scholarly journals External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 1101-1108
Author(s):  
Qing Yang ◽  
Nong Chen ◽  
Wenqin Fu
Keyword(s):  
External Fixation ◽  
Clinical Outcomes ◽  
Acute Treatment ◽  
Reduction Rate ◽  
Young Patients ◽  
Harris Hip Score ◽  
Fixation Time ◽  
Trauma Patients ◽  
Anterior Inferior Iliac Spine ◽  
The Mean

Abstract Background and aim Acute treatment of young patients with proximal femoral fracture (PFF) remains a challenge for trauma surgeons due to major fracture displacement and heavy pain in clinical practice. Traditional methods have a variety of intrinsic defaults and cannot successfully manage the requirements of young patients. Benefiting from our anatomic research, we explored a new method of external fixation for this specific trauma and evaluated its feasibility and clinical outcomes. Material and methods Twenty-three young multiple-trauma patients with PFF were included in this study. Surgical treatment was applied using an external fixator via the anterior inferior iliac spine (AIIS). Electronic patient records, surgical characteristics, clinical outcomes, and complications were reviewed for each patient. Results The mean surgical time was 30.3 ± 7.3 min. The mean blood loss was 25.3 ± 10.8 mL. No iatrogenic nerve palsy, pin tract infection, failure of external fixation, or bedsores were observed. The postoperative visual analog scale score was significantly lower than the preoperative score (P < 0.01). The mean fracture reduction rate of the femur was 58.1 ± 17.0%, and the mean degree of reduction was 13.5 ± 6.9°. The mean external fixation time was 7.6 ± 4.0 days and intramedullary nailing was performed. The mean hospital, follow-up, and healing times were 28.7 ± 8.7 days, 23.5 ± 7.9 months, and 22.8 ± 5.7 weeks, respectively. The Harris Hip Score indicated excellent or good results in 20 patients. Conclusion Collectively, the results of this study revealed that external fixation via the AIIS is a safe, rapid, and effective method for acute treatment of PFF in young patients.

scholarly journals Improving postoperative radiographs for the parameter measurement of hexapod external fixator using an additional foot ring

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yanshi Liu ◽  
Kai Liu ◽  
Feiyu Cai ◽  
Tao Zhang ◽  
Aihemaitijiang Yusufu
Keyword(s):  
External Fixation ◽  
Clinical Outcomes ◽  
External Fixator ◽  
Demographic Data ◽  
Deformity Correction ◽  
Parameter Measurement ◽  
Fixation Time ◽  
Trauma Patients ◽  
Group I ◽  
Outcomes Evaluation

Abstract Background It is challenging to determine the orthogonality of radiographs in daily clinical practice. The purpose of this study was to show the usefulness of an additional foot ring which might determine the orthogonality of postoperative radiographs for the parameter measurement of hexapod external fixator. Methods We retrospectively analyzed 81 consecutive trauma patients with tibial shaft fractures treated by the hexapod external fixator at our institution from September 2014 to July 2019. Starting in March 2016, the postoperative radiographs for parameter measurement were obtained under the control of an additional foot ring. The final data consisted of 47 patients in traditional radiographs (Group I) and 34 patients under the control of foot ring during the radiographic process (Group II). The demographic data, original postoperative deformities, residual deformities after final correction, number of repeated radiographs after the first postoperative radiographs, time to the satisfactory reduction achieved, and external fixation time in all patients were documented and analyzed. The Johner–Wruhs criteria were used for the final clinical outcomes evaluation at the last clinical visit. Results Satisfactory reduction and bone union were achieved in all patients. There were no statistical significances between the two groups in the demographic data, original postoperative deformities, residual deformities after final correction, external fixation time, and the final clinical outcomes (P > 0.05). The mean number of repeated radiographs after the first radiographs (1.4 times) and mean time to the satisfactory reduction achieved (3.3 days) in patients with an additional foot ring used were all less than those without foot ring (2.4 times, 5.3 days) (P < 0.05). Conclusions The additional foot ring is a practical device to ensure the orthogonality of postoperative radiographs for the hexapod external fixator parameter measurement. Radiation exposure, duration of deformity correction, and cost for patients might be reduced due to the less repeated radiographs with the wrong position.

scholarly journals Improving postoperative radiographs for the parameter measurement of hexapod external fixator using an additional foot ring

2021 ◽  
Author(s):  
Yanshi Liu ◽  
Kai Liu ◽  
Feiyu Cai ◽  
Tao Zhang ◽  
Aihemaitijiang Yusufu
Keyword(s):  
External Fixation ◽  
Clinical Outcomes ◽  
External Fixator ◽  
Demographic Data ◽  
Deformity Correction ◽  
Parameter Measurement ◽  
Fixation Time ◽  
Trauma Patients ◽  
Outcomes Evaluation ◽  
Mean Time

Abstract Background It is challenging to determine the orthogonality of radiographs in daily clinical practice. The purpose of this study was to show the usefulness of an additional foot ring which might determine the orthogonality of postoperative radiographs for the parameter measurement of hexapod external fixator. Methods We retrospectively analyzed 81 consecutive trauma patients with tibial shaft fractures treated by the hexapod external fixator at our institution from September 2014 to July 2019. Starting in March 2016, the postoperative radiographs for parameter measurement were obtained under the control of an additional foot ring. The final data consisted of 47 patients in traditional radiographs (Group Ⅰ) and 34 patients under the control of foot ring during the radiographic process (Group Ⅱ). The demographic data, original postoperative deformities, residual deformities after final correction, number of repeated radiographs after the first postoperative radiographs, time to the satisfactory reduction achieved, and external fixation time in all patients were documented and analyzed. The Johner-Wruhs criteria were used for the final clinical outcomes evaluation at the last clinical visit. Results Satisfactory reduction and bone union were achieved in all patients. There were no statistical significances between the two groups in the demographic data, original postoperative deformities, residual deformities after final correction, external fixation time, and the final clinical outcomes (P > 0.05). The mean number of repeated radiographs after the first radiographs (1.4 times) and mean time to the satisfactory reduction achieved (3.3 days) in patients with an additional foot ring used were all less than those without foot ring (2.4 times, 5.4 days) (P < 0.05). Conclusions The additional foot ring is a practical device to ensure the orthogonality of postoperative radiographs for the hexapod external fixator parameter measurement. Radiation exposure, duration of deformity correction, and cost for patients might be reduced due to the less repeated radiographs with the wrong position.

scholarly journals Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052092040
Author(s):  
Yao Lu ◽  
Teng Ma ◽  
Cheng Ren ◽  
Zhong Li ◽  
Liang Sun ◽  
...  
Keyword(s):  
External Fixation ◽  
Locking Plate ◽  
Short Form ◽  
Clinical Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Fixation Time ◽  
Sf 36 ◽  
Health Related ◽  
The Mean

Objective To evaluate the effectiveness of bone transport involving circular external fixation and locking plate application for the treatment of segmental tibial defects. Methods A retrospective review of 12 patients with segmental tibial defects who underwent bone transport with circular external fixation and locking plate application. We evaluated external fixation time, external fixation index, time to achieve union, and complications. Clinical results were assessed using the Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Generic health-related outcome was assessed using the 36-Item Short-Form Health Survey questionnaire (SF-36). Results The mean follow-up was 25.8 months, and the mean defect size was 6.7 cm. All of the patients achieved union at the distraction callus and docking site. The average external fixation time was 299.5 days. The mean external fixation index was 16.5 days/cm, and the mean healing index was 44.9 days/cm. The functional outcomes were excellent in eight cases and good in four. The average SF-36 score was 92. Conclusion Bone transport with external fixation and locking plate application may be a promising method for the treatment of segmental tibial defects.

scholarly journals Clinical outcomes of arthroscopic repair of acetabular labral tears

2018 ◽  
Vol 4 (1) ◽  
pp. e000328 ◽  
Author(s):  
Carlos César Vassalo ◽  
Antônio Augusto Guimarães Barros ◽  
Lincoln Paiva Costa ◽  
Euler de Carvalho Guedes ◽  
Marco Antônio Percope de Andrade
Keyword(s):  
Clinical Outcomes ◽  
Arthroscopic Repair ◽  
Final Evaluation ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Senior Surgeon ◽  
Labral Tears ◽  
Significant Difference ◽  
The Mean

