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Objective:To compare the clinical effects robot navigation assisted and conventional proximal femoral nail antirotation (PFNA) implantation and fixation in the treatment of elderly femoral trochanteric fractures.Methods:A total of 86 elderly patients with tuberosity fracture of the femur were admitted as research samples from January to March in 2022 in the Department of Trauma Orthopaedic, Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University, including 37 males and 49 females, who aged from 63 to 92 years, with an average age of (79.6 ± 6.9) years. All patients were treated with intramedullary nails (PFNA), 32 with dimensity robotic-assisted therapy (robot group) and 54 with traditional methods (conventional group). The length of incision, the number of intraoperative fluoroscopy, the amount of intraoperative blood loss, and the operation time were recorded. The occurrence of postoperative complications in the two groups was observed. The rate of excellent hip Harris score at 3 month after surgery was compared between the two groups. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; the comparison of count data were represented as [ n(%)], and was conducted by Chi-square test or Fisher exact probability between groups. Results:All patients were followed up for 9 to 12 months, with an average of (10.6 ± 0.9) months. The incision length and tip apex distance (TAD) of the robot group were (3.40±0.82) cm and (21.85±1.44) mm, which were smaller than (4.82±0.75) cm and (26.83±1.75) mm in the conventional group ( P<0.05 for all). The number of intraoperative fluoroscopy and guide needle adjustment [(14.53±3.26) and 0 times] in the robot group were less than those in the conventional group [(20.67±4.84) and (2.83±1.42)] ( P<0.05). The intraoperative blood loss and drainage rate of the robot group were (87.03±9.41) and (46.40±8.91) mL, which were smaller than that of the conventional group [(110.00±12.52) and (69.62±10.22) mL] ( P<0.05). There was no significant difference in the number of days of hospitalization and operation time between the two groups ( P>0.05). The postoperative complication rate in the robot group was 9.4%, which was lower than that in conventional group (42.6%), and the difference was statistically significant ( χ2=11.88, P=0.036). The excellent rate of postoperative hip joint function in the robot group was 75.0%, and the conventional group was 66.7%, and there was no significant difference between the two groups ( χ2=0.66, P=0.416). Conclusion:Robot-assisted navigation downward PFNA surgery can have good clinical effect in the treatment of femoral tuberosity fracture in the elderly, which can reduce the number of surgical incisions and intraoperative fluoroscopy, and reduce the incidence of postoperative complications, which is helpful to achieve minimally invasive surgery and rapid recovery of elderly patients with femoral tuberosity fracture.
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Objective To study the stability of plate-assisted intramedullary nailing for fixing proximal third tibiafractures, compare and observe biomechanical characteristics of anterolateral or posteromedial plate-assisted intramedullary nailing after fixation of proximal third tibia fractures. Methods Eight artificial tibia of 4th-generation sawbones were divided into two groups based on location of the assisted plate, namely, anterolateral plate group and posteromedial plate group, with 4 specimens in each group. Each two locking bolts were fixed to theintramedullary nail proximally and distally, and each three bicortical screws were fixed to the plate proximally and distally. The specimens were osteotomized with a 10-mm defect which located 0. 5 cm to the proximal locking bolt of intramedullary nail or 5-6 cm distally to the knee joint line, in order to simulate an AO/ OTA 41-A2 type proximal third tibia fracture after fixation of intramedullary nail. After osteotomy was finished, axial compression test, three point bending test, cyclic loading and overstress test were conducted by mechanical testing machine. The results of axial stiffness and three-point stiffness between two groups were compared and analyzed. Results Axial compression test showed that the average axial stiffness in posteromedial plate group was lower than that in anterolateral plate group, but no significantly statistical differences were found between the two groups. Three point bending test showed that the average bending stiffness in posteromedial plate group was significantly higher than that in anterolateral plate group when stimulating either varus stress (plate located at pressure side of the fracture, t = 3. 679, P<0. 05) or valgus stress (plate located at tension side of the fracture, t = 8. 975, P<0. 05). Conclusions Plate-assisted intramedullary nailing for fixation of proximal third tibia fractures can minimize the angulation malalignment, improve the stability of nailed proximal tibial fragment and allow the early weight bearing. Both anterolateral and posteromedial plate-assisted intramedullary nail can provide satisfactory axial stability for proximal third tibia fractures, while posteromedial plate-assisted intramedullary nail shows better bending stability than anterolateral plate in countering varus or valgus stress deformity. This study provides an essential basis for clinical decision making about plate-assisted intramedullary nailing for fixing proximal third tibia fractures.
