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Craig Ⅴ distal clavicle fracture treated with distal clavicle excision plus suture anchor

Shun YANG ; Ming XIANG ; Hang CHEN ; Jie XIE ; Guoyong YANG ; Jianxiong XI ; Chunyan JIANG

Chinese Journal of Orthopaedic Trauma.2011;13(1):8-11. doi:10.3760/cma.j.issn.1671-7600.2011.01.004

Objective To introduce distal clavicle excision plus suture anchor to treat Craig Ⅴ distal clavicle fracture.Methods From November, 2005 to August, 2007, 25 patients with Craig Ⅴ distal clavicle fracture were treated with distal clavicle excision plus suture anchor.They were 18 men and 7 women,with a median age of 42.6 years.They were followed up periodically by radiological examination.At the final follow-up, their shoulder functions were evaluated by University of California-Los Angeles (UCLA) scoring system and Constant scoring system, and the pain was evaluated according to visual analog scale (VAS).Results All the patients obtained a median follow-up of 13.6 months (8 to 24) .The height of distal clavicle in all patients reached anatomical reduction.Their average UCLA score was 33.5 (28 to 35), and average Constant score was 90.6 (79 to 100) .Their mean VAS score was 1.2 (0 to 4) .Their average forward flexion and elevation was 156.4° ( 145° to 170°), and external rotation was 45.6° (40° to 60°) .The rate of top quality was 88.0% (22/25).Conclusion Distal clavicle excision plus suture anchor is an effective method to treat Craig Ⅴ distal clavicle fracture which results from serious trauma.

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Analysis of close reduction under the C-arm X-ray perspective for femoral neck fractures

Xin LI ; Zhong CHEN ; Hongchang YANG

Chinese Journal of Orthopaedic Trauma.2011;13(1):25-28. doi:10.3760/cma.j.issn.1671-7600.2011.01.008

Objective To evaluate the actual displacement of a femoral neck fracture following close reduction under the C-arm X-ray perspective.Methods From June, 2006 to June, 2009, we managed 12 patients with femoral neck fracture by open reduction and internal fixation.They were 8 males and 4 females, aged from 23 to 65 (average, 42.3) years old.We tried close reduction of their fractures under the C-arm X-ray perspective before a temporary fixation.Next we performed open reduction, readjusted the fracture ends, and placed internal fixation.The actual displacement of the fracture measured after open reduction was carefully compared with the close reduction under the X-ray perspective.Results A substantial displacement was found after open reduction in 7 patients who had achieved anatomic reduction under the X-ray perspective.In the other 5 patients who presented with a slight displacement after close reduction under X-ray perspective, the actual displacements were larger than the X-ray observations but completely reduced after open reduction.The actual measurements after open reduction were significantly larger (3.21 ± 0.96 mm on average) in the anteroposterior displacement ( t = 11.540, P = 0.000), but insignificantly larger (0.58 ±0.93 mm on average) in the superior-inferior displacement ( t = 2.184, P = 0.346) than those after close reduction.Conclusions In general, anatomic reduction can not be achieved for a femoral neck fracture under the C-arm X-ray perspective.Consequently, open reduction may be better than close reduction in the treatment of femoral neck fracture in that improper reduction can block blood supply to the femoral neck and dissection of the capsula articularis coxae can improve blood supply as well as help decompression.

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The risk of chondral injury during the Rigidfix femoral fixation via the anteromedial portal to reconstruct the anterior cruciate ligament

Huaqiang FAN ; Changming HUANG ; Huixiang DONG

Chinese Journal of Orthopaedic Trauma.2010;12(12):1156-1159. doi:10.3760/cma.j.issn.1671-7600.2010.12.015

Objective To evaluate the risk of chondral injury during anterior cruciate ligament (ACL) reconstruction using a double cross-pin femoral fixation device via the anteromedial portal in Chinese cadavers. Methods Nine specimens of the knee (6 left ones and 3 right ones) were taken from 5 male and 4 female conservative cadavers of Chinese adult. The average age of the cadavers were 34.8 (26 to 45)years old. Femoral tunnel drilling and cross-pin guide insertion were performed using the Rigidfix Cross Pin device through the anteromedial portal. The ACL reconstructions were simulated at 3 entrance points of the cross-pin (0°, 45° and 90° relative to the horizontal plane) . The risks of chondral injury were statistically analyzed when the cross-pin entrance point was at the 3 different positions relative to the femoral chondral surface. Results The incidence of chondral injury was 100% when the Rigidfix cross-pin guide was at 90° relative to the horizontal plane. When the Rigidfix cross-pin guide was at 45° and 0° the incidences of chondral injury were 66. 7% and 22. 2% respectively. Conclusion Since there is always a risk of chondral injury when the Rigidfix cross-pin device is used to reconstruct ACL via the anteromedial portal, the anteromedial portal is not recommended for the ACL reconstruction using Rigidfix femoral fixation.

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Gene function assembly analysis to screen key genes associated with deep vein thrombosis after trauma

Hailan HU ; Jianwen MO ; Bo BAI

Chinese Journal of Orthopaedic Trauma.2010;12(12):1139-1141. doi:10.3760/cma.j.issn.1671-7600.2010.12.011

Objective To screen key genes related to deep vein thrombosis (TDVT) after trauma using gene function assembly analysis. Methods Thirty Sprague Dawley rats were randomized into control, thrombosis and non-thrombosis groups. Traumatic limb DVT models were established in rats through quantitative beating on the bilateral posterior limbs. The Genechip Rat genome 430 2. 0 genechips were applied to detect changes in genes expressions on difference phases of DVT. On the basis of the differential gene expressions in the thrombosis and non-thrombosis groups, the gene function assembly analysis was conducted to define the most significant and concentrated gene functions leading to the biological characters of DVT.Results B factor (bf), complement 4 binding protein α (C4bpα), plasminogen activator inhibitor 1 (serpinel), urokinase-type plasminogen activator receptor (plaur) were screened to be the key genes related to DVT, because they were found to be involved in the functions like complement activation, development,growth, morphogenesis, primary metabolism, cell motility, protein metabolism, localization of cell, locomotion and localization. The abundance values of the genes expressed were 1.6, -0. 2, 2. 1, 5. 1 in the thrombosis group, and -0. 5, - 1.4, 2. 7, 3. 3 in the non-thrombosis group. Conclusion Bf, C4bpα,serpinel, plaur may be the key genes that play a role in the process of DVT.

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A binary logistic regression analysis of deep venous thrombosis after hip fracture surgery

Kai WU ; Qiugen WANG

Chinese Journal of Orthopaedic Trauma.2010;12(12):1104-1107. doi:10.3760/cma.j.issn.1671-7600.2010.12.002

Objective To explore the incidence, etiological and protective factors, and preventive countermeasures of deep venous thrombosis (DVT) in patients undergoing hip surgery. Methods Four hundred and forty-one patients who had hip fracture surgery in our department from January, 2005 to May, 2010were analyzed retrospectively. They were 223 males and 218 females, aged 65.7 years. (range, 22 to 87). A binary logistic regression was performed, using gender, age, duration of surgery, surgery type, anesthesia type, blood transfusion, physical therapy, thrombo-prophylaxis and complication as covariates, taking DVT incidence as the dependant variable. Results The patients obtained a median follow-up of 17.2 months (range, 3 months to 4 years and 7 months). Sixty-nine patients developed DVT (incidence, 15.6%).Analysis of multiple variables showed that duration of surgery, anesthesia type, blood transfusion, hypertension and diabetes were risk factors to DVT. Physical therapy and thrombo-prophylaxis were protective factors.Age, gender and surgery type had no statistically significant influence on DVT (P ＞ 0.05). Conclusions The DVT incidence after hip fracture surgery is high. In order to decrease the DVT incidence, surgeons should try their best to estimate risk factors for every patient perioperatively, avoid general anesthesia or blood transfusion, shorten operating duration, effectively control complications, actively perform physical therapy or thrombo-prophylaxis, and prolong the anticoagulant therapy for patients with higher risk factors.

