OBJECTIVE:To compare therapeutic effects of single locking plates and locking plates with suture anchors in treating type Neer IIb distal clavicle fractures.METHODS:From January 2013 to January 2015, 40 distal clavicle fractures patients with Neer IIb were treated by retrospectively analyzed and divided into single locking plates (control group) and locking plates with suture anchors(observation group) according to methods of operation. There were 20 patients in control group treated by single locking plates, including 16 males and 4 females aged from 26 to 64 years old with an average of(40.60±12.64) years old; while there were 20 patients in observation group treated by locking plates with suture anchors, including 15 males and 5 females aged from 20 to 57 years old with an average of(37.30±10.56) years old. Length of incisions, operation time, blood loss, hospital stays, fracture healing observed by X-ray, position of internal fixation, and changes of coracoclavicular distance were compared, Constant-Murley score was used to evaluate shoulder joint function.RESULTS:All patients were followed up from 22 to 42 months with an average of (30.08±6.72) months. There was no statistical significance in length of incisions, operation time, blood loss, hospital stays and fracture healing time (P>0.05). Constant-Murley score in control group was 83.10±5.81, and lower than that of observation group (92.30±6.05)(P<0.05) at final following-up. Coracoclavicular distance in control group (11.22±3.85) mm, was longer than that of observation group (8.71±2.14) mm(P<0.05).CONCLUSIONS:Compared with locking plates, locking plates with suture anchors for type Neer IIb distal clavicle fractures has better shoulder joint, shorter coracoclavicular distance. It showed coracoclavicular ligament is an effectiveness method for treating Neer IIb distal clavicle fractures.

Objective To investigate the incidence and associated factors of rotator cuff injuries in patients surgically treated for proximal humerus fracture.Methods A retrospective investigation was conducted in the patients over 40 years old who had been surgically treated for proximal humeral fracture from April 10th 2017 to December 1st 2017 at Department of Traumatic Orthopaedics,Beijing Jishuitan Hospital.Intraoperative direct visualization was used to collect their clinical data concerning rotator cuff injuries in combination with proximal humeral fracture.All the data were analyzed to find the incidence,gender ratio,age distribution and fracture type distribution concerning rotator cuff injuries.Results A total of 143 eligible patients were included in this investigation.Their average age was 61.95 years and their male-female ratio 1:2.3.The incidence was 46.2％ (66/143) for all the rotator cuff injuries in proximal humerus fracture and 23.1％ (33/143) just for rotator cuff tears.There were no significant differences in age,male to female ratio or distribution of Neer fracture type between patients with rotator cuff injury and those without rotator cuff injury (P ＞ 0.05).There was no significant difference in the age and or distribution of Neer fracture type between patients with rotator cuff tear and patients without rotator cuff tear (P ＞ 0.05).The proportion of females in patients with rotator cuff tears (84.8％,28/33) was significantly higher than that in patients with no rotator cuff tears (63.6％,21/33) (P ＜ 0.05).There was no significant difference between different age groups of the patients in incidence of combined rotator cuff injury (P ＞ 0.05).Conclusions Concomitant rotator cuff injuries are relatively common in patients over 40 years old with a proximal humerus fracture.About half of the injuries may be simple wear or wear plus degeneration while the other half rotator cuff tear happening mostly in female patients.The incidence of concomitant rotator cuff injury may increase with the age of the patients with a proximal humerus fracture.

Objective To retrospectively compare the clinical effect of anatomically designed perpendicular and parallel double plates in fixation of intercondylar humerus fractures.Methods A complete follow-up was made on 45 patients treated with anatonic locking plates for intercondylar humerus fractures.Among them,26 underwent perpendicular double plate fixation (perpendicular group) and 19 parallel double plate fixation (parallel group).Mayo elbow performance score (MEPS)was performed at the last follow-up.All postoperative complications were documented as well.Results All fractures were healed without joint pain in the elbow.Arc of elbow flexion and extension,arc of forearm rotation,MEPS and rate of excellent/good outcomes between parallel and perpendicular groups were (100 ± 21) °vs (99 ±34)°,(164± 12)° vs (171 ± 16)°,(91 ± 6) points vs (91 ± 10) points,100％ vs 92％,respectively (P ＞ 0.05).Conclusions Both fixation methods are effective in treatment of intercondylar humerus fractures.Additionally,the surgeons can make a choice about fixation methods based on fracture pattern and individual condition of the patients.

目的 总结肱骨干骨折涉及或合并肱骨近端骨折时,采用髓内针治疗的效果.方法 采用髓内针治疗肱骨干骨折涉及或合并肱骨近端骨折19例,手术均采用闭合复位,近端锁定的髓内针固定.其中14例获得随访,随访9 ～38个月,平均23.5个月.复查时拍片判断骨折愈合情况,采用Constant-Merley绝对值评分方法评价术后疗效.结果 14例新鲜骨折均顺利愈合,平均愈合时间14.2周(10 ～20周),平均Constant-Merley绝对值86.8分(76 ～ 98分),平均前屈上举148.5°,其中优良11例,可3例.结论 髓内针是治疗涉及或合并肱骨近端骨折的肱骨干骨折可选的方法之一.

Objective To evaluate Stryker external fixator, DJD Ⅱ (Dynamic Joint Distractor Ⅱ), in treatment of elbow stiffness and instability. Methods Eleven patients with elbow stiffness and insta-bility were treated with DJD Ⅱ. Follow-up was completed in 9 of them, 8 males and 1 female. Their average age was 39.6 (21 to 52) years. The injury involved the left side in 3 cases and the fight side in 6; the upper limb on the dominant side in 7 eases and the upper limb on the non-dominant side in 2. Four cases had post-trauma stiffness of the elbow, 2 triad of the elbow, and 3 elbow dislocations combined with various fractures. Results The average follow-up time was 6.67 months. In the 4 cases of elbow stiffness, the mean ROM was 30.0°+ 15.8° before operation and 112.5°+ 13.2° after operation; the mean Mayo elbow score was 41.3 + 13.2 before operation and 83.8 ±2.5 after operation, Both showed a significant difference ( P ＜ 0.05) . In the other 5 eases, the average ROM of the elbow flexion-extension was 108° and the mean Mayo elbow score was 85. Totally, 2 cases were excellent, 6 good and 1 poor. Slight complications were observed in only 2 cases. Conclusion The Stryker DJD Ⅱ can obtain favorable effects in treatment of patients with elbow stiffness or unstable fracture dislocation.