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Objective:To compare the clinical efficacy between femoral neck system (FNS) and inverted cannulated compression screws (ICCS) in the fixation of adult femoral neck fracture.Methods:The clinical data were retrospectively analyzed of the 119 patients with femoral neck fracture who had received FNS or ICCS internal fixation at Department of Traumatic Orthopedics, West China Hospital from September 2019 to June 2020. They were divided into 2 groups according to their internal fixation methods. In the FNS group of 62 patients, there were 38 males and 24 females, with an age of (54.0±13.0) years, and 13 cases of type Ⅱ, 34 cases of type Ⅲ and 15 cases of type Ⅳ according to the Garden classification; in the ICCS group of 57 patients, there were 42 males and 15 females, with an age of (53.2±11.3) years, and 9 cases of type Ⅱ, 33 cases of type Ⅲ and 15 cases of type Ⅳ according to the Garden classification. The operation time, intraoperative blood loss, fluoroscopy frequency, hospitalization time, fracture healing time, Harris hip score and incidence of complications were compared between the 2 groups.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data or follow-up duration ( P>0.05). There were significant differences between the FNS and ICCS groups in fluoroscopy frequency [(8.8±2.9) times versus (15.6±3.4) times], operation time [(45.2±10.1) min versus (51.8±11.7) min], fracture healing time [(3.2±0.4) months versus (4.0±0.6) months], Harris hip score at the last follow-up [(91.8±4.4) points versus (84.6±3.3) points], and femoral neck shortening at the last follow-up, favoring the FNS group (all P<0.05). There were no significant differences in follow-up time, hospitalization time, intraoperative blood loss or incidence of complications between the 2 groups ( P>0.05). Conclusions:In the fixation of adult femoral neck fractures, compared with ICCS, FNS can significantly reduce fluoroscopy frequency, shorten fracture healing and operation time, reduce risk of femoral neck shortening and hospitalization time, and promote functional recovery of the hip.
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Due to the complex anatomical structure of ankle and the various mechanisms of ankle injury, manyeponyms and systematic classifications of ankle fracture have been developed in the past centuries. Before the emergence and constant improvement of classifications of ankle fracture, ankle fractures were most commonly named afterthe physicians who first described them. Now,these ankle fracture eponyms are still found in medical literature, textbooks and even mass media. Many special named ankle fractures can be explained by the Lauge-Hansen classification now, and they may have little practical use. However, it is still necessary to summarize and review these ankle fracture eponyms, in order to correct the wrong usage of these and to remember the sages in this field.We reviewed both common and less frequently used ankle fracture eponyms, focusing on imaging features to identify and differentiate these injuries. We also briefly reviewed the mechanism of each injury, associated complications, its diagnosis and treatment.
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Objective To compare elastic intramedullary nail (EIN) and plate-screw (P+S) system in the treatment of fibular diaphyseal fractures. Methods From January 2014 to April 2017, 48 tibiofibular fractures were treated with internal fixation using EIN (21 cases) or plate-screw (27 cases). The 2 groups were compared in terms of intraoperative blood loss, operative time, fibular healing time, fibular union rate, ankle function and postoperative complications.Results All the patients were followed up for 3 to 24 months (average, 14.0 months). The intraoperative blood loss (17.9 ± 4.9 mL), operative time (23.2 ± 5.8 min) and fibular healing time(10.3 ± 1.8 weeks)for the EIN group were significantly less than those for the plate-screw group (28.9 ± 9.6 mL, 30.0 ± 10.7 min and 11.6 ± 2.0 weeks)(P <0.05). There were no significant differences be-tween the 2 groups in fibular union rate(95.2% versus 92.6%) or incision infection(0 versus 7.4%)(P> 0.05) . The AOFAS ankle-hindfoot scoring revealed 12 excellent, 8 good and one fair cases (91.0 ± 5.3 points on aver-age) in the EIN group, and 14 excellent, 10 good and 3 fair cases(90.1 ± 6.1 points on average) in the plate-screw group, showing no significant difference between the 2 groups(P=0.594). Conclusions Compared with plate-screw system, elastic intramedullary nail for fibular diaphyseal fractures may be in line with the biome-chanical characteristics of the fibula and with the basic principles of minimally invasive surgery. It may be ad-vantageous in blood loss, operative time and fracture healing but not in fibular union rate or functional recovery of the ankle. An appropriate way of internal fixation for a fibular diaphyseal fracture should be chosen according to the specific conditions of the patient.
