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Objective:To investigate the risk factors for nonunion after surgery for femoral shaft fractures in order to reduce them.Methods:The clinical data were retrospectively analyzed of the 804 patients with femoral shaft fracture who had been treated from January 2014 to December 2020 at Department of Orthopaedics, Xijing Hospital. There were 575 males and 229 females, aged from 18 to 96 years (average, 43.7 years). The patients were divided into 2 groups according to whether nonunion had occurred after surgery: a nonunion group of 112 cases and a fracture healing group of 692 cases. The preoperative general data, such as age, gender and fracture type, as well as intraoperative and postoperative data, such as operation time, internal fixation method, reduction method and internal fixation failure, were compared between the 2 groups. Items with P<0.05 were included in the multivariate logistic regression analysis to identify the risk factors for nonunion. Results:There were statistically significant differences between the nonunion group and the fracture healing group in smoking history, drinking history, injury mechanism, injury type, multiple injuries, fracture AO classification, fixation method, internal fixation failure, postoperative infection and use of non-steroid anti-inflammtory drugs ( P<0.05). Multivariate logistic regression analysis showed that smoking ( OR=3.261, 95% CI: 2.072 to 5.133, P<0.001), high energy injury ( OR=2.010, 95% CI: 1.085 to 3.722, P=0.026), multiple injuries ( OR=3.354, 95% CI: 1.985 to 5.669, P<0.001), AO type 32-C fracture (type 32-C fracture used as a reference, P=0.034), internal fixation failure ( OR=3.517, 95% CI: 1.806 to 6.849, P<0.001), external stent fixation (external stent fixation used as a reference, P=0.009) were the risk factors for nonunion after femoral shaft fractures. Conclusions:After surgery for patients with femoral shaft fracture, special attention should be paid to those with a smoking habit, high-energy injury, multiple injuries, AO type 32-C fracture, external stent fixation or a failed internal fixation, because they are high-risk groups prone to postoperative nonunion.
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Objective:To evaluate the Ganz approach in the internal fixation of Pipkin Ⅳ femoral head fracture.Methods:The data of 7 patients with Pipkin Ⅳ femoral head fracture were retrospectively analyzed who had been admitted to Department of Orthopaedics, Xijing Hospital from March 2013 to April 2019. They were 5 males and 2 females, aged from 23 to 66 years (average, 40.5 years). The time from injury to operation ranged from 5 to 13 days (average, 7.3 days). In all the 7 patients, the Ganz approach was adopted in the internal fixation with double-head compression screws for femoral head fracture and in the internal fixation with screws plus a reconstruction plate for acetabular fracture. Their operation time, intraoperative bleeding, fracture reduction, hip functional recovery and complications were recorded. The hip function was assessed by Harris hip score.Results:Their operation time ranged from 155 to 235 min (mean, 197.9 min) and their intraoperative bleeding from 450 to 765 mL (mean, 590.0 mL). This cohort was followed up for 12 to 86 months (mean, 34.4 months). According to the Letournel recommended criteria for reduction quality of acetabular fractures, anatomical reduction was achieved in 6 cases and satisfactory reduction in one; according to the Thompson-Epstein clinical and imaging evaluation, the reduction of femoral head fracture was excellent in 6 cases and good in one. Their Harris hip scores at the last follow-up ranged from 92 to 97 (mean, 93.0). Traumatic arthritis developed in one case which was still under observation and muscular vein thrombosis developed in the affected limb in 2 cases but was organized after standard treatment.Conclusion:In the treatment of Pipkin Ⅳ femoral head fracture, the Ganz approach can lead to good reduction quality and fine functional recovery of the hip.
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Objective To compare the function recovery of multiple injuries combined with floating knee joint injury and simple knee joint injury,and to analyze the risk factors.Methods A retrospective case control study was conducted to analyze the clinical data of 41 patients with multiple injuries combined with Blake and McBryde Ⅱ A floating knee injury admitted to Xijing Hospital of Air Force Medical University from June 2011 to June 2017.There were 26 males and 15 females,aged 18-76 years,with an average of 34.5 years.There were 25 patients with simple knee joint injury and and 16 patients with multi-joint combined injury involving knee joint and ipsilateral hip joint or ankle joint injury.Surgical fixation was performed in different parts by external fixation,intramedullary nail and plate screw fixation.According to the Kalstr(o)m and Olerud functional evaluation criteria,the excellent and good rate of postoperative functional recovery was compared between the two groups.The surgical fixation methods of the two groups were compared.Logistic regression analysis was performed on the influencing factors of functional recovery.Results The patients were followed up for 1-7 years,with an average of 3 years.The excellent and good rate of overall functional recovery in the two groups was 68％,and the rate was 84％ in simple knee injury group and 44％ in multi-joint combined injury group (P ＜ 0.01).There was no significant difference in the ratio of intramedullary nail and plate screw fixation between the two groups (P ＞ 0.05),while the proportion of the external fixation in the multi-joint combined injury group [31％ (5/16)] was significantly higher than that in the simple knee joint injury group [16％ (4/25)] (P ＜ 0.05).Logistic regression analysis showed that the rate of external fixation was an independent factor affecting the postoperative function (OR =0.15,P ＜ 0.01).Conclusions The postoperative function in multi-joint injury patients is poorer than in the single joint injury patients.The higher rate of using external fixation in multi-joint injury patients is a risk factor.For Blake and McBryde Ⅱ A floating knee injury combined with multi-joint injury,less external fixation should be used,so as to improve the postoperative function.
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Objective@#To evaluate the effect of 3DBody software assisted problem-based learning (PBL) teaching in orthopedic teaching.@*Methods@#Undergraduates of clinical medicine from grade 2013 who had internship in our hospital were divided into experimental group and control group. Undergraduates in the experimental group were taught by 3DBody software assisted PBL teaching, with designed questions and the method of using 3DBody software handing to students before class. While undergraduates in the control group were taught by traditional teaching, with the use of textbooks and multimedia courseware. Examination scores of theory and probation were compared between the two groups. Questionnaires were used to evaluate the subjective perception of different teaching method among the participants in each group.@*Results@#Scores of theoretical examination in the experimental group (84.6±5.9) were higher than those in the control group (73.2±6.1); scores of probation examination in the experimental group (17.7±2.1) were significantly higher than those in the control group (12.7±1.9); the degree of satisfaction in the experimental group (9.2±0.8) was significantly higher than that in the control group (7.2±1.3); all differences were statistically significant (P<0.05).@*Conclusion@#3DBody software assisted PBL teaching can significantly improve the effectiveness of orthopedic teaching and enhance students' learning initiative and interest, which is worth promoting.
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Objective To evaluate the effect of 3DBody software assisted problem-based learning (PBL) teaching in orthopedic teaching. Methods Undergraduates of clinical medicine from grade 2013 who had internship in our hospital were divided into experimental group and control group. Undergraduates in the experimental group were taught by 3DBody software assisted PBL teaching, with designed questions and the method of using 3DBody software handing to students before class. While undergraduates in the control group were taught by traditional teaching, with the use of textbooks and multimedia courseware. Examination scores of theory and probation were compared between the two groups. Questionnaires were used to evaluate the subjective perception of different teaching method among the participants in each group. Results Scores of theoretical examination in the experimental group (84.6 ±5.9) were higher than those in the control group (73.2 ±6.1); scores of probation examination in the experimental group (17.7 ± 2.1) were significantly higher than those in the control group (12.7 ±1.9); the degree of satisfaction in the experimental group (9.2 ±0.8) was significantly higher than that in the control group (7.2 ±1.3); all differences were statistically significant (P<0.05). Conclusion 3DBody software assisted PBL teaching can significantly improve the effectiveness of orthopedic teaching and enhance students' learning initiative and interest, which is worth promoting.