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Low modulus titanium alloy plating for femoral shaft fractures: A finite element analysis

Xiaokang LI ; Zheng GUO ; Jipeng LIU

Chinese Journal of Orthopaedic Trauma.2010;12(12):1164-1168. doi:10.3760/cma.j.issn.1671-7600.2010.12.017

Objective To investigate the effects of internal plating with high and low moduli of elasticity on the stress and its distribution on the femoral shaft fracture. Methods A femur from a normal Chinese adult male was scanned by 64-detector row helical CT at 0. 5 mm interval. The CT images were used to establish a finite element model of the femur by software. The mid-femoral fracture was simulated in the model and fixated by eight-hole plates of Ti-6Al-4V (high modulus group, E = 110 GPa) and of Ti2448 (low modulus group, E = 30 GPa). When the femur was in axial compression, flexion and torsion loads, the stress and its distribution on the bone fracture site were analyzed to compare the biomechanics of the plates with high and low moduli. Results Under axial compression load, the contact stress between fracture ends in the low modulus group was larger than that in the high modulus group, while the max stress at the hole (11.47MPa) was smaller than that in the high modulus group (13.89 MPa) . Under four-point bending load, the contact stress in the low modulus group was still larger, while the bending movement was smaller. Under the torsion load, stress on the femur was well-distributed in both groups, but the max stress at the hole in the low modulus group (11.47 MPa) was smaller than that in the high modulus group (31.24 MPa). Conclusions Under internal fixation by plates of low modulus, the stress stimulus at the fracture site may be increased,while the stress concentrated at the hole may be decreased. The stress shielding of the low modulus plate may also be modified.

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Deep vein thrombosis in elderly patients with hip fracture and its association with laboratory tests

Jie WEI ; Fan YANG ; Manyi WANG

Chinese Journal of Orthopaedic Trauma.2010;12(12):1112-1114. doi:10.3760/cma.j.issn.1671-7600.2010.12.004

Objective To investigate incidence and onset of deep vein thrombosis (DVT) in elderly patients with hip fracture, and to evaluate the laboratory tests of plasma levels of D-Dimer, fibrinogen(FIB)and platelet(PLT) in diagnosing DVT. Methods From January, 2005 to December, 2006, 112 patients, 47 men and 65 women, aged 65 and over, were recruited into this study. Their mean age was 75.5 (range, 65 to 90) years. D-Dimer, FIB and PLT, as high specific fibrin degradation products, were detected via laboratory testing. The incidence, onset and distribution of DVT in these cases were observed. Univariate analysis was used to determine the associations between laboratory values and DVT. Influences of sex and type of hip fracture on the concentration of D-Dimer were studied as well. Results DVT was detected in 18 patients by means of B-mode ultrasonography and venography. The incidence rate of DVT in the elderly was 16. 1%. The onset of DVT took place between the second day and sixth day of hospitalization (average, 5.4 days), apparently earlier than the time of surgery (11. 6 days). Serum D-Dimer level was found significantly higher in the DVT group (P ＜ 0. 05) whereas levels of plasma FIB and PLT showed no significant influence on DVT(P ＞ 0. 05) . The D-Dirmer level was strongly influenced by type of fracture but not by sex.Conclusions Elderly patients with hip fracture have a high incidence of DVT. Since the onset of DVT usually happens before surgery, emergent operation is strongly indicated. A normal level of serum D-Dimer may be clinically significant in excluding the onset of DWT, but a simple rise in plasma D-Dimer level may not indicate DWT. The plasma levels of FIB and PLT may have no clinical significance in diagnosing DVT.D-Dimer level is not associated with sex of patients but with type of fracture.

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Prevention and treatment of deep venous thrombosis in hip fracture patients

Yabo LIU ; Fan YANG ; Lidan ZHANG

Chinese Journal of Orthopaedic Trauma.2010;12(12):1123-1125. doi:10.3760/cma.j.issn.1671-7600.2010.12.007

Objective To analyze factors influencing the incidence of deep venous thrombosis (DVT) and discuss the prevention and treatment of DVT in hip fracture patients. Methods The present study enrolled 531 patients who received surgery between June, 2008 to June, 2010 for hip fractures. They were 242 men with a mean age of 56. 2 years and 289 women with a mean age of 65.2 years. There were 336 femoral neck fractures, 183 femoral intertrochanteric fractures, and 12 femoral subtrochanteric fractures. The associations between DVT incidence and fracture type, plasma D-Dimer, sex, age and preoperative duration of immobilization were statistically analyzed. Inferior yens cava filters were used for patients who suffered DVT while surgery was performed. Results The total incidence of DVT was 10. 4% in this series. DVT occurred in 21 cases of femoral neck fracture, 34 cases of femoral intertrochanteric fracture and 0 case of femoral subtrochanteric fracture. All DVT events happened before surgery. DVT incidence had no significant associations with age or sex (P =0. 347 and 0. 376, respectively), but did with plasma D-Dimer, fracture type and preoperative duration of immobilization (P = 0. 002, 0. 017 and 0. 037, respectively). All the 55 DVT patients underwent a successful surgery. Conclusions The DVT incidence in hip fracture patients may have no significant associations with age or sex, but may do with plasma D-Dimer, fracture type and preoperative duration of immobilization. Inferior vena cava filters can ensure a successful internal fixation of the fracture and an uneventful postoperative rehabilitation.

