目的通过Meta分析系统评价闭合复位弹性髓内钉固定术与切开复位克氏针固定术对于儿童桡骨颈骨折的临床疗效。方法检索相关数据库，收集包括两种术式在内的治疗儿童桡骨颈骨折的对照试验，提取数据，进行质量评价，并通过Rev Man 5.3软...目的通过Meta分析系统评价闭合复位弹性髓内钉固定术与切开复位克氏针固定术对于儿童桡骨颈骨折的临床疗效。方法检索相关数据库，收集包括两种术式在内的治疗儿童桡骨颈骨折的对照试验，提取数据，进行质量评价，并通过Rev Man 5.3软件进行系统评价，比较两组术后骨折断端复位情况、术后肘关节功能恢复情况、总的并发症发生情况、去除固定后骨折再移位、皮肤激惹症状、桡神经损伤、桡骨头骨骺早闭等结局指标。结果本次Meta分析共纳入9篇文献。结果表明，对于儿童桡骨颈骨折，闭合复位组与切开复位组在术后骨折断端复位情况方面差异无统计学意义[RR＝0.98，95%CI（0.86，1.11），P＝0.72]；在总的并发症发生情况方面差异无统计学意义[RR＝0.61，95%CI（0.24，1.60），P＝0.32]；在皮肤激惹症状方面差异无统计学意义[RR＝0.08，95%CI（0.00，1.40），P〈0.08]；在桡神经损伤方面差异无统计学意义[RR＝1.22，95%CI（0.13，11.20），P〈0.86]；在桡骨头骨骺早闭方面差异无统计学意义[RR＝0.20，95%CI（0.02，1.64），P＝0.13]；在去除固定后骨折再移位方面，由于原始文献较少，该指标暂无可比性，尚需更多临床研究得出结论。在术后肘关节功能恢复方面，闭合复位组占有较大优势，差异有统计学意义[RR＝0.28，95%CI（0.16，0.52），P〈0.000 1]。结论闭合复位弹性髓内钉固定治疗儿童桡骨颈骨折术后疗效优于切开复位克氏针固定，在并发症的预防方面并无明显优势。但仍需要更多大样本、双盲、高质量的随机对照研究加以论证。展开更多
Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of...Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures.Plating is fraught with complications of wound dehiscence and infection.There are limited studies which document outcomes in such cases using intramedullary interlocking nail.We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India.There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study.Only cases with fresh injury (less than 1 week),fracture below the isthmus,closed and open Gustilo Anderson type 1 and 2 fractures were included in the study.Patients were reviewed at 3,6,12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing,any complications,time to union and functional outcome.Results:There were 102 males and 45 females (male/female ratio is 2.3∶1) with a mean age of 38.96 (range 23-65) years.According to AO classification,there were 78 cases (53.06%) of 43-A1,39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%.The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks),none of the patient in our series had a delayed or non-union.Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°).The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score,there were no cases with poor score.Conclusion:Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome.Wound complications rel展开更多
AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures ...AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn's scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion(ROM), functional status, complications, and parent's satisfaction.RESULTS Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery(hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn's scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent's satisfaction level of 9.1/10.CONCLUSION TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.展开更多
Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is...Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd<展开更多
Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic ...Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic aspects of PSA of the diaphysis of long bones. Method: This retrospective work concerns 30 cases of non-union of the diaphysis of long bones treated in the orthopedic and trauma surgery department at Donka National Hospital, during a period of 18 months from January 1, 2019 to June 30, 2020. Results: We recruited 30 patients, 80% of whom were male, with an average age of 39.9 years. Public road accidents (AVP) represented the main cause of fractures of the diaphysis of long bones 87%, they were open in 25 cases or 83%. The fractures were located in the middle 1/3 of the diaphysis of the long bones in 50% of cases. Treatment of initial fractures was traditional in 21 cases, orthopedic in 2 cases and surgical in 7 cases. It was aseptic nonunion in 28 cases (93%) and septic nonunion in 2 cases. They were hypertrophic in 7 cases, slightly hypertrophic in 5 cases, oligotrophic in 11 cases, atrophic in 6 cases and with bone defect in 1 case. The treatment was based on osteosynthesis including 16 cases of screwed “PV” plate: 7 cases of centromedullary “ECM” nailing, 2 cases of external fixator, 1 case of broaching and 4 cases of Plastering. The results according to ASAMI criteria on an anatomical level were excellent in 19 cases, good in 3 cases and poor in 3 cases, with a union rate of 76%. And 5 patients undergoing consolidation. Conclusion: Based on the literature data and the experience of our department, the true treatment of PSA requires correct management of the initial fracture without forgetting the interest in preventing AVP which appears to be an element essential, making it possible to reduce the incidence of fractures of the diaphysis.展开更多
AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients an...AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients and 131 dynamization patients were identified and analyzed. The following key words were inputted in different combinations in order to search the field of publications in its entirety: "nonunion", "delayed union", "ununited", "femur fracture", "femoral fracture", "exchange nailing", "dynaiz(s)ation", "secondary nailing", "dynamic", "static", and "nail revision". The initial search yielded over 150 results, and was refined based on the inclusion criteria: Only studies reporting on humans, non-unions and delayed unions, and the usage of exchange nailing and/or dynamization as a secondary treatment after failed IM nailing. The resulting 66 articles were obtained through online journal access. The results were filtered further based on the exclusion criteria: No articles that failed to report overall union rates, differentiate between success rates of their reported techniques, or articles that analyzed less than 5 patients. RESULTS Exchange nailing lead to fracture union in 84.785% of patients compared to the 66.412% of dynamization with statistically comparable durations until union(5.193 ± 2.310 mo and 4.769 ± 1.986 mo respectively). Dynamically locking exchange nails resulted in an average union time of 5.208 ± 2.475 mo compared to 5.149 ± 2.366 mo(P = 0.8682) in statically locked exchange nails. The overall union rate of the two procedures, statically and dynamically locked exchange nailing yielded union rates of 84.259% and 82.381% respectively. Therefore, there was no significant difference between the different locking methods of exchange nailing for union rate or time to union at a significance value of P < 0.05. The analysis showed exchange nailing to be the more successful choice in the treatment of femoral non-unions in respect to its higher success rate(491/567 EN, 24/57 dynam, P < 0.0001展开更多
Reinforcement of slopes using soil nailing can effectively improve slope stability, and it has been widely used in upgrading cut slopes. Based on the assumptions of stresses on the slip surface, a new method for analy...Reinforcement of slopes using soil nailing can effectively improve slope stability, and it has been widely used in upgrading cut slopes. Based on the assumptions of stresses on the slip surface, a new method for analyzing the stability of a slope reinforced with soil nails was established in the limit equilibrium theory framework, by considering that slope sliding occurs owing to shear failure of the slip surface, which subjects to Mohr–Coulomb(M–C) strength criterion. Meanwhile, in order to easily analyze the stability of a soil nailed slope in actual engineering and facilitate optimum design of parameters for soil nailing, factor of safety(FOS) contour curve charts were drawn on the basis of the established linear proportional relationship between the spacing of soil nails and slope height, and the length of soil nails and slope height. Then, by analyzing and verifying the results obtained from classic examples, some conclusions can be got as follows: 1) The results obtained from the current method are close to those obtained from the traditional limit equilibrium methods, and the current method can provide a strict solution for the slope FOS as it satisfies all the static equilibrium conditions of a sliding body, thus confirming the feasibility of the current method; 2) The slope FOS contour curve charts can be used not only to reliably analyze the stability of a soil nailed slope, but also to design optimally the parameters of soil nailing for the slope with a certain safety requirement.展开更多
