Forty cases of intertrochanteric fractures of femur were treated with percutaneous nonmetallic external fixator. The patients were followed up for 6 months to 3 years, and the fractures were all united without coxa vara or shirtening deformities. There was no mortality in this series. This method had the advantages ofbeing simple, save time and effort, less traumatic and early ambulation. The design of the apparatus tallied with the biomechanics of the neck and shaft of the femur.
【Abstract】 Objective To investigate the effect of the volar capsular l igament complex on stabil ity of the wrist jointand to provide basic biomechanical theoretical criteria for cl inic appl ication of the external fixator. Methods Nine upperl imbs specimens (left 6, right 3) were taken from fresh adult cadavers to make wrist joint-bone capsular l igament complex specimens. Firstly, soft tissues of forearms and hands were resected and capsular membranes and l igaments were reserved to make the bone-articular l igament complex (normal specimen). Secondly, the volar capsular l igament complex was cut off from radial malleolus to ulnar malleolus (impaired specimen). Thirdly, the impaired volar capsular l igament complex was interruptedly sutured by the use of 4# suture silk (repaired specimen). To simulate cl inical operation with external fixator, the biomechanical test was done according to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed). Statistical significance was analyzed through selected loads at the three different shifts (1.5, 2.0, 2.5 cm). Results According to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed), when the shift was 1.5 cm, the different respective loads were (60.74 ± 20.60), (35.23 ± 13.88), (44.36 ± 20.78), (168.40 ± 29.21) and (139.00 ± 33.18) N, respectively. When the shift was 2.0 cm, the different loads were (138.46 ± 12.93), (87.17 ± 24.22), (97.52 ± 23.29), (289.00 ± 54.29) and (257.98 ± 55.74) N, respectively. When the shift was 2.5 cm, the different loads were (312.87 ± 37.15), (198.16 ± 37.14), (225.66 ± 30.96), (543.15 ± 74.33) and (450.35 ± 29.38) N, respectively. There was no statistically significant difference between the impaired and repaired specimens (P gt; 0.05). Similarly, there was statistically significant difference among the rest specimens (P lt; 0.05). The same statistical results were obtained when the two different shifts were compared. There was statistically significant difference at the three different shifts for the same specimen (P lt; 0.05). Conclusion Volar capsular l igament complex is an important anatomic structure to keep stabil ity of the wrist joint. The carpal instabil ity arises out of the injured complex. Repairing the injured complex only can not immediately restore stabil ity of the wrist joint. The external fixator can effectively help to diminish the relative shift of the impaired capsular l igament complex, to reduce the load of the repaired complex and to protect the complex accordingly. The device plays an important role in maintaining stabil ity of the wrist joint.
【Abstract】 Objective To summary the effects of staged pelvic closure using external fixator combined withreconstruction plate for old Tile B1 pelvic fracture. Methods From August 2000 to August 2006, 14 patients (9 males and 5 females, age ranging from 21 to 65 years with old Tile B1 pelvic fracture with pubic symphysis separation were treated. The injuries were caused by the traffic accident in 10 patients, high crash in 3, and crush in 1. The duration ranged from 4 weeks to 3 months. The 14 patients were compl icated with other injuries in some degrees. The X-ray and CT showed pubic symphysis separation. In 13 patients, pubic symphysis separation distance was more than 2.5 cm, who also had fracture or dislocation in the posterior structure of pelvis. The X-ray films showed the mean pubic symphysis separation distance was (6.67 ± 2.11) cm preoperatively. The 14 patients underwent pelvic external fixation at first and staged pelvic closure gradually for the pubic symphysis separation. After 2 to 3 weeks, when the pubic symphysis separation distance was less than 1 cm, the patients underwent open reduction and internal fixation with reconstruction plate. Pubic symphysis separation distance was measuredin the preoperative and postoperative pelvic anterioposterior X-ray films. The condition of the posterior structure of pelvis was observed in CT films. The functions of patients were assessed according to Majeed grading system. Results All incisions healed by first intention. The 14 patients were followed up for 6 months to 2 years (15 months on average). The X-ray films showed the mean pubic symphysis separation distance of post-operation was (0.85 ± 0.23) cm, showing statistically significant difference when compared with that of pre-operation (P lt; 0.05). The CT films showed fracture and dislocation of the posterior structure of pelvis had bony heal ing after 6 to 12 months. According to the Majeed grading system, the results were excellent in 5 cases, good in 4 cases, fair in 4 cases and poor in 1 case; the excellent and good rate was 64.29%. Conclusion Staged pelvic closure using external fixation combined with reconstruction plate for old pelvic fracture with pubic symphysis separation can reduce the pubic symphysis separation distance significantly. Satisfactory effects can be expected in treating the patients with TileB1 fracture.
ObjectiveTo investigate the effectiveness of limited internal fixation combined with hinged super-articular external fixator to treat type C3 fracture of the distal humerus. MethodsBetween September 2007 and November 2012, 37 cases of type C3 fracture of the distal humerus were treated. There were 22 males and 15 females with an average age of 43.6 years (range, 22-66 years). The causes were accident injury in 24 cases, falling injury in 5 cases, falling from height in 4 cases, heavy crush injury in 2 cases, machine injury in 1 case, and other injury in 1 case. There were 22 cases of open injury and 15 cases of closed injury. The time from injury to operation was 3-46 hours (mean, 18 hours). ResultsNeedle tract reaction and incision infection occurred in 3 cases and 1 case respectively, healing of incision by first intension was obtained in the other cases. Thirty-six patients were followed up 9-48 months (mean, 25.4 months). Heterotopic ossification occurred in 3 cases after operation and no recurrence was found by release after fracture healing. Fractures healed in the other patients after 6-14 months (mean, 9 months) of operation except 1 patient who suffered chronic osteomyelitis. One patient had delayed ulnar neuritis at 12 months after operation, and the nerve function returned to normal after the ulnar nerve transposition. There was no bone ischemic necrosis, elbow joint instability, or loosening of internal fixation. At last follow-up, the average range of motion of injured elbow was 105.0° in flexion,-25.0° in extension, 69.2° in pronation, and 75.6° in supination. According to Mayo elbow joint function score (MEPS) and disability of arm shoulder and hand (DASH) score, the results were excellent in 22 cases, good in 8 cases, fair in 4 cases, and poor in 2 cases with an excellent and good rate of 83.3%; and according to Cassebaum elbow joint function score, the results were excellent in 21 cases, good in 7 cases, fair in 5 cases, and poor in 3 cases with an excellent and good rate of 77.8%. ConclusionA combination of limited internal fixation and hinged super-articular external fixator has satisfactory clinical curative effect for type C3 fractures of the distal humerus, relatively few complications.
ObjectiveTo summarize the progress in treatment of pubic symphysis diastasis. MethodsRelated literature concerning treatment of pubic symphysis diastasis was extensively reviewed and comprehensively analyzed in terms of anatomy, biomechanics, and treatment. ResultsThere are many fixation methods for treatment of pubic symphysis diastasis, which aims at restoring the stability of the anterior pelvic ring. External fixator is often used as a temporary fixation; tension band wire has been abandoned due to its poor biomechanical stability; screw loosening and plate breakage often appears when a single reconstruction plate is used; box plate significantly increases the biomechanical stability of anterior pelvic ring but it leads to a considerable surgical trauma; locking plate has been used for pubic symphysis diastasis recently, especially for osteoporotic fractures; percutaneous cannulated screw has the advantages of less trauma, less bleeding, and good stability, so it is good choice for treatment of pubic symphysis diastasis. ConclusionThere is no uniform standards about the treatment of pubic symphysis diastasis, but the minimally invasive treatment is an undeniable trend. Percutaneous cannulated screw has achieved satisfactory effectiveness, however, its biomechanical stability and anatomic channels need to be further studied.
Objective To compare effects, advantages and disadvantages of simple internal fixation to that of l imited internal fixation with external supporting frame fixation in the treatment of complex fractures of tibial plateau. Methods From July 2002 to August 2006, 66 cases of complex fractures of the tibial plateau were divided into the internal fixation group (n=39) and the external fixator group (n=27). The interal fixation group had 18 cases of IV, 7 cases V and 14 cases VI according to Schatzker, including 25 males and 14 females aged 18-79 years with an average of 45.4 years. The external fixator group had 13 cases of IV, 6 cases V and 8 cases VI according to Schatzker, including 18 males and 9 femles aged 18-64 years with an average of 44.2 years. No significant difference was evident between the two groups (P gt; 0.05). Patients were treated by using screws, steel plates or external supporting frame fixation strictly based on the princi ple of internalfixation. Results All patients were followed up for 1-5 years. Fracture healed with no occurrence of nonunion. Two cases inthe internal fixation group presented partial skin infection and necrosis, and were cured through the dressing change and flap displacement. Fracture heal ing time was 6-14 months with an average of 7.3 months. The time of internal fixator removal was 6-15 months with an average of 8.3 months. In the external fixation group, 11 cases had nail treated fluid 7 days to 3 months after operation, combining with red local skin; 3 cases had skin necrosis; and 3 cases had loose bolts during follow-up. Through debridement, dressing change and flap displacement, the skin wounds healed. Fracture heal ing time was 3-11 months with an average of 5.1 months. The time of external fixator removal was 5-11 months with an average of 6.4 months. At 8-14 months after operation, the knee function was assessed according to Merchant criteria. In the internal fixation group, 29 cases were excellent, 4 good, 5 fair and 1 poor, while in the external fixation group, 20 cases were excellent, 3 good, 2 fair and 2 poor. There was no significant difference between the two groups (P gt; 0.05). Conclusion The therapeutic effects of simple internal fixation and l imited internal fixation with external supporting frame fixation were similar in the treatment of complex fractures of tibial plateau. Fixation materials should be selected according to the state of injury and bone conditions for the treatment of tibial plateau fracture of type IV, V and VI based on Sehatzker classification.
ObjectiveTo explore the efficacy and safety of the axial load mechanical testing for removing external fixator. MethodsBetween January 2014 and August 2015, 27 patients with tibia and fibula fractures caused by trauma underwent an external fixation. Of 27 patients, 21 were male and 6 were female with the average age of 45 years (range, 19-63 years), including 7 cases of closed fracture and 20 cases of open fracture. X-ray film results showed spiral unstable fracture in 4 cases and comminuted unstable fracture in 23 cases. All patients underwent an external fixation. Bone nonunion occurred in 3 cases because of infection, and bone nonunion combined with bone defect occurred in 1 case, who received tibial osteotomy lengthening surgery. When X-ray film showed continuity high density callus formation at fracture site, axial load mechanical test was performed. If the axial load ratio of external fixator was less than 10%, the external fixator was removed. ResultsAt 21-85 weeks after external fixation (mean, 44 weeks), axial load mechanical test was performed. The results showed that the axial load ratio of external fixation was less than 10% in 26 cases, and the external fixator was removed; at 6 weeks after removal of external fixator, the patients could endure full load and return to work, without re-fracture. The axial load ratio was 14% in 1 case at 85 weeks, and the X-ray film result showed that fracture did not completely heal with angular deformity; re-fracture occurred after removing external fixator, and intramedullary fixation was used. ConclusionExternal fixator axial load mechanical testing may objectively reveal and quantitatively evaluate fracture healing, so it is safe and reliable to use for guiding the external fixator removal.
Objective To investigate the cl inical results of treating leg open fracture with soft tissue defect by pedicle flap transfer in combination with external fixator. Methods From May 2004 to June 2007, 12 cases of leg open fracture with soft tissue defect, 9 males and 3 females aged 18-75 years, were treated. Among them, 8 cases were caused by traffic accidents, 2 crush, 1 fall ing and 1 mechanical accident. According to the Gustilo Classification, there were 2 cases of type II, 5 of type IIIA and 5 of type IIIB. There were 2 cases of upper-tibia fracture, 3 of middle-tibia and 7 of middle-lower. The sizes of soft tissue defect ranged from 5 cm × 3 cm to 22 cm × 10 cm.The sizes of exposed bone ranged from 3 cm × 2 cm to 6 cm × 3 cm. The course of the disease was 1-12 hours. Fracture fixation was reached by external fixators or external fixators and l imited internal fixation with Kirschner wire. The wounds with exposed tendons and bones were repaired by ipsilateral local rotation flap, sural neurocutaneous flap and saphenous nerve flap. The size of selected flap ranged from 5 cm × 4 cm to 18 cm × 12 cm. Granulation wounds were repaired by skin grafting or direct suture. Results All patients were followed up for 6 months to 2 years. All patients survived, among whom 2 with the wound edge infection and 1 with the distal necrosis were cured by changing the dressing, 8 with pin hole infection were treated by taking out the external fixator, 1 with nonunion received facture heal ing after bone graft in comminuted fracture of lower tibia, 2 suffered delayed union in middle-lower tibia fracture. The ROM of ankle in 3 cases was mildly poor with surpass-joint fixation, with plantar extension of 0-10° and plantar flexion of 10-30°, while the others had plantar extension of 10-20° and plantar flexion of 30-50°. Conclusion The method of pedicle flap transfer combined with external fixator is safe and effective for the leg open fracture with soft tissue defect.
The causes of development of 56 cases of bone defects from firearm injuries of extremities were analyzed, and the advantages of transfer of vascularized iliac bone graft with deep iliac circumflex vessels in 28 cases and the indications of transfer of vascularked fibular bone graft with fibular vessel in 15 cases and the exporiences in 9 cases from the methed of transter of seapula-cutaneous composite graft were summarized. It was emphatically pointed out that the half-circle typo externa fixators had its unique advantages in the treatment of the bone defects of long bones of extremities from firearm injuries. It would enentually become the method of priority for the treatment of fractures, nonunion of fractures and bone defects of extremities from firearm injuries.
Objective To compare the clinical results of locking compress plate (LCP) as an external fixator and standard external fixator for treatment of tibial open fractures. Methods Between May 2009 and June 2012, 59 patients with tibial open fractures were treated with LCP as an external fixator in 36 patients (group A), and with standard external fixator in 23 patients (group B). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, location, and interval between injury and surgery between 2 groups (P gt; 0.05). The time of fracture healing and incision healing, the time of partial weight-bearing, the range of motion (ROM) of knee and ankle, and complications were compared between 2 groups. Results The incidence of pin-track infection in group A (0) was significantly lower than that in group B (21.7%) (P=0.007). No significant difference was found in the incidence of superficial infection and deep infection of incision, and the time of incision healing between 2 groups (P gt; 0.05). Deep vein thrombosis occurred in 5 cases of group A and 2 cases of group B, showing no significant difference (χ2=0.036, P=0.085). All patients were followed up 15.2 months on average (range, 9-28 months) in group A, and 18.6 months on average (range, 9-47 months) in group B. The malunion rate and nonunion rate showed no significant difference between groups A and B (0 vs. 13.0% and 0 vs. 8.7%, P gt; 0.05); the delayed union rate of group A (2.8%) was significantly lower than that of group B (21.7%) (χ2=5.573, P=0.018). Group A had shorter time of fracture healing, quicker partial weight-bearing, greater ROM of the knee and ankle than group B (P lt; 0.05). Conclusion The LCP external fixator can obtain reliable fixation in treating tibial open fracture, and has good patients’ compliance, so it is helpful to do functional exercise, improve fracture healing and function recovery, and reduce the complication incidence.