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Extraperitoneal pelvic packing for hemodynamically unstable pelvic fractures

Wei ZHANG ; Congfeng LUO ; Bingfang ZENG

Chinese Journal of Orthopaedic Trauma.2010;12(9):805-809. doi:10.3760/cma.j.issn.1671-7600.2010.09.002

Objective To discuss clinical outcomes of extraperitoneal pelvic packing (EPP) plus external fixation for hemodynamically unstable pelvic fractures. Methods We used EPP plus external fixation to control 15 cases of hemodynamically unstable pelvic fractures from further damage. They were 6 males and 9 females. Their average age was (44. 0 ± 1.2) (38 to 56) years old. Their injury was caused by a traffic accident (13 patients) and falling from a great height (2 patients). According to the Tile classification,there were 3 cases of type B1, 2 cases of type B2-2, 5 cases of type C1, 3 cases of type C2, and 2 cases of type C3. All the 15 patients were hemodynamically unstable and had a hypovolemic shock. Results There was a statistically significant increase in systolic blood pressure, hematocrit and hemoglobin measured immediately after EPP( P < 0. 05) . However, the units of RBC transfusion significantly decreased( P <0.05) and there were no significant difference in pulse rate( P > 0. 05) . The average operation time was (32.0 ± 2.6) min(30 to 40 min). Five patients died (72. 0 ± 4.2) h after operation ( 1 to 7 d). There was no significant difference between the survivors and the non-survivors in systolic blood pressure, pulse rate,hemoglobin, ISS score, hematocrit and blood transfusion( P > 0. 05). But there was significant difference in age and time between injury and EPP ( P < 0. 05). Conclusions In emergency treatment of patients with the hemodynamically unstable pelvic fracture, especially those combined with hypovolemic shock, EPP plus external fixation can effectively control the massive venous (presacral venous plexus) and bone hemorrhage.The blood pressure and pulse rate can be restored by fluid replacement and blood transfusion. Consequently,this method may significantly improve the hemodynamical parameters and decrease the mortality.

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Chronic scaphoid nonunion treated with vascularized bone graft and external fixator

Zexiang LI ; Jifei SHI

Chinese Journal of Orthopaedic Trauma.2010;12(11):1025-1028. doi:10.3760/cma.j.issn.1671-7600.2010.11.006

Objective To evaluate the medium-term follow-up outcomes of treatment of chronic scaphoid nonunion with vascularized bone graft based on 1, 2 intercompartmental supraretinacular artery.Methods From February, 1995 to November, 2006, 13 cases of chronic scaphoid nonunion were treated with vascularized bone graft based on 1, 2 intercompartmental supraretinacular artery in our hospital. Nine cases were complicated with avascular necrosis of the proximal pole. The interval between injury and treatment averaged 22. 2 months. The nonunions were stabilized by screw or external fixator. Procedures of arthrolysis were applied and early wrist mobilization was initiated under the protection of external fixator. Radiographic finding and Mayo scoring system were used to evaluate the clinical outcomes. Results The mean time of follow-up was 82.9 months. The union time for the 13 cases averaged 11.2 weeks. At the final follow-up,there were 3 excellent, 8 good and 2 fair evaluations;the range of motion of the wrist, Mayo score, grip strength, intrascaphoid angle and scapholunate angle were significantly improved. Conclusions Chronic scaphoid nonunion can be well treated with vascularized bone graft based on 1, 2 intercompartmental supraretinacular artery. A simple arthrolysis during the procedure can produce satisfactory results. External fixation plays a critical role in early mobilization and functional restoration of the wrist.

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