Objective To summarize the application of the Cable Plate System in the treatment of periprosthetic femur fracture after hip replacement. Methods The clinical data and image records of 11 patients who underwent reduction and fixation by means of the Cable Plate System from 1998 to 2002 were retrospectively analyzed. The follow-up and X-ray results at different times after operation were evaluated. Results Out of the 11 cases, non-deforming union and stable prosthesis were obtained in 8 cases, non-deforming union and slight subsidence of prosthesis in 2 cases, and, a broken plate and varus malunion occurred in 1 case, in which a second operation was required. Conclusions The Cable Plate System is one of the effective methods in the treatment of periprosthetic femur fracture after hip replacement.

Objective To investigate the clinical results of limited exposure and indirect reduction in treatment of tibial plateau fractures. Methods 41 cases of tibial plateau fractures were treated with limited exposure and indirect reduction. According to Schatzker classification, there were 6 cases of type Ⅰ, 13 type Ⅱ, 11 type Ⅲ, 6 type Ⅳ, 3 type Ⅴand 2 type Ⅵ. Type I fractures were reduced in the close manner by applying large reduction forceps and fixed with percutaneous lag screws. Type Ⅱ, type Ⅲand Type Ⅳfractures were reduced by applying large reduction forceps and fixed by percutaneous plating after restoring joint surface and bone grafting. Type Ⅴand Type Ⅵfractures were reduced by applying fracture distracter and large reduction forceps before they were fixed with percutaneous plating. The clinical outcomes were assessed according to Rasmussens system. Results 36 patients were followed up from 6 to 60 months, with an average of 30.2 months. No deep vein thrombosis, infection, or compartment syndrome was found postoperatively. All the 36 fractures united. Overall, 25 (69%) patients were rated as excellent, 8 (22%) good, and 3 (9%) fair. Conclusion In treatment of tibial plateau fracture, limited exposure and indirect reduction has advantages of less dissection, stable fixation, early movement, better joint function and fewer complications.

Objective To explore the surgical result of unilateral half-pin external fixation in the treatment of distal tibial fracture. Methods For type A fracture, two pins were inserted into the proximal fragment of tibia fracture and another two pins into the distal fragment; for type B and C fracture, distal pins were inserted into the talus and calcaneus. The fracture reduction was performed by distraction of external fixators. A limited open reduction was required in some difficult cases to restore the joint surface, with bone grafting and small fragments fixed with wires or screws. Meanwhile, fracture of fibula was fixed with plate and screws. Results The duration of external fixation was 3.5~8 months (mean, 5 months) in 22 patients. Bone union was achieved in all patients, without serious deep infection, osteomyelitis, or non-union. The patients were followed for 10~32 months (mean, 20 months). Functional exercise was carried out for more than 6 months after the removal of the external fixator. According to the Tornetta’s evaluation standard, excellent results were obtained in 11 patients, good in 7 patients, fair in 3, and poor in 1. Conclusions Unilateral half-pin external fixation combined with limited open reduction and internal fixation is a simple and effective minimally invasive method for the treatment of distal tibial fracture.

Objective To evaluate the short-term outcomes of minimally invasive percutaneous plate osteosynthesis(MIPPO) combined with locking compression plate(LCP) in the treatment of distal tibial fractures.Methods From June 2004 to March 2006,16 patients with distal tibial fractures were treated using MIPPO combined with LCP in our department.According to the AO classification,there were 7 cases of type 43A1,5 type 43A3,2 type 43B1 and 2 type 43C3.After reduction of tibial fracture with three methods,LCP was inserted and fixed with locking screw.All the cases were followed up periodically after the operation.Results All the cases were followed up for 5 to 20 months(mean,11.5 months).Primary wound healing was achieved in 16 patients.No complications,such as non-union,abnormal union and breakage of the plate,occurred in the cases.Callus formation was seen on X-rays at 7.6 weeks(4 to 12 weeks) after the surgery,when the patients began part weight-bearing exercises.The bone union was detected at 16 weeks(8 to 20 weeks),when the patients began full weight bearing.3 patients felt uncomfortable at the distal tibia around the implant.According to the AOFAS Ankle-Hindfoot Scale,14 cases(87.5%) were excellent and 2(12.5%) were good.Conclusions MIPPO combined with LCP technique is an effective treatment for the fractures of the distal tibia.This minimally invasive method can achieve stable fixation,promote bone healing,and permit early functional rehabilitation.

Objective To investigate the clinical results, indications and choices of surgical treatment of minimally invasive internal fixation by cannulated compression screws in the treatment of femoral neck fractures. Methods The authors retrospectively analyzed clinical data of 83 patients with femoral neck fractures treated by minimally invasive internal fixation by AO cannulated screws. Results According to the Garden classification, the patients comprised 12 cases of type I, 39 cases of type II, 23 type III and 9 type IV. The mean time from injury to surgery was 63.4 hours, the mean operation time was 65.7 min, the mean intraoperative blood loss was 64 ml and the mean hospital stay was 7.7 days. No wound infection, deep venous thrombosis of leg, pulmonary embolism or breakage of internal fixation occurred. No patients died. Follow-up observation ranged 12～48 months, with a mean of 31.3 months. Normal bone union was obtained in all the cases. Postoperatively, shortening of femoral neck took place in 4 patients (4/83, 4.8%) and different degrees of osteonecrosis happened in 7 patients (7/83, 8.4%). The mean postoperative Harris hip score was 94.6. Conclusions Minimally invasive internal fixation by cannulated compression screws for femoral neck fractures may be an effective alternative. This method is indicated for Garden I/II fractures without displacement in patients above 65 years old, or any types of femoral neck fractures in patients below 65 years old.

Objective To investigate the clinical results of minimally invasive plate fixation for tibial plateau fractures. Methods Minimally invasive plate fixation was adopted in 26 cases of tibial plateau fractures from January 2000 to June 2003. Results Follow-up for 6 months ～ 4 years (mean, 2 1 years) showed bone union in all the patients. The results of therapy were assessed according to the Merchant criteria as follows: excellent in 20, good in 5 and fair in 1. Conclusions Minimally invasive plate fixation in the management of tibial plateau fractures has advantages of minimal trauma, reliable fixation, early movement and fewer complications, being a valuable clinical alternative.

[Summary] Acute acromioclavicular joint dislocation is a common injury of the shoulder .Its surgical treatment is various .In recent years , with the promotion of arthroscopic techniques , arthroscopic treatment has gradually become a hot spot in the field of minimally invasive treatment for acute acromioclavicular joint dislocation .There are various types of internal fixation .The overall treatment effect is satisfactory .In this review we summarized minimally invasive treatment for acromioclavicular joint dislocation .

Objective To investigate outcomes of different operations in treatment of cervical spinal fracture in patients with ankylosing spondylitis and summarize experiences and bases in selection of operation.Methods A retrospective study was done on 19 patients with cervical spinal fracture following ankylosing spondylitis treated between 2005 and 2011 and received complete follow-up.Among them,nine patients were treated with combined anterior and posterior surgical approach (combined treatment group),seven with single posterior surgical approach (posterior approach group) and three with single anterior surgical approach (anterior approach group).Clinical data,follow-up data and image outcome of the patients were collected and compared.Results All patients received average 14 months of follow-up (range,12-20 months).In combined treatment group,the fracture was healed at postoperative 4-6 months.One patient had palsy of recurrent laryngal nerve but was recovered at postoperative three months.Seven patients with incomplete spinal cord injury had at least one level improvement in neurological function according to American Spinal Injury Association (ASIA) classification.No implant loosening or shifting were found in internal fixation.In posterior approach group,fracture was healed at postoperative 4-6 months,with no surgical complications,loosening or shifting of implants.Five patients with incomplete spinal cord injury had at least one level improvement in neurological function according to ASIA classification.In anterior approach group,an additional operation for implant loosening was performed in one patient at postoperative four weeks.The other two patients obtained fracture healing at postoperative four and five months respectively,without implant loosening.Condusions Combined anterior and posterior approaches can not only be the first choice for treatment of cervical spinal fracture following ankylosing spondylitis,but also be used for patients with bone defect at fracture site or separation at fracture end,with no necessity of postoperative external fixation.Single posterior reduction and fixation can be considered in patients with transvertebral fracture in the absence of bone defect,separation at fracture end,displacement or slight displacement,with necessary postoperative external fixation.However,single anterior fixation takes risk of implant failure and needs postoperative external fixation.

Objective To compare the efficacy of reversed less invasive stabilization system (LISS) and intramedullary fixation devices for treatment of femoral trochanteric fractures.Methods Data of 362 consecutive patients with femoral trochanteric fractures who were treated with reversed LISS or intramedullary fixation devices at our institution between March 2004 and May 2011 were retrospectively analyzed.There were 32 males and 38 females treated with reversed LISS.The mean age at injury was 73.4 years.There were 125 males and 167 females treated with intramedullary fixation.The mean age at injury was 74.7 years.The operation time,intraoperation blood loss and length of hospitalization were compared.The patients were asked to fill in a questionnaire of Harris hip score,and radiographs were used to evaluate the bone healing situation.Results The mean operation time was 120 min in reversed LISS group and 80 min in intramedullary group.The length of hospitalization was 12 days in reversed LISS group and 10 days in intramedullary group.More operation time and longer length of hospitalization were needed in reversed LISS group.The intraoperation blood loss was 100 ml in reversed LISS group and 100 ml in intramedullary group.There were 3 DVT in reversed LISS group,10 DVT and 3 PE in intramedullary group.No difference was found in the aspect of intraoperation blood loss,postoperative deep venous thrombosis and pulmonary embolism rate.A total of 320 patients were successfully followed-up,including 63 in LISS group and 257 in intramedullary group.The median Harris score was 75 in LISS group and 77 in intramedullary fixation group respectively.There was no difference of hip function score between two groups.The implant-related complication rate was 11.1％ in reversed LISS group,including 7 implant breakages.In intramedullary fixation group,there were neck screw exiting in 2 patients and cutout in 9 patients.So the implant-related complication rate was 4.3％ in intramedullary fixation group,which is statistically lower.Conclusion Both reversed LISS and intramedullary are effective for the treatment of proximal femoral fractures.There were no major difference in functional outcome between LISS and intramedullary nail.Intramedullary nail is still the choice of priority in most unstable proximal femoral fractures.The implants related complications in reversed LISS group are higher than Intramedullary nail group.However,for the unstable fractures proximal femoral fractures with lateral wall fracture,in which nailing may be difficult,reversely using LISS may be a good alternative.

Objective To evaluate the curative effects of surgical treatment of unstable clavicular fractures. Methods From August 2000 to April 2005, 50 cases of clavicular fracture in our department underwent open reduction and internal fixation with reconstruction plate or clavicular hook plate or 1/3 tubiform titanium plate. According to Robinson’s classification, 12 of them were identified as type-2B1, 24 as type-2B2, 1 as type-3A1 and 13 as type-3B2. 13 cases of them had other injuries. 37 patients were fixated with a reconstruction plate. Clavicular hook plates were applied in 12 cases. One patient was fixated with the 1/3 tubiform titanium plate. The curative effects were evaluated on the basis of healing time, quality of healing and function of the shoulder. Results All the 50 patients were followed up. The mean follow-up was 19 months (2 to 57). All the clavicular fractures achieved bony union. The mean healing time was 2.5 months (2 to 4). 3 patients experienced malunion. The functions of the shoulder were excellent in 32 cases, good in the other 18 patients. The total clinical efficacy was evaluated as excellent in 22 patients, good in 23 and fair in 5. Conclusions The type-2B and type-3B fractures in Robinson’s classification belong to unstable clavicular fractures. The patients treated by operation can recover normal functions soon without considerable complications.