Humans ; East Asian People ; External Fixators ; Fracture Fixation/methods* ; Fracture Fixation, Internal/methods* ; Fractures, Bone/surgery* ; China ; Minimally Invasive Surgical Procedures/methods*

OBJECTIVE: To evaluate the needle puncture safety and clinical efficacy of manual reduction combined with external fixation of ankle frame in the treatment of trimalleolar fracture under the guidance of Chinese Osteosynthesis (CO) theory. METHODS: The clinical data of 118 patients with trimalleolar fractures admitted from December 2010 to December 2021 were retrospectively analyzed. Fifty-three patients were treated with manual reduction combined with external fixation of ankle frame(observation group). Sixty-five patients were treated with open reduction and internal fixation with plate and screws(control group). The operation time, hospitalization days, non-weight-bearing time of the affected limb, clinical healing time of fracture, incidence of complications, visual analogue scale (VAS) before and 1 month after operation, and American Orthopedic Foot and Ankle Society(AOFAS) score of ankle joint before and 1 year after operation were compared between the two groups. RESULTS: Patients in both groups were followed up for more than 1 year. All patients were followed up, and the duration ranged from 14 to 70 months, with an average of(35.28±14.66) months. There were statistically significant in operation time, hospitalization days, non-load-bearing time of affected limbs, clinical healing time of fractures and VAS score one month after operation between the two groups. One month after operation, the VAS score of the observation group was lower than that of the control group(t=3.343, P=0.001). The operation time of the observation group was significantly shorter than that of the control group(t=9.091, P=0.000). The hospitalization days in the observation group were significantly less than those in the control group(t=5.034, P=0.000). The non-load-bearing time of the affected limb in the observation group was significantly shorter than that in the control group(t=11.960, P=0.000). The clinical healing time of fracture in the observation group was significantly shorter than that in the control group(t=4.007, P=0.000). There was no significant difference in AOFAS score between the two groups one year after operation(t=0.417, P=0.678). In the observation group, there were 2 cases of pinhole infection and 3 cases of loss of reduction less than 2 mm. There were 3 cases of surgical incision infection in the control group. There was no significant difference in the incidence of complications between the two groups(χ²=0.446, P=0.504). CONCLUSION Manual reduction combined with external fixation is safe and effective in the treatment of trimalleolar fracture under the guidance of CO theory, and the function of ankle joint recovers well after operation. This therapy has good clinical value.
Humans ; Ankle Fractures/surgery* ; Ankle Joint/surgery* ; East Asian People ; External Fixators ; Lower Extremity ; Retrospective Studies ; Manipulation, Orthopedic/methods* ; Fracture Fixation/methods* ; Open Fracture Reduction/methods* ; Fracture Fixation, Internal/methods*

OBJECTIVE: To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection. METHODS: The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score. RESULTS: All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up ( P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%. CONCLUSION Limited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.
Male ; Female ; Humans ; Adult ; Elbow ; Elbow Joint/surgery* ; Retrospective Studies ; Bone Cements ; Treatment Outcome ; External Fixators ; Fracture Fixation, Internal/methods* ; Fractures, Bone ; Range of Motion, Articular

Schatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane, consequent to valgus impaction caused by low velocity of trauma. However, a deep understanding of the different columns of the tibial plateau and patho-mechanisms of the injury led to the unmasking of atypical fractures around the tibial plateau. We have encountered 2 cases with unusual fracture pattern of the lateral tibial condyle caused by road traffic accidents. The fracture pattern and severity of injury deviate from the original description of Schatzker type 1; in view of dual plane split, there is rotation of the posterolateral column fragment along its sagittal plane plus grade-III medial collateral ligament injury. The patients were initially treated with knee spanning external fixator and after a latency of 5 days, definitive fracture specific fixation was done, combined with repair of grade-III medial collateral ligament injury. At the 6 months follow-up both the patients achieved satisfactory knee functions (knee society score case 1: 100 and case 2: 92) and returned to their jobs. The severity of fracture pattern and displacement as described should prompt for examination of associated ligament injury. Because of timely diagnosis, early and appropriate care promised an excellent function outcome even in such a severe nature of knee injury. To prompt the description of injury pattern we coined the name "dual split and dislocation" of lateral tibial plateau, as a complex injury variant of split fracture of lateral tibial plateau fracture.
External Fixators ; Fracture Fixation, Internal ; Humans ; Joint Dislocations ; Knee Injuries ; Tibial Fractures/surgery*

