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Objective:To investigate the effect of Notch on periprosthetic fracture (PPF) of the femoral prosthesis after primary total knee arthroplasty.Methods:A total of 34 patients diagnosed with femoral PPF at Xi'an Honghui Hospital were retrospectively collected from January 2013 to December 2020. There were 4 males and 30 females with a mean age of 69.2±7.2 years (range, 55-84 years). A total of 102 patients without PPF were matched by gender and age as the control group in a ratio of 1∶3. There were 12 males and 90 females with a mean age of 69.2±7.2 years (range, 55-84 years). The main observation indexes included patients' general information and factors such as coronal alignment, prosthesis design and Notch conditions. Then, subgroup analysis was performed with the depth and Tayside classification of Notch to analyze their effects on PPF.Results:The PPF and control groups were comparable in terms of baseline information such as gender, age, body mass index (BMI), and surgical side. There was no significant difference between the two groups in coronal alignment (χ 2=1.019, P=0.601) and prosthesis design (χ 2=1.545, P=0.214). There was no statistical difference in Notch between the PPF and control groups (χ 2=3.548, P=0.060). The mean length of Notch in the PPF group was 4.5±2.7 mm, compared with 4.9±2.8 mm in the control group, with no significant difference between the two groups ( t=0.732, P=0.465). Further subgroup analysis using a Notch depth of 3 mm as a cut-off and Tayside classification revealed a statistical difference between the two groups (χ 2=11.262, P=0.004; χ 2=14.601, P=0.003). Compared with patients without Notch, the risk of PPF was higher when the depth of Notch exceeded 3 mm, with an odds ratio ( OR) of 4.88 (95% CI: 1.76, 13.51). The incidence of PPF was higher when Notch depth reached Tayside grade 3 or 4. Compared with patients without Notch, the risk of PPF would be 6.99-fold (95% CI: 1.85, 26.32) higher when Notch depth reached grade 3. In female patients, there was a significant difference in Notch status between the PPF and control groups (χ 2=3.956, P=0.047), with a higher risk of PPF in female patients with Notch, OR 2.33 (95% CI: 1.01, 5.43). In patients who underwent right-sided TKA, the risk of PPF was higher in patients with Notch compared to those without Notch (χ 2=5.502, P=0.019), with an OR of 3.58 (95% CI: 1.19, 10.75). Conclusion:The Notch has no significant effect on the femoral PPF after primary total knee arthroplasty. However, the risk of PPF will increase significantly when the Notch depth exceeds 3 mm or is above Tayside grade 3.
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Objective:To evaluate the effects of weight-bearing area compression injury of the femoral head on the prognosis of elderly acetabular fractures after open reduction and internal fixation.Methods:A retrospective analysis of 36 elderly patients with acetabular fractures treated with open reduction and internal fixation during January 2014 to January 2018 were conducted. All patients with compression injury of the weight-bearing area of the femoral head, including 22 males and 14 females with 73.2±6.5 years old (range 60-87 years old), were included. The compression injury of weight-bearing area of the femoral head was not treated. According to the Letournel-Judet classification of acetabular fractures, there were 14 cases with both-column, 12 cases with anterior column and posterior hemitransverse, 4 cases with T type, 4 cases with transverse, and 2 cases with posterior column+ posterior wall. A total of 14 cases were accompanied by acetabular joint surface compression, while 29 cases were accompanied by joint dislocation. The Merle d'Aubigné score was used to evaluate the hip function during follow-up. The Matta classification method was used to evaluate the results of acetabular fracture reduction. The Kellgren-Lawrence classification standard and Ficat-Alert staging method were used to evaluate the traumatic arthritis of the hip and femoral head necrosis, respectively. During the follow-up, the femoral head necrosis with stage III, IV, or traumatic arthritis III, IV, or with indications for joint replacement was defined as surgery failure. CT scans of the pelvis were performed before and at 2-5 days after operation. The compression size of the femoral head on the coronal and axial planes of the CT scan was calculated for the compression volume. The compression severity was divided into small (<1 cm 3), medium (1-2 cm 3) and large (>2 cm 3) according to the volume. Binary Logistic regression analysis was used to analyze whether the postoperative measurement of the femoral head compression volume was associated with the risk of surgical failure. Results:All patients were followed up for 34.7±8.9 months (range 25-54 months). There were 7 cases with large compression of femoral head, 14 cases with medium, and 15 cases with small pre-operatively. However, there were 12 cases, 10 cases and 14 cases with large, medium and small at 2-5 days after operation, respectively. Six cases were excellent reduction, 22 cases were good, and 8 cases were poor. Thus, the excellent and good rate was 78% (28/36). At the last follow-up, Merle d'Aubigné score was excellent in 2 cases, good in 8 cases, fair in 5 cases, and poor in 21 cases. The excellent and good rate was 28% (10/36). There were 20 cases with surgery failure with 56% (20/36) failure rate. There were no statistically significant differences in the patient's age, body mass index, operation duration, blood volume, fracture type, fracture reduction, combined acetabular joint surface compression, and combined joint dislocation between the two groups. However, there was a statistically significant difference in the frequency distribution of compression volume in the weight-bearing area of the femoral head after surgery (χ 2=22.047, P<0.001). In patients with large, medium, and small-volume compression of the femoral head weight-bearing area, the surgery failure rates were 92%, 80%, and 7%, respectively. The large and medium-volume compression of the femoral head weight-bearing area were independent risk factors for surgical failure. Conclusion:Open reduction and internal fixation can be used to treat elderly patients with acetabular fractures combined with femoral head compression injury. Despite satisfactory reduction for acetabular fractures, the larger volume of femoral head compression affects the clinical outcomes with extremely high rate of surgical failure within 2 years.
