RESUMEN
BACKGROUND: Distal tibial fractures represent common lower limb injuries, frequently accompanied by significant soft tissue damage. The optimal surgical approach for managing these fractures remains a topic of considerable debate. The aim of this study was to perform a comparative analysis of the outcomes associated with retrograde intramedullary tibial nails (RTN) and minimally invasive plate osteosynthesis (MIPO) in the context of treating extra-articular distal tibial fractures. METHODS: A retrospective review was conducted on a cohort of 48 patients who sustained extra-articular distal tibial fractures between December 2019 and December 2021. Patients underwent either RTN or MIPO procedures. Various parameters, including operative duration, intraoperative fluoroscopy exposure, time to union, duration until full weight-bearing, American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications, were recorded and compared between the two treatment groups. RESULTS: No statistically significant differences were observed in operative duration, time to union, angulation of the distal tibial coronal plane, or AOFAS scores between the RTN and MIPO groups. However, the RTN group had a higher average number of intraoperative fluoroscopy images (8.2 ± 2.3) compared to the MIPO group (4.1 ± 2.0). The RTN group demonstrated shorter average hospital stays (7.1 ± 1.4 days) and a quicker return to full weight-bearing (9.9 ± 1.3 weeks), which were significantly superior to the MIPO group (9.0 ± 2.0 days and 11.5 ± 1.5 weeks, respectively). In terms of complications, the RTN group had one case of superficial infection, whereas the MIPO group exhibited two cases of delayed union and nonunion, two occurrences of deep infection, and an additional three cases of superficial infection. CONCLUSIONS: Both RTN and MIPO are effective treatment options for extra-articular distal tibial fractures. However, RTN may offer superior outcomes in terms of decreased inpatient needs, faster return to full weight-bearing capacity, and a lower rate of complications.
Asunto(s)
Clavos Ortopédicos , Placas Óseas , Fijación Intramedular de Fracturas , Procedimientos Quirúrgicos Mínimamente Invasivos , Fracturas de la Tibia , Humanos , Estudios Retrospectivos , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Adulto , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/instrumentación , Resultado del Tratamiento , Tempo Operativo , Anciano , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Soporte de Peso , FluoroscopíaRESUMEN
Objective: To investigate the effectiveness of compression screw combined with Buttress plate through direct axillary approach for Ideberg typeâ ¡ scapular glenoid fractures. Methods: A retrospective analysis was conducted on 11 patients with Ideberg type â ¡ scapular glenoid fractures treated with compression screws combined with Buttress plate fixation through the direct axillary approach between January 2014 and June 2022. There were 7 males and 4 females, aged from 34 to 75 years, with an average of 56.0 years. The causes of injury included 4 cases of falling from height injury, 4 cases of heavy object injury, and 3 cases of traffic accident injury. The time from injury to operation was 2-5 days, with an average of 3.8 days. The operation time, intraoperative blood loss, hospital stay, complications, and fracture healing time were recorded. The Constant-Murley score, American Society of Shoulder and Elbow Surgeons (ASES) score, and shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion were used to evaluate shoulder joint pain and function. Results: The operation time was 45-105 minutes, with an average of 79.0 minutes; the intraoperative blood loss was 80-200 mL, with an average of 99.2 mL; the hospital stay was 3-8 days, with an average of 5.8 days. One patient had poor wound healing after operation, and the wound healed after strengthening dressing change; the rest wounds had primary healing, and no axillary nerve paralysis occurred. Except for 1 patient lost follow-up, the remaining 10 patients were followed up 10-54 months, with an average of 26.4 months. The postoperative X-ray film examination showed that the fractures healed well within 8-15 weeks, with an average of 11.0 weeks. There was no complication such as fracture displacement, internal fixator failure or fracture during follow-up. At last follow-up, the patient's shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion, Constant-Murley score, and ASES score significantly improved when compared with those before operation ( P<0.05). Conclusion: Compression screw combined with Buttress plate through direct axillary approach is an effective way to treat Ideberg typeâ ¡ scapular glenoid fracture, with advantages of small trauma, concealed incision, and good effectiveness.
Asunto(s)
Pérdida de Sangre Quirúrgica , Fracturas del Hombro , Masculino , Femenino , Humanos , Estudios Retrospectivos , Fijación Interna de Fracturas , Resultado del Tratamiento , Fracturas del Hombro/cirugía , Tornillos Óseos , Placas ÓseasRESUMEN
BACKGROUND: Fractures of the talar neck are relatively uncommon yet current interventions suffer from a high incidence of complications and poor functional outcomes. In the present study, we report a surgical treatment of Hawkins type III talar neck fracture through the approach of medial malleolar osteotomy and mini-plate for fixation and discuss the therapeutic effects after long-term follow-up. METHODS: From January 2010 to January 2015, 21 patients with 22 fractures were treated using this approach within days of sustaining the injury. Clinical and radiographic data were collected during regular post-operative follow-ups. Health-related quality of life factors were evaluated using visual analogue scale (VAS). Functional outcomes were determined according the Hawkins score and the Ankle-Hind foot Scale of the American Orthopedic Foot and Ankle Society (AOFAS). Present of complications such as arthritis, avascular necrosis (AVN), and malunion were evaluated using radiographs and magnetic resonance imaging (MRI). Anatomical parameters of injured and corresponding uninjured talus were measured and compared using digital three-dimensional (3D) computer model. RESULTS: The mean duration of surgery was 65.6 ± 9.7 min. The average blood loss volume of the patients was 29.1 ± 5.7 ml. All the patients except 1 were followed up 18 to 41 months (average 29.6 months). The average VAS score for these patients was 3.2 ± 1.1, and the mean Hawkins score was 11.4 ± 3.4 at the final follow-up visit. The average AOFAS score was 72.8 ± 17.3. Nine patients outcomes were rated as "excellent", 4 as "good", 4 as "fair," and 4 as "poor". No malunion, screw loosening, plate breakage, or other internal fixation failures were found at final follow-up. Long-term complications included: 1 case of malunion, 5 cases of complete AVN, 8 cases of partial AVN, 13 cases of talocrural arthritis, 14 cases of subtalar arthritis, and 3 cases of talonavicular arthritis. Secondary surgery was performed in 4 cases. The relevant average anatomical data of injured and uninjured talus show no significant difference. CONCLUSIONS: This surgical treatment we used here resulted in decreased soft tissue trauma, adequate exposure of talar neck, satisfactory performance of daily life activities, and quality of life following surgery and restoration of anatomy of injured talus. However, long-term complications such as arthritis and AVN are still commonly seen.