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Objective To evaluate open reduction and internal fixation (ORIF) combined with Ilizarov joint distraction in the treatment of comminuted talar body fractures.Methods Between July 2010 and May 2016,16 patients with comminuted talar body fracture underwent ORIF followed by ankle joint distraction by Ilizarov external fixator at our department.They were 9 males and 7 females,aged from 17 to 56 years (average,35.6 years).Radiological assessments were conducted by plain radiographs and computed tomography (CT) scans pre-and post-operatively.Clinical outcomes were evaluated according to visual analogue scale (VAS),American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score,the short form (SF)-36 health survey scores and patients' satisfaction.Results Two patients were lost to follow-up.The remaining 14 patients were followed up for an average duration of 33.3 months (from 13 to 52 months).All the fractures united.Superficial wound infection occurred in one case.Eight patients developed post-traumatic osteoarthris;4 patients presented with avascular necrosis.At final follow-ups,the AOFAS scores ranged from 30 to 97 points (mean,69.8 points),the VAS scores from 0 to 6 points (mean,2.5 points),the physical component summary in SF-36 from 18.0 to 55 points (mean,41.7 points),and the mental component summary from 40 to 70 points (mean,54.1 points).Two patients reported strong satisfaction,5 satisfaction,4 moderate satisfaction,and 3 dissatisfaction.Conclusion For comminuted talar body fractures,ORIF combined with Ilizarov joint distraction is a new and effective treatment which can not only provide adequate fixation strength but also reduce the incidence of post-traumatic osteoarthris or avascular necrosis.
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Objective To evaluate the clinical outcomes of treating Freiberg's disease with dorsal wedge osteotomy and Charlotte breakage screw fixation.Methods From June 2010 to June 2014,11 patients with Freiberg's disease were treated at our department.They were 5 males and 6 females at an average age of 32 years(range,from 15 to 52 years).X-ray revealed osteosclerosis and collapse of the metatarsal head.According to Smillie classification system,there were 5 cases of stage Ⅱ and 6 ones of stage Ⅲ.The duration of symptoms was from 7 to 48 months (average,23 months).The metatarsal heads were rotated to reconstruct the joint surface.After dorsal closed V-shaped osteotomy,Charlotte breakage screws were implanted.Results All wounds healed with no complications in the early postoperative period.The 11 patients were followed up for 14 to 48 months (average,19 months),showing obvious pain relief.X-ray showed that the osteotomy sites got solid union in all patients at an average time of 10 weeks (range,from 8 to 13 weeks) after operation.Average shortening of the metatarsal was 1.5 mm (range,from 1.1 to 1.8 mm).The American Orthopaedic Foot and Ankle Society(AOFAS) score,Lesser Metatarsophalangeal-Interphalangeal Scale(LMIS) score,and range of motion at one day,one month and one year after operation were significantly improved compared with the preoperative ones (P ＜ 0.05).Significant differences were also observed between all postoperative time points (P ＜ 0.05).No such complications happened as referred pain from the adjacent metatarsophalangeal joint,displacement,nonunion,necrosis or infection.All patients returned to sports and recreational activities at 6 months after operation,except one case of stage Ⅲ who had constant swelling in the metatarsophalangeal joint but eventually recovered at 10 months after operation.According to patients' satisfaction at the last follow-ups,including 7 cases were excellent,3 good and one poor.Conclusion Dorsal closed V-shaped osteotomy with Charlotte breakage screw fixation is an effective procedure for Freiberg' s disease of stages Ⅱ and Ⅲ,because it leads to effective reconstruction of the metatarsophalangeal joint,allows early joint motion and avoids a second operation.
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Deep venous thrombosis (DVT) is an important cause of disability and mortality after major orthopedic surgery. The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who require major surgery have not yet been well explored in Chinese clinical practice. Here we report a case of calf muscular venous thrombosis in a 55-year-old woman with femoral neck fracture before surgery. Preventive and treatment measures including the administration of heparin sodium, application of venous foot pump and placement of inferior vena cava filter were taken. The condition of the patient was stable during the perioperative period and the surgery was successful. Besides, postoperative examination showed that the femur healed well and the functional recovery was satisfactory. Our results suggest that femoral neck fracture patients combined with DVT can receive surgery after accurate preoperative assessment and proper preoperative treatment.
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Female , Humans , Middle Aged , Femoral Neck Fractures , General Surgery , Perioperative Care , Vena Cava Filters , Venous Thrombosis , TherapeuticsABSTRACT
Objective To evaluate the long-term efficacy of vascularized pisiform transfer for patients with Kienb(o)ck's disease in Lichtman stages Ⅲ-Ⅳ. Methods Eleven patients were reviewed to analyze results after lunate resection and vascularized pisiform transfer for Lichtman stages Ⅲ and Ⅳ. There were six men and five women. Age ranged from 20 to 67 years with a average of 41.0±14.3 years. According to Lichtman stage. There were 4 cases in stage Ⅲa, 5 cases in stage Ⅲb, and 2 cases in stage Ⅳ. Assessment criteria included subjective assessment of pain, visual analogue scale (VAS), range of motion (ROM), grip power,Cooney wrist score and radiographic changes on each follow-up visit. The radiographic changes including pis iform bone location, shape, sclerosis change, osteoarthritis, carpal height ratio, Nattrass index, Radioscaphoid angle and ulnar variance were recorded. Results The follow-up periods of all of cases were 61-202 months,with an average of 104.1 months. Pain had improved in 10 patients and disappeared in 7 cases. The VAS score was 2.2±1.9 at follow-up visit. Range of motion of injured wristw as only 65.3% of opposite side. Grip power was 84.3% of the contralateral hand. According to Cooney score, the results were excellent in 1 case, good in 7cases, fair in 2 cases and poor in 1 case, with the excellent and good rate of 72.7%. Radiologically, 8 cases had normal position of the pisiform bone, 2 had volar displacement and 1 had ulnar displacement which leaded to widen scaphopisiform space. Six pisiform bones had normal trabecular structure, three had degenerative changes. Bone sclerosis was seen in 2 cases and osteoarthritis was found in 3 patients. Compared with radiographic parameter before surgery, carpal height ratio and Nattrass index significantly lowered and radioscaphoid angle significantly increased. Conclusion Lunate resection and vascularized pisiform transfer is an effective method for Kienb(o)k′s disease in stages Ⅲ-Ⅳ. Although carpal collapse appeared postoperatively,the results show high patient satisfaction and good function after vascularized bone transplantation.
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Objective To determine the influence factors for limb salvage of bone fracture patients with hyperpotassemia caused by Wenchuan earthquake,to discuss the clinical symptom and to improve the clinical treatment. Methods The clinical symptom, drug therapy, limb incision decompression, hemodialysis, and limb salvage of hyperpotassemia caused by earthquake were analyzed by logistic regression. Results All the 37 patients received drug therapy: 9 patients received incision and decompression singlely,8 received hemodialysis singlely,and the other 20 received decompression and hemodialysis simultaneously. The concentration of potassium decreased from (6.25 ± 0.91) mmol/L to (4.47±0.65) mmol/L,with significant difference (P＜0.05).Five patients with Gustilo III grade open injury received amputation at the concentration of potassium of (6.13±(0.78)) mmol/L, while the concentration of potassium for the other 32 patients was (6.25±0.31) (mmol/L). There was no significant difference between them(P>0.05). Logistic regression analysis found the time of compression, the time before incision and decompression, and the time before hemodialysis were the main factors to affect limb salvage. The OR value of these factors was 4.394, 3.793 and 5.432;while the P value was 0.013, 0.047, and 0.015, respectively. Conclusion Decreasing the time of compression, appropriate incision and decompression, and hemodialysis help improve the result of limb salvage in hyperpotassemia patients with bone fracture caused by earthquake.
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Objective To investigate the clinical characteristics and therapeutic methods of bac-terial colonization and infection of Acinetobacter baumannii on the wound of earthquake induced patients. Methods A retrospective study was done on 42 Wenehuan earthquake induced patients with positive wound germiculture of Acinetobacter baumannii. There were 24 males and 18 females, at mean age of 37 years (12-96 years). Open injury was located at the upper arm in one patient, at the forearm in four, at the thigh in 12, at the calf in 23 and at the trunk in two. The time between injury and treatment varied from 3 to 7 days. The clinical characteristics including the bacteria identification and drug sensitivity test were studied to compare drug resistance to 15 antibiotics. Results Bacterial colonization of Acineto-bacter baumannii was found in 31 patients (8.2%) and infection of Acinetobacter baumannii in 11 (2.9%). After debridement, pruphylactic antibiotics and nutrition support, 15 patients with bacterial colonization were managed with Ⅱ stage suture or skin grafting. The other 16 patients were transferred to hospitals of other provinces after germiculture turned negative. Through debridement and drainage, antibi-otic therapy and nutrition support, the infection was controlled and the wound eliminated in six patients through Ⅱ stage suture but four were concomitant with pulmonary infection and one with septicemia. Drug sensitivity test showed that sensitive rate to imipenem, amikacin, levofloxacin, ticarcillin-clavulanic acid, tobramycin were 59.5%, 21.4%, 21.4%, 19.5% and 19.0% respectively. Conclusions The risk factors of infection of Acinetobacter baumannii include severe tissue trauma, severe wound contamination, delayed treatment and weak body resistance. During treatment, the bacterial colonization and infection of Acinetobacter baumannii should be distinguished and treated respectively. Correct wound treatment, suit-able antibiotic therapy and increased body resistance are key to improvement of clinical curative effect.
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Myoblast transplantation has been carried out for a certain period,but its efficiency in repairing inherited myopathy or severe muscular injury is not satisfactory.The improvements in myoblast culture,transplantation approach,recipient and cell preparation before transplantation,scaffold material and its selection,and body immunity can positively influence transplantation efficacy,and improve recipient function.In addition,these improvements influence the prospect of myoblast transplantation or cell-mediated gene therapy.
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[Objective]To discuss the injury severity and treatment of 236 patients with upper limb injuries in Wenchuan Earthquake.[Method]The basic informations of patients with upper limb injures in Wenchuan Earthquake,and the injury mechanisms,clinical symptoms and treatment were collected and analyzed.[Result]In 236 cases of patients with upper limb injuries,there were 208 patients,378 cases with fracture,and 64 cases with open fracture.There were 35 cases of clavicle fracture,31 cases of scapula fracture,113 cases of humerus fracture,46 cases of ulna fracture,87 cases of radial fracture and 66 cases of carpometacarpai phalangeal fracture.Fifty cases received debridement and suture,60 cases received fracture reduction and internal fixation and 7 cases received external fixation.Totally,19 limbs were carried on amputation,and only one patient died of hyperkalemia and combined injury.[Conclusion]Analysis of patients with injury mechanisms,clinical symptoms and treatment can provide advices for rescuing and treating of patients with upper limb injuries in earthquake or other disaster cases.