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Objective:To compare the early clinical efficacy between reaming after distal tibia cortical fenestration combined with antibiotic-loaded calcium sulphate and trench grooving combined with polymethyl methacrylate (PMMA) for the treatment of chronic tibial osteomyelitis after intramedullary nail fixation.Methods:A retrospective analysis was conducted in the 20 patients who had been surgically treated for chronic tibial osteomyelitis after intramedullary nail fixation at Department of Trauma Orthopaedics, Honghui Hospital from January 2019 to January 2021. According to the surgical methods, they were divided into a reaming group and a grooving group. In the reaming group, there were 6 males and 3 females with an age of (47.6±11.4) years; in the grooving group, there were 9 males and 2 females with an age of (49.2±13.9) years. The 2 groups were compared in terms of duration of infection, operation time, intraoperative blood loss, bacterial culture results, total hospital stay, time for inflammatory indexes to return to normal, time for weight-bearing, complication rate, infection control rate, and good to excellent rate by Johner-Wruhs joint function scoring.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P > 0.05). All patients were followed up for 12 to 25 months after operation. There were no significant differences in the duration of infection, operation time, intraoperative blood loss, bacterial culture results, time for inflammatory indexes to return to normal, complication rate, infection control rate, or Johner-Wruhs scoring between the 2 groups ( P > 0.05). The total hospital stay [(11.7 ± 4.7) d] and weight-bearing time [(5.8 ± 1.6) weeks] for the reaming group were significantly shorter than those for the grooving group [(16.8 ± 4.6) d and (8.1 ± 2.9) weeks] ( P < 0.05). Conclusion:In the treatment of chronic tibial osteomyelitis after intramedullary nail fixation, compared with conventional trench grooving combined with PMMA, reaming after distal tibia cortical fenestration combined with antibiotic-loaded calcium sulphate can not only obtain satisfactory outcomes by infection control but also shorten the treatment cycle by allowing the patients to start early weight bearing.
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Objective:To evaluate the clinic efficacy of channel bone grafting [preservation of the sclerotic bone at the broken nonunion ends and fixation with limited contact dynamic compression plate (LC-DCP)] in the treatment of postoperative atrophic nonunion of middle clavicular fracture.Methods:The 41 patients were retrospectively analyzed who had been treated at Department of Orthopaedics and Traumatology, Xi'an Hong-Hui Hospital for atrophic nonunion after internal fixation of middle clavicular fracture from June 2015 to December 2019. They were 23 males and 18 females, with a mean age of 47.6 years (from 28 to 63 years). The left side was affected in 25 cases and the right side in 16 cases. The time interval between initial fracture surgery and nonunion surgery averaged 18.5 months (from 9 to 40 months). Thirty-six cases had undergone one operation and 5 cases 2 operations before admission. The length of bone defect was measured during operation. All nonunions were treated with construction of a graft channel, iliac bone graft and LC-DCP internal fixation above the clavicle. The upper limb function of the affected side was evaluated by the Disabilities of Arm, Shoulder and Hand (DASH) 12 months after operation.Results:The 41 patients were followed up for an average of 13.6 months (from 12 to 15 months). A bone defect ≤2.0 cm was found in 25 cases and that >2.0 cm in 16 ones. Nonunion healed in all patients after an average time of 14 weeks (from 12 to 16 weeks). One patient reported continuous pain in the donor area after operation and the other developed deep venous thrombosis at the right lower limb. The DASH upper limb scores at 12 months after operation averaged 14.7.Conclusion:Channel bone grafting is a feasible clinical treatment of postoperative atrophic nonunion of middle clavicular fracture, because it preserves the sclerotic bone at the broken nonunion ends, reduces the amount of iliac bone graft and leads to fine clinic efficacy.
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Objective:To characterize the biomechanical performance of our self-designed novel blocking screws in the treatment of distal tibial fractures.Methods:Thirty artificial composite tibial bones were used to create models of unstable distal tibial fracture (AO type 43-A3) which were randomized into 3 even groups ( n=10) according to modes of fixation. Group A was subjected to fixation with intramedullary nails only with merely preset holes reserved for the blocking screws, group B to fixation with intramedullary nails plus conventional anteroposterior blocking screws, and group C to fixation with intramedullary nails plus novel lateral blocking screws. In all the 3 groups, a lateral bending stress test was conducted to record the maximum transversal displacement of the intramedullary nail, a fatigue test to observe the structural abnormality in the model and an axial stress test to record the maximum axial displacement of the intramedullary nail-bone structure. The 3 groups were compared in structural abnormality, the maximum transversal displacement of the intramedullary nail and the maximum axial displacement of the intramedullary nail-bone structure. Results:The lateral bending stress tests showed the maximum transversal displacements were (5.02±1.03) mm; (4.19±0.64) mm and (4.18±0.65) mm in groups A, B and C; compared with group A, the maximum transversal displacement decreased by 16.6%( P=0.027) in group B and decreased by 16.8%( P=0.025) in group C, showing significant differences but there was no significant difference in the maximum transversal displacement between groups B and C ( P=0.978). In the fatigue test, all models showed no structural abnormality under cyclic loading. In the axial stress test, the maximum axial displacements of the intramedullary nail-bone structure were, respectively, (5.69±0.75) mm, (5.31±0.61) mm and (5.51±0.65) mm in groups A, B and C, showing no statistically significant difference among the 3 groups ( P>0.05). Conclusion:Our self-designed novel blocking screws can be a new means in clinical application, because they are similar to conventional blocking screws in increasing the stability of nail-bone construct and other biomechanical performance.
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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 evaluate short-term clinical efficacy of femoral neck system (FNS) for treatment of femoral neck fractures in young and middle-aged patients.Methods:A retrospective analysis was conducted of the 70 middle-aged and young patients who had been surgically treated for femoral neck fractures at Department of Trauma Orthopaedics, Honghui Hospital from January to November 2020. Of them, 32 cases were fixated by FNS; they were 16 males and 16 females, with an age of (49.4±11.0) years, including 10 cases of type Ⅱ, 12 cases of type Ⅲ and 10 cases of type Ⅳ by the Garden classification. The other 38 patients were fixated by cannulated compression screws (CCS); they were 19 males and 19 females, with an age of (48.8±10.1) years, including 12 cases of type Ⅱ, 15 cases of type Ⅲ and 11 cases of type Ⅳ by the Garden classification. The 2 groups were compared in terms of operation time, intraoperative blood loss, fracture reduction, fracture union time, weight-bearing time, complications, Barthel index at 3 months after surgery, and hip function at 6 months after surgery.Results:There was no statistically significant difference in preoperative general information or follow-up time between the 2 groups, showing comparability between groups ( P>0.05). There was no significant difference in operation time, intraoperative blood loss or fracture reduction quality between the 2 groups ( P>0.05). In the FNS group, weight-bearing time [(11.4±3.4) weeks] and fracture healing time [(3.1±0.9) months] were significantly shorter than those in the CCS group [(16.4±3.9) weeks and (3.6±0.9) months], rate of complications (12.5%, 4/32) was significantly lower than that in the CCS group (34.2%, 13/38), Barthel index at 3 months after operation (98.1±2.8) and Harris hip score at 6 months after operation (96.8±4.0) were significantly higher than those in the CCS group (93.8±4.1 and 93.6±6.7) ( P<0.05). Conclusion:In the treatment of femoral neck fractures in young and middle-aged patients, compared with CCS fixation, FNS fixation can obtain better short-term curative effects, due to its advantages of shorter bone union and weight-bearing time, a decreased rate of complications and early functional recovery of daily activities.
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Objective:To study the influence of anticoagulation timing on incidence of perioperative deep venous thrombosis (DVT) in elderly patients with hip fracture.Methods:A retrospective analysis was made of the 179 elderly patients with hip fracture who had been admitted to Department of Orthopedics and Traumaology, Hong-Hui Hospital from July 2017 to December 2018. They were 78 males and 101 females, aged from 62 to 91 years (mean, 79.5 years). There were 79 femoral neck fractures and 100 intertrochanteric fractures, 109 of which were treated by internal fixation and 70 by hip replacement. The patients were divided into 3 groups depending on the timing of anticoagulation after injury. In group 1 of 74 cases, anticoagulation started <24 h after injury; in group 2 of 36 cases, anticoagulation started 24 to 48 h after injury; in group 3 of 69 cases, anticoagulation started >48 h after injury. Anticoagulation continued until 12 h before surgery in all patients but was resumed 8 to 12 h after surgery. The 3 groups were compared in incidence of perioperative DVT.Results:The 3 groups were comparable due to insignificant differences between them in their pre-operative general data ( P>0.05). DVT occurred perioperatively in 84 patients, yielding an incidence of 46.9% (84/179). The incidences of perioperative DVT were 27.0% (20/74), 47.2% (17/36) and 68.1% (47/69) in groups 1, 2 and 3, respectively, showing significant differences ( χ2=24.206, P<0.001), between any 2 groups ( P<0.05). Conclusion:Since the earlier anticoagulation starts after injury the lower incidence of perioperative DVT in elderly patients with hip fracture, early standardized prophylactic anticoagulation after injury can effectively reduce incidence of perioperative DVT.
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Objective:To evaluate arthrography-assisted reduction in minimally invasive treatment of tibial plateau fractures.Methods:From January to May 2019, 9 patients with tibial plateau fracture were treated by arthrography-assisted minimally invasive surgery at Department of Orthopaedics and Traumatology, Hong-Hui Hospital. They were 6 males and 3 females with an average age of 45.5 years (from 27 to 63 years). According to the Schatzker classification, there were 6 cases of type Ⅱ, one of type Ⅲ and 2 cases of type Ⅳ. Arthrography was used to determine the lowest filling point of contrast medium after intra-articular injection and to ensure satisfactory reduction of articular surface after fracture reduction and bone grafting, followed by minimally invasive percutaneous plate implantation. Comparisons were made between preoperation and 6 months postoperation in the range of knee motion and knee scores of The Hospital for Special Surgery (HSS). Knee X-ray films were evaluated by the Rasmussen imaging system at 6 months postoperation. Collapse of articular surface was recorded pre- and post-operation as well as postoperative complications.Results:All the 9 patients were followed up for 6 to 9 months (average, 7 months). All patients achieved bony union within 12 weeks postoperation. The preoperative knee flexion (60.7°±13.1°) and HSS (51.9±5.7) were significantly improved to 122.4°±10.8° and 84.9±5.3 at 6 months postoperation ( P<0.05), but there was no significant difference between preoperation and 6 months postoperation in knee extension (4.4°±2.5° versus 4.6°±2.9°) ( P>0.05). The collapse of articular surface was improved from preoperative 9.5 mm (from 5 to 15 mm) to postoperative 1.3 mm (from 0 to 3 mm). The Rasmussen imaging scores at 6 months postoperation showed 6 excellent and 3 good. No such postoperative complications occurred as incision infection, joint stiffness, loosening or breakage of implants. Conclusion:Arthrography helps minimally invasive treatment of tibial plateau fracture because it can better display fracture collapse during operation and accurately judge indirect reduction of articular surface.
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Objective:To explore the efficacy of our novel reduction technique in the surgical treatment of complicated tibial plateau fractures.Methods:From May 2016 to September 2018, 50 fractures of tibial plateau (Schatzker types Ⅴ and Ⅵ) were treated at Department of Orthopaedics and Traumatology, Hong Hui Hospital. They were 34 males and 16 females, aged from 27 to 56 years (average, 42.3 years). They were divided into 2 groups according to the reduction techniques. In the group of novel reduction ( n=23), bone fragments were reduced one by one from the distal to the proximal until the compression fracture was reduced and fixated. In the conventional reduction group ( n=27), the articular surface was reduced first before fixation of articular fragments with distal ends of tibial fracture. The 2 groups were compared in terms of intraoperative bleeding, operation time, tibial plateau angle (TPA) on the knee anteroposterior X-ray film taken on the second day after operation, and rate of acceptable TPA (±5°). Results:There were no significant differences between the 2 groups in general preoperative data, showing comparability ( P>0.05). There were no significant differences between the 2 groups in either operation time (2.7 h ± 0.4 h versus 3.0 h ± 0.6 h) or intraoperative bleeding (215 mL ± 56 mL versus 221 mL ± 52 mL) ( P>0.05). The novel reduction group had a significantly higher rate of acceptable TPA [78.2% (18/23)] than the conventional reduction group [48.1%(13/27)]( P<0.05). Conclusion:In the surgical treatment of complicated tibial plateau fractures, compared with conventional reduction technique, our novel reduction technique can increase the rate of acceptable reduction but not operation time nor intraoperative bleeding.
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Objective:To explore the clinical efficacy of proximal femoral anatomical locking plate and autogenous iliac graft for failed primary internal fixation in treatment of femoral intertrochanteric fracture.Methods:A retrospective analysis was conducted of the 29 patients with femoral intertrochanteric fracture who had been treated after failed primary internal fixation at Department of Orthopaedics and Trauma, Xi'an Honghui Hospital between January 2014 and March 2017. They were 17 men and 12 women, aged from 35 to 83 years (mean, 68.7 years). Their primary internal fixation involved dynamic hip screw in 12 cases, proximal femoral locking plate in 13 cases, and intramedullary nail in 4 cases. The causes for their internal fixation failure included head cutting in 8 cases, fracture nonunion in 10 cases, plate or screw breakage in 6 cases, intramedullary nail breakage in 3 cases, and hip varus in 2 cases. Their revision surgery was performed with anatomical proximal femoral locking plate and autogenous iliac bone graft. Their fracture union time, and visual analogue scale (VAS), hip Harris score, SF-36 health survey scale and complications at the final follow-ups were recorded.Results:All the 29 patients were followed up for 12 to 24 months (18 months on average). Bony union was eventually achieved in all the 29 patients after an average time of 4.5 months (from 3 to 7 months). There were no such complications as nonunion, re-fracture or internal fixation failure. The VAS pain score at the final follow-up(4.6±1.6) was significantly lower than that before surgery(7.1±2.1), and the Harris hip score(85.2±8.2) and SF-36 score(75.9±15.5) at the final follow-up were significantly higher than those before surgery (48.0±12.7 and 48.7±18.8) (all P<0.05). According to their hip Harris scores at the final follow-ups, the therapeutic efficacy was rated as excellent in 9 cases, as good in 15 cases and as poor in one, yielding an excellent and good rate of 82.8%. Conclusion:For patients with femoral intertrochanteric fracture whose primary internal fixation has failed, especially those with fine femoral head and neck and hip joint, proximal femoral anatomic locking plate and autogenous iliac bone graft can result in satisfactory clinical efficacy.
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Objective:To investigate the effects of surgical revision for humeral shaft nonunion on health-related quality of life.Methods:The data of 62 patients were studied retrospectively who had been hospitalized at Department of Orthopaedics and Traumatology, Hong-Hui Hospital for humeral shaft nonunion from March 2013 to September 2018. They were 43 males and 19 females, aged from 20 to 73 years (average, 42.3 years). Their nonunions belonged to the atrophic type in 19 cases, to the ischemic type in 14 cases and to the hypertrophic type in 29 cases. Their demographic and clinical data, imaging manifestations and treatment methods were recorded and analyzed. The 12-item short form health survey (SF-12) and brief pain inventory (BPI) were used to evaluate their health-related quality of life and the Mayo elbow performance score (MEPS) was used to evaluate their elbow function.Results:Upon admission, their physical component summary (PCS) scored 24.3±5.2, mental component summary (MCS) 26.3±3.8, brief pain inventory- severity (BPI-S) 6.5±1.9, and brief pain inventory-interference (BPI-I) 6.7±2.5. At 1-year follow-up, their PCS averaged 43.6±8.1, MCS 34.7±4.4, BPI-S 4.9±1.2, and BPI-I 4.4±1.4. There were statistically significant differences between preoperation and postoperation in the above 4 groups of indicators ( P<0.05). Their MEPS at the last follow-up revealed a 95.2% rate of excellent elbow function (59/62). By comparison with the literature data, their postoperative PCS scores were not significantly different from those for the patients with Barrentt＇s esophagus, primary hypertension, chronic obstructive pulmonary disease and silicosis ( P>0.05). There was no significant difference either in the postoperative MCS scores between them and stroke patients ( P>0.05). Conclusions:As a destructive chronic disease, humeral shaft nonunion has negative effects on physical and mental health and quality of life of the patients. Although the pain effect on the limb can be alleviated by surgical revision, the entire treatment may cause permanent psychological trauma to the patients.
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Objective:To evaluate the clinical efficacy and operative techniques of medullary external fixation with proximal femoral plate (PFP) and locking compression plate (LCP) assisted by double grafting (cancellous bone and allograft bone grafting in nail holes plus structural grafting at ununited fracture ends) for subtrochanteric femoral nonunions after intramedullary fixation.Methods:Between January 2018 and December 2008, 21 patients received secondary revision at Department of Orthopedics, Honghui Hospital for subtrochanteric femoral nonunion after intramedullary fixation. All of them obtained full follow-up. They were 15 men and 6 women, with an average age of 52.3 years (from 27 to 65 years). There were 18 cases of atrophic nonunion and 3 ones of ischemic nonunion. The intervals between primary operation and secondary revision averaged 10.3 months (from 9 to 13 months). All the fractures were treated by intramedullary fixation with closed reduction in 10 cases and open reduction in 11 cases (including 8 ones of wire binding). All the nonunions were managed with PFP and LCP assisted by double grafting (cancellous bone and allograft bone grafting in nail holes plus structural grafting at ununited fracture ends). Functional recovery of the hip was evaluated by Harris scoring 12 months after operation.Results:The 21 patients obtained an average follow-up of 11.4 months (from 10 to12 months).All the nonunions got united after an average time of 5.2 months (from 4 to 6 months). Postoperative subcutaneous haematomas occurred in only one patient which was treated by a secondary debridement. The mean hip Harris scores were 85.7 (from 84 to 92).Conclusions:As PFP can effectively correct varus deformity and strengthen fixation, LCP plus structural grafting can provide medial mechanical support, and cancellous bone and allograft bone grafting can increase the bone mass in nail holes, our composite method can greatly increase the healing rate of subtrochanteric femoral nonunions after intramedullary fixation with better functional recovery of the hip joint.
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Objective:To report our experience in the admission and perioperative management of 88 patients with lower extremity fracture in a mildly affected area in the epidemic of COVID-19.Methods:A retrospective analysis was conducted of the 88 patients with 97 lower extremity fractures who had been admitted to Department of Orthopedic Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine from 23rd January, 2020 to 22nd February, 2020. They were 43 males and 45 females, aged from 15 to 95 years (average, 65.5 years). The patients underwent screening for COVID-19 infection before admission. Their fractures were located at the femoral neck in 33 cases and at the femoral trochanter in 26. Open reduction and internal fixation was performed for 29 cases, internal fixation with proximal femoral nail anti-rotation (PFNA) for 25 and hip replacement for 28. The time from injury to admission, time from admission to surgery, operation time, fracture reduction, hospital stay, and perioperative deep venous thrombosis (DVT) of lower limbs were recorded. COVID-19 infection was observed in the medical staff and patients as well.Results:All the 88 patients were COVID-19 negative in the screening before admission. The time from injury to admission averaged 4.5 days, the time from admission to surgery 3.7 days and hospital stay 6.6 days. The prostheses were all well located in the 28 patients undergoing hip replacement. The rate of functional and anatomic reduction was 94.2%(65/69) in the 69 patients undergoing internal fixation. Peri-operatively, DVT occurred in 25 cases (28.4%). High temperature was observed in 7 patients within 3 days after operation, which was diagnosed as absorption fever. No medical staff or patients were infected by COVID-19.Conclusion:In the epidemic of COVID-19, orthopedic surgeons in a medical institute in a mildly affected area can still provide effective and safe medical services for fracture patients and reduce nosocomial infection, as long as they comprehend the diagnosis and treatment guidelines for the epidemic, strictly screen the patients accordingly, stick to operative indications, protect against possible infection cautiously, and carry out the procedures in a standard manner.
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Fracture-related infection is one of the most feared complications for orthopedic surgeons and patients. What is more frightening than aseptic bone nonunion is the presence of deep or shallow bone tissue infection at the broken end of the fracture.The high rate of recurrence of bone infections, long treatment cycles and the risk of disability, amputation and death bring physical and mental suffering to patients.At the same time, the complexity of the disease puts forward higher requirements for the diagnosis and treatment of orthopedic doctors. This paper reviews the treatment methods of fracture related infections in recent years at home and abroad.
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Objective:To investigate the effect of double steel plate internal fixation combined with autogenous iliac bone grafting on aseptic nonunion after femoral shaft fractures.Methods:Retrospective analysis of clinical data of 73 patients with aseptic nonunion after femoral shaft fracture treatment was performed in department of orthopedies, Honghui Hospital, Xi′an Jiaotong University from January 2017 to December 2018, there were 42 males and 31 females, aged 30 to 58 years, with an average age of 40.63 years. They were divided into control group ( n=33) and observation group ( n=40) according to different surgical methods, the control group was treated with intramedullary nail replacement, and the observation group was treated with double steel plate internal fixation combined with autogenous iliac bone grafting. The general indicators of perioperative period (intraoperative blood loss, duration of operation, postoperative drainage), bone nonunion healing, and surgical efficacy were compared between the two groups. The follow-up time in outpatient clinic was (15.24 ± 4.72) months, and the follow-up deadline was December 2019. At 6 months after surgery, joint function, joint mobility, visual analogue scale (VAS) and Oswestry disability index(ODI) were evaluated. Measurement data were expressed as mean ± standard deviation ( Mean ± SD), and comparison between groups was analyzed using independent sample t test. Count data were expressed as percentage (%), and comparison between groups was analyzed using χ2 test. Comparison of ordinal data was analyzed by Mann-whitney U non-parametric test. Results:The patients in both groups were followed up. The amount of intraoperative blood loss, duration of operation, and postoperative drainage [(201.6±38.4) mL, (138.7±22.7) min, (25.8±6.9) mL] in the observation group were significantly less than those in the control group [(278.5±40.6) mL, (171.4±20.1) min, (43.2±8.5) mL], the differences were statistically significant between the two groups ( P<0.05). Comparison of postoperative bone nonunion healing, the healing time of the observation group (5.15±0.42) months was significantly shorter than that of the control group (6.31±0.58) months, and the healing rate of the observation group (100%) was significantly higher than that of the control group (90.1%), the differences were statistically significant between the two groups ( P<0.05). After 6 months of follow-up, the excellent and good rate of joint function were compared between the two groups. The knee joint excellent and good rate (97.50%) and hip joint excellent and good rate (97.50%) in the observation group were significantly better than those of the control group (78.79%, 81.81%), the differences were statistically significant between the two groups ( P<0.05). Comparison of joint mobility between the two groups of patients, knee joint mobility [extension angle (0.64±0.14) °, flexion angle (138.72±6.37) °]and hip joint activity [adduction angle (35.13±9.44) °, the abduction angle (74.38±5.22) °] were significantly better than the knee joint mobility [extension angle (0.48±0.21) °, flexion angle (113.57±5.43) °] and hip joint motion [adduction angle (21.57±8.63) °, abduction angle (69.57±6.37) °], the differences were statistically significant between the two groups ( P<0.05). The VAS and ODI efficacy scores [(3.24±0.43), (23.45±4.77) scores]in the observation group were significantly better than those of the control group [(4.64±0.71), (27.25±4.38) scores] at 2 and 4 weeks after operation, the differences were statistically significant between the two groups ( P<0.05). Conclusions:The double steel plate internal fixation combined with autologous iliac bone grafting is ideal and significant in the treatment of aseptic nonunion after femoral shaft fracture. Meanwhile, it has the advantages of less trauma throughout the operation, quicker postoperative recovery, and significantly improved joint function. It is worthy of clinical application.
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With the development of social economy, high-intensity energy is the direct cause of fracture, such as traffic accident, fall injury and tumble. Fracture healing is affected by many factors, such as malunion, delayed union, nonunion and wound infection. Tibial fractures are usually caused by high-energy mechanisms and can also be caused by low-energy mechanisms of ankle rotation. With the gradual deepening of orthopedic surgeons′ understanding of bone nonunion, the treatment of tibial nonunion is mainly divided into surgical treatment and non-operative treatment. Surgical treatment is generally the first choice for the treatment of bone nonunion, in which plate internal fixation plays an unique advantage in the treatment of tibial nonunion. By reviewing the recently published literature, this paper reviews the latest progress in the treatment of tibial nonunion with plate internal fixation.
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Nonunion of femur is a common complication after intramedullary nail operation of femoral fracture, with an incidence of 1% to 12.5%. At present, the treatment of femoral nonunion is mainly divided into surgical treatment and non-operative treatment, and surgical treatment is the first choice. The gold standard for surgical treatment of femoral nonunion is replacement of intramedullary nail, but for non-isthmus femoral nonunion, larger diameter intramedullary nail could not solve the problem of rotation and angular displacement of the broken end of nonunion. For malnourished nonunion, atrophic nonunion and bone nonunion with large bone defect, the replacement of intramedullary nail and autogenous bone graft are not enough to eliminate the gap between the broken ends and increase the contact area between the broken ends. It cannot provide a good biological environment for the broken ends. Because the replacement of intramedullary nail does not expose the broken ends of bone nonunion, and the corresponding tissue cannot be taken for bacteriological culture, so it is difficult to judge whether the broken end sare complicated with infection. The double plate technique is to find the site of bone nonunion under direct vision, and two plates are placed with different angles. This paper reviews the literature related to the treatment of femoral nonunion with double plate technique published at home and abroad in the past 10 years, and concludes that double plate fixation combined with autogenous iliac bone graft provides a three-dimensional fixation model for the healing of nonunion. It has the characteristics of strong stability and plays an active role in improving the biological behavior and mechanical stability of the fracture ends. The operation is beneficial to the flexion and extension of the knee joint, with the characteristics of high healing rate, low complication rate, effective pain relief and so on.
ABSTRACT
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.
ABSTRACT
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.