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Fractures are mostly caused by direct or indirect external forces and may lead to death in worsened situations. Timely and accurate diagnosis of fractures is critical in determining the severity of injury. Medical imaging is an important diagnosis and evaluation tool for fractures, but uncertain imaging, excessive images and doctors′ subjective reading will weaken diagnosis efficiency and affect subsequent treatment. Whereas, fracture diagnosis models based on deep learning technology can effectively reduce missed diagnosis and misdiagnosis caused by unclear fracture imaging, showing good diagnostic potential. The authors reviewed the deep learning technology and its application in fracture diagnosis, hoping to offer new ideas for the research and application of deep learning technology in fracture diagnosis.
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Objective:To explore the feasibility and advantages and disadvantages of local anesthesia for TiRobot-assisted removal of sacroiliac screws by comparison with general anesthesia for TiRobot-assisted removal of sacroiliac screws.Methods:A retrospective study was performed in 39 patients with posterior pelvic ring fracture-dislocation who had undergone removal of percutaneous sacroiliac screws after fracture union from January 2017 to December 2020 at Department of Orthopaedic Surgery, Hospital Affiliated to Chengdu University. Their sacroiliac screws were removed with TiRobot assistance under local anesthesia (LA group) or general anesthesia (GA group). In the LA group of 18 cases, there were 10 males and 8 females, aged (43.3 ± 8.4) years (from 25 to 58 years); in the GA group of 21 cases, there were 12 males and 9 females, aged (44.9 ± 9.0) years (from 23 to 60 years). The 2 groups were compared in terms of time for planning screw removal path, fluoroscopy frequency, fluoroscopy time, operation time, anesthesia time, anesthesia cost, postoperative visual analogue scale (VAS) and postoperative ambulation time.Results:There was no statistically significant difference in baseline data between the 2 groups, showing comparability ( P>0.05). Follow-ups revealed grade A wound healing in all patients. There were no significant differences between the 2 groups in time for planning screw removal path, fluoroscopy frequency, fluoroscopy time or operation time ( P>0.05). The anesthesia time [(41.6 ± 8.3) min], anesthesia cost [(653.5 ± 102.6) yuan] and postoperative ambulation time [(2.6 ± 0.6) h] in the LA group were significantly less than those in the GA group [(52.3 ± 9.5) min, (2,475.6 ± 261.8) yuan and (8.7 ± 2.4) h] while the VAS score in the former group (3.8 ± 1.5) was significantly higher than that in the latter group (2.5 ± 1.3) (all P<0.05). Conclusions:It is feasible to use local anesthesia for TiRobot-assisted removal of sacroiliac screws. In TiRobot-assisted removal of sacroiliac screws, compared with general anesthesia, local anesthesia may lead to shorter anesthesia time, lower anesthesia cast and shorter ambulation time, but the patients need to be compliant enough.
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Objective@#To study the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fracture and construct a risk assessment model.@*Methods@#A retrospective analysis was performed on 251 patients with intramedullary nail fractures of the femoral subtrochanteric fracture from February 2006 to January 2018. According to the different treatment time, the 251 patients included in this study were divided into the modeling group and the verification group. In the modeling group, postoperative fracture nonunion rate, general data, fracture related factors, surgical reduction related factors, mechanical and biological factors were calculated, and the influencing factors of fracture nonunion were screened by univariate analysis. Indicators with statistical differences in univariate analysis were analyzed using Logistic regression model for multivariate analysis to build the risk assessment model. The influencing factors were re-evaluated through the verification group, and the differentiation and calibration of the model were evaluated.@*Results@#Fracture nonunion occurred in 34 of 149 patients in the modeling group. Among the 13 potential influencing factors, univariate analysis and logistic regression analysis showed that postoperative hip varus, intramedullary nail fixation failure and complete open reduction were the risk factors of fracture nonunion. Postoperative reduction of medial cortex was a protective factor for fracture nonunion, and a regression equation was established. Based on the logistic regression model, the Nomogram diagram was drawn. In the verification group, fracture nonunion occurred in 24 of 149 patients. The area under the ROC curve was AUC=0.883>0.7, indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation. The goodness of fit test: the H-L test (χ2=2.921, P=0.712) showed that the model had a good calibration.@*Conclusion@#The risk factors of fracture nonunion were hip varus, failure of intramedullary nail fixation and complete open reduction after intramedullary nailing of subtrochanteric fracture, and postoperative reduction of medial cortex was the protective factor. The risk assessment model has moderate differentiation and good calibration, which can provide reference for the risk assessment of fracture nonunion after subtrochanteric fracture operation.
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Objective To study the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fracture and construct a risk assessment model.Methods A retrospective analysis was performed on 251 patients with intramedullary nail fractures of the femoral subtrochanteric fracture from February 2006 to January 2018.According to the different treatment time,the 251 patients included in this study were divided into the modeling group and the verification group.In the modeling group,postoperative fracture nonunion rate,general data,fracture related factors,surgical reduction related factors,mechanical and biological factors were calculated,and the influencing factors of fracture nonunion were screened by univariate analysis.Indicators with statistical differences in univariate analysis were analyzed using Logistic regression model for multivariate analysis to build the risk assessment model.The influencing factors were re-evaluated through the verification group,and the differentiation and calibration of the model were evaluated.Results Fracture nonunion occurred in 34 of 149 patients in the modeling group.Among the 13 potential influencing factors,univariate analysis and logistic regression analysis showed that postoperative hip varus,intramedullary nail fixation failure and complete open reduction were the risk factors of fracture nonunion.Postoperative reduction of medial cortex was a protective factor for fracture nonunion,and a regression equation was established.Based on the logistic regression model,the Nomogram diagram was drawn.In the verification group,fracture nonunion occurred in 24 of 149 patients.The area under the ROC curve was AUC=0.883 ＞ 0.7,indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation.The goodness of fit test:the H-L test (x2=2.921,P=0.712) showed that the model had a good calibration.Conclusion The risk factors of fracture nonunion were hip varus,failure of intramedullary nail fixation and complete open reduction after intramedullary nailing of subtrochanteric fracture,and postoperative reduction of medial cortex was the protective factor.The risk assessment model has moderate differentiation and good calibration,which can provide reference for the risk assessment of fracture nonunion after subtrochanteric fracture operation.
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CT three-dimensional reconstruction has been widely used in the diagnosis and classification of fractures. Fracture mapping based on the CT three-dimensional reconstruction can visually display the morphology of fracture lines by drawing a fracture model, showing the starting and ending points, progress and area of the fracture lines. It provides a new method for diagnosis and classification of fractures, operative plan and design of implants for fractures, statistic analyses of predominant fracture sites, and developing standardized fracture models. This review gives a brief introduction of the research progress at home and abroad in fracture mapping for scapular fracture, pilon fracture, ulnar coronoid fracture, tibial plateau fracture, radial head fracture, intertrochanteric lateral wall fracture and acetabular quadrilateral surface fracture, summarizes the likely sites in the above fracture models and clinical application of fracture mapping in fracture classification, and discusses the prospects and problems of this technique in clinical application.