The software of 3D-Modeling(UG NX 10.0) was used to design a new external fixator model for proximal femoral fracture, and fresh femoral cadaver specimens were used to simulate experimental operation. The results showed that the external fixator designed with the proximal femoral locking plate shape can improve the accuracy of Kirschner wire penetration into the femoral neck, reduce fluoroscopic and soft tissue incision injuries, and make a good stability and is easy to operate, which has a certain value for patients with proximal femoral fracture, such as intolerant surgery and poor physical condition.
Bone Plates ; External Fixators ; Femoral Fractures/surgery* ; Fracture Fixation, Internal/methods* ; Humans

OBJECTIVE: To explore the clinical effect of manual reduction combined with homemade splint external fixation in the treatment of metacarpal fractures. METHODS: A retrospective analysis was performed in 126 patients with metacarpal fracture treated by manual reduction and homemade splint external fixation in the emergency department of our hospital from January 2018 to December 2018, including 102 male, 24 female, ranging in age from 9 to 73 year old, with an average of (33.2±14.3)years old. During the treatment, the X-ray was re-examined regularly, and the external fixation was continued or adjusted according to the X-ray situation. The X-ray showed callus growth. After the fracture was stable, the external fixation was removed to continue functional exercise. The TAM scoring standardwas used to evaluate the hand function, and the fracture healing and complications were summarized. RESULTS: Of the 126 patients, 6 patients were treated with operation because of fracture displacement during the treatment. The other 120 patients were treated with this method and all of them got bony healing. The healing time was (6.3±1.8) weeks. The follow up time ranged from 2 to 12 months, with a mean of (4.4±2.2) months. At the latest follow up, TAM score was used to evaluate the hand function:excellent in 105 cases, good in 13 cases, fair in 2 cases and poor in 0 case. Shortening deformity was found in 7 cases and angulation deformity in 3 cases. CONCLUSION Manual reduction combined with homemade splint external fixation in the treatment of metacarpal fractures can achieve good clinical results. Homemade splint is easy to obtain materials and low cost, and it is an effective method worthy of clinical promotion.
Adolescent ; Adult ; Aged ; Child ; External Fixators ; Female ; Fracture Fixation ; Fracture Fixation, Internal ; Humans ; Male ; Metacarpal Bones ; Middle Aged ; Retrospective Studies ; Splints ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore clinical effect of bridge-link combined fixation system(BCFS) in treating open middle and lower tibial fractures by external fixation. METHODS: From October 2016 to September 2017, 11 patients with open middle and lower tibial fractures were treated with BCFS by external fixation, including 7 males and 4 females aged from 23 to 65 years old with an average of 44.2 years old;the course of disease ranged from 7 to 10 days. All fractures were open, middle and lower tibiofibular fractures. According to AO classification, 5 patients were type A, 5 patients were type B, and 1 patient was type C. All fractures were classified as typeⅡaccording to Gustilo-Anderson classification. The time of fracture healing, postoperative complications were observed, Johner-Wruhs standard were used to evaluate clinical effect. RESULTS: All patients were followed up from 7 to 13 months with an average of 10.1 months. Fracture healing time ranged from 4 to 8 months with an average of 6.2 months. The removal time of BCFS ranged from 5 to 11 months with an average of 7.8 months. No screws loosening and BCFS breakage occurred after operation, while 1 patient occurred infection of proximal and distal tibia after operation which was healed by anti-inflammatory treatment and dressing change. According to Johner-Wruhs standard, 8 patients were excellent and 3 patients good at the latest follow-up. CONCLUSION BCFS could be used to treat open middle and lower tibial fractures by external fixation, which had features of small size, flexible use, solid and elastic fixation. It could not effectively reduce tissue injury and promote fracture healing, but also have advantages of less postoperative complications and better recovery of limb function.
Adult ; Aged ; Bone Plates ; External Fixators ; Female ; Fracture Fixation ; Fracture Fixation, Internal ; Fracture Healing ; Fractures, Open ; Humans ; Male ; Middle Aged ; Tibial Fractures/surgery* ; Treatment Outcome ; Young Adult

OBJECTIVE: To retrospectively analyze the clinical efficacy of external fixation in the treatment of femoral neck fracture with two different pin layout. METHODS: From April 2000 to April 2018, 140 cases of femoral neck fracture were treated with closed reduction and percutaneous pin external fixation, among them 121 cases were followed up for more than 1 year, including 31 cases in traditional group, 12 males and 19 females, aged 45 to 74(65.4±8.4) years;90 cases in modified group, 39 males and 51 females, aged 12 to 75 (64.5±7.8) years. In traditional group, the first needle was put on the femoral talus, the second and third needles were put under the tension line, and the three needles were not on the same line in the lateral phase; in modified group, the first needle was drilled into the lateralcortex of the femur, obliquely penetrating the distal and proximal end of the femoral talus fracture, and the other two needles were drilled into the medial cortex of the femoral neck and the femoral talus, respectively. The operation time, hospital stay, postoperative ambulation time, femoral neck shortening rate, fracture healing time, fracture healing rate and femoral head necrosis rate of the two groups were observed and compared. Harris hip function score was used one year after operation. RESULTS: These 121 patients were followed-up, the follow up time of traditional group was 13 to 45(30.5±11.4) months;the follow-up time of modified group was 14 to 120(34.5±12.5) months. There was no significant difference in operation time, hospital stay and femoral head necrosis rate between two groups ( CONCLUSION Compared with the traditional group, the modified group has the advantages of lower femoral neck shortening rate, shorter fracture healing time, higher fracture healing rate and higher Harris hip function score.
Adolescent ; Adult ; Aged ; Child ; External Fixators ; Female ; Femoral Neck Fractures/surgery* ; Fracture Fixation ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore clinical effect of locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with bone defects. METHODS: Totally 92 patients of open and comminuted tibial fractures with bone defects were chosen form January 2018 to July 2019, and randomly divided into external fixation group and internal fixation group, 46 patients in each group. In external fixation group, there were 29 males and 17 females, aged from 25 to 62 years old, with an average of (37.45±10.92) years old;according to AO classification, 15 patients were type A, 22 patients were type B and 9 patients were type C;according to Gustilo classification, 21 patients were typeⅡ, 10 patients were type ⅢA, 10 patients were type ⅢB, 5 patients were type Ⅲ C;treated by fracture reduction with locking plate external fixation. In internal fixation group, there were 31 males and 15 females, aged from 23 to 60 years old, with an average of(36.88±10.64) years old;according to AO classification, 18 patients were type A, 20 patients were type B and 8 patients were type C; according to Gustilo classification, 22 patients were typeⅡ, 11 patients were type ⅢA, 7 patients were type ⅢB, 6 patients were type Ⅲ C;treated by traditional open reduction with plate internal fixation. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time and postoperative complications between two groups were observed and compared, bone mineral density, osteocalcin, blood calcium and phosphorus before operation and 1 month after operation. RESULTS: All patients were followed up from 12 to 18 months with an average of (14.92±2.46) months. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time of external fixation group were significantly better than that of internal fixation group( CONCLUSION Locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with severe post-traumatic bone defects has advantages of less trauma, reliable fixation, shorter fracture healing time, and could improve bone metabolic activity with less postoperative complications.
Adult ; Bone Plates ; External Fixators ; Female ; Fracture Fixation ; Fracture Fixation, Internal ; Fractures, Comminuted/surgery* ; Humans ; Male ; Middle Aged ; Technology ; Tibial Fractures/surgery* ; Treatment Outcome ; Young Adult

OBJECTIVE: To compare clinical efficacy and safety of plate internal fixation (ORIF) and external fixator (EF) in treating distal radius fractures by Meta-analysis. METHODS: From establishment of database to August, 2019, randomized controlled trial (RCT) about open reduction and internal fixation (ORIF) and external fixation (EF) in treating distal radius fractures was conducted by using computer-based databases, including CNKI, VIP, Wanfang Data, Medline, Cochrane library databases. Data extraction and quality evaluation of included study according to inclusion and exclusion criteria, RevMan 5.3 software was used to perform Meta-analysis. Palm angle, ulnar deflection angle, radius height, grip strength, ulnar variation, disabilities of arm, shoulder and hand (DASH) score, total complication rate, infection rate and tendon rupture between two groups were compared. RESULTS: Totally 19 RCT were included with 1 730 patients, 873 patients in ORIF group and 857 patients in EF group. Meta analysis result showed that after operation at 12 months, there were no significant difference in radial height [ CONCLUSION Compared with EF in treating distal radius fracture, ORIF has better clinical effects in postoperative complications, palm angle, ulnar deviation angle, ulnar variation rate and infection rate. While there were no significant difference between in DASH score, radial height, tendon rupture and carpal tunnel syndrome better EF and ORIF. For the patient pursue rapid recovery of function, ORIF is better choice.
Bone Plates ; External Fixators ; Fracture Fixation ; Fracture Fixation, Internal ; Humans ; Radius Fractures/surgery* ; Range of Motion, Articular ; Treatment Outcome