ABSTRACT
Objective To investigate the structure and biomechanical property differences in different regions of the femoral head for elderly patients with femoral neck fractures,and to study its influence on internal fixation for fracture.Methods Twenty femoral head specimens were collected from elderly patients with femoral neck fracture after joint replacement.The femoral head was divided into 3 parts (lateral,inferior and medial region) with reference to anatomical markers on surface of the femoral head.After the position and drilling direction of the ring drill were determined,a circular drill was used to obtain the cylindrical cancellous bone columns with 10 mm in diameter and 10 mm in height.The data of cancellous bone columns in different regions were analyzed by Micro-CT scanning system,including bone volume fraction (BVF),trabecular space (Tb.Sp),trabecular thickness (Tb.Th),the number of trabecular number (Tb.N),the bone surface volume ratio (bone surface/bone volume,BS/BV),structural model index (SMI).Mechanical property differences of bone tissues in different regions were calculated by micro-finite element analysis.Results Bone mass in the elderly osteoporotic femoral head decreased,and there were significant differences in bone microstructure and mechanical properties in different regions of the femoral head.Bone microstructure and mechanical properties in medial region were obviously superior to those in lateral and interior region.Conclusions The bone structure and mechanical strength in medial region of the femoral head are obvious superior to those in lateral and inferior regions.The position for internal fixation should be fully considered during treatment of osteoporotic femoral neck fracture in clinic.
ABSTRACT
BACKGROUND:Proximal humeral fractures are commonly treated by open reduction and internal fixation, which greatly injuries tissue and noticeably damages local blood supply. However, with the development of material and progress of repair method, complications have obviously reduced. OBJECTIVE: To compare the difference of locking plate and ordinary steel plate in the repair of proximal humeral fractures. METHODS:A total of 68 patients with great displacement and comminuted proximal humeral fractures, who were treated in the Department of Orthopedics, Affiliated Tongren Hospital, Shanghai Jiao Tong University School of Medicine from February 2012 to October 2014, were enroled in this study. According to fixation method, they were divided into two groups. 32 cases in the locking plate group were subjected to locking plate, and 36 cases in the ordinary steel plate group received fixation with T type plate and Clover plate. They were folowed up at the out-patient clinic at 2, 4, 6, 12 and 24 weeks after treatment. The satisfaction rate of shoulder function treatment was assessed using Neer scoring system. They received reexamination before withdrawal of fixator. The incidence of complications was observed in patients. RESULTS AND CONCLUSION: The satisfaction rate was significantly lower in the ordinary steel plate group than in the locking plate group (75%, 81%,P < 0.05). No screw and plate breakage, shoulder seam impact,humeral head necrosis or infection was found in the locking plate group. Six cases suffered from pain. In the ordinary steel plate group, there were screw and plate breakage in five cases, shoulder seam impact in five cases, pain in eight cases, humeral head necrosis in two cases and infection in two cases. The incidence of complications was significantly greater in the ordinary steel plate group than in the locking plate group (P < 0.05). These data suggest that locking plate can be used as the first choice for internal fixation in treatment of proximal humeral fractures. No matter satisfaction rate of repair or complications, it is better than ordinary steel plate fixation.
ABSTRACT
BACKGROUND:Hip fracture has become one of the main reasons for morbidity, death and heavy medical costs in the elderly. With aging, the incidence of hip fractures in the elderly is increased day by day. OBJECTIVE:To investigate and analyze the incidence and distribution of hip fractures in middle-aged and old population from Changning District of Shanghai, China. METHODS:Medical records of patients with hip fracture ICD-9 CODE (femoral neck fracture and intertrochanteric fracture) admitted from July 2008 to June 2013 were col ected at the Changning District Public Health Information Center and Shanghai Shen Kang Medical Al iance Center. Population distributions of Changning District in 2010 and 2011 were provided by the Disease Control Center of Changning District. Then, the crude morbidity of hip fracture was calculated in terms of different ages and genders. For patients aged over 50 years, every 5 years served as an age group. RESULTS AND CONCLUSION:The incidence rate of hip fractures in the population aged over 50 years was 197.04/100 000, 88.51/100 000 in male and 304.73/100 000 in female. The annual standardized incidence rate of hip fracture was higher in female than male (P<0.05). The crude incidence rate of hip fracture was increased dramatical y in the population over 70 years, especial y in females. It indicates that the incidence rate of hip fractures is closed related to age, gender and osteoporosis.