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Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.
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As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.
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Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.
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The life safety and quality of life of elderly patients with hip fractures face great threat due to the particularity of fracture site. Elderly patients with hip fracture are often complicated with a variety of basic medical diseases, thus the perioperative management and comprehensive treatment are relatively complex and diverse, and surgical treatment is only one of the links. With the deepening understanding of senile hip fractures, we increasingly realized that the comprehensive management of senile hip fractures should focus on prevention. Combined with the conception and connotation of tertiary-prevention in preventive medicine, this review summarize the common etiology and preventive measures of senile hip fractures, the application of intelligent devices for fall prevention and monitoring, the green channel for hip fracture patient admission, the management mode of the comprehensive geriatric ward based on multi-disciplinary team, the evolution of surgical methods, and the perioperative comprehensive treatments, which in order to provide reference for medical and health workers to reduce the incidence and improve the treatment effects and prognosis of the senile hip fracture via multifaceted and systematic prevention and treatment measures.
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Objective:To investigate the application effects of SBAR communication mode (situation, background, assessment and recommendation) combined with 3D printing model technology in bed-side teaching of trauma orthopaedics.Methods:A total of 80 clinical medicine students were randomly divided into two groups according to the order of the school number, with 40 students in each group. One was experimental group which received SBAR communication mode combined with 3D printing model technology teaching, and the other one was the control group, which received regular reaching mode. At the end of teaching, the teaching effects were evaluated, including the scores of theoretical examinations and operational examinations, total scores and the anonymous questionnaires. SPSS 22.0 was used for recording and statistical analysis.Results:The average scores of theoretical examinations (48.30±1.41), operational examinations (42.20±1.48) and total scores (90.70±1.38) of experimental group were significantly higher than those of control group [(43.40±1.52); (34.80±1.53); (78.10±1.51)], with significant differences ( P <0.05). The anonymous questionnaires showed that the students in the experimental group had a significant advantage in autonomous learning ability, learning enthusiasm, the ability of literature retrieval and analysis and clinical thinking ability, and enhancing students' humanistic care consciousness in clinical work ( P <0.05). While the two groups had the same recognition in improving problem solving ability, teamwork ability and communication ability with patients, with no significant difference ( P > 0.05). Conclusion:The new teaching mode, SBAR mode combined with 3D printing model technology, applied to trauma orthopaedics bed-side teaching is helpful for students to improve their learning interest and autonomous learning ability, cultivate their lifelong learning habits and their comprehensive quality, so this mode will significantly improve the teaching effects, with good application value.
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TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.
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Since December 2019, corona virus disease 2019 (COVID-19) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of COVID-19. Based on the needs of emergency surgery for orthopedic trauma patients and review of the latest diagnosis and treatment strategy of COVID-19 and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of COVID-19 and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.
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With the outbreak of corona virus disease 2019 (COVID-19) caused by 2019 novel coronavirus (2019-nCoV) in Wuhan, Hubei Province in December 2019, more and more suspected or confirmed patients have been found in various regions of China. Although China has adopted unprecedented strict quarantine and closed management measures to prevent the spreading of the disease, Department of Traumatic Orthopedics may still have to manage COVID-19 patients with open fractures or severe trauma that require emergency surgery. Therefore, the identification and management of 2019-nCoV infection as soon as possible as well as the protection of all medical staff involved in the emergency treatment of patients are the serious challenges faced by orthopedic traumatologists during the prevention and control of COVID-19. Based on the characteristics of such patients and related diagnosis and treatment experiences during the epidemic of COVID-19, the authors formulate the strategies of surgical management and infection prevention and control for orthopedic trauma patients.
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With the spread of corona virus disease 2019 (COVID-19) in December 2019, the management and rehabilitation of elderly patients with hip fractures and protection of medical staff face new challenges, and need to be adjusted appropriately under this very circumstances. Hip fractures in the elderly account for more than half of osteoporotic fractures. Expert group formulate this consensus to make better decision against this epidemic and protect patients and medical staff. This consensus elaborates not only epidemic condition of COVID-19, but also general principles of medical admission, treatment and protection for both medical staff and patients, so as to provide some reference and promote the standardization of clinical diagnosis and treatment of elderly patients with hip fractures under the condition of COVID-19.
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With the outbreak of novel coronavirus pneumonia (NCP) induced by 2019 novel coronavirus (2019-nCoV) in Wuhan, Hubei Province in December 2019, more and more suspected or confirmed cases have been found in various regions of China. Although China has adopted unprecedented strict quarantine and closed management measures to prevent the spreading of the disease, Department of Traumatic Orthopedics may still have to manage NCP patients with open fractures or severe trauma that require emergency surgery. Therefore, the identification and management of 2019-nCoV infection as soon as possible as well as the protection of all medical staff involved in the emergency treatment of patients are the severe challenges faced by orthopedic traumatologists during the prevention and control of NCP. Based on the characteristics of such patients and related diagnosis and treatment experiences during the epidemic of NCP, the authors formulate the surgical management strategies for orthopedic trauma patients.
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Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.
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With the spread of novel coronavirus pneumonia (NCP) in December 2019, the management and rehabilitation of elderly patients with hip fractures and protection of medical staff face new challenges, and need to be adjusted appropriately under this very circumstances. Hip fractures in the elderly account for more than half of osteoporotic fractures. Expert group formulate this consensus so as to make better decision against this epidemic and protect patients' families and medical staff. This consensus elaborates not only epidemic condition of NCP, but also general principles of medical admission, treatment and protection for both medical staff and patients, in order to provide some reference and promote the standardization of clinical diagnosis and treatment of elderly patients with hip fractures under the condition of NCP.
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Objective To investigate the application of 3-dimension printed guide plate technology in sacroiliac screw fixation.Methods A study of 5 cases (from June 2016 to December 2016) applying the 3-dimension printed guide plate technology in sacroiliac screw fixation for the treatment of posterior ring injury of pelvis was performed.There were 4 male and 1 female,aged from 42 to 67 years (average,52.4 years),4 combined with sacral fracture (3 cases of Denis Ⅰ and 1 case of Denis Ⅱ combined with nerve injury),and 1case of sacroiliac joint separation.Patients' pre-operative CT scanning data were collected and introduced to the computer system to reconstruct and print a 3-dimensional pelvic model.The working tunnel for sacroiliac screw insertion was imitated by the system and a guiding template was designed and printed on the basis of that.The analysis of each screw placement time,the exposure of X ray and bleeding volume were undertook,and the Matta radiological criteria was used to evaluate the reduction quality.The visual analogue scale (VAS) was applied to evaluate the preoperative,1week and 6-monthspostoperative coccydynia.Results 5 sacroiliac screws were inserted in 5 patients.The time for each screw placement ranged from 8 to 16 min,average 11.2 min,and the times for each screw implantation exposed to X-ray ranged from 4 to 8,average 5.6.According to Matta radiological criteria,the fracture reduction was excellent in 4 cases and good in 1,giving an excellent to good rate of 100％.The volume of intraoperative bleeding was 20 to 50 ml,mean 30±0.7 ml.The average preoperative VAS score was 5.2 to 8.1,mean 7.04±0.1.The average VAS score was 5.46±0.3 at 1-week of postoperation;1.48±0.2 at 6-month after operation.The pain level decreased significantly from moderate/severe (preoperative) to slight (6-month postoperative).Postoperative Majeed score was 86 to 92,mean 90±0.5,giving a good-excellent rate 100％.Conclusion The 3-dimension printed guide plate technology,with the advantages of minimal invasive,less exposure to X-ray and a definite curative effect,can significantly simplify the procedure of the placement of sacroiliac screws in fixation of posterior ring injury of pelvis.
