[Limited open reduction and intramedullary fixation for the treatment of refractory femoral subtrochanteric fractures]

OBJECTIVE

To explore the surgical technique and clinical effect of limited open reduction and intramedullary fixation assisted with orthopedic traction bed for the treatment of femoral subtrochanteric fractures.

METHODS

From July 2015 to October 2017, 12 patients with femoral subtrochanteric fractures were treated including 9 males and 3 females with an average age of 44 years old ranging from 33 to 67 years old. Among them, 10 cases were on the left trochanter and 2 on the right, and there were 8 cases of highly fall injury and 4 cases of traffic accident injury. All patients received operation at 2 to 5 days after injury. According to the Seinsheimer classification, 8 cases were type IIIA, 2 were type IIIB and 2 were type IV, and all cases were closed injury. The patients were placed on the orthopedic traction bed for trial closed reduction to maintain proper traction before operation. Under C-arm X-ray fluoroscopy, it was advisable to take the fracture end of the main bone block without obvious shortening and shifting. Then limited incision and lengthened InterTan intramedullary nailing were performed, and the Sanders traumatic hip score was used to evaluate the postoperative efficacy.

RESULTS

All 12 patients were followed up from 6 to 24 months with an average of 12 months. All cases were received bone healing at 3 to 6 months with an average time of 4 months. According to the Sanders grades, the results were excellent in 9 cases, good in 2 cases and medium in 1 case. Infection, breakage of internal fixation loosening and adverse complications such as malunion were not appeared in all the cases.

CONCLUSIONS

Limited open reduction assisted with traction bed can be effective to solve the problem of the intraoperative reduction in the complex subtrochanteric fractures, which could save operation time and decrease bleeding. Combined with intramedullary fixation, this method could acquire good counterpoint and stability for the fracture end, and provide a method for the treatment of refractory subtrochanteric fractures.

[Application of warm liquid in proximal femoral nail antirotation(PFNA) internal fixation]

OBJECTIVE

To investigate the effect and application of warm fluid in patients with proximal femoral nail antirotation(PFNA) internal fixation.

METHODS

From November 2012 to December 2016, 80 patients with femoral intertrochanteric fracture were treated with PFNA internal fixation, including 35 males and 45 females, aged from 62 to 90 years old. The patients were divided into two groups. In the control group 40 patients were infused and rinsed at the normal temperature liquid(22 to 24 °C) during the operation; in the experimental group 40 patients were infused and rinsed at warm liquid(36.5 to 37.5 °C). The amount of bleeding, the temperature, the occurrence of shiver and the C-reaction protein in the two groups were analyzed.

RESULTS

The incidence of hypothermia and shiver in the experimental group was significantly lower than that in the control group(P<0.05). The amount of intraoperative bleeding and C-reaction protein were significantly decreased(P<0.05).

CONCLUSIONS

The application of warm liquid infusion and flushing in PFNA internal fixation can effectively reduce the incidence of hypothermia and shiver, reduce the amount of bleeding in the operation and the infection rate of the surgical site, improve the comfort of the patients, and ensure the safety of the patients.

[Surgical technique and effect of proximal femoral nail anti-rotation internal fixation assisted with large retractor for the treatment of femoral intertrochanteric fractures]

OBJECTIVE

To investigate the surgical technique and efficacy of large retractor assisted maintenance of proximal femoral nail antirotation(PFNA) in the treatment of femoral intertrochanteric fracture in the absence of a retractor.

METHODS

A total of 55 patients with intertrochanteric fractures treated with PFNA internal fixation were selected from April 2012 to December 2016 with a large retractor assisted in maintaining reduction, including 18 males and 37 females with an average age of 75.65 years old ranging from 47 to 90 years old; 31 cases were on the left side and 24 on the right side. All patients had preoperative ipsilateral hip pain, limited mobility, ipsilateral lower extremity extreme external rotation malformation or accompanied by shortening, and preoperative radiographs were clearly diagnosed intertrochanteric fractures. The operative time, intraoperative blood loss, and intraoperative fluoroscopy time were recorded. Postoperative hip function were evaluated.

RESULTS

The average operation time was 45.35 min, the average intraoperative blood loss was 117.64 ml and the mean intraoperative fluoroscopic time was 3.42 min. All the fractures were well restored. All patients were followed up from 12 to 24 months with an average of 16.43 months. All the intertrochanteric fractures were bone healed without hip varus deformity, and there were no complications such as internal fixation loosening and fracture. According to Harris hip function score criteria, the results were excellent in 40 cases, good in 8 cases, fair in 5 cases, poor in 2 cases.

CONCLUSIONS

Large retractor assisted in maintaining the use of PFNA under reposition can fix various types of femoral intertrochanteric fractures. It has simple requirements for surgical position, low equipment requirements, short operation time, less trauma, reliable fixation, and good postoperative recovery. The surgical procedure can be carried out in a primary hospital without a traction bed.

[Minimally invasive retrograde insertion of elastic intramedullary nails for displaced clavicle fractures in children]

OBJECTIVE

To study the application and effect of retrograde titanium elastic nails fixation for the treatment of displaced clavicle fracture in children under closed reduction.

METHODS

From January 2014 to November 2016, 26 children with displaced fractures of the clavicle were treated by closed reduction and retrograde inserted titanium elastic nails including 14 boys and 12 girls with an average age of 9.2 years old ranging from 7 to 14 years. Time from injury to operation was 2 to 7 days with an average of 2.8 days. Visual analogue score (VAS) was used to evaluate the main complaint pain in all patients before and 2 days after operation. The Neer score of shoulder function between affected side and healthy side at 2 months after operation were compared.

RESULTS

All the 26 children were followed up for 6 to 12 months. All cases healed well without infection, broken nails or titanium elastic nails exit complications. All children achieved anatomical reduction, good bony union, and good recovery of shoulder joint activity. The average time of removing nail was 14 to 32(16.25±2.62)weeks. The pain VAS score was significantly relieved 2 days after operation (P<0.05). At 2 months after operation, the Neer score of shoulder joint was 98.46±1.07 in affected side and 98.58±1.10 in healthy side respectively, there was no significant difference between the two groups (P>0.05).

CONCLUSIONS

Titanium elastic intramedullary nail fixation for the treatment of displaced clavicular fracture in children has the advantages of minimal invasion, no effect on skin beauty, rapid healing of fracture, good recovery of postoperative function, simple nailing and less complications.

[PFNA combined reconstruction and locking titanium plate for the treatment of comminuted femoral intertrochanteric fractures involving lateral wall]

OBJECTIVE

To investigate the operative effect of PFNA combined with reconstructive locking plate on the treatment of comminuted femoral intertrochanteric fracture which involving the lateral wall.

METHODS

A total of 35 patients with comminuted femoral intertrochanteric fractures involving the lateral wall were surgically treated from November 2014 to January 2016. According to whether there was reconstruction of the lateral wall or not and the internal fixation method, the patients were divided into PFNA group (no reconstruction of the lateral wall), PFNA recontruction group (reconstructive locking plate was used to reconstruct the lateral wall, PFNA internal fixation). The clinical curative effect was evaluated by the analysis of operation time, intraoperative blood loss, postoperative activity time, the time of fracture healing, complications, and hip joint Harris score at 12 months after operation.

RESULTS

All 35 patients completed the operation successfully. All the incisions were healed by first intention and no incision infection or fat liquefaction occurred. All 35 patients were followed up from 12 to 16 months with an average of 14.4 months. All patients had bone healing. There was no statistical significant in surgery time and intraoperative blood loss between two groups(P>0.05). There were 5 postoperative complications in the PFNA group and 1 in the PFNA combined with reconstructive locking plate group. There was a statistical difference between two groups(P<0.05). The postoperative activity time, bone healing time, complications, and Harris score of PFNA reconstruction group were all superior to PFNA group, there were statistically significant differences between two groups.

CONCLUSIONS

Although the operation time and blood loss of PFNA combined with reconstructive locking plate in treatment of comminuted femoral intertrochanteric fracture which involving the lateral wall are more than those in the PFNA group, and the surgical trauma is larger than PFNA, the fracture healing time, postoperative activity time, and hip joint function were all superior to those of the PFNA group, which can effectively shorten the postoperative bed rest time, and reduce bed complications as well as improve hip joint function.

[Modified one-stage revision procedure for treating proximal femoral infected nonunion after intramedullary nail fixation]

OBJECTIVE

To explore the methods and results of modified one-stage revision procedure for treating proximal femoral infected nonunion after intramedullary nail fixation.

METHODS

From June 2010 to June 2015, 10 patients of proximal femoral infected nonunion after intramedullary nail fixation were treated with modified one-stage revision procedure, including 9 males and 1 female, ranging in age from 35 to 77 years old. There were 3 cases of intertrochanteric fractures, 2 cases of intertrochanteric fractures accompanied with proximal femoral fractures and 5 cases of subtrochaneric fracures. The fractures ware fixed by LISS plate after radically debridement. The bone defects were repaired by free vascularized fibular graft and autogenous cancellous bone graft mixed artificial bone containing antibiotics. Postoperatively, ambulation without weight bearing was encouraged as early as possible.

RESULTS

Ten patients were followed up from 9 to 30 months and all nonunions healed smoothly without wound infection recurrence or internal fixation failure at the final follow-up. The time for full weight bearing was from 12 to 28 weeks. The hip joint function was evaluated by Sanders Traumatic Hip Rating Scale, the result was excellent in 7 cases, good in 2, and fair in 1 at the final follow-up.

CONCLUSIONS

Modified one-stage revision procedure is an effective treatment with a good functional result for proximal femoral infected nonunion after intramedullary nail fixation. On the basis of radical debridement, the combination of infection control and bone healing therapeutic techniques is key for success.

[Traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children]

OBJECTIVE

To study clinical effects and safety of traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children.

METHODS

From October 2012 to May 2016, 65 patients with proximal humeral fractures were treated with traditional manipulative reduction and percutaneous elastic intramedullary nail fixation. There were 52 boys and 13 girls, ranging in age from 7 to 14 years old, with an average age of 11.2 years old. Twenty-three patients had injuries on the left side, and 42 patients had injuries on the right side. There were 13 cases of oblique fracture, 49 cases of transverse fracture, and 3 cases of comminuted fracture. All the patients had closed, obviously displaced fractures, without vascular and nerve injuries. The duration from injury to treatment ranged from 20 minutes to 5 days, with a mean of 3 days. The fracture healing and complications were observed after operation, and the curative effect was evaluated by Neer shoulder function score.

RESULTS

The operation time ranged from 30 to 40 minutes, with a mean of 35 minutes; intraoperative blood loss ranged from 5 to 10 ml, with a mean of 6.5 ml. All the patients were followed up, and the duration ranged from 12 to 28 months, with an average of 18 months. All the fractures healed. According to the Neer evaluation system, 59 patients got an excellent result, 5 good and 1 fair. Four patients had a small amount of secretions on the tail of the needle; 2 patients had skin irritation; 1 patient had partial withdrawal of the nail, and the skin in all the patients healed after taking out the nail. No patients had nonunion fractures due to the broken nails and loosen screws, and no vascular or nerve injuries occurred.

CONCLUSIONS

Traditional manipulative reduction and percutaneous elastic intramedullary nail fixation for the treatment of proximal humeral fractures in children has the advantages of less trauma, quicker recovery, less complications and simple operation.

[Minimally invasive elastic intramedullary nailing for the treatment of radial neck fracture in children: a report of 18 cases]

OBJECTIVE

To investigate effects of elastic stable intramedullary nails(ESIN) for the treatment of radial neck fracture in children.

METHODS

From January 2014 to April 2017, 18 children with radial neck fractures were treated with minimally invasive internal fixation including 6 males and 12 females with an average age of 8.6 years old ranging from 4 to 15 years old; 7 cases were on the left, 11 cases on the right. According to Judet type, 5 cases were type II, 9 cases were type III, 1 case was type IVa, 3 cases were type IVb. Postoperative radial neck fracture healing, elbow pain, deformity and range of activities were recorded.

RESULTS

All children were followed up for 3 to 14 months with an average of 8 months. All fractures were healed well. There was 1 case of nail tail irritation, and the fracture healed and pain disappeared after removal. Satisfactory results were achieved in 1 case after reduction and fixation, but a lateral and angulation shift in 20 degrees was observed after 2 days, while the elbow joint function seen well at 6 months. According to Tibone-Stoltz clinical function assessment criteria, the results were excellent in 11 cases, good in 5 cases, fair in 2 cases.

CONCLUSIONS

The operation of elastic intramedullary nail fixation for the treatment of radial neck fracture in children is simple, reliable and minimally invasive, which can restore functional activity and less complication as soon as possible.

[Clinical observation of proximal femoral anti-rotation nail for the treatment of femoral intertrochanteric fracture]

OBJECTIVE

To explore the curative effect and the recessive loss of blooding of PFNA for the treatment of intertrochanteric fractures of femur.

METHODS

From January 2012 to January 2015, a total of 49 patients with intertrochanteric fractures of femur were treated with proximal femoral anti-rotation nail including 41 males and 8 females with an average age of 79 years old ranging from 65 to 91 years old. According to the modified Evans type, 1 case was type I, 12 cases were type II, 36 cases were type III. All cases were fresh fractures. Patients had hip pain, movement limited, joint swelling, bruising, extorsion deformity, X-ray and CT examination showed completely fractures. All patients were treated by closed reduction and PFNA internal fixation. Three comminuted fractures using closed reduction were not satisfied, then were treated by limited PFNA fixation after open reduction.

RESULTS

The patients' incision got the grade A healing, no complications such as infection and internal fixation failure happened. All patients were followed up from 6 to 36 months (means 22 months). The pain VAS score decreased from preoperative 7.70±1.97 to 1.00±0.26 at 6 months after operation(P<0.01). Harris hip score improved from preoperative 8.70±4.19 to 91.70±5.31 at 6 months after operation(P<0.01). The outcome at 6 months after operation was excellent in 34 cases, good in 7, poor in 1. The fracture healing time was from 8 to 16 weeks with an average of 12 weeks after operation. One patient with osteoporosis, crushing broken, poor compliance, associated with schizophrenia at the same time, appeared with the displacement of the femoral greater trochanter, with conservative treatment for healing.

CONCLUSIONS

Intertrochanteric fractures of femur are common in the elderly trauma, in pain relief, recovery of hip function, to provide quality of life for the patients, PFNA achieved satisfactory effect, but its existence is worth to pay close attention to the recessive loss of blood.

[Intramedullary nailing combined with cannulated screw in treating femoral condyles fractures]

OBJECTIVE

To observe the clinical effects of retrograde intramedullary nailing and cannulated screws in the treatment of femoral condylar fracture.

METHODS

From June 2009 to June 2015, 13 patients with femoral condyles fracture were treated by retrograde intramedullary nailing and cannulated screws including 6 males and 7 females with an average age of 46.1 years old ranging from 16 to 76 years old. There were 10 cases of closed fractures, 3 cases of open fraetures. According to AO classification criteriam, 4 cases were type C1, 7 cases were type C2, 2 cases were type C3. Postoperative reduction of fracture and the knee joint function recovery were observed.

RESULTS

All patients were followed up for 12 to 36 months with a mean of 24 months. X-ray examination showed that the union time of fracture was 18 to 24 weeks, 21 weeks on average. There were no cases of loosening, breakage of internal fixators and re-fracture. Hospital for Special Surgery(HSS) knee score was 90.07±4.99 at 1 year after the operation.

CONCLUSIONS

The clinical efficacy for retrograde intramedullary nailing and cannulated screw for the treatment of femoral condyles fracture was excellent. It can improve the anatomical reattachment rate and reduce the complications and promote the knee functional recovery.

[Interlock plate fixation for the treatment of femoral hypertrophic nonunions after intramedullary nailing fixation]

OBJECTIVE

To investigate clinical effect of locking plate assisted intramedullary nail in treating femoral hypertrophic nonunions after intramedullary fixation.

METHODS

From January 2006 to December 2015, clinical data of 40 patients with femoral nonunions after intramedullary nail internal fixation treated with interlock plate internal fixation were respectively analyzed. Among patients, there were 22 males and 18 females, aged from 21 to 60 years old with an average age of (35.0±2.2) years. The time of bone nonunion ranged from 9 to 24 months with an average of (14.1±1.5) months. Operative time, blood loss, hospital stay , complications, bone healing time and recovery of function were observed, Evanich scoring was applied to evaluate clinical effects.

RESULTS

All patients were followed up from 12 to 24 months with an average of (15.2±2.7) months. Operative time ranged from 105.1 to 130.2 min with an average of (112.5±10.2) min;blood loss ranged from 207.0 to 250.2 ml with an average of (220.6±14.7)ml; hospital stay ranged from 10 to 15 days with an average of (12.2±1.5) d. All patients were obtained bone healing from 4 to 12 months after additional plate internal fixation, with an average of (6.2±1.9) months. No implant failure and infection occurred after operation. According to Evanich scoring of knee joint, total score was 83.2±5.6, 22 cases obtained excellent results, 17 good and 1 fair.

CONCLUSIONS

Limited incision approach locking plate with original intramedullary nail fixation for femoral hypertrophic nonunions subsequent to intramedullary fixation could receive good results, increase stability of fracture, and could increase stability of fracture, provide environment for callus growth. It had advantages of high cure rate, less trauma and complications, and also could do functional exercise earlier to promote good recovery of knee joint.

[Otimization of auxiliary lines for proximal femoral intramedullary nail in the treatment of simple femoral intertrochanteric fractures]

OBJECTIVE

To investigate the clinical outcomes of C-arm X-ray fluoroscopy before incision to make assistant lines and insert the guide wire of PFNA and PFNA blade.

METHODS

From January 1st 2012 to January 1st 2015, 132 intertrochanteric fracture patients of type 31A1 and 31A2 according to AO-classification, were retrospectively analyzed. Among them, 62 patients(14 males and 48 females) aged from 52 to 95 years with a mean age of(69.58±8.55) years in traditional group were operated by traditional procedure, while 70 patients in the skin marking group included 15 males and 55 females aged from 61 to 88 years with a mean age of(71.94±7.64) years, on the basis of the traditional operation method, the assistant line of the body surface and the C-arm X-ray was increased, and the guide pin positioning of the proximal femoral nail and the spiral blade was guided by the auxiliary line in the operation. Operative time, frequency of C-arm fluoroscopy, Harris hip score of the third months after surgery and the complications in both groups were queried for statistical analysis.

RESULTS

In addition to skin making group 1 patients had superficial wound infection complications, all patients were stage I wound healing. All patients were followed up for 3 to 18 months with an average of (6.81±3.07) months. The operative time was significantly reduced in skin marking group (56.16±6.36) minutes compared to traditional group (59.06±9.19) minutes (P>=0.035). And the frequency of C-arm fluoroscopy of skin marking group was(25.89±5.81) times which was also significantly reduced compared to traditional group(31.32±9.81) times (P<0.001). There was no statistical difference in Harris hip score at 3 months after operation and the complication rate between the two groups(P>0.05).

CONCLUSIONS

In this study, a simple and easy method of assistant line marking can shorten the operation time and reduce the number of times of operation.

[Imaging characteristics and the operative effect of the irreducible femoral intertrochanteric fractures]

OBJECTIVE

To analyse the imaging characteristics of the irreducible femoral intertrochanteric fracture and evaluate the operative effect of closed poking reduction and intramedullary nail fixation.

METHODS

From December 2011 to October 2015, 28 patients with irreducible femoral intertrochanteric fracture were treated by closed poking reduction and intramedullary nail fixation including 12 males and 16 females with an average age of 72 years old ranging from 58 to 89 years old. According to AO classification: 5 cases were type A2.1, 10 cases were type A2.2, 13 cases were type A3.3. The postoperative complications were observed, and the postoperative X ray were used to evaluate the fracture healing, and the Harris score was used to evaluate the hip joint function.

RESULTS

Preoperative X rays for determine irreducible femoral intertrochanteric fracture was difficult, but dimensional CT had characteristic performance: the fracture near the end displaced forward rotation. Operation time was 45 to 100 minutes with an average of 65 minutes. Intraoperative bleeding was 80 to 300 ml with an average of 160 ml. Two cases died within 3 months after operation, 26 patients were followed up for 6 to 12 months with an average of 8.4 months. Fracture healing time was 12 to 16 weeks with an average of 13.6 weeks. Two cases occurred inversion deformity.There were no wound infection, nonunion and fracture fixation failure. Hip Harris score was 86.7±5.3 at the last follow up, the result was excellent in 14 cases, good in 12 cases.

CONCLUSIONS

Dimensional CT can be very good to predict the fracture of the irreducible femoral intertrochanteric fracture. Closed poking reduction and intramedullary nail fixation for the treatment of the irreducible femoral intertrochanteric fracture has satisfactory clinical result.