An attempt has been made to study the behavior of nailed vertical excavations in medium dense to dense cohesionless soil under seismic conditions using a pseudo-dynamic approach. The effect of several parameters such ...An attempt has been made to study the behavior of nailed vertical excavations in medium dense to dense cohesionless soil under seismic conditions using a pseudo-dynamic approach. The effect of several parameters such as angle of internal friction of soil （φ）, horizontal （kh） and vertical （kv） earthquake acceleration coefficients, amplification factor （fa）, length of nails （L）, angle of nail inclination （a） and vertical spacing of nails （S） on the stability of nailed vertical excavations has been explored. The limit equilibrium method along with a planar failure surface is used to derive the formulation involved with the pseudo-dynamic approach, considering axial pullout of the installed nails. A comparison of the pseudo-static and pseudo-dynamic approaches has been established in order to explore the effectiveness of the pseudo-dynamic approach over pseudo-static analysis, since most of the seismic stability studies on nailed vertical excavations are based on the latter. The results are expressed in terms of the global factor of safety （FOS）. Seismic stability, i.e., the FOS of nailed vertical excavations is found to decrease with increase in the horizontal and vertical earthquake forces. The present values of FOS are compared with those available in the literature.展开更多
Introduction: Adult bone tumors may be primary or secondary. Their diagnosis is often based on the results of imaging tests but can also be completed by biopsy. Case Presentation: We report the observation of a clinic...Introduction: Adult bone tumors may be primary or secondary. Their diagnosis is often based on the results of imaging tests but can also be completed by biopsy. Case Presentation: We report the observation of a clinical case of fortuitous discovery in the orthopaedic-traumatology department of the national hospital Amirou Boubacar Diallo of Niamey, pathological fracture of the right humeral shaft secondary to metastasis of clear-cell adenocarcinoma of renal origin, a 57-year-old man, a refrigeration engineer by profession, from Niger living in the Middle East. This patient has no known pathological history. He consulted us for pain in his right arm that was more severe at night. All imaging and pathology examinations carried out both in Niger and in the Middle East confirmed the diagnosis of humeral metastasis of clear-cell renal cell carcinoma. Surgical management consisted of tumor resection and Kuntscher-type centromedullary alignment nailing of the fracture site. The loss of bone substance in the fracture is filled with acrylic cement. The treatment was completed by chemotherapy. Conclusion: Bone tumours are most often secondary in location. However, the diagnosis must be sought in the presence of any clinical sign.展开更多
The pull-out capacities for soil nailing systems comprising of one single 29 mm diameter(type A) and four 16 mm diameter(type B) rebars with grouted cement were examined.A field test and numerical analysis for the typ...The pull-out capacities for soil nailing systems comprising of one single 29 mm diameter(type A) and four 16 mm diameter(type B) rebars with grouted cement were examined.A field test and numerical analysis for the type A and type B systems were carried out to investigate the pull-out capacities and the slope stability reinforcement efficiency in soil and rock slopes.The results of the pull-out tests show the mobilized shear force and load transfer characteristics with respect to soil depth.The load-displacement relationship was examined for both type A and type B systems.Slope stability analyses were carried out to study the relationships between soil and nail reinforcement and bending stiffness as well as combined axial tension and shear forces.Factors of safety were calculated in relation to the number of nails and their outside diameters.Both soil and rock slopes were included in this evaluation.展开更多
Purpose:Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage.There is considerable controversy regarding the superior o...Purpose:Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage.There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis(MIPPO)technique and intramedullary interlocking(IMIL)nailing for extra-articular distal tibia fractures.The aim of our study is to compare the functional outcome between the two treatment methods.Methods:This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups.The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing.Patients were followed up in outpatient department to assess the functional outcomes,malunion,delayed union,nonunion,superficial and deep infection between the two groups.Statistical analyses were performed using the SPSS software(version 16.0).Results:Average malunion(degrees)in the MIPPO group was 5(3—7)±1.41 vs.10.22(8—14)±2.04 in the IMIL group(p=0.001).Similarly postoperative knee pain in the IMIL group was 10%vs.2%in the MIPPO group(p=0.001).In terms of superficial infection and nonunion,the results were 8%vs.4%and 2%vs.6%for the MIPPO and IMIL group,respectively(p=0.001).Conclusion:Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue,bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing.Considering the results of the study,we have slightly more preference for the MIPPO technique.展开更多
Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral...Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral nailing surgery performed for reverse obliquity intertrochanteric fractures using two proximal lag screws and a nail of 250 mm. There is prospective study of fifty three patients with AO/OTA 31 A-A3 fractures being treated by proximal femoral nailing in our institute after seeking approval from the Hospital ethics board. The quality of the reduction, the operative time, complications and the functional status of the patients were the parameters on which the results were evaluated. The mean Harris hip score was 76.66 (range 70 - 93) and the mean Barthel activity score was 16.21 (range 12 - 20). The average surgical time was 50 minutes and the mean consolidation time was 11.5 weeks. Intramedullary nailing with proximal femoral nails seems to be a good option in the treatment of reverse obliquity intertrochanteric fractures as against the various existing options available for the management.展开更多
Background: Proximal femoral nailing in communited intertrochanteric fractures is increasingly becoming popular in view of superior biomechanics and prevention of varus collapse associated with Dynamic hip screw. Howe...Background: Proximal femoral nailing in communited intertrochanteric fractures is increasingly becoming popular in view of superior biomechanics and prevention of varus collapse associated with Dynamic hip screw. However, technical difficulties and implant related complications have been described with this technique, thus we need more studies to address these issues. Our study aims to understand technical difficulties involved in proximal femoral nailing, and specifically analyses neck shaft angle at follow-up indicating varus collapse and also to compare results of stable and unstable fractures. Materials and Methods: In this study, patients who presented to the Orthopedic Unit of Dr. TMA Pai Hospital (An associated hospital of Manipal University, Manipal) with trochanteric fractures included and treated with proximal femoral nailing. The technical difficulties involved with surgical procedure and techniques adapted to overcome such difficulties were recorded. All patients were followed up for a period of 2 years and final outcome assessment included the number of shortening, neck shaft angle and harris hip score. Results: 41 patients (mean age 71) who underwent proximal femoral nailing from January 2004 to December 2009 were included in the study, 38 patients completed 2-year follow-up. The technical difficulties we faced were divided into 3 categories, difficulties in securing entry point and guide wire placement especially when greater trochanter and piriform fossa were gathered, reduction was lost while passing nail, and finally difficulties faced during placement of hip screws. In all except one, neck shaft angle of more than 130 degrees was achieved, and this was also maintained in the final follow-up (Mean 131.9 degrees). All fractures were united, with mean shortening of 2 mm. Conclusions: Although PFN is technically required, with a proper technique PFN gives excellent clinical results with almost negligible varus collapse even in unstable trochanteric fractures. Regarding the techniques, reaming the p展开更多
Retaining walls have been used in many construction projects such as for road and inclined surfaces protection. The damage caused by an earthquake depends on the fundamental frequency, amplitude and the duration of th...Retaining walls have been used in many construction projects such as for road and inclined surfaces protection. The damage caused by an earthquake depends on the fundamental frequency, amplitude and the duration of the seismic motion. These parameters strongly depend on the seismic properties of the layers that are near the surface. In the study of retaining walls, in addition to the infl uence of soil, the infl uence of topography is also important. In the present study, site response analysis is performed by using fi nite element software PLAXIS