To investigate the therapeutic effect of open reduction, bone grafting, and internal fixation with plastic ti-alloy plate on intra-articular calcaneal fracture. Methods From January 2005 to December 2007, 32 patients (37 feet) with intra-articular calcaneal fracture underwent open reduction, bone grafting of autogeneic il ium (30-80 g) and internal fixation of plastic ti-alloy plate. There were 21 males and 11 females aged 18-56 years old (average 42.1 years old). There were 5 cases of bilateral calcaneal fracture and 27 cases of unilateral calcaneal fracture, including 2 cases of open fracture and 30 cases of close fracture. According to Sanders classification system, there were 11 cases of type II, 18 cases of type III and 8 cases of type IV. Preoperatively, Bouml;hler angle was (— 9.6 ± 4.2)° and Gissane angle was (101.4 ± 10.6)°. Nine feet underwent emergency operation and 28 feet received operation 5-7 days after injury. Results The wounds of 34 feet healed by first intention. The wound margin of 3 feet was gray with a small amount of colorless exudates, and healed after dressing change. All patients were followed for 12-24 months (average 16 months). X-ray films displayed that the fracture all healed within 3-4 months after operation. At 6 months after operation, the Bouml;hler angle and the Gissane angle was (28.5 ± 6.1)° and (128.9 ± 4.8)°, respectively, indicating there were significant differences when compared with before operation (P lt; 0.05). According to Maryland foot score system, 15 cases were graded as excellent, 18 cases were good, 4 cases were poor, and the excellent and good rate was 89.19%. Conclusion Open reduction, bone grafting, and internal fixation with plastic ti-alloy plate is an effective method to treat intra-articular calcaneal fracture. Choosing right operational timing, performing subarticular surface grafting when necessary and using appropriate plastic ti-alloy plate internal fixation can minimize the incidence of postoperative compl ications
Objective To compare the bone resorption between the proximal fixation of the anatomique benoist giraud（ABG） hip and the distal fixation of the anatomic medullary locking（AML） hip by the medium-term X-ray films, and to evaluate the clinical results of the two prostheses. Methods From January 1992 to December 1996, 298 patients (396 hips) underwent the total hip arthroplasty at Wilson Hospital in Korea. In 125 patients, 176 hips were ABG hips, including 103 avascularnecrosis hips, 57 dysplasia hips, and 16 other diseased hips; In the other 173 patient the remaining 220 hips were AML hips, including 147 avascular necrosis hips, 65 dysplasia hips, and 8 other diseased hips. The A-P X-ray imagings were followed up for 5-12 years averaged 8 years, and were compared with the immediate postoperative X-ray imagings. The bone resorption area was measured and the bone resorption cases were recorded according to the Gruen zone obsesvation. Results During operation, 2 ABG hips and 5 AML hips were cracked at the femoral diaphysis; 3 ABG hips and 1 AML hip were cracked at the metaphysis; 6 ABGhips and 3 AML hips were fractured because of trauma after operation; among them, 2 ABG hips needed the stem revision and the remaining hips underwent the openreduction and the internal fixation. During the follow-up, 9 ABG hips were revised, 7 hips of which developed the aseptic loosening. No AML hip was revised, but 3 AML hips developed the aseptic loosening. The bone resorption pattern in theABG and AML hips was similar. The bone resorption occurred most commonly in theGruen zones 1 and 7, and it extended from the metaphysis to the diaphysis. In the Guren zones 2, 5, 6 and 7, there were more AML hips than ABG hips that developed the bone resorption. The bone resorption area around the AML hip was larger than that around the ABG hip. Conclusion The stress shielding bone resorption usually occurs proximally to the union area of the bone and the prosthesis. The ABG prosthesis is a proximal fixation prosthesis, therefore, the stress shielding bone resorption can be reduced. The bone resorption around the AML prosthesis develops slowly within 10 years after operation. The stress shielding bone resoption may reach the summit within 10 years and it will not develop endlessly, so the prosthesis will be stable for a long time. The probabilityof the bone resorption in the ABG prosthesis is smaller than that in the AMLprosthesis. The bone resorption around the AML prosthesis may develop slowly after 10 years and will not affect the stability of the prosthesis for a long time.
ObjectiveTo compare the effectiveness and radiological changes between KMC interspinous dynamic reconstruction and Coflex for degenerative lumbar spinal disorders and evaluate the clinical outcome of the KMC interspinous dynamic internal fixation for degenerative lumbar spinal disorders. MethodsA randomized controlled double-blind trial was conducted. Thirty-three patients with degenerative lumbar spinal disorders were divided into 2 groups between May 2011 and July 2012, 19 patients received Coflex treatment (group A), and 14 patients received KMC (group B). Single Coflex or KMC fixation was used. There was no significant difference in age, gender, disease duration, affected segment, and disease diagnosis between 2 groups (P>0.05). The Oswestry disability index (ODI) score and visual analogue scale (VAS) score were used to evaluate the effectiveness. The anterior disc height, middle disc height, posterior disc height, and foramen intervertebral height and width of operated segment were measured and compared between at preoperation and last follow-up on the X-ray films. Range of motion (ROM) of operated segment and adjacent segment was measured. ResultsThere was no significant difference in operation time, intraoperative blood loss, postoperative recovery time, and hospitalization time between 2 groups (P>0.05). The patients were followed up 12-24 months (mean, 16.2 months) in group A and 12-26 months (mean, 17.9 months) in group B. No shift, loosening, or breaking of internal fixation occurred. The ODI score and VAS score were significantly decreased at last follow-up when compared with preoperative scores (P<0.05); there was no significant difference in the ODI score and VAS score at preoperation and last follow-up, and in improvement rate at last follow-up between 2 groups (P>0.05). The middle disc height and posterior disc height, and foramen intervertebral height and width were significantly increased when compared with preoperative ones (P<0.05), while there was no significant difference in anterior disc height (P>0.05). At last follow-up, ROM of the operated segments was significantly improved when compared with preoperative one in 2 groups (P<0.05), but no significant difference was found at the upper adjacent level (P>0.05). There was no significant difference in ROM of the operated segment and upper adjacent segment between 2 groups at preoperation and last follow-up (P>0.05). ConclusionThe early effectiveness is satisfactory to treat degeneration lumbar spinal disorders with KMC interspinous dynamic internal fixation.
Objective To evaluate the biomechanical effect of a self-made iliac screw plate on the stability of lumbo-iliac fixation construct before and after fatigue loading. Methods Twelve fresh lumbo-pelvic specimens from donated adult cadavers with formalin embalm were used in the study. According to whether use the iliac screw plate or not, the specimens were randomly assigned into group A (with iliac screw plate, n=6) and group B (without iliac screw plate, n=6). The bone mineral density (BMD) of L1-4 was measured using dual-energy radiograph absorptiometry. The pedicle screw and iliac screw fixation were given at L3-5, and bilateral facetectomy and diskectomy at L5, S1 level were performed to prepare the model of the intervertebral destabilization. The biomechanical testing was conducted on a material testing machine under 0-600 N compression and — 7-7 N · m torsion loading modes for the initial compressive stiffness and torsional stiffness evaluation. And then 20 000 cyclic compressive loading of 40-400 N was given to the specimen, the stiffness evaluation was repeated. Then the maximum pull-out strength of screws at every level was measured and compared. Gross observation and radiological observation were performed during experiment. Results The BMD values of groups A and B were (1.15 ± 0.13) g/cm2 and (1.12 ± 0.11) g/ cm2 respectively, showing no significant difference between 2 groups (t=0.428, P=0.678). All pedicle screws and iliac screws were inserted in good position; no loosening or breaking of screw was observed during loading. After fatigue loading, the incidence of halo ring around the iliac screws of groups A and B was 16.7% (1/6) and 50.0% (3/6), respectively. The compressive stiffness and torsional stiffness after fatigue loading were significantly lower than those in initial state in groups A and B (P lt; 0.05); there was no significant difference in compressive stiffness and torsional stiffness between groups A and B before fatigue loading (P gt; 0.05). However, group A had higher compressive stiffness than group B (t=2.664, P=0.024) after fatigue loading, and there was no significant difference in torsional stiffness between 2 groups (t=0.410, P=0.690). No significant difference was found in screw pull-out strength of pedicle screws at L3, L4, and L5 levels between groups A and B (P gt; 0.05); however, the pull-out strength of the iliac screws in group A was significantly higher than that in group B (t=3.398, P=0.007). In groups A and B, the pull-out strength of L3 screw was significantly lower than that of L4 and L5 screws (P lt; 0.05). In group A, pull-out strength of the iliac screws was significantly higher than that of L3, L4, and L5 screws (P lt; 0.05); in group B, the pull-out strength of iliac screws was significantly lower than that of L4 and L5 screws (P lt; 0.05). Conclusion In the lumbo-iliac reconstruction, the use of iliac screw plate could resist iliac screw loosening, therefore, it has the potential to increase the stability of lumbo-iliac fixation construct.
Objective To introduce a method for fixation in periprosthetic fracture with locking compression plate (LCP). Methods Duringthe surgery, a long 12-hole LCP was placed to the lateral side of the femur. Six holes of the plate were placed proximal to the main fracture line to make sure that there could be enough cortex units for rigid fixation of proximal fragments. Locking screws used except for the most proximal hole where a 4.5 mm screw was used instead. Results The patient was pain free at the fracture site one week after the surgery,and was able to walk with a cane 3 months after the surgery. Bone union was evident radiographically 3 months after the surgery. There was no loose signs around the stem. Six months after the surgery, the patient recovered full function without pain. Conclusion In our experience from this case, LCP in treating periprosthetic fracture was easy and less time consuming, more over, extensive periosteal stripping could be avoided. LCP is a good choice in treating some periprosthetic fractures.
Objective To review the latest research progress of fixation techniques of ankle arthrodesis.Methods The l iterature concerning the research of fixation techniques of ankle arthrodesis in recent years was reviewed. Then the characteristics and new research progress of different internal and external fixation techniques were analysed and compared. Results There are plenty of different types of internal and external fixation devices, each with distinct characteristics. Now it is widely considered that internal fixation is the first choice for end-stage ankle arthropathy. However, under the circumstances that patients with serious bone defect, chronic active infection, or extensive soft tissue damage are not suitable for internal fixation, ankle arthrodesis with external fixation is still a safe and effective method. Conclusion For severe or end-stage ankle arthropathy, ankle arthrodesis is a mature therapeutic way with exact effect. Researches on these two aspects, expansion of indications of internal fixation and comparison and combination of internal and external fixation techniques, need to be deepened, which is of great significance for choosing a better fixation method and acquiring a better therapeutic effect.
Objective To explore the anatomic basis for theanterior approach screw fixation through the C2 vertebral body into the C1 lateral mass and toinvestigate its primary clinical application. Methods Twenty-one adult corpse specimens were anatomically measured. The minimum lateral angle α, the maximum lateral angle β, and the maximum posterior angle γ were calculated based on the data from the anatomic measurement. All the specimens were given an X-ray examination, the minimum lateral angle α, the maximum lateral angle β, and the maximum posterior angle γ were measured. The statistical analysis was made on the data obtained from the calculation in the specimens and the measurement in the X-ray films. The simulation of the approach was made onthe specimen. From October 2004 to July 2006, the simulated approach was used in 5 patients (3 males, 2 females; age, 30-55 years; illness course, 3 months-2 years) with the old atlanto-axial joint dislocation . The Frankel grading system revealed the spinal cord injury degree as follows: 1 patientwas in Grade B, 2 in Grade C, and 2 in Grade D. All the patients were treated with this surgical approach. The postoperative X-ray and CT examinations were performed. Results Angle α was 14.0±1.6°, β was 30.0±2.3°, γ was 29.0±2.9°. No significant difference existed between the angles calculated in the specimens and measured in the X-ray films (Pgt;0.05). The angles for the practical application during operation were as follows: α was 11.2±1.6°, β was 28.8±2.3°, and γ was 29.3±2.9°. The follow-up for an average of 14 months revealed that 1 patient recovered to Grade C, 1 to Grade D2, and 3 to Grade D3 in the spinal cord function according the modified Frankel grading system.Conclusion The anterior approach screw fixation through the C2 vertebral body into the C1 lateral massis feasible and safe in treatment of the old atlantoaxial joint dislocation ifthe screw insertion is exact in direction. This technique only makes the atlas temporarily stable, and so the posterior bone graft should be added into the atlantoaxial joint immediately in the one- or two-stage operation so as to achieve a long-lasting stability.
Objective To find out an ideal method of internal fixation for the treatment of fractures of proximal radius. Methods From August 2001 to April 2004, 24 patients suffering from fractures of proximal radius were treated with NiTi shape memory alloy embracing fixator. Of 24 patients, there were 19 males and 5 females, aging from 16 to 48 years; there were 9 cases of wrestling injury, 5 cases of crush injury, 4 cases of traffic accident injury, 3 cases of direct violence impact injury and 3 cases of high falling injury. All patients were given operation according to fix method of the shape memory alloy embracing fixator. All cases were regularly followed up to observe the fracture healingand functional recovery. Results All cases were followed up postoperatively from 4 months to 21 months with an average of 10 months. No complication occurred during operation and after operation. Healing by first intention was achieved. X－ray showed that all cases achieved clinical union 8－12 weeks after operation. According to Anderson’scriteria and the results were excellent in 18 cases, good in 5 cases, and fairin 1 case. The excellent and good rate was 95.83 %. Conclusion The internal fixation with shape memory alloy embracing fixator has as follows adventages: less trauma, esay－to－do, stable fixation, better tissue compatibility and less complication in treating fractures of proximal radius. This method can enhance the fracture healing and functional recovery. So it is a better method to treat fractures of proximal radius.
