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Objective To evaluate the efficacy of a modified risk scoring system in predicting the mortality during hospitalization in the elderly patients undergoing hip fracture surgery.Methods At the first stage,we retrospectively analyzed the clinical data of 1,562 elderly patients with hip fracture who had been admitted to Department of Trauma and Orthopedics,Peking University People's Hospital from January 2010 to December 2014.A multi-factor risk-adjustment model for surgical risks was constructed by multi-variate logistic regression analysis to obtain a modified preoperative risk scoring system for elderly patients undergoing hip fracture.At the second stage,a cohort of 1,356 elderly patients with hip fracture from January 2015 to December 2018 was included for a prospective evaluation of the modified risk scoring system.The patients included were divided into 5 groups according to their scores:a very low risk group of 0 to 10 points,a low risk group of 11 to 20 points,a moderate risk group of 21 to 30 points,a high risk group of 31 to 40 points and a very high risk group of ≥41 points.The consistency between the scores and the actual outcomes of the patients was observed and the receiver operating characteristic curve (ROC) was drawn accordingly.Results The 1,356 cases included in the study scored 25.12 ± 10.30 points (from 0 to 67 points).The in-hospital mortality was 0％ (0/96) in the very low risk group,0.23％ (1/443) in the low risk group,0.49％ (2/409) in the moderate risk group,2.16％ (6/278) in the high risk group,and 5.38％ (7/130) in the very high risk group.The area under the ROC curve was 0.825 (95％ CI:0.728-0.921,P ＜ 0.01).Conclusions As the in-hospital mortality is positively correlated with the scores of the modified preoperative risk scoring system for elderly patients undergoing hip fracture,the modified scoring system can be used to predict the in-hospital morbidity of the patients.The modified scoring system can be further verified and calibrated by multi-center clinical evaluation.
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Objective To verify the effectiveness of a self-designed preoperative risk scoring system for elderly patients with hip fracture.Methods A total of 286 elderly patients with hip fracture were included for this prospective study who had been admitted from February 1,2014 to February 1,2016 to Department of Trauma and Orthopedics,Peking University People's Hospital.They were divided into 5 groups according to their scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture:0 to 10 points,11 to 20 points,21 to 30 points,31 to 40 points and above 41 points.Postoperative complications and deaths were recorded.The correlations between their preoperative scores and postoperative medical complications or death were analyzed to verify the effectiveness of the preoperative risk scoring system for elderly patients with hip fracture.Results The 286 patients scored 24.9 ± 11.0 (from 0 to 69) preoperatively.The femoral neck fractures scored 24.0±11.0 and femoral intertrochanteric fractures 26.3±10.8.The incidence of medical complications was 4.00％ (1/25) in the 0 to 10 points group,4.17％ (3/72) in the 11 to 20 points group,14.66％ (17/116) in the 21 to 30 points group,23.53％ (12/51) in the 31 to 40 points group and 50.00％ (11/22) in the above 41 pints group.Conclusion As the incidence of postoperative medical complications in elderly patients with hip fracture is positively correlated with the scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture,the preoperative risk scoring system can provide an effective prediction of surgical risks.
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Objective To establish a preoperative risk scoring system for elderly patients with hip fracture on the basis of investigation into the factors influencing their mortality during hospitalization. Methods The data were collected from the database of hospitalization summary reports ( HSR ) of Beijing Public Health Commission concerning the 14, 577 patients who had been 55 years old or older and hospitalized for hip fracture from January 1, 2006 throughout December 31, 2010 at the 35 top-rank hospitals in Beijing. They were divided into a surgery group and a non-surgery group. Two multivariable risk-adjustment models were established for the 2 groups on the basis of an investigation into the factors influencing their mor-tality during hospitalization. Finally a preoperative risk scoring system for elderly patients with hip frac-ture was formulated according to the valuation of the least common multiples of β coefficients of the risk factors.Results Besides senior age and male gender, 10 different comorbidities were independently associated with in-hospital mortality, particularly pulmonary embolism, respiratory failure, renal failure and diabetes. The risk for inpatient mortality associated with a specific comorbidity was relatively higher in the surgery group than in the non-surgery group. The risk-adjustment models based on the variables had better accuracy in predicting in-hospital mortality ( ROC＝0.91 in surgery group versus ROC＝0.85 in non-surgery group ). In our preoperative risk scoring system for elderly patients with hip fracture, 10 points were for an age of 65 to 74 years old, 14 points for an age of 75 to 84 years old, 18 points for an age beyond 85 years old, 4 points for male gender, 20 points for pulmonary embolism, 18 points for respiratory failure, 10 points for renal insufficiency, 8 points for diabetes, 8 points for heart failure, 7 points for malignant tumor, 7 points for lung infection, 7 points for disturbance of water, electrolyte and acid-base balance, 6 points for arrhythmia, and 6 points for cerebral infarction, totaling 119 points. Conclusions The primary risk factors for in-hospital mortality in the elderly patients with hip fracture seem to be senior age, male gender and 10 different comorbidi-ties. A preoperative risk scoring system has been successfully established for elderly patients with hip fracture.
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Objective:To investigate the morphology character of sagittally unstable intertrochanteric fractures and reduction methods.Methods: A retrospective study was used to analyze the clinical data of sagittally unstable intertrochanteric fractures cases,which were treated with proximal femoral nail anti-rotation (PFNA) fixation from March 2009 to June 2016.In the study,36 cases were followed up completely,in which 17 cases accepted open reduction,and the other 19 cases accepted minimally invasive reduction.The operation time,amount of bleeding,the fluoroscopy times,postoperative radiographic measurements,such as tip-apex distance (TAD) and sliding distance of the spiral screw,and hip Harris scores were analyzed.The morphology character of the fractures was documented and investigated.Results: The average follow-up time was 15 months.The amount of bleeding of the open reduction group was (170.5±19.7) mL,and the amount of bleeding of the minimally invasive group was (54.7±12.5) mL.The amount of bleeding of the minimally invasive group was significantly less than that of the open reduction group (P<0.001).Between the two groups,there were no significant differences in other evaluation parameter,including operation time (P=0.054),the fluoroscopy times (P=0.053),fracture healing time (P=0.305),postoperative radiographic measurements,such as TAD (P=0.317) and sliding distance of the spiral screw (P=0.206),and hip Harris scores (P=0.459).In regard to morphology character of the fractures,the proximal anterior unstable fractures with separation displacement were more common than the proximal posterior unstable fractures with impaction.The characteristic feature of the proximal anterior unstable fractures was the proximal anterior and medial long oblique fracture,and a V shape cortical defect in the distal fracture fragment on the externally rotation X-ray.Conclusion: Sagittally unstable intertrochanteric fractures can be divided into the proximal anterior unstable fractures with separation displacement,and the proximal posterior unstable fractures with impaction.The two types have their own morphology character individually.The reduction should be performed by minimally invasive techniques.
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Objective:To evaluate the meaning and value of high-frequency ultrasound in the diagnosis of carpal tunnel syndrome (CTS).Methods:In this study,48 patients (unilateral hand)with CTS were analyzed.The thickness of transverse carpal ligaments at the pisiform bone was measured using high-fre-quency ultrasound.Open carpal tunnel release procedure was performed in the 48 CTS patients,and the thickness of transverse carpal ligaments at the hamate hook bone measured using vernier caliper under di-rect vision.The accuracy of thickness of transverse carpal ligaments was evaluated using high-frequency ultrasound.High-frequency ultrasound measurement of thickness of transverse carpal ligaments at the ha-mate hook bone and pisiform bone,and determination of the diagnostic threshold measurement index using receiver operating characteristic (ROC)curve,sensitivity and specificity were performed and the correlation between the thickness of transverse carpal ligaments and nerve conduction study (NCS)ana-lyzed.Results:The thickness of transverse carpal ligaments in the CTS patients were (0.42 ±0.08)cm (high-frequency ultrasound)and (0.41 ±0.06)cm (operation)at hamate hook bone,and there was no significant difference between the two ways (t =0.672,P>0.05 ).The optimal cut-off value of the transverse carpal ligaments at hamate hook bone was 0.385 cm,the sensitivity 0.775,and the specificity 0.788.The optimal cut-off value of the transverse carpal ligaments at the pisiform bone was 0.315 cm, the sensitivity 0.950,and the specificity 1 .000.The transverse carpal ligaments thickness and wrist-in- dex finger sensory nerve conduction velocity (SCV),wrist-middle finger SCV showed a negative correla-tion.Conclusion:High frequency ultrasound measurements of thickness of transverse carpal ligaments is a valuable method for the diagnosis of CTS.
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Objective:To identify the characteristics and risk factors of the refractures after percuta-neous kyphoplasty ( PKP) and percutaneous vertebroplasty ( PVP) .Methods:A retrospective analysis of 148 patients who had undergone PKP or PVP between March 2006 and October 2013 inPeking University People’ s Hospital was conducted.In the study, 29 patients with 42 refractured vertebra and 119 patients without refracture were included.All the patients were observed for a time of (34.4 ±26.8) months. Clinical, imaging and procedure related factors ( gender, age, height, weight, body mass index, the level of the injured vertebra, the time interval between the procedure and the refracture, the level of the refractured vertebra, the bone cement volume injected, performed PKP or PVP,performed unilateral or bilateral, the percentage of anterior vertebral height restoration, the correction of the Cobb angle, cement diffusion, bone mineral density, presence or absence of diabetes mellitus, history of fractures of the whole body, anti-osteoporosis treatment, cement leakage) for each group were analyzed by Cox propor-tional hazards regression analysis.Results:Of all the patients,16 (55.17%, 16/29) had refractures in the adjacent vertebra, and 13 (44.83%, 13/29) had refractures in the nonadjacent vertebra.Refrac-tures within 3 months accounted for 31.03%(9/29) of all the refractures, and within 1 year accounted for 55.17%(16/29).Both older age (P=0.027, HR=1.051, 95%CI=1.006-1.098) and a his-tory of fractures of the whole body (P=0.012, HR=0.386, 95%CI=0.184-0.812) were statistical-ly significant as the independent risk factors for predicting refractures.Others were not associated with re-fractures ( P>0.05) .Conclusion:Older age and a history of fractures of the whole body are the inde-pendent risk factors of the refractures after PKP and PVP.The mechanism of the refractures after PKP and PVP is mainly the natural development of osteoporosis.
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Objective:To investigate the characteristics and perioperative management of hemophilia patients with fracture.Methods:Retrospectively, we analyzed 8 patients with hemophilia combined with fracture, who were admittted to our department from 2005 to 2013.Six patients were with hemophilia A and two with hemophilia B;Based on the severity of hemophilia, 2 cases were light, 3 moderate and 3 severe;Based on the location of fracture, 4 cases were femoral neck fractures, 1 femoral intertrochanteric fracture, 1 bilateral distal femur fractures, 1 tibiofibula fracture, and 1 humerus intercondylar fracture. Blood coagulation factor replacement therapy was conducted preoperatively, intraoperatively and postoper-atively, All the patients underwent closed or open reduction and internal fixation or joint replacement. Also, we analyzed the perioperative complications and observed whether the fracture healed.Results:The average age was 33.5 years (14 to 47 years); In 6 cases, fractures occurred at femur, accounting for 75%of all the fractures; Femoral neck fracture was treated by closed reduction and hollow screws fixation;Femoral intertrochanteric fracture, distal femur fracture, and tibiofibula fracture were treated by open reduction and internal fixation with plate;Humerus intercondylar fracture was treated by elbow joint replacement.Intraoperative bleeding was from 50 to 600 mL, an average of 262 mL;Perioperatively, the average use of FⅧ/activated prothrombin complex concentrates ( APCC) was 358 U/kg (125 to 554 U/kg) .Postoperatively, poor wound healing was observed in 2 patients, and the condition improved after symptomatic treatment; In patients with internal fixation, all the fractures united, and the average hea ling time was 14 weeks.No complications such as fixation loosening or rupture occurred after internal fixation.Conclusion:Hemophilia combined with fracture mainly occurred in the young, and the site of fracture was given priority to femur.With perfect preoperative preparation, on the basis of the replace-ment therapy, hemophilia combined with fractures was safe for surgical treatment, and postoperative frac-tures healing wasgood.But the risk of poor wound healing was high.
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Objective:To apply modified proximal femoral nail anti-rotation ( PFNA ) fixation tech-niques performed by percutaneous placement of guide wire combined with true lateral view and to make the procedures simpler.Methods:A retrospective study was used to analyze the clinical data of femoral intertrochanteric fractures cases, which were treated with conventional PFNA fixation or modified PFNA fixation performed by percutaneous placement guide wire combined with true lateral view in our hospital, from March, 2011 to May, 2014.In the study, 60 cases were followed for average 13 months.The oper-ation time, the amount of bleeding, the fluoroscopy time, postoperative radiographic measurements ( tip apex distance, TAD ) and hip function scores were analyzed.Results:In modified PFNA group, the amount of bleeding, the operation time and the fluoroscopy time were (70.5 ±12.5) min, (34.9 ±6.1) mL, ