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<p><b>OBJECTIVE</b>To evaluate the results of Acumed intramedullary nail for the treatment of adult diaphyseal fractures of both-bone forearm fractures.</p><p><b>METHODS</b>From January 2009 to December 2016, 86 adult patients with both forearm fractures were treated by intramedullary nail including 54 males and 32 females with an average age of 36.8 years old ranging from 18 to 72 years old;There were 50 cases were on the right and 36 cases on the left. The operation time, blood loss and X-ray expose time intra-operation, time of fracture union, complications, DASH(Disabilities of the Arm, Shoulder and Hand questionnaire), Grace-Eversman criteria were recorded to evaluate the clinical outcomes of intramedullary nail for the treatment of forearm fractures.</p><p><b>RESULTS</b>All patients were followed up from 48 to 144 weeks with an average of 86.8 weeks; the blood loss intraoperation was 30 to 80 ml with an average of 52 ml; the the X-ray expose time was 1 to 6 min with an average of 2.5 min;the operation time was 31 to 55 min with an average of 46 min; Among them, 85 cases healed successfully, the union time was 10 to 16 weeks with an average of 13.3 weeks. There were 1 case of hypertrophic nonunion, 1 case of ulnar radial bone bridge formation, and 1 case of extensor hallucis longus tendon injury. The DASH score was 4 to 37(means 15.6); according to Grace-Eversman criteria, the results were excellent in 65 cases, good in 15, acceptable in 5, poor in 1.</p><p><b>CONCLUSIONS</b>Intramedullary fixation method in treating both-bone forearm fractures has advantages of closed application, short operation time, little complication, and clinical outcomes is satisfied.</p>
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BACKGROUND: For the treatment of middle clavicle fractures, elastic intramedullary nailing has gradually gained everyone's approval because of its small incision and short operation time. Locking plate fixation is currently the main surgical treatment. At present, there are a few comparative studies on the results of the two surgical treatments, but the results are still controversial. In particular, there is a lack of comparative studies on long-term efficacy and complications. OBJECTIVE: To compare clinical results and complications of locking plate and elastic intramedullary nailing for middle clavicular fracture. METHODS: A retrospective analysis of 85 patients with middle clavicular fractures who were hospitalized at the Army General Hospital of Second Medical College of Southern Medical University from June 2014 to June 2015 undergoing surgeries was performed. They were divided into two groups randomly: locking plate group (n=62) and elastic intramedullary nailing group (n=23). The incision length, operation time, blood loss and time of hospital staying were compared between the two groups. Regular follow-up, radiography assessment and postoperative complications and shoulder function score were measured. RESULTS AND CONCLUSION: (1) Incision length, operation time, blood loss and time of hospital staying were significantly better in the elastic intramedullary nailing group than in the locking plate group (P < 0.05). (2) The complications of the elastic intramedullary nailing group were significantly lower than that of the locking plate group (P < 0.05). The main complications of locking plate group were superficial wound infection, hypesthesia in the local incision and implant protuberance. Only two patients in the intramedullary nailing group experienced complications. (3) The healing rate of elastic intramedullary nailing group was higher than that of the locking plate group, which was not statistically significant (P > 0.05). (4) The DASH scores and the Constant-Murley scores of the two groups after operation were not statistically significant (P > 0.05). (5) The elastic intramedullary nailing and locking plate are both effective methods for the treatment of middle clavicular fracture. Incision length, operation time, blood loss and average length of hospital stay have obvious advantages; the incidence of complications is low; and recovery is fast in the elastic intramedullary nailing group. However, elastic nail may stimulate the local skin, causing some impact for the patients' daily life.
