinal metastases treated with kyphoplasty. Outcome data (vertebral body height variation, degree of kyphosis, visual analog scale score for pain, Oswestry Disability Index score, the Short Form-36 [SF-36] questionnaire score for function) were collected preoperatively, postoperatively, and at 1 month, 6 months, 1 year, and 2 years after treatment. Significant improvements in all of the outcome measures were observed postoperatively and throughout the duration of follow-up. The mean anterior vertebral body height variation improved from 52.7 ± 16.8% preoperatively to 85.3% ± 13.2% postoperatively (p < 0.001). Kyphotic angle improved from 16.4° ± 4.7° preoperatively to 8.4° ± 2.5° postoperatively (p < 0.001). The mean visual analog scale score decreased significantly from presurgery to postsurgery (7.4 ± 2.1 to 3.8 ± 1.6; p < 0.001), as did the Oswestry Disability Index score (71.5 ± 16.7 to 32.4 ± 9.6; p < 0.001). The SF-36 scores for bodily pain, physical function, vitality, and social functioning all also showed significant improvement (p < 0.05). Kyphoplasty is an effective, minimally invasive procedure for the stabilization of pathological vertebral fractures caused by metastatic disease, even in levels with vertebral wall deficiency, leading to a statistically significant reduction in pain, improvement in function and prevention of further kyphotic deformity of the spine.     

系统综合护理在四肢骨折患者中的应用

目的:探讨系统综合护理在四肢骨折患者中的应用方法及临床效果。方法:将120例四肢骨折患者随机分为观察组与对照组各60例。对照组给予四肢骨折常规护理,观察组在对照组基础上给予系统综合护理;观察比较两组并发症发生情况、废用性肌肉萎缩、舒适度情况、住院时间及患者满意度。结果:两组在并发症、废用性肌肉萎缩、舒适度及住院时间、患者满意度等方面比较,差异有统计学意义(P<0.05)。结论:加强系统综合护理可以提高患者舒适度及满意度,降低并发症发生率,缩短住院时间,有效促进四肢骨折患者尽早恢复,值得推广。     

Does nutritional intervention for patients with hip fractures reduce postoperative complications and improve rehabilitation?

Aims and objectives. The aims were to investigate whether there were any differences between patients receiving nutritional intervention preoperatively and over five days postoperatively and patients who did not, in terms of postoperative complications, rehabilitation, length of stay and food and liquid intake. Background. Patients with hip fractures are often malnourished at admission to hospital and they typically do not receive the energy and calories needed postoperatively. Design. The design was a quasi‐experimental, pre‐ and post‐test comparison group design without random group assignment. Methods. One hundred patients with hip fractures were consecutively included. The control group (n = 50) received regular nutritional support. The intervention group (n = 50) received nutrition according to nutritional guidelines. The outcome measures used were risk of pressure ulcer, pressure ulcers, weight, nosocomial infections, cognitive ability, walking assistance and functional ability, collected preoperatively and five days postoperatively. Each patient’s nutrient and liquid intake were assessed daily for five days postoperatively. Results. Significantly fewer (p = 0·043) patients in the intervention group (18%) had pressure ulcers five days postoperatively compared with the control group (36%). Nutrient and liquid intake was significantly higher (p < 0·001) in the intervention group. Median length of stay decreased from nine to seven days (p = 0·137), as did nosocomial infections, from 18–8·7% (p = 0·137). Conclusion. Patients with hip fractures receiving nutrition according to nutritional guidelines developed fewer pressure ulcers. This is invaluable to patients’ quality of life and a major economic saving for society. Relevance to clinical practice. Great benefits can be gained for the patients through modest efforts by nurses and physicians such as nutritional intervention.     

锁定型颈椎前路钢板系统治疗胸骨骨折

胸骨骨折常合并有胸腹部严重并发症和其它部位骨折,病情凶险,如诊治不当,可引起严重后果[1]。2006年5月～2011年9月,我们采用锁定型颈椎前路钢板系统治疗9例严重胸骨骨折患者,取得了较好效果,报道如下1材料与方法