Objective To precisely treat compl icated calcaneal fracture by 3D simulation through computer aid designed operation. Methods From November 2007 to March 2008, 38 patients of calcaneal fracture were treated. There were 29 males and 9 females aged 14-69 years old (average 29.8 years old). According to Sanders classification, there were 4 patients oftype I, 14 of type II, 12 of type III, and 8 of type IV. The time between injury and surgery was 3 hours to 5 days. The CT images of calcaneal fracture of 38 patients were put into computer for 3D reconstruction, then the Bouml;hler angles were measured and bone grafting angles were designed. According to the angle surveyed by the computer, the individual-oriented operation program was made, and then the operation was done under C-arm X-ray machine. Results The preoperative Bouml;hler angel was (34.58 ± 4.38)° in the normal side and (8.33 ± 12.62)° in the injured side, indicating there was significant difference (P lt; 0.05). During the process of the poking reduction by 3D simulation, when the bone rotating angle was (28.84 ± 6.51)°, the Bouml;hler angel was restored to (32.86 ± 1.72)°, indicating there was no significant difference when compared with the normal side before operation (P gt; 0.05), and significant difference compared with the injured side before operation (P lt; 0.05). Twenty-eight patients were followed up for 12-22 months (average 18 months). The Bouml;hler angel was restored to (32.41 ± 1.42)° 1 year after operation. According to the foot function scoring system made by American Ankle Surgery Association, 16 cases were graded as excellent, 10 as good, 1 as fair, 1 as poor, and the excellent and good rate was 92.9%. Conclusion Computer aid designed operation of compl icated calcaneal fracture by 3D simulation technique can restore the Bouml;hler angel and subtalar joint precisely. It is aneffective supplementary treatment method for calcaneal fracture.
ObjectiveTo discuss the effectiveness of Poking reduction with shoulder arthroscopy-assisted surgery for displaced scapular neck fracture. MethodsBetween January 2009 and January 2012,9 cases of displaced scapular neck fracture underwent shoulder arthroscopy-assisted surgery for Poking reduction treatment.Of 9 cases,6 were men,and 3 were women,aged 21-54 years (mean,39 years).The causes were traffic accident injury in 7 cases,falling injury from height in 1 case,and hurt injury in 1 case.The shoulder abduction,flexion,and external rotation were obviously limited.X-ray films showed all cases had obvious displaced scapular neck fracture.Three-dimensional reconstruction of CT showed a grossly displaced of fracture.The time of injury to surgery was 4-27 days (mean,11 days). ResultsPatients obtained healing of incision by first intension,without infection,neurovascular injury,or other surgery-related complications.All patients were followed up 19-31 months (mean,23 months).X-ray films showed scapular neck fractures healed from 7 to 11 weeks (mean,8 weeks).At last follow-up,the shoulder abduction,flexion,and external rotation activity were improved significantly when compared with ones at preoperation (P<0.05);the shoulder Constant score,American Shoulder and Elbow Surgenos (ASES) score,and Rowe score were significantly better than preoperative scores (P<0.05). ConclusionThe reduction of displaced scapular neck fracture is necessary,and arthroscopic Poking reduction and fixation for displaced scapular neck fracture can reconstruct the shoulder stability and reduce complications
ObjectiveTo assess the effectiveness of percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation for treating severe displaced radial neck fractures in children. MethodsBetween November 2010 and August 2014, 17 children with severe displaced radial neck fractures were treated with percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation. There were 13 boys and 4 girls with an average age of 8.7 years (range, 6-14 years). The right side was involved in 9 cases, and the left side was involved in 8 cases. The causes of injury were falling in all cases. The angular deformity at fracture was 64-102° (mean, 84°). According to the Judet classification, 7 cases were classified as grade ⅠVa and 10 cases as grade ⅠVb. The time from injury to operation was 4.2 days (range, 1-7 days). Metaizeau classification and Tibone-Stoltz elbow performance score were used to access the radiological and clinical results, respectively. ResultsThe operation time was 20-50 minutes (mean, 30 minutes). All incisions healed by first intention. The patients were followed up 12-46 months (mean, 20 months). All fractures healed at 2 months after operation. There was no complication of malunion, early epiphyseal closure, avascular necrosis, enlargement of the radial head epiphysis, cubitus varus and valgus deformities, or proximal radioulnar joint synostosis. One case had elbow extension limitation. At last follow-up, the elbow range of motion in flexion, extension, pronation, and supination showed no significant difference between affected side and normal side (P>0.05). The clinical results were excellent in 16 cases and good in 1 case, with an excellent and good rate of 100%. The angulation was 0-12° (mean, 3.7°) on the X-ray film; anatomic reduction or nearly anatomic reduction was obtained, and the radiological results were excellent in 13 cases and good in 4 cases, with an excellent and good rate of 100%. ConclusionPercutaneous Kirschner wire poking reduction followed by fixation with elastic stable intramedullary nailing is a simple, safe, minimally invasive, and effective method to treat severe displaced radial neck fractures in children.