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Objective To explore the significance of proximal femoral medial wall plating by finite element analysis of the stability after medial wall fixation of the proximal femur in all types of 6-part classification of femoral intertrochanteric fractures.Methods Finite element method was used to establish models of 7 types of 6-part classification of femoral intertrochanteric fractures which were fixated with proximal femoral nail anti-rotation (PFNA),medial wall plating (bi-cortex),PFNA + medial wall plating (uni-cortex).The boundary conditions and material properties were defined according to the data published in literature.A load of the peak hip stress was applied in simulation of a normal adult of 70 kg in weight walking.The conditions above produced the Von Mises stress diagrams and Min Principal stress distributions of the normal femur for 21 groups of internal fixation models.The stability of the model was assessed by analyzing the peak stress value of the key part and fragmental displacements in each group.Results In 7 types of fractures fixated with PFNA,the changes in stress and fragmental displacement were small for all major femoral parts while the fragmental displacement increased in the greater trochanter.In the medial wall plating,the stress increased obviously with the increase in bone fragments,especially the lateral ones,for the significant femoral parts and internal fixation,and the fragmental displacements increased greatly but the displacement was always limited for the medial fragments.In the fixation with PFNA + medial wall plating,the stress changes and fragmental displacements for significant femoral parts were the smallest of the 3 fixation methods.Conclusions Proximal femoral plating can effectively reduce stress concentration at the proximal femur and provide better support for the medial wall of the proximal femur.For unstable fractures,PFNA plus medial plating may provide rigid fixation because it better reduces stress on the femur than simple PFNA,does not increase fragmental displacements and leads to no significant abnormal changes in internal fixation structure.
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Objective To explore the advantages and security of orthopaedic TiRobot used to assist internal fixation with sacroiliac lag screws.Methods From December 2015 to August 2017,11 patients with fracture of pelvic posterior ring or sacroiliac separation were treated by internal fixation with sacroiliac lag screws assisted by an orthopaedic TiRobot at Department of Orthopaedic Surgery,Affiliated Hospital to Chengdu University.They were 7 men and 4 women,aged from 23 to 61 years (average,42.5 years).According to AO classification,there were one case of type B1.2,one case of type B2.2,6 cases of type C1.2,2 cases of type C1.3 and one case of type C2.3.The number of sacroiliac lag screws inserted,time for planning insertion approaches,fluoroscopy frequency,fluoroscopy time,exposure time of C-arm X-ray,operation time,blood loss and reduction quality were documented.Results The 11 patients were followed up for 5 to 22 months (average,9.5 months).A total of 15 sacroiliac screws were inserted.In the operations,time for planning insertion approaches averaged 8.5 minutes (from 9 to 25 minutes),fluoroscopy frequency 8.5 times (from 4 to 15 times),fluoroscopy time 5.5 minutes (from 3.2 to 6.5 minutes),exposure time of C-arm X-ray machine 5.8 seconds (from 2.4 to 16.3 seconds),operation time 34.5 minutes (from 25 to 45 minutes),and blood loss 35 mL (from 10 to 80 mL).All the screw positions were satisfactory,with no penetration into the sacral canal,sacral foramen or bone cortex.No postoperative neurovascular injury happened.All the incisions primarily healed.All the fractures united well after 4 to 7 months (average,5.6 months),without any screw loosening.By the Matta scoring for fracture reduction,9 cases were excellent,one was good and one fair.By the Majeed functional scoring for pelvic fractures,8 cases were rated as excellent and 3 as good at the last follow-up.Conclusion Orthopaedic TiRobots can be used to assist internal fixation with sacroiliac lag screws in the treatment of pelvic posterior ring injuries,with advantages of limited invasion,time,hemorrhage,and high safety and accuracy as well.
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Objective To analyze the stability of six-part intertrochanteric fractures fixated with proximal femoral nail antirotation(PFNA),dynamic hip screw(DHS) and percutaneous compression plate(PCCP).Methods The finite element models of six-part intertrochanteric fractures fixated with PFNA,DHS and PCCP were established.According to the literature data,the boundary conditions and material attributes of the models were set.The peak moments of hip force were loaded in simulation of normal walking of a 70 kg adult.Using the above-mentioned conditions,finite element analysis resulted in 21 groups of stress and deformation figures of internal fixation models.The stress peak values and displacements of each fracture block in the important parts of each model were analyzed.The stability of each fracture model after fixation with different internal fixators was analyzed.Results After PFNA fixation,no obvious stress concentration was observed in all the important femoral structures.The stress was decreased on the proximal medial femur,distal medial femur and lateral femur in all types of fracture.There was no obvious stress concentration in the femoral screw holes.In all types of fracture,PFNA fixation led to smaller displacement amplitude of each fracture block and slightly increased displacement of each fracture block of the greater trochanter.After DHS fixation,the stress on the medial proximal end in all types of fracture was significantly increased and the stress on the other important femoral sites was reduced to a certain extent.In DHS fixation for all types of fracture,the displacement amplitude of each femoral fracture block increased with the increase of fracture mass.In terms of displacement amplitude,anterior lateral wall>lesser trochanter>posterior medial wall.After PCCP fixation,there was no obvious stress concentration in all important femoral structures.The stress on the medial part of proximal femur was increased while the stress on the other important femoral sites was reduced to a certain extent.In PCCP fixation for all types of fracture,the displacement amplitude of each fracture block increased with the increase of fracture mass.In terms of displacement amplitude,lesser trochanter>posterior medial wall>anterior lateral wall.Conclusions In fixation of intertrochanteric fractures with unstable medial wall,DHS>PCCP>PFNA in terms of hip varus and failure of internal fixation.For the fracture type of lateral wall rupture,DHS fixation may be unsuitable.PCCP may be suitable for two-,three- and four-part fractures of the femur.
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Objective@#To investigate the distribution characteristics of the fracture lines on the posteromedial wall by mapping the femoral intertrochanteric fractures involving the posteromedial wall on 3D CT.@*Methods@#A retrospective study was conducted of the 136 patients with femoral intertrochanteric fracture who had been treated at Department of Orthopaedics, Affiliated Hospital to Chengdu University from January 2009 to October 2018. They were 57 men and 79 women with an average age of 64 years (from 48 to 81 years). By the AO classification, 101 cases were type 31-A2 and 35 type 31-A3. Their CT data were collected for 3D reconstruction. By comparing the specific markers on the femoral shaft and lesser trochanter, the 3D CT reconstruction images were superimposed and orientated to the standard models of intertrochanteric posteromedial wall to create a map of the fracture. The width, height, area, and fracture deviation angle of the fracture of posteromedial wall were measured to characterize the distribution of the fracture lines.@*Results@#In the 136 femoral intertrochanteric fractures involving the posteromedial wall, the height of the posteromedial wall fracture was 48.76±4.11 mm, the width 29.78±3.29 mm, the area 1,468.47±75.26 mm2, and the fracture deviation angle 49.93°±13.05°. The fracture area ratio (fracture area/posteromedial wall area) was 38.34%±16.58%. On the map of the posteromedial wall fracture, the fracture lines were densely distributed in the lesser trochanter and in front of it. In the fractures of type 31-A2, the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and below it, going obliquely from anterosuperior to posteroinferior to affect the lower calcar femorale. In the fractures of type 31-A3, the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and above it, going obliquely from anteroinferior to posterosuperior to affect the upper calcar femorale.@*Conclusion@#The fracture map can help visual understanding of the intertrochanteric fracture involving the posteromedial wall, and provide further characterization of the posteromedial wall fracture in the fractures of AO types 31-A2 and 31-A3.
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In view of problems such as students in clinical orthopedic practice lack of basic theoretical knowledge and practical ability, both teachers and students' lack of preparations for clinical practice and their insufficient attention etc., this paper attempts to strengthen the standardized management of department teaching. Some measures were adopted to stimulate the potential of students, such as teaching based on case combination, department discussion, strengthening education of humanities, improving examination methods and so on, so as to improve students' comprehensive ability and achieve teaching goals. The results showed that by changing the above teaching methods, students can improve their mastery of knowledge, proficiency in basic operation, clinical thinking ability, communication and coordination ability, subjective initiative and so on. At the same time, students' problem-solving ability, learning interests, self-confidence and the satisfaction with teaching effect have also been improved, which promoted the performance of students in clinical practice.