to obtain the eff ect of various factors such as embedded length of the sheet pile, underground water table, length and angle of the nail, shear wave velocity of soil on site eff ect and dynamic response. Moreover, for better understanding of the eff ect of the above parameters, the stability analysis was performed by using shear reduction method. The results show that an increase in the embedded length of the sheet pile and the length of nailing causes an increase in the amplifi cation factor. Moreover, for shear-wave velocity in the range of 200- 600 m/s, the amplifi cation factor increases with increase of the shear-wave velocity due to the decrease of nonlinear behavior.展开更多
The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device. Methods： Seven...The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device. Methods： Seventy-nine patients with extra capsular hip fractures treated with cephalo-medullary nailing were included in the study. Age, sex, ASA grade, timing of surgery, preoperative and postoperative haemoglobin, length of hospital stay, fracture type, number of units transfused and 30-day mortality were recorded. Results： The mean age was 82.3 years. Forty-seven patients underwent a short nail and 32 patients a long nail; 53.4% patients required blood transfusion postoperatively. Transfusion was required in 71,8% of the long nails （p 〈 0.05）, 65.8% patients above the age of 80 （p 〈 0.05）, 100% of the patients with hemoglobin below 90 g/L and 20 patients with a ASA grade of 3 （p 〈 0.05）. 78.5% patients with A2 fracture and 75% of A3 fractures needed blood transfusion （p 〉 0.05）. Length of hospital stay in non-transfusion group was 13 days and in transfusion group was 19 days （p 〈 0.05）. 55.1% operated within 36 h and 47,B% operated after 3B h of admission needed transfusion （p 〉 0.05）. Thirty-day mortality in patients needing blood transfusion was 5% and in non-transfusion group was 3.7% （p 〉 0.05）, Conclusion： Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy.展开更多
文摘目的通过Meta分析系统评价闭合复位弹性髓内钉固定术与切开复位克氏针固定术对于儿童桡骨颈骨折的临床疗效。方法检索相关数据库，收集包括两种术式在内的治疗儿童桡骨颈骨折的对照试验，提取数据，进行质量评价，并通过Rev Man 5.3软件进行系统评价，比较两组术后骨折断端复位情况、术后肘关节功能恢复情况、总的并发症发生情况、去除固定后骨折再移位、皮肤激惹症状、桡神经损伤、桡骨头骨骺早闭等结局指标。结果本次Meta分析共纳入9篇文献。结果表明，对于儿童桡骨颈骨折，闭合复位组与切开复位组在术后骨折断端复位情况方面差异无统计学意义[RR＝0.98，95%CI（0.86，1.11），P＝0.72]；在总的并发症发生情况方面差异无统计学意义[RR＝0.61，95%CI（0.24，1.60），P＝0.32]；在皮肤激惹症状方面差异无统计学意义[RR＝0.08，95%CI（0.00，1.40），P〈0.08]；在桡神经损伤方面差异无统计学意义[RR＝1.22，95%CI（0.13，11.20），P〈0.86]；在桡骨头骨骺早闭方面差异无统计学意义[RR＝0.20，95%CI（0.02，1.64），P＝0.13]；在去除固定后骨折再移位方面，由于原始文献较少，该指标暂无可比性，尚需更多临床研究得出结论。在术后肘关节功能恢复方面，闭合复位组占有较大优势，差异有统计学意义[RR＝0.28，95%CI（0.16，0.52），P〈0.000 1]。结论闭合复位弹性髓内钉固定治疗儿童桡骨颈骨折术后疗效优于切开复位克氏针固定，在并发症的预防方面并无明显优势。但仍需要更多大样本、双盲、高质量的随机对照研究加以论证。
文摘Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures.Plating is fraught with complications of wound dehiscence and infection.There are limited studies which document outcomes in such cases using intramedullary interlocking nail.We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India.There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study.Only cases with fresh injury (less than 1 week),fracture below the isthmus,closed and open Gustilo Anderson type 1 and 2 fractures were included in the study.Patients were reviewed at 3,6,12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing,any complications,time to union and functional outcome.Results:There were 102 males and 45 females (male/female ratio is 2.3∶1) with a mean age of 38.96 (range 23-65) years.According to AO classification,there were 78 cases (53.06%) of 43-A1,39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%.The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks),none of the patient in our series had a delayed or non-union.Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°).The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score,there were no cases with poor score.Conclusion:Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome.Wound complications rel
文摘AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn's scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion(ROM), functional status, complications, and parent's satisfaction.RESULTS Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery(hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn's scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent's satisfaction level of 9.1/10.CONCLUSION TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.
文摘Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd<
文摘Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic aspects of PSA of the diaphysis of long bones. Method: This retrospective work concerns 30 cases of non-union of the diaphysis of long bones treated in the orthopedic and trauma surgery department at Donka National Hospital, during a period of 18 months from January 1, 2019 to June 30, 2020. Results: We recruited 30 patients, 80% of whom were male, with an average age of 39.9 years. Public road accidents (AVP) represented the main cause of fractures of the diaphysis of long bones 87%, they were open in 25 cases or 83%. The fractures were located in the middle 1/3 of the diaphysis of the long bones in 50% of cases. Treatment of initial fractures was traditional in 21 cases, orthopedic in 2 cases and surgical in 7 cases. It was aseptic nonunion in 28 cases (93%) and septic nonunion in 2 cases. They were hypertrophic in 7 cases, slightly hypertrophic in 5 cases, oligotrophic in 11 cases, atrophic in 6 cases and with bone defect in 1 case. The treatment was based on osteosynthesis including 16 cases of screwed “PV” plate: 7 cases of centromedullary “ECM” nailing, 2 cases of external fixator, 1 case of broaching and 4 cases of Plastering. The results according to ASAMI criteria on an anatomical level were excellent in 19 cases, good in 3 cases and poor in 3 cases, with a union rate of 76%. And 5 patients undergoing consolidation. Conclusion: Based on the literature data and the experience of our department, the true treatment of PSA requires correct management of the initial fracture without forgetting the interest in preventing AVP which appears to be an element essential, making it possible to reduce the incidence of fractures of the diaphysis.
文摘AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients and 131 dynamization patients were identified and analyzed. The following key words were inputted in different combinations in order to search the field of publications in its entirety: "nonunion", "delayed union", "ununited", "femur fracture", "femoral fracture", "exchange nailing", "dynaiz(s)ation", "secondary nailing", "dynamic", "static", and "nail revision". The initial search yielded over 150 results, and was refined based on the inclusion criteria: Only studies reporting on humans, non-unions and delayed unions, and the usage of exchange nailing and/or dynamization as a secondary treatment after failed IM nailing. The resulting 66 articles were obtained through online journal access. The results were filtered further based on the exclusion criteria: No articles that failed to report overall union rates, differentiate between success rates of their reported techniques, or articles that analyzed less than 5 patients. RESULTS Exchange nailing lead to fracture union in 84.785% of patients compared to the 66.412% of dynamization with statistically comparable durations until union(5.193 ± 2.310 mo and 4.769 ± 1.986 mo respectively). Dynamically locking exchange nails resulted in an average union time of 5.208 ± 2.475 mo compared to 5.149 ± 2.366 mo(P = 0.8682) in statically locked exchange nails. The overall union rate of the two procedures, statically and dynamically locked exchange nailing yielded union rates of 84.259% and 82.381% respectively. Therefore, there was no significant difference between the different locking methods of exchange nailing for union rate or time to union at a significance value of P < 0.05. The analysis showed exchange nailing to be the more successful choice in the treatment of femoral non-unions in respect to its higher success rate(491/567 EN, 24/57 dynam, P < 0.0001
基金Project(2015M580702)supported by the Postdoctoral Science Foundation of ChinaProject(51608541)supported by the National Natural Science Foundation of ChinaProject(2014122066)supported by the Guizhou Provincial Department of Transportation Foundation,China
文摘Reinforcement of slopes using soil nailing can effectively improve slope stability, and it has been widely used in upgrading cut slopes. Based on the assumptions of stresses on the slip surface, a new method for analyzing the stability of a slope reinforced with soil nails was established in the limit equilibrium theory framework, by considering that slope sliding occurs owing to shear failure of the slip surface, which subjects to Mohr–Coulomb(M–C) strength criterion. Meanwhile, in order to easily analyze the stability of a soil nailed slope in actual engineering and facilitate optimum design of parameters for soil nailing, factor of safety(FOS) contour curve charts were drawn on the basis of the established linear proportional relationship between the spacing of soil nails and slope height, and the length of soil nails and slope height. Then, by analyzing and verifying the results obtained from classic examples, some conclusions can be got as follows: 1) The results obtained from the current method are close to those obtained from the traditional limit equilibrium methods, and the current method can provide a strict solution for the slope FOS as it satisfies all the static equilibrium conditions of a sliding body, thus confirming the feasibility of the current method; 2) The slope FOS contour curve charts can be used not only to reliably analyze the stability of a soil nailed slope, but also to design optimally the parameters of soil nailing for the slope with a certain safety requirement.
文摘An attempt has been made to study the behavior of nailed vertical excavations in medium dense to dense cohesionless soil under seismic conditions using a pseudo-dynamic approach. The effect of several parameters such as angle of internal friction of soil （φ）, horizontal （kh） and vertical （kv） earthquake acceleration coefficients, amplification factor （fa）, length of nails （L）, angle of nail inclination （a） and vertical spacing of nails （S） on the stability of nailed vertical excavations has been explored. The limit equilibrium method along with a planar failure surface is used to derive the formulation involved with the pseudo-dynamic approach, considering axial pullout of the installed nails. A comparison of the pseudo-static and pseudo-dynamic approaches has been established in order to explore the effectiveness of the pseudo-dynamic approach over pseudo-static analysis, since most of the seismic stability studies on nailed vertical excavations are based on the latter. The results are expressed in terms of the global factor of safety （FOS）. Seismic stability, i.e., the FOS of nailed vertical excavations is found to decrease with increase in the horizontal and vertical earthquake forces. The present values of FOS are compared with those available in the literature.
文摘Introduction: Adult bone tumors may be primary or secondary. Their diagnosis is often based on the results of imaging tests but can also be completed by biopsy. Case Presentation: We report the observation of a clinical case of fortuitous discovery in the orthopaedic-traumatology department of the national hospital Amirou Boubacar Diallo of Niamey, pathological fracture of the right humeral shaft secondary to metastasis of clear-cell adenocarcinoma of renal origin, a 57-year-old man, a refrigeration engineer by profession, from Niger living in the Middle East. This patient has no known pathological history. He consulted us for pain in his right arm that was more severe at night. All imaging and pathology examinations carried out both in Niger and in the Middle East confirmed the diagnosis of humeral metastasis of clear-cell renal cell carcinoma. Surgical management consisted of tumor resection and Kuntscher-type centromedullary alignment nailing of the fracture site. The loss of bone substance in the fracture is filled with acrylic cement. The treatment was completed by chemotherapy. Conclusion: Bone tumours are most often secondary in location. However, the diagnosis must be sought in the presence of any clinical sign.
文摘The pull-out capacities for soil nailing systems comprising of one single 29 mm diameter(type A) and four 16 mm diameter(type B) rebars with grouted cement were examined.A field test and numerical analysis for the type A and type B systems were carried out to investigate the pull-out capacities and the slope stability reinforcement efficiency in soil and rock slopes.The results of the pull-out tests show the mobilized shear force and load transfer characteristics with respect to soil depth.The load-displacement relationship was examined for both type A and type B systems.Slope stability analyses were carried out to study the relationships between soil and nail reinforcement and bending stiffness as well as combined axial tension and shear forces.Factors of safety were calculated in relation to the number of nails and their outside diameters.Both soil and rock slopes were included in this evaluation.
文摘Purpose:Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage.There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis(MIPPO)technique and intramedullary interlocking(IMIL)nailing for extra-articular distal tibia fractures.The aim of our study is to compare the functional outcome between the two treatment methods.Methods:This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups.The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing.Patients were followed up in outpatient department to assess the functional outcomes,malunion,delayed union,nonunion,superficial and deep infection between the two groups.Statistical analyses were performed using the SPSS software(version 16.0).Results:Average malunion(degrees)in the MIPPO group was 5(3—7)±1.41 vs.10.22(8—14)±2.04 in the IMIL group(p=0.001).Similarly postoperative knee pain in the IMIL group was 10%vs.2%in the MIPPO group(p=0.001).In terms of superficial infection and nonunion,the results were 8%vs.4%and 2%vs.6%for the MIPPO and IMIL group,respectively(p=0.001).Conclusion:Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue,bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing.Considering the results of the study,we have slightly more preference for the MIPPO technique.
文摘Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral nailing surgery performed for reverse obliquity intertrochanteric fractures using two proximal lag screws and a nail of 250 mm. There is prospective study of fifty three patients with AO/OTA 31 A-A3 fractures being treated by proximal femoral nailing in our institute after seeking approval from the Hospital ethics board. The quality of the reduction, the operative time, complications and the functional status of the patients were the parameters on which the results were evaluated. The mean Harris hip score was 76.66 (range 70 - 93) and the mean Barthel activity score was 16.21 (range 12 - 20). The average surgical time was 50 minutes and the mean consolidation time was 11.5 weeks. Intramedullary nailing with proximal femoral nails seems to be a good option in the treatment of reverse obliquity intertrochanteric fractures as against the various existing options available for the management.
文摘Background: Proximal femoral nailing in communited intertrochanteric fractures is increasingly becoming popular in view of superior biomechanics and prevention of varus collapse associated with Dynamic hip screw. However, technical difficulties and implant related complications have been described with this technique, thus we need more studies to address these issues. Our study aims to understand technical difficulties involved in proximal femoral nailing, and specifically analyses neck shaft angle at follow-up indicating varus collapse and also to compare results of stable and unstable fractures. Materials and Methods: In this study, patients who presented to the Orthopedic Unit of Dr. TMA Pai Hospital (An associated hospital of Manipal University, Manipal) with trochanteric fractures included and treated with proximal femoral nailing. The technical difficulties involved with surgical procedure and techniques adapted to overcome such difficulties were recorded. All patients were followed up for a period of 2 years and final outcome assessment included the number of shortening, neck shaft angle and harris hip score. Results: 41 patients (mean age 71) who underwent proximal femoral nailing from January 2004 to December 2009 were included in the study, 38 patients completed 2-year follow-up. The technical difficulties we faced were divided into 3 categories, difficulties in securing entry point and guide wire placement especially when greater trochanter and piriform fossa were gathered, reduction was lost while passing nail, and finally difficulties faced during placement of hip screws. In all except one, neck shaft angle of more than 130 degrees was achieved, and this was also maintained in the final follow-up (Mean 131.9 degrees). All fractures were united, with mean shortening of 2 mm. Conclusions: Although PFN is technically required, with a proper technique PFN gives excellent clinical results with almost negligible varus collapse even in unstable trochanteric fractures. Regarding the techniques, reaming the p
文摘Retaining walls have been used in many construction projects such as for road and inclined surfaces protection. The damage caused by an earthquake depends on the fundamental frequency, amplitude and the duration of the seismic motion. These parameters strongly depend on the seismic properties of the layers that are near the surface. In the study of retaining walls, in addition to the infl uence of soil, the infl uence of topography is also important. In the present study, site response analysis is performed by using fi nite element software PLAXIS to obtain the eff ect of various factors such as embedded length of the sheet pile, underground water table, length and angle of the nail, shear wave velocity of soil on site eff ect and dynamic response. Moreover, for better understanding of the eff ect of the above parameters, the stability analysis was performed by using shear reduction method. The results show that an increase in the embedded length of the sheet pile and the length of nailing causes an increase in the amplifi cation factor. Moreover, for shear-wave velocity in the range of 200- 600 m/s, the amplifi cation factor increases with increase of the shear-wave velocity due to the decrease of nonlinear behavior.
文摘The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device. Methods： Seventy-nine patients with extra capsular hip fractures treated with cephalo-medullary nailing were included in the study. Age, sex, ASA grade, timing of surgery, preoperative and postoperative haemoglobin, length of hospital stay, fracture type, number of units transfused and 30-day mortality were recorded. Results： The mean age was 82.3 years. Forty-seven patients underwent a short nail and 32 patients a long nail; 53.4% patients required blood transfusion postoperatively. Transfusion was required in 71,8% of the long nails （p 〈 0.05）, 65.8% patients above the age of 80 （p 〈 0.05）, 100% of the patients with hemoglobin below 90 g/L and 20 patients with a ASA grade of 3 （p 〈 0.05）. 78.5% patients with A2 fracture and 75% of A3 fractures needed blood transfusion （p 〉 0.05）. Length of hospital stay in non-transfusion group was 13 days and in transfusion group was 19 days （p 〈 0.05）. 55.1% operated within 36 h and 47,B% operated after 3B h of admission needed transfusion （p 〉 0.05）. Thirty-day mortality in patients needing blood transfusion was 5% and in non-transfusion group was 3.7% （p 〉 0.05）, Conclusion： Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy.