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Objective:To investigate the effect of intraoperative blood transfusion on postoperative deep vein thrombosis in patients with orthopedic trauma.Methods:A retrospective analysis was conducted of the 502 patients who had been treated operatively at Department of Orthopaedics and Trauma, Xi＇an Honghui Hospital from January 2015 to September 2018. They were divided into 2 groups according to the use of intraoperative blood transfusion. In the observation group of 203 cases who had received intraoperative blood transfusion, there were 98 males and 105 females with an age of (61.0±20.7) years; in the control group of 299 cases who had not received intraoperative blood transfusion, there were 166 males and 133 females with an age of (57.7±19.0) years. Blood coagulation series such as D-dimer and fibrinogen were measured at admission, 1 day pre-operation, 1 day and 3 days postoperation. After operation, venous ultrasound examination of both lower limbs was performed to observe postoperative DVT in the patients. The 2 groups were compared in changes in coagulation series and occurrence of postoperative DVT.Results:There was no statistically significant difference in the preoperative general data between the 2 groups ( P>0.05), showing they were comparable. There was no significant difference between the observation group and the control group in the D-dimer level at admission or 1 day pre-operation ( P>0.05), but the D-dimer levels at 1 day and 3 days postoperation in the observation group [4.18 (2.35, 7.08) mg/L and (6.20±3.77) mg/L] were significantly higher than those in the control group [3.41 (1.91, 5.63) mg/L and (4.05±2.62) mg/L] ( P<0.05). There was no statistically significant difference in fibrinogen between the 2 groups at different time points ( P>0.05). The incidence of DVT in the observation group was 43.3% (88/203), significantly higher than that in the control group (32.8%, 98/299) ( P<0.05). Conclusion:As intraoperative blood transfusion can increase the level of D-dimer and thus the incidence of postoperative venous thrombosis in patients with orthopaedic trauma, we should pay more attention to the risk of postoperative DVT in patients receiving intraoperative blood transfusion.
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Objective:To compare the predictive values between 4 risk assessment scales for deep venous thrombosis (DVT) in patients with pelvic or acetabular fracture.Methods:The clinical data of 235 patients with pelvic or acetabular fracture were retrospectively analyzed who had been admitted to Xi'an Honghui Hospital from July 2014 to July 2018. They were 168 males and 67 females, aged from 18 to 90 years (average, 43.5 years). They were divided into a DVT group and a DVT-free group according to the results of vein ultrasongraphy. The RAPT, Caprini, Wells, and Autar scales were used respectively to assess the risk of DVT in the patients. The 2 groups were compared in terms of the scores of the 4 scales. After the receiver operating characteristic curve (ROC) was drawn and the area under the ROC curve (AUC) was calculated, the predictive values of the 4 scales were evaluated for lower limb DVT in the patients with pelvic or acetabular fracture.Results:Of the 235 patients, 104 (44.3%) had DVT. There was no statistically significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The DVT group scored significantly higher in RAPT, Wells and Autar scales than the DVT-free group( P<0.05). The AUCs for the RAPT, Caprini, Wells, and Autar scales were respectively 0.84±0.02, 0.65±0.05, 0.81±0.02 and 0.72±0.03, showing significant differences ( F=1.254, P=0.031). The AUCs for RAPT and Wells scales were significantly higher than those for Caprini and Autar scales, and the AUS for Autar scale was significant higher than that for Caprini ( P<0.05). The sensibilities for RAPT, Caprini, Wells and Autar scales were respectively 94.0%, 65.0%, 90.6% and 84.0% while the specificities for them 62.1%, 51.8%, 67.2% and 32.5%. Conclusion:Although all the 4 scales have a certain predictive value for the DVT risk in patients with pelvic or acetabular fracture, RAPT and Wells scales are more valuable.
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Objective:To investigate the incidence of pre- and post-operative lower extremity deep venous thrombosis (DVT) in hospitalized patients with intertrochanteric fractures and to analyze the relevant risk factors.Methods:A retrospective case-control study was conducted to analyze the data of 218 patients with femoral intertrochanteric fractures admitted to Xi'an Honghui Hospital, Xi'an Jiaotong University from July 2015 to October 2017, including 85 males and 133 females. There were 85 males and 133 females, aged 32-102 years [(76.0±11.9)years]. Of the patients, 213 had open reduction and internal fixation, 4 partial hip arthroplasty, and 1 external fixation. All patients underwent deep venous ultrasound of the lower extremities before and after surgery to determine the occurrence of DVT. DVT of the lower extremities was divided into distal thrombosis, proximal thrombosis and mixed thrombosis. According to the preoperative and postoperative ultrasonography results, the patients were divided into thrombosis group [82 patients (37.6%) before operation, 128 patients (58.7%) after operation] and non-thrombosis group [136 patients (62.4%) before operation, 90 patients (41.3%) after operation]. Location of DVT were recorded before and after operation and outcome was evaluated. All patients were assessed for risk factors associated with thrombosis, including general patient data, time of surgery, tourniquet time, blood transfusion, blood loss, fluid volume, drainage, and serological markers. Multivariate Logistic regression analysis was used for detecting the risk factors.Results:The DVT rate was 37.6% preoperatively and increased to 58.7% postoperatively. The type of thrombosis was mainly distal DVT, which accounted for 86.6% and 90.6% of DVT before and after surgery, respectively. After the operation, 2.8% of the distal DVT extended above the popliteal vein. A total of 23.4% of the patients had no thrombosis before surgery, and distal, proximal, or mixed DVT occurred after surgery (22.0%, 0.5% and 0.9%, respectively). No fatal pulmonary embolism occurred. The univariate analysis showed no statistical differences between the preoperative thrombosis group and non-thrombosis group in terms of age, gender, fracture side, combined diseases, body mass index, American Society of Anesthesiologists (ASA) classification, admission D-dimer, and admission C-reactive protein (CRP) ( P>0.05), but the time from fracture to hospitalization and the time from fracture to surgery were significantly different between the two groups ( P<0.05). There were no statistical differences between the postoperative thrombosis group and the postoperative non-thrombosis group in age, gender, fracture side, combined diseases, body mass index, length of stay, ASA classification, surgical method, operation time, blood transfusion, blood loss, infusion volume, drainage volume, D-dimer on admission, and CRP on admission ( P>0.05), but the time from fracture to admission, time from fracture to surgery, D-dimer before surgery, D-dimer at day 1 after surgery, D-dimer at day 5 after surgery, and CRP at day 5 after surgery showed significant differences between the two groups ( P<0.05). Multivariate analysis results showed the time from fracture to hospitalization ( OR=1.109, 95% CI 1.003-1.225, P<0.05) and the time from fracture to surgery ( OR=1.090, 95% CI 1.007-1.180, P<0.05) were independent risk factors for preoperative DVT. The time from fracture to hospital ( OR=1.137, 95% CI 1.002-1.290, P<0.05) and 1 day postoperative D-dimer ( OR=1.087, 95% CI 1.033-1.142, P<0.05) were independent risk factors for postoperative DVT. Conclusions:For intertrochanteric fractures, distal DVT is the main type of thrombosis. Time from fracture to hospitalization is an independent risk factor of DVT before and after operation, and time from fracture to operation is an independent risk factor of DVT before operation. Early intervention (early admission and early surgery) may reduce the incidence of DVT.
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Objective To investigate the incidence and risk factors of deep venous thrombosis (DVT) in lower extremity in patients with tibial plateau fracture.Methods The data from 148 patients with tibial plateau fracture were retrospectively analyzed who had been admitted to the Department of Orthopaedic Trauma,Honghui Hospital between September 2014 and December 2017.They were 90 males and 58 females,aged from 19 to 83 years (average,47.2 ± 13.1 years).According to the Schatzker classification of tibial plateau fractures,24 cases belonged to type Ⅰ,17 to type Ⅱ,25 to type Ⅲ,29 to type Ⅳ,34 to type Ⅴ,and 19 to type Ⅵ.The incidence of DVT was detected by venous ultrasound of bilateral lower extremities before and after surgery.The factors related to the occurrence of DVT were statistically analyzed.Univariate analysis was used to determine risk factors,and multivariate logistic regression analysis was used to identify the primary independent risk factors.Results The preoperative DVT incidence was 43.92％ (65/148) and the postoperative DVT incidence 52.70％ (78/148).Distal thrombus predominated both preoperatively and postoperatively.Age (OR =1.043,95％ CI 1.015 ～ 1.072,P =0.002) and D-dimer level upon admission (OR =1.219,95％ CI 1.009 ～ 1.473,P =0.040) were independent risk factors for preoperative DVT formation;age (OR =1.075,95％ CI 1.042 ～ 1.110,P =0.000),operative time (OR =0.994,95％ CI 0.989～0.999,P=0.016),D-dimer level at 1 day postoperatively (OR=1.135,95％ CI 1.025～1.258,P =0.015) and at 3 days postoperatively (OR =1.366,95％ CI 1.008 ～ 1.853,P =0.044) were independent risk factors for postoperative DVT.Conclusions The incidence of DVT in the lower extremity may be high in patients with tibial plateau fracture.Distal thrombus is the main manifestation.In fracture patients,especially the middle-aged and elderly ones,dynamic monitoring of D-dimer level should be combined with lower extremity venous ultrasound for early diagnosis of DVT.In patients with lower extremity DVT,surgical progress should be accelerated on the basis of good surgical quality to reduce the incidence of postoperative lower extremity DVT.
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Objective@#To investigate the regularity in and risk factors for perioperative deep venous thrombosis (DVT) and the changes in plasma D-dimer in patients with tibiofibular fracture.@*Methods@#A retrospective analysis was done of the 180 patients with tibiofibular fracture who had been treated at Department of Orthopaedics and Trauma, Xi'an Honghui Hospital from September 2014 to February 2018. They were 114 males and 66 females, aged from 16 to 83 years (average, 47.6 years). The levels of plasma D-dimer were detected at admission, one day preoperation, and 1, 3, 5 days postoperation. B-ultrasound examination of both lower extremities was performed before and after surgery. According to the results of B-ultrasound, the patients were divided into a DVT group and a non-DVT group. The 2 groups were compared in the plasma D-dimer levels measured at different time points. DVT risk factors were screened by univariate analysis, and multivariate logistic regression analysis was used to determine independent risk factors.@*Results@#Of this cohort, 54 cases (30%) developed DVT and 39 cases (21.7%) did preoperation. Of the 39 cases (mixed DVT in one and distal DVT in 38 ones), DVT disappeared in 14 postoperation. Of the 40 cases (22.2%) of postoperative DVT (proximal DVT in one, mixed DVT in one and distal DVT in 38 ones), 15 developed newly postoperation. Multivariate logistic regression analysis showed that age, time from injury to operation, pre-operative and postoperative D-dimer elevation were independent risk factors for DVT in the patients. The D-dimer levels in the DVT group were significantly higher than in the non-DVT group at one day preoperation, and 1, 3, 5 days postoperation (P<0.05). The area under the receiver operating characteristic curve was 0.704. When the critical value of D-dimer was 1.4 mg/L, its sensitivity for DVT diagnosis was 0.944 and its specificity 0.246 (poor). When the concentration of D-dimer was 4.45 mg/L, its sensitivity for DVT diagnosis was 0.574 and its specificity 0.817 (the highest).@*Conclusions@#Perioperative DVT may happen in patients with tibiofibular fracture, mostly at the distal end beyond the popliteal vein. Clinically, patients who are advanced in age, have plasma D-dimer elevation at admission and after operation, and have waited long for operation should be alert to the occurrence of DVT. The plasma D-dimer level with a recommended threshold of 4.45 mg/L may have a certain diagnostic value for patients with tibiofibular fracture.
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Objective@#To explore the application of Doppler ultrasound to assess the stability of pelvic ring in treatment of lateral-compression-1 (LC-1) pelvic fractures.@*Methods@#For this prospective study 38 patients with LC-1 pelvic fracture were enrolled who had been admitted to the Department of Orthopedic Trauma, Honghui Hospital from July 2016 to November 2017. They were 22 men and 16 women with an age of 55.2±16.1 years. After the patient's condition was stable, they underwent a Doppler ultrasound examination in the pelvic compression separation test. According to the criteria preset: those with a left-right mobility ≥ 0.3 cm were assigned as an unstable group (16 cases) and those with a mobility<0.3 cm as a stable group (22 cases). The stable group received conservative treatment while the unstable group surgical treatment. The 2 groups were compared in terms of mobility of fracture ends, follow-up time, weight-bearing time, fracture healing time, and the Majeed scores of pelvic function at the last follow-up.@*Results@#The 2 groups were compatible due to their insignificant differences in baseline data(P>0.05). The mobility of fracture ends (left-right distance: 0.45±0.22 cm; anterior-posterior distance: 0.26±0.16 cm; oblique distance: 0.50±0.23 cm) in the unstable group was all significantly greater than in the stable group (left-right distance: 0.11±0.03 cm; anterior-posterior distance: 0.05±0.04 cm; oblique distance: 0.11±0.07 cm) (P<0.05). The weight-bearing time in the stable group (0.9±0.5 months) was significantly shorter than that in the unstable group (1.9±2.0 months) (Z=-2.353, P=0.019). There were no significant differences between the 2 groups in follow-up time (13.9±3.8 months versus 15.1±3.0 months), fracture healing time (4.6±1.3 months versus 4.5±1.2 months) or the Majeed scores (84.8±6.4 versus 80.3±12.2) (all P>0.05).@*Conclusions@#Since ultrasonography is helpful in assessment of the stability of LC-1 pelvic fractures, a proper treatment strategy can be decided. Stable ones can be treated conservatively and unstable ones surgically.
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Objective To explore the application of Doppler ultrasound to assess the stability of pelvic ring in treatment of lateral-compression-1 (LC-1) pelvic fractures.Methods For this prospective study 38 patients with LC-1 pelvic fracture were enrolled who had been admitted to the Department of Orthopedic Trauma,Honghui Hospital from July 2016 to November 2017.They were 22 men and 16 women with an age of 55.2 ± 16.1 years.After the patient's condition was stable,they underwent a Doppler ultrasound examination in the pelvic compression separation test.According to the criteria preset:those with a left-right mobility ≥ 0.3 cm were assigned as an unstable group (16 cases) and those with a mobility ＜ 0.3 cm as a stable group (22 cases).The stable group received conservative treatment while the unstable group surgical treatment.The 2 groups were compared in terms of mobility of fracture ends,follow-up time,weight-bearing time,fracture healing time,and the Majeed scores of pelvic function at the last follow-up.Results The 2 groups were compatible due to their insignificant differences in baseline data(P ＞ 0.05).The mobility of fracture ends (left-right distance:0.45 ± 0.22 cm;anterior-posterior distance:0.26 ± 0.16 cm;oblique distance:0.50 ±0.23 cm) in the unstable group was all significantly greater than in the stable group (left-right distance:0.11 ± 0.03 cm;anterior-posterior distance:0.05 ± 0.04 cm;oblique distance:0.11 ±0.07 cm) (P ＜ 0.05).The weight-bearing time in the stable group (0.9 ±0.5 months) was significantly shorter than that in the unstable group (1.9 ±2.0 months) (Z =-2.353,P=0.019).There were no significant differences between the 2 groups in follow-up time (13.9 ± 3.8 months versus 15.1 ± 3.0 months),fracture healing time (4.6 ± 1.3 months versus 4.5 ± 1.2 months) or the Majeed scores (84.8 ± 6.4 versus 80.3 ± 12.2) (all P ＞ 0.05).Conclusions Since ultrasonography is helpful in assessment of the stability of LC-1 pelvic fractures,a proper treatment strategy can be decided.Stable ones can be treated conservatively and unstable ones surgically.
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Objective To investigate the regularity in and risk factors for perioperative deep venous thrombosis (DVT) and the changes in plasma D-dimer in patients with tibiofibular fracture.Methods A retrospective analysis was done of the 180 patients with tibiofibular fracture who had been treated at Department of Orthopaedics and Trauma,Xi'an Honghui Hospital from September 2014 to February 2018.They were 114 males and 66 females,aged from 16 to 83 years (average,47.6 years).The levels of plasma D-dimer were detected at admission,one day preoperation,and 1,3,5 days postoperation.B-ultrasound examination of both lower extremities was performed before and after surgery.According to the results of B-ultrasound,the patients were divided into a DVT group and a non-DVT group.The 2 groups were compared in the plasma D-dimer levels measured at different time points.DVT risk factors were screened by univariate analysis,and multivariate logistic regression analysis was used to determine independent risk factors.Results Of this cohort,54 cases (30％) developed DVT and 39 cases (21.7％) did preoperation.Of the 39 cases (mixed DVT in one and distal DVT in 38 ones),DVT disappeared in 14 postoperation.Of the 40 cases (22.2％) of postoperative DVT (proximal DVT in one,mixed DVT in one and distal DVT in 38 ones),15 developed newly postoperation.Multivariate logistic regression analysis showed that age,time from injury to operation,preoperative and postoperative D-dimer elevation were independent risk factors for DVT in the patients.The D-dimer levels in the DVT group were significantly higher than in the non-DVT group at one day preoperation,and 1,3,5 days postoperation (P ＜ 0.05).The area under the receiver operating characteristic curve was 0.704.When the critical value of D-dimer was 1.4 mg/L,its sensitivity for DVT diagnosis was 0.944 and its specificity 0.246 (poor).When the concentration of D-dimer was 4.45 mg/L,its sensitivity for DVT diagnosis was 0.574 and its specificity 0.817 (the highest).Conclusions Perioperative DVT may happen in patients with tibiofibular fracture,mostly at the distal end beyond the popliteal vein.Clinically,patients who are advanced in age,have plasma D-dimer elevation at admission and after operation,and have waited long for operation should be alert to the occurrence of DVT.The plasma D-dimer level with a recommended threshold of 4.45 mg/L may have a certain diagnostic value for patients with tibiofibular fracture.
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Objective To investigate the clinical characteristics and risk factors of perioperative deep venous thrombosis (DVT) in fracture patients.Methods A retrospective case control study was conducted to analyze the clinical data of 147 patients with DVT diagnosed by color Doppler ultrasound or lower extremity deep venography from July 2015 to November 2017 in Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine.The patients were divided into proximal thrombosis group (including the popliteal vein) and distal thrombosis group according to the involvement site with the popliteal vein as reference.The proximal thrombosis group (56 patients) included 31 males and 25 females,aged 38-89 years,with an average age of 67.8 years.There were three patients with pelvic and acetabular fractures,39 with hip fractures,10 with femoral shaft fractures,three with periarticular fractures,and one with tibia and fibula fracture.According to the site of involvement,four patients had proximal vein thrombosis,and the other 52 patients had proximal combined with distal thrombosis.There were 44 patients with left thrombosis and 12 with right thrombosis.Thrombosis at femoral vein and above was found in 20 patients (7 with external iliac vein thrombosis),and thrombosis at popliteal vein was found in 36 patients.The distal thrombosis group (91 patients) consisted of 51 males and 40 females,aged 21-92 years,with an average of 63.6 years.There were 12 patients with pelvic and acetabular fractures,39 with hip fractures,four with femoral shaft fractures,16 with fractures surrounding knee joint,12 with tibia and fibula fractures,and eight with ankle joint fractures.There were 43 patients with left thrombosis and 48 with right thrombosis.The gender,age,fracture location,time from injury to operation,operation time,blood transfusion rate,thrombus side,D-dimer level before and after operation,and internal medical diseases were compared between the two groups.The risk factors with statistical significance were screened for multivariate Logistic regression analysis.Results In proximal thrombosis group,70％ (39/56) had hip fracture and 18％ (10/56) had femoral shaft fracture,while 43％ (39/91) had hip fracture and 4％ (4/91) had femoral shaft fracture in distal thrombosis group (P＜0.05).In the proximal thrombosis group,79％ (44/56) had thrombosis in the left lower extremity,which was much higher than that in the distal thrombosis group 47％ (43/91) (P ＜ 0.05).In proximal thrombosis group,77％ (43/56) received blood transfusion,which was higher than 39％ (35/91) in distal thrombosis group (P ＜0.05).D-dimer levels in proximal thrombosis group before and after operation [(8.5 ± 8.1) mg/L,(12.8 ± 9.7) mg/L],were higher than those in distal thrombosis group [(4.6 ± 3.8) mg/L,(7.2 ± 7.5) mg/L] (P ＜ 0.05).There were no significant differences in gender,age,time from injury to operation,operation time and internal medical complications between the two groups (P ＞0.05).Logistic regression analysis showed that hip fracture and femoral shaft fracture,left lower limb,blood transfusion,high D-dimer level before and after operation were risk factors for proximal thrombosis.Conclusions Proximal venous thrombosis is often combined with distal venous thrombosis.Hip fracture,femoral shaft fracture,left lower limb,blood transfusion,preoperative and postoperative high D-dimer levels have significant effects on proximal thrombosis.
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Objective To investigate the incidence and risk factors of intraoperative deep venous thrombosis (DVT) in patients with multiple injuries.Methods A retrospective analysis was conducted of the 183 patients with multiple injuries who had been admitted to the Department of Orthopaedics and Trauma,Xi'an Honghui Hospital from January 2016 to November 2017.They were 117 males and 66 females,aged from 16 to 84 years (average,47.3 years).Craniocerebral injuries occurred in 16 cases,chest injuries in 24 cases,spinal injuries in 9 cases,pelvic acetabular fractures in 64 cases,upper limb fractures in 40 cases,and lower limb fractures in 145 cases.Venous ultrasonography of bilateral lower limbs was performed preoperatively and postoperatively to detect incidence of DVT.The patients were divided into a DVT group and a non-DVT group.The 2 groups were compared in terms of gender,age,interval from injury to surgery,D-dimer levels upon admission and discharge,operation time,intraoperative blood transfusion,injury severity scoring (ISS) and type of injury.After single-factor analysis was used to screen risk factors,multivariate logistic regression analysis was used to determine the main independent risk factors.Results The incidence of lower limb DVT in patients with multiple injuries was 42.08％ (77/183).Of the 77 DVT patients,12 had proximal thrombosis (6.56％) and 65 distal thrombosis (35.52％).Multivariate logistic regression analysis showed that age of ＞ 60 years,operative time for ≥2 hours,and presence of spinal injury were independent risk factors for DVT in patients with multiple injuries (P ＜ 0.05).Conclusions The incidence of lower limb DVT can be high in patients with multiple injuries.An age of ＞ 60 years,operation time for ≥2 hours and presence of spinal injury are independent risk factors for DVT in these patients.
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Objective To investigate the anatomical distribution and change of distal deep venous thrombosis in patients with hip fracture,to provide evidence for prevention and treatment of deep vein thrombosis in patients with hip fracture and lower limb deep vein ultrasound examinatio.Methods The clinical data of 383 patients with hip fractures who were admitted in Department of Orthopaedics Trauma,Xi'an Jiaotong University Medical College Red Cross Hospital from July 2014 to April 2018 were analyzed retrospectively.There were 122 males and 261 females,the age range was 17 to 94 years,the median was 78 years,and the interquartile range was 12 years.There were 154 cases of femoral neck fracture,208 cases of femoral intertrochanteric fracture,and 21 cases of femoral subtrochanteric fracture.Deep venous thrombosis was assessed by ultrasonography before and 3-5 days after operation,and the anatomical location and changes of deep vein thrombosis were analyzed.The skewed distribution data were represented by the median and interquartile range.The proportion of the number of deep venous thrombosis case in the anatomical position of the lower extremities was expressed as a percentage.Results Of the 383 patients with hip fracture who had distal deep venous thrombosis before surgery,isolated distal deep vein thrombosis (IDDVT) accounted for 89.30％ (342/383),and multivessel thrombosis accounted for 10.70％ (41/383).In IDDVT,intermuscular venous thrombosis was the most common,and no anterior venous thrombosis occurred.In multivessel thrombosis,two or three of the intermuscular vein,the posterior tibial vein,and the iliac vein were more common.Twenty-eight (7.31％) patients had distal thrombus extension to the proximal end (including 21 cases involving the iliac vein and 7 cases involving the superficial femoral vein),IDDVT accounted for 61.88％ (237/383).The involvement of multiple venous thrombosis accounted for 16.19％ (62/383),62.40％ (239/383) of the distal thrombus position did not change,and 14.62％ (56/383) of the distal thrombus disappeared.Conclusions For patients with hip fracture,the intermuscular vein is the most common site of distal deep venous thrombosis,ultrasound examination of anterior tibial vein is not necessary.Under anticoagulatio(n),7.31％ of distal deep venous thrombosis may extend to the proximal and 14.62％ of distal deep venous thrombosis disappear.For patients with hip fracture complicated with distal deep venous thrombosis in hospital,patients without contraindication of anticoagulation should be treated with anticoagulation at an early stage to prevent the proximal progression or fall off of thrombosis and reduce the risk of distal deep venous thrombosis.
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Objective To investigate the incidence and risk factors of deep venous thrombosis in patients with open fracture of lower extremities.Methods A retrospective study was conducted to analyze the clinical data of 203 patients with open fracture of lower limbs admitted to Department of Orthopaedics and Trauma,Xi'an Jiangtong University Medical College Red Cross Hospital from January 2015 to November 2017.There were 75 males and 45 females,the average age was 47.3 years,and the age ranged from 18 to 63 years.Classification of open fracture sites of lower limbs:open fracture of femoral shaft in 59 cases;open fracture of tibia and fibula in 107 cases;open fracture of ankle in 37 cases.Gustilo classification of open fracture included 34 cases of type Ⅰ,71 cases of type Ⅱ and 98 cases of type Ⅲ.According to whether thrombosis occurs or not,the patients were divided into thrombosis group (n =63) and non-thrombosis group(n =140).The incidence of thrombosis was expressed as percentage (％).The age,fracture degree,injury type,Gustilo classification of open fracture,gender,body mass index (BMI),combined medical diseases,fracture site,preoperative and postoperative D-dimers were subjected to x2 test or Fisher's exact test.The test αt value was taken as 0.05 on both sides.P ＜ 0.05 suggested that the difference was statistically significant.Results The incidence of deep venous thrombosis in 63 cases of open fracture was 31.03％,of 63 DVT patients,5 were central thrombosis (7.93％),17 were mixed thrombosis (26.98％) and 41 were peripheral thrombosis (65.08％).The main type of thrombosis was peripheral thrombosis.There were significant differences in age,fracture degree,injury type and open fracture Gustilo type between the two groups of thrombus group and non thrombus group (P ＜ 0.05).Sex,BMI,internal medical diseases,fracture sites,and D-two polymer before and after operation were not statistically significant (P ＞0.05).Conclusions The incidence of DVT was higher in patients with open fracture of lower extremities,the main type of thrombosis was peripheral thrombosis.Age over 60 years old,high falling injury,2 or more fractures and comminuted fractures,open fractures Gustilo type Ⅲ was associated with DVT.
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Objective To investigate the factors associated with preoperative deep venous thrombosis (DVT) in female patients with lower extremity fracture in menstrual phase.Methods A retrospective analysis was conducted of the 119 women with lower extremity fracture in childbearing age who had been treated at Traumatic Orthopaedics Center,Red Cross Hospital,Xi'an Jiaotong University Health Science College from October 2016 to October 2017.Of them,41 were in menstral phase,aged from 20 to 50 years (average,37.1 ± 8.9 years),and 78 were not,aged from 19 to 50 years (average,36.9 ± 8.0 years).The 2 groups were compared in terms of DVT incidence,D-dimer level,prothrombin time,partial prothrombin time,thrombin time,fibrinogen level,and preoperative bed time.Results The patients with menstruation had significantly higher incidence of lower extremity DVT (82.9％) and significantly longer preoperative bed time (9.1 ± 3.4 d) than those without menstruation did (14.1％ and 3.8 ± 2.2 d,respectively) (P ＜0.05).There were no significant differences between the 2 groups in the preoperative coagulation indexes:D-dimer,prothrombin time,partial prothrombin time,thrombin time or fibrinogen (P ＞ 0.05).Conclusions The incidence of preoperative DVT may be high the female patients with lower extremity fracture in menstrual phase,chiefly because of long preoperative bed time.Detection of D-dimer level is of limited significance in the screening for thrombosis in menstrual phase.Menstruation may not be a surgical contraindication.
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Objective To compare the perioperative incidence of deep venous thrombosis (DVT) and level of plasma D-dimer between different ages in patients with lower limb fracture in Northwest China.Methods The data were retrospectively analyzed of the 1,185 patients with lower limb fracture in 5 provinces in Northwest China from July 2014 to March 2017.They were 583 males and 602 femals,with an average of 60.3 years(from 18 to 102 years).Of them,723 were from Shaanxi Province,148 from Gansu Province,137 from Qinghai Province,128 from Ningxia Hui Nationality Autonomous Regions and 49 from Xinjiang Uygur Autonomous Region.They were divided into a young group (≤44 years old) (n =288),a middle-aged group (from 45 to 59 years old) (n =256),a junior elderly group (from 60 to 74 years old) (n =263),and a senior elderly group (≥75 years old) (n =378).The incidences of perioperative deep venous thrombosis (DVT) and levels of plasma D-dimer were compared between the 4 age groups.Results The DVT incidences before and after operation in the young group were significantly lower than in the other 3 groups (P ＜ 0.05);the DVT incidence after operation in the middle-aged group was significantly lower than that in the junior elderly group (P ＜ 0.05).The pre-and post-operative levels of plasma D-dimer increased with the age of the patients;the pre-and post-operative levels of plasma D-dimer in the senior elderly group were significantly higher than in the other 3 groups (P ＜ 0.05).Conclusions The perioperative incidence of DVT was high in the elderly patients with lower limb fracture in Northwest China,peaking in the age range from 60 to 74 years old.The pre-and post-operative levels of plasma D-dimer increased with the age of the patients.
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Objective To investigate the therapeutic efficacy of contralateral less invasive stabilization system (LISS) through a medial-posterior approach for fractures of femoral medial condyle.Methods From December 2010 to December 2014,14 patients with fracture of femoral medial condyle were treated surgically at our department.They were 10 males and 4 females,aged from 33 to 64 years (average,44.6 years).By AO classification,10 cases were type 33-B2 and 4 cases type 33-B3.Causes of injury included traffic accident in 7 cases,falling in 6 and heavy object crush in one.Internals from injury to operation ranged from 3 to 10 days (average,5.4 days).All the patients were treated by open reduction and internal fixation with contralateral LISS plate or T plate through a knee medial posterior approach.Results The 14 patients were followed up for 12 to 24 months (average,18 months).All fractures got bony healing after 3 to 5 months (average,3.5 months).No collapse of joint surface,joint stiffness,joint infection,malunion or nonunion occurred.According to the Schatzker-Lambert criteria for functional recovery of the distal femoral fractures,the function of the affected knee was assessed at the last follow-up as excellent in 9 cases,good in 3,fair in one and poor in one.Conclusion Open reduction and internal fixation with contralateral LISS plate through a medial-posterior approach is effective for fractures of femoral medial condyle due to its strong buttress,rigid fixation,advantage for early functional exercise,and satisfactory therapeutic outcome.
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Objective To evaluate the clinical treatment of unstable pelvic fractures by posterior ring fixation using percutaneous minimally invasive pedicle screws following anterior ring fixation.Methods From January 2010 to January 2016,31 patients with unstable pelvic fracture were treated at our department.They were 20 males and 11 females,with an average age of 44.4 years (range,from 18 to 65 years).According to the Tile classification,6 cases were type B2,8 cases type B3,12 cases type C1,and 5 cases type C2.The anterior pelvic ring was fixated in supine position first,and the posterior pelvic ring was fixated next using percutaneous minimally invasive pedicle screws.The operation time,intraoperative bleeding,and frequency of fluoroscopy needed for the posterior ring fixation were recorded.Reduction quality,complications like loss of reduction and pelvic function at the final follow-up were also assessed.Results For the posterior ring fixation in the 31 patients,the operation time ranged from 40 to 60 minutes (average,50.7 minutes),blood loss from 30 to 80 mL (average,42.9 mL),and fluoroscopic frequency from 7 to 12 times (average,9.7 times).By the Tornetta evaluation,the reduction was rated postoperatively as excellent in 15 cases and as good in 16 ones,yielding an excellent and good rate of 100％.Twenty-nine patients obtained complete follow-up for 12 to 83 months (average,34.7 months),and they achieved bone union after an average of 14.5 weeks (range,from 12 to 16 weeks).According to the Majeed criteria for pelvic function at the final follow-up,10 cases were rated as excellent,16 cases as good,and 3 cases as fair,giving an excellent and good rate of 89.7％.No reduction loss,incision infection,vascular or nerve injury,screw loosening or breakage,or fracture displacement was observed during follow-up.Conclusion In the treatment of unstable pelvic fractures,posterior ring fixation using percutaneous minimally invasive pedicle screws following anterior ring fixation can lead to less operation time,intraoperative bleeding and fluoroscopic radiation,and satisfactory fracture reduction and functional recovery of the pelvis as well.
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Objective To investigate the relationship between the incidence of deep vein thrombosis (DVT) during hospitalization and the energy of injury in tibial plateau fractures (TPFs).Methods 140 patients were enrolled in the study between September,2014,and October,2017 in Honghui Hospital,Xi'an Jiaotong University.According to the Schatzker classification,the low-energy group (Schatzker Ⅰ-Ⅲ) X-ray showed a simple or lateral fracture or compression fracture of the lateral plateau (n =63);the high-energy group (Schatzker Ⅳ-Ⅵ) X-ray showed the medial tibia or double of the tibial plateau (n =77).Duplex Ultrasonography was performed in lower extremities before and after surgical intervention for DVT evaluation and record the incidence of DVT,the days during hospitalization,the blood loss during surgery and the level of D-Dimer.All patients received mechanical and chemical thromboprophylaxis.The patient was followed up for one month after surgery,and the lower extremity ultrasound was reviewed and recorded.The measurement data were expressed as ((x) ± s),and the categorical variables were expressed in composition ratio.The measurement data were all in accordance with the normal distribution and the variance was uniform.The t-test was used,and the Chi-square test was used for comparison between groups.Results The incidence of thrombosis of tibial plateau fracture in TPFs was 36.43％ and 46.43％ pre-operation and post-operation respectively.The thrombosis incidence was 31.75 ％ (20/63) in the low-energy group and 40.26％ (31/77) in the high-energy group pre-operation.The thrombosis incidence was 44.44％ (28/63) in the low-energy group and 48.05％ (37/77) in the high-energy group post-operation.Statistical analysis showed no significant difference between the two groups pre-operation (P =0.298) and post-operation(P =0.785).The days during hospitalization [(11.94 ± 4.18) d,(9.56 ± 2.54) d],the blood loss during surgery [(208.96 ±224.43) ml,(129.68 ± 142.14) ml] and the level of D-Dimer [(2.39 ± 3.38) mg/L,(1.21 ± 2.32) mg/L] at pre-operation showed differences in the high energy group and the low energy group,respectively.Conclusions The incidence of DVT in TPFs is high during the hospital,but most of DVT is concentrated in the distal to the knee.Although the incidence of high energy injury and low energy injury DVT is not significantly different in TPFs,we should also be alert to the occurrence of DVT.
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Objective To investigate the incidence of and risk factors for deep venous thrombosis (DVT) at the uninjured limb during hospitalization in patients with lower extremity fracture. Methods The clinical data were retrospectively analyzed of the 494 patients who had been hospitalized for lower extremity fracture at Department of Orthopedics, Honghui Hospital from September 1, 2014 to October 1, 2017. They were 228 males and 266 females with an average age of 58.9 ± 18.9 years ( from 16 to 94 years ) . 290 fractures occurred proximally to the knee, 101 fractures around the knee and 103 fractures distally to the knee. They received anticoagulant prophylaxis or treatment during hospitalization. After operation, they were examined with Doppler sonography for bilateral lower limbs to detect occurrence of thrombus. The incidence of DVT at the uninjured limb during hospitalization was recorded and its possible risk factors were analyzed statistically. The possible risk factors ( gender, age, fracture type, body mass index, concomitant internal disease, time from injury to surgery, time from surgery to discharge, American Society of Anesthesiologists rating, operation duration, blood loss, fluid infusion volume and D-dimer level ) were screened by single factor logistic regression analysis and the major independent risk factors were determined by multi-factor logistic re-gression analysis.Results DVT occurred at the injured limb during hospitalization in 237 cases ( 47.97%). Of them, 221 ( 44.74%) had peripheral thrombus, 7 central thrombus ( 1.42%) and 9 mixed thrombus ( 1.82%). DVT occurred at the uninjured limb during hospitalization in 98 cases ( 19.84%). Of them, 90 (18.2%) had peripheral thrombus, one central thrombus (0.2%) and 7 mixed thrombus (1.4%). Of the 98 patients with DVT at the uninjured limb, 74 (75.51%) had DVT at both lower limbs and 24 (24.49%) had DVT only at the uninjured limb. Age and D-dimer level one day after surgery were independent risk factors for DVT at the uninjured limb during hospitalization. Conclusions The incidence of actual DVT at the unin-jured limb in patients with lower extremity fracture cannot be ignored in spite of use of anticoagulants for pro-phylaxis or treatment during hospitalization. We should also be aware that age and D-dimer level one day after surgery are independent risk factors for DVT at the uninjured limb during hospitalization.