BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the man...BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the management of proximal humeral shaft fractures.AIM To evaluate parallax-free panoramic X-ray images during surgery.METHODS A retrospective series of 17 proximal humeral shaft fractures were treated using combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with MIPO.The operating time and radiation exposure time were recorded,and early postoperative physical therapy and partial weight bearing were encouraged.Patients were followed at regular intervals and evaluated radiographically and clinically.RESULTS The mean operating time and radiation time were 73(range,49-95)minutes and 57(range:36-98)seconds,respectively.No complications occurred during the operation.All fractures healed at an average of 16.9(range:15-23)weeks.The average Constant-Murley score for all the patients was 89.5(range:75-100)points.None of the patients showed symptoms of vascular or nerve damage or wound infection.Three months after the operation,none of the patients developed subacromial impingement syndrome.No loosening or fracture of the implants occurred.The frontal and lateral radiographs showed good alignment.CONCLUSION We consider that MIPO with combined parallax-free panoramic X-ray imaging during surgery is an efficient method for treating proximal humeral shaft fractures,and could significantly reduce operative morbidity as well as lower the rate of intra-and postoperative complications.展开更多
BACKGROUND The volar approach with plate fixation is the gold standard for treating distal radius fractures,often requiring incision of the pronator quadratus(PQ)muscle.Preserving the PQ during surgery may facilitate ...BACKGROUND The volar approach with plate fixation is the gold standard for treating distal radius fractures,often requiring incision of the pronator quadratus(PQ)muscle.Preserving the PQ during surgery may facilitate early postoperative recovery.However,conventional minimally invasive plate osteosynthesis(MIPO)techniques frequently necessitate multiple(3-4)intraoperative fluoroscopic adjustments to achieve optimal plate positioning,which can inadvertently damage the PQ muscle.Based on our clinical observations,we developed a novel 3-point positioning technique to minimize PQ injury while ensuring accurate plate placement.Preliminary results demonstrate promising early clinical outcomes.AIM To retrospectively analyze distal radius fractures treated using the 3-point positioning-assisted MIPO technique with preservation of the PQ.METHODS The 3-point positioning technique was applied:The Kirschner wire was inserted after fluoroscopy and was correctly adjusted the position of the plate above the PQ.With the aid of Kirschner wires positioning the PQ stripping was performed only once,and the plate then placed in a correct and satisfactory position.Operation time,incision length,wrist pain score,upper extremity function disabilities of the arm,shoulder and hand(DASH)score,wrist Gartland-Werley score,wrist grip strength,and range of motion were among the quantitative variables recorded.Qualitative variables including AO fracture classification,intraoperative and postoperative complications were evaluated.RESULTS At a mean follow-up of 6.9±0.8 months,the mean scar length was 25.4±1.5 mm,the pain score was 0.7±0.6,the DASH score for the upper limb was 4.7±1.3,and the Gartland-Werley score for wrist function was 4.1±1.1 at the last follow-up.Mean flexion was 97.3%,extension was 97.0%,pronation was 98.9%,supination was 98.9%,and grip strength was 86.6%compared to contralateral values.No unfavorable intraoperative or postoperative complications occurred.CONCLUSION The 3-point positioning technique may reduce the damage to the PQ muscle and is a safe and effective method for MIPO for distal radius fractures.展开更多
Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted pre...Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted preoperative planning （CAPP） has the potential to improve efficiency and time in the operating room. Methods Sixty-four patients with proximal humeral fractures were treated using locking plates by minimally invasive plate osteosynthesis （MIPO） with CAPP. The time needed for virtual segmentation, reduction, and fixation of the fracture fragments were recorded. Intra and interobserver reliabilities were analyzed using the intraclass correlation coefficient. The clinical function was analyzed using Constant Score and radiology. Results The mean total time required for CAPP of two-part, three-part, and four-part proximal humeral fractures were （13.63±1.38） minutes, （23.14±2.18） minutes, and （39.61±3.01） minutes, respectively. The intra and interobserver reliabilities for all variables were high, ranging from 0.785 to 0.992. The mean operation time was （50.1±6.7） minutes. Fifty- two patients were followed up with an average time of 34.2 months. The mean Constant Score of the injury side was （82.5 ± 9.9）. Three of the fifty-two patients had four complications. Conclusion The application of CAPP was efficient and reliable, and provided excellent clinical and radiographic outcomes for the treatment of proximal humerus fractures by MIPO.展开更多
BACKGROUND Humeral shaft fractures are relatively common in adults.Rotational malalignment is reported as one complication but severe rotational deformity of the humerus is extremely rare.To our knowledge,only three c...BACKGROUND Humeral shaft fractures are relatively common in adults.Rotational malalignment is reported as one complication but severe rotational deformity of the humerus is extremely rare.To our knowledge,only three cases of symptomatic humeral malrotation have been reported.There are sparse literature reports of humeral reconstruction correction.CASE SUMMARY We present a case of extreme rotational deformity of the humerus(180°)after humeral shaft fracture.The patient complained of pain and difficulties with activities of daily living.In addition,she found the deformity cosmetically unacceptable.Therefore,she was searching for surgical correction.Neurolysis of the radial nerve followed by derotational osteotomy of the humerus and internal fixation were performed.Postoperatively,the patient demonstrated transient iatrogenic radial nerve palsy which recovered completely during postoperative follow-up.The Disabilities of the Arm,Shoulder,and Hand score improved from 55 preoperatively to 16 at the final 2-year follow-up.CONCLUSION Single-stage radial neurolysis,derotational osteotomy and stable fixation is a feasible option to improve anatomic and functional problems of severely malrotated humeral shaft fractures.展开更多
Objective: The purpose of this meta-analysis is to determine whether plating or intramedullary nailing(IMN) for adult diaphyseal both-bone forearm fractures(BBFF) provides better clinical outcomes. Methods: MEDLINE, E...Objective: The purpose of this meta-analysis is to determine whether plating or intramedullary nailing(IMN) for adult diaphyseal both-bone forearm fractures(BBFF) provides better clinical outcomes. Methods: MEDLINE, EMBASE, Google Scholar and The Cochrane Library were comprehensively searched until July 31, 2016.Both retrospective study and prospective trails about comparison of dual IMN or hybrid fixation versus dual plating fixation in the treatment of adult diaphyseal BBFF were included. Using Rev Man5.3 software, data of functional recovery, the union time,operating time and complication was extracted for meta-analysis. Results: The pooled analysis showed similar results in the union time, functional recovery and the rates of complications, but showed a significant difference in operating time. Conclusion: This meta-analysis demonstrates similar radiographic outcomes, functional outcomes and complications with plates or IMN used in the treatment of adult diaphyseal BBFF. IMN fixation for these fractures seems to be an alternative and effective treatment with shorter operating times and minimally invasive.展开更多
基金Supported by Wuhu Municipal Science and Technology Bureau of Anhui Province,No.2022cg43.
文摘BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the management of proximal humeral shaft fractures.AIM To evaluate parallax-free panoramic X-ray images during surgery.METHODS A retrospective series of 17 proximal humeral shaft fractures were treated using combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with MIPO.The operating time and radiation exposure time were recorded,and early postoperative physical therapy and partial weight bearing were encouraged.Patients were followed at regular intervals and evaluated radiographically and clinically.RESULTS The mean operating time and radiation time were 73(range,49-95)minutes and 57(range:36-98)seconds,respectively.No complications occurred during the operation.All fractures healed at an average of 16.9(range:15-23)weeks.The average Constant-Murley score for all the patients was 89.5(range:75-100)points.None of the patients showed symptoms of vascular or nerve damage or wound infection.Three months after the operation,none of the patients developed subacromial impingement syndrome.No loosening or fracture of the implants occurred.The frontal and lateral radiographs showed good alignment.CONCLUSION We consider that MIPO with combined parallax-free panoramic X-ray imaging during surgery is an efficient method for treating proximal humeral shaft fractures,and could significantly reduce operative morbidity as well as lower the rate of intra-and postoperative complications.
基金Supported by Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma,No.2020Y2014Fuzhou Health Technology Innovation Platform Construction Project,No.2019-S-wp2.
