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Objective:To investigate the clinical effect of Ilizarov technique with compression and distraction osteogenesis in treatment of traumatic femoral shaft defects.Methods:A retrospective case series study was conducted to analyze the clinical data of 52 patients with traumatic femoral shaft defects admitted to West China Hospital of Sichuan University from September 2015 to September 2019，including 32 males and 20 females at age of 19-60 years［（40.3 ± 12.1）years］. There were 15 patients with fractures at the proximal 1/3，20 at middle 1/3 and 17 at distal 1/3 part of femoral shaft. Types of bone defects were bone defect after open fracture in 2 patients，infectious nonunion in 29 and atrophic nonunion in 21. Length of bone defects after debridement and osteotomy was 3.0-5.8 cm［（4.2 ± 0.8）cm］. A total of 24 patients underwent primary direct shortening and compression as well as re-lengthening of the broken ends；28 patients were operated by osteotomy and compression，and then by re-lengthening of the broken ends at Ⅱ stage with the average interval of 2.8 months. Postoperative wound healing，bone healing time，external fixation index（EFI）and complications were observed. Preoperative and postoperative levels of white blood cell count（WBC），C-reactive protein（CRP）and erythrocyte sedimentation rate（ESR）were measured. Association for the study and application of the method of Ilizarov（ASAMI）score was used to evaluate bone healing and functional recovery at the latest follow-up.Results:All patients were followed up for 20-60 months［（36.5 ± 10.3）months］. All wounds were healed at Ⅰ stage，with no infection or sinus tract recurrence. Bone healing time was 9-20 months［（14.5 ± 3.8）months］，and EFI was 1.2-1.9 months/cm［（1.5 ± 0.2）months/cm］. Nail tract infection was found in 14 patients，with the infection rate of 27%. Poor healing of broken ends fracture occurred in 4 patients，out of which 3 with infectious nonunion and 1 with atrophic nonunion. Axial deviation was observed in 2 patients and poor mineralization was observed in 1 patient. In 2 patients，the affected side was shortened by 1.8 cm and 2.0 cm when compared to the healthy side. At the latest follow-up，levels of WBC［（6.0 ± 1.4）× 10 9/L］，CRP［（6.8 ±1.7）mg/L］and ESR［（10.5 ± 6.1）mm/h］were lower than those before surgery［（9.2 ± 2.2）× 10 9/L，（31.7 ± 22.1）mg/L，（45.8 ± 31.3）mm/h］（ P < 0.01）. At the latest follow-up，bone healing rated on ASAMI score was excellent in 31 patients，good in 13 and fair in 8，with the excellent and good rate of 85%；limb function rated on ASAMI score was excellent in 28 patients，good in 14，fair in and good in 3，with the excellent and good rate of 81%. Conclusions:For traumatic femoral shaft defects，Ilizarov technique with compression and distraction osteogenesis can fully remove infection or ischemic bone lesions. Distraction osteogenesis technology can complete continuous compression of broken ends to further promote healing of broken ends and limb lengthening and attain limb reconstruction and bone healing and functional recovery.
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Objective:To explore the perioperative management strategy for the elderly with hip fractures during the epidemic of corona virus disease 2019 (COVID-19) and evaluate its clinical effect.Methods:A retrospective case series study was conducted on 33 elderly patients with hip fractures admitted to Chongqing General Hospital, University of Chinese Academy of Sciences, from January 20 to February 29, 2020, including 14 males and 19 females, aged 65-92 years [(76.5±6.3)years]. There were 20 patients with intertrochanteric fractures and 14 with femoral neck fractures. In total, 15 patients were combined with hypertension and 9 with diabetes. A total of 19 patients were treated with open reduction and internal fixation and 14 with total hip/semi-hip replacement. The time from injury to admission was 2-14 hours. The temperature measurement, routine blood test and chest CT examination were performed to exclude COVID-19 in all patients, which showed 12 patients with pulmonary infection. The medical staff received different levels of protection: first level protection for those in the special ward, secondary level protection for the emergency isolation ward and tertiary level protection for those collecting the throat swab samples. The time from admission to operation, intensive care unit (ICU) stay time, hospitalization time, visual analogue score (VAS), perioperative complications as well as infection of patients and medical staff were observed and recorded.Results:The time from admission to operation was (3.18±0.19)days for all patients, with (2.24±0.28)days for 21 patients with no obvious pulmonary abnormality and (4.83±0.39)days for 12 with pulmonary infection. The hospitalization time was (10.97±0.31)days in all patients, with (9.71±0.27)days for 21 patients with no obvious pulmonary abnormality and (12.51±0.78)days for 12 with pulmonary infection. After operation, 12 patients were treated in ICU for 1-3 days, and the rest 21 patients were treated in general wards. The pain of all patients was effectively controlled. The time for exercise was (4.0±1.4)days after operation in all patients, among which 19 treated with fracture reduction and internal fixation started at (4.3±1.3)days after operation and 14 treated with total hip/semi-hip replacement started at (3.6±1.3)days after operation. VAS was (4.55±0.29)points at 12 hours before operation, (5.62±1.12)points at 6 hours, (3.54±0.39)points at 24 hours, and (2.42±0.11)points at 72 hours after operation ( P<0.05). Chest CT showed that the pulmonary inflammation was significantly improved one day before discharge. There was no indication of nucleic acid detection, with no urinary tract infection, pressure sore, deep vein thrombosis or other complications were found. No infection of patients or medical staff occurred. Conclusion:During pandemic of COVID-19, early surgical treatment for the elderly with hip fractures can be done in the general wards, based on strictly following the principle of infection prevention and control and carefully evaluating the perioperative risks, which can avoid the probability of infection of patients and medical staff without prolonging the hospitalization time or increasing the incidence of complications.
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Objective To compare the clinical efficacy between absolute fixation and bridging fixation in plate osteosynthesis for simple distal tibia fracture.Methods A retrospective case control study was conducted to analyze 41 patients with simple distal tibia fracture admitted to the Chongqing People's Hospital from January 2013 to November 2016.There were 24 males and 17 females,aged 24-70 years [(46.3 ± 13.1)years].According to AO/OTA classification,fractures weres was AO/OTA type 42A1 in 29 cases,type 42A2 in nine cases,type 42A3 in two cases,and type 43A1 in one case.All patients were treated with plate and screw fixation.According to the method of plate fixation,the patients were divided into the locking compression plate (LCP) absolute fixation group (14 patients),the LCP bridge fixation group (12 patients) and the LCP + dynamic double thread locking screw (DDTL) bridge fixation group (15 patients).The patients were followed up by taking anteroposterior and lateral radiographs of tibia and fibula during outpatient visits 1,2,3,6 months and 1 year after operation.The operation time,time to radiological fracture union,time to full weight bearing,callus index and complications were analyzed.Results All the patients were followed up for 12-18 months [(14.5 ± 2.0)months].In the LCP absolute fixation,LCP and LCP + DDTL groups,the operation time was (74.3 ± 15.6) minutes,(78.6 ± 20.1) minutes and (82.5 ± 24.6) minutes,respectively;the time to radiological fracture union was (4.3 ± 1.5) months,(4.5 ± 1.3) months and (4.6 ± 1.4) months,respectively;the time to full weight bearing were (3.4 ± 0.7) months,(3.5 ± 0.6) months and (3.6 ±1.1) months,respectively (all P ＞ 0.05).There was no significant difference in complication incidence among the three groups (P ＞ 0.05).However,the callus index in the LCP + DDTL group (1.19 ±0.13) was significantly higher than that of the LCP absolute fixation group (1.08 ±0.06) and that of the LCP group (1.09 ± 0.09) (P ＜ 0.05).Conclusion For simple distal tibia fracture,both absolute and bridging fixation can attain good fracture union,and LCP combined with DDTL can better promote the formation of callus and facilitate the union.
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Objective To compare the pain management effects between painless wards with quality control circle mode and conventional pain management mode.Methods A retrospective case control study was conducted on the clinical data of 233 patients with lower limb fracture admitted from August 2015 to August 2016.There were 124 males and 109 females,aged 18-74 years [(48.3 ±3.3)years].The patients were divided into observation group (n =117) and control group (n =116) according to the pain management mode.The observation group followed the standard continuous quality improvement program and combined with professional team and patients Wechat group to implement pain management,and further measures were taken in accordance with the feedbacks.The control group adopted routine painless ward nursing model for perioperative analgesia nursing intervention.The pain score VAS,the start time of functional exercise,the compliance of rehabilitation activities,the length of hospital stay,and the healing time of fracture were compared between the two groups.Results There was no significant difference in VAS scores between the two groups at 12 hours before operation and 6 hours after operation (P ＞ 0.05).The observation group had lower VAS scores at 12 hours (3.2± 1.4),24 hours (2.8 ±0.9),48 hours (1.6 ± 0.7),and 72 hours (1.5 ± 0.8) after operation than the control group (P ＜0.05).The observation group started functional exercises earlier [(18.9 ± 0.4) hours after operation]than the control group earlier [(48.1 ± 1.7) hours after operation] (P ＜ 0.01).The observation group had a rehabilitation compliance rate of 62.6％,higher than that of the control group (17.6％) (P ＜0.05).The hospital stay [(12.18 ± 0.14) days] and fracture healing time [(97.86 ± 0.83) days] of the observation group were shorter than those of the control group (P ＜ 0.05).Conclusion The pain management model of standardized continuous quality improvement can significantly relieve pain in patients with lower limb fracture,shorten hospitalization time,bring forward the start time of functional exercise,improve the compliance of rehabilitation activities,and promote fracture healing.
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Objective To evaluate whether the patients with Parkinson′s Disease (PD) having higher occurrence rate of frac-ture .Methods CMB ,CNKI ,PubMed ,Embase ,Web of Science ,Medline ,Embase and Cochrane Library were retrieved ,meanwhile which was assisted by the manual retrieval .The retrieval time was until February 2017 .The cohort studies on the occurrence rate of fracture in PD patients were collected .Then the included studies were analyzed after the data extraction and treatment evaluation . Results A total of 1160 articles were retrieved ,finally 11 cohort studies were included ,involving 988723 subjects .The analysis showed that the fracture occurrence risk in PD patients was significantly higher than that in the control group (RR=2 .09 ,95% CI:1 .91-2 .28) ,in which the occurrence rate of hip fracture was significantly higher than that in the control group (RR=2 .33 ,95%CI:1 .79-3 .02) ,while the occurrence rate of spinal fracture had no statistical difference (RR=1 .33 ,95% CI:0 .78-2 .27) ,and the fracture occurrence risk in male and female patients of PD group was significantly higher than that in the control group (RR=2 .40 , 1 .69 ,95% CI:2 .21-2 .60 ,1 .62-1 .76) .Conclusion The fracture occurrence risk in PD patients is significantly higher than that in the control group ,due to existence of certain geographic bias and publication bias risk ,it is needed more high quality clinical stud-ies to accurately evaluate whether the fracture risk in PD patients being much higher .
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Objective To investigate the effects of open reduction and internal fixation plus calcium sulfate artificial bone graft for the treatment of Sanders type Ⅲ and Ⅳ calcaneal fractures.Methods Thc clinical data of patients with Sanders type Ⅲ and Ⅳ calcaneal fractures treated from January 2012 to December 2015 were retrospectively reviewed by case-control study.The patients were divided into two groups as bone graft group (open reduction and internal fixation combined with artificial bone graft) and control group (open reduction and internal fixation).The bone graft group was composed of 17 cases,among which there were 12 males and five females with age range of 19-62 years [(41.6 ± 12.9) years].In bone graft group,there were 12 cases of Sanders Ⅲ and five cases of Sanders Ⅳ.The control group was composed of 13 cases,among which there were eight males and five females with age range of 20-59 years [(39.4 ± 11.8) years].In control group,there were ten cases of Sanders Ⅲ and three cases of Sanders Ⅳ.The follow-up visits were done at 1,2,3,6,and 12 months after surgery with record of complication occurrence.The changes of Bohler's angle and Gissan's angle were observed preoperatively as well as at 2 days and 12 months after surgery.The function recovery was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up visit.Results Five cases of marginal necrosis of the incision and two cases of superficial soft tissue infection were seen in bone graft group,while there were two cases of marginal necrosis of the incision and one cases of superficial soft tissue infection in control group.In early postoperative comparison between two groups,the variation of Bohler's angle and Gissan's angle had no significant difference (P ＞ 0.05).At 12 months after surgery,Bohler's angle of bone graft and control groups were (23.2 ± 9.0) ° and (19.5 ± 11.1) °,respectively.The losses of Bohler's angle were (3.6 ± 2.7) ° and (6.9 ± 3.1) °,respectively.The difference in the losses of angle in two groups had statistical significance (P ＜ 0.05).Gissan's angle of bone graft and control groups were (123.4 ± 9.4)o and (122.2 ± 9.0)°,respectively.The losses of Gissan's angle were (2.8 ± 1.8) °and (3.8 ± 2.3) °,respectively (P ＞ 0.05).At the final follow-up,bone union was found in all cases,and there was no significant difference in AOFAS score between the two groups (P ＞ 0.05).Conclusions Open reduction and internal fixation can attain good treatment results for Sanders type Ⅲ and Ⅳ calcaneal fractures,no matter whether bone graft is carried out.However,artificial bone graft may have good effects to sustain the stability of fracture fragments and provide early mechanical support for the subtalar joint.