1.Kirschner wire for clavicle fracture fixation is broken and displaces to the neck: a case report.
Cheng-peng ZHOU ; Shi-chang GAO ; Jia LIU
China Journal of Orthopaedics and Traumatology 2012;25(4):281-282
Aged
;
Bone Wires
;
adverse effects
;
Clavicle
;
injuries
;
surgery
;
Fracture Fixation, Internal
;
adverse effects
;
Humans
;
Male
;
Neck
2.External fixation versus open reduction and internal fixation for tibial pilon fractures: A meta-analysis based on observational studies.
Chinese Journal of Traumatology 2016;19(5):278-282
PURPOSETibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation (ExFix) and open reduction and internal fixation (ORIF) are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications.
METHODSA computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library (before December 2014) for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference (WMD), risk ratio (RR) and corresponding 95% confidence intervals (CI) were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2.
RESULTSTen cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection (p = 0.13), reduction (p = 0.11), clinical evaluation (p = 0.82), post-traumatic arthrosis (p = 0.87), and union time (p = 0.35). Besides, ExFix group was found to have a higher rate of superficial infection (p =0.001), malunion (p = 0.01) and nonunion (p = 0.02), but have a lower risk of unplanned hardware removal (p = 0.0002).
CONCLUSIONSWe suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, but a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation, post-traumatic arthrosis and union time.
External Fixators ; adverse effects ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Tibial Fractures ; surgery
3.Advances on internal fixation treatment for femoral neck fracture in elderly patients.
China Journal of Orthopaedics and Traumatology 2014;27(8):706-708
Compared with hip replacement, internal fixation in the treatment of the elderly femoral neck fracture, especially the application of cannulated screws, is minimally invasive, easy to operate and economical. In recent years, it becomes the research focus in the field of orthopedic clinical research. However, configuration of cannulated screws is still controversial. Most clinicians believe that three cannulated screws being placed in parallel in an inverted triangle configuration is better than that in a triangular configuration in biomechanics and clinical effect. Nonparallel strong oblique nailing technique allows the screws to share more weight to reduce postoperative complications, so that it is more suitable for elderly patients with osteoporosis. However, the related complications of internal fixation such as nonunion, femoral neck shortening and other problems are still the focus of domestic and foreign scholars. Issues about how to control the indication of internal fixation surgery, understand related factors of the complications, and prevent complications are required to be further explored.
Aged
;
Bone Nails
;
Femoral Neck Fractures
;
surgery
;
Fracture Fixation, Internal
;
adverse effects
;
methods
;
Humans
;
Internal Fixators
4.Clinical efficacy and safety of limited internal fixation combined with external fixation for Pilon fracture: A systematic review and meta-analysis.
Shao-Bo ZHANG ; Yi-Bao ZHANG ; Sheng-Hong WANG ; Hua ZHANG ; Peng LIU ; Wei ZHANG ; Jing-Lin MA ; Jing WANG
Chinese Journal of Traumatology 2017;20(2):94-98
PURPOSETo compare the clinical efficacy and complications of limited internal fixation combined with external fixation (LIFEF) and open reduction and internal fixation (ORIF) in the treatment of Pilon fracture.
METHODSWe searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the rate of nonunion, malunion/delayed union and the excellent/good rate assessed by Mazur ankle score. The complications including infections and arthritis symptoms after surgery were also investigated.
RESULTSNine trials including 498 pilon fractures of 494 patients were identified. The meta-analysis found no significant differences in nonunion rate (RR = 1.60, 95% CI: 0.66 to 3.86, p = 0.30), and the excellent/good rate (RR = 0.95, 95% CI: 0.86 to 1.04, p = 0.28) between LIFEF group and ORIF group. For assessment of infections, there were significant differences in the rate of deep infection (RR = 2.18, 95% CI: 1.34 to 3.55, p = 0.002), and the rate of arthritis (RR = 1.26, 95% CI: 1.03 to 1.53, p = 0.02) between LIFEF group and ORIF group.
CONCLUSIONLIFEF has similar effect as ORIF in the treatment of pilon fractures, however, LIFEF group has significantly higher risk of complications than ORIF group does. So LIFEF is not recommended in the treatment of pilon fracture.
Combined Modality Therapy ; External Fixators ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Tibial Fractures ; surgery
5.Retrieval of a broken guide wire transfixing the hip through the proximal femoral nail hole.
Saurabh JAIN ; Abhishek PATHAK ; Rajeev Kant PANDEY
Chinese Journal of Traumatology 2014;17(1):50-53
Retrieval of a broken guide wire transfixing the acetabulum or with intrapelvic migration is challenging and frustrating for surgeons. We here present a case report on a method to remove a broken guide wire transfixing the acetabulum through the proximal hole of recon nail using a grasping forceps. This method is little invasive, easy, time-saving and without need for changing the inital fixation.
Adult
;
Bone Wires
;
adverse effects
;
Fracture Fixation, Internal
;
instrumentation
;
Hip Fractures
;
surgery
;
Humans
;
Male
;
Prosthesis Failure
8.Related factors of revision of distal femoral fractures treated with lateral locking plate.
Guo Jin HOU ; Fang ZHOU ; Yun TIAN ; Hong Quan JI ; Zhi Shan ZHANG ; Yan GUO ; Yang LV ; Zhong Wei YANG
Journal of Peking University(Health Sciences) 2022;54(6):1172-1177
OBJECTIVE:
To analyze the factors related to the need for revision surgery due to nonunion or internal fixation failure after the treatment of distal femoral fracture with lateral locking plate (LLP).
METHODS:
Retrospective analysis was made of the clinical data of 130 cases with distal femoral fracture treated in our hospital from March 2005 to March 2019. SPSS 17.0 software (univariate analysis and Logistic regression analysis) was used to analyze the general condition [gender, age, body mass index (BMI), comorbidities, smoking history], injury related factors (energy of injury, open or closed injury, AO/OTA classification of fracture, fracture area distribution), operation related factors (operation time, reduction quality, postoperative infection) and construct characteristics of internal fixation.
RESULTS:
Twelve of 130 patients who were included in the study underwent revisional surgery, with a revision rate 9.2%. Univariate analysis showed that there were significant differences in age, BMI, AO/OTA classification, fracture area distribution, operation time, reduction quality, length of plate/fracture area, length of plate/fracture area above condylar between the two groups (P < 0.05). Logistic regression analysis showed that AO/OTA classification (A3), supracondylar involved fracture, operation time, reduction quality and the length of the plate/fracture area above the condylar were the possible related factors (P < 0.05). Destruction of the medial support ability of the femur in comminuted type A3 fracture, supra-condylar cortex area fracture involvement, increase of the bending stress of the LLP due to poor fracture reduction quality, damage of the blood supply of fracture end due to long-time operation, and stress concentration caused by insufficient length of plate might be risk factors of revisional operation after the treatment of distal femoral fracture with LLP. For the patients who needed revision after LLP treatment, additional use of medial minimally invasive plate fixation and autologous bone transplantation, change to intramedullary nail fixation were commonly used clinical treatment strategies.
CONCLUSION
AO/OTA classification (A3), supracondylar involved fracture, long operation time, poor reduction quality and the length of the plate/fracture area above the condylar were the possible predictive factors of the revision in distal femoral fractures treated with lateral locking plate. The appropriate application of the locking plate and operation strategy are the key to reduce the revision rate in distal femoral fractures.
Humans
;
Femoral Fractures/etiology*
;
Retrospective Studies
;
Femoral Fractures, Distal
;
Bone Plates/adverse effects*
;
Fracture Fixation, Internal/adverse effects*
;
Treatment Outcome
9.Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures.
Kapil Mani KC ; Bandhu Ram PANGENI ; Suman Babu MARAHATTA ; Arun SIGDEL ; Amuda KC
Chinese Journal of Traumatology 2022;25(2):90-94
PURPOSE:
Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.
METHODS:
This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0).
RESULTS:
Average malunion (degrees) in the MIPPO group was 5 (3-7) ± 1.41 vs. 10.22 (8-14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001).
CONCLUSION
Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.
Bone Plates/adverse effects*
;
Fracture Fixation, Internal/methods*
;
Fracture Fixation, Intramedullary/methods*
;
Fracture Healing
;
Humans
;
Minimally Invasive Surgical Procedures/methods*
;
Prospective Studies
;
Tibia/surgery*
;
Tibial Fractures
;
Treatment Outcome
10.Percutaneous poking reduction and fixation versus open reduction and fixation in the treatment of displaced calcaneal fractures for Chinese patients: A systematic review and meta-analysis.
Xiao-Jian WANG ; Yun-Xing SU ; Lu LI ; Zhi-Hua ZHANG ; Xiao-Chun WEI ; Lei WEI
Chinese Journal of Traumatology 2016;19(6):362-367
PURPOSETo compare the efficacy of percutaneous poking reduction and fixationwith open reduction and fixation in the treatment of displaced calcaneal fractures.
METHODSReports of studies using case-controlled trials (CCT) to compare the percutaneous poking reduction and fixation with the open reduction and fixation in the management of calcaneal fractures were retrieved from the Cochrane Library, PubMed Database, CNKI, Chinese Biomedical Database, Wanfang Data (from January of 2005 to August of 2015). Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.0 was used for data-analysis.
RESULTSFifteen articles were included in the meta-analysis. Comparison of the efficacy of percutaneous poking reduction and fixation with open reduction and fixation in the treatment of calcaneal fractures revealed statistical significance in the incidence of complications after operation [RR = 0.32, 95% CI (0.20, 0.5), p < 0.05]. However, there were neither statistical significance in the degrees of recovery for calcaneal Bohler angle [WMD = -1.65, 95% CI (-3.43, 0.14), p > 0.05] and calcaneal Gissane angle [WMD = -3.21, 95% CI (-6.75, 0.33), p > 0.05], nor statistical significance in the rate of good foot function after operation [RR= 0.95, 95% CI (0.90, 1.00), p > 0.05].
CONCLUSIONFor the treatment of calcaneal fractures, percutaneous poking reduction and fixation is su- perior to open reduction and fixation in terms of the incidence of postoperative complications. But both techniques can obtain satisfactory clinical function.
Calcaneus ; injuries ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Fractures, Bone ; surgery ; Humans ; Open Fracture Reduction ; adverse effects ; methods ; Postoperative Complications ; epidemiology ; Publication Bias