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Objective To propose a novel regional injury classification for open pelvic fractures and characterize its application in clinical treatment.Methods The clinical data of 67 open pelvic fractures were retrospectively analyzed which had been treated from January 2001 through December 2017 at Department of Orthopedics,Affiliated Hospital to Chengdu University.They were 48 males and 19 females,from 12 to 68 years of age (average,34 years).According to the Tile classification,23 cases were type A,19 Type B and 25 Type C.Their main injuries were located at pubic perineum in 29 cases,at ilioinguinal region in 20,at sacroiliac region in 7,at ilioinguinal-perineum in 5 and at sacroiliac-perineum in 6.Our novel regional injury classification was proposed according to the assessment of soft tissue injuries at the Faringer regions.The mortalities and complications were compared between types of our regional injury classification to find associations between them.Results Despite active treatment 28 patients died,giving a mortality of 41.8％ (28/67).Our regional injury classification grouped the open pelvic fractures into 4 types:perineal type (type Ⅰ),ilioinguinal type (type Ⅱ),sacroiliac type (type Ⅲ) and composite type (type Ⅳ).The mortalities for the 4 types were respectively 20.7％ (6/29),45.0％ (9/20),71.4％ (5/7) and72.7％ (8/11).The mortality of open pelvic fractures was positively correlated with our classification (y =0.620,P =0.001).Type Ⅰ mainly included cystourethral injury,anorectal injury and infection,type Ⅱ and Ⅲ injury to iliac vessels and Type Ⅳ injury to iliac vessels and infection.The incidences of complications for type Ⅲ (100.0％,7/7) and type Ⅳ (100.0％,11/11) were significantly higher than those for type Ⅰ (82.8％,24/29) and type Ⅱ (85.0％,17/20) (P ＜ 0.05).Conclusions Our regional injury classification gives clear criteria.The mortality increases gradually with the 4 types.The incidence of complications for each type varies and thus leads to different therapies.
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Objective@#To map OTA/AO type B and type C distal radial fractures according to three-dimensional (3D) CT scan data, and to describe the morphological distribution of fracture lines.@*Methods@#A total of 468 cases of distal radius fractures admitted to the Affiliated Hospital of Chengdu University from January 2016 to March 2019 were analyzed and AO classification were performed. AO type B and type C fractures meet the inclusion criteria and then CT data were 3D reconstructed, and morphological description were performed on the fracture lines of each joint surface, including fracture shape angle, fracture area and fracture ratio. At the same time, the articular surface fracture model was superimposed on the standard model, then fracture line and fracture area distribution map were drawn to create the fracture map of intra-articular distal radial fractures.@*Result@#Intra-articular fractures of the distal radius were 209 cases, accounting for 44.7% (209/468) of the distal radius fractures, among which 67 cases of AO type B fracture. In type B fractures, average fracture height were 20.30±11.26 mm, average fracture width were 12.24±6.83 mm, average fracture area were 189.61±101.84 mm2, average angle were 57.23°±14.95°, and average area ratio of fracture (fracture zone area/joint surface area ratio) were 32.42%±10.24%. 142 cases were OA type C fracture, the average fracture height were 24.43±11.37 mm, average fracture width were 20.38±7.59 mm, average fracture area were 425.26±314.31 mm2, average angle were 51.26°±13.17°, and average area ratio of fracture were 73.81%±26.29%. According to fracture map formed by main fracture lines, five different fracture areas were identified: ① 63 cases in central area; ② 25 cases in Lister's nodule area; ③ 59 cases in scaphoid area; ④ 36 cases in lumbar fossa area; ⑤ 26 cases in lower iliac area. Main fracture lines were concentrated in the area on the dorsal side of the central area and the scaphoid area. The fracture lines of type B fracture mainly concentrated in scaphoid region, which accounted for 29.85% (20/67), and dorsal side and central area accounted for 26.87% (18/67). The fracture lines of type C fracture accounted for 27.46% (39/142) in scaphoid area and 31.69% (45/142) in central area. The fracture line of type C fracture increased in the lumbar fossa region (17.61%, 25/142) and the lower ulnar region (12.68%, 18/142) compared with type B fracture (28.69%). Compared with the type B fracture, the overall distribution of the fracture line of the type C fracture is more central.@*Conclusion@#The map of intra-articular fracture of distal radius was drawn and morphological distribution of fracture lines were quantified. Fracture-prone site and shape of fracture line were visually recognized. At the same time, description of articular surface fracture line and fracture area of type B and type C fractures of OA classification were improved, which may help with new classification and diagnosis.
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Objective To investigate the distribution characteristics of the fracture lines on the posteromedial wall by mapping the femoral intertrochanteric fractures involving the posteromedial wall on 3D CT.Methods A retrospective study was conducted of the 136 patients with femoral intertrochanteric fracture who had been treated at Department of Orthopaedics,Affiliated Hospital to Chengdu University from January 2009 to October 2018.They were 57 men and 79 women with an average age of 64 years (from 48 to 81 years).By the AO classification,101 cases were type 31-A2 and 35 type 31-A3.Their CT data were collected for 3D reconstruction.By comparing the specific markers on the femoral shaft and lesser trochanter,the 3D CT reconstruction images were superimposed and orientated to the standard models of intertrochanteric posteromedial wall to create a map of the fracture.The width,height,area,and fracture deviation angle of the fracture of posteromedial wall were measured to characterize the distribution of the fracture lines.Results In the 136 femoral intertrochanteric fractures involving the posteromedial wall,the height of the posteromedial wall fracture was 48.76 ± 4.11 mm,the width 29.78 ± 3.29 mm,the area 1,468.47 ± 75.26 mm2,and the fracture deviation angle 49.93° ± 13.05°.The fracture area ratio (fracture area/posteromedial wall area) was 38.34％ ± 16.58％.On the map of the posteromedial wall fracture,the fracture lines were densely distributed in the lesser trochanter and in front of it.In the fractures of type 31-A2,the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and below it,going obliquely from anterosuperior to posteroinferior to affect the lower calcar femorale.In the fractures of type 31-A3,the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and above it,going obliquely from anteroinferior to posterosuperior to affect the upper calcar femorale.Conclusion The fracture map can help visual understanding of the inteetrochanteric fracture involving the posteromedial wall,and provide further characterization ofthe posteromedial wall fracture in the fractures of AO types 31-A2 and 31-A3.
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In view of problems such as students in clinical orthopedic practice lack of basic theoretical knowledge and practical ability,both teachers and students' lack of preparations for clinical practice and their insufficient attention etc.,this paper attempts to strengthen the standardized management of department teaching.Some measures were adopted to stimulate the potential of students,such as teaching based on case combination,department discussion,strengthening education of humanities,improving examination methods and so on,so as to improve students' comprehensive ability and achieve teaching goals.The results showed that by changing the above teaching methods,students can improve their mastery of knowledge,proficiency in basic operation,clinical thinking ability,communication and coordination ability,subjective initiative and so on.At the same time,students' problem-solving ability,learning interests,self-confidence and the satisfaction with teaching effect have also been improved,which promoted the performance of students in clinical practice.
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The main structures of proximal femur, such as femoral calcar and lesser trochanter, play an important role in anti-flexion and anti-varus. As the proximal femur is rich in blood supply and its fracture rarely leads to nonunion after treatment, surgical treatment has become the first choice for orthopaedists to deal with such fractures. The key to a successful surgery for proximal femoral fracture is to restore the continuity of medial cortex. However, it is still a great challenge how to restore the medial continuity of the proximal femur and its supporting role as well. This article reviews the current progress in research on the proximal femoral medial wall and its supporting fixation in order to provide clinical guidance for orthopaedists treating proximal femoral frac-tures.