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<p><b>OBJECTIVE</b>To compare of clinical effects of different surgical methods in the treatment of elderly femoral neck fractures.</p><p><b>METHODS</b>From January 2013 to June 2016, 144 elderly patients with femoral neck were treated and divided into artificial hip replacement group and cannulated screw fixation group according to the surgical methods. In the total hip arthroplasty group, there were 89 cases, 28 males and 61 females, with an average age of(84.10±3.10) years old;Hollow nail fixation group 55 cases, 20 males and 35 females, with an average age of (86.80±2.88) years. Preoperative patients data, postoperative complications, mortality and postoperative Harris hip score were compared between the two groups.</p><p><b>RESULTS</b>A total of 144 cases were followed up for 12 to 36 months with an average of 18 months. There was no significant difference between two groups in gender, fracture side, preoperative complications, osteoporosis, ASA score, injury to surgery interval, the number of patients admitted to ICU and perioperative death. However, the patients in hollow screw fixation group was older than the joint replacement group(=5.311,<0.05);The degree of preoperative fracture displacement in the joint replacement group was higher than that in the hollow nail fixation group(χ²=6.894,=0.009<0.05);Hollow nail fixation group in operation time, hospital stay, intraoperative blood loss, perioperative blood transfusion was significantly better than the number of joint replacement group(<0.05);The Harris score of the joint replacement group was higher than that of the hollow screw fixation group(<0.05).</p><p><b>CONCLUSIONS</b>For elderly femoral neck patients, if there is a significant shift in the fracture (Garden III, IV), the preferred treatment is hip replacement. Postoperative complications are relatively small, satisfactory joint function recovery. If the fracture displacement is not obvious (Garden type I, II) or patients with more medical diseases, poor physical condition, poor surgical tolerance, postoperative life expectancy is not high, the first choice is closed reduction and cannulated screw fixation.</p>
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Objective To explore the safety of early minimally invasive surgery without stopping anti-platelet drugs in treatment of elderly patients with hip fractures. Methods Data of elderly patients with femoral intertrochanteric fractures treated with proximal femoral intramedullary nail between Jan. 2012 and Dec. 2013 were collected, in which 32 patients who took long-term oral anti-platelet drugs due to cardiovascular and cerebrovascular disorders received early closed reduction of minimally invasive intramedullary nail treatment without stopping anti-platelet drugs. Retrospective study was performed to analyze the clinical data of 32 patients, including gender, age, ASA score, fracture AO type, time from injured to surgery, pre-and post-operative hemoglobin, hospital stays, ICU stays, bleeding volume, post-operative blood transfusions, incision complications, systemic complications and intra-1-month and 1-year mortality. Results Thirty-two patients were aged 65-81 years old, with 11 males and 21 females. Twenty-five patients were taking only clopidogrel and 7 patients were taking both clopidogrel and aspirin. The mean time from injured to surgery was (4.8±2.5) d (range 2-13 d), and the mean operative time was (89.0±33.2) min. The mean inter-operation bleeding volume, post-operative drainage volume, post-operation hemoglobin and post-operative blood transfusions were (242.9±83.7) mL, (259.8±94.9) mL, (73±11) g/L, and (390.2±103.1) mL, respectively. The ICU stays was (1.7±0.9) d and the hospital stays was (12.5±2.5) d. Three patients experienced post-operative incision complications (9.4%), with 2 poor incision and 1 incisional hematoma. During the first month after surgery, acute cardiovascular event was found in 3 cases (9.4%), acute stroke in 2 cases (6.2%), pneumonia in 2 cases (6.2%), and pressure ulcer in 1 case (3.1%). Three patients (9.4%) died during the first month after surgery and 12 patients (37.5%) died in the first year. Conclusion Early minimally invasive surgery without stopping anti-platelet drugs in elderly patients with femoral intertrochanteric fractures will not increase the incidence of local and systemic complications within 1 year.
