Background. For severe soft tissue damage or open fracture, unilateral external fixation is one of the treatment choices. In the current study, a unilateral external fixator combined with a lateral auxiliary frame was used to treat tibia and fibula shaft fractures with poor soft tissue conditions to verify its feasibility for the ultimate treatment. Methods. We retrospectively analyzed the patients with tibia and fibula shaft fractures who underwent unilateral external fixator combined with lateral auxiliary frame between December 2018 and October 2020. The clinical outcomes were recorded. Results. 31 patients with tibia and fibula shaft fractures who received unilateral external fixator combined with lateral auxiliary frame were included in the current study. Among them, 23 cases had closed fractures with poor soft tissue and 8 cases had Gastilo type I open fractures. The average duration of hospital stay was 7.3 ± 2.3 days. The causes of injury were traffic accidents in 15 cases (48.4%), fall from height in 7 cases (22.6%), crush injury in 5 cases (16.1%), and other causes in 4 cases (12.9%). During follow-up, the clinical healing time was 3.0 ± 0.85 months. Additionally, the infection rate of pin-tract and reoperation rate was 12.9% and 3.2%. Fortunately, all patients achieved fracture healing and recovered well without joint dysfunction and obvious claudication. The Johner-Wruh scores showed that 27 cases (87.1%) were “excellent” and 4 cases (12.9%) were “good.” Conclusions. The unilateral external fixator combined with lateral auxiliary frame is an effective option for ultimate treatment of the tibia and fibula shaft fractures with poor soft tissue conditions.
As one of the knee preservation surgical approaches, good clinical outcomes of high tibial osteotomy were reported. Aims of this study were to analyze the clinical outcome and pre- and postoperative radiographical parameter and knee functional score between distal tibial tubercle high tibial osteotomy (DTTHTO) and open wedge- high tibial osteotomy (OWHTO) in patients with varus knee osteoarthritis after more than 1 year following-up. A total of 194 consecutive patients in our joint center from March 2016 to October 2021 were enrolled, according to the surgical method, patients were divided into DDTHTO and OWHTO groups. Radiographic parameters of Kellgren-Lawrence grading, hip-knee-ankle angle, weight bearing line ratio and medial tibial plateau angle, knee functional score of American knee society (AKS) score, western Ontario and McMaster universities arthritis index (WOMAC) score, visual analogue score (VAS) were introduced to evaluate clinical outcome for patients who received DDTHTO and OWHTO. There were 103 knees and 89 knees in the OWHTO and DTTHTO group, respectively. Mean weight bearing line ratio for OWHTO and DTTHTO were 25.1 ± 11.7 and 25.2 ± 12.0% respectively, medial tibial plateau angle and hip-knee-ankle angle angle demonstrated that all patients in the present study inherited a varus angle ranges from 3.4° to 9.5°. Preoperative AKS, WOMAC and VAS were 68.4 ± 5.7 versus 69.0 ± 5.9, 109.3 ± 15.0 versus 107.7 ± 14.0 and 6.8 ± 1.0 versus 6.9 ± 0.8, and there was no significant difference between 2 groups ( P > .05). Mean postoperative AKS and WOMAC score for patients in both OWHTO and DTTHTO group were significantly improved, moreover, postoperative VAS of DTTHTO patients was lower than that in OWHTO group ( P < .05). When comparing the operation time, intraoperative blood loss and bone union time, DHHTO group shows a superiority in these variables over patients in OWHTO (121 ± 29.6 vs 145.7 ± 35.2 minutes, 115.0 ± 20.8 vs 103.3 ± 17.3 mL, 13.7 ± 4.1 vs 12.0 ± 2.8 weeks; P < .005) and incidence of complication was lower for DTTHTO group. DTTHTO in patients with varus knee osteoarthritis has good clinical outcomes, and it can achieve a better postoperative alignment. Operation time and surgical trauma were also less in patients who underwent DTTHTO.
Background The aims of current study were to present the clinical outcomes in patients with pediatric tibia shaft fractures who were treated with unilateral external fixation combined with joystick for fracture reduction and describe the details of our technique. Methods We retrospectively analyzed the patients with pediatric tibia shaft fractures who were treated with unilateral external fixation combined with joystick for fracture reduction between July 2018 and March 2020. The clinical outcomes were evaluated. Results A total of 23 patients were included in the current study with the average age of 8.0 years (ranged 4–14 years). The average duration of hospital and follow-up were 5.9 days (ranged 4–8 days) and 17.4 months (ranged 8–27 months), respectively. At postoperative 3 days, the visual analog scale (VAS) score was 3.1 ± 1.43, which was significantly lower than the preoperative score of 7.3 ± 1.5. Of these, 2 cases showed redness and swelling of pin-tract and exudation at postoperative 1 month, who improved after oral antibiotics without causing fixation failure. The average time to full weight-bearing without crutches was 5.1 weeks (ranged 3–8 weeks). All patients achieved fracture healing and good functional recovery. No complications including fixation failure, reoperation, epiphyseal injury occurred, infection around implants, vessel damage, nerve damage, and limitation of joint movement were observed. The Johner-Wruh scores showed that 21 cases (91.3%) were “excellent” and 2 cases (8.7%) were “good.” Conclusions This procedure had advantages of simple operation, minimum trauma, early recovery of lower limb function, and no risk of complications. It may provide a new choice for children with tibia shaft fractures who require surgical treatment.
Background: A nail and cement spacer is one of the option for the reconstruction of the proximal humerus after tumor resection among prosthesis unaffordable patients. However, making the cement spacer anatomically match its replacement remains challenging. Presentation of case: A 12-year-old boy was diagnosed with osteosarcoma in the right proximal humerus by core needle biopsy. After preoperative neo-adjuvant chemotherapy, a wide resection was performed, and the defect was reconstructed with an anatomically matched cement spacer. The cement spacer was fabricated using 3D-printed moulds, which were made according to the mirror image of the left humerus based on CT data. The post-operative course was uneventful, and at the 12-month follow-up, the patient is able to move with only some restriction in abduction and upward lift. The MSTD score was 21. Conclusion: Fabrication of an anatomically matched cement spacer using 3D-printed moulds is a simple, inexpensive, and reproducible procedure for reconstruction complex bone defect.
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