1.Effectiveness comparison of medial-lateral approach and posteromedian approach in release of elbow stiffness after distal humeral fractures surgery.
Lingzhe XUAN ; Hongru MA ; Fengfeng LI
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(11):1395-1401
OBJECTIVE:
To investigate the difference of effectiveness between medial-lateral approach and posteromedian approach in the release of elbow stiffness after distal humeral fracture surgery.
METHODS:
A retrospective analysis was conducted on the clinical data of 41 patients with elbow stiffness following medial and lateral plate fixation for distal humeral fractures, admitted between January 2021 and June 2023 and meeting selection criteria. Patients were divided into the medial-lateral approach release group (study group, 20 cases) and the posteromedian approach release group (control group, 21 cases) based on surgical approach. Baseline data including age, gender, affected side, body mass index, disease duration, and preoperative extension angle, flexion angle, range of motion, visual analogue scale (VAS) pain score, Mayo elbow performance score, ulnar nerve symptoms, and heterotopic ossification showed no significant difference between groups ( P>0.05). The operation time, intraoperative blood loss, and complication incidence were recorded and compared between groups. Clinical effectiveness was evaluated using pre- and postoperative Mayo score, VAS score, elbow extension/flexion angles, and range of motion on the affected side. Statistical analysis focused on changes in these indicators relative to preoperative values.
RESULTS:
There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). Patients in both groups were followed up 15-36 months, with a mean of 23.8 months; there was no significant difference in the follow-up time between the two groups ( t=-1.542, P=0.131). In the control group, 1 patient had obvious subcutaneous hematoma and 5 patients had poor wound healing within 2 months after operation, all of which were cured by symptomatic treatment, while no related complications occurred in the study group, there was a significant difference in poor wound healing incidence between the two groups ( P<0.05). At last follow-up, 2 patients in the study group and 3 patients in the control group had mild symptoms of ulnar nerve numbness, and there was no significant difference in the incidence of ulnar nerve symptoms ( P>0.05). All patients had no recurrence or new onset of heterotopic ossification, no skin necrosis or reoperation due to complications. At last follow-up, elbow extension angle, flexion angle, flexion-extension range of motion, VAS score, and Mayo score significantly improved in both groups when compared with the preoperative ones ( P<0.05). There was no significant difference between the change values in elbow extension angle and VAS score between the two groups ( P>0.05); the change values in flexion angle, range of motion, and Mayo score in the study group were significantly better than those in the control group ( P<0.05).
CONCLUSION
The medial-lateral approach can release the elbow stiffness and concurrently remove the medial, lateral, or posterior lateral plates. The incision minimizes disruption to rehabilitation exercises and reduces complications like inadequate wound healing, ultimately leading to improved treatment outcomes.
Humans
;
Humeral Fractures/surgery*
;
Male
;
Female
;
Retrospective Studies
;
Elbow Joint/physiopathology*
;
Middle Aged
;
Fracture Fixation, Internal/adverse effects*
;
Range of Motion, Articular
;
Adult
;
Bone Plates
;
Postoperative Complications/surgery*
;
Treatment Outcome
;
Aged
;
Humeral Fractures, Distal
2.Effectiveness of composite loop plate around coracoid process for reconstructing coracoclavicular ligament in treatment of Rockwood type Ⅲ acute acromioclavicular joint dislocations.
Hongqing HE ; Ningkai LI ; Meng LIU ; Hua WANG ; Qiang WANG ; Yinchang ZHANG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(11):1402-1408
OBJECTIVE:
To compare the effectiveness of using a composite loop plate to reconstruct the coracoclavicular ligament around the coracoid process and using a clavicular hook plate for fixation in treatment of Rockwood type Ⅲ acute acromioclavicular joint dislocation.
METHODS:
A retrospective analysis was conducted on the clinical data of 60 patients with Rockwood type Ⅲ acute acromioclavicular joint dislocation who were admitted between June 2022 and September 2023 and met the selection criteria. Among them, 30 patients were treated with the composite loop plate to reconstruct the coracoclavicular ligament around the coracoid process (loop plate group) and 30 with clavicular hook plate fixation (hook plate group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, injured side, cause of injury, disease duration, preoperative visual analogue scale (VAS) score for pain, and Constant-Murley score. The incision length, operation time, length of hospital stay, and the occurrence of complications during follow-up were recorded. The Constant-Murley score and VAS score were used to evaluate shoulder joint function and pain, and the differences (change values) of the indicators between before operation and at 6 months after operation were calculated for inter-group comparison. In the loop plate group, the coracoclavicular distance (CCD) on the anteroposterior X-ray films of the acromioclavicular joint was measured at 1 day and 6 months after operation to assess the loss of acromioclavicular joint reduction.