PurposeTo evaluate the primary clinical outcomes of arthroscopic labral repair.MethodsAll patients who underwent arthroscopic repair of the acetabular labrum performed by a senior surgeon between October 2010 and December 2013 were invited to participate in this prospective study. Patients included were those who had a preoperative diagnosis of labral tears, a lateral centre edge greater than 25° and a labral tear believed to be suturable during the intraoperative evaluation. Patients with Tönnis grade 2 or grade 3 hip osteoarthritis and those who had undergone a previous hip surgery were excluded. All patients were evaluated using the modified Harris Hip Score (mHHS) during the final appointment before surgery, 4 months after surgery and at the final evaluation. Interviews were conducted by the senior surgeon.ResultsEighty-four patients (90 hips) underwent arthroscopic repair. The mean age was 44.2 years and the mean follow-up period was 43.0 months (minimum of 25 months and maximum of 59 months). The mean mHHS was 80.4 preoperatively, 95.0 at 4 months postoperatively and 96.6 at final evaluation. A statistically significant difference existed among these scores (p<0.001).ConclusionArthroscopic labral repair was associated with a clinically significant improvement in mHHS after short-term (4 months) and medium-term (43 months) follow-up.Level of evidenceLevel IV, therapeutic case series.

scholarly journals A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

2021 ◽  
Vol 7 (6) ◽  
pp. 1194
Author(s):  
S. F. Kammar ◽  
Karthik B. ◽  
V. K. Bhasme ◽  
Suryakanth Kalluraya
Keyword(s):  
Clinical Outcomes ◽  
Road Traffic ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Lateral View ◽  
Successful Outcome ◽  
Harris Hip Score ◽  
Full Weight Bearing ◽  
Subtrochanteric Fractures ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.</p><p class="abstract"><strong>Methods:</strong> This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.</p><p class="abstract"><strong>Conclusions:</strong> From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.</p>

The effects of full weight-bearing mobilization on clinical outcomes and subsidence in cemented and uncemented hemiarthroplasty in osteoporotic patients: A retrospective single-center study

2021 ◽  
pp. 1-8
Author(s):  
Betül Başar ◽  
Hakan Başar
Keyword(s):  
Clinical Outcomes ◽  
Weight Bearing ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Full Weight Bearing ◽  
Single Center ◽  
Single Center Study ◽  
Uncemented Hemiarthroplasty ◽  
The Mean ◽  
Center Study

BACKGROUND: Early full weight-bearing mobilization is controversial in osteoporotic patients who have undergone uncemented hemiarthroplasty (CH). OBJECTIVES: The aim of the study was to compare the results of early full weight-bearing mobilization in CH and uncemented hemiarthroplasty (UCH). The effect of subsidence on the results was also evaluated. METHODS: Fifty-nine patients who underwent CH and UCH were evaluated. The mean age was 79.8 years (10 females, 15 males) for CH and 75.5 years (10 females, 24 males) for UCH. All patients started immediate full weight-bearing mobilization and weight-bearing exercises. RESULTS: There was no difference between the groups according to the Harris Hip Score. Both groups were evaluated in subgroups according to whether there is varus in the femoral stem. There was no difference between subgroups according to the Harris Hip Score. The femoral subsidence was not determined in CH group. In the UCH group, the subsidence was 1.13 ± 1.03 mm in varus femoral stem subgroup and 0.81 ± 0.85 mm in without femoral stem varus subgroup. There was no difference in subsidence between femoral stem with varus and without varus. The subsidence did not affect the Harris Hip Score. CONCLUSION: Full weight-bearing mobilization could be safely preferred in UCH, as in CH. Femoral stem varus below 5 degrees does not affect the results and subsidence.

Assessment of the differences in the short-term clinical outcomes of superotemporal and inferonasal Baerveldt glaucoma implantation surgeries performed via the pars plana route

2021 ◽  
Vol 2 (4) ◽  
pp. 199-205
Author(s):  
Masashi Sakamoto ◽  
◽  
Takahiro Sodeno ◽  
Kenichirou Aso ◽  
Ryuya Hashimoto ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medical Center ◽  
Reduction Rate ◽  
Neovascular Glaucoma ◽  
Short Term ◽  
Pars Plana ◽  
Baerveldt Glaucoma Implant ◽  
The Mean ◽  
Student’S T ◽  
Student’S T Test

AIM: To investigate and discover whether different insertion areas for Baerveldt glaucoma implant (BGI) surgery produce different outcomes in terms of the reduction of intraocular pressure (IOP). METHODS: This retrospective study involved the review of cases of patients admitted at Toho University Sakura Medical Center, who underwent BGI surgery via the pars plana route for the treatment of neovascular glaucoma. The patients were divided into two groups: the superotemporal insertion group [18 eyes in 16 subjects (13 males, 3 females; mean age 62.9±14.4y)] and the inferonasal insertion group [17 eyes in 15 subjects (11 males, 4 females; mean age 56.9±10.7y)]. The patients were followed up and re-evaluated at 12mo. The IOP reduction rate 12mo after surgery relative to preoperative IOP was compared between the two groups. RESULTS: The mean preoperative IOP was 31.1±10.0 mm Hg and postoperative IOP was 14.4±4.5 mm Hg in the superotemporal group, whereas for the inferonasal group, the mean preoperative IOP was 34.9±9.7 mm Hg and postoperative IOP was 15.9±3.7 mm Hg. The IOP reduction rate of the superotemporal group was 50.0%±19.0% and that of the inferonasal group was 51.2%±16.3%. There was no significant correlation between the two groups (Student’s t-test, P=0.590). CONCLUSION: There was no difference in the short-term clinical outcomes between superotemporal and inferonasal BGI performed via the pars plana route.

scholarly journals Clinical Outcomes in the Definitive Treatment of High-energy Tibial Diaphyseal Fractures using Hexapod External Fixator Versus Monolateral External Fixator

2021 ◽  
Author(s):  
Yanshi Liu ◽  
Kai Liu ◽  
Feiyu Cai ◽  
Xingpeng Zhang ◽  
Hong Li ◽  
...  
Keyword(s):  
External Fixation ◽  
Clinical Outcomes ◽  
External Fixator ◽  
High Energy ◽  
Definitive Treatment ◽  
Fixation Time ◽  
Significant Difference ◽  
Diaphyseal Fractures ◽  
Monolateral External Fixator ◽  
Surgical Duration

Abstract Background: External fixation, which can preserve the biomechanical microenvironment of fracture healing, playing an important role in managing the high-energy fractures with poor surrounding soft tissues. The purpose of this study was to determine the differences of clinical outcomes, if any, between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures.Methods: A total of 53 patients with high-energy tibial diaphyseal fractures and definitively treated by the hexapod external fixator (HEF) or monolateral external fixator (MEF) were retrospectively collected and analyzed, from March 2015 to June 2019. There were 31 patients in the HEF treatment, and the other 22 patients were managed by the MEF. The demographic data, surgical duration, external fixation time, final radiological results, complications, and clinical outcomes were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: The mean surgical duration in the HEF group (62.4±8.3 minutes) was shorter than that in the MEF group (91.4±6.9 minutes) (P<0.05). All patients acquired complete bone union finally. Patients in the HEF group (24.2±3.1 weeks) underwent a shorter average external fixation time than that in the MEF group (26.3±3.8 weeks) (P<0.05). Satisfactory alignment was achieved in all patients without the need for remanipulation. The residual sagittal plane deformities in the HEF group were all less than that in the MEF group (P<0.05). The complication rate was 35.5% in the HEF group, while 45.5% in the MEF group. There was no statistically significant difference between the two groups in ASAMI scores (P>0.05).Conclusion: There is no statistically significant difference in finally clinical outcomes between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures. The hexapod external fixation treatment is a superior effective method, including advantages of stable fixation, less surgical duration, postoperatively satisfactory fracture reduction, and fewer complications.

scholarly journals Improving Postoperative Radiographs for the Correction Planning of Hexapod External Fixator Using an Additional Foot Ring

2021 ◽  
Author(s):  
Yanshi Liu ◽  
Kai Liu ◽  
Feiyu Cai ◽  
Xingpeng Zhang ◽  
Hong Li ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Demographic Data ◽  
Deformity Correction ◽  
Radiological Examination ◽  
Fixation Time ◽  
Trauma Patients ◽  
X Rays ◽  
Examination Time ◽  
Mean Time