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<p><b>OBJECTIVE</b>To determine the effect of site of fracture on the prognosis for patients of elderly hip fracture.</p><p><b>METHODS</b>From January 2012 to December 2014, 667 patients with hip fractures were divided into femoral neck fracture group and intertrochanteric fracture group according to the site of fracture. There were 304 cases of intertrochanteric fracture, including 96 males and 208 females, with an average age of (80.33±7.94) years old. There were 217 cases of femoral neck fracture, including 74 males and 143 females, with an average age of (79.82±9.33) years old. Patients' data, mortality and activities of daily living were compared between two groups.</p><p><b>RESULTS</b>There were no significant differences in age, gender, comorbidity, ASA classification, and anesthesia between two groups, but the time of admission to surgery, duration of operation, blood loss of intra-operative, volume of drainage, and the average of transfusion were shown to have significant differences. The levels of White blood cell count (WBC) for intertrochanteric fracture group were shown to be higher than that of femoral neck fracture patients at admission, 1, 3 and 5 days after operation. The levels of hemoglobin, and albumin for intertrochanteric fracture were lower than that of femoral neck fracture patients at all period of time. The mortality of intertrochanteric fracture group during hospitalization, 1, 3, 6, and 12 months were higher than that of femoral neck fracture, but did not reach significant difference. In patients who survived, the scores of ADL for femoral neck fracture were higher than that of intertrochanteric fracture at discharge, 1, 3 months after operation, but there was no significant difference for ADL at 6 and 12 months between two groups.</p><p><b>CONCLUSIONS</b>The response of stress for intertrochanteric fracture were more than femoral neck fracture, but the mortality was similar than that of femoral neck fracture after excluding the influence of age, sex, comorbidity, and other factors. Compared to intertrochanteric fracture, the femoral neck fracture patients had a better functional recovery during early stage, and the two groups reached a similar functional recovery at 1 year after operation.</p>
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<p><b>OBJECTIVE</b>To evaluate the curative effect and surigical skills of reconstruction intramedullary nailing in the treatment of ipsilateral femoral neck and shaft fractures.</p><p><b>METHODS</b>From January 2007 to January 2013, 13 patients with ipsilateral femoral neck and shaft fractures were treated by reconstruction intramedullary nailing including 11 males and 2 females with an average age of 38.9 yeas old ranging from 25 to 53 years old. For femoral neck fractures,10 cases were basilar neck fracture, 3 were transcervical fractures and according to Garden classification,10 were type II, 2 were type III and 1 was type IV. For feormal shaft fracture, 5 were type I, 4 were type II, 3 were type III and 1 was type IV according to Winquist classification. The location of all 13 feormal shaft fractures were all in the uper 3/4 of the feormal shaft. Complications and postoperative function were recorded and evaluated.</p><p><b>RESULTS</b>Eleven patients were followed up for 23.45 months (12 to 36 months). Time from injury to operation was 5.9 days in average. Malunion of femoral neck fracture happened in 1 patient, nonunion of femoral shaft fracture happened in 2 patients. NO femoral head osteonecrosis, infection and malunion of femoral shaft fracture happened. According to Friedman-Wyman classification, 8 cases get good result, 2 get faii and 1 get poor.</p><p><b>CONCLUSION</b>Reconstruction intramedullary nailing is a good choice for the ipsilateral femoral neck and shaft fractures with the advantages of less soft-tissue trauma and complications.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Femoral Fractures , General Surgery , Femoral Neck Fractures , General Surgery , Fracture Fixation, Intramedullary , MethodsABSTRACT
