Objective To investigate the effects of long proximal femoral nail antirotation (PFNA-long) in treating long-segment fracture in middle-up part of femoral. Methods From June 2006 to December 2013, we treated 139 cases long-segment fracture in middle-up part of femoral with long proximal femoral nail antirotation (PFNA, 320-380 mm) by minimally invasive per-cutaneous fixation and autogenous iliac bone graft. Data of 139 patients (104 male and female 35;ages 18 to 86 years, with an aver-age age of 48.8 years). Type IA 58 cases (41.73%, 58/139), type IB 25 cases (17.99%, 25/139), type IC 4 cases (2.88%, 4/139), type II 28 cases (20.14%, 28/139), type IIIA 12 cases (8.63%, 12/139), type IIIB in 5 cases (3.60%, 5/139), type IV 7 cases (5.04%, 7/139). The duration from injury to surgery was 3 hours to 12 days, with an average of 4.2 days. The postoperative follow-up was at 1, 2, 3, 6, 9, 12 months, and annually at least. The clinical efficacy was evaluated with Harris hip function score. The postoperative pain was evaluated with visual analogue scale (VAS). Results The operative time of 139 cases was from 35 to 90 minutes, averaged 45 minutes and the blood loss during surgery averaged 78.6 ml (ranged from 30 to 200 ml). All patients walked by walking aid appliance after 4 to 10 days postoperatively, apart from 16 cases with serious long grinding fracture. All patients had been followed up for 3 to 37 months (mean 19 months). No complications, such as infection, lower limb vein infarction, cut-out and breakage of the implants, occurred. However, there were 4 patients with nail broken and 6 patients with hip internal rotation who were treated by secondary operation. There were 5 cases with slight hip external rotation and 8 cases with hip internal reverse-lamb shortening malformation. All fractures healed after 2.8-6.8 months (mean 3.9 months). According to Harris criteria, the clini-cal results were best in 108 cases, better in 22 cases, good in 8 cases, and bad in 1 case. The excellent and good rate was 93.53%(130/139). The score for VAS was 0-6 (mean 0.8), 93 cases in which no pain, mild pain in 33 cases, moderate pain in 13 cases, 25 cases occasionally need to take non-steroidal analgesics. Conclusion Closed reduction or limited open reduction with PFNA-long is an effective treatment for long-segment fracture in middle-up part of femoral, with higher strength in fixation, higher rate of fracture union, early functional recovery and lower rate of complications.

Objective To compare the clinical effects of conventional incision versus oblique mini-incision in the treatment of displaced midshaft clavicular fractures. Methods A prospective randomized controlled trial was performed between August 2014 and August 2016 in 79 patients with acute displaced midshaft clavicular fracture. They were randomly divided into 2 groups to receive either conventional incision or oblique mini-incision treatment. In the oblique mini-incision group, there were 37 cases, 20 males and 17 females, with an average age of 37.4 ± 13.2 years. By the Robinson fracture classification, there were 9 cases of type 2A2, 16 ones of type 2B1, and 12 ones of type 2B2. In the conventional incision group, there were 42 cases, 22 males and 20 females, with an average age of 38.2 ± 14.5 years. By the Robinson fracture classification, there were 9 cases of type 2A2, 19 ones of type 2B1, and 14 ones of type 2B2. We recorded operation time, intraoperative blood loss, scar size, clinical complications and fracture healing time. Functional assessments were conducted at l2 months using the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores, and a questionnaire on numbness, scar appearance and satis-faction. Results Only 58 patients finished a complete follow-up. The preoperative general data showed no statistical significance between the 2 groups (P > 0.05). All the 58 patients were followed up for 13 to 24 months (average, 15.3 months). There were no significant differences between the 2 groups in operation time, fracture healing time, the DASH or Constant-Murley score, or clinical complications (P> 0.05). However, the intraoperative blood loss in the oblique mini-incision group (20.8 ± 10.7 mL) was significantly less than that in the conventional incision group (41.6 ± 7.6 mL), the scar size in the former (3.6 ± 1.6 cm) significantly shorter than that in the latter (10.3 ± 2.6 cm), and the rate of symptoms of residual injury to the supra-clavicular nerve in the former (10.7%, 3/28) significantly lower than that in the latter (43.3%, 13/30) (P <0.05). Moreover, the oblique mini-incision group was significantly better than the conventional incision group in numbness on the shoulder or anterior chest, scar appearance and satisfaction. Conclusions The oblique mini-incision may be advantageous over the conventional incision in intraoperative blood loss, scar size and appearance, iatrogenic supraclavicular nerve damage and satisfaction. However, the 2 incisions may lead to similar functional recovery of the shoulder.