| Part One Application of a double reverse traction repositor in the retr-ograde intramedullary nailing of distal fem-ur fracturesObjective:The purpose of this prospective study was to introduce the application of a double reverse traction repositor(DRTR)in the retrograde intramedullary nailing(RE-IMN)of AO/OTA 33 A distal femur fractures.Methods: A total of 48 patients with AO/OTA type 33 A distal femur fractures who were admitted from January 2015 to May 2017 to a level I trauma centre of a tertiary university hospital were enrolled in this prospective study.They were randomly divided into experimental group(double reverse traction group)and control group(traditional treatment group).The demographic and fracture characteristics,surgical data,postoperative complications and prognostic indicators of patients were recorded.Results: The DRTR helped achieve and maintain the reduction of all distal femur fractures in the present study.The average operation time and blood loss in the experimental group were 137 min(80 ? 210 min)and 320 ml(200 ? 600 ml).The average operation time of the control group was 124 min(range 70-200 min).The mean intraoperative blood loss was 412ml(range300-800ml).19 patients were found to have postoperative deep venous thrombosis before discharge.No cases of wound infection were observed.No cases of nonunion or malunion were observed.The average follow-up duration was 21 months(18-30 months).The HHS,LKFS and VAS scores of the experimental group were 89.9(86-97),79.1(75-87)and 2.1(from 0 to 5),respectively.The HHS,LKFS and VAS scores of the control group were 89.8(85-98)and 73.5(73-85)and 1.8(from 0 to 5),respectively.No complications associated with DRTR were found.Conclusions: A DRTR can be successfully applied in the treatment of distal femur fractures with RE-IMN,and it can not only help achieve or maintain the reduction of distal femur fractures with closed methods but also promote fixation with RE-IMN.Part Two Closed reduction and minimally invasive fixation for femoral intracondylar fractures with bi-direction traction deviceObjective: To evaluate Bi-direction traction closed reduction of minimally invasive fixation femoral intracondylar fractures.Methods: From March 2018 to February 2020,24 patients with femoral intracondylar fractures underwent operation at Trauma Emergency Center,The Third Hospital of Hebei Medical University.All patients were femoral intracondylar fractures,according to the AO/OTA fracture classification are33c3.They were randomly divided into double reverse traction group(12cases)and traditional operation group(12 cases).The operation time,incision length and postoperative complications were recorded for each patient;The Hospital for Special Surgery(HSS)scores were recorded at the last follow-up visit.Results: 24 patients were followed up for 12-36 months(mean 17.5months).In the experimental group,the average operation time was 52.2 min(41 min ? 73 min),and the average incision length was 13.8 cm(11 cm ? 17cm).No varus deformity or knee joint infection occurred.In the control group,the average operation time was 71.2min(45min ? 103min),and the average total incision length was 16.3cm(14cm ? 19cm).At the last follow-up,the knee function was evaluated according to the American Special Surgery Hospital scoring standard: the average score of the experimental group was86.3(78-93);The average score of the control group was 82.7(76-90).Conclusions: Bi-direction traction closed reduction and minimally invasive fixation of femoral intracondylar fractures can achieve fine reduction and function.This method does not need to open the capsule.The patients with functional exercise of knee joint after operation have fine tolerance and avoid knee joint adhesion and stiffness.Part Three Biomechanical study of compression self-breaking bolt and locking screw assisted double plate fixation of distal femoral fractureObjective: To compare various mechanical characteristics of compression self-breaking bolt and locking screw assisted double plate fixation of distal femoral fracture through biomechanical research.Methods: Twelve adult male specimens were selected to establish a model of distal femoral fracture(AO type: 33-C2.3).According to the random number table,the fracture models were randomly divided into control group(locking screw assisted double plate group)and experimental group(compression self-breaking bolt assisted double plate group).Axial load test,torsional load test and cyclic axial load test were performed on the two groups of specimens successively,and the torsional stiffness,axial stiffness and irreversibility shape variables of each specimen were recorded.Results: Under a vertical load of 600 N and a cyclic load,neither of the two models showed internal fixation failures such as screw loosening or steel plate fracture.The vertical stiffness and irreversible deformation of the experimental group were 2224.67±61.41 N/mm and 0.24±0.01 mm,which were significantly better than the control group's 2121.33±79.04 N/mm and0.26±0.01 mm.The difference between the two groups was statistically significant(P=0.030,P<0.05).However,in the torsion experiment,the torsional stiffness of the control group was 2.42±0.48 Nm/degree,and the torsion stiffness of the experimental group was 2.47±0.67 Nm/degree.Although the experimental group was slightly better than the control group,there was no statistical difference(P= 0.229).Conclusions:The stability and biomechanical advantages of compression self-breaking bolt assisted double plate in the treatment of distal femoral fracture are better than those of locking screw assisted double plate.This is beneficial to the early and long-term functional exercise of patients with internal fixation,and has obvious clinical application value for the treatment of distal femoral fracture,especially for comminuted distal femoral fracture.Part Four Minimally invasive treatment of Fraser ? floating knee injuryObjective:To evaluate the clinical effect of minimally invasive treatment of Fraser ? floating knee by homeopathic reduction.Methods: From November 2016 to July 2018,7 patients with Fraser ?floating knee injury who were treated with homeopathic reduction and minimally invasive surgery were analyzed retrospectively.There were 5 males and 2 females,aged from 30 to 82 years,with an average age of 52 years.Seven patients were all floating knee injury with tibial plateau fracture,including 5 cases of Fraser ? a(tibial plateau fracture with femoral shaft fracture)and 2 cases of ? C(tibial plateau fracture with femoral condyle fracture).The femoral and tibial plateau fractures were reduced with the bidirectional traction reduction device,and the internal fixator was implanted minimally.The operation time,average length of single incision,blood loss and times of fluoroscopy were recorded.During the last follow-up,the function of knee joint was evaluated by HSS.Results: The average operation time of 7 patients was 87.2 minutes,the average length of a single incision was 2.8 cm(1-4 cm),the average blood loss was 471 m L,and the average number of fluoroscopy was 37 times.The X-ray of all patients showed that the fracture alignment and force line were good,and the articular surface was smooth.All the incisions of 7 patients were healed.The follow-up time of 7 patients was 12-21 months(average 15.6months),and the average time of fracture healing was 12.8 weeks.At the last follow-up,7 patients were evaluated according to the score of HSS: excellent in 6 cases,good in 1 case.Conclusions: The injury of floating knee is complex.The fracture of femur side and tibia side can be closed reduction and fixed separately by using the homeopathic bidirectional traction reduction device.The complex multiple fractures of the same side of lower limb can be transformed into the simple fractures of two parts,which can obtain better knee joint function. |
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