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Objective To explore the relationship between atrial fibrillation and hip fractures caused by falls in the elderly.Methods All patients aged 65 years or older who underwent surgical treatment for hip fractures caused by falls in our department from January 2015 to December 2017 were enrolled.The relationships of atrial fibrillation as well as chronic medical history with hip fractures were retrospectively analyzed.The control group was matched 1 to 1 by age,sex,and admission time.Chi-square test and Logistic regression analysis were used to calculate the odds ratio (ORvalue) of fractures in patients with atrial fibrillation.Results There was no significant difference in the history of smoking,drinking,diabetes,coronary heart disease,heart failure,chronic kidney disease,chronic obstructive pulmonary disease(COPD),and Parkinson's disease between the two groups.A total of 37 patients had a history of atrial fibrillation in the fracture group,compared to 18 patients with atrial fibrillation in the control group.The incidence of atrial fibrillation in the fracture group and the control group were 9.6％ and 4.7％,respectively,with crude OR=2.18,95％CI(1.32-4.15),P=0.008 and adjusted OR=2.27,95％CI(1.37-5.20),P=0.02.Compared with the control group,the incidence of stroke (x2 =14.06,P ＜ 0.05),osteoporosis (x2 =200.64,P ＜ 0.01) and cognitive impairment(x2 =8.23,P ＜0.01)increased in the fracture group.When classified by age and sex in the fracture group,the incidence of atrial fibrillation had no significant difference between different gender and age subgroups.Conclusions Atrial fibrillation is an independent risk factor for hip fractures caused by falls in the elderly.There is no significant difference in the incidence of atrial fibrillation in hip fracture patients between the different ages(65-74 years,75-84 years,≥of 85 years)and genders.In addition,stroke,osteoporosis,and cognitive impairment increase the risk of hip fractures caused by falls in elderly patients.
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Objective To compare the function recovery of multiple injuries combined with floating knee joint injury and simple knee joint injury,and to analyze the risk factors.Methods A retrospective case control study was conducted to analyze the clinical data of 41 patients with multiple injuries combined with Blake and McBryde Ⅱ A floating knee injury admitted to Xijing Hospital of Air Force Medical University from June 2011 to June 2017.There were 26 males and 15 females,aged 18-76 years,with an average of 34.5 years.There were 25 patients with simple knee joint injury and and 16 patients with multi-joint combined injury involving knee joint and ipsilateral hip joint or ankle joint injury.Surgical fixation was performed in different parts by external fixation,intramedullary nail and plate screw fixation.According to the Kalstr(o)m and Olerud functional evaluation criteria,the excellent and good rate of postoperative functional recovery was compared between the two groups.The surgical fixation methods of the two groups were compared.Logistic regression analysis was performed on the influencing factors of functional recovery.Results The patients were followed up for 1-7 years,with an average of 3 years.The excellent and good rate of overall functional recovery in the two groups was 68％,and the rate was 84％ in simple knee injury group and 44％ in multi-joint combined injury group (P ＜ 0.01).There was no significant difference in the ratio of intramedullary nail and plate screw fixation between the two groups (P ＞ 0.05),while the proportion of the external fixation in the multi-joint combined injury group [31％ (5/16)] was significantly higher than that in the simple knee joint injury group [16％ (4/25)] (P ＜ 0.05).Logistic regression analysis showed that the rate of external fixation was an independent factor affecting the postoperative function (OR =0.15,P ＜ 0.01).Conclusions The postoperative function in multi-joint injury patients is poorer than in the single joint injury patients.The higher rate of using external fixation in multi-joint injury patients is a risk factor.For Blake and McBryde Ⅱ A floating knee injury combined with multi-joint injury,less external fixation should be used,so as to improve the postoperative function.
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Objective To investigate the efficacy of anti-infective reconstituted bone xenograft (ARBX) combined with external fixation in the treatment of adult infective nonunion of humeral shaft.Methods A retrospective case series study was conducted to analyze the clinical data of 18 patients with infected nonunion of humeral shaft admitted to Xijing Hospital of Air Force Military Medical University from January 2014 to December 2016.There were 10 males and eight females,aged 19-62 years [(36.9 ± 11.8)years].According to Umiarov classification of infective nonunion,there were 11 patients with type Ⅲ and seven with type Ⅳ.All patients were treated with anti-infective reconstituted bone xenograft (ARBX) combined with external fixation.The number of operations,bone healing time,bone healing rate,infection control rate,postoperative weight bearing time,the time of external fixation removal,postoperative complications,erythrocyte sedimentation rate (ESR),and C-reactive protein (CRP) before and after operation were recorded.Fracture healing and functional recovery were evaluated using the Johner-Wruch lower limb function score.Results The patients were followed up for 12-30 months [(21.3 ±5.6)months].The operation was performed for (1.4 ±0.9) times,with time of bone healing for (16.6 ± 5.8)months,bone healing rate of 83％ (15/18),and infection control rate of 94％ (17/18).The postoperative weight bearing time in 15 patients who obtained bone healing was (3.3 ± 1.5)months after operation,and the external fixation removal time was (18.5 ± 4.2) months after operation.There were three patients with nonunion after operation including one with infection recurrence.Five patients were found with nail tract infection.ESR and CRP at postoperative 3 months [(13.1 ± 8.4)mm/h and (5.6 ± 4.6)mg/L] were significantly lower than those before operation [(47.3 ± 19.2)mm/h and (23.4 ± 7.4) mg/L] (P ＜ 0.05).According to Johner-Wruch lower limb function scores,the results were excellent in nine patients,good in four,fair in one,and poor in four,with excellent and good rate of 72％.Conclusion ARBX combined with External fixation can effectively treat infective nonunion of humeral shaft,improve bone healing rate,and promote function recovery.
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This paper summarizes the concept of rapid recovery, the its application in trauma orthopeadics of rapid recovery in limb fractures and the future prospect. That rapid rehabilitation is not a pure time acceleration, in patients with perioperative safety and improve the life quality, shorten the hospitalization time and lower cost only its added value, focusing on how to make the patients safe, painless, no cross for perioperative complications. To make the patient with more humanized, individualized, full-dimensional embodiment of professional characteristics of quality care services. It is required that nurses quickly change their ideas, improve their professional knowledge, strengthen communication skills and develop in a more professional direction.