Objective:To compare the treatment efficacy between the Windowing and Open Book techniques in the treatment of tibial plateau fractures of Schatzker type Ⅱ.Methods:A retrospective study was performed to analyze the clinical data of the 211 patients with tibial plateau fracture of Schatzker type Ⅱ who had been treated by open reduction and internal fixation via the anterolateral knee incision at Department of Traumatic Orthopaedics, The Sixth Hospital of Ningbo from January 2014 to June 2022. There were 142 males and 69 females, with an age of (57.7±14.3) years. Based on the intraoperative reduction techniques, the patients were divided into 2 groups: a Windowing group ( n=107) in which reduction of the split bone fragments was followed by reduction of the depressed articular surface, and an Open Book group ( n=104) in which reduction of the depressed articular surface was followed by reduction of the split bone fragments. The following data were collected and compared between the 2 groups: preoperative general data, operative time, quality of fracture reduction, loss of fracture reduction, fracture healing rate at postoperative 6 months, visual analogue scale (VAS) pain score at postoperative 24 months, post-traumatic arthritis grading at the final follow-up (based on the Resnick-Niwoyam criteria), and Rasmussen classifications of knee function at postoperative 3 and 24 months. Results:There were no significant differences in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The follow-up period for all patients was (34.0±10.6) months. The operative time was (65.0±8.3) minutes for the Windowing group and (64.2±10.2) minutes for the Open Book group, showing no significant difference ( P>0.05). Postoperative CT scans revealed residual articular depression in 10 cases in the Windowing group and in 25 cases in the Open Book group, showing a significant difference ( P<0.05). However, there was no significant difference in plateau widening or varus/valgus alignment between the 2 groups ( P>0.05). There were no statistically significant differences between the 2 groups in loss of fracture reduction, fracture healing rate at postoperative 6 months, VAS score at postoperative 24 months, post-traumatic arthritis grading at the final follow-up, or Rasmussen classifications of the knee function at postoperative 3 or 24 months ( P>0.05). Conclusions:In the treatment of Schatzker type Ⅱ tibial plateau fractures, the Windowing technique demonstrates superior radiographic outcomes compared to the Open Book technique, but the 2 techniques show similar efficacy in functional evaluation and medium-term prognosis.

Objective:To compare the treatment efficacy between the Windowing and Open Book techniques in the treatment of tibial plateau fractures of Schatzker type Ⅱ.Methods:A retrospective study was performed to analyze the clinical data of the 211 patients with tibial plateau fracture of Schatzker type Ⅱ who had been treated by open reduction and internal fixation via the anterolateral knee incision at Department of Traumatic Orthopaedics, The Sixth Hospital of Ningbo from January 2014 to June 2022. There were 142 males and 69 females, with an age of (57.7±14.3) years. Based on the intraoperative reduction techniques, the patients were divided into 2 groups: a Windowing group ( n=107) in which reduction of the split bone fragments was followed by reduction of the depressed articular surface, and an Open Book group ( n=104) in which reduction of the depressed articular surface was followed by reduction of the split bone fragments. The following data were collected and compared between the 2 groups: preoperative general data, operative time, quality of fracture reduction, loss of fracture reduction, fracture healing rate at postoperative 6 months, visual analogue scale (VAS) pain score at postoperative 24 months, post-traumatic arthritis grading at the final follow-up (based on the Resnick-Niwoyam criteria), and Rasmussen classifications of knee function at postoperative 3 and 24 months. Results:There were no significant differences in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The follow-up period for all patients was (34.0±10.6) months. The operative time was (65.0±8.3) minutes for the Windowing group and (64.2±10.2) minutes for the Open Book group, showing no significant difference ( P>0.05). Postoperative CT scans revealed residual articular depression in 10 cases in the Windowing group and in 25 cases in the Open Book group, showing a significant difference ( P<0.05). However, there was no significant difference in plateau widening or varus/valgus alignment between the 2 groups ( P>0.05). There were no statistically significant differences between the 2 groups in loss of fracture reduction, fracture healing rate at postoperative 6 months, VAS score at postoperative 24 months, post-traumatic arthritis grading at the final follow-up, or Rasmussen classifications of the knee function at postoperative 3 or 24 months ( P>0.05). Conclusions:In the treatment of Schatzker type Ⅱ tibial plateau fractures, the Windowing technique demonstrates superior radiographic outcomes compared to the Open Book technique, but the 2 techniques show similar efficacy in functional evaluation and medium-term prognosis.

Objective:To investigate the efficacy of the posterior axillary approach combined with the deltoid pectoralis major approach in the treatment of proximal humeral fracture combined with lower glenoid fracture.Methods:From July 2019 to September 2021, 7 patients were treated at Department of Traumatic Othopeadics, The Sixth Hospital of Ningbo for proximal humeral fracture combined with lower glenoid fracture by internal fixation via the posterior axillary approach combined with the deltoid pectoralis major approach. They were 2 males and 5 females, aged from 51 to 78 years (average, 62.9 years). All fractures were closed ones. According to the Neer classification for the proximal humeral fractures, there were one case of type Ⅱ, one case of type Ⅲ, 3 cases of type Ⅳ and 2 cases of type Ⅵ. According to the Ideberg classification for the glenoid fractures, 5 cases were type Ⅰ and 2 cases type Ⅱ. The anteroposterior, lateral and axillary X-ray films of the affected shoulder were taken at 6 and 12 weeks, and 6 and 12 months after operation to follow up fracture healing and occurrence of complications. The Constant-Murley shoulder joint scores and the Disability of Arm Shoulder and Hand (DASH) scores for the upper limb dysfunction were recorded at the last follow-up for all patients.Results:All the 7 patients were followed up for 8 to 15 months (mean, 11.9 months). Bone union was achieved after an average of 4.3 months (from 3 to 6 months) in all patients. None of the functional activities was affected in all by postoperative shoulder joint instability, incision infection or axillary scar hyperplasia. At the last follow-up, their Constant-Murley scores averaged 83.4 points (from 55 to 92 points), and their DASH scores 13.5 points (from 4.2 to 33.3 points).Conclusion:In the treatment of proximal humeral fracture combined with lower glenoid fracture, the posterior axillary approach combined with the deltoid pectoralis major approach can lead to fine early curative efficacy due to their advantageous possibilities to allow for easy fracture reduction, reliable fixation and early rehabilitation.

Objective:To investigate the efficacy of treatment of Sanders Ⅱ & Ⅲ calcaneal fractures with an absorbable stick plus Kirschner wire through the tarsal sinus incision.Methods:From July 2017 to May 2020, 37 patients with 42 Sanders Ⅱ & Ⅲ calcaneal fractures were treated with an absorbable stick plus Kirschner wire through the tarsal sinus incision at The Third Ward of Department of Traumatic Orthopeadics, The Sixth Hospital of Ningbo. There were 25 males and 12 females, with an age of (48.2±5.6) years (from 20 to 69 years). The fractures were at the left side in 12 cases, at the right side in 20 and at bilateral sides in 5. By Sanders classification, 20 fractures were type Ⅱ and 22 ones type Ⅲ. Fracture union time and complications were recorded. Their B?hler and Gissane angles were compared between preoperation, postoperation and the last follow-up. The range of motion of the subtalar joint was evaluated by the Morrey method at 6 months postoperation. The functional recovery was evaluated by the American Society of Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at 12 months postoperation.Results:The 37 patients were followed up for (15.2±2.7) months (from 13 to 18 months). There were no such complications as incision skin necrosis, Kirschner wire deformation, loss of fracture reduction or Kirschner wire infection. The anatomical morphology of the calcaneus was restored satisfactorily in the 37 patients. At preoperation, postoperation and the last follow-up, the B?hler angles were 13.3°±1.6°, 32.5°±5.5° and 32.7°±5.4° and the Gissane angles 78.3°±6.7°, 127.2°±6.7° and 128.0°±6.4°, respectively, showing significant differences between the preoperative and postoperative values ( P<0.05) but no significant differences between postoperation and the last follow-up ( P>0.05). The range of motion of the subtalar joint at 6 months postoperation was slightly limited in 25 cases and moderately limited in 12 cases, giving a rate of moderate and above limitation of 32.4% (12/37). By the AOFAS ankle-hindfoot score at 12 months postoperation, 12 cases were excellent, 21 ones good and 4 ones fair, giving a good to excellent rate of 89.2% (33/37). Conclusion:Treatment with an absorbable stick plus Kirschner wire through the tarsal sinus incision may lead to fine clinical efficacy for Sanders Ⅱ & Ⅲ calcaneal fractures.

Objective To compare dynamic hip screw (DHS),InterTan and proximal femoral nail antirotation-Ⅱ (PFNA-Ⅱ) in the treatment of femoral intertrochanteric fracture in terms of their effects on postoperative hidden blood loss (HBL) and deep venous thrombosis (DVT).Methods We retrospectively analyzed the 133 patients with femoral intertrochanteric fracture who had been treated in our hospital from November 2011 to November 2015.Of them,42 received DHS treatment,including 22 males and 20 females;43 underwent InterTan fixation,including 21 males and 22 females;48 had PFNA-]Ⅱtreatment,including 25 males and 23 females.At preoperation,1,3 and 7 days postoperation,all of them had tests of hemoglobin (Hb),hematocrit value (Hct),blood platelet (PLT),thrombin time (TT),activated partial thromboplastin time (APTT),prothrombin time (PT),human fibrinogen (FIB) and D-dimer.DVT was detected using color Doppler ultrasound at 7 days postoperation.Results At 1,3 and 7 days postoperation,the DHS patients had the smallest values of Hb,Hct,TT,PT and APTT while the PFNA-Ⅱ patients the largest.The DHS patients had the largest values of intraoperative bleeding,PLT,FIB and D-dimer while the PFNA-Ⅱ patients the smallest.There were significant differences between the 3 groups in all the indexes (P ＜ 0.05) except in TT at 7 days postoperation and APTT at 1 and 7 days postoperation between the InterTan and PFNA-Ⅱ groups (P ＞ 0.05).The incidence of DVT in the InterTan group (2.3％,1/43) and in the PFNA-Ⅱ group (0) was significantly lower than in the DHS group(7.1％,3/42) (P ＜ 0.05).Conclusion In the treatment of femoral intertrochanteric fracture,PFNA-Ⅱ may be superior to InterTan and DHS in reducing postoperative HBL and control of DVT.