OBJECTIVETo investigate the results of hip arthroplasty for the treatment of severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture.

METHODSFrom June 2007 to September 2013, 8 patients (8 hips) with severe comminuted proximal femoral fracture combined with ipsilateral acetabulum fracture were treated with hip arthroplasty. All patients were male and using biological prosthesis. Aged from 33 to 64 years old with an average of 41.9 years. According to Harris score in aspect of pain, function, range of motion to evaluate clinical effects.

RESULTSThere was no untoward reaction in 8 patients. And bed rest at 3 months after operation, waiting for acetabulum fracture healed to out-of-bed activity. There was no complications such as pneumonia, bedsore and so on in the patients. Follow-up time was from 9 to 72 months with an average of 35.8 months, the wound healed, there was no the subsidence and loosening of prosthesis, no dislocation and infection. The mean of Harris score was 87.5 points after operation.

CONCLUSIONThe effect of the hip replacement in treating severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture is confirmed. It can restore motor function and reduce traumatic complication, may serve as a substitute for internal fixation of difficult operation. The long-term efficacy is necessary to further observe.

Acetabulum ; injuries ; surgery ; Adult ; Arthroplasty, Replacement, Hip ; methods ; Femoral Fractures ; physiopathology ; surgery ; Fractures, Comminuted ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Range of Motion, Articular

BACKGROUND: To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures. METHODS: Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure. RESULTS: Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5% greater than that of LP (12,249.3 N; SD, 1,371.6), and 60% less than that of IN (22,879.6 N; SD, 1,578.8; p < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group. CONCLUSIONS: During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate.
Biomechanical Phenomena ; Bone Nails ; Bone Plates ; Fracture Fixation, Internal/*instrumentation ; Fractures, Comminuted/physiopathology/*surgery ; Humans ; Models, Anatomic ; Tibial Fractures/physiopathology/*surgery

OBJECTIVETo treat the comminute distal radius fractures by improved splint, and obersve the curative effect and compare the radiology with the traditional splint.

METHODSNinety-two patients with distal radius comminute fracture were randomly divided into two groups. There were 38 males and 54 females. The average age was 63 years old ranging from 23 to 82. Acording to AO classification on the distal fracture of the radius, there were 15 cases of A3, 40 cases of C1, 26 cases of C2 and 11 cases of C3. After all patients were treated by manipulative reduction, 46 cases of the treatment group were fixed supra-carpometacarpal joints by improved splint and trapezoid pad, the other 46 cases of control group were treated with the traditional spilint. Both groups were regularly taken X-ray recheck and changed dressings to obtain the clinical cicatrization. Patients were guided to do functional exercise after splints were taken off. Six weeks later all patients were evaluated the curative and radiologic effect according to Gartland-Werlley wrist score and Lidstrom grade respectively.

RESULTSAccording to wrist score,there were 13 cases on excellent, 34 cases on fine and 9 cases on normal in treatment group, which average score was (4.0 +/- 2.6) and the percent of wrist functional fitness was 80.6%. There were 9 cases on excellen, 19 cases on fine and 18 cases on normal in control group, which average score was (6.0 +/- 4.2) and the percent of wrist grad and 4 cases on the third grade in treatment group. There were 22 cases on the first grade, 16 cases on the second grad and 8 cases on the third grade in control group.

CONCLUSIONThe outcome of improved splint was better than that of traditional splint on the function and radiology for treating the comminute distal radius fracture.

Adult ; Aged ; Aged, 80 and over ; Female ; Fracture Healing ; Fractures, Comminuted ; pathology ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Radius Fractures ; pathology ; physiopathology ; surgery ; Recovery of Function ; Splints

Adult ; Elbow Joint ; physiopathology ; Female ; Fracture Fixation ; methods ; Fracture Healing ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Ulna Fractures ; physiopathology ; surgery

OBJECTIVETo evaluate the clinical effects of external fixator in treating comminuted fracture of distal radius.

METHODSFrom Mar.2008 to Dec.2009, 37 patients with comminuted fracture of distal radius were treated with external fixator or assisted with Kirschner wire and T-shape locking compression plate (T-LCP) fixation. There were 14 males and 23 females, ranging in age from 30 to 79 years, with an average of 59.1 years. According to AO typing, type C1 was in 3 cases, type C2 was in 11 cases and type C3 was in 23 cases. Function of wrist joint and X-ray films were observed according to Gratland-Werley system at different months.