RESULTS:
The incision length of the loop plate group was significantly shorter than that of the hook plate group ( P<0.05). There was no significant difference in the operation time and the length of hospital stay between the two groups ( P>0.05). All incisions healed by first intention after operation. All patients were followed up 12-18 months (mean, 16.3 months). There was no significant difference in the follow-up time between groups ( P>0.05). The Constant-Murley scores and VAS scores of both groups significantly improved at 6 months after operation when compared with those before operation ( P<0.05); the differences in the change values of the two indicators between groups were significant ( P<0.05). The CCD of the loop plate group were (10.40±0.83) mm at 1 day and (10.70±0.68) mm at 6 months and no repositioning loss was observed. Three cases in the hook plate group had residual shoulder joint pain after operation. The difference in the accidence of complications between groups was not significant ( P>0.05).
CONCLUSION
For Rockwood type Ⅲ acute acromioclavicular joint dislocation, compared with the clavicular hook plate fixation, the composite loop plate for reconstructing the coracoclavicular ligament around the coracoid process has the advantages of simple operation, safety, minimally invasive, good functional recovery, and fewer complications. Moreover, it avoids the need for a second surgery to remove the internal fixation device, and the patient acceptance and satisfaction are higher.
Humans
;
Acromioclavicular Joint/surgery*
;
Bone Plates
;
Male
;
Retrospective Studies
;
Female
;
Adult
;
Ligaments, Articular/injuries*
;
Joint Dislocations/surgery*
;
Coracoid Process/injuries*
;
Treatment Outcome
;
Middle Aged
;
Plastic Surgery Procedures/instrumentation*
;
Fracture Fixation, Internal/instrumentation*
;
Young Adult
;
Clavicle/surgery*
3.TiRobot-assisted minimally invasive treatment of geriatric fragility fractures of the pelvis.
Canhui LI ; Yonghong DAI ; Weiqiong CAI ; Xiaopeng SITU ; Yanhui ZENG ; Xuelian DU ; Shi HONG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(11):1421-1427
OBJECTIVE:
To investigate the effectiveness of TiRobot-assisted minimally invasive treatment for fragility fractures of the pelvis (FFP) in elderly patients.
METHODS:
A retrospective analysis was conducted on the clinical data of 176 patients with FFP who were admitted between July 2018 and July 2024 and met the selection criteria. Among them, 95 patients underwent TiRobot-assisted closed reduction and minimally invasive cannulated screw fixation (robot group), while 81 patients underwent traditional open reduction and plate screw fixation (control group). There was no significant difference in baseline data such as gender, age, fracture classification, disease duration, and preoperative visual analogue scale (VAS) pain scores between the two groups ( P>0.05). The following parameters were recorded and compared between the two groups, including operation time, intraoperative blood loss, intraoperative transfusion rate, volume of intraoperative blood transfusion, maximum incision length, hospital stay, maximum residual displacement, reduction quality, fracture healing time, incidence of complications, VAS scores, Majeed pelvic function scores, and functional grading.
RESULTS:
All surgeries in both groups successfully completed. The robot group exhibited significantly shorter operation time, reduced intraoperative blood loss, lower intraoperative transfusion rate, smaller volume of intraoperative blood transfusion, shorter maximum incision length, and shorter hospital stay compared to the control group ( P<0.05). In the robot group, a total of 14 INFIX internal fixation frames and 280 cannulated screws were implanted, among which 250 screws were rated as excellent, 17 as good, and 13 as poor, resulting in a screw placement excellent and good rate of 95.36%. Radiological review revealed that the excellent and good rate of reduction quality was in 91.58% (87/95) in the robot group and 81.48% (66/81) in the control group, with no significant difference in postoperative maximum residual fracture displacement or reduction quality between the two groups (P>0.05). All patients in both groups were followed up 12-66 months, with an average of 28.9 months, and there was no significant difference in follow-up time between the two groups ( P>0.05). The fracture healing time in the robot group was significantly shorter than that in the control group ( P<0.05). At last follow-up, both groups showed significant improvement in VAS scores compared to preoperative values ( P<0.05); the change values of VAS scores, Majeed scores, and the excellent and good rate of Majeed pelvic function were significantly higher in the robot group than in the control group ( P<0.05). Regarding postoperative complications, there was no significant difference between the two groups in terms of gait changes, secondary surgeries, heterotopic ossification, incision infections, walking difficulties, internal fixation failure, or mortality rates ( P>0.05); however, the incidence of delayed wound healing was significantly lower in the robot group than in the control group ( P<0.05).