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Objective To compare the clinical effect of three-dimensional printing template technology with X-ray fluoroscopy in assisting surgery for sacroiliac screw placement. Methods A retrospective case-control study was conducted on 28 cases of sacroiliac complex injury from January 2015 to December 2016. The patients were divided into template group (13 cases) and fluoroscopy group (15 cases) according to whether the preoperative three-dimensional printing template was adopted. In template group, there were nine males and four females, with an average age of 46.7 years (range, 18-68 years). According to Tile typing, there were eight cases of type B (two type B1, three type B2, and three type B3) and five cases of type C (three type CI and two type C2). In fluoroscopy group, there were 11 males and four females, with an average age of 47.1 years (range, 18-65 years). According to Tile typing, there were 10 cases of type B (three type B1, four type B2, and three type B3) and five cases of type C (three type C 1 and two type C2). The screw numbers, time for single screw placement, and fluoroscopy frequency were recorded. The Matta criteria was used to evaluate fracture reduction quality, and Majeed score was used to evaluate pelvic fracture function at the last follow-up. Results All patients were followed up for 6-20 months [(10.4±0.6) months]. Fifteen screws were implanted in template group, and 17 in fluoroscopy group. The time for single screw placement was 25-38 minutes [(28 ±5.3) minutes] in template group and 45-70 minutes [(60.3 ±5.8) minutes] in fluoroscopy group (P ＜0.01). The fluoroscopy frequency was 2-5 times [(2.8 ±0.5) times] in template group and 11-23 times [(15.4 ±3.5) times] in fluoroscopy group. According to the Matta criteria, there were eight excellent cases, four good, one fair, with an excellent and good rate of 92％ in template group; there were seven excellent cases, six good, two fair, with an excellent and good rate of 87％ in fluoroscopy group (P＞0.05). According to Majeed score at the last follow up, there were eight excellent cases, three good, two fair, with an excellent and good rate of 85％ in template group; there were six excellent cases, six good, three fair, with an excellent and good rate of 80％ in fluoroscopy group (P＞0.05). Conclusions Compared with traditional surgery, three-dimensional printing template technology assisted surgery for sacroiliac screws placement presents advantages of less operation time and reduced fluoroscopy frequency. This technology improves the safety profile and should be further promoted in clinical applications.
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Objective To investigate the advantage and application prospect of 3D printing technology in assisting surgery for complex tibial plateau fractures.Methods The complete clinical data of 41 patients (48 knees) were retrospectively analyzed.And these patients were divided into two groups as 3D printing assisted operation group and traditional operation group,according to whether 3D printing technology was applied.Study was carried out to compare the clinical efficacy of surgery assisted by 3D printing technology and traditional surgery in the treatment of complex tibial plateau fractures.The 3D printing assisted operation group included 18 patients (22 knees,12 males and 6 females),aging from 16 to 68 (mean age 45.5±7.2),and there were 12 cases of Schatzker Ⅴ and 10 Ⅵ.The traditional operation group included 23 patients (26 knees,15 males and 8 females),aging from 19 to 69 (mean age,46.2±6.8),and there were 14 cases of Schatzker Ⅴ and 12 Ⅵ.The operation time,intraoperative blood loss,the Rasmussen score and hospital for special surgery knee score (HSS) at 6 weeks post-operation were analyzed and the difference between the two groups was tested.Results All those patients were followed up for 7 to 20 months (mean 15 months).For 3D printing assisted operation group,the mean operation time was 81.4±6.3 min for Schatzker Ⅴ and 90.6± 15.4 min for Schatzker Ⅵ;the mean intraoperative blood loss was 200.4±72.3 ml for Schatzker Ⅴ and 280.6±101.6 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,6 good and 2 fair (excellent and good rate 90.9％);the result of 6-week HSS score was 15 excellent,5 good and 2 fair (excellent and good rate 90.9％).Then for traditional operation group,the mean operation time was 100.4± 15.3 min for Schatzker Ⅴ and 111.5±20.2 min for Schatzker Ⅵ;the mean intraoperative blood loss was 450.4±173.3 ml for Schatzker Ⅴ and 500.5±247.2 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,8 good,2 fair and 2 bad (excellent and good rate 84.6％);the result of 6-week HSS score was 13 excellent,8 good,2 fair and 3 bad (excellent and good rate 80.8％).The difference in operation time,intraoperative blood loss had statistical significance between the two groups;but the difference in 6-month post-operation Rasmussen score and HSS score had no statistical significance.Conclusion Compared with traditional surgery,3D printing technology assisted surgery for complex tibial plateau fracture possesses advantage such as shortened operation time,reduced intraoperative blood loss;but there's no evidence for improved knee function at 6 weeks post-operation.
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Objective To study the age peak of incidence,pathologic sites,therapeutic effect and complications of different treatment for hip fractures in the elderly.Methods Hip fractures,therapy,elderly were used as key words to search articles both in English and Chinese from 1979 to 2017.The articles were filtrated by title,abstract and full text and 32 of them were left.All the patients were objects of this study,but the repeated cases were excluded.The patients' data such as age of onset,gender,fracture type,operation method,follow-up time,and complications were collected and analyzed by systematic analysis.Results Data of 2 758 patients in 32 papers had been collected for analysis.There were 1791 femoral neck fractures and 967 intertrochanteric fractures,with a ratio of 1.85:1.The patients' age of onset was ranging from 54 to 92 years old,with an average of 76.7 years old,and the age peak of incidence was from 70 to 79 years old.The sex ratio was 1:1.66 (1 037 males:1721 females).All the patients had been followed up for 0.5 to 18 years,(average,7.8 years).Among 927 femoral neck fractures who were treated by 3 lag screws,there were 278 cases of non-union (29.9％),139 femoral head necrosis(15.1％) and 19 internal fixation loosening (2.0％);but for 183 femoral neck fractures who were treated by dynamic hip screws (DHS),there were 51 cases of non-union (28.1％),31 femoral head necrosis(17.0％),3 internal fixation losening(1.8％),and 27 cutting effect (15％).Then for 400 femoral neck fractures who were treated by hemiarthroplasty,there were 6 cases of dislocation(1.5％),14 shaft fracture (3.5％),8 deep infection (2.0％);while for 281 femoral neck fractures who were treated by total hip arthroplasty,there were 14 cases of dislocation (5.0％),11 shaft fracture (4.0％),and 10 deep infection (3.5％).On the other hand,for 354 intertrochanteric fractures who were treated by proximal femoral nail or proximal femoral nail antirotation internal fixation (PFN or PFNA),there were 18 cases of trochanter fracture (5.0％),28 hip varus (8.1％),32 displacement (9.0％);and for 210 intertrochanteric fractures who were treated by Gamma nail,there were 17 cases of trochanter fracture (7.9％),11 cutting effect (5.0％),6 displacement (3.0％);and for 135 intertrochanteric fractures who were treated by DHS,there were 8 cases of cutting effect (6.1％),7 displacement (5.2％);and for 101 intertrochanteric who were treated by proximal femoral locking plate,there were 5 cases of displacement (5.0％);Also for 89 intertrochanteric fractures who were treated by hemiarthroplasty,there were 2 cases of dislocation(1.8％),3 shaft fracture (3.0％),1 deep infection(1.5％);and for 78 intertrochanteric fractures who were treated by total hip arthroplasty,there were 4 cases of dislocation (4.8％),3 shaft fracture (4.0％),2 deep infection (2.5％).Conclusion The elderly hip fractures' age peak of incidence is from 70 to 79 years old,and femoral neck fracture takes up a majority of it.Female patients are more than male patients.The femoral neck fractures are mainly treated by 3 lag screws internal fixation;non-union and femoral head necrosis are the common complications postoperation.While the intertrochanteric fractures are mainly treated by proximal femoral nails;displacement,hip varus and trochanter fractures are the common complications postoperation.The artificial hip replacement is the effective remedy measure for secondary femoral head necrosis after hip fractures.