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[Objective]To assess the early diagnosis and treatment and outcome of patients with crush syndrome in earthquake disaster.[Method]We conducted a retrospective analysis of 27 patients with crush syndrome and subsequent acute renal failure (ARF) and wound complication who were treated in our university hospital.All of patients had been extricated from buildings that collapsed in the Wenchuan earthquake.Crush injury involved the upper extremities and low extremities.Each patient received intravenous fluids and diuretic drugs.Twenty-one patients received hemodialysis.Emergency fasciotomy performed in 11 patients and amputation were performed in 16 patients,4 to 102 hours after extrication.[Result]No patient died.Twenty-one patients among the ARF patients were retracted from hemodialysis.Among the patients who were performed fasciotomy or amputation,13 patients had wound complication including infection,however,the wounds in 10 patients were healed by dressing change,debridement and coordinate treatment with ICU and related subjectives.[Conclusion]Crush syndrome requires urgent recognition and prompt surgical treatment with simultaneous measures to control hyperkalemia and ARF.Wound healing is a difficult task for the crush syndrome patients.The authors believe that immediate intensive care therapy and multisubjective coordination would improve the survival rate.
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To evaluate the application of self-reinforced ploy-DL-lactide (SR-PDLLA) absorbable screws in the treatment of spongy bone and intra-articular fractures, the internal fixation with SR-PDLLA absorbable screw was performed on 58 cases,of which 25 were medial malleolus fractures, 14 condyle of humerus fractures, 9 tibial plateau fractures, 7 ulnar olecranon fractures, and 3 lateral malleolus fractures. Observations were made on the orthopaedic operation sites and overall conditions frequently and radiography was performed for periodic analysis. The results showed that SR-PDLLA absorbable screws were particularly effective and reliable, they had good biocompatibility in the treatment of spongy bone and intra-articular fractures and could be used safely in clinical practice.
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Absorbable Implants , Ankle Injuries , General Surgery , Bone Screws , Fracture Fixation, Internal , Fractures, Bone , General Surgery , Humeral Fractures , General Surgery , Internal Fixators , Lactic Acid , Chemistry , Polyesters , Polymers , ChemistryABSTRACT
<p><b>OBJECTIVE</b>To study the histocompatibility of three bio-derived bones.</p><p><b>METHODS</b>After treatment with different physical and chemical method, three bio-derived bones, the composite fully deproteinized bone (CFDB), partially deproteinized bone (PDPB) and partially decalcified bone (PDCB) were implanted into rabbits. The toxicity, immune response and subperiosteum osteogenesis of CFDB, PDPB and PDCB were studied through gross observation, serum antibody measurement, evaluation of local cellular immune response and HE staining.</p><p><b>RESULTS</b>The study showed that CFDB, PDPB and PDCB had no toxicity. They could conduct peripheral tissue to grow into them and had no harmful effect on subperiosteum osteogenesis. They could also promote cartilage and osteoid tissue derived from periosteum to calcify to new bone, and combine with the peripheral bone. The degree of immune response caused by them was in the sequence of PDCB > PDPB > CFDB.</p><p><b>CONCLUSIONS</b>The three bio-derived bones, CFDB, PDPB and PDCB have good histocompatibility.</p>
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Animals , Female , Male , Rabbits , Antibodies , Blood , Bone Transplantation , Bone and Bones , Allergy and Immunology , Histocompatibility , Histocompatibility Testing , Tissue EngineeringABSTRACT
To detect the properties of natural xenogeneic bone derived materials which were processed with different physical and chemical treatments, we made fully deproteinized bone(FDB), partially deproteinized bone (PDPB), partially decalcified bone(PDCB) from pig ribs. Their morphological features, constitute components and mechanical properties were examined by scanning electron microscopy, x-rays diffraction analysis, mechanical assay and so on. The results showed that FDB, PDPB and PDCB maintained natural network pore system. The ratios of calcium to phosphorus were 1.81, 1.74 and 1.50, and the protein contents were 0.01% +/- 0.02%, 22.41% +/- 0.83% and 35.75% +/- 2.12% respectively. The sequence of their mechanic strength was PDCB > PDPB > FDB. These data indicate that FDB, PDPB and PDCB possess natural network pore system. Their organic and inorganic component ratios and contents are different, so their mechanic properties are not alike. Additionally, more investigations will be necessary to detect the biocompatibility of the three different scaffold materials of natural derived bone.