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Objective@#To explore the characteristics and methods of different fixation methods and prevention of open knee joint fracture.@*Methods@#The data of 86 cases of open knee joint fracture admitted from January 2002 to December 2015 in Department of Orthopaedics, Affiliated Hospital of Chengdu University were analyzed retrospectively.There were 65 males and 21 females aged of 38.6 years. There were 38 cases treated with trans articular external fixation alone, 48 cases were in the trans articular external fixation plus auxiliary limited internal fixation group. All the patients were treated according to the same three stages except for different fixation methods. Observation of external fixation and fracture fixation, fracture healing, wound healing and treatment, treatment and related factors of infection control and knee function recovery. χ2 test was used to analyze data.@*Results@#Eleven patients had primary wound healing, accounting for 12.8%. Seventy-five patients had two wounds healed, accounting for 87.2%. Only 38 cases of trans articular external fixator group had 31 cases of articular surface reduction, accounting for 81.6%; Five cases of trans articular external fixator assisted limited internal fixation group had 5 cases of poor reduction, accounting for 10.4%; There was significant difference between the two groups (χ2=44.132, P<0.05). Take a single cross joint external fixation group, a total of 23 cases of patients with infection, accounted for 60.5% of external fixation group; trans articular external fixation assisted limited internal fixation group there were 30 cases of patients with infection, accounting for the assistance of external fixator and limited internal fixation group 62.5%; There was significant difference between the two groups(χ2=0.035, P>0.05). Five cases of fracture nonunion cases of serious infection, patients voluntarily underwent amputation. The Lysholm Knee Scale: In the external fixation group, 23 cases were less than 50 points, accounting for 60.5%, 15 cases were more than 50 points, accounting for 39.5%, external fixation and limited internal fixation group 20 cases were less than 50 points, accounting for 41.7%, 28 cases were more than 50 points, accounting for 58.3%; There was significant difference between the two groups(χ2=1.279, P>0.05).@*Conclusions@#Prevention and control of infection is a central link in the treatment of open fracture of the knee. Trans articular external fixator plus limited internal fixation is an important measure to treat open fracture of the knee-joint.
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Objective To investigate the relationship between body position and fracture reduction in cephalomedullary nailing for femoral intertrochanteric fractures. Methods Included in this analysis were 368 femoral intertrochanteric fractures undergoing cephalomedullary nailing from January 2010 to De-cember 2015. They were 191 men and 177 women, aged from 42 to 102 years ( average, 73. 1 ± 11. 0 years ) . By AO classification, there were 105 cases of type 31-A1, 131 ones of 31-A2, and 132 ones of type 31-A3. Supine position A ( contralateral hip and knee flexed at 90 degrees ) was applied in 99 cases, supine position B ( contralateral limb supine straight and abduction ) in 178 cases, and lateral position in 91 cases. The 3 groups were compared in terms of reduction quality, fluoroscopy time, fluoroscopy frequency, operative time, and Harris hp score at 6 months after operation. Results Reduction quality: supine position A group ( 97. 8％) > supine position B group ( 87. 9％) > lateral position group ( 72. 5％) . Fluoroscopy time: lat-eral position group ( 34. 4 ± 5. 8 min ) > supine position A group ( 29. 4 ± 6. 4 min ) > supine position B group ( 27. 1 ± 5. 2 min ) . Fluoroscopy frequency: lateral position group ( 15. 5 ± 5. 0 times ) > supine posi-tion A group ( 14. 0 ± 3. 4 times ) > supine position B group ( 11. 2 ± 2. 9 times ) . The above differences were significant between any 2 groups ( P <0. 05 ) . Operation time: lateral position group ( 59. 0 ± 10. 7 min ) >supine position A group ( 58. 4 ± 11. 2 min ) > supine position B group ( 51. 2 ± 8. 7 min ) . There were sig-nificant differences between supine position B group and either of the other 2 groups ( P < 0. 05 ) . There were no significant differences among the 3 groups in the Harris hp score at 6 months after operation ( P >0. 05 ) . Conclusion In cephalomedullary nailing for patients with femoral intertrochanteric fracture, the position of contralateral limb supine straight and abduction can benefit fracture reduction, affect anteroposterior and lateral fluoroscopy the least, provide convenience for surgical maneuver and thus shorten surgical time.
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Objective To compare intramedullary nail (IN) and dynamic hip screw (DHS) regarding their effects on hip abduction following fixation of intertrochanteric fractures.Methods From January 2008 to December 2015,310 patients with intertrochanteric firacture were treated at our department.They were divided into 2 groups depending on the manner of treatment.198 patients (71 males and 127 females) were subjected to intramedullary nailing,with an average age of 74.7 ± 5.6 years;there were 50 cases of 31-A 1,134 ones of 3 1-A2 and 14 ones of 3 1-A3 according to the AO classification.112 patients (35 males and 77 females) were subjected to dynamic hip screwing,with an average age of 74.1 ± 6.7 years;there were 24 cases of 31-A1,78 ones of 31-A2 and 10 ones of 31-A3.The 2 groups were compared in terms of time for weight-bearing ambulation and stand on one leg,gait,pelvic tilt,range of hip active abduction,muscle strength of the abductor and hip function at the final follow-up.Results Of this series,284 patients were followed up for 1.5 to 8.5 years (average,3.6 years) and 26 patients died.The IN group achieved significantly better outcomes in terms of time for weight-bearing ambulation (37.6 ±4.9 d),time for stand on one leg (60.1 ± 9.5 d),cases of normal gait and normal pelvic tilt (171 and 179),muscle strength of the abductor (62.3 ±4.4 N · m),and range of hip active abduction than the DHS group (53.0 ±8.4 d;71.0 ± 12.0 d;67 and 85;56.6 ± 3.3 N · m,respectively) (P ＜ 0.05).There was no significant difference between the 2 groups in the hip function at the final follow-up(91.4％ versus 84.5％ in the excellent and good rate)(P ＞ 0.05).Conclusion Compared with dynamic hip screwing,intramedullary nailing has a limited effect on hip abduction so that the patients may benefit from quicker functional recovery and faster improvement in quality of life.
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The lateral wall,a new concept in the study of trochanteric hip fractures,has a great influence on the choice of internal fixation methods,stability of the fracture and prognosis of the patients.Currently,the research on the lateral wall focuses on the factors leading to its rupture,its anatomical features and its effect on internal fixation,but results in controversial views which are mostly influenced by the subjective and experimental factors.This review deals with how the concept of lateral wall was proposed,the importance and anatomical features of lateral wall,the causes for lateral wall rupture and current treatment perspectives of trochanteric hip fractures,aiming at increasing the awareness of the lateral wall among orthopedic surgeons and related researchers.
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BACKGROUND:Biodegradable implants cannot only rebuild bone defect site, moreover, with the gradual degradation of the materials, new bone tissue can completely replace the graft materials to fil bone defects. OBJECTIVE:To summarize the research progress of biodegradable materials combined with osteogenic factor in orthopedics. METHODS: We took the “biodegradable materials, factors, cel active factor, bone tissue engineering” as the search terms in Chinese and English, respectively, to retrieve the related literatures from PubMed, Wanfang and CNKI database during 2000 to 2015 by computer. RESULTS AND CONCLUSION: Biodegradable medical polymer materials can be divided into natural polymer materials and synthetic biodegradable materials. Natural polymeric materials have good biocompatibility, but poor mechanical strength. The mechanical strength of synthetic biodegradable materials is higher than that of natural polymer materials, but the synthetic biodegradable materials are likely to cause local accumulation of acidic substances, produce local inflammation. The biodegradable medical polymer materials combined with osteogenic factor can improve the mechanical strength and osteoinductive ability of materials, but as a bone repair material, it stil has many problems to be solved.