文摘BACKGROUND The volar approach with plate fixation is the gold standard for treating distal radius fractures,often requiring incision of the pronator quadratus(PQ)muscle.Preserving the PQ during surgery may facilitate early postoperative recovery.However,conventional minimally invasive plate osteosynthesis(MIPO)techniques frequently necessitate multiple(3-4)intraoperative fluoroscopic adjustments to achieve optimal plate positioning,which can inadvertently damage the PQ muscle.Based on our clinical observations,we developed a novel 3-point positioning technique to minimize PQ injury while ensuring accurate plate placement.Preliminary results demonstrate promising early clinical outcomes.AIM To retrospectively analyze distal radius fractures treated using the 3-point positioning-assisted MIPO technique with preservation of the PQ.METHODS The 3-point positioning technique was applied:The Kirschner wire was inserted after fluoroscopy and was correctly adjusted the position of the plate above the PQ.With the aid of Kirschner wires positioning the PQ stripping was performed only once,and the plate then placed in a correct and satisfactory position.Operation time,incision length,wrist pain score,upper extremity function disabilities of the arm,shoulder and hand(DASH)score,wrist Gartland-Werley score,wrist grip strength,and range of motion were among the quantitative variables recorded.Qualitative variables including AO fracture classification,intraoperative and postoperative complications were evaluated.RESULTS At a mean follow-up of 6.9±0.8 months,the mean scar length was 25.4±1.5 mm,the pain score was 0.7±0.6,the DASH score for the upper limb was 4.7±1.3,and the Gartland-Werley score for wrist function was 4.1±1.1 at the last follow-up.Mean flexion was 97.3%,extension was 97.0%,pronation was 98.9%,supination was 98.9%,and grip strength was 86.6%compared to contralateral values.No unfavorable intraoperative or postoperative complications occurred.CONCLUSION The 3-point positioning technique may reduce the damage to the PQ muscle and is a safe and effective method for MIPO for distal radius fractures.
文摘Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted preoperative planning （CAPP） has the potential to improve efficiency and time in the operating room. Methods Sixty-four patients with proximal humeral fractures were treated using locking plates by minimally invasive plate osteosynthesis （MIPO） with CAPP. The time needed for virtual segmentation, reduction, and fixation of the fracture fragments were recorded. Intra and interobserver reliabilities were analyzed using the intraclass correlation coefficient. The clinical function was analyzed using Constant Score and radiology. Results The mean total time required for CAPP of two-part, three-part, and four-part proximal humeral fractures were （13.63±1.38） minutes, （23.14±2.18） minutes, and （39.61±3.01） minutes, respectively. The intra and interobserver reliabilities for all variables were high, ranging from 0.785 to 0.992. The mean operation time was （50.1±6.7） minutes. Fifty- two patients were followed up with an average time of 34.2 months. The mean Constant Score of the injury side was （82.5 ± 9.9）. Three of the fifty-two patients had four complications. Conclusion The application of CAPP was efficient and reliable, and provided excellent clinical and radiographic outcomes for the treatment of proximal humerus fractures by MIPO.
文摘BACKGROUND Humeral shaft fractures are relatively common in adults.Rotational malalignment is reported as one complication but severe rotational deformity of the humerus is extremely rare.To our knowledge,only three cases of symptomatic humeral malrotation have been reported.There are sparse literature reports of humeral reconstruction correction.CASE SUMMARY We present a case of extreme rotational deformity of the humerus(180°)after humeral shaft fracture.The patient complained of pain and difficulties with activities of daily living.In addition,she found the deformity cosmetically unacceptable.Therefore,she was searching for surgical correction.Neurolysis of the radial nerve followed by derotational osteotomy of the humerus and internal fixation were performed.Postoperatively,the patient demonstrated transient iatrogenic radial nerve palsy which recovered completely during postoperative follow-up.The Disabilities of the Arm,Shoulder,and Hand score improved from 55 preoperatively to 16 at the final 2-year follow-up.CONCLUSION Single-stage radial neurolysis,derotational osteotomy and stable fixation is a feasible option to improve anatomic and functional problems of severely malrotated humeral shaft fractures.
文摘Objective: The purpose of this meta-analysis is to determine whether plating or intramedullary nailing(IMN) for adult diaphyseal both-bone forearm fractures(BBFF) provides better clinical outcomes. Methods: MEDLINE, EMBASE, Google Scholar and The Cochrane Library were comprehensively searched until July 31, 2016.Both retrospective study and prospective trails about comparison of dual IMN or hybrid fixation versus dual plating fixation in the treatment of adult diaphyseal BBFF were included. Using Rev Man5.3 software, data of functional recovery, the union time,operating time and complication was extracted for meta-analysis. Results: The pooled analysis showed similar results in the union time, functional recovery and the rates of complications, but showed a significant difference in operating time. Conclusion: This meta-analysis demonstrates similar radiographic outcomes, functional outcomes and complications with plates or IMN used in the treatment of adult diaphyseal BBFF. IMN fixation for these fractures seems to be an alternative and effective treatment with shorter operating times and minimally invasive.