CONCLUSION
TiRobot-assisted minimally invasive treatment of elderly FFP is superior to traditional open reduction and internal fixation in terms of surgical trauma control, postoperative rehabilitation speed, and functional recovery.
Humans
;
Male
;
Retrospective Studies
;
Female
;
Minimally Invasive Surgical Procedures/instrumentation*
;
Fracture Fixation, Internal/instrumentation*
;
Pelvic Bones/surgery*
;
Aged
;
Bone Screws
;
Bone Plates
;
Robotic Surgical Procedures/methods*
;
Aged, 80 and over
;
Treatment Outcome
;
Osteoporotic Fractures/surgery*
;
Operative Time
;
Blood Loss, Surgical
;
Fracture Healing
;
Fractures, Bone/surgery*
4.Effectiveness of staged therapy using external fixation frame for infectious nonunion near knee joint.
Zhiguo WANG ; Xiaoguang GUO ; Zheng KANG ; Xinwei WANG ; Guoqiang JIN ; Honglue TAN ; Xiaohui DENG ; Weihua FENG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(11):1428-1434
OBJECTIVE:
To explore the methods, fixation points, and effectiveness of staged therapy using external fixation frame in treatment of infectious nonunion near knee joint.
METHODS:
A retrospective analysis was conducted on the clinical data of 60 patients with infectious nonunion near knee joint, who underwent staged therapy using external fixation frame between June 2021 and June 2024 and were followed up. There were 48 males and 12 females with an average age of 47.9 years (range, 16-70 years). The disease duration ranged from 9 months to 20 years, with a median of 14 months. Among them, 21 cases of infectious nonunion located in the distal femur, 36 cases in the proximal tibia, and 3 cases in the patella; 12 cases exhibited segmental bone defects (≥4 cm), while 48 cases presented with localized bone defects (<4 cm). Osteomyelitis was classified using the Cierny-Mader system, with 3 cases classified as type Ⅰ, 6 cases as type Ⅱ, 35 cases as type Ⅲ, and 16 cases as type Ⅳ. Preoperative C-reactive protein levels ranged from 15.1 to 55.8 mg/L (mean, 36.4 mg/L). The erythrocyte sedimentation rate was 35-80 mm/1 h (mean, 56.9 mm/1 h). The Hospital for Special Surgery (HSS) score for knee joint was 69.3±17.7 and the range of motion was (70.61±40.60)°. After debridement and placement of antibiotic carriers at the first-stage operation, unilateral orbital frames ( n=14), combined frames ( n=27), or Ilizarov frames ( n=19) were used for cross joint fixation ( n=9) or joint preservation fixation ( n=51). After 6-8 weeks of infection control, the bone grafting or bone transport was performed at the second-stage operation based on the type of bone defect, with internal fixation employed as an adjunct if necessary. After operation, the infection control and fracture healing were observed and the bone healing time was recorded. The knee joint function was assessed using the HSS score, and the knee joint range of motion was measured as well as the angle of motion loss. Patients were grouped according to the site of nonunion, type of external fixation frame, and fixation method. The bone healing time, change value of HSS score, and knee joint range of motion loss (difference between pre- and post-operation) were compared between groups.
RESULTS:
All infection markers returned to the normal range within 6 weeks after the first-stage operation. All patients were followed up 12-48 months (mean, 22.0 months) after the second-stage operation. There were 5 cases of needle tract infection during the external fixation period, and 3 cases of infection recurrence after the second-stage operation, all of which were cured after symptomatic treatment. The bone healing time was 6-18 months (mean, 11.0 months). At last follow-up, the HSS score was 88.5±7.9 and the range of motion was (61.84±40.59)°, with significant differences compared to preoperative values ( P<0.05); the knee joint range of motion loss was (8.77±11.07)°. The bone healing time was significantly longer in the distal femur group than in the proximal tibia group ( P<0.05), and in the unilateral orbital frames group than in the Ilizarov frames group and the combined frames group ( P<0.05). The angle of motion loss was significantly larger in the Ilizarov frames group than in the unilateral orbital frames group and the combined frames group ( P<0.05). The change value of HSS score was significantly higher in the cross joint fixation group than in the joint preservation fixation group ( P<0.05).
CONCLUSION
During the first-stage operation, debridement is performed and antibiotic carriers are placed to control infection. External fixation frames are then precisely positioned based on the distance between the lesion and the joint surface, avoiding the infected wound while ensuring mechanical balance. During the second-stage operation, bone grafting options are selected according to the extent of bone defects to enhance the bone union. Postoperative early functional exercises of the knee joint are permitted to improve joint function.
Humans
;
Male
;
Female
;
Middle Aged
;
Adult
;
Fractures, Ununited/surgery*
;
Retrospective Studies
;
External Fixators
;
Aged
;
Knee Joint/surgery*
;
Adolescent
;
Young Adult
;
Treatment Outcome
;
Osteomyelitis/surgery*
;
Fracture Fixation/instrumentation*
;
Bone Transplantation
;
Tibial Fractures/surgery*
5.Clinical study on reduction of posterior malleolar fractures via modified Rammelt transfibular approach.
Shaozhen JI ; Jianyi LEI ; Jianbo GUO ; Dehang LIU ; Xiangliang GE ; Jinxi HU ; Shixin LIU ; Zhenhui SUN
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(11):1441-1446
OBJECTIVE:
To evaluate the safety and effectiveness of reducing posterior malleolar fractures via the modified Rammelt transfibular approach.
METHODS:
A retrospective analysis was conducted on 26 patients with ankle fractures who met the selection criteria and were admitted between September 2023 and May 2024. There were 13 males and 13 females, aged from 14 to 59 years (median, 43.5 years). Causes of injury included traffic accident (1 case), falls (7 cases), and sprains (18 cases). Time from injury to operation ranged from 1 to 13 days (mean, 3.9 days). According to the Lauge-Hansen classification, there were 5 supination-external rotation type Ⅲ fractures and 21 supination-external rotation type Ⅳ fractures. According to the Bartoníček classification for posterior malleolar fractures, there were 12 type Ⅱ fractures, 10 type Ⅲ fractures, and 4 type Ⅳ fractures. During operation, the fracture was exposed via the modified Rammelt transfibular approach; then, the fracture reduction was achieved under direct vision using techniques such as towel clip traction, posterolateral compression, and lifting with a posterior transverse periosteal elevator; finally, the fracture was fixed using anteroposterior cannulated screws or Kirschner wires. The incision healing was observed after operation. At 4 months after operation, X-ray film and CT were reviewed to evaluate the quality of fracture reduction. The medial clear space, tibiofibular clear space, and the anterior/posterior tibiofibular syndesmotic distances were measured. At last follow-up, the ankle function was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the range of motion.
RESULTS:
The marginal necrosis occurred in 2 lateral malleolar incisions, and superficial infection occurred in 1 lateral malleolar incision; the remaining incisions healed by first intention. All 26 patients were followed up 13-21 months (mean, 15.6 months). X-ray films showed that fractures in 25 patients achieved clinical union within 3-8 months (mean, 5.4 months); 1 case had delayed union of the lateral malleolus. At 4 months after operation, no significant difference was found between the injured and healthy sides in the medial clear space, tibiofibular clear space, or the anterior/posterior tibiofibular syndesmotic distances ( P>0.05). No malreduction of the posterior malleolus or the tibiofibular syndesmosis occurred. At last follow-up, the AOFAS score ranged from 80 to 100 (mean, 91.9). The range of motion ranged from 17° to 22° (mean, 21.0°) in active ankle dorsiflexion and from 40° to 49° (mean, 44.6°) in plantar flexion. Internal fixator was removed in 12 patients at 1 year after operation, with no ankle instability occurring. Ankle joint degeneration was observed in 1 patient at last follow-up.
