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YU Fu- bin, LIU Cheng-yao, LI Wei, MENG Hong- zheng, JIANG Hong-yu, ZHANG Ming, ZHANG Wen-qiang
2025,33(3):193-199, DOI: 10.20184/j.cnki.Issn1005-8478.110672
Abstract:
[Objective] To compare the mid-term clinical outcomes of anterior stabilized insert versus cruciate retaining insert in primary total knee arthroplasty. [Methods] A retrospective study was conducted on 116 patients (116 knees) who underwent unilateral primary total knee arthroplasty with Vanguard knee prosthesis for knee osteoarthritis from January 2016 to January 2017. According to the preoperative doctor-patient communication, 65 patients received anterior stabilized insert (the AS group), while other 51 patients had cruciate retaining insert used (the CR group). The documents regarding perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had corresponding TKA performed successfully with no statistical significance in perioperative parameters between the two groups (P>0.05). The VAS, HSS, and KSS scores, as well as knee ROM in both groups were significantly improved at the latest follow-up lasted for (7.0±0.1) years in a mean compared with those preoperatively (P<0.05), which were not statistical significant between the two groups at any time points accordingly (P>0.05). In addition. there was no significant difference in FJS scores between the two groups at the last follow-up (P>0.05). Radiographically, the femorotibial angle (FTA), hip knee ankle angle (HKAA), femoral varus-valgus angle (FVVA), femoral sagittal angle (FSA), tibial varus-valgus angle (TVVA), posterior tibial slope angle (PTSA), posterior condylar offset ratio (PCOR) and Insall-Salvati index remained unchanged at the latest follow-up compared with those immediately after surgery (P> 0.05). The AS group had significantly less PTSA than the CR group immediately postoperatively and at the latest follow-up [(2.2±1.5)° vs (6.1±1.4)°, P<0.001; (2.2±1.4)° vs (6.1±1.4)°, P<0.001], despite of the fact that no significant difference in other imaging indicators were noted between the two groups (P>0.05). [Conclusion] The midterm clinical and imaging consequences of AS insert used in primary total knee arthroplasty are good, and not significantly different compared with CR insert. In the clinical setting, the surgeon might choose the inserts flexibly according to the specific situation.
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YANG Shao-wu, GUI Wei-wei, LI Ying
2025,33(3):200-206, DOI: 10.20184/j.cnki.Issn1005-8478.090954
Abstract:
[Objective] To evaluate the clinical significance of preoperative Mimics-assisted design of proximal femoral nail anti-rotation (PFNA) combined with buttress plate fixation of type A2-3 femoral intertrochanteric fractures. [Methods] A retrospective analysis was performed on 53 patients who received open reduction and internal fixation (ORIF) with PFNA and buttress plate for type A2-3 femoral intertrochanteric fractures in our hospital from January 2018 to June 2021. According to the preoperative doctor-patient communication, 28 patients had ORIF performed based on preoperative design with Mimics software, while other 25 patients had routine ORIF conducted without preoperative digital design (routine group). The documents regarding to perioperative period, follow-up and images were compared between the two groups. [Results] The design group proved significantly superior to the routine groups in terms of operation time [(52.7±5.2) min vs (69.5±7.1) min, P＜0.001], intraoperative blood loss [(102.7±10.9) ml vs (165.9±10.7) ml, P＜0.001], intraoperative fluoroscopy times [(8.3±2.1) times vs (10.2±3.5) times, P=0.018]. In addition, the design group resumed full loading activity significantly earlier than that of the routine group [(36.3±5.8) days vs (47.5±6.3) days, P＜0.001]. The Harris score, hip extension-flexion ROM and internal-external rotation ROM significantly increased in both groups over time (P＜0.05), which were significantly better in the design group than the routine group at 1 month and 6 months after surgery. With respect of imaging, there was no statistically significant difference in the fracture reduction quality between the two groups (P＞0.05). The design group had the neck-shaft angle (NSA) remained unchanged, whereas the routine group had NSA significantly decreased by the latest followup (P＜0.05). At corresponding time points after surgery, the design group proved significantly better than the routine group in tip-apex distance (TAD) and femoral head and neck shortening (P＜0.05). [Conclusion] For femoral intertrochanteric fractures involving the lateral wall, preoperative virtual design with virtual reconstruction provides the surgeon with accurate classification and individualized fixation plan, shorten the operation time and reduce the incidence of internal fixation failure.
