Research For Skills Of Surgical Treatment In Fracture Around The Joints With Absorbable Internal Fixation Materials

Objective: Through the retrospective analysis of the absorbablescrew for the surgical treatment of fracture, to explore the considerationsand operation skills for using the absorbable internal fixation materialduring the operation.Methods: The26patients with joint fractures around,using theabsorbable internal fixation material (absorbable screw, absorbable boneplate, fixed absorbable rods) surgery were selected from jilin universityhospital from October2012to November2014.The preoperative andpostoperative of joint function, surgical complications and imaging dataof each patient were analyzed retrospectively.The male,18cases, female,8cases;19-55years old, average38.25years; Femoral fractures in8cases,6cases of medial malleolus fracture, fracture of tibial plateau in2cases,2cases of external ankle fracture,4cases of talus fracture, shoulderjoint, fractures in2cases,4cases of the metatarsal bone. In26patients,20patients have different degree of compound injury.To deal with thecombined injuries timely and actively,do the open reduction and internalfixation with absorbable fixation in1~2weeks,forming a complete set ofsurgical instruments and materials,choose appropriate surgical approachaccording to the fracture site,expose the fracture end fully,and cut thejoint capsule show fracture block when necessary.According to thestandard operation and conform to the AO fracture fixed principle.Operation specification.Do the appropriate function exercise after theoperation under guidance of physician,with the auxiliary functionexercise when necessary. All the patients check the high quality digitalimaging (DR) or three dimensional CT and surface reconstruction of jointparts.Review DR in1~2days after the surgery,after1,3,6and12monthsof the surgery review the x ray,and follow up the patients from4to24 months.Judge the fracture healing through physical examination, patients’feedback information and regularly review the X-ray after surgery,at thesame time record accordingly, relevant treatment methods, complicationsand disease outcome.According to The American association oforthopaedic(AASO) joint function evaluation standard,all patients aredivided into four grade, best:normal joint activities, painless, completelyreturn to independent living ability;Good: motion was75%, light pain,will not affect the life and work;General:motion was50%, in pain, affectthe life and work; Poor: motion <5%, pain, significantly affect the lifeand work.Evaluate the joint function.Do the statistical analysis of thepreoperative and postoperative related data.Results:In the process of operation,3patients appeared broken nailin the process of operation;2patients appeared screw holding poor on thefracture block or screw loose in the process of operation;2patientsappeared large implanted resistance and remaining nail implanteddifficulty in the process of nail implant surgery.Postoperative:postoperative follow-up time in all26cases needs4to24months.Themajority of patients can review on time (after1,3,6,12months),andtelephone follow-up; A small number of patients failed to do it, only togive telephone follow-up.One of the patients who is not in accordancewith the requirements for physicians in postoperative due to personalfactors don’t review or rehabilitation training,telephone follow-up can’tlearn its recovery;One of the patients who is not recreation and functionalexercise,weight walk ahead of time, poor fracture healing and jointfunction well;Two cases whose fracture healing is not fully absorbed aftersubcutaneous head of nail but not cause pain and inflammatory reactionare cut to removed.The remaining patients’ treatment effect is good,wound and fracture healing is good,and they are satisfied with the joint functional recovery and they all meet the needs of the daily work andlife.All patients with preoperative and postoperative joint functionevaluation grade are increased.Conclusion:1, absorbable screw is suitable for the fracture around the joint.2, absorbable screw treat the joint fractures: without secondaryoperation, no stress shelter, no video interference, good biocompatibility,no metal tissue residue in the body.3,the application of absorbable internal fixation treatment of articularfractures around the intraoperative standardized operation and relatedsurgical technique is the key to a successful operation.