ВНУТРЕННИЙ ОСТЕОСИНТЕЗ ПРИ ЛЕЧЕНИИ ОТКРЫТЫХ ПЕРЕЛОМОВ БЕДРЕННОЙ КОСТИ

Objective To analyze of related factors in affecting condylar buttress plate (CBP) surgical treatment of distal femoral fractures.Methods One hundred patients with distal femoral fractures were grouped according to eight related factors (gender,age,fracture type,fracture classification,surgical time,reset quality,whether bone graft and plaster braking),respectively.Operative efficacy was scored by the Neer knee functional score table,and score ≥ 72 was excellent,while ＜ 72 was good.Eight related factors were carried out single factor analysis with x2 test to compare the operative efficacy of each group,then the related factors with single factor analysis result of P＜0.05 were put in Logistic multifactor regression analysis,in order to clarify the independent risk factors for CBP treatment of distal femoral fractures.Results There was no significant difference (P＞0.05) in the operative efficacy between male and female group,open fracture and closed fracture group.The difference between youth,middle-aged and elderly group,type A and type C fracture group was statistically significant (P＜0.05).The operative efficacy of patients got surgery within 7 d was obviously better than those who got surgery 7 d later (P＜0.05).The operative efficacy of patients who had no intraoperative bone graft was better than those who had bone graft (P＜0.05).The operative efficacy of satisfactory reset group and none plaster braking group was better than that of unsatisfied reset group and plaster braking group (P＜0.05),respectively.Conclusions Age,fracture type and reset quality are CBP therapy independent risk factors for the efficacy of operation for patients with distal femoral fractures,which will provide some reference for improving the operative efficacy of CBP operation in treatment of distal femoral fractures. Key words: Condylar buttress plate; Distal femoral fractures; Fracture type

Objective To investigate the clinical efficacy of inverted intramedullary nail combined with medial minimally invasive plate in treatment of type C2 and C3 distal femoral fractures. Methods A retrospective case control study was conducted on 38 patients with complex distal fractures of the femur treated from January 2015 to January 2017. There were 22 males and 16 females, aged 24-72 years [(45.6±2.5)years]. AO fracture classification was type C2 in 24 patients and type C3 in 14. All of them were fresh closed fractures. The time duration from injury to operation was 4-16 days (average, 7.5 days). Based on the different surgical methods, the patients were divided into lateral single plate fixation group (single plate group, 20 patients) and inverted intramedullary nail combined with medial minimally invasive locked plate fixation group (locked plate group, 18 patients). The two groups were compared in terms of operation condition, early weight bearing time, fracture healing time, postoperative complications, postoperative knee function and activity of living. Hospital for Special Surgery (HSS) score was used for evaluating postoperative knee function and Barthel index for activity of living. Results The patients were followed up for 10-24 months [(12.2±1.8)months]. The operation duration was (110.5±35.4)min for single plate group and (116.7±42.3)min min for locked plate group(P>0.05). Intraoperative blood loss in single plate group was [(450.5±120.7)ml] and [(455.2±130.4)ml]in locked plate group (P>0.05). The early weight bearing time in single plate group was (28.5±8.6)days and 18.7±4.9 (P<0.01)days in the locked plate group. The fracture healing time in single plate group was (8.5±2.2)months, and [(6.5±1.6)months]in locked plate group (P<0.01). After 3 weeks, 6 months and 12 months, HSS scores of knee joint function of the locked plate group was significantly better than that of single plate group (P<0.01). At 6 months and 12 months after operation, Barthel index score of locked plate group was significantly better than that of single plate group (P<0.01). No infection occurred in two groups after operation. There were no complications such as internal fixation failure, knee valgus, external rotation deformity or fat embolism in locked plate group. There were two cases of internal fixation failure, one knee eversion, and two knee varus in single plate group (P<0.01). Conclusion Compared with single plate fixation, the therapeutic method of inverted intramedullary nail combined with medial minimally invasive locked plate has the advantages of early weight bearing time, quick recovery, better function restoration and fewer complications, and hence is a preferable choice for treatment of type C2 and C3 complex distal femoral fractures. Key words: Femoral fractures; Fracture fixation, intramedullary; Interlocking intramedullary nail

Objective To investigate the clinical efficacy of different surgical fixation for distal femoral fractures.Methods 82 patients with distal femoral fracture who had been hospitalized during the period of August 2005 to January 2011 were included in this study.Group A ( 19 patients ) received lag screws and multifunctional external fixation,group B ( 20 patients ) locking plates,group C ( 18 patients ) received retrograde intramedullary nails,and group D ( 25 patients ) received condylar buttress plates.The knee function was assessed in the four groups,and the treatment was observed.Results The knee function restored in patients with type-A fracture in the four groups,with no difference ( P＞ 0.05 ).The knee function restored better in the patients with type-C fractures in group B than in those in group A strong ( P＜ 0.05 ),and it was better in group A than in group C ( P＜ 0.05 ),and was better in group D than in group C ( P＜ 0.05 ).Conclusions Locking plate is the best in the treatment of distal femoral fractures,followed by condyle buttress plate.Primary hospitals can choose locking plates or femoral condyle buttress plates based on the economic situation. Key words: Distal femur; Fractures; Fixation

We studied 43 patients with ipsilateral femoral shaft and femoral neck fractures who had dynamic hip screw fixation alone or in combincation with dynamic compression plate. All patients except two were diagnosed early; 37 patients had other associated injuries. There were 41 males and two females. The follow-up ranged from eight months to four years (mean 2-1/2 years). Six patients were lost to follow-up. Fracture of the neck of the femur healed in all 37 patients. Four patients had delayed union and two patients developed nonunion of the shaft of the femur. The aim of this paper is to show our experience and results using one technique for the treatment of such fractures.

Open fractures of the femoral shaft, treated with osteosynthesis or temporary external fixation

Objective To investigate the influence to knee joint rehabilitation with the ipsilateral or contralateral ilium harvesting in the distal femur C3 fracture surgery. Methods According to the inclusion and exclusion criteria, patients who underwent surgical treatment of distal femoral C3 fractures from April 2013 to July 2015 were prospectively selected. According to the donor site, the patients underwent ipsilateral or contralateral iliac harvesting alternately, were then grouped in ipsilateral harvesting group and contralateral harvesting group. Theatre time, time interval of knee joint active extension to 10° and flexion to 120°, visual analog score(VAS) of the donor site at three months post-operatively were compared respectively. Complications such as incision redness, delayed incision healing, hematoma, infection, iliac crest avulsion fracture were recorded. The t-test or rank sum test was used for the measurement data. The chi-square test was used for the count data. The Kaplan-Meier method was used for survival analysis of the knee joint with active extension to 10° and flexion to 120°, and the Breslow test was performed. Results A total of 12 patients in the ipsilateral harvesting group and 11 patients in the contralateral harvesting group were included. The time of follow-up were 18 (14, 21) months for the ipsilateral harvesting group and 15 (13, 20) months for the contralateral harvesting group. Compared to the ipsilateral harvesting group, the theatre time of the contralateral harvesting group was significantly less(t=2.169, P<0.05), the median survival time of knee active extension to 10° and flexion to 120° were less (χ2=7.999, P<0.05; χ2=9.325, P<0.05 respectively). The pain relief in the donor area were better in contralateral harvesting group than that in the ipsilateral harvesting group(t=8.910, P<0.01). There were three cases of red incision, with one in the ipsilateral harvesting group and two in the other one. All the incisions healed after treatment. During the follow-up period, no hematoma, infection or iliac crest avulsion fracture of the donor area happened. Conclusion Harvesting of the contralateral ilium for the C3 fracture of distal femur is beneficial to the early rehabilitation of knee joint. Key words: Femoral fractures; Fractures, comminuted; Bone transplantation; Knee injuries; Prospective studies

Objective To compare the clinical efficacy of locking compression plate (LCP) versus intramedullary nail in staged treatment of complex compound tibial fractures.Methods From February 2008 to January 2013,55 cases of complex tibial open fracture were treated at our department.They were 39 men and 16 women,with an average age of 32.5 years (from 17 to 72 years).The fractures were on the left side in 24 patients,on the right side in 28 and both sides in 3.By Gustilo classification,18 fractures were type Ⅰ,24 type Ⅱ and 16 type ⅢA; by AO classification,6 fractures were type 42-A,32 type 42-B,and 20 type 42-C.They were treated by external fixation and vacuun sealing drainage (VSD) at the primary stage followed by fixation with LCP or intramedullary nail at the secondary stage.Locking intramedullary nail was used in 32 patients (34 fractures) and LCP in 23 patients (24 ffractures).The 2 groups were compared in terms of fracture healing time,functional recovery of the affected limbs,and postoperative complications.Results The 55 patients were followed up for 12 to 34 months (average,18 months).All the fractures were healed from 16 to 48 weeks after the staged treatment,with an average of 24.2±5.3 weeks in the intramedullary nail group and 26.1 ± 7.2 weeks in the LCP group.There was no significant difference in the healing time between the 2 groups (P ＞ 0.05).According to the functional assessment by the Johner-Wruhs system,the intramedullary nail group had 13 excellent cases,18 good ones and 3 fair ones (the excellent to good rate,91.2％) while the LCP group had 9 excellent,12 good and 3 fair ones (the excellent to good rate,87.5％),showing no significant between-group difference (P ＞ 0.05).There was no significant difference either between the 2 groups regarding the postoperative complication rate [20.6％ (7/34) for the intramedullary nail group versus 12.5％ (3/24) for the LCP group] (P ＞ 0.05).Conclusion In the staged treatment of complex open tibia fractures,both intramedullary nail and LCP can result in reliable fixation of the fracture ends,a low complication rate and thus satisfactory clinical efficacy. Key words: Tibial fractures; Fractures, open; External fixator; Bone nails; Bone plates

Objective To investigate the methods and results of lengthened proximal femoral nail antirotation (PFNA) in the treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures. Methods Of the 21 patients with femoral shaft combined with ipsilateral femoral neck fractures treated by lengthened PFNA from 2006 to 2009,16 patients with complete follow-up were retrospectively studied.There were 15 males and 1 female,at mean age of 35 years (range,21-51 years).Injury causes were all high-energy trauma including traffic injuries in 11 patients and fall injuries in five.According to Garden classification,there were seven patients with type Ⅰ femoral neck fractures,six with type Ⅱ and three with type Ⅲ.Femoral shift fractures contained six superior part fractures and nine medial part fractures and one inferior part fracture.According to Winquist classification,there were two patients with type Ⅰ femoral shaft fractures,four with type Ⅱ,six with type Ⅲ and four with type Ⅳ.Two patients had open fractures belonging to type Ⅰ Gustilo-Anderson.Harris hip score was used to evaluate functional outcomes at the last follow-up postoperatively. Result The mean follow-up time was 2.4years (range,1-4 years ).The mean period for healing of femoral neck and shaft fractures was 4.2months ( range,3-6 months) and 5.1 months ( range,3-8 months) respectively.Four patients showed delayed diagnoses of femoral neck fractures ; two patients had delayed union of femoral shaft fractures ; one suffered from avascular necrosis of the femoral head ; one patient presented 3 cm of extension of the affected limb and was accompanied by active pain of the knee joint for over four months.According to Harris score,function of hip joints was excellent in seven patients,good in six and fair in three,with excellence rate of 82％. Conclusions It is relatively few that the femoral shaft fracture is combined with ipsilateral femoral neck fracture.The rate of missed diagnosis of femoral neck fractures is high and the patients with high energy trauma hould be highly paid attention to.Lengthened PFNA conforms to characteristics of biomechanical fixation and presents short operation time and solid fixation. Lengthened PFNA achieves affirmatory effects for treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures. Key words: Femoral fractures; Femoral neck fractures; Fracture fixation,internal

Initial definitive treatment of open femoral shaft fractures with retrograde nailing - is it safe? A retrospective analysis comparing antegrade to retrograde nailing

Nonunion is a highly morbid complication that exacerbates the pain, disability and financial burden of distal and diaphyseal femur fractures. This study examined the modern rates of healing, nonunion, and other complications requiring reoperation of different fixation methods for distal and diaphyseal femur fractures. A systematic review and meta-analysis of all records from PubMed, Embase and the Cochrane Review system was performed. Included studies had >20 acute, non-pathologic distal or diaphyseal femur fractures treated with primary internal fixation. Excluded were studies on abnormal patient/fracture populations, external fixation, or cement/bone graft use. Thirty-eight studies with 2,829 femoral shaft fractures and 11 studies with 505 distal femur fractures were included. Distal fractures had a lower healing rate (86.6% vs. 93.7%) and a higher re-operation rate (13.4% vs 6.1%) than shaft fractures (p < 0.00001), primarily due to higher rates of mechanical failure (p < 0.00001). Nonunion was the most frequent complication, occurring in 4.7% of distal fractures and 2.8% of shaft fractures. There was no difference between plate and nail fixation of distal fractures in healing, nonunion, or other causes of re-operation. Shaft fractures developed nonunion in 6.6% of unreamed nails and 2.1% of reamed nails (p = 0.002). Nonunion occurred in 2.3% of antegrade nailed fractures and 1.5% of retrograde nailed fractures (p = 0.66). Approximately one out of every eight distal fractures and one of every 16 shaft fractures requires re-operation. The most common cause of fixation failure is nonunion. Further research is needed to improve outcomes, particularly in distal femur fractures.

Objective To explore the clinical effect of radial extracorporeal shock wave therapy in the treatment of postoperative delayed union of open tibial fractures. Methods A total of 41 patients with delayed union after external fixator fixation of open tibial fractures treatment by extracorporeal shock wave from January 2014 to February 2018 were selected. All the patients were followed up after treatment and the effect of treatment was observed. Results All the patients were followed up for 9 months, including 37 cases of fracture healing, and the cure rate was 90.2%. Conclusions Radial extracorporeal shock wave therapy is efficient in the treatment of postoperative delayed union of open tibial fractures, the effect is satisfactory and the complications are few. It is an iseal treatment method. Key words: Radial extracorporeal shock wave therapy; Tibial; Open fractures; Delayed unions

Objective To evaluate the the rapeutic effect of the converge interlocking intramedullary nail combining with continuous passive motion (CPM)on patients with distal femoral fracture.Mathods Twenty-four cases of distal femoral fracture were operated with the method of converse interlocking intramedullary nail,and the CPM practice were carried out and observed after the operation.Results Twenty-four cases were followed up for 6-18 months after operation.of which the average period was 11 months.The healing times of the fracture were 3-7 months and knee joints function recovered well.The excellent ratio was above 91.5%.Conclusion Treating distal end femoral fracture by converse interlocking intramedullary nail possesses the advantages of simpleness,safety,a fewer complication and earlier concrescence,and also could carry out CPM practice PAlrtier,which is a satisfactory method of curing distal femoral fracture. Key words: Distal femoral fracture; Converse intedncking intramedullary nail; Internal fixation; Continuous passive motion simpleness

Objective To characterize emergent treatment of open distal tibiofibular fractures in earthquake rescue in comparison with conventional medical treatment.Methods From 21 to 27 April,2013,we treated 12 patients with open distal tibiofibular fracture who had been injured in the earthquake at Lushan,Yaan,Sichuan,China.They were 5 men and 7 women,aged from 33 to 85 years (average,54.8years).By the Gustilo classification,there were 5 cases of type Ⅱ,4 cases of type ⅢA and 3 cases of type Ⅲ B.Two patients were complicated with ipsilateral closed fracture of the knee.Emergent debridement and external fixation with Hoffmann assembled fixator were performed for 11 patients while one patient received external fixation 5 days after injury.Secondary correction of the external fixation was conducted for those with poor alignment or ankle dislocation after primary management.Results Among the 11 patients receiving emergent debridement and external fixation,4 had satisfactory alignment of the lower limb but 7 did not.Of them,4 with mild injury of the soft tissue received direct correction of the alignment of the lower limb when the external fixation was changed while the other 3 with severe injury of the soft tissue or with ankle dislocation or fracture received secondary correction of the external fixation.Good alignment,good fracture reduction and perfect congruence of adjacent joints were achieved in all patients.Conclusions Open distal tibiofibular fractures can be treated quickly and efficiently using an assembled external fixator in earthquake rescue.Initial restoration of the limb alignment and congruence of adjacent joints are crucial and secondary adjustment of the external fixation is necessary for those with poor reduction in case their final treatment and functional recovery are affected by later transportation. Key words: Tibial fractures; Fibula; Fractures, open; External fixator; Earthquake

Objective To compare and analyze the epidemiological features of adult patients with distal femoral fracture between the east and west areas in China from 2010 to 2011. Methods The data of adult patients with distal femoral fracture treated from January 2010 through December 2011 in 63 hospitals were collected through the PACS system and case reports checking system. The data from 35 hospitals in the east area were classified as group A and those from 28 hospitals in the west area as group B. The analytic items included gender, age and AO classification. Results A total of 2,523 adult distal femoral fractures were collected, involving 1,544 males and 979 females, with a male to female ratio of 1.58∶1. The adult femoral fractures predominated in an age range from 41 to 50 years (18.94%) and their high-risk type was 33-A (50.18%). In group A of 1,650 cases, there were 1,027 males and 623 females, with a male to female ratio of 1.65∶1 and a median age of 48 years; in group B of 873 cases, there were 517 males and 356 females, with a male to female ratio of 1.45∶1 and a median age of 45 years. There were no significant differences in the age distribution and gender proportion between groups A and B (P >0.05). The age distribution showed that the peak ranges were from 31 to 60 years in both groups. The proportion of type 33-A was the most and that of type 33-B the least in both groups. The proportion of type 33-A in group B (53.49%) was significantly higher than in group A (48.42%) while that of type 33-B in group B (16.84%) was significantly lower than in group A (21.39%) (P< 0.05). Conclusions Adult distal femoral fractures were common in middle-aged males and their high-risk type was 33-A. Their peak age was from 31 to 60 years in both east and west areas in China. They were more common in men. The predominant fracture type was 33-A in both areas. The east area witnessed a significant higher proportion of type 33-B and a significant lower proportion of type 33-A than the west area. Key words: Femoral fractures; Epidemiology; Case-control studies; Adult

Objective To evaluate composite bridge internal fixation in the treatment of limb metaphyseal fractures in children. Methods From October 2015 to December 2018, 16 children was treated by composite bridge internal fixation for limb metaphyseal fractures at Department of Orthopaedics, The Second People's Hospital of Changzhou. They were 11 boys and 5 girls, aged from 8 to 14 years (average, 11.0 years). Their fractures were located at proximal humerus in 4 cases, at distal femur in 3 cases, at proximal tibia in 3 cases and at distal tibia in 6 cases. According to the Salter-Harris classification, 6 cases were type Ⅱ, 5 cases type Ⅲ and 5 cases type Ⅳ. The time from injury to surgery ranged from 3 to 8 days, averaging 5.3 days. The fracture healing time, postoperative complications (infection and implant failure) and postoperative functional recovery were recorded. Results This cohort obtained follow-up from 12 to 18 months (average, 13 months). All the children obtained bony union after 2 to 5 months (average, 2.4 months). At the last follow-up, the 4 proximal humeral fractures were evaluated by the Neer scores, giving 4 excellent cases; the 6 distal femoral and proximal tibial fractures were evaluated by the knee function scores of The Hospital for Special Surgery (HSS), giving 5 excellent and one good cases; the 6 distal tibial fractures were evaluated by the Baird scores, giving 5 excellent and one good cases. Follow-ups found no complications like postoperative infection, loosening or breakage of implants, or bone nonunion. Conclusion Composite bridge internal fixation is a good alternative treatment for children metaphyseal fractures, because it has advantages of minimal invasion, operative simplicity, reliable fixation and limited postoperative complications. Key words: Extremities; Fractures, bone; Fracture fixation, internal; Internal fixators; Children