Objective To investigate the effectiveness and adverse effect of the absorbable fixation system on cranial bone flap reposition and fixation after craniotomy. Methods Between July 2010 and December 2011, 67 cases underwent cranial bone flap reposition and fixation with absorbable fixation system after craniotomy and resection of intracranial lesions. There were 38 males and 29 females with a median age of 32 years (range, 5 months to 73 years). The disease duration ranged from 3 months to 6 years (median, 25 months). Forty-one lesions were located at supratentorial and 26 at subtentorial, including at the frontotemporal site in 13 cases, at the frontoparietal site in 12 cases, at the temporal oprietal site in 8 cases, at the temporooccipital site in 5 cases, at the occipitoparietal site in 4 cases, and at the posterior cranial fossa in 25 cases. The diagnosis results were glioma in 15 cases, cerebral vascular diseases (aneurysm, arteriovenous malformation, and cavemous angioma) in 8 cases, meningioma in 7 cases, arachnoid cyst in 7 cases, acoustic neurinoma in 5 cases, cholesteatoma in 3 cases, primary trigeminal neuralgia in 5 cases, cerebral abscess in 3 cases, hypophysoma in 2 cases, craniopharyngioma in 2 cases, metastatic tumor in 2 cases, radiation encephalopathy in 2 cases, medulloblastoma in 1 case, ependymocytoma in 1 case, germinoma in 1 case, atypical teratoma/rhabdoid tumor in 1 case, facial spasm in 1 case, and subdural hematoma in 1 case. Intracranial lesion size ranged from 3 cm × 2 cm to 7 cm × 5 cm. The changes of local incision and general condition were observed. Results Subcutaneous effusion occurred in 2 supratentorial lesions and 3 subtentorial lesions, which was cured at 2 weeks after puncture and aspiration. All incisions healed primarily and no redness or swelling occurred. CT scans showed good reposition of the cranial bone flap and smooth inner and outer surfaces of the skull at 2 weeks after operation. All 67 patients were followed up 3-20 months (mean, 10.3 months). During follow-up, the skull had satisfactory appearance without discomfort, local depression, or effusion. Moreover, regular CT and MRI scans showed no subside, or displacement of the cranial bone flap or artifacts. Conclusion Absorbable fixation system for reposition and fixation of the cranial bone flap not only is simple, safe, and reliable, but also can eliminate the postoperative CT or MRI artifact caused by metals fixation system.
Objective To explore the effectiveness of fixation of atlas translaminar screws in the treatment of atlatoaxial instability. Methods A retrospective analysis was made on the clinical data of 32 patients with atlatoaxial instability treated with atlantoaxial trans-pedicle screws between March 2007 and August 2009. Of them, 7 patients underwent atlas translaminar screws combined with axis transpedicle screws fixation because of fracture types, anatomic variation, and intraoperative reason, including 5 males and 2 females with an average age of 48.2 years (range, 35-69 years). A total of 9 translaminar screws were inserted. Injury was caused by traffic accident in 4 cases, falling from height in 2 cases, and crushing in 1 case. Two cases had simple odontoid fracture (Anderson type II), and 5 cases had odontoid fracture combined with other injuries (massa lateralis atlantis fracture in 2, atlantoaxial dislocation in 1, and Hangman fracture in 2). The interval between injury and operation was 4-9 days (mean, 6 days). The preoperative Japanese Orthopaedic Association (JOA) score was 8.29 ± 1.60. Results The X-ray films showed good position of the screws. Healing of incision by first intention was obtained, and no patient had injuries of the spinal cord injury, nerve root, and vertebral artery. Seven cases were followed up 9-26 months (mean, 14 months). Good bone fusion was observed at 8 months on average (range, 6-11 months). No loosening, displacement, and breakage of internal fixation, re-dislocation and instability of atlantoaxial joint, or penetrating of pedicle screw into the spinal canal and the spinal cord occurred. The JOA score was significantly improved to 15.29 ± 1.38 at 6 months after operation (t=32.078, P=0.000). Conclusion Atlas translaminar screws fixation has the advantages of firm fixation, simple operating techniques, and relative safety, so it may be a remedial measure of atlatoaxial instability．