RESULTSAll patients were followed up from 8 to 24 months with an average of 12 months. All fractures had healing with an average time of 8 weeks. According to Gratland-Werley system, 16 cases obtained excellent result, 17 good, 4 fair, the rate of excellent and good was 89.0%.

CONCLUSIONExternal fixator can obtained satisfactory clinical effect in treating comminuted fracture of distal radius.

Adult ; Aged ; External Fixators ; Female ; Fracture Healing ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Radius Fractures ; physiopathology ; surgery ; Wrist Joint ; physiopathology

OBJECTIVETo study the effect of the treatment for comminuted fractures of proximal humerus with open reduction and internal fixation, and the influence of the different internal fixation.

METHODSFrom January 2003 to June 2007, 423 cases of comminuted fractures of proximal humerus were treated with open reduction and internal fixation. Among them, 139 patients included 51 males and 88 females were treated with the Kirschner needle with an average age of 55.8 years old ranging from 35 to 72 years, and the average course was 7 days (from 3 to 20 days); 103 patients included 48 males and 55 females were treated with the cloverleaf plate with an average age of 56.7 years old (from 22 to 76 years), and the average course was 8.5 days (from 3 to 23 days); 181 patients included 85 males and 96 females were treated with the locking plate with an average age of 57.1 years old (from 29 to 77 years), and the average course was 7.9 days (from 3 to 21 days). The pain, daily activities, orbit, and the strength of the shoulder were evaluated with the Constant's scale.

RESULTSThe wound of all the cases was primary healing. All patients were followed-up for over 12 months, the sings and symptoms of all the patients were improved very well. There was significant difference between, before and after operation on Constant's scoring. While there was not significant difference among the different internal fixation.

CONCLUSIONOpen reduction and internal fixation is effective for comminuted fractures of proximal humerus. There is no significant difference on therapeutic efficacy in different internal fixation.

Adult ; Aged ; Female ; Fracture Fixation, Internal ; adverse effects ; Fractures, Comminuted ; physiopathology ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Shoulder Fractures ; physiopathology ; surgery ; therapy ; Treatment Outcome

OBJECTIVETo assess the early efficacy of metallic modular radial head prostheses in patients with Mason III and IV unreconstructable radial head fractures.

METHODSThe medical records of 16 patients (9 males, 7 females) with a mean age of 43 years old (31 to 57) with Mason III/IV unreconstructable radial head fractures requiring metallic modular radial head replacement between January 2009 and March 2012, were reviewed retrospectively. The functional results were assessed by range-of-movement, Mayo elbow performance score (MEPS). All patients underwent radiographic evaluation for radial head height and radiolucent lines.

RESULTSFourteen patients were evaluated with follow-up for 12 to 33 months with an average of 23 months. Range of movement parameters was significantly lower in the affected elbow than in the unaffected side (P < 0.01). MEPS results were excellent in 9 cases, good in 2 cases, fair in 2 cases, and poor in 1 case. According to Grewal grading, there were 4 cases of periprosthetic lucencies of the radius and 1 case had significant clinical signs of loosening.

CONCLUSIONRadial head replacement with the metallic modular prostheses yields satisfactory results regarding range of motion and function of the elbow joint in short term. The evolution of this prostheses needs to be evaluated with further studies to assess mid-term and long-term follow-up results.

Adult ; Arthroplasty, Replacement, Elbow ; methods ; Female ; Fracture Fixation ; methods ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Radius ; surgery ; Radius Fractures ; physiopathology ; surgery ; Retrospective Studies

PURPOSE: Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner. METHODS: Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated. All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software. RESULTS: Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale. Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient = -0.554). CONCLUSION A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.
Adult ; Compartment Syndromes ; prevention & control ; Connective Tissue ; physiopathology ; Female ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Fractures, Comminuted ; physiopathology ; surgery ; Humans ; Knee ; physiopathology ; Male ; Middle Aged ; Range of Motion, Articular ; Tibial Fractures ; physiopathology ; surgery ; Treatment Outcome