Objective: To analyze the therapeutic effect of combining dental arch splint intermaxillary traction with rigid internal fixation for the treatment of facial comminuted fractures. Methods: Sixty patients with facial c...Objective: To analyze the therapeutic effect of combining dental arch splint intermaxillary traction with rigid internal fixation for the treatment of facial comminuted fractures. Methods: Sixty patients with facial comminuted fractures admitted for treatment between July 2023 and December 2024 were selected. Using a random number table method, 30 patients were assigned to the observation group, where moderate traction using a dental arch splint combined with rigid internal fixation was applied. Another 30 patients were assigned to the control group and only received dental arch splint traction treatment. The total effective rate, postoperative recovery indicators, periodontal status, complication rate, and quality of life scores were compared between the two groups. Results: The total effective rate in the observation group was higher than that in the control group. The postoperative recovery indicators and periodontal status in the observation group were superior to those in the control group. The complication rate and quality of life score were lower in the observation group compared to the control group, with P < 0.05. Conclusion: Combining dental arch splint intermaxillary traction with rigid internal fixation can improve the periodontal status and quality of life of patients with facial comminuted fractures, shorten postoperative recovery time, reduce various complications, and enhance surgical efficacy.展开更多
The synthesis and characterization of PEG-like macromolecular structures on Nit inol surface from tri (ethylene glycol) dimethyl-ether under ECR-cold-plasma conditions were discussed. It was demonstrated that based o...The synthesis and characterization of PEG-like macromolecular structures on Nit inol surface from tri (ethylene glycol) dimethyl-ether under ECR-cold-plasma conditions were discussed. It was demonstrated that based on high-resolution ES CA, ATR-FTIR and contact angle investigations, the deposited PEG-like layers a re composed mainly of -CH 2-CH 2-O- linkages. These structures have a relati vely low contact angle. Compared to the unmodified surfaces, the plasma-treated Nitinol surfaces are more hydrophilic. Plasma enhanced coatings of PEG-like la yers can prevent Ni ion from releasing, thereby improving the biocompatibility o f Nitinol.展开更多
Lipid oxidation and degradation are generally recognized as unfavorable reactions in food processing. However, lipids can be utilized to produce meat-like flavorings through reaction with amino acids after degradation...Lipid oxidation and degradation are generally recognized as unfavorable reactions in food processing. However, lipids can be utilized to produce meat-like flavorings through reaction with amino acids after degradation to carbonyls such as aldehydes and ketones. The fatty acids in chicken fat mainly comprise palmitic acid, oleic acid and linoleic acid. After being heated at 120 ~C for 3 h, the degraded carbonyls of chicken fat were reacted with cysteine, alanine, glycine and thiamine to form a chicken-like flavoring. The key aromatic components of the flavoring were identified by GC-MS. In the overall volatile profile, 22 kinds of compound were detected, among which 2-furanmethanol was formed by the Maillard reaction, 1-（2-furanyl）-ethanone by cyclization and 2,4,6-trimethyl-l,3,5-trithiane by the Strecker degradation of cysteine. Dihydro-2-methyl-3（2H）-furanone, dihydro-2-methyl- 3（2H）-thiophenone, 2-acetyl-lH-pyrroline and 4-methyl-5-thiazoleethanol were the degradation products of thiamine. The prepared chicken flavoring was added to comminuted chicken product （CCP）. GC-MS analysis and sensory evaluation showed that the flavor and odor of the CCP were greatly enhanced.展开更多
The objective of this study was to expound a novel surgical management technique assisted by patient-specific implants(PSIs)for comminuted fractures of the zygomaticomaxillary complex(ZMC).The aim of this study was to...The objective of this study was to expound a novel surgical management technique assisted by patient-specific implants(PSIs)for comminuted fractures of the zygomaticomaxillary complex(ZMC).The aim of this study was to explore the feasibility of using PSIs to accurately restore and fix comminuted fractures.A male patient with an old ZMC comminuted fracture was used to describe the workflow,technique,and method.Computerassisted surgical simulation was used to determine the optimal plan for the reduction of bone segments prior to surgery.The PSIs were used to accurately guide the surgeon’s position of the bone segments,as planned,during the operation.Oral panoramic films and cephalometric films were taken immediately at 1,3,6,and 12 months after the operation,while computed tomography images of the whole skull were taken immediately,half a year,and one year after the operation.The patient’s follow-up showed that the zygomatic symmetry recovered well post-surgery and the patient was satisfied with the outcome.This new surgical method greatly improved the facial symmetry of this patient.展开更多
Objective: to summarize the surgical treatment methods of comminuted calcaneal fracture and the effect differences of different surgical methods. Methods: patients with calcaneal fractures admitted to our hospital and...Objective: to summarize the surgical treatment methods of comminuted calcaneal fracture and the effect differences of different surgical methods. Methods: patients with calcaneal fractures admitted to our hospital and confirmed for surgical treatment were selected. All patients were comminuted fractures and met the requirements of surgical indications. The cases were selected from June 2018 to June 2020, and the conventional group took incision reduction surgery based on L-type incision. The experimental group performed minimally invasive plate internal fixation with plate screws according to the posterior heel or the tarsal sinus incision position. When observed after the operation, the items involved included the function of the heel, the recovery status of the calcaneus, the surgery-related indicators, and the complications occurring during and after the surgery. Results: the patients of the experimental group were significantly higher than the height. Bolher and Gissen angle were better than the conventional group in March and June, P <0.05;the time, bleeding volume, incision length, hospitalization time and related complications were significantly better than the conventional group, P <0.05. Conclusion: minimally invasive plate and screw internal fixation can effectively treat comminuted calcaneal fracture, which has a significant effect on the foot and ankle function, and obviously acts on the fracture site and function.展开更多
Objective To investigate the stress distribution of the femur after cemented prosthetic replacement in aged patients with comminuted intertrochanteric fracture and to analyze the difference of stress distribution betw...Objective To investigate the stress distribution of the femur after cemented prosthetic replacement in aged patients with comminuted intertrochanteric fracture and to analyze the difference of stress distribution between cemented long展开更多
Objective To investigate mechanism involved i n knee joint rehabilition by compreh ensive rehabilitation therapy foll owing com-minuted fracture of patella surgery.Method25patients suffered from comminute d fracture o...Objective To investigate mechanism involved i n knee joint rehabilition by compreh ensive rehabilitation therapy foll owing com-minuted fracture of patella surgery.Method25patients suffered from comminute d fracture of patella received rehabilitation training,drugs administration and physical therapy.Results Knee joint function was evaluated,e xcellent 22cases,good 2cases,favo rable 1case,good rate was 96%.Conclusion Rehabilitation of knee joint is satisfying in patients underwent compre hensive rehabilitation treatment.So,comprehensive rehabilitation treatment is valuable in clinic.展开更多
Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with...Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results,the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures.The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.Methods We assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures.Eighteen patients were treated with a locking plate and an autologous crest bone graft （experimental group）,and 22 were treated with only the locking plate and no bone graft （control group）.Postoperative assessments included radiographic imaging,range of motion analysis,pain level based on the visual analogue scale （VAS）,and the SF-36 （Short Form （36） Health Survey）,as well as whether patients could retum to their previous occupation.Results All fractures healed both clinically and radiologically in the experimental group.There was no more than 2 mm collapse of the humeral head,and no osteonecrosis or screw penetration of the articular surface.In contrast,two patients had a nonunion in the control group,and they eventually accepted total shoulder replacements.The average time from surgery to radiographic union was significantly shorter in the experimental group （（4.66±1.63） months） compared with the control group （（5.98±1.57） months） （P ＜0.05）.For the experimental versus controls groups,the mean shoulder active flexion （148.00±18.59 vs.121.73±17.20） degrees,extension （49.00±2.22 vs.42.06±2.06） degrees,internal rotation （45.00±5.61 vs.35.00±3.55）degrees,external rotation （64.00±9.17 vs.52.14±5.73）degrees,and abduction （138.00±28.78 vs.105.95±15.66） degrees were all significantly higher （all P ＜0.001）.The median SF-36 in the experimental group （（88.00±5.71） points） was significantly higher than that of the control group （（69.45±9.45） points; P ＜0.001）.The median VAS pain level （mean rank,10.50） in the experimental group was lower than that （mean rank,47.19） of the control group （P ＜0.001）.All but one patient （17 of 18,94.4％） in the experimental group returned to their previous activities or occupations,and that one patient changed to a different occupation because of slight restrictions to activities.On the other hand,four patients could not return to their previous activities or occupations in the control group.Conclusion Locking plate fixation combined with an iliac crest bone graft is an effective technique for treating proximal humerus comminuted fractures.展开更多
Bone graft may be needed to fill bone defect in elderly patients with a metaphyseal comminuted distal radius fracture. In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical and radiolog...Bone graft may be needed to fill bone defect in elderly patients with a metaphyseal comminuted distal radius fracture. In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical and radiologic outcomes of using both dorsal locking plates with or without augmentation with mineralized collagen （MC） bone graft for elderly patients with dorsally metaphyseal comminuted radius fractures. Patients in group 1 （n = 12） were treated with dorsal locking plates with MC bone graft application into the metaphyseal bone defect, and those in group 2 （n - 12） only with dorsal locking plates. Clinical and radiologic parameters were determined at three and 12 months after surgery. At final follow-up, no significant difference was noted between the 2 groups in terms of palmar tilt and radial inclination （p - 0.80）; however, ulnar variance increased significantly in the group 2 treated with dorsal locking plates without augmentation （p〈0.05）. Functionally, there was no significant difference between the groups. Our preliminary study suggests that combination of MC as bone-graft substitutes and dorsal locking plates may be a usefully alternative for elderly patients with metaphyseal comminuted distal radius fracture.展开更多
Purpose:Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment.This study compared the functional outcomes between variable angle volar plating and exte...Purpose:Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment.This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation.Methods:A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups:volar plate group and external fixator group.These patients aged between 18 and 60 years had unilateral fractures,and agreed to be included in the study.Patients with a history of fracture,bilateral fracture,associated other injuries,delayed injury for more than 2 weeks,open fracture,pre-existing arthrosis or disability,psychiatric illness and pathological fracture were excluded.Patients were followed up at 6 weeks,3 months,6 months and 1 year.The assessment of pain,functional activity,range of motion and grip strength was done at each stage of follow-up.The pain and functional activities were assessed by patient rated wrist evaluation(PRWE)score and disabilities of the arm,shoulder and hand(DASH)score.Results:Patients in volar plate group had superior PRWE score and DASH score at each stage of followup.At 1 year follow-up,the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group;while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group.They had better flexion and extension range of movement.They also had better pronation and supination range of motion at initial follow-up,however the difference get attenuated by 1 year.Volar plate group had significantly better grip strength than external fixator group.Complication rates were higher in external fixation group.Conclusion:Fixation with variable angle volar plate results in early wrist mobilization,better range of movement,less pain and disability and early return of function.展开更多
Objective: To report and assess the efficacy of a coupled exofixator in the treatment of comminuted fracture of the humeral shaft.Methods: From June 1999 to September 2003, 24 patients with comminuted fracture of the ...Objective: To report and assess the efficacy of a coupled exofixator in the treatment of comminuted fracture of the humeral shaft.Methods: From June 1999 to September 2003, 24 patients with comminuted fracture of the humeral shaft were treated in our department, in whom 11 were involved in left humerus fractures and 13 in right humerus fractures. Closed reduction or open reduction with a small incision as well as a coupled exofixator was used to treat these patients. Results: All cases got anatomical reduction after 6-12 months follow-up. The time for fracture union averaged 5.8 months with a good functional recovery of the shoulder-elbow joints. Conclusions: The coupled exofixator is favorable to the treatment of comminuted humeral shaft fractures. It can shorten union time and avoid nonunion occurrence.展开更多
Purpose： The results for fixation of comminuted posterior wall acetabular fractures are not very promising with reported complications in terms of osteoarthritis, nonunion and malunion which subsequently require conv...Purpose： The results for fixation of comminuted posterior wall acetabular fractures are not very promising with reported complications in terms of osteoarthritis, nonunion and malunion which subsequently require conversion to total hip arthroplasty. The conversion to total hip arthroplasty is possible in patients over 50 years of age but not in younger patients. So this requires new methods for salvage of the native hip in young patients. Methods： There were six patients in our series with highly comminuted posterior wall acetabular frac- tures where the fragments were excised and the gap filled with tricortical anterior iliac-crest strut autograff, fixed with screws and plate. Results： Good results were achieved in four out of six patients analyzed clinically using the Merle d＇Aubinge score modified by Matta and radiologically by Matta scoring. These patients have returned to original work and are walking independently. The good result in one patient deteriorated from good to poor between one and two years. One patient developed infection and excision arthroplasty was done, The graft incorporated well in five out of six patients. Conclusion： The use of iliac crest autograff is a better, advanced and promising technique as it provides a new wall to the weight bearing dome of the acetabulum for articulation with the femoral head. The rates of nonunion, malunion, post traumatic osteoarthritis are less as compared to the fixation of the comminuted fragments. The need for conversion to total hio arthroolastv is also less.展开更多
Objective: To explore the clinical efficacy of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non union in revision total hip arthroplasty with tension band fixation. Methods: A retrospe...Objective: To explore the clinical efficacy of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non union in revision total hip arthroplasty with tension band fixation. Methods: A retrospective review of 295 revision total hip operations performed between 1992 and 1998 was undertaken. Twenty hips of 19 patients with comminuted fractures or nonunion of the greater trochanter were stabilized with tension band technique. Multiple 2.0 mm k wires and tension band wires were placed through the intact cortex distally and the abductor tendon proximally in the pattern "8". Results: The average follow up was 30 months. The Harris Hip Score improved on average from 45 preoperatively to 89 at follow up. Sixteen hips with intra operative trochanteric fracture through osteolytic bone and four hips with symptomatic trochanteric nonunion were approached with tension band fixation. Perioperative loss of fixation in one patient required a repeated surgery. The same fixation at the second operation achieved an uneventful healing. Two patients had a 2 cm proximal migration of one K wire without loss of bony fixation. The trochanteric fractures healed with no further proximal wire migration. One patient had loss of fixation with trochanteric escape at 6 weeks post operatively. The patient has abductor weakness with Trendleburg limp but without pain. On average, radiographic examination showed that healing occurred at 16.6 weeks postoperatively. Six patients developed grade 1 heterotopic ossification and two patients grade 3. All were asymptomatic. None of the 19 patients experienced a dislocation during the follow up. Conclusions: Tension band fixation for greater trochanter can enhance the success rate of revision total hip arthroplasty without a deficient abductor mechanism.展开更多
基金Special Support Program for Scientific and Technological Talent“Application and Impact of Dental Arch Splint Intermaxillary Traction Combined with Rigid Internal Fixation on Oral Health in Patients with Facial Fractures”(DX2023BR18)。
文摘Objective: To analyze the therapeutic effect of combining dental arch splint intermaxillary traction with rigid internal fixation for the treatment of facial comminuted fractures. Methods: Sixty patients with facial comminuted fractures admitted for treatment between July 2023 and December 2024 were selected. Using a random number table method, 30 patients were assigned to the observation group, where moderate traction using a dental arch splint combined with rigid internal fixation was applied. Another 30 patients were assigned to the control group and only received dental arch splint traction treatment. The total effective rate, postoperative recovery indicators, periodontal status, complication rate, and quality of life scores were compared between the two groups. Results: The total effective rate in the observation group was higher than that in the control group. The postoperative recovery indicators and periodontal status in the observation group were superior to those in the control group. The complication rate and quality of life score were lower in the observation group compared to the control group, with P < 0.05. Conclusion: Combining dental arch splint intermaxillary traction with rigid internal fixation can improve the periodontal status and quality of life of patients with facial comminuted fractures, shorten postoperative recovery time, reduce various complications, and enhance surgical efficacy.
基金Funded by the National Natural Science Foundation of China (No.1997207150274065) and the Special Funds for Major State Basic Research Project (No.2002CB412704)
文摘The synthesis and characterization of PEG-like macromolecular structures on Nit inol surface from tri (ethylene glycol) dimethyl-ether under ECR-cold-plasma conditions were discussed. It was demonstrated that based on high-resolution ES CA, ATR-FTIR and contact angle investigations, the deposited PEG-like layers a re composed mainly of -CH 2-CH 2-O- linkages. These structures have a relati vely low contact angle. Compared to the unmodified surfaces, the plasma-treated Nitinol surfaces are more hydrophilic. Plasma enhanced coatings of PEG-like la yers can prevent Ni ion from releasing, thereby improving the biocompatibility o f Nitinol.
文摘Lipid oxidation and degradation are generally recognized as unfavorable reactions in food processing. However, lipids can be utilized to produce meat-like flavorings through reaction with amino acids after degradation to carbonyls such as aldehydes and ketones. The fatty acids in chicken fat mainly comprise palmitic acid, oleic acid and linoleic acid. After being heated at 120 ~C for 3 h, the degraded carbonyls of chicken fat were reacted with cysteine, alanine, glycine and thiamine to form a chicken-like flavoring. The key aromatic components of the flavoring were identified by GC-MS. In the overall volatile profile, 22 kinds of compound were detected, among which 2-furanmethanol was formed by the Maillard reaction, 1-（2-furanyl）-ethanone by cyclization and 2,4,6-trimethyl-l,3,5-trithiane by the Strecker degradation of cysteine. Dihydro-2-methyl-3（2H）-furanone, dihydro-2-methyl- 3（2H）-thiophenone, 2-acetyl-lH-pyrroline and 4-methyl-5-thiazoleethanol were the degradation products of thiamine. The prepared chicken flavoring was added to comminuted chicken product （CCP）. GC-MS analysis and sensory evaluation showed that the flavor and odor of the CCP were greatly enhanced.
文摘The objective of this study was to expound a novel surgical management technique assisted by patient-specific implants(PSIs)for comminuted fractures of the zygomaticomaxillary complex(ZMC).The aim of this study was to explore the feasibility of using PSIs to accurately restore and fix comminuted fractures.A male patient with an old ZMC comminuted fracture was used to describe the workflow,technique,and method.Computerassisted surgical simulation was used to determine the optimal plan for the reduction of bone segments prior to surgery.The PSIs were used to accurately guide the surgeon’s position of the bone segments,as planned,during the operation.Oral panoramic films and cephalometric films were taken immediately at 1,3,6,and 12 months after the operation,while computed tomography images of the whole skull were taken immediately,half a year,and one year after the operation.The patient’s follow-up showed that the zygomatic symmetry recovered well post-surgery and the patient was satisfied with the outcome.This new surgical method greatly improved the facial symmetry of this patient.
文摘Objective: to summarize the surgical treatment methods of comminuted calcaneal fracture and the effect differences of different surgical methods. Methods: patients with calcaneal fractures admitted to our hospital and confirmed for surgical treatment were selected. All patients were comminuted fractures and met the requirements of surgical indications. The cases were selected from June 2018 to June 2020, and the conventional group took incision reduction surgery based on L-type incision. The experimental group performed minimally invasive plate internal fixation with plate screws according to the posterior heel or the tarsal sinus incision position. When observed after the operation, the items involved included the function of the heel, the recovery status of the calcaneus, the surgery-related indicators, and the complications occurring during and after the surgery. Results: the patients of the experimental group were significantly higher than the height. Bolher and Gissen angle were better than the conventional group in March and June, P <0.05;the time, bleeding volume, incision length, hospitalization time and related complications were significantly better than the conventional group, P <0.05. Conclusion: minimally invasive plate and screw internal fixation can effectively treat comminuted calcaneal fracture, which has a significant effect on the foot and ankle function, and obviously acts on the fracture site and function.
文摘Objective To investigate the stress distribution of the femur after cemented prosthetic replacement in aged patients with comminuted intertrochanteric fracture and to analyze the difference of stress distribution between cemented long
文摘Objective To investigate mechanism involved i n knee joint rehabilition by compreh ensive rehabilitation therapy foll owing com-minuted fracture of patella surgery.Method25patients suffered from comminute d fracture of patella received rehabilitation training,drugs administration and physical therapy.Results Knee joint function was evaluated,e xcellent 22cases,good 2cases,favo rable 1case,good rate was 96%.Conclusion Rehabilitation of knee joint is satisfying in patients underwent compre hensive rehabilitation treatment.So,comprehensive rehabilitation treatment is valuable in clinic.
文摘Background Although the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results,the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures.The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.Methods We assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures.Eighteen patients were treated with a locking plate and an autologous crest bone graft （experimental group）,and 22 were treated with only the locking plate and no bone graft （control group）.Postoperative assessments included radiographic imaging,range of motion analysis,pain level based on the visual analogue scale （VAS）,and the SF-36 （Short Form （36） Health Survey）,as well as whether patients could retum to their previous occupation.Results All fractures healed both clinically and radiologically in the experimental group.There was no more than 2 mm collapse of the humeral head,and no osteonecrosis or screw penetration of the articular surface.In contrast,two patients had a nonunion in the control group,and they eventually accepted total shoulder replacements.The average time from surgery to radiographic union was significantly shorter in the experimental group （（4.66±1.63） months） compared with the control group （（5.98±1.57） months） （P ＜0.05）.For the experimental versus controls groups,the mean shoulder active flexion （148.00±18.59 vs.121.73±17.20） degrees,extension （49.00±2.22 vs.42.06±2.06） degrees,internal rotation （45.00±5.61 vs.35.00±3.55）degrees,external rotation （64.00±9.17 vs.52.14±5.73）degrees,and abduction （138.00±28.78 vs.105.95±15.66） degrees were all significantly higher （all P ＜0.001）.The median SF-36 in the experimental group （（88.00±5.71） points） was significantly higher than that of the control group （（69.45±9.45） points; P ＜0.001）.The median VAS pain level （mean rank,10.50） in the experimental group was lower than that （mean rank,47.19） of the control group （P ＜0.001）.All but one patient （17 of 18,94.4％） in the experimental group returned to their previous activities or occupations,and that one patient changed to a different occupation because of slight restrictions to activities.On the other hand,four patients could not return to their previous activities or occupations in the control group.Conclusion Locking plate fixation combined with an iliac crest bone graft is an effective technique for treating proximal humerus comminuted fractures.
文摘Bone graft may be needed to fill bone defect in elderly patients with a metaphyseal comminuted distal radius fracture. In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical and radiologic outcomes of using both dorsal locking plates with or without augmentation with mineralized collagen （MC） bone graft for elderly patients with dorsally metaphyseal comminuted radius fractures. Patients in group 1 （n = 12） were treated with dorsal locking plates with MC bone graft application into the metaphyseal bone defect, and those in group 2 （n - 12） only with dorsal locking plates. Clinical and radiologic parameters were determined at three and 12 months after surgery. At final follow-up, no significant difference was noted between the 2 groups in terms of palmar tilt and radial inclination （p - 0.80）; however, ulnar variance increased significantly in the group 2 treated with dorsal locking plates without augmentation （p〈0.05）. Functionally, there was no significant difference between the groups. Our preliminary study suggests that combination of MC as bone-graft substitutes and dorsal locking plates may be a usefully alternative for elderly patients with metaphyseal comminuted distal radius fracture.
文摘Purpose:Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment.This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation.Methods:A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups:volar plate group and external fixator group.These patients aged between 18 and 60 years had unilateral fractures,and agreed to be included in the study.Patients with a history of fracture,bilateral fracture,associated other injuries,delayed injury for more than 2 weeks,open fracture,pre-existing arthrosis or disability,psychiatric illness and pathological fracture were excluded.Patients were followed up at 6 weeks,3 months,6 months and 1 year.The assessment of pain,functional activity,range of motion and grip strength was done at each stage of follow-up.The pain and functional activities were assessed by patient rated wrist evaluation(PRWE)score and disabilities of the arm,shoulder and hand(DASH)score.Results:Patients in volar plate group had superior PRWE score and DASH score at each stage of followup.At 1 year follow-up,the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group;while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group.They had better flexion and extension range of movement.They also had better pronation and supination range of motion at initial follow-up,however the difference get attenuated by 1 year.Volar plate group had significantly better grip strength than external fixator group.Complication rates were higher in external fixation group.Conclusion:Fixation with variable angle volar plate results in early wrist mobilization,better range of movement,less pain and disability and early return of function.
文摘Objective: To report and assess the efficacy of a coupled exofixator in the treatment of comminuted fracture of the humeral shaft.Methods: From June 1999 to September 2003, 24 patients with comminuted fracture of the humeral shaft were treated in our department, in whom 11 were involved in left humerus fractures and 13 in right humerus fractures. Closed reduction or open reduction with a small incision as well as a coupled exofixator was used to treat these patients. Results: All cases got anatomical reduction after 6-12 months follow-up. The time for fracture union averaged 5.8 months with a good functional recovery of the shoulder-elbow joints. Conclusions: The coupled exofixator is favorable to the treatment of comminuted humeral shaft fractures. It can shorten union time and avoid nonunion occurrence.
文摘Purpose： The results for fixation of comminuted posterior wall acetabular fractures are not very promising with reported complications in terms of osteoarthritis, nonunion and malunion which subsequently require conversion to total hip arthroplasty. The conversion to total hip arthroplasty is possible in patients over 50 years of age but not in younger patients. So this requires new methods for salvage of the native hip in young patients. Methods： There were six patients in our series with highly comminuted posterior wall acetabular frac- tures where the fragments were excised and the gap filled with tricortical anterior iliac-crest strut autograff, fixed with screws and plate. Results： Good results were achieved in four out of six patients analyzed clinically using the Merle d＇Aubinge score modified by Matta and radiologically by Matta scoring. These patients have returned to original work and are walking independently. The good result in one patient deteriorated from good to poor between one and two years. One patient developed infection and excision arthroplasty was done, The graft incorporated well in five out of six patients. Conclusion： The use of iliac crest autograff is a better, advanced and promising technique as it provides a new wall to the weight bearing dome of the acetabulum for articulation with the femoral head. The rates of nonunion, malunion, post traumatic osteoarthritis are less as compared to the fixation of the comminuted fragments. The need for conversion to total hio arthroolastv is also less.
文摘Objective: To explore the clinical efficacy of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non union in revision total hip arthroplasty with tension band fixation. Methods: A retrospective review of 295 revision total hip operations performed between 1992 and 1998 was undertaken. Twenty hips of 19 patients with comminuted fractures or nonunion of the greater trochanter were stabilized with tension band technique. Multiple 2.0 mm k wires and tension band wires were placed through the intact cortex distally and the abductor tendon proximally in the pattern "8". Results: The average follow up was 30 months. The Harris Hip Score improved on average from 45 preoperatively to 89 at follow up. Sixteen hips with intra operative trochanteric fracture through osteolytic bone and four hips with symptomatic trochanteric nonunion were approached with tension band fixation. Perioperative loss of fixation in one patient required a repeated surgery. The same fixation at the second operation achieved an uneventful healing. Two patients had a 2 cm proximal migration of one K wire without loss of bony fixation. The trochanteric fractures healed with no further proximal wire migration. One patient had loss of fixation with trochanteric escape at 6 weeks post operatively. The patient has abductor weakness with Trendleburg limp but without pain. On average, radiographic examination showed that healing occurred at 16.6 weeks postoperatively. Six patients developed grade 1 heterotopic ossification and two patients grade 3. All were asymptomatic. None of the 19 patients experienced a dislocation during the follow up. Conclusions: Tension band fixation for greater trochanter can enhance the success rate of revision total hip arthroplasty without a deficient abductor mechanism.