<p><b>BACKGROUND</b>Percutaneous vertebroplasty (PKP) has proved its effectiveness regarding minimal invasion, rapid pain reduction, safe cement augmentation, restoring vertebral height, and accelerating complete recovery of osteoporotic vertebral compression fractures (OVCFs). Whether unipedicular or bipedicular PKP provides a better outcome is controversial.</p><p><b>METHODS</b>We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Knowledge, Chinese Biomedical Literature Database, and Wanfang Data from January 1980 to March 2013 with "kyphoplasty", "unipedicular", "bipedicular", "compression fracture", and "randomized controlled trial". Risk of bias in the included studies was assessed according to a 12-item scale. Meta-analysis was performed. Dichotomous and continuous variables were calculated using the odds ratio (OR) and standardized mean difference (SMD), respectively.</p><p><b>RESULTS</b>Seven studies involving 440 patients and 559 vertebral bodies met the criteria for inclusion. Among them, one randomized controlled trial had a high risk of bias and six a low risk. The pain visual analogue scale (VAS) SMDs were -0.02 (P = 0.88) for short-term follow-up (≤3 months) and 0.03 (P = 0.82) for long-term follow-up (≥ 1 year). Oswestry Disability Index (ODI) SMDs at short- and long-term follow-up were not statistically significant (-0.04, P = 0.77 and -0.07, P = 0.74, respectively). This meta-analysis showed greater polymethylmethacrylate volume (SMD -1.08, P = 0.00) and operation time (SMD -2.40, P = 0.00), favoring unipedicular PKP. Radiographic outcomes-preoperative kyphosis angle, restoration rate, reduction angle, loss of reduction angle-were not statistically different between the groups. Pooled analyses of cement leakage and subsequent adjacent OVCFs showed no significant differences between the groups, with OR = 0.82 (P = 0.79) and OR = 1.41 (P = 0.70), respectively.</p><p><b>CONCLUSIONS</b>This meta-analysis comparing unipedicular and bipedicular PKP demonstrated no significant differences regarding VAS, ODI, radiographic outcomes, or complications. Considering the longer operation time and radiation exposure with bipedicular PKP, we recommend unipedicular PKP over bipedicular PKP for treating OVCFs.</p>
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Humans , Fractures, Compression , General Surgery , Kyphoplasty , Methods , Osteoporotic Fractures , General Surgery , Spinal Fractures , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To evaluate the curative effect and surgical skills of reconstruction intramedullary nailing for ipsilateral fractures of shaft of femur and hip.</p><p><b>METHODS</b>Fifteen patients with ipsilateral femoral shaft and hip fractures from June 2002 to June 2008 were treated with reconstruction intramedullary nails. All of them were male with an average age of 45 years (range,34-85 years). According to the Winquist-Hansen classification, there were 2 type I, 6 type II, 2 type III, and 2 type IV shaft fractures. Hip fractures consisted of 7 intertrochanteric and 8 (53.3%) neck fractures. According to Garden's classification, 1 femoral neck fracture was type I, 3 were type II, 2 were type III and 2 were type IV.</p><p><b>RESULTS</b>All of the patients were followed up for an average of 30.9 months (range, 12 to 55 months). Due to other combined severe injuries, operations were delayed for 1-14 days (average is 5 days). Delayed union of femoral shaft occurred in 1 case; nonunion of femoral shaft occurred in 2 cases. Nonunion of femoral neck occurred in 1 and coxa vara occurred in 1. Hip fractures healed in 14 (93.3%) patients, and shaft fractures healed in 13 (86.7%)patients. The average union time was 4 months (range, 2-6 months) for the hip fractures and 5.5 months (range, 4-9 months) for the shaft fractures. No femoral head osteonecrosis, wound infection or shortening more than 2 cm occurred. Functional results using Friedman-Wyman criteria were good in 13 cases, fair in 1 case, and poor in 1 case.</p><p><b>CONCLUSION</b>Reconstruction intramedullary nails can provide biological fixation of both fractures with fewer complications, and is an effective device to treat this kind of combined fractures.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Femur , Wounds and Injuries , General Surgery , Follow-Up Studies , Fracture Fixation, Intramedullary , Methods , Fracture Healing , Hip Fractures , General Surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate the effect of augmentative plate fixation to increase stability in the treatment of femoral shaft nonunions subsequent to intramedullary fixation.</p><p><b>METHODS</b>Nine patients with femoral nonunions after intramedullary nail internal fixation were treated with augmentative plate internal fixation from April 1998 to Jane 2008, included 8 males and 1 female, with an average age of 32 years old ranging from 21 to 54 years. One case was upper 1/3 femoral fractures, 5 cases were middle 1/3 femoral fractures, 3 cases were lower 1/3 femoral fractures. The interspace of bone nonunion was more than 5 mm in 6 cases, of them, iliac bone grafting were applied in 4 cases, artificial bone combined with iliac bone grafting were applied in 2 cases; The interspace of bone nonunion was less than 5 mm in other 3 cases,artificial bone grafting was applied in 1 case, fitting bone callus were applied in 2 cases. All patients got protected weight loading preventing the main screw break.</p><p><b>RESULTS</b>All patients achieved radiological solid union at an average of 8 months (ranged 6 to 11 months ). The fixation was removed during 6 to 11 months after operation in 5 cases. Donor site pain of iliac occurrenced on 4 cases,3 cases relieved 1 month later and 1 case relieved 3 months later. No infection, fixation loosening or breaking was observed.</p><p><b>CONCLUSION</b>The augmentative plate fixation can be applied at the fracture site to prevent the rotational instability. The technique is simple and does not require any special instrument, which facilitates an early weight bearing and gives a quick recovery from nonunion.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Bone Plates , Femoral Fractures , General Surgery , Femur , Pathology , Fracture Fixation, Intramedullary , Methods , Fractures, Ununited , General Surgery , HypertrophyABSTRACT
<p><b>OBJECTIVE</b>To investigate the relationship between the operation time of femur shaft fracture with post-operation system inflammation changes and clinical outcomes for those multiple fractures.</p><p><b>METHODS</b>This investigation was designed as a prospective, nonrandomized cohort study. From April 2005 to August 2007, all 78 hospitalized patients were divided into 3 groups by an inclusion criteria: multiple fractures with opened fracture of femur shaft (group A, n = 26), multiple fractures with closed fracture of femur shaft (group B, n = 23), single closed fracture of femur shaft (group C, n = 29). In the group A, damage control orthopaedics (DCO) procedure were performed. In the group B and C, all the femur shaft fractures were performed intramedullary nail fixation early (< 24 h). From serially sampled venous blood, inflammatory reaction index were estimated by measured the concentration of IL-6, TNF-alpha surround the operation, and the conditions of multiple organs were estimated by assayed PaO2/FiO2, total bilirubin (TBIL), creatinine (Cr) levels, the postoperation complication rates were analyzed among each groups. The extent of inflammation changes, multiple organs damage conditions and postoperation complication rates were compared and analyzed among the 3 groups.</p><p><b>RESULTS</b>In the group A, the median increase values of IL-6,TNF-alpha after the secondary surgery were 59 ng/L and 85 ng/L, whereas they were 154 ng/L and 250 ng/L respectively in the group B, there was a significant difference between the 2 groups (P < 0.01). In addition, the median increase values of IL-6, TNF-alpha after the first surgery in group A and in group C were both significantly less than group B (P < 0.01). Correspondingly, the abnormal rates of PaO2/ FiO2, TBIL, Cr levels occurred in the group B were all greater than group A after the 2 surgery procedures (P < 0.05), and in the aspects of average ventilation days, ICU staying days, duration of positive fluid balance (input/output > 500 ml/24 h), the group B were all greater than group A after the second surgery ( P < 0.01). Compared with group A after the first surgery, group B showed a longer average ventilation days, but it had no significant difference in average ICU stay days and duration of positive fluid balance. In addition, for group C, all the aspects above were less than group B (P < 0.01). Concerned with the complications after surgery in each groups, fat embolism and MODS rate between group A and B had no significant difference (11.5% vs 13.0% ,P > 0.05), but higher than which of group C (P < 0.01).</p><p><b>CONCLUSIONS</b>The early intramedullary nail fixation of femur shaft fracture in multiple fractures may lead to a significant system inflammation changes, and may develop the subclinical changes of multiple organs. However, these changes are less in those surgery procedures later performed, namely intramedullary nail fixation of femur shaft fracture in multiple fractures as a primary definitive treatment has a potential risk, and should be carefully evaluated.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Femoral Fractures , Blood , General Surgery , Fracture Fixation, Intramedullary , Interleukin-6 , Blood , Multiple Trauma , Blood , General Surgery , Postoperative Complications , Prospective Studies , Time Factors , Treatment Outcome , Tumor Necrosis Factor-alpha , MetabolismABSTRACT
This paper introduces a pathological information network and image analysis system designed by ourselves. The system offers an efficient means for modern medical diagnosis and treatment, teaching, research and management in the department of pathology.