OBJECTIVE: To observe and compare the shoulder joint function, complications and clinical effects of hemiarthroplasty and open reduction and locking plate in the treatment of comminuted proximal humeral fracture (Neer IV) with 3D printing technique. METHODS: From March 2012 to April 2018, 31 middle age and elderly patients with comminuted proximal humeral fractures (Neer IV) were treated, including 4 males and 27 females, aged from 55 to 94 years old with an average age of 71 years, with a course of 1 to 3 years. Among them, 20 cases were treated with open reduction and locking plate internal fixation (ORIF group) and 11 cases were treated with lower half shoulder replacement (HA group) assisted by 3D printing technology. Using CT data and Mimics software of Materialise Company in Belgium, the reconstruction of fracture was simulated on computer. The height of fracture end to humeral head, the height of tubercle to humeral head, the angle of humeral head backward obliquity were measured to assist the hemiarthroplasty. Follow-up and X-ray examination were performed, the incidence of complications were observed, and Neer score was used for the shoulder joint function. RESULTS: Thirty-one patients were followed up for 1 to 3 years with an average of 2 years. In HA group, there was no prosthesis loosening, fracture and subsidence, the head of artificial humerus was intact, the fracture of nodules and nodules did not heal in 1 case, Neer score was 84.18±3.55; in ORIF group, there were 8 cases of proximal humerus bone resorption, 1 case of fracture nonunion, 1 case of internal fixation loosening, Neer score was 55.91±10.78; there was significant difference in Neer score of shoulder joint function between the two groups(<0.05). CONCLUSIONS Ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures, which promise minimal incision, protect sural nerve, ensure quality of tendon anastomosis and fixation, and is a ideal method for repairing acute closed Achilles tendon ruptures.
Aged ; Aged, 80 and over ; Bone Plates ; Female ; Fracture Fixation, Internal ; Fractures, Comminuted ; Humans ; Male ; Middle Aged ; Shoulder ; Shoulder Fractures ; surgery ; Treatment Outcome

OBJECTIVETo discusses the clinical effects of arthroscopy combined with minimally invasive percutaneous plate osteosynthesis(MIPPO) technology in treating Schatzker IV tibial plateau fractures.

METHODSFrom January 2012 to January 2016, 19 patients with Schatzker type IV tibial plateau fractures were treated with arthroscopy combined with minimally invasive technique including 12 males and 7 females with an average age of 46.5 years old ranging from 19 to 78 years old. Patients were suffering knee pain, swelling, flexion and extension limited, and other symptoms preoperative. Patients were followed up and assessed by Rasmussen knee function score.

RESULTSNo infection, traumatic arthritis, and knee joint valgus occurred after operation. Nineteen cases were followed up for 12 to 24 months with an average of 18.6 months. Fracture healing time was 3 to 5 months with an average of 3.8 months. The knee pain and limited mobility improved significantly. The range of autonomic movement of joints was from 90 to 136 degrees. According to Rasmussen functional score criteria, the total score was 27.00±2.49, the result was excellent in 16 cases, good in 2 cases, fair in 1 case.

CONCLUSIONSArthroscopic treatment for Schatzker type IV tibial plateau fractures combined with MIPPO can simultaneously treat internal structural injuries such as meniscus and other knee joints, with less trauma, fewer complications, and faster joint function recovery, but we must strictly grasp surgical indications and avoid expanding injuries.

OBJECTIVETo investigate the preliminary effects of modified percutaneous compression plate in treating femoral neck fractures of Pauwels type III.

METHODSFrom March 2012 to March 2016, 35 patients with femoral neck fracture were treated by closed reduction and internal fixation with a modified percutaneous compression plate, including 21 males and 14 females with an average age of 45 years old ranging from 23 to 62 years old. The anatomical position of fracture was divided into 8 cases of lower head type, 27 cases of head and neck. According to the Garden classification, there were 8 cases of type II, 18 of type III, and 9 of type IV fractures. All patients were closed injury. The general information, reduction quality, fracture healing time, postoperative complications were recorded and evaluated. Harris scoring was used to evaluate the hip joint function.

RESULTSAll patients were followed up for 15 to 24 months with an average of 20 months. All the incisions were primary healing. The reduction quality of the femoral neck fracture was evaluated according to the Garden's alignment Index, and the quality of reduction was grade I reduction in 29 cases and grade II reduction in 6 cases. No nonunion, femoral avascular necrosis, implant failure and hip varus was observed during follow-up. Harris score was(92.70±4.60) points at final follow-up, the results of the treatment was evaluated as excellent in 26 cases, good in 8 cases, fair in 1 case. No complications such as internal fixation loosening, nail breaking, and heterotopic ossification occurred.

CONCLUSIONSInternal fixation with modified percutaneous compression plate has an advantages of decreased trauma, simple operation, rigid fixation, good function outcome, and low risk of complications.

