Background: Patella fractures treated with traditional open approach and tension band fixation are associated with a significant rate of soft tissues complications, including hardware irritation, postoperative adhesions and non-cosmetic scar. An alternative is to utilize cannulated screws and high-strength sutures by the minimally invasive technique. Methods: This retrospective study comprised 48 patients who had been treated for unilateral closed transverse patellar fracture, type 34C1 according to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, between June 2018 to June 2020. All patients were treated either by closed reduction and internal fixation using cannulated screws combined with high-strength sutures and Nice knots (the CRIF-NK group, n=24), or traditional open reduction and internal fixation using cannulated screws and tension band wiring (the ORIF-TBW group, n=24). The operative time and intraoperative blood loss for each patient were recorded. All the patients were underwent a regularly clinical and radiological follow-up. The clinical evaluation was performed using the Böstman scale and the Visual Analogue Scale (VAS) for pain.Results: Average follow up was 21.9 months (range, 16-29 months). The mean intraoperative blood loss of the CRIF-NK group (35.21±6.16 mL) was significantly less than that of the ORIF-TBW group (75.42±7.92 mL; P<0.001). The mean VAS scores at 4 and 8 weeks and the mean Böstman scale score at 8 weeks after surgery were significantly better in the 1.47±0.40 and 28.13±0.94, respectively) than the ORIF-TBW group (5.16±0.68, 3.14±0.72 and 26.33±1.00, respectively; all P<0.001). No significant differences were observed between the two groups in terms of operative time, Böstman scale score at 1-year follow-up, or fracture healing time. The union rate was 100% (24/24) in both groups. One patient (1/24) in the CRIF-NK group, and all patients (24/24) in the ORIF-TBW group required internal fixation removal. Conclusions:The percutaneous minimally invasive technique using cannulated screws combined with high-strength sutures and Nice knots exhibited some superiority to traditional open reduction with cannulated screws and tension band wiring for treatment of transverse patellar fractures in terms of efficacy and safety by reducing soft-tissue stimulating complications and promoting functional recovery.
Background: The application of free skin flaps to repair severe peri-knee soft tissue defects is a common clinical approach. This article aims to investigate clinical efficacy and precautions of using a free anterolateral thigh flap with the descending genicular vessels as a recipient pedicle for repairing Gustilo IIIB and IIIC soft tissue defects around the knee.Methods: We retrospectively analyzed the data of the patients with severe peri-knee Gustilo IIIB or IIIC soft tissue defects operated on from January 2015 to December 2019. All patients underwent repair of the severe soft tissue defect using anterolateral thigh flap transplantation with the descending genicular vessels as the recipient pedicle.Results: All patients completed effective follow-up for an average of 14.1 [6-30] months. For two patients with larger flaps, necrosis occurred in the distal tip of the flaps, 6 cm and 4 cm in size. The necrotic flaps were removed, and the wound healed after skin grafting. In the other 12 patients, the skin flaps fully survived.Conclusions: Using a free anterolateral thigh flap with descending genicular vessels as the recipient pedicle to repair Gustilo IIIB and IIIC soft tissue defects around the knee is a convenient and preferred technique that can achieve satisfactory efficacy.
Despite advances in Masquelet techniques of bone transfer, complex lower extremity trauma reconstruction remains a challenge. Herein, we present the use of a modified version of the Acute Masquelet technique to treat Grade III open fractures of the lower extremity. This modification can reduce the treatment period and complications of external fixation. We aimed to assess the outcomes of this technique for open fractures with bone and soft tissue defects. Between January 2018 and March 2021, 20 patients with Gustilo grade IIIB/C open fractures were treated with an antibiotic cement-coated locking plate as a temporary internal fixator during the initial surgery stage. Thorough debridement was performed in the emergency department, and temporary internal fixation was performed with a 3.5-mm system antibiotic cement-coated locking plate. Ten patients required free bone fragment removal, followed by bone cement packing. The final stage involved internal fixation and wound repair with a free anterolateral thigh flap. Clinical and imaging results were retrospectively analysed. The repair time ranged from 1 to 7 days. All flaps survived. Two patients experienced wound infection, and one developed severe bone infection 3 months after three-stage bone graft surgery. Autologous cancellous bone grafting was performed on ten patients with bone defects 6 weeks after surgery. Bone union was universally achieved after 1 year. This method proved to be safe and effective, with the repair of Grade III open fractures of the lower extremity achieved 1 to 7 days after treatment.
Background The treatment of completely displaced midshaft clavicle fractures is still controversial, especially Robinson 2B fractures. Titanium elastic nail (TEN) fixation is a good option for simple fractures, but there are no reports on its use in complex fractures. The aim of this study was to present a surgical method using the Nice knot-assisted TEN fixation to treat Robinson 2B midshaft clavicular fractures.Methods A retrospective analysis of 29 patients who underwent fixation with TEN and had a 1-year postoperative follow-up between 2016 and 2020 was performed. The fractures were classified as Robinson type 2B1 in 17 cases and type 2B2 in 12 cases. Length of the incision, postoperative shoulder function, Disability of Arm Shoulder and Hand (DASH) score, complications, and second surgical incision length were recorded.Results The length of the incision was 2–6 cm (mean, 3.7 cm). All incisions healed by first intention, and no infection or nerve injury occurred. The Constant score was 92–100 (mean, 96) and the DASH score was 0-6.2 (mean, 2.64). ESIN bending and hypertrophic nonunion occurred in one case (3.4%) and implant irritation occurred in four (13.8%) after operation. Internal fixators were removed at 12–26 months (mean, 14.6 months) after operation, and the length of the second incision was 1-2.5 cm (mean, 1.3 cm).Conclusions Intramedullary clavicle fixation with TEN is an ideal surgical technique. Nice knot-assisted fixation effectively stabilizes multifragmentary fractures, thereby achieving fracture healing. Surgeons should consider this technique in cases of Robinson 2B midshaft clavicular fractures.Trial registration: Retrospectively registered. This study was approved by the Ethics Committee of Wuxi Ninth People's Hospital (LW20220021).
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