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Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.
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Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.
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Objective:To investigate the application effects of SBAR communication mode (situation, background, assessment and recommendation) combined with 3D printing model technology in bed-side teaching of trauma orthopaedics.Methods:A total of 80 clinical medicine students were randomly divided into two groups according to the order of the school number, with 40 students in each group. One was experimental group which received SBAR communication mode combined with 3D printing model technology teaching, and the other one was the control group, which received regular reaching mode. At the end of teaching, the teaching effects were evaluated, including the scores of theoretical examinations and operational examinations, total scores and the anonymous questionnaires. SPSS 22.0 was used for recording and statistical analysis.Results:The average scores of theoretical examinations (48.30±1.41), operational examinations (42.20±1.48) and total scores (90.70±1.38) of experimental group were significantly higher than those of control group [(43.40±1.52); (34.80±1.53); (78.10±1.51)], with significant differences ( P <0.05). The anonymous questionnaires showed that the students in the experimental group had a significant advantage in autonomous learning ability, learning enthusiasm, the ability of literature retrieval and analysis and clinical thinking ability, and enhancing students' humanistic care consciousness in clinical work ( P <0.05). While the two groups had the same recognition in improving problem solving ability, teamwork ability and communication ability with patients, with no significant difference ( P > 0.05). Conclusion:The new teaching mode, SBAR mode combined with 3D printing model technology, applied to trauma orthopaedics bed-side teaching is helpful for students to improve their learning interest and autonomous learning ability, cultivate their lifelong learning habits and their comprehensive quality, so this mode will significantly improve the teaching effects, with good application value.
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Since December 2019, corona virus disease 2019 (COVID-19) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of COVID-19. Based on the needs of emergency surgery for orthopedic trauma patients and review of the latest diagnosis and treatment strategy of COVID-19 and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of COVID-19 and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.
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Objective To explore the clinical effect of bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs in treating lumbar vertebral compression fracture in the elderly.Methods A retrospective case-control study was carried out to analyze the clinical data of 48 cases of lumbar vertebral compression fracture in the elderly admitted to the Union Hospital between October 2015 and October 2018.There were 34 males and 14 females,aged 60-78 years [(62.8 ± 2.5) years].Segment of injury was L1 in 37 cases,L2 in 7,L3 in 2,and L4 in 4.There were 20 cases in bone grafting group involving 15 males and five females,aged from 60 to 78 years [(63.7 ± 2.1)years].There were 28 cases in non-bone grafting group involving 19 males and nine females,aged from 60 to 75 years [(62.4 ± 2.9) years].The Frankel scale in bone grafting group was grade D in 15 cases and grade E in 5,and in non-bone grafting group was grade D in 18 cases and grade E in 10.All the cases were treated by pedicle screw fixation combined with antiosteoporosis drugs,and the bone grafting group were treated by bone grafting via the injured vertebrae,but the other group were not.The intraoperative blood loss and operation time for each segmental vertebrae were recorded.The visual analogue scale (VAS) before operation and one year after operation,the bone healing at three months and one year postoperatively were recorded.The compression rate of the injured vertebrae at operation,at one day and one-year postoperatively as well as the height loss of the injured vertebrae at postoperative one year were measured.Spinal cord injury was also evaluated by Frankel scale.Wound healing,lower limb thrombosis,lung infection and ulcer were observed.Results All the cases were followed up,with duration for 12-25 months [(16.2 ±3.4) months] in bone grafting group and 15-24 months [(17.5 ± 5.4) months] in non-bone grafting group (P ＞ 0.05).The blood loss was (240 ± 70) ml in bone grafting group and (210 ± 65) ml in non-bone grafting group (P ＞ 0.05).Screw implantation time for each segment was (38.5 ±9.6)minutes in bone grafting group and (30.5 ±5.4)minutes in non-bone grafting group (P ＜ 0.05).The VAS was (7.5 ± 1.8)points preoperatively and (1.5 ± 0.7)points at one year postoperatively in bone grafting group,while (7.8 ± 1.4) points and (2.9 ± 1.2) points in non-bone grafting group,with significant difference between the two groups at one year postoperatively (P ＜ 0.05).The fracture healing rate was 85％ (17/20) and 95％ (19/20) at three months and one year postoperatively in bone grafting group,while 64％ (18/28) and 86％ (24/28) in non-bone grafting group,with no statistical difference between the two groups (P ＞ 0.05).No significant difference was found in compression rate of the injured vertebral height between the two groups before and after operation (P ＞ 0.05).The height loss rate of the injured vertebrae was 3％ (2％,4％) at one year postoperatively in bone grafting group and 6％ (5％,8％) in non-bone grafting group (P ＜0.05).The Frankel scale was all Grade E postoperatively.During the follow-up,no lower limb thrombosis,lung infection or ulcer occurred.One case had bone non-union in bone grafting group and four in non-bone grafting group (P ＞ 0.05).Conclusion For lumbar vertebral compression fracture in the elderly,bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs is significantly better in recovering and maintaining the injured vertebrae height,relieving the pain and promoting the bone healing,although the screw implantation time is prolonged.
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Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.
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Objective@#To explore the clinical effect of bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs in treating lumbar vertebral compression fracture in the elderly.@*Methods@#A retrospective case-control study was carried out to analyze the clinical data of 48 cases of lumbar vertebral compression fracture in the elderly admitted to the Union Hospital between October 2015 and October 2018. There were 34 males and 14 females, aged 60-78 years [(62.8±2.5)years]. Segment of injury was L1 in 37 cases, L2 in 7, L3 in 2, and L4 in 4. There were 20 cases in bone grafting group involving 15 males and five females, aged from 60 to 78 years [(63.7±2.1)years]. There were 28 cases in non-bone grafting group involving 19 males and nine females, aged from 60 to 75 years [(62.4±2.9)years]. The Frankel scale in bone grafting group was grade D in 15 cases and grade E in 5, and in non-bone grafting group was grade D in 18 cases and grade E in 10. All the cases were treated by pedicle screw fixation combined with antiosteoporosis drugs, and the bone grafting group were treated by bone grafting via the injured vertebrae, but the other group were not. The intraoperative blood loss and operation time for each segmental vertebrae were recorded. The visual analogue scale (VAS) before operation and one year after operation, the bone healing at three months and one year postoperatively were recorded. The compression rate of the injured vertebrae at operation, at one day and one-year postoperatively as well as the height loss of the injured vertebrae at postoperative one year were measured. Spinal cord injury was also evaluated by Frankel scale. Wound healing, lower limb thrombosis, lung infection and ulcer were observed.@*Results@#All the cases were followed up, with duration for 12-25 months [(16.2±3.4)months] in bone grafting group and 15-24 months [(17.5±5.4)months] in non-bone grafting group (P>0.05). The blood loss was (240±70)ml in bone grafting group and (210±65)ml in non-bone grafting group (P>0.05). Screw implantation time for each segment was (38.5±9.6)minutes in bone grafting group and (30.5±5.4)minutes in non-bone grafting group (P<0.05). The VAS was (7.5±1.8)points preoperatively and (1.5±0.7)points at one year postoperatively in bone grafting group, while (7.8±1.4)points and (2.9±1.2)points in non-bone grafting group, with significant difference between the two groups at one year postoperatively (P<0.05). The fracture healing rate was 85% (17/20) and 95% (19/20) at three months and one year postoperatively in bone grafting group, while 64%(18/28) and 86%(24/28) in non-bone grafting group, with no statistical difference between the two groups (P>0.05). No significant difference was found in compression rate of the injured vertebral height between the two groups before and after operation (P>0.05). The height loss rate of the injured vertebrae was 3% (2%, 4%) at one year postoperatively in bone grafting group and 6% (5%, 8%) in non-bone grafting group (P<0.05). The Frankel scale was all Grade E postoperatively. During the follow-up, no lower limb thrombosis, lung infection or ulcer occurred. One case had bone non-union in bone grafting group and four in non-bone grafting group (P>0.05).@*Conclusion@#For lumbar vertebral compression fracture in the elderly, bone grafting in the injured vertebrae combined with pedicle screw-rod system assisted with drugs is significantly better in recovering and maintaining the injured vertebrae height, relieving the pain and promoting the bone healing, although the screw implantation time is prolonged.
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Objective To investigate the application of 3-dimension printed guide plate technology in sacroiliac screw fixation.Methods A study of 5 cases (from June 2016 to December 2016) applying the 3-dimension printed guide plate technology in sacroiliac screw fixation for the treatment of posterior ring injury of pelvis was performed.There were 4 male and 1 female,aged from 42 to 67 years (average,52.4 years),4 combined with sacral fracture (3 cases of Denis Ⅰ and 1 case of Denis Ⅱ combined with nerve injury),and 1case of sacroiliac joint separation.Patients' pre-operative CT scanning data were collected and introduced to the computer system to reconstruct and print a 3-dimensional pelvic model.The working tunnel for sacroiliac screw insertion was imitated by the system and a guiding template was designed and printed on the basis of that.The analysis of each screw placement time,the exposure of X ray and bleeding volume were undertook,and the Matta radiological criteria was used to evaluate the reduction quality.The visual analogue scale (VAS) was applied to evaluate the preoperative,1week and 6-monthspostoperative coccydynia.Results 5 sacroiliac screws were inserted in 5 patients.The time for each screw placement ranged from 8 to 16 min,average 11.2 min,and the times for each screw implantation exposed to X-ray ranged from 4 to 8,average 5.6.According to Matta radiological criteria,the fracture reduction was excellent in 4 cases and good in 1,giving an excellent to good rate of 100％.The volume of intraoperative bleeding was 20 to 50 ml,mean 30±0.7 ml.The average preoperative VAS score was 5.2 to 8.1,mean 7.04±0.1.The average VAS score was 5.46±0.3 at 1-week of postoperation;1.48±0.2 at 6-month after operation.The pain level decreased significantly from moderate/severe (preoperative) to slight (6-month postoperative).Postoperative Majeed score was 86 to 92,mean 90±0.5,giving a good-excellent rate 100％.Conclusion The 3-dimension printed guide plate technology,with the advantages of minimal invasive,less exposure to X-ray and a definite curative effect,can significantly simplify the procedure of the placement of sacroiliac screws in fixation of posterior ring injury of pelvis.
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Objective To investigate the clinical effect of phase Ⅰ debridement combined with antibiotic bone cement bead chain packing for chronic infection after fracture.Methods A retrospective case series study was carried out to analyze the clinical data of 50 patients with chronic bone infection admitted to Wuhan Union Hospital from February 2015 to June 2017.There were 38 males and 12 females,aged 28-70 years [(48.4 ± 5.1) years].In terms of the infection site,there were 36 patients at the humerus,seven at the femur,three at the phalanges,two at the calcaneus,and two at the spine.A total of 42 infection patients were reported after internal fixation,and eight infection patients were reported after fracture.All patients were treated with phase I debridement combined with antibiotic bone cement bead chain packing.The changes of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) before operation and 1,4 and 7 days after operation,infection control rate,number of debridement operations,bone healing time after bone grafting,and infection recurrence rate were recorded.Results The patients were followed up for 6-22 months [(12.4 ± 2.9) months].At postoperative 1,4 and 7 days,the preoperative ESR [(41.2 ± 5.3) mm/h] and preoperative CRP [(83.2 ± 9.3) mg/L] were decreased to (37.1 ± 4.8) mm/h,(32.5 ± 3.1) mm/h,(22.3 ± 1.9) mm/h and (71.1 ± 4.6)mg/L,(66.5 ± 3.1) mg//L,(39.3 ± 1.9) mg/L,respectively (P ＜ 0.05).The infection control rate was 94％ (47/50),and the number of debridement operations was 2-5 [(2.2 ± 0.3)].The bone healing time was 14-30 weeks [(24.6 ± 6.7) weeks],and the infection recurrence rate was 2％ (1/47).Conclusion Phase I debridement combined with antibiotic bone cement bead chain packing is an ideal method in treating chronic bone infection,with high infection control rate,low recurrence rate,and satisfactory bone union.