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Objective To explore the role of serum inflammatory factors in prediction of infection following internal fixation of closed fractures and its significance for surgical timing and infection prophylaxis.Methods A retrospective study was conducted of the 100 patients who had been treated by internal fixation for closed fracture from January 2014 through July 2016.They were 52 men and 48 women,aged from 24 to 76 years (average,45 years).There were 14 femoral fractures,19 tibial plateau fractures,25 patella fractures,8 pilon fractures,22 tibiofibular shaft fractures,and 12 calcaneal fractures.Of them,21 were inflicted by wound infection.The preoperative and postoperative infection indexes,CRP,ESR,PCT and leukocyte count,were recorded.Logistic regression analysis was conducted to test the correlation between the infection indexes and postoperative infection.The optimal cut-off value was determined by the receiver operating characteristic curve.Results CRP showed a significant correlation with postoperative infection while other indexes did not.The optimal cut-off value was 25 mg/L at one day before operation.Conclusions Preoperative determination of CRP may predict the risk of postoperative infection.CRP ＞ 25 mg/L at one day before operation may indicate the following day is not suitable for surgery and active infection prophylaxis should be conducted after surgery.
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Objective To explore the effect of topical application of sodium hyaluronate on preventing perivascular adhesion of the vein grafts in rabbits. Methods Thirty-six male New Zealand white rabbits, aged 5 months, were randomly and equally divided into 2 groups: groups A and B. Arterial defect model was established by cutting about 1cm artery from the middle part of the dissected left common carotid artery. A section about 3cm was cut from the right external jugular vein, and the harvested vein was inverted and anastomosed end-to-end to the artery defect. After the anastomosis, the adventitia and two anastomoses of the grafted veins in group A were coated locally with 0.2ml sodium hyaluronate. The grafted veins were obtained 1, 2 and 4 weeks after the operation, with the perivascular adhesion of the vein grafts being examined macroscopically before the resection. HE staining and Masson staining were preformed for histological changes of grafted vein wall and the perivascular adhesion of the vein grafts. At 2, 4 weeks postoperation, the perivascular adhesions of the vein grafts were graded by the grading criteria of adhesion in macroscopic evaluation and histological evaluation. Result At 1, 2 and 4 weeks postoperatively, the macroscopic and histological observation found that the perivascular adhesions in group A were looser than those in group B. The macroscopic grade and histological grade were lower in group A than in group B, there was a significant difference between the two groups at 2 and 4 weeks postoperation (P<0.05). Conclusion Topical application of sodium hyaluronate can reduce the perivascular adhesion and is an ideal treatment strategy for preventing perivascular adhesion of vein grafts.
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Objective To assess the treatment of fresh Monteggia fracture with a steel-wire loop for adults whose annular ligament needs repairing. Methods From May 2006 to March 2008, we treated 15 adult patients with fresh Monteggia fracture whose annular ligament needed repairing with a steel-wire loop. A retrospective study was performed for the 15 cases, including 9 males and 6 females. Their ages ranged from 19 to 46 years. According to the Bado classification system, there were 6 cases of type Ⅰ, 4 type Ⅱ, 5 type Ⅲ. The ulnar fractures were treated with open reduction and compression plate fixation. Next, radial head dislocations were reduced openly and the reduced heads were hitched to the proximal end of the ulna with a steel-wire loop of 0.8 mm in diameter around the radial neck. Last, the broken annular ligaments were repaired. The elbow functional trainings were carried out 48 hours after operation and the steel-wire was removed 3 weeks postoperatively. Results The patients were followed up for 8 to 11 months (mean,9. 5 months). The functional recovery evaluated by Broberg and Morrey evaluation system showed excellent results in 11 patients, good in 2, fair in 2 and poor in 0. The excellent to good rate was 86. 7%.Conclusion The steel-wire loop treatment is a good strategy for adults with fresh Monteggia fracture whose annular ligament needs repairing.
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Objective To test the Footscan system for guiding the postoperative rehabilitation of calcaneus fractures.Methods Sixty patients with unilateral calcaneus fracture were divided randomly into a rehabilitation group and a control group.Patients in both groups began a routine of functional rehabilitation training 24 h after a reduction and fixation operation.The patients in the rehabilitation group received individualized rehabilitation protocols based on regular dynamic evaluation of their plantar pressure using the Footscan system.Those in the control group were administered routine rehabilitation training without the personal modifications.At the 2nd and 7th month postoperation,the dynamic plantar pressure of both groups was evaluated and the functioning of their feet Was scored.Results At the 2nd month post-operation,there was no significant difference between the two groups in terms of subtalar ioint range of motion,the lateral deviation of pressure center,the time of heel touch with the ground,the maximum pressure at the lateral aspect of the calcaneus and impulsive force during walking.The functional evaluation scores were also not significantly different.At the 7th month post-operation,all the indices in both groups had improved significantly over the 2nd month,bulthe improvement in the rehabilitation group Was greater(except the time of heel touch with the ground).Conclusion The Footscan system can be a valuable tool for evaluating patients with calcaneus fracture and serve as a reference for planning rehabilitation interventions for such patients.
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BACKGROUND:Surgery has become gold standard to treat fracture of acetabulum.The incidence of posterior column fracture of affected acetabulum is high.The appropriate treatment for posterior column fracture of acetabulum remains controversial.OBJECTIVE:To establish the model of posterior column fracture of acetabulum,and evaluate the stability of internal fixation with the plate and lag screw for the posterior column fracture of acetabulum.METHODS:A total of 20 preserved cadaveric semipelvic specimens were randomly divided into two groups.Models of isolated posterior column fracture of acetabulum were established.The models were fixed with plate or lag screw.Under vertical compression load,the horizontal displacements of the fracture site were measured and the shear rigidity of two fixation conditions was compared.RESULTS AND CONCLUSION:The horizontal displacements of the fracture site fixed with plate and lag screw were (1.64±0.17) mm and (1.70±0.20) mm.The shear rigidity fixed with plate and lag screw were (392.40±41.22) N/mm and (386.33±50.07) N/mm.The differences of both horizontal displacements and shear rigidity between the two groups were not significant (P>0.05).The fracture model provides an ideal tool for biomechanical evaluation of the stability of internal fixation for the posterior column fracture of acetabulum.There was no significant difference in the stability of internal fixation with the plate and lag screw for the posterior column fracture of acetabulum.
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Objective To evaluate the stability of 4 different methods of plate internal fixation for simulated posterior column fracture of the acetabulum.MethodsTwenty preserved cadaveric semipelvic specimens were divided into 4 groups randomly.Models of isolated posterior column fractures of acetabulum were established and then fixed with 1 of following 4 methods of plate internal fixation:2 screws at the each end of plate(group A),3 screws at the each end of plate(group B),1 screw each side in the closest allowable hole to the fracture and 2 screws at the each end of plate(group C),and 4 screws on each side of the fracture(group D).Under vertical compression load of 3 times' body weight,the displacements of the fracture site were measured and the shear rigidity of different internal fixation methods were compared.ResultsThe displacements of the fracture site in Group A,B,C,and D were 4.68?0.35,2.80?0.25,2.12?0.11 and 1.58?0.17 mm respectively,with a decreasing trend from Group A to D.The shear rigidity of internal fixation methods in Group A,B,C,and D were 129.42?9.60,228.91?12.05,285.21?26.16 and 414.71?34.29 N/mm respectively,with an increasing trend from Group A to D.The differences of both displacements and shear rigidity between each 2 groups were significant(P