Bolt through plastic compression plate internal fixation for the treatment of femoral intercondylar fractures Huang Xingli, Zhang Zeping, Tan Ping Yang Pingba County Guihang Group 303 Hospital, Guizhou Ping gauge should be the lower end of the compression plate for the treatment of femoral intercondylar bone dissection After treatment of 37 patients with intercondylar fractures of the femur, the results were excellent in 21 cases, good in 8 cases, fair in 4 cases, and poor in 4 cases. The excellent and good rate accounted for 7 cases. Conclusion Femoral intercondylar fractures should be treated with early surgery. It is simple and convenient to treat the intercondylar fractures of the femur with bolts through plastic compression plate internal fixation. Good curative effect Femoral intercondylar fracture is a common injury of the knee joint. The fracture line passes through the articular surface. It is not easy to be reset after fracture. It is not easy to maintain the position after the reduction and the concomitant ligament collateral ligament meniscus injury. If you do not get timely and correct treatment, you are not satisfied.
General information on the clinical data from our department during the 199 years such as 1999, treated 37 cases of femoral intercondylar fracture patients, 18 cases Kuang fractures, fractures in 15 cases, tomb-shaped fractures in 8 cases, more than four large blocks of fracture in 6 cases , combined with cross early or meniscus injury in 4 cases, 7 cases of open fractures. After the surgical operation to when continuous epidural anesthesia, the knee injury lateral incision, the incision through the distal end of the tibial tuberosity joint line distal end, the patella turned inwardly to expose the fracture, the fracture test satisfied end Kirschner wire has first to drill into the fracture fixation end, the compression plate femoral condyle shaping by bending, so that it is attached with the same femoral condyle, the lowermost plate between the bolt holes through the femoral condyle is fixed, then the plate on the condyle screw with fixed, as more severe condylar pulverized, to add fixed lag screw. In the operation, if there is a tibiofibular fracture, the cruciate ligament is damaged. For meniscus injury, the tibial tension band is fixed and the cruciate ligament is fixed. Meniscus repair or resection of severely broken meniscus after placement of drainage tube, long leg plaster support fixed knee flexion 2,21 after removal of drainage tube, 2, after removal of plaster support for non-weight-bearing exercise results 37 patients after surgery respectively 5 Follow-up for 2 months, according to. Yi-articular fractures paint evaluation criteria 1 21 cases superior. Good 8 cases. There were 4 cases, 4 cases were poor, and the excellent rate was 78. The 8 cases with unsatisfactory curative effect were mainly discussed. The mechanics of the paint was analyzed. When the muscles around the patellofemoral joint contracted, the femoral condyle was subjected to stress from the humerus and tibia. When the knee joint is extended to the flexion, the force between the bone and the patellofemoral joint is increased. The joint force of the two stresses is due to the fact that the tibia acts as a wedge, which makes the femoral condyle easily fracture 2!
Femoral intercondylar fractures are treated with traction, closed reduction and other conservative treatments, often without effect. First, the structure of the femoral condyle is more complicated. The calf and intestines of the medial and lateral collateral ligaments are attached to the internal and external iliac crest, and the cruciate ligament is also attached to the internal and external bone and articular surfaces. Due to the complexity of the traction of the soft tissue attached to the femoral condyle, it is difficult to achieve anatomical reduction after traction or closed reduction of the femoral condyle fracture, which may lead to traumatic arthritis. Secondly, the dislocation bleeding at the fracture end occurs in the knee joint. It affects the supraorbital sac or between the femoral head and the femur. It needs long-term treatment after traction or plaster fixation, which is prone to adhesion of the knee joint sliding structure. The joint activity is limited and stiff; again, the meniscus and cruciate ligament in the knee are important components of the knee joint function, and the intercondylar fracture of the femur is often accompanied by meniscus or cross initial injury. Therefore, from the above perspective, the intercondylar fracture of the femur should be anesthetized and restored in the early stage, clearing the intra-articular hemorrhage and small broken bones for strong internal fixation. If the cruciate ligament and meniscus injury are found during surgery, it should be repaired in time. There are a variety of internal fixation methods for intercondylar fractures of the femur. Often fixed inside the angle plate. For example, the nail is fixed by a nail, and the screw is passed through a plastic plate fixing bolt through a shaped compression plate and a simple Kirschner wire and a wire screw.
The steel plate is at 95 degrees. To ensure fracture; stable. But surgery requires high technology.
The plate should be accurate in a plane position, otherwise the fracture end flexion varus or external malleolus deformity may result in the operation of the sacral fracture, and the heavier comminuted fracture is not securely fixed. Pain at the end of the needle, easy to infect 4. Simple wire screw, Kirschner wire and other fixation effects are not good, have to be fixed with a long time plaster, functional exercise can not be carried out early, knee function recovery is not ideal lag screw through the shaping plate The internal fixation adaptability is simple and convenient to use, but the connection between the steel plate and the screw is prone to loosening or even breaking, and it is difficult to maintain the stability of the fracture. 2 The patient who has been treated by this method has internal fixation looseness due to the bolt. The pressurization of the distal nut can pressurize the intercondylar fracture end more closely, and the compression plate can be loosened after being screwed. The patient does not need long-term external fixation, and can perform functional exercise early to reduce the occurrence of knee stiffness. Among the 37 patients treated in our department, none of the patients with internal fixation loosening and fracture has excellent knee function recovery. It can be concluded that the intercondylar fracture of the femur should be treated with early surgical incision and internal fixation. The internal fixation of the bolt through the shaped compression plate is a kind of internal fixation method with convenient adaptability, simple and convenient use, and excellent curative effect. I Qiu Yiyi, Liu Shan. Shang Jianzhang. Wait. 1 shape 5 圮 money Guan Wei, the application of the fold. The ugly order is the magazine of the loss. 19917295.23 Wang Yiwei, Meng Jiyu, Guo Ziheng. Bone and joint damage the elbow. The second edition, Beijing People's Medical Publishing House, 1990.674677.
4 money use, Jiang Jinghui. Internal fixation for the treatment of femoral condyle fractures in 62 cases reported in the Journal of Practical Orthopaedics, 1999, 54237.
Received date 2001548 clavicular mid-section fracture internal fixation treatment 32 cases Guo Shinan, Wu Changchun, Zheng Longpo. Huang Hong Department of Orthopaedics, 100 Hospital of PLA, Suzhou, Jiangsu 215007, China From July 1994 to July 1999, 120 patients with clavicular fractures were treated, including 32 cases of mid-clavicular fixation of the mid-clavicular fracture, accounting for 26.6 of the same period, achieving satisfactory results. The report is as follows, 20 cases on the data and method side, and 12 cases on the right side. The age is 1465 years old, with an average age of 21. There were 17 cases of car accident injuries, 10 cases of sports injuries and 5 cases of slipping. There were 15 cases of comminuted and 17 cases of oblique shape. There were 26 cases of fresh fracture, 6 cases of old injury, 2 cases of neurological symptoms, 1 case of basil artery weakening, 1 case of open injury, 1 case of Kirschner wire fixation, 3 cases of Kirschner wire and wire fixation, and 9 For example, 19 cases of Sterling needle plus wire fixation.
The treatment method is to take the supine position in the supine position and the head to the healthy side. Make a hemp at the clavicle fracture end, make about 46 along the clavicle, incision, expose the two ends of the fracture, scrape the broken end embedded tissue and blood clot, try to reset, the fracture end is well, then dislocation, take the intramedullary needle 1 The larvae are inserted into the medullary cavity of the lateral bone, and the cortical bone of the lateral arc of the clavicle is passed through the skin of the shoulder and back to repair the fracture, and then the steel needle is reversely inserted into the medial fracture end cavity. Drill 5 straight through the cortical bone of the medial segment of the clavicle. The outer end of the steel needle is bent, the excess part is cut off, and the outer end of the steel needle is embedded in the skin 5. For the middle section oblique or comminuted fracture. It was necessary to be reinforced with steel wire, and the horns were suspended for 28 months after operation. After the fracture was healed, the internal fixation was performed, and the internal fixation was taken out for an average of 3 months. There was a case of nonunion, bone healing was obtained by reoperation, and 2 cases of lateral needle infection did not affect healing. According to the shape of the shoulder, the function of the shoulder joint, the disappearance of pain, and the healing of the line fracture evaluate the effect 1!
Among the 32 cases, 28 cases were excellent, 1 case was good, 2 cases were fair, and 1 case was poor. The excellent and good rate was 90.65. The discussion was small and the operation was simple. The disadvantages were that the reset was inaccurate and re-shifted. The fixation time was long, which affected the shoulder joint function. The indications for the treatment of clavicular fractures are relatively strict. Combined with neurovascular damage. Displacement of the medial end and penetration of the trapezius muscle cause soft tissue embedding between the fracture ends; open or multiple injuries; non-surgical treatment can not improve the severe displacement of the fracture; that is, with the improvement of people's living standards, life rhythm The acceleration of this type of proximal body fracture of the clavicle fracture requires anatomical reduction, firm fixation, and more attention to the function of the fracture after surgery, so that the report of internal fixation for the treatment of clavicular fracture has gradually increased in recent years. Tension band fixation is suitable for the treatment of fractures of the distal clavicle. 4. Steel snails have also been reported. Recalling the gold inside fixed è…½. Uniform storage of steel, over 7 and poor toughness, extensive peeling of periosteum, affecting bone healing, etc. Some scholars recommend high-strength toughness and pre-finishable materials, blunt titanium plate nails 3. Have superiority 1. Like price 1 report More intramedullary nails fix the fracture of the clavicle. The advantage is that the incision is small, the membrane is not peeled off, and the operation is simple and convenient. The impact on Guanji function is small. Ice points; observation of complications, but can not rule out the human factors in the surgical procedure.
Pay attention to the following points during surgery. The choice of intramedullary needle should be thick enough to fill the medullary cavity and not slip, strong enough to not bend. For adults, the diameter is 4 steel needles. In this group of 1 case, the Kirschner wire of 2 was selected. Because the needle was too thin, the horn was removed after 2, and the upper limb was drooping, causing the Kirschner wire to bend and fix the sputum. For oblique fractures, split fractures, comminuted fractures, as far as possible free of bone fragments. In this group, 22 cases were bundled with steel wire, which was reliable and easy to operate. The steel needle and bone piece were used to stab the subclavian vascular nerve and pleura. The inner needle end should penetrate the cortical bone, so that the fixation can be more secure, but it can not be worn out. Too long, so as not to puncture the skin to cause infection; the outer needle tail is bent into 90 and buried under the skin. In this group, 2 cases of needle-end infections were not enough at the end of the needle, buried under the skin too shallow, piercing the skin and causing local infection
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