CONCLUSION
The modified Rammelt transfibular approach is a safe and reliable technique. It enables precise reduction under direct vision, improves the quality of reduction for the distal tibial articular surface and the tibiofibular syndesmosis, and provides satisfactory ankle functional recovery in short-term follow-up.
Humans
;
Male
;
Female
;
Adult
;
Ankle Fractures/diagnostic imaging*
;
Middle Aged
;
Retrospective Studies
;
Fracture Fixation, Internal/instrumentation*
;
Adolescent
;
Treatment Outcome
;
Young Adult
;
Bone Screws
;
Ankle Joint/surgery*
;
Fibula/surgery*
;
Range of Motion, Articular
6.Treatment options and research progress of proximal tibial extra-articular fractures.
Yuelei ZHANG ; Qi ZHANG ; Yuan LIN ; Yuandong FAN
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(11):1485-1490
OBJECTIVE:
To review the main fixation methods for proximal tibial extra-articular fractures based on clinical and biomechanical results, and to provide evidence for clinical application.
METHODS:
Extensive related literature at home and abroad was conducted in recent years, and external fixation systems such as external fixation braces and external locking plates, as well as internal fixation systems such as plates and intramedullary nails, were systematically reviewed regarding their application indications, clinical efficacy, and biomechanical results in proximal tibial extra-articular fractures.
RESULTS:
External fixation systems have advantages in fractures with open or severe soft tissue injury, facilitating wound management and maintaining stability of the fracture site to some extent. However, in proximal tibial extra-articular fractures with good soft tissue conditions, internal fixation systems such as plates and intramedullary nails are still the first choice. Some studies have found that intramedullary nails allow patients to bear weight early, with shorter fracture healing time and higher rate of malunion, while other studies have found that both intramedullary nails and plates have similar clinical efficacy and can achieve satisfactory treatment results.
CONCLUSION
The choice of fixation method for proximal tibial extra-articular fractures depends not only on the type of fracture, but also on the surgeon's habits and operational skills. Larger-scale studies are still needed to clarify the advantages and disadvantages of intramedullary nails and locking plates in the treatment of proximal tibial extra-articular fractures.
Humans
;
Tibial Fractures/surgery*
;
Bone Plates
;
Fracture Fixation, Intramedullary/instrumentation*
;
Fracture Fixation, Internal/instrumentation*
;
Fracture Healing
;
External Fixators
;
Bone Nails
;
Fracture Fixation/instrumentation*
;
Treatment Outcome
;
Biomechanical Phenomena
7.Anteromedial cortical support reduction in treatment of trochanteric femur fractures: a ten-year reappraisal.
Sunjun HU ; Shouchao DU ; Shimin CHANG ; Wei MAO ; Zhenhai WANG ; Kewei TIAN ; Tao LIU ; Yunfeng RUI
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(12):1501-1509
OBJECTIVE:
This review summarized the first 10-year progresses and controversies in the concept of anteromedial cortical support reduction, to provide references for further study and clinical applications.
METHODS:
Relevant domestic and foreign literature on cortical support reduction was extensively reviewed to summarize the definition of positive, neutral, and negative support, anteromedial cortices at the inferior corner, intraoperative technical tips for fracture reduction, radiographic assessment at different periods, comparison between positive versus neutral and medial versus anterior support, and the clinical efficacy of Chang reduction quality criteria (CRQC) and postoperative stability score.
RESULTS:
Anteromedial cortical support reduction was only focused on the cortex of anteromedial inferior corner, with no concern the status of lateral wall or lesser trochanter. Anteromedial cortex was seldom involved by fracture comminution, it was thicker, denser, and stronger, and was the key for mechanical buttress of the head-neck fragment to share compression load. Positive, neutral, and negative support were also called "extramedullary, anatomic, and intramedullary reduction", respectively. There was hardly seen parallel cortical apposition, but characterized by some kinds of head-neck rotation, for example 10°-15° flexed rotation for positive cortical contact and support. Due to intraoperative compression and postoperative impaction, the status of cortical support may be changed at different time of radiographic examination. The positive medial cortex support was more reliable with less reduction loss than its neutral counterpart, and the anterior cortex contact was more predictive than the medial cortex for final results. As incorporation the bearing of cortex apposition and using a 4-point score, CRQC demonstrated more efficacy and was gradually accepted and applied in the evaluation of trochanteric fracture reduction quality. Postoperative stability score (8 points) provided a assessment tool for early weight-bearing in safety to prevent mechanical failure.
CONCLUSION
Anteromedial cortical support reduction is a key point for stability reconstruction in the treatment of trochanteric femur fractures. Evidence has definitely shown that non-negative (positive and neutral) is superior to negative (loss of cortical support). There is a tendency that positive cortex support is superior to neutral, but high quality study with large sample size is needed for a clear conclusion.
Humans
;
Femur/diagnostic imaging*
;
Fracture Fixation, Internal/methods*
;
Hip Fractures/diagnostic imaging*
;
Treatment Outcome
;
Fracture Fixation, Intramedullary/methods*
8.Application of bridge combined fixation system in pediatric Bado type Ⅰ chronic Monteggia fractures.
De PAN ; Xiaoqing HE ; Ying XIONG ; Bolin YUE ; Xi YANG ; Yongqing XU ; Yongyue SU
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(12):1516-1520
OBJECTIVE:
To investigate effectiveness of the bridge combined fixation system (BCFS) for Bado typeⅠchronic Monteggia fractures (CMF) in children.
METHODS:
A clinical data of 8 children with Bado type ⅠCMF, who were treated with the BCFS between November 2023 and February 2025, was retrospectively analyzed. There were 6 boys and 2 girls, with a mean age of 7.0 years (range, 4-12 years). The time from injury to operation ranged from 29 to 370 days (median, 68.5 days). Preoperative elbow range of motion was (111.3±17.9)° in flexion, (13.1±13.9)° in extension, (71.9±14.6)° in pronation, and (75.6±13.5)° in supination. Fracture healing time and postoperative complications were observed, and clinical outcomes were evaluated using the Mayo elbow performance score.
RESULTS:
All incisions healed by primary intention without infection, non-healing of the incision, or iatrogenic nerve injury. All children were followed up 4-18 months (mean, 10.3 months). At last follow-up, the elbow range of motion significantly improved to (142.5±2.7)° in flexion, (2.5±2.7)° in extension, (87.5±2.7)° in pronation, and (88.8±2.3)° in supination ( P<0.05). According to the postoperative Mayo elbow performance score, all cases were rated as excellent. Radiographic review showed no radial head dislocation, nonunion at the ulnar osteotomy site, or elbow stiffness, and no breakage of the BCFS or screw loosening. The fracture healing time ranged from 3 to 6 months, with a median of 4 months.
CONCLUSION
The BCFS was confirmed to be effective in the treatment of pediatric Bado type Ⅰ CMF, with good restoration of elbow function and the advantage of avoiding secondary implant removal surgery.
Humans
;
Child
;
Monteggia's Fracture/surgery*
;
Male
;
Female
;
Child, Preschool
;
Range of Motion, Articular
;
Retrospective Studies
;
Fracture Fixation, Internal/instrumentation*
;
Elbow Joint/physiopathology*
;
Bone Plates
;
Treatment Outcome
;
Fracture Healing
;
Bone Screws
;
Elbow Injuries
9.Treatment of inferior pole patellar fractures with suture anchors and headless compression screws.
Junsong WANG ; Wei ZHANG ; Zhuang TIAN ; Yu JIANG ; Qi YAO
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(12):1521-1525
OBJECTIVE:
To evaluate the effectiveness of suture anchors combined with headless compression screw fixation in treating inferior pole patellar fractures.
METHODS:
A retrospective analysis was conducted on 36 patients with inferior pole patellar fractures, who were admitted between January 2018 and October 2024 and met the selective criteria. There were 15 males and 21 females with a mean age of 52.3 years (range, 23-81 years). The fracture were reduced and fixed using suture anchors combined with headless compression screws. The operation time, intraoperative blood loss, and the length of hospital stay were recorded. Functional recovery was assessed using knee range of motion (ROM), Hospital for Special Surgery (HSS) knee score, and Böstman patellar fracture efficacy score.
RESULTS:
The operation time ranged from 10 to 100 minutes, with an average of 57.6 minutes. The intraoperative blood loss was 10 to 120 mL, with an average of 73.3 mL. The length of hospital stay was 5 to 10 days, with an average of 6.3 days. All incisions healed by first intention. All 36 patients were followed up 18-24 months (mean, 20.6 months). Postoperative X-ray films indicated that the fractures had healed; no screw breakage, anchor loosening, or implant foreign body rejection reactions occurred during follow-up. At last follow-up, the ROM of the affected knee joint was (136.0±2.3)°, and there was no significant difference when compared with the healthy side (136.6±2.3)° ( t=-1.944, P=0.060). The HSS score of the affected knee joint was 96-100 (mean, 99.1), and all cases were rated as excellent. The Böstman patellar fracture efficacy score was 27-30 (mean, 29.1), and 35 cases were rated as excellent and 1 as good.
CONCLUSION
The suture anchors combined with headless compression screws technique provides reliable fixation for inferior pole patellar fractures. This method combines surgical simplicity with excellent functional outcomes.
Humans
;
Male
;
Female
;
Middle Aged
;
Bone Screws
;
Aged
;
Retrospective Studies
;
Patella/surgery*
;
Fracture Fixation, Internal/instrumentation*
;
Adult
;
Aged, 80 and over
;
Suture Anchors
;
Fractures, Bone/surgery*
;
Range of Motion, Articular
;
Treatment Outcome
;
Young Adult
;
Operative Time
;
Length of Stay
10.Effectiveness of posterior single-level osteotomy with 360° release and correction in treatment of osteoporotic vertebral compression fractures with moderate to severe kyphosis.
Peidong QING ; Hongda XU ; Youpeng HU ; Bin XIE ; Tieheng WANG ; Lei ZHANG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(12):1574-1579
OBJECTIVE:
To explore the effectiveness of posterior single-level osteotomy with 360° release and correction for the treatment of osteoporotic vertebral compression fractures (OVCF) complicated with moderate to severe kyphosis.
METHODS:
A retrospective analysis was conducted on 11 patients with OVCF complicated with moderate to severe kyphosis between January 2022 and March 2023. There were 4 males and 7 females with an average age of 57 years ranging from 47 to 69 years. The disease duration ranged from 3 to 15 months, with an average of 7 months. Fracture segments included T 11 in 3 cases, T 12 in 5, L 1 in 2, and L 2 in 1. The T value of lumbar spine bone density was -5.0 to -2.0, with an average of -3.5. The preoperative neurological function was grade E according to Frankel grading. The Pfirrmann classification of the intervertebral disc above the injured vertebra was grade Ⅲ in 8 cases and grade Ⅳ in 3 cases. All patients underwent posterior single-level osteotomy with 360° release and correction. The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded. Thoracolumbar local kyphosis Cobb angle, the mean height of the functional spinal unit (FSU), the sagittal vertical axis (SVA), and the sagittal index (SI) were measured. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the improvement of pain and function before operation, at 1 month after operation, and at last follow-up.
RESULTS:
The operation successfully completed in all patients, and there was no obvious complication. The operation time ranged from 100 to 190 minutes, with an average of 153 minutes, and the intraoperative blood loss ranged from 200 to 800 mL, with an average of 468 mL. The length of hospital stay was 8-14 days (mean, 12 days). All patients were followed up 6-24 months, with an average of 12.4 months. At last follow-up, all the 11 patients had bony fusion in the osteotomy area, and there was no displacement or subsidence of the Cage, no complication such as internal fixation failure or pseudarthrosis formation was found. The Cobb angle of local thoracolumbar kyphosis, the mean height of FSU, SVA, and SI significantly improved immediately after operation and at last follow-up when compared with preoperative ones, and the VAS score and ODI also significantly improved at 1 month after operation and at last follow-up ( P<0.05); there was no significant difference in above indexes between the two time points after operation ( P>0.05).
CONCLUSION
Posterior single-level osteotomy with 360° release and correction is an effective surgical method for treating OVCF complicated with moderate to severe kyphosis, with definite early effectiveness.
Humans
;
Kyphosis/etiology*
;
Male
;
Female
;
Osteotomy/methods*
;
Middle Aged
;
Retrospective Studies
;
Aged
;
Spinal Fractures/diagnostic imaging*
;
Fractures, Compression/diagnostic imaging*
;
Osteoporotic Fractures/complications*
;
Treatment Outcome
;
Lumbar Vertebrae/injuries*
;
Thoracic Vertebrae/injuries*
;
Operative Time
;
Fracture Fixation, Internal/methods*

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