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FENG Yan-hua, REN qiang, LI Xiang, LI Jing-yan, WANG Ming-xin
2025,33(3):207-212, DOI: 10.20184/j.cnki.Issn1005-8478.100950
Abstract:
[Objective] To explore the therapeutic outcomes of full-thickness versus split-thickness skin grafting for repairing the wounds secondary to necrotizing soft tissue infection (NSTI) in children. [Methods] A retrospective study was conducted on 56 children who had wound of NSTI treated in the Children's Hospital of Hebei Province from January 2014 to June 2022. According to patient-doctor communication, 31 children underwent full-thickness skin grafting (FT group), while other 25 patients had split-thickness skin grafting performed (ST group). The documents regarding perioperative period and follow-up were compared between the two groups. [Results] There were no significant differences in operation time, intraoperative blood loss, defect area after debridement, donor site and treatment, graft survival rate, walking time and hospital stay between the two groups (P＞0.05). As time went during follow-up period lasted for an average of (12.0±2.4) months, the visual analogue scale (VAS) for appearance, and Vancouver scar scale (VSS) of recipient and donor areas significantly decreased (P＜0.05), while the function of recipient area significantly improved (P＜0.05), despite of the fact that function of donor area remained unchange in both groups (P＞0.05). The FT group proved significantly superior to the ST group in terms of VAS for appearance [(5.7±0.7) vs (6.0±0.4), P=0.017; (2.0±0.7) vs (3.6±0.7), P＜0.001] VSS score [(4.3±0.8) vs (5.4±0.7), P＜0.001; (2.5±0.6) vs (4.1±0.5), P＜ 0.001], the area function [normal/ limited/deformity, (11/16/4) vs (4/11/10), P=0.045; (24/7/0) vs (9/16/0), P=0.002] 3 months postoperatively and at the latest follow-up. [Conclusion] Full-thickness skin grafting have good consequence in wound repair, and can be used for the repair of wound secondary to necrotic soft tissue infection in children.
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JING Li-zhong, ZHANG Xia, WANG Shao-shan, YANG Jiu-shan
2025,33(3):213-218, DOI: 10.20184/j.cnki.Issn1005-8478.100757
Abstract:
[Objective] To compare the clinical efficacy of arthroscopic repair of type IV medial meniscal ramp lesion with suture hook (SH) versus Fast-fix (FF). [Methods] A retrospective study was conducted on 45 patients who received arthroscopic surgery for anterior cruciate ligament (ACL) tear combined with type IV medial meniscal ramp lesion from January 2016 to October 2020. All patients underwent ACL reconstruction with autologous hamstring tendon, however, 21 cases of them had medial meniscal ramp lesion repaired by using SH, and 24 cases were by using FF based on the preoperative doctor-patient communication. The perioperative period, follow-up and imaging results were compared between the two cohorts. [Results] All patients in both groups had operation done successfully without complications such as vascular and nerve injury during the operation. The SH group consumed significantly longer operation time [(91.2±10.6) min vs (62.5±8.4) min, P＜0.001], and total length of incision [cm (5.9±0.5) vs (5.1±0.6) cm, P＜0.001] than the FF group, but the former spend significantly less hospitalization cost than the latter [(3.4±0.3) ten-thousand yuan vs (4.3±0.7) ten-thousand yuan, P＜0.001]. There were no significant differences in ramp lesion length, number of meniscal stitches, walking time, incision healing grade and hospital stay between the two groups (P＞0.05). All patients were followed up from 36 months to 72 months, and there was no significant difference between the two groups in time to resume full-weight bearing activity (P＞0.05). The knee joint space tenderness, McMurray sign, pivot shift sign, knee flexionextension ROM, IKDC and Lysholm scores significantly improved in both groups 1 year after surgery and at the last followup compared with those preoperatively (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). As for imaging, the meniscus injury grade and posterior tibial plateau bone marrow edema were significantly improved in both groups 1 year after surgery (P＜0.05), and no statistical significance in the above indexes was noted between the two groups at any corresponding time points (P＞0.05). One year after surgery, MRI showed that the healing rate of the lesion was of 90.5% in SH group, while 87.5% in the FF group, with no statistical significance between them (P＞0.05). [Conclusion] Arthroscopic repair of type IV medial meniscal ramp lesion with both suture hook and Fast-fix do obtain satisfactory clinical consequences.
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YU Yun-fei, HU Gang, WU Mao, WU Li-qin, ZHANG Yan-min
2025,33(3):219-224, DOI: 10.20184/j.cnki.Issn1005-8478.110265
Abstract:
[Objective] To search the factors related to pulmonary infection after internal fixation of femoral intertrochanteric fractures in the elderly. [Methods] A retrospective study was conducted on 629 elderly who had femoral intertrochanteric fractures fixed surgically in our department from January 2015 to December 2023. According to the occurrence of pulmonary infection within 30 days after surgery, 90 patients were fall into the infection group, while the remaining 539 patients were classified as the non-infected group. Univariate comparison and multiple logic regression were used to search the related risk factors, additionally, a disease prediction model was constructed and its efficacy was verified. [Results] As results of univariate comparison, the infection group proved significantly greater than the non-infection group in terms of male ratio [male/female, (44/46) vs (178/361), P=0.003], age [(86.5±7.0) years vs (76.8±9.4) years, P<0.001], chronic obstructive pulmonary disease (COPD) ratio [y/n, (47/43) vs (11/528), P<0.001], coronary heart disease (CHD) ratios [y/n, (19/71) vs (50/489), P=0.002], smoking ration [y/n, (49/41) vs (184/355), P<0.001], cognitive impairment ratio [y/n, (48/42) vs (81/458), P<0.001], NLR [(8.0±4.6) vs (5.3± 2.0), P<0.001], the general anesthesia ratio [intravertebral anesthesia / general anesthesia (44/46) vs (388/151), P<0.001], the ratio of intraoperative sputum aspiration (P<0.05), the ratio of LISS plate used (P<0.05), incision length (P<0.05), intraoperative blood loss and total blood loss (P<0.05). As for multiple logistic regression analysis, the COPD (OR=151.48, P<0.001), general anesthesia (OR=9.85, P<0.001), cognitive impairment (OR=3.16, P=0.027), preoperative high NLR (OR=1.75, P<0.001), advanced age (OR=1.28, P<0.001) were the independent risk factor for pulmonary infection. The ROC curve showed that the area under curve (AUC) of the predictive model was of 0.96 (95%CI 0.96~ 0.98,P<0.001). [Conclusion] The advanced age, COPD, cognitive impairment, preoperative high NLR and general anesthesia are independent risk factors for pulmonary infection after internal fixation of the femoral intertrochanteric fractures. This established disease prediction nomogram might effectively distinguish the occurrence of postoperative pulmonary infection risk.
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LIU Deng-ke, LIU Tao-tao, TAN Xing-guo, GAO Qiu-ming
2025,33(3):225-230, DOI: 10.20184/j.cnki.Issn1005-8478.110260
Abstract:
[Objective] To compare the clinical efficacy of fully threaded screws (FTS) and partially threaded screws (PTS) for fixation of femoral neck fractures. [Methods] The data bases, including PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang, VIP and others were searched from January 2010 to May 2024 to collect studies comparing the clinical efficacy of FTS and PTS for fixation of femoral neck fractures, and a meta-analysis was performed using Review Manager 5.4 software. [Results] Nine studies were included, involving one randomized controlled study and eight cohort studies. A total of 778 patients were enrolled, including 342 in the FTS fixed group, and 436 in the PTS fixed group. As results of meta-analysis, the FTS was significantly superior to the PTS in terms of femoral neck shortening rate (OR=0.27, 95%CI 0.18~0.42, P＜0.001), screw withdrawal rate (OR=0.23, 95%CI 0.14~0.38, P＜0.001), internal fixation failure rate (OR=0.25, 95%CI 0.13~0.48, P＜0.001), and decline of neck shaft angle (MD=-1.57, 95%CI -2.35~-0.78, P＜0.001). However, there were no significant differences between the two groups regarding to intraoperative bleeding (MD=2.45, 95%CI -6.63 ~11.54, P=0.60), operation time (MD=1.25, 95%CI -0.92~3.42, P=0.26), fracture healing time (MD=0.05, 95%CI -0.75~0.86, P=0.89), bone nonunion rate (OR=0.66, 95%CI 0.37~1.19, P=0.17), and femoral head necrosis rate (OR=0.65, 95%CI 0.32~1.31, P=0.23). [Conclusion] The FTS for internal fixation of femoral neck fractures has less loss in the femoral neck shaft angle, lower incidence of screw retraction, femoral neck shortening, and internal fixation failure than the PTS, therefore, the FTS fixation is more reliable for femoral neck fractures.
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2025,33(3):231-237, DOI: 10.20184/j.cnki.Issn1005-8478.100611
Abstract:
The ligamentum mucosum (LM), also known as infrapatellar plica (IPP) or infrapatellar synovial plica, is a ligamentous structure within the synovial layer of the knee joint. The prevalence of the LM in adults ranges from 65% to 90% and decreases with age, probably due to injuries and degeneration of the knee. The LM originates from the intercondylar notch of the femur and inserts into the infrapatellar fat pad (IFP), it is located anteriorly to the anterior cruciate ligament (ACL) and parallel to the ACL. The LM is a highly variable structure and is composed of dense regular connective tissue which consistent with other knee ligaments. In recent years, this structure has received increasing attention due to its potential clinical role. LM has been found to be one of the causes of anterior knee pain (AKP). However, whether LM should be routinely removed during arthroscopy has been controversial. This article reviews the definition, origin, anatomy, classification, clinical significance, examination and treatment of the LM.
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XU Wei- zhen, ZHANG Jin- hui, ZHANG Jianping, WU Jin
2025,33(3):238-243, DOI: 10.20184/j.cnki.Issn1005-8478.100698
Abstract:
Osteopetrosis is a disease characterized by osteoclast dysfunction, which is often familial, and most cases are recessive inheritance. The patients present persistent existence of calcified cartilage, which leads to extensive sclerosis, and in severe cases, the medullary cavity is closed, combined with thrombocytopenia and severe anemia. Because of the brittleness and poor flexibility of the bones, the patients are prone to occur fractures. This paper reports a case of osteopetrosis with femoral shaft re-fracture after primary open reduction and internal fixation, who was revised with adolescent femoral intramedullary nail, buttress locking plate and bone morphogenetic protein7, and achieved good outcome. In addition, relative literatures were reviewed in this article.
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DING Yi-jia, MAN Zhen-tao, LI Wei
2025,33(3):244-248, DOI: 10.20184/j.cnki.Issn1005-8478.110713
Abstract:
Osteoporosis (OP) and coronary atherosclerotic heart disease (CAHD) are two diseases that seriously threaten the health of middle-aged and elderly people. The more calcium loss from the bones increases, the more calcium deposits in the blood vessel wall, resulting in a calcification paradox between the bone and the blood vessel wall. Inflammation plays an important role in the occurrence and development of this process, and there may be a commonality-inflammatory factor mechanism in the main pathogenesis of the two. In this review, we explore the possible mechanisms of inflammation in osteoporosis and coronary heart disease from the perspective of modern molecular biology, and summarize the feasible solutions for the bone-vascular axis from the perspective of inflammation in recent years.
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GAO Jin, JIA Peng, Lü Fei, QI Yan-song, XU Yong-sheng, HU He
2025,33(3):249-254, DOI: 10.20184/j.cnki.Issn1005-8478.110170
Abstract:
[Objective] To investigate the mechanical effect of proximal fibula on posterior lateral tibial plateau fracture by finite element analysis. [Methods] The CT data of a volunteer's tibia and fibula were collected and imported into SolidWorks software to simulate 3 conditions, including the normal control (NC), posterolateral tibial plateau fracture with plate fixation and intact fibula group (IF) and posterolateral tibial plateau fracture with plate fixation and fibular fracture (FF). Under 250 N, 500 N and 1 000 N axial loads, the displacement of the model of internal fixation and tibial fracture and under daily activities was measured. [Results] Compared with that of NC group, the Von Mises stress of plates and screws in IF group and FF group was significantly increased with the increase of load (P＜0.05). Under loads of 250 N, 500 N and 1 000 N, the IF group proved significantly less than the FF group in terms Von Mises stress of the plate [(20.3±1.5) MPa vs (28.5±1.6) MPa, P＜0.001; (42.3±1.6) MPa vs (59.4±1.7) MPa, P＜0.001; (90.5±7.8) MPa vs (123.3±15.9) MPa, P=0.003] and the screw [(24.4±3.1) MPa vs (35.7±2.5) MPa, P＜0.001; (50.2±7.9) MPa vs (70.3±9.6) MPa, P=0.007; (101.1±15.7) MPa vs (143.7±16.4) MPa, P= 0.003]. With the increase of load, the displacement of fracture fragment and the displacement of medial tibial plateau in both groups were significantly increased (P＜0.05). Under the same load, the displacement of fracture fragment and medial tibial plateau in IF group were significantly less than the FF group (P＜0.05). [Conclusion] In posterolateral tibial plateau fractures, the intact fibula does improve the overall axial stiffness of plates and screws, make lateral fracture fragment and medial tibial plateau more stable, and promote the healing of fracture.
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HUANG Zi-qi, GAO Shi-hua, WU Yu-feng
2025,33(3):255-258, DOI: 10.20184/j.cnki.Issn1005-8478.110054
Abstract:
[Objective] To introduce the surgical technique and preliminary clinical results of double Endobutton fixation of ulnar coronoid process fracture under arthroscopy. [Methods] A 29-year-old male patient was diagnosed with left Regan-Morrey type 2 ulnar coronoid process fracture by X-ray, and was treated with total elbow arthroscopic surgery. As brachial plexus block anesthesia was performed, the portals were established for arthroscopy and instruments. The parallel bone tunnels was created with 1.2mm Kirscher's wire as the fracture fragment were reduced by locator, double Endobutton-suture loops were introduced and tightened to finish the fracture fixation. Routine nursing and rehabilitation exercise were carried out after operation. [Results] The patient had operation conducted smoothly with operation time of 1 hour and 50 minutes. The Mayo score was of 75 and 100 respectively, 1 and 3 months postoperatively. The patient had fracture healed with elbow function recovered well, and the elbow motion range from -5° to 140°. [Conclusion] This complete elbow arthroscopic double Endobutton fixation of ulna coronoid process fracture is an effective treatment method, with advantages of simple operation, reliable fixation and rapid postoperative recovery.
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CHEN Lei, LI Kuo-kuo, XU xu, HE Meng, LI Chang-run, LIU Li-jun, WANG Da-ping, WANG Man-yi, ZHANG Sheng-li.
2025,33(3):259-263, DOI: 10.20184/j.cnki.Issn1005-8478.110216
Abstract:
[Objectives] To introduce the surgical technique and preliminary clinical consequence of modified anti-tension plate in the treatment of epiphyseal fractures of the tibial tubercle in adolescents. [Methods] The patient was placed in a supine position with the affected limb abducted to a neutral position, and the knee joint flexed at 25°. A 5 cm incision was made in front of the tibial tubercle, exposing the patellar tendon and the proximal epiphyseal fracture, As hematoma at the fracture ends was debrided and irrigated, the fracture was reduced with a towel clamp, and temporally fixed with 3 Kirschner wires 1.2 mm in diameter. After intraoperative fluoroscopy confirmed good fracture reduction, the patellar tendon was longitudinally split, a modified anti-tension plate was placed across the epiphyseal plate, and fixed with a compression screw, followed by 2 locking screws. If the large bone fragments involving the articular surface, another two 3.5 mm cannulated screws would be used for fixation. At the end of the procedure, an attention was given to suture the longitudinally split patellar tendon. [Results] All patients had the operation performed successfully, and were followed up time for 9 to 18 months, with an average of (15.0±1.4) months. The patients had fracture healed from 2 to 3.1 months, with an average of (2.2±0.2) months, regained normal level of activity 3 to 4 months after surgery, had implants removed 6 months postoperatively. According to Mosier's criteria, the clinical outcome was marked as excellent in 17 patients and good in 1 patient. [Conclusion] The modified tension plate to fix tibial tubercular epiphyseal fracture does obtain satisfactory clinical consequence with quick restoration of the knee function in adolescents.
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WANG Jun, HUANG Dan-lei, YE Zhi-yang, WANG Guang-ze, HUANG Jian-ming
2025,33(3):264-268, DOI: 10.20184/j.cnki.Issn1005-8478.100919
Abstract:
[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopyassisted fixation of Neer type II distal clavicular fracture through three small incisions. [Methods] A total of 53 patients underwent the abovementioned operation for Neer type II distal clavicle fracture. After general anesthesia, the patient was placed in a beach chair, and D portal was established as the observation channel to examine the upper surface of the coracoid process. Then, the arthroscope was moved to E portal for observation and D portal for operation, to reveal the lower surface of the coracoid process. Assemble the acromioclavicular joint guide handle to locate the midpoint of the lower surface of the coracoid process. An epidural needle was used to locate the anterior and posterior edges of the clavicle at a distance of about 3.5 cm from the distal end of the clavicle. The guide drill was installed with a positioning handle. A transverse incision was made along the clavicle at the sleeve of the guide drill as an H protal. The fixation system of acromioclavicular dislocation was introduced through the coracoid process and the clavicular tunnel from bottom to top through the guide wire loop, and then tightened from the upper surface of the clavicle. Prying the proximal fracture fragments to correct anteroposterior displacement, a Kirschner wire 1.5 mm in diameter was drilled passing acromion, acromioclavicular joint, proximal end and distal end of the clavicle to the cortical bone. [Results] All patients had operation performed successfully without complications, such as nerve injury and newly-occurred fracture during the operation. The Oxford Shoulder Score (OSS) significantly decreased from (52.1±2.3) before surgery to (13.7±1.9) 1 year after surgery (P＜0.001), whereas the Constant-Murley score (CMS) significantly increased from (28.5±5.7) before surgery to (92.9±2.3) one year after surgery (P＜ 0.001). All patients got fracture healed well 1 year postoperatively on imaging. [Conclusion] This arthroscopy-assisted fixation of Neer type II distal clavicular fracture through three small incisions is a feasible, and minimally invasive technique with high accuracy and less complications, achieves satisfactory primary clinical consequence.
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LIN Wang, HUANG Jia-qing, WANG Ying-ying, GUO Wei-zhong, LIN Wei-min, LIN Cheng-shou, YUAN Cui-hua
2025,33(3):269-273, DOI: 10.20184/j.cnki.Issn1005-8478.100892
Abstract:
[Objective] To investigate the clinical efficacy of anteromedial approach combined with lateral approach in surgical treatment of terrible triad of the elbow (TTE). [Methods] A retrospective study was done on 15 patients who had TTE treated surgically through anteromedial approach combined with lateral approach in our hopsital from October 2017 to October 2022. Clinical and imaging data were evaluated. [Results] All the 15 patients underwent operation smoothly, with average operation time of (218.6±70.5) min, and average intraoperative blood loss of (150.0±116.5) ml, and followed up for (15.1±4.1) months in an average. As time went preoperatively, 3 months after surgery and the last follow-up, the VAS score significantly reduced [(8.1±0.9), (1.3±0.6), (0), P＜0.001] , while the varus stress test [-/1+/2+/ 3+, (0/7/7/1), (12/3/0/0), (15/0/0/0), P＜0.001], and valgus stress test [-/1+/2+/3+, (0/1/12/2), (13/2/0/0), (15/0/0/0), P＜0.001] significantly improved. Compared with that 3 months after surgery, Mayo score [(77.7±8.2), (94.3±5.9), P＜0.001] was significantly increased at the last follow-up, whereas the elbow flexion-extension ROM and forearm rotation ROM remained unchanged (P＞0.05). Radiographically, the humeroulnar congruence [concentric/eccentric/dislocation, (1/9/5), (12/3/0), (15/0/0), P＜0.001] significantly improved 3 months after surgery and at the last follow-up compared with that preoperatively. [Conclusion] This combination, treating ulnar coronoid fractures through anteromedial approach passing between teres pronator and the flexor carpi radialis, and treating the radial head fracture through lateral approach, is safe and effective treatment for TTE.
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WEN Zuzhou, YE Yun, WU Xi-zhi, ZHOU Hua, CHEN Hong-qiang.
2025,33(3):274-277, DOI: 10.20184/j.cnki.Issn1005-8478.100772
Abstract:
[Objective] To investigate the clinical consequence of locking plate combined with titanium cable cerclage for fixation of Vancouver type B1 periprosthetic femoral fractures. [Methods] A retrospective study was done on 9 patients who had Vancouver type B1 periprosthetic femoral fractures treated by locking plate combined with titanium cable cerclage in our hospital from August 2021 to March 2023. The clinical and imaging document were evaluated. [Results] All the patients had revision performed successfully with no vascular and nerve injuries and other serious complications during the operation, whereas with the average operation time of (95.1±15.8) min, intraoperative blood loss of (622.2±272.9) ml, and hospital stay of (12.9±4.8) days, and were followed up for (15.3±5.3) months in an average. With time from that before revision, 3 months preoperatively to the latest follow-up, the VAS [(8.7±1.2), (4.8±1.1), (0.7±0.7), P＜0.001] significantly reduced, while the hip flexion-extension range of motion (ROM) [(10.3±6.0)°, (88.2±8.3)°, (111.4±6.0)°, P＜0.001], internal-external rotation ROM [(3.8±2.5)°, (20.4±4.0)°, (39.6±3.2)°, P＜0.001] and the Harris score [(21.3±7.8), (72.1±5.3), (89.3±7.7), P＜0.001] significantly increased. As for imaging, the femoral alignment [case, excellent/good/fair/poor, (0/0/2/7), (9/0/0/0), (9/0/0/0), P＜0.001] and the femoral prosthetic position [case, excellent/good/fair/poor, (0/0/1/8), (9/0/0/0), (9/0/0/0), P＜0.001] significantly improved over time. [Conclusion] The locking plate and titanium cable cerclage used for fixation of Vancouver type B1 periprosthetic femoral fractures achieve satisfactory shortterm outcomes, with the hip function of the affected limb recovered well.
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FENG Yong-qi, XUE Yuan-liang, Lü Hao, ZHENG Fang-long
2025,33(3):278-281, DOI: 10.20184/j.cnki.Issn1005-8478.100647
Abstract:
[Objective] To investigate the surgical outcomes of Tillaux fracture combined with distal fibular metaphyseal fracture in adolescent. [Methods] A retrospective study was done on 17 adolescents who received open reduction and internal fixation for the Tillaux fracture combined with distal fibular fracture from January 2016 to December 2021. The clinical and imaging documents were evaluated. [Results] All the 17 patients were successfully operated on. Compared with those before operation, the VAS score decreased [(9.2±3.6), (1.4± 0.3), P＜0.001], while Lowa score [(26.9±6.7), (94.1±4.9), P＜0.001], ankle plantar-dorsal flexion range of motion (ROM) [(41.6±5.3)°, (73.1± 7.3)°, P＜0.001] and inversion-eversion ROM [(27.4±4.4)°, (64.1±6.0)°, P＜0.001] significantly increased at the last follow-up. Radiographically, the aLDTA [(73.8±7.2)°, (93.1±4.8)°, P＜0.001], ADTA [(68.7±5.0)°, (81.1±6.8)°, P＜0.001], TFCS [(2.6±1.0) mm, (2.5±0.9) mm, P＜ 0.001], TFO [(3.0±1.1) mm, (3.2±1.1) mm, P＜0.001], TFL [(0.9±0.5) mm, (0.7±0.5) mm, P＜0.001] were improved postoperatively compared to those before surgery. Bony healing of the fractures was observed in all the patients. [Conclusion] Adolescent Tillaux fracture combined with distal fibular fracture is a rare injury. Using open reduction and internal fixation, the anatomical alignment of articular surface and epiphyseal plate can be achieved, and the stability of the distal tibiofibular syndesmosis can be restored, which can achieve good clinical consequences.
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HE Li-min, ZHAO Bin, WANG Dan-dan, YANG Po, ZHANG Yong-xiang, XU Hao
2025,33(3):282-285, DOI: 10.20184/j.cnki.Issn1005-8478.100956
Abstract:
[Objective] To investigate the clinical efficacy of dynamic hip screw (DHS) with intramedullary reinforcement pad for fixation of femoral intertrochanteric fractures in elderly. [Methods] From April 2019 to December 2022, 28 elderly patients with intertrochanteric fracture of femur were treated with DHS with intramedullary reinforcement pad. The clinical and imaging documents were evaluated. [Results] All patients had the fractures reduced and fixed successfully, with the average operation time of (60.2±8.4) min, the average incision length of (12.5±3.2) cm, the average intraoperative blood loss of (110.3±25.2) ml, the average intraoperative fluoroscopy times of (16.5±4.3) times, and the average bed rest time of (3.2±1.1) days, and were effectively followed up. As time went 1 month, 3 months after surgery and the latest follow up, the VAS score significantly decreased [(3.2±1.1), (2.6±1.2), (1.3±0.8), P＜0.001], while the Harris score [(68.6±8.5), (76.3± 4.2), (86.6±5.7), P＜0.001], flexion-extension range of motion (ROM) [(82.5±10.3)°, (101.5±9.6)°, (120.2±5.1)°, P＜0.001] and internal-external rotation ROM [(50.2±6.4)°, (61.2±5.6)°, (80.2±7.41)°, P＜0.001] increased significantly. Regarding to imaging, there were no significant changes in femoral neck shaft angle, head and neck length and tip-apex distance at the last follow-up compared with those 1 and 3 months after surgery (P＞0.05). Bone healing was observed in all patients at the last follow-up. [Conclusion] The dynamic hip screw (DHS) with intramedullary reinforcement pad enhances mechanical support of calcar femorale, facilitate early weightbearing walking, reduce the incidence of complications, and might be a good choice for osteoporotic femoral intertrochanteric fractures in the elderly.
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ZHAO Mao-sheng, SHAO Hong-bin, ZHOU Peng, LI Shen-song
2025,33(3):286-288, DOI: 10.20184/j.cnki.Issn1005-8478.100134
Abstract:
