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Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.
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Objective:To characterize the geriatric osteoporotic pelvic fractures using 3-D computed tomography (CT) fracture mapping.Methods:Retrospectively analyzed were the 79 elderly patients with pelvic fracture who had been admitted to Department of Orthopaedics, The 7th Medical Center of PLA General Hospital between January 2017 and December 2021. There were 24 men and 55 women, aged from 60 to 98 years (average, 74.3 years). The CT scan data of the pelvis from all patients were imported into the software (Mimics Medical 18.0, Geomagic Studio 2014, Rhinoceros 6.0, and Matlab) to create a 3-D pelvic fracture model. The fracture pieces were imported into a standard pelvic template to obtain the morphology of the fracture lines after fitting. A map of fracture line distribution frequency and a fracture heat map were created by fitting the fracture lines of all patients into a common pelvic template.Results:Of the 79 elderly patients with pelvic fracture, 69 (87.3%) had fractures of both the anterior and the posterior rings. The fracture map and heat map of geriatric pelvic fractures showed the following: the fracture lines of the anterior ring were concentrated in the junction of the cancellous bone and cortical bone of the superior and inferior pubic rami; the fracture lines of the posterior ring were concentrated in the middle and posterior 1/3 of the ilium and in the sacral wing; the fracture frequencies incurred by the pubic bone, sacrum, and ilium were from the highest to the lowest.Conclusions:Fracture mapping can visually characterize the distribution of fracture lines of the geriatric pelvic fractures. Simultaneous fractures of the anterior and posterior rings of the pelvis are the most typical kind of pelvic fractures in the elderly. The junction of the cancellous and cortical bones of the superior and inferior pubic rami and the area surrounding the sacroiliac joint are the most frequent locations for the fractures.
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Objective:To investigate the prognosis of hip fracture in elderly patients with dementia.Methods:From January 2012 to December 2017, 91 dementia patients aged (82.7±6.6)y (21 males and 70 females) with hip fracture were enrolled in the study; 91 non-dementia patients matched by age, gender and fracture type were selected as controls. There were 54 cases of intertrochanteric fracture and 37 cases of femoral neck fracture. The length of hospital stay, mortality within 30 days and 1 year, walking ability and risk of reoperation were compared between the two groups. The effect of dementia on the mortality after surgery was analyzed by adjusting confounding factors through multivariate logistic regression analysis.Results:There was no significant difference in the length of hospital stay between dementia group and non-dementia group [(13.95±7.33) vs.(12.63±8.68)d, t=1.12, P=0.266]. The incidence rate of perioperative complications in dementia group was higher than that in non-dementia group [63.7%(58/91) vs. 23.1%(21/91), χ 2 = 44.59, P<0.001]. The incidence of delirium in dementia group was higher than that in non-dementia group [35.3%(42/91) vs.13.2%(12/91), χ 2 = 5.71, P=0.017]. The incidence of pulmonary infection in dementia group was higher than that in non-dementia group [11.0%(10/91) vs. 2.2%(2/91), χ 2= 11.989, P<0.001]. There was no significant difference in 30-day fatality rate [7.7%(7/91) vs. 1.1%(1/91), χ 2= 3.27, P=0.071] between two groups; while the 1-year fatality rate in dementia group was higher than that in non-dementia group [27.5%(25/91) vs. 14.3%(13/91), χ 2= 4.79, P=0.029]. After adjusting for the differences of confounding factors between the two groups, dementia was an independent risk factor for 1-year mortality after hip fracture surgery ( OR = 1.852, 95 %CI:1.048-3.043, P= 0.022). For walking ability of 1 year after operation, 22 (33.3%) patients in dementia group walked independently, 38 (57.6%) patients partially walked independently, 6 (9.1%) patients were in bed; while in non-dementia group, 45 (57.7%) patients walked independently, 27 (34.6%) patients partially walked independently, 6 (7.7%) patients were in bed; there was significant difference between the two groups (χ 2= 8.82, P=0.012). There was no significant difference in reoperation rate between two groups [6.6%(6/91) vs. 5.5%(5/91), χ2=0.10, P=0.756]. Conclusion:Compared to non-dementia patients, dementia patients with hip fracture have poorer prognosis, higher incidence of perioperative complications, pulmonary infection and delirium, higher risk of mortality 1 year after operation, and poorer ability of independent walking.
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Objective:To determine the factors related to postoperative 1-year and 5-year mortalities in elderly patients with hip fracture plus chronic obstructive pulmonary disease (COPD).Methods:A retrospective study was conducted of the elderly patients with hip fracture who had sought medical attention at Department of Orthopaedics, The 7th Medical Center of PLA General Hospital from January 2012 to December 2016.Of them, 103 were complicated with COPD, and another 103 without COPD were selected as controls who were matched in age, gender and fracture site. The 2 groups were compared in terms of postoperative 30-day, 1-year and 5-year mortalities; the risk factors were explored for postoperative 1-year and 5-year mortalities in patients with hip fracture plus COPD.Results:The postoperative 30-day, 1-year and 5-year mortalities in the COPD group were 7.8%(8/103), 29.1%(30/103) and 48.5%(50/103), significantly higher than those in the control group except for the 30-day value [1.9%(2/103), 13.6%(14/103) and 31.1%(32/103)] ( P<0.05). Advanced age ( P=0.003), cardiovascular disease ( P=0.006), respiratory disease ( P=0.009), acute exacerbation of COPD (AECOPD) ( P<0.01), American Society of anesthesiologists (ASA) grades Ⅲ+Ⅳ ( P=0.001), delayed surgery (>48 h) ( P=0.015), pre-injury activities of daily living (ADL) score ( P=0.002) and mobility ( P=0.010) were related to an increased risk for 1-year mortality after operation. Advanced age ( OR=1.106, 95% CI: 1.016 to 1.210, P=0.021), AECOPD ( OR=5.053, 95% CI: 1.520 to 16.800, P=0.008), and ASA grades Ⅲ+Ⅳ ( OR=1.657, 95% CI: 1.072 to 3.912, P=0.040) were the risk factors for 5-year mortality in patients with COPD; pre-injury ADL ( OR=0.974, 95% CI: 0.987 to 0.967, P=0.043) was negatively correlated with 5-year mortality. Conclusions:COPD can significantly increase the short-term and long-term mortalities in elderly patients with hip fracture.Cardiovascular disease, AECOPD and ASA grades Ⅲ+Ⅳ are factors related to postoperative 1-year mortality in patients with hip fracture plus COPD. Advanced age, AECOPD and ASA grades Ⅲ+Ⅳ and delayed surgery (>48 h) are risk factors for postoperative 5-year mortality in patients with hip fracture plus COPD. ADL score before injury is negatively correlated with postoperative 1-year and 5-year mortalities.
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Objective:To evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of elderly patients with fragility fracture of pelvis.Methods:Elderly patients with fragile pelvic fractures undergoing minimally invasive surgery and being followed up were retrospectively analyzed from January 2015 to December 2019.Based on the classification of pelvic fragile fractures(FFP), open reduction and internal fixation with pelvic anterior ring instability internal fixator(INFIX)plus posterior ring sacroiliac screw, or open reduction and internal fixation with iliac fossa approach, were performed for elderly patients with fragile pelvic fractures.The general data of all patients(age, sex, mechanism of injury)were recorded.Time from injury to operation, VAS(visual analogue scale)before and after operation, blood loss during operation, complications during hospitalization, time to ambulation, mortality, and Koval walking index at 2 year follow-up were recorded to evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of fragility fracture of pelvis.Results:Thirty-two patients were followed up, including 11 males and 21 females, aged 65-88 years(76.9±5.5)years.The mechanism of injury was fall on the ground as a percentage of 59.4%(19/32), fall in the sitting position as a percentage of 25.0%(8/32), and 15.63%(5/32)had unknown history of trauma.The time from injury to operation was 3-36 days(9.6±3.3)days.There were 50.0%(16/32)type Ⅱ, 31.3%(10/32)type Ⅲ and 18.8%(6/32)type Ⅳ cases according to FFP classification.The mean blood loss during operation was(65.9±35.2)ml(range, 20-200 ml). The preoperative VAS score was 5-9 scores, with an average of(6.41±1.07)scores.The postoperative VAS score was 1-4(1.71±0.63). Average time from injury to operation was(9.6±3.3)days(range, 3~36). The incidence of complications during operation was 9.4%(3/32), including 1 case of gastrointestinal bleeding, 1 case of lower extremity deep vein thrombosis, and 1 case of superficial wound infection.Ambulation was at 4 weeks post-operation in 56.3%(18/32)cases, at 6 weeks post-operation in 31.3%(10/32)cases and at 8 weeks post-operation in 12.5%(4/32)cases.6.25%(2/32)patients died within 2 year follow-up.Koval walking index of the rest 30 patients included grade 1 in 46.9%(15/32)cases, grade 2 in 18.8%(6/32)cases, grade 3 in 6.3%(2/32)cases, grade 4 in 18.8%(6/32)cases and grade 6 in 3.1%(1/32)case(1 year after surgery, hemiplegia after cerebral infarction).Conclusions:Minimal invasive surgery achieves significant pain relief and early mobilization in patients with fragility fracture of pelvis.
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Objective:To explore the predictive values of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) for postoperative delirium in the elderly patients with hip fracture.Methods:The data of 1,278 elderly patients with hip fracture were analyzed retrospectively who had been admitted to Department of Orthopedics, The 7th Medical Center, General Hospital of Chinese People's Liberation Army from January 2012 to December 2018. There were 418 males and 860 females, with a median age of 81 (75, 90) years. There were 728 intertrochanteric fractures and 550 femoral neck fractures. The working characteristic curves (ROC) of NLR, MLR, and PLR used to predict postoperative delirium in the elderly patients with hip fracture were worked out to obtain the best cutoff points (sensitivity, specificity, and area under the curve) respectively. According to the best cutoff points, the NLR, MLR, and PLR were respectively divided into an increase group and a normal group. According to whether postoperative delirium occurred or not, the patients were divided into a delirium group and a delirium-free group. After univariable analysis was conducted to screen out the risk factors, binary logistic regression analysis was conducted of the factors with P<0.05 to determine the risk factors. Results:The median values of NLR, MLR and PLR in the 1,278 elderly patients with hip fracture at admission were 5.43 (3.87, 7.88), 0.40 (0.29, 0.54) and 158.40 (118.00, 222.50), respectively. Postoperative delirium occurred in 153 patients (12.0%). In the study of the predictive values of NLR, MLR, and PLR using ROC curves for postoperative delirium in the elderly patients with hip fracture, the best cutoff points (sensitivity, specificity, and area under the curve) for prediction were 7.613 (57.5%, 77.1%, 0.726), 0.512 (52.3%, 74.0%, 0.663), and 201.125 (68.6%, 73.3%, 0.751), respectively. The risk factors for postoperative delirium were increased NLR ( OR=2.046, 95% CI: 1.322 to 3.166, P<0.001), increased MLR ( OR=1.568, 95% CI: 1.039 to 2.367, P=0.032), and increased PLR ( OR=3.489, 95% CI: 2.290 to 5.317, P<0.001). Conclusion:As NLR≥7.613, MLR≥0.512 and PLR≥201.125 may be risk factors for postoperative delirium in elderly patients with hip fracture, NLR, MLR and PLR may have a positive value in prediction of postoperative delirium.
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Objective:To study the predictive value of high serum lactate for the risk of death after hip fractures.Methods:Data of hip fracture patients admitted to the authors' unit from January 2012 to December 2016 were analyzed retrospectively.A total of 1004 patients were included.According to the receiver operating characteristic(ROC), the predictive values of lactate for predicting the risk of death 30 days and 1 year after hip surgery were obtained.Results:The mortality rates of patients with serum hyperlactatemia were 10.8% and 23.3% for 30 days and 1 year after surgery, respectively.The 30-day and 1-year mortality rates for patients in the normal group were 1.3% and 11.8%, respectively.The differences between the two groups were statistically significant( χ2=47.764, 27.433, P=0.000 for both). The average survival time was(23.9±16.6)m for patients in the hyperlactatemia group and(28.8±16.5)m for subjects in the normal group, with a significant difference between the two groups( t=4.340, P=0.000). The incidences of complications were 28.6% for the serum hyperlactatemia group and 21.9% for the normal lactate group.There were significant differences between the two groups( χ2=5.249, P=0.022). The average length of stay was(13.6±8.7)d for the hyperlactatemia group and(12.5±7.8)d for the normal group, with the difference showing statistical significance( t=1.988, P=0.047). Lactate levels were able to predict the risk of death 30 days after hip fracture surgery.The predicted cutoff value was 2.35 mmol/L, the sensitivity and specificity were 0.744 and 0.834, respectively, and the area under the curve was 0.829. Conclusions:The incidence of hyperlactatemia after hip fractures is high.Compared with hip fracture patients with normal lactate levels, patients with hyperlactatemia show longer hospital stays, a higher incidence of complications, and higher mortality rates within 30 days and 1 year of surgery.Lactate levels(2.35 mmol/L)may be used to predict the risk of death within 30 days of hip fracture surgery.
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Objective:To investigate the characteristics of fragility fractures of pelvis(FFP) in the elderly and compare the clinical efficacy between conservative treatment and minimally invasive surgery.Methods:A retrospective study was conducted in the 56 elderly FFP patients who had been treated at Department of Orthopaedics, The General Hospital of Chinese People＇s Liberation Army from January 2017 to January 2019. They were 16 males and 40 females, with an age of 73.4 years (from 65 to 93 years). By the American Society of Anesthesiologists (ASA) classification, there were 12 cases of grade Ⅰ, 16 cases of grade Ⅱ, 20 cases of grade Ⅲ, and 8 cases of grade Ⅳ; by the FFP classification, there were 6 cases of type Ⅰ, 10 cases of type Ⅱ, 36 cases of type Ⅲ, and 4 cases of type Ⅳ. The morphological characteristics and injury mechanisms of FFP were analyzed. According to the treatment methods, the patients were divided into a conservative treatment group of 32 cases and a minimally invasive surgery group of 24 cases. The 2 groups were compared in terms of complication incidence, mortality and the Koval attenuation rate of walking ability after one-year follow-up.Results:There were mostly the fractures of pubic branches on both sides of the pubic symphysis and compression fractures of the sacral wing caused by lateral crush injury. The 2 groups were comparable due to no significant differences in the preoperative general data between them other than FFP classification ( P>0.05). By one year after treatment, the conservative treatment group had a complication incidence of 34.4% (11/32), a mortality of 9.4% (3/32) and a Koval attenuation rate of walking ability of 13.8% (4/29) while the minimally invasive surgery group had a complication incidence of 20.8% (5/24), a mortality of 4.2% (1/24) and a Koval attenuation rate of walking ability of 8.7%(2/23), showing no significant difference between the 2 groups ( P>0.05). Conclusions:The injury mechanism of geriatric FFP is mostly lateral compression injury. The fracture sites are mostly located on both sides of the pubic symphysis, pubic branches and the sacral wing of anterior and posterior rings simultaneously. Although there may be no significant difference in complication incidence, mortality or Koval attenuation rate of walking ability between conservative treatment and minimally invasive surgery after one year, the minimally invasive surgery deals with more unstable fracture types.
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Objective:To study the relationship between hyperlactatemia and hip fracture complications, length of hospital stay, and mortality; And to study the predictive value of serum lactic acid on the risk of death after hip fracture surgery.Methods:The data of 1 004 cases of hip fracture admitted to our unit from January 2012 to December 2016 were retrospectively analyzed. The levels of lactate at admission, 1 day, 3 days and 5 days after operation were recorded. According to whether the average lactate level during hospitalization was higher than 2 mmol/L, the patients were divided into hyperlactic acid and control group. Finally, according to receiver operating characteristic (ROC), the predictive value of lactic acid in predicting the risk of death 30 days and 1 year after hip surgery was obtained.Results:Lactate level: 1.84±0.84 mmol/L on admission, 1.89±0.77 mmol/L at 1 day after operation, 1.79±0.78 mmol/L 3 day after operation, and 1.75±0.72 mmol/L at 5 day after operation. The incidence of lactic acid was 27.1% (272/1 004) in 272 patients with average lactic acid higher than 2 mmol/L during hospitalization. The mortality of 30 days (12.5%, 34/272) and 1 year (29.4%, 80/272) in the hyperlactemia group were significantly higher than that of 1.2% (9/732) and 10.8% (79/732) in the control group (30 days, t=61.448, P<0.001; 1 year, t=51.581, P<0.001). The incidence of perioperative complications in the hyperlactemia group was 28.7% (78/272), which was higher than 22.3% (163/732) in the control group ( χ2=4.465, P=0.035). The average length of hospital stay in the hyperlactemia group (13.95±9.02 d) was significantly higher than that in the control group (12.53±7.71 d) ( t=2.775, P=0.036). Lactic acid level could predict the 30 day mortality risk of hip fracture ( P<0.001). The cutoff value was 2.25 mmol/L, the sensitivity and specificity were 0.721 and 0.820, respectively, and the area under the curve was 0.832. Conclusion:The incidence of serum hyperlactatemia after hip fracture was high. Compared to patients with control group, the length of stay was longer, the incidence of complications was higher, and the mortality within 30 days and 1 year after operation were higher in serum hyperlactatemia group. Lactate level (2.25 mmol/L) could be used to predict the risk of mortality within 30 days after hip fracture operation.
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Objective:To evaluate the clinical outcomes of Acumed intramedullary nailing for AO type A3 forearm diaphyseal fracture in adults.Methods:A retrospective study was conducted of the 20 adult patients with AO type A3 forearm diaphyseal fracture who had been treated by Acumed intramedullary nailing from January 2016 to November 2018 at PLA General Hospital. They were 18 males and 2 females, aged from 18 to 56 years (average, 36.5 years). There were 6 radius diaphyseal fractures, 9 ulna diaphyseal fractures and 5 diaphyseal fractures of both forearm bones. The clinical outcomes of Acumed intramedullary nailing for AO type A3 forearm diaphyseal fractures were evaluated by recording the perioperative complications, fracture union time, forearm rotation range at 12-month follow-up, and Disability of the Arm, Shoulder and Hand Questionnaire (DASH) scores for the upper limb function.Results:The 20 patients were followed up for 12 to 18 months (mean, 15.8 months). Bony union was achieved in all the patients after 3 to 4 months (average, 3.3 months). Partial rupture of the extensor pollicis longus tendon happened during operation in one patient and at 3 months post-operation in another due to fixation irritation, and linear ossification of interosseous membranes was observed in one patient with diaphyseal fractures of both forearm bones. 12-month follow-ups showed that, in the 20 patients, forearm pronation ranged from 80° to 90° (average, 89°), supination from 60° to 90° (average, 86.3°) and DASH scores from 0 to 37 (average, 6.5).Conclusions:In the treatment of AO type A3 forearm diaphyseal fracture in adults, Acumed intramedullary nailing can lead to successful fracture union and excellent rotational activity at one year after operation. Therefore, adult AO type A3 forearm diaphyseal fracture can be listed as an indication for Acumed intramedullary nailing.
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Objective:To determine whether subpopulations may exist which are related to regulation of immunization or inflammation in bone marrow mononuclear cells (BMMNCs) from 2 elderly patients with hip fracture and whether there might be any difference in the subpopulations between them.Methods:Two elderly patients with hip fracture were enrolled in this study. Their venous blood was harvested to determine subpopulations of complement (C)3, C4, interleukins (IL)-2, IL-6, IL-10, and lymphocytes. Single cell RNA sequencing (scRNA-Seq) was used to group their BMMNCs. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed of the top 20 differentially expressed genes for each subpopulation to judge the main function of each subpopulation. The subpopulations and the key genes related to regulation of immunization or inflammation were found out. The relationships were explored between subpopulations and prognosis of the patients.Results:By the venous blood indexes, IL-10 was slightly high in patient A; C3 below normal, C4 close to the lower normal limit, IL-2, IL-6 and IL-10 were significantly high, CD8 +T % was low, and CD4 +/CD8 + high in patient B. After scRNA-Seq and bioinformatics analyses, the BMMNCs in the 2 patients were divided into 5 subpopulations. GO and KEGG enrichment analyses showed that the functions of subpopulation 2 and subpopulation 4 were related to immunization or inflammation. CCL4, CCL5, LTB and CXCR4 in subpopulation 2 and C1QA, C1QB, CD14 and SPP1 in subpopulation 4 were related to the regulation of immunization or inflammation. The final prognosis of patient A was much better. The proportions of BMMNCs involved in subpopulation 2 and subpopulation 4 from patient A were higher than those from patient B [47.00% (1,431/3,045) versus 29.28% (882/3,012); 5.88% (179/3,045) versus 3.85% (116/3,012)]. Conclusions:The BMMNCs from elderly patients with hip fracture can be divided into subpopulations by scRNA-Seq. Some of the subpopulations may be related to regulation of immunization or inflammation, which may affect the post-injury immune inflammatory state and prognosis of the patients.
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Pelvic fragility fractures are increasing with the aging population in China, characterized by high incidence, high mortality and high morbidity just as geriatric hip fractures. In diagnosis of a pelvic fragility fracture in the elderly, the patient＇s age, comorbidities, osteogenic factors, clinical manifestations and imaging examinations should be taken into consideration, as well as the special anatomical features and morphologies resulted from degenerative anatomy of the pelvis in the aged. Standard pelvic X-rays and CT scans may confirm the diagnosis in most cases, but MRI may prevent missing a fracture of malfunctioning pelvis or an insidious fracture line on the posterior ring. Fragility fractures of pelvis (FFP) classification, base on X-ray and CT checks, is a common guiding system in current clinic. Usually, conservative treatment is indicated for fractures of FFP types Ⅰ-Ⅱ while surgery for those of FFP types Ⅲ-Ⅳ. As far as possible, minimally invasive reduction and simultaneous fixation of the anterior and posterior rings are recommended. This article intends to review the characteristics, classification and development of minimally invasive techniques concerning pelvic fragility fractures in recent years, and to discuss the future trends in treatment of geriatric pelvic fractures.
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Objective:To investigate the clinical effect of minimally invasive plate osteosynthesis (MIPO) through anterolateral approach in treatment of middle-distal humeral shaft fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 patients with middle-distal humeral shaft fracture admitted to 7th Medical Center of Chinese PLA General Hospital from August 2015 to March 2018, including 12 males and 9 females, aged 18-68 years [(31.3±3.6)years]. All were closed fracture. According to AO classification, the fracture were classified as type A in 6 patients, type B in 10 and type C in 5. All patients were treated with anterolateral minimally invasive plate fixation. The operation time, intraoperative blood loss and hospital stay were recorded. The fracture healing was observed after operation. The visual analogue scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, and Mayo elbow performance score (MEPS) were used to evaluate the effectiveness before operation and at 2 weeks, 3 months and 12 months after operation.Results:All patients were followed up for 12-26 months [(18.2±2.4)months]. The operation time was 50-82 minutes [(68.2±19.4)minutes], with intraoperative blood loss of 40-95 ml [(60.2±21.3)ml]. The hospital stay was 6-16 days [(6.8±1.2)days]. There was no iatrogenic vascular or nerve injury during operation. The patients with radial nerve injury before operation were all adventitia contusion. The nerve function returned to normal within 3 months after operation. All fractures were healed within 5-10 months [(5.3±1.2)months]. At 2 weeks, 3 months and 12 months after operation, the VAS [(3.6±0.8)points, (2.1±0.4)points, (1.8±0.3)points] was lower than that before operation [(8.3±1.6)points] ( P<0.05); UCLA shoulder rating scale [(31.2±1.5)points, (33.6±0.8)points, (34.6±0.5)points] was higher than that before operation [(28.4±2.3)points] ( P<0.05); and MEPS [(80.2±3.4)points, (93.4±2.2)points, (96.4±3.5)points] was higher than that before operation [(60.5±4.5)points] ( P<0.05). At the last follow-up, the UCLA shoulder rating scale and MEPS showed excellent results. Conclusion:For middle and lower humeral shaft fracture especially for the fracture line relatively distal to the shaft, MIPO technique through anterolateral approach can attain satisfactory results in terms of pain, range of motion of shoulder and elbow joint, and joint function.
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Objective:To investigate the mortality and related risk factors for hip fractures in elderly patients within 30 days of surgery.Methods:Clinical data of elderly hip fracture patients in our hospital from January 2012 to December 2016 were retrospectively analyzed.Based on whether they survived within 30 days of surgery, patients were divided into the death group and the survival group.Differences in age, gender, comorbidities, timing of operation and fixation mode between the two groups were compared.Univariate analysis was conducted to detect significant factors, and Logistic regression analysis were performed to identify independent risk factors for 30-day mortality after operation.Results:A total of 1350 elderly hip fracture patients were treated in our hospital, and 1004 cases met the inclusion criteria.Forty-three cases(4.28%)died within 30 days of operation.Univariate analysis showed that, compared with the survival group, the death group had a higher average age, a higher white blood cell count, lower hemoglobin and albumin levels, higher proportions of patients with arrhythmia, more pulmonary infections, higher cardiac insufficiency and more people with ≥4 comorbidities.Multivariate Logistic analysis showed that arrhythmia( OR=2.36, P=0.038), pulmonary infection( OR=2.50, P=0.020), cardiac insufficiency( OR=3.15, P=0.016), high white blood cell count( OR=1.14, P=0.006), and low albumin( OR=1.08, P=0.037)were independent risk factors for increased mortality within 30 days of operation. Conclusions:The 30-day mortality rate is high in elderly hip fracture patients.Arrhythmia, pulmonary infection, cardiac insufficiency, high white blood cell count, and low albumin level are independent risk factors for mortality in elderly hip fracture patients.
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Objective:To evaluate the clinical outcome of 3D printing titanium cage combined with Masquelet technology for the treatment of calcaneus infective defect.Methods:Data of 5 cases with chronic calcaneus infectivedefect treated with regional flap, 3D printing titanium cage combined with Masquelet technology with rib autograft from January 2017 to January 2019 were retrospectively analyzed. There were 3 males and 2 females, with an average age of 37 years old (range, 17-52 years). The mechanism of the five patients included two motor vehicle incidents, two high fall injuries and one rolling compaction. All patients were treated by two-stage procedures. First stage included debridement, polymethyl methacrylate (PMMA) filling and regional flap coverage. The soft tissue defect of the 5 cases included 10 cm×8 cm in 2 cases, 8 cm×7 cm, 8 cm×5 cm, and 5 cm×3 cm each in one case. Bone defect included 4 cm×3 cm×2 cm in two cases, 3 cm×3 cm× 2 cm in two cases and 3 cm×1 cm×1 cm in one case. Second stage was 3D printing titanium cage combined with masquelet technology of rib autograft. Time of bone union, morphology of calcaneus, position of implant, Maryland score and AOFAS hind foot score were recorded to evaluate the clinical outcome.Results:All five patients were followed up for an average time of 18.2 months (range, 12-30 months). Infection happened in one patient 2 months after first stage operation and successfully treated by debridement and PMMA replacement. Incision of the rest 4 cases all healed successfully. Germiculture of the five cases included Methicillin-resistant Staphylococcus aureus (MRSA) in three cases, Staphylococcus epidermidis in one case and Bacterium coli in one case. All five patients got calcaneus bone union after second stage operation. The average time for bone union was 4.32 (range, 3-8) month. Bone trabecular were observed in CT scan 13 (range, 10-22) month post-operation. Average Maryland score in 12 months post-operation was 92 (range, 86-98) and average AOFAS ankle hind foot score was 89.8 (range, 83-100).Conclusion:3D printing titanium cage and Masquelet technology maybe an effective treatment for calcaneus infective defect.
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Objective:To explore the risk factors for adverse cardiac events within 30 postoperative days in the aged patients with hip fracture.Methods:We retrospectively evaluated the clinical data of 1, 004 aged patients who had been admitted to Department of Orthopaedics, The 7th Medical Center, PLA General Hospital for hip fractures from January 2012 to December 2016. According to whether cardiac complications occurred within 30 days after operation, they were divided into 2 groups: a group with adverse cardiac events and a group free from adverse cardiac events. The 2 groups were compared in terms of age, gender, concomitant disease, timing of surgery, type of surgery and anesthesia mode. Multivariate Logistic regression analysis was used to determine the independent risk factors of adverse cardiac events 30 days after operation. In addition, the 2 groups were also compared in 30-day mortality, 1-year mortality, and total mortality postoperation.Results:Adverse cardiac events occurred in 45 patients (4.5%) within 30 days after operation. The multivariate Logistic regression analysis showed that advanced age ( OR=1.085, 95% CI: 1.033-1.139), chronic renal insufficiency ( OR=5.296, 95% CI: 2.172-12.910), cardiac insufficiency ( OR=2.938, 95% CI: 1.283-6.729), delayed operation ( OR=3.682, 95% CI: 1.110-12.220) were independent risk factors for cardiac adverse events 30 days after operation. The 30-day mortality, 1-year mortality, and total mortality postoperation were respectively 17.8% (8/45), 26.7% (12/45) and 46.7% (21/45) for the group with adverse cardiac events, and respectively 3.6% (35/959), 9.1% (87/959) and 28.5%(273/959) for the group free from adverse cardiac events, showing significant differences between the2 groups (all P<0.05). Conclusions:Advanced age, cardiac insufficiency, chronic renal insufficiency and delayed surgery may be independent risk factors for adverse cardiac events within 30 days after surgery in the elderly patients with hip fracture who show a significantly higher mortality than those free from adverse cardiac events.
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Objective:To analyze the impacts of operative timing on the operative outcomes in elderly patients with hip fracture.Methods:A cohort of 814 elderly patients with hip fracture were analyzed retrospectively who had been treated at Department of Orthopaedics, The 7th Medical Center, General Hospital of Chinese People's Liberation Army from January 2012 to December 2015. They were 272 males and 542 females, aged from 60 to 99 years (average, 79.9 years). They were divided into 2 categories according to their systemic status by the American Association of Anesthesiologists (ASA) classification. There were 403 cases of ASA class Ⅰ and Ⅱ in the good status category and 411 cases of ASA class Ⅲ and Ⅳ in the poor status category. Each category was further divided into one early operation group and one late operation group depending on whether the patients were operated on within 48 hours after admission. The 2 groups were compared in terms of hospital stay, incidence of complications, 30-day and 1-year mortalities, and 1-year activities of daily living(ADL) scores.Results:In the good status patients there were no significant differences between the 2 groups in the preoperative general data, showing compatibility ( P>0.05). The early operation group showed significantly lower 30-day mortality [0% (0/94)] and 1-year mortality [5.3% (5/94)], significantly shorter hospital stay (9.6 d ± 5.2 d) and significantly higher 1-year ADL scores [75 (70, 85)] than the late operation group [4.2% (13/309) and 14.2% (44/309), 12.3 d ± 5.9 d, and 70 (60, 80), respectively] (all P< 0.05). There was no significant difference in incidence of complications between the 2 groups ( P>0.05). In the poor status patients there were no significant differences between the 2 groups in the preoperative general data, showing compatibility ( P>0.05). The incidence of complications in the early operation group [42.2% (35/83)] was significantly higher than in the late operation group [30.5% (100/328)] ( P< 0.05). There were no significant differences between the 2 groups in 30-day mortality, 1-year mortality, hospital stay or 1-year ADL score ( P>0.05). Conclusion:For the elderly patients with hip fracture, operation can be carried out as soon as possible if they are in good physical condition, and early operation is not necessary if they are in poor systemic condition because operation should be carried out at an appropriate time after evaluation of their physical condition allows.
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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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The crescent fracture-dislocation of pelvis (CFDP), also known as sacroiliac joint fracture dislocation, is the posterior iliac wing crescent fracture result from lateral compression force with associated sacroiliac joint dislocation. CFDP accounts for about 12% of the pelvic injury. At present, Day classification has been widely used in clinic. With the development of minimally invasive treatment of pelvic fracture, fine classification, closed reduction and precise screw placement are still the difficulties for clinicians. The authors review the applied anatomy, injury mechanism, classification, diagnosis and treatment of CFDP in order to provide reference for clinical diagnosis and treatment of CFDP.
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Objective@#To compare the efficacy of operation and non-operation treatment for nonagenarians with hip fracture.@*Methods@#A retrospective case control study was conducted to analyze the data of 183 patients over 90 years old with hip fracture admitted to the seventh medical center of Chinese PLA General Hospital from January 2012 to December 2016. There were 87 males and 96 females, aged 90-104 years [(93.0±2.9) years]. Among the patients, 101 were treated surgically (operation group) and 82 were treated nonoperatively (non-operation group). The hospitalization time, incidence of complications, mortality and survival curve at 30 days and 1 year after injury were compared between the two groups. Multivariate logistic regression analysis was used to calculate the risk of death in patients who did not undergo operation at 30 days and 1 year after injury. Functional recovery was assessed by comparing the walking ability and activities of daily living (ADL) before injury and 1 year after injury.@*Results@#The hospitalization time was (16.6±13.7)days for operation group and (21.7±16.0)days for the non-operation group (P<0.05). The operation group had a complication incidence of 40.6% (41/101), and the non-operation group 58.5% (48/82). Nine patients (8.9%) in the operation group and nine patients (11.0%) in the non-operation group died 30 days after injury (P<0.05). A total of 27 deaths (26.7%) in operation group and 38 deaths (46.3%) in the non-operation group were recorded within 1 year after injury (P<0.05). The non-operation group had a much higher death risk than the operation group (P<0.05). Multivariate Logistic regression analysis showed that non-operation treatment was significantly associated with death risk 1-year after injury (OR=2.672, 95%CI 1.262-5.655, P<0.05), but not with the death risk 30-day mortality (OR=1.144, 95% CI 0.678-3.461, P>0.05). In the operation group, 45 patients (44.6%) could walk independently before injury and 56 patients (55.4%) could walk partially independently before injury; in the non-operation group, 31 patients (37.8%) could walk independently before injury and 51 patients (62.2%) could walk partially independently before injury, with no significant difference between the two groups (P>0.05). The average ADL score before injury in operation group was (61.4±8.2)points, while that in non-operation group was (60.3±9.2)points (P>0.05). At 1 year after operation, 20 patients (19.8%) in the operation group could walk independently , 43 patients (42.6%) could walk partially independently, and 11 patients (10.9%) needed to stay in bed; only one patient (1.2%) in the non-operation group could walk independently, 32 patients (39.0%) could walk partially independently, and 11 patients (13.4%) needed to stay in bed, with significant difference between the two groups (P<0.05). The average ADL score was (51.4±10.9)points in the operation group and (43.2±7.2)points in the non-operation group 1 year after operation (P<0.05).@*Conclusions@#For the nonagenarians patients with hip fracture, operation treatment is superior to non-operation treatment in terms of hospitalization time, complication incidence, 1-year mortality and functional recovery. Non-operation treatment is the independent risk factor for death risk 1 year after injury.