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Wu J, Chen Y, Zhu Y, Wu X, Ren P, Cao F. Clinical efficacy of internal fixation with locking compression plates in the treatment of patients with extremity fractures and the effect on the recovery of limb function. Medicine (Baltimore) 2023; 102:e35884. [PMID: 38050232 PMCID: PMC10695631 DOI: 10.1097/md.0000000000035884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/11/2023] [Indexed: 12/06/2023] Open
Abstract
The purpose of this study was to evaluate the clinical efficacy of internal fixation with locking compression plates (LCP) in the treatment of patients with extremity fractures and the effect on the recovery of limb function. A total of 488 patients with extremity fractures admitted to our hospital from June 2019 to December 2022 were retrospectively analyzed and divided into open reduction and internal fixation (ORIF) group (n = 236) and internal fixation with LCP group (n = 252) according to the surgical procedure. Outcome indicators included intraoperative bleeding, operative time, length of hospital stay, pain duration, quality of life, healing time of the fracture, postoperative complications, and restoration of limb function as per the X-ray examination results and Johner-Wruhs criteria. Self-rating Depression Scale and Self-rating Anxiety Scale were used to evaluate the changes of patients' negative emotions before and after treatment. LCP group was associated with significantly less intraoperative bleeding and shorter operative time, length of hospital stays, and pain duration compared with ORIF group (P < .05). Compared with ORIF group, LCP group provided more rapid fracture healing in tibial fractures, ulnar fractures, radial fractures, and external ankle fractures (P < .05). Compared with the ORIF group, patients in the LCP group showed better quality of life in terms of physical, psychological and social functions after surgery (P < .05). The incidence of postoperative complications in the LCP group was significantly lower than that in the ORIF group (19.92% vs 7.14%, P < .001). The Self-rating Depression Scale and Self-rating Anxiety Scale scores of the LCP group were lower than those of the ORIF group (P < .05). The recovery of limb function was significantly better in the LCP group than in the ORIF group (97.22% vs 85.17%, P < .001). The overall satisfaction rate of treatment in the LCP group was higher than that in the ORIF group (92.06% vs 81.90%, P < .001). Internal fixation with LCP in patients with extremity fractures can effectively promote the recovery of limb function, reduce the incidence of complications and improve the quality of life of patients.
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Affiliation(s)
- Jun Wu
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Yang Chen
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Yin Zhu
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Xiaodong Wu
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Pengpeng Ren
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Feng Cao
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
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Xu K, Wang G, Lu L, Ding C, Ding Y, Chang X, Tong D, Ji F, Zhang H. Intramedullary nail fixation assisted by locking plate for complex subtrochanteric femur fractures: A retrospective study. J Orthop Sci 2023; 28:1105-1112. [PMID: 35864029 DOI: 10.1016/j.jos.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/02/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aims to compare therapeutic effects of two methods in complicated subtrochanteric femur fractures surgery: intramedullary nail fixation assisted with lateral monocortical locking plate versus intramedullary nail fixation assisted with supplementary cables. METHODS From June 2015 to June 2020, seventy-seven patients with complex subtrochanteric fractures (i.e., Seinsheimer's classification type IV or V) were included in this study. Thirty-six patients (plate group) were operated using the intramedullary nail fixation assisted by lateral monocortical locking plate, and forty-one patients (cable group) were using the intramedullary nail fixation assisted by cables. The clinical information and demographic results were collected and compared. RESULTS Operation time of plate group was shorter than cable group and the Incisions length of plate group was longer. The fluoroscopy times were 22.8 ± 8.2 in plate group and 33.0 ± 9.0 in cable group (p < 0.01). Compared with the cable group, patients in plate group used less cerclage cables (p < 0.01). Patients in the plate group has less medial cortex displacement compared with the cable group. (p = 0.038). As for the angular difference of neck shaft angle between operated hip and uninjured hip, plate group has less difference compared with the cable group. Time to union was 14.2 ± 3.1 weeks in plate group which is shorter than the cable group (17.9 ± 4.8 weeks). In terms of follow up period, number of malunion, Harris hip score, walking ability and traumatic hip rating scale, no significant differences were detected. CONCLUSIONS Our results suggest that using lateral monocortical plate as an auxiliary way may have a longer surgical incision and more intraoperative blood loss, however, the operation time is shorter, the fluoroscopy times is less, and the time to union is shorter. Intramedullary nail fixation assisted by lateral monocortical locking plate may be a new option for patients with complex subtrochanteric femur fractures.
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Affiliation(s)
- Kaihang Xu
- Department of Orthopedics, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China; Hospital Affiliated to 71217, Yantai, China
| | - Guangchao Wang
- Department of Orthopedics, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China
| | - Lingyu Lu
- Faculty of Anesthesiology, Changhai Hospital Affiliated to the Navy Military Medical University, Shanghai, China
| | - Chen Ding
- Department of Orthopedics, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China
| | - Yun Ding
- Department of Orthopedics, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China
| | - Xinyu Chang
- Department of Orthopedics, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China
| | - Dake Tong
- Department of Orthopaedics, Shanghai Ninth People's Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Fang Ji
- Department of Orthopaedics, Shanghai Ninth People's Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Hao Zhang
- Department of Orthopedics, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, China.
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Sabacinski K, Booth M, Bramer M. Managing Osteopetrosis in the Complex Polytrauma Orthopedic Patient. Cureus 2022; 14:e21886. [PMID: 35265418 PMCID: PMC8898095 DOI: 10.7759/cureus.21886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/12/2022] Open
Abstract
Osteopetrosis is a genetic illness defined by defective osteoclasts that are incapable of absorbing adequate amounts of bone. This exceedingly rare disorder has been linked to multiple genetic mutations that have a direct impact on osteoclast function. Osteopetrosis causes bones to become brittle with large amounts of cortical bone formation making patients susceptible to pathologic fractures, pancytopenia, and cranial neuropathies among other sequelae. Known as the “marble bone disease,” this condition can range from as severe as causing death in newborn infants to as mild as an incidental finding of increased cortical thickening in a trauma patient. This case demonstrates an incidental finding of osteopetrosis in a trauma patient who suffered from significant injuries as a result of a high-velocity trauma. The patient was the pedestrian in a car vs pedestrian accident and suffered from a central cord syndrome in his cervical spine, a right humerus fracture, a left subtrochanteric femur fracture, a right tibia fracture, and a right fibula fracture. This case report illustrates the complexity of dealing with a polytrauma patient with osteopetrosis and reviews the literature on the approach to fracture fixation in osteopetrotic individuals. This paper will also discuss current medication recommendations and the current standard of care for optimizing patients with osteopetrosis as well as genetic counseling.
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Tu Y, Liu F, Jia H, Yang J, Lv X, Li C, Wu J, Wang F, Yang Y, Wang B. The Treatment of Subtrochanteric Fracture with Reversed Contralateral Distal Femoral Locking Compression Plate (DF-LCP) Using a Progressive and Intermittent Drilling Procedure in Three Osteopetrosis Patients. Orthop Surg 2022; 14:254-263. [PMID: 34914206 PMCID: PMC8867429 DOI: 10.1111/os.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To describe the application of reversed contralateral distal femoral locking compression plate (DF-LCP) inserted through a progressive and intermittent drilling procedure in the treatment of osteopetrotic subtrochanteric fracture (OSF). METHODS Three patients (one male and two females with an average age of 45.33 ± 11.09 years) with OSF hospitalized between September 2015 and September 2020, were included in this present study. Lateral approach was applied in all patients who accepted open reduction and internal fixation (ORIF) with a reversed contralateral DF-LCP inserted through a progressive and intermittent drilling procedure. The operation time and intraoperative blood loss were recorded to evaluate the efficiency of this surgical method. Physical examination and imaging examination of the fracture site were used to evaluate the fracture union status, the position and stability of the implant, and the alignment of the injured limb at 1, 3, 6, and 12 months after operation, then a subsequent visit was conducted at least once a year. Harris Hip Score (HHS) was used to evaluate the hip joint function at 6 and 12 months after operation. RESULTS The average operation time was 140 ± 21.60 min (110, 160, and 150 min); The average intraoperative blood loss was about 333.33 ± 23.57 ml (300, 350, and 350 ml). The average follow-up time was 22.33 ± 7.41 months (29, 26, and 12 months). All patients achieved bone union with an average time of 6.67 ± 0.94 months (6, 8, and 6 months). At the time of 6 months after operation, case 1 and 3 were almost pain-free and could walk with full weight bearing while case 2 could walk only with partial weight bearing using a crutch. The HHS scores of cases 1, 2, and 3 were 84/100, 74/100, and 92/100, respectively. At the follow-up at 12 months after operation, the HHS score improved to 91/100, 81/100, and 96/100, respectively. The contralateral incomplete old subtrochanteric fracture was deteriorated in case 1 at 26 months after operation. After 3 months of limited weight bearing using a crutch, bone union was verified in radiograph imaging. Fresh contralateral subtrochanteric fracture occurred in case 2 at 26 months after operation, which was treated using a similar surgical approach, and its clinical outcome is under follow-up. Moreover, no perioperative complications including operation-related death, vascular/nerve injury, deep venous thrombosis, pulmonary embolism, and incision infection, and long-term complications involving malunion, nonunion, implant failure, ankylosis, heterotopic ossification, osteonecrosis, and osteomyelitis were identified. CONCLUSION The application of reversed contralateral DF-LCP in OSF is practicable and reliable. Progressive and intermittent drilling is a safe and efficient method for implant insertion in this complicated situation.
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Affiliation(s)
- Yi Tu
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong UniversityJinanChina
| | - Fan‐xiao Liu
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong UniversityJinanChina
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong First Medical UniversityJinanChina
| | - Hong‐lei Jia
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong UniversityJinanChina
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong First Medical UniversityJinanChina
| | - Juan‐juan Yang
- Department of RadiotherapyShandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Xiao‐long Lv
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong UniversityJinanChina
| | - Chao Li
- Department of Anesthesia SurgeryShandong Provincial Hospital affiliated to Shandong First Medical UniversityJinanChina
| | - Jun‐wei Wu
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong UniversityJinanChina
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong First Medical UniversityJinanChina
| | - Fu Wang
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong UniversityJinanChina
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong First Medical UniversityJinanChina
| | - Yong‐liang Yang
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong UniversityJinanChina
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong First Medical UniversityJinanChina
| | - Bo‐min Wang
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong UniversityJinanChina
- Department of OrthopaedicsShandong Provincial Hospital affiliated to Shandong First Medical UniversityJinanChina
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Liu D, Liu HZ, Ma ML, Zhou N, Wang H. The Clinical Efficacy of Minimally Invasive Clamp-Assisted Reduction and Open Reduction with Wire Cerclage for Unstable Subtrochanteric Fractures. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5340504. [PMID: 35126929 PMCID: PMC8808220 DOI: 10.1155/2022/5340504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to compare the clinical effectiveness of minimally invasive clamp-assisted reduction and open reduction with wire cerclage and intramedullary nails for unstable subtrochanteric fractures. Between January 2016 and October 2019, 68 patients who had unstable subtrochanteric fractures experienced intramedullary nail surgery in this retrospective study. There were 41 cases in the minimally invasive clamp or closed reduction group (group A) and 27 cases in the open reduction with wire cerclage group (group B). There were 3 cases of complications in group A and 2 cases of complications in group B. Remarkable distinction was observed between the two groups in the operation time (p < 0.05), quality of reduction (p < 0.05), and union time (p < 0.05). For the successful surgical treatment of unstable femoral subtrochanteric fractures, an anatomical reduction is crucial. Reduction and wire cerclage are cut to give medial support for the anatomical reduction, which has a positive effect on fracture healing.
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Affiliation(s)
- Dong Liu
- Department of Orthopedics Trauma, Binzhou Medical University Hospital, Binzhou, Shandong, China
- Department of Trauma Center, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Hong-zhi Liu
- Department of Orthopedics Trauma, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Ming-liang Ma
- Department of Orthopedics Trauma, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Nan Zhou
- Department of Orthopedics Trauma, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Hui Wang
- Department of Orthopedics Trauma, Binzhou Medical University Hospital, Binzhou, Shandong, China
- Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Hua X, Liu Z, Wang X. Subtrochanteric Femoral Fracture in a Patient with Osteopetrosis: Treated with Internal Fixation and Complicated by Intraoperative Femoral Neck Fracture. Int J Gen Med 2020; 13:1551-1557. [PMID: 33364816 PMCID: PMC7751704 DOI: 10.2147/ijgm.s289265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/04/2020] [Indexed: 12/21/2022] Open
Abstract
Objective Osteopetrosis (OP) is a rare, heritable skeletal disorder that is caused by osteoclast dysfunction, leading to failure of bone resorption and increased bone density. The fragility of such dense bone may result in an increased incidence of fractures. Furthermore, surgery in patients with OP is associated with increased technical difficulty and a higher risk of complications. Case Report We report a case of a 20-year-old woman with autosomal dominant OP who developed a subtrochanteric femoral fracture. The fracture was treated by open reduction and internal fixation using a dynamic hip screw. Although technical difficulties were experienced and an intraoperative femoral neck fracture occurred, the surgical outcome was satisfactory. Union of the fractures was visible on radiographs obtained 12 months postoperatively. At 2 years postoperatively, the patient was completely free of any complications resulting from her injury and treatment. Conclusion Open reduction and internal fixation may be an effective option for fractures in patients with OP. Orthopedic surgeons should be aware that the increased density and stiffness of osteopetrotic bone increases the risks of intraoperative technical difficulties, iatrogenic fractures, and postoperative complications.
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Affiliation(s)
- Xing Hua
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
| | - Zhenyu Liu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
| | - Xinjia Wang
- Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
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Yiğit Ş, Arslan H, Akar MS, Şahin MA. Mid-term outcomes of surgical treatment in fractures in patients with osteopetrosis. Bone Joint J 2020; 102-B:1082-1087. [PMID: 32731834 DOI: 10.1302/0301-620x.102b8.bjj-2020-0431.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS Osteopetrosis (OP) is a rare hereditary disease that causes reduced bone resorption and increased bone density as a result of osteoclastic function defect. Our aim is to review the difficulties, mid-term follow-up results, and literature encountered during the treatment of OP. METHODS This is a retrospective and observational study containing data from nine patients with a mean age of 14.1 years (9 to 25; three female, six male) with OP who were treated in our hospital between April 2008 and October 2018 with 20 surgical procedures due to 17 different fractures. Patient data included age, sex, operating time, length of stay, genetic type of the disease, previous surgery, fractures, complications, and comorbidity. RESULTS The mean follow-up period was 92.5 months (25 to 140). Bony union was observed in all of our patients. Osteomyelitis developed in two patients with femoral shaft fractures, and two patients had peri-implant stress fractures. CONCLUSION Treatment of fractures in OP patients is difficult, healing is protracted, and the risk of postoperative infection is high. In children and young adults with OP who have open medullary canal and the epiphyses are not closed, fractures can be treated with surgical techniques such as intramedullary titanium elastic nail (TENS) technique or fixation with Kirschner (K)-wire. Cite this article: Bone Joint J 2020;102-B(8):1082-1087.
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Affiliation(s)
- Şeyhmus Yiğit
- Department of Orthopaedic Surgery, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Hüseyin Arslan
- Department of Orthopaedic Surgery, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Mehmet S Akar
- Department of Orthopaedic Surgery, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Mehmet A Şahin
- Department of Orthopaedic Surgery, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
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