Abstract Background: It is challenging to determine the orthogonality of radiographs in daily clinical practice. The purpose of this study was to show the usefulness of an additional foot ring which might determine the orthogonality of postoperative radiographs for the correction planning of hexapod external fixator.Methods: We retrospectively analyzed 81 consecutive trauma patients with tibial shaft fractures treated by the hexapod external fixator at our institution from September 2014 to July 2019. Starting in March 2016, the postoperative radiographs for fracture reduction planning were obtained under the control of an additional foot ring. In this simple way, the radiologist and the patient himself can easily control the rotation position of the limb while taking the radiographs, and the two X-rays are orthogonal to each other. The final data consisted of 47 patients in traditional radiographs (Group Ⅰ) and 34 patients under the control of foot ring during the radiographic process (Group Ⅱ). The demographic data, original postoperative deformities, number of repeated radiographs after the first postoperative radiological examination, time to the satisfactory reduction achieved, and external fixation time in all patients were documented and analyzed.Results: Satisfactory reduction and bone union were achieved in all patients. There were no statistical significances between the two groups in the demographic data, original postoperative deformities, and external fixation time (P>0.05). The mean number of repeated radiographs after the first postoperative radiological examination (1.2 times) and mean time to the satisfactory reduction achieved (3.0 days) in patients with an additional foot ring used were all less than that (2.1 times, 5.3 days) in patients without foot ring (P<0.05).Conclusions: The additional foot ring is a practical device to ensure the orthogonality of postoperative radiographs for the correction planning of hexapod external fixator. Radiation exposure, duration of deformity correction, and cost for patients might be reduced due to the less repeated radiographs with the wrong position.

scholarly journals Clinical Outcome and Biomechanical Analysis of Dynamic Hip Screw Combined with Derotation Screw in Treating Displaced Femoral Neck Fractures Based on Different Reduction Qualities in Young Patients (≤65 Years of Age)

2022 ◽  
Vol 2022 ◽  
pp. 1-15
Author(s):  
Jian Zhu ◽  
Yonglong Li ◽  
Yingze Zhang ◽  
Xiaodong Cheng
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Clinical Outcomes ◽  
Young Patients ◽  
Femoral Neck Fractures ◽  
Harris Hip Score ◽  
Surgical Time ◽  
Displaced Femoral Neck Fractures ◽  
Reduction Group ◽  
Hip Screw

Objective. To examine the clinical results and biomechanical mechanism of the dynamic hip screw (DHS) and derotation screw (DS) in the treatment of displaced femoral neck fractures (FNF) based on different reduction qualities in young patients (≤65 years of age). Methods. All patients with FNF who received closed reduction and internal fixation with DHS+DS from January 2014 to August 2019 were retrospectively analyzed. Data on demographics, surgery, clinical outcomes, and postoperative complications were collected. According to the reduction quality immediately after surgery, all patients were categorized into the positive buttress reduction group (PBRG) and the anatomical reduction group (ARG). The complications and clinical outcomes were compared between the two groups. Meanwhile, the biomechanical mechanism of different reduction qualities was further analyzed with finite element analysis (FEA). The distribution of von Mises stress, the peak stress of internal fixation, and the displacement of the proximal fragment were compared between the two groups. Results. A total of 68 patients were included in our study. Among them, 31 were divided into the PBRG while 37 were in the ARG. The surgical time and fluoroscopy time were significantly shorter in the PBRG than in the ARG ( p < 0.05 ). The degree of femoral neck shortening and the varus change of the femoral-neck shaft angle were lower in the PBRG compared to the ARG ( p < 0.05 ). The excellent-good rate of the Harris hip score was higher in the PBRG compared to the ARG (83.9% vs. 64.8%). The FEA results demonstrated that the stress of DHS+CS and the downward displacement of the proximal femoral neck fragment were greater in the ARG than in the PBRG. Conclusion. For displaced FNF with difficulty to achieve reduction, DHS+CS combined with positive buttress reduction was an effective treatment in young patients due to better mechanical support, shorter surgical time, less radiation exposure, and higher excellent-good rate of Harris hip score.

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