OBJECTIVETo compare the clinical effects of double screws system and compressed three canulated screws in treating femoral neck fractures.

METHODSFrom January 2007 to June 2009, the clinical data of 67 patients with femoral neck fractures underwent operation were retrospectively analyzed. There were 38 males and 29 females,aged from 31 to 71 years with an average of 50.6 years, left was in 41 cases and right was in 26 cases. The patients were divided into two groups (group A and B) based on the different fixation method. Of them, 30 cases (group A,19 males and 11 females) were treated with double screws system and 37 cases (group B, 19 males and 18 females) with compressed three canulated screws. In group A, Pauwells angle was more than or equal 50 degrees in 16 cases and Pauwells angle less 50 degrees in 14 cases; in group B, Pauwells angle was more than or equal 50 degrees in 22 cases and Pauwells angle less 50 degrees in 15 cases. Duration of hospitalization, operative time, intraoperative blood loss, postoperative time in bed, infection of incision, postoperative complication, quality of fracture reduction, position of internal fixation, incidence of non-union and femoral head necrosis, incidence of failure fixation, joint function (Harris score) were compared between two groups.

RESULTSAll patients were followed up from 30 to 59 months with an average of 42 months. There was no significant differences in aspect of duration of hospitalization, infection of incision, intraoperative blood loss, walking time, postoperative complications between two groups(P>0.05). Operative time of group A [(31.1 +/- 9.7) min]was less than that of group B [(40.4 +/- 12.7) min] (P<0.05). There was no significant differences in quality of fracture reduction, position of internal fixation, incidence of non-union and femoral head necrosis between two groups (P>0.05). In the patients with Pauwells angle more than or equal 50 degrees in group A, there was no retreated screws, broken screws, screw cut-off from the femoral head;a head;and in group B, retreated screws occurred in 2 cases, screw cut-off from the femoral head occurred in 2 cases, screws not completely getting in femoral head occurred in 2 cases; there was significant differences between two groups (P<0.05). The patients with Pauwells angle less 50 degrees in group A, screw loosening occurred in one case; and in group B, screw retreating occurred in one cases; there was no significant differences between two groups (P>0.05). All patients who suffered from screw loosening, retreating or cut-off from the femoral head were more than 65 years old. There was no significant differences in the joint function between two groups at 6 and 30 months after operations (P>0.05).

CONCLUSIONDouble screws system has advantages of minimal invasion, easy operation, reliable fixation in treatment of femoral neck fractures. Compared with the traditional compressed three canulated screws,double screws system has less fixation failure rate and higher hip function scoring. It has a good clinical effect especially for the patients with Pauwells angle more than or equal 50 degrees.

Adult ; Aged ; Biomechanical Phenomena ; Bone Screws ; Case-Control Studies ; Female ; Femoral Neck Fractures ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Postoperative Care ; Retrospective Studies

OBJECTIVETo investigate the application of transpedicular porking repositor, thread device and transpedical interbody bone grafting apparatus in the treatment of thoracolumbar spinal fracture.

METHODSFrom March 2008 to March 2011, 17 males and 15 females with thoracolumbar spinal fracture were treated by using self-designed transpedicular porking reposito, thread device and transpedical interbody bone grafting apparatus. The average age was 39.4 years (ranged from 25 to 65 years). All the cases were checked by X-ray and CT before and one week, one year after operation, removal of internal fixation. The angle of injured vertebral sagittal, cobbs angle and injured vertebral height were measured.

RESULTSAll patients were followed up, and the duration ranged for 14 to 21 months (averaged 16 months). The content of following up included loss of ithycyphos and height of spinal, fracture healing and implant fixation. Nerve vascular complication caused by implantation didn't occurred; interverbral body fusion was good. The results preoperative, 1 week and year postoperative and 3 months after taking out the internal fixation showed injured spinal height maintained well, loss and collapse of height and angle did not occurred.

CONCLUSIONTreating thoracolumbar spinal fracture can obtained satisfactory effects by using transpedicular porking repositor, thread device and transpedical interbody bone grafting apparatus. It has advantages of minimal invasive, and can promote fracture healing earlier, recover spinal height, rebuild stability of spinal, prevent loss and collapse of vertebral body height to avoid anterior lumbar surgery on the late stage.

Adult ; Aged ; Bone Transplantation ; Female ; Fracture Fixation, Internal ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo explore operative method for the treatment of double injuries of superior shoulder suspensory complex (SSSC).

METHODSFrom January 2008 to March 2010,11 patients wiht SSSC injuries were treated, including 9 males and 2 females with an average age of 38 years (ranged from 20 to 47 years). The patients were treated with 4 methods as follows: 4 patients with fractures of neck of scapula combined with homolateral fracture of clavicle were treated with reconstituted plates; 2 patients with fractures of coracoid process or disruption of coracoclavicular ligament combined with the fracture of extremitas acromialis claviculae or acromioclavicular dislocation were treated with clavicular hook plates and cannulated compression screws; 3 patients with injuries of basilar part of acromial process combined with the glenoid cavity and acromioclavicular articulation were treated with reconstuction plates and clavicular hook plates; 2 patients with fractures of acromial process combined with acromioclavicular dislocation and the fracture of lateral third of clavicle were treated with small "T" plates and clavicular hook plates.

RESULTSAmong 11 patients, 9 patients were followed up with an average duration of 9.2 months (ranged from 6 to 12 months). All the fractures were healed without bone nonunion or failure of internal fixators. The average union time was 2.6 months. The profile of articulatio capitis humeri was normal and hibateral articulatio capitis humeri was symmetrical without crispation, descensus, adduct and adtorsion of articulatio capitis humeri or other abnormity. According to the Constant-Murley evaluation system, the score ranged from 69 to 100, with an average of 89.7, which included average pain score of 10 to 15, daily activities score of 14 to 20, myodynamia score of 15 to 25, territory score of 34 to 40.

CONCLUSIONThe double injuries of SSSC should be treated by types to recover the integrity and constancy of SSSC.

Acromioclavicular Joint ; injuries ; Adult ; Female ; Humans ; Male ; Middle Aged ; Shoulder Dislocation ; surgery ; Shoulder Joint ; injuries

OBJECTIVETo explore the diagnosis and treatment of tarsometatarsal joint complex injury (TJC).

METHODSFrom January 2007 to January 2009,16 patients with tarsometatarsal joint complex injury were treated with open reduction and internal fixation. There were 12 males and 4 females, ranging in age from 21 to 45 years with an average of 34.1 years. Seven cases were left and 9 cases were right and all injuries caused by direct violence. Four cases caused by traffic accident 5 by fall from high and 7 by crush injury. Intercuneiform dislocation were in 11 cases, naviculocuneiform joint dislocation in 3 cases and cuboid fracture in 2 cases. All the cases were three column injuries. According to the situation of exploring and the stability, screw fixation was used for intertarsal joint, internal and middle column tarsometatarsal joint, the Kirschner wire fixation for external column and miniature plate fixation for comminuted fracture of metatarsal bones and compressible fracture of cuboid. The criteria of the AOFAS Foot and Ankle Surgery by the United States Association of ankle-rear foot functional scale was used to evaluate the clinical effect.

RESULTSAll the patients were followed up,the duration ranged from 6 to 18 months(averaged 12.6 months). According to the score system of AOFAS,the total score was (74.6+/-10.4 ) points, including pain items of (29.3+/-5.9), the score of functional items of (32.4+/-5.6) points, and power lines of (12.9+/-2.6). All the incisions were primarily healed without infection, skin necrosis,fixture broken or loosen. Three cases received arthrodesis due to osteoarthritis. Four cases were followed up continually because they only had the radiologic osteoarthritis without pain.

CONCLUSIONAnatomical reduction and stable fixation is the key point of the treatment of tarsometatarsal joint complex injury. Open reduction and internal fixation at the first stage is good for secondary arthrodesis.

Adult ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Metatarsal Bones ; injuries ; surgery ; Middle Aged ; Tarsal Joints ; injuries ; surgery

OBJECTIVETo analyze the reason of error diagnosis and inappropriate treatment of radius head fractures complicating distal radioulnar joint dislocation (Essex-Lopresti injury) and to seek for the reasonable treatment.

METHODSFrom 2008 to 2009, 2 male patients of radius head fractures complicating distal radioulnar joint dislocation were treated, the age was 56 and 66 years old respectively. The symptom included elbow swelling and limitation of forearm rotation. X-ray showed comminuted fractures of capitulum radius. There were 1 case of Mason type III and 1 cases of type IV. Two patients were treated by resection of capitulum radius and plaster fixation after operation.

RESULTSBoth of the 2 cases had limited rotation of forearm and the distal radioulnar joint pain. The X-ray showed that the distal radioulnar joint was separated obviously and the proximal radius was translocated.

CONCLUSIONThe early diagnosis is very important for the Essex-Lopresti injury. Rebuilding the longth of the radius and reduction fixating the distal radioulnar joint after fixated is an effective treatment while the interosseous membranes can't be repaired and rebuilded.

Aged ; Diagnostic Errors ; Elbow Joint ; injuries ; Humans ; Joint Dislocations ; diagnosis ; therapy ; Male ; Middle Aged ; Radius Fractures ; complications ; Ulna Fractures ; complications

Aged ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Rotator Cuff ; surgery ; Rotator Cuff Injuries

Adult ; Female ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Spinal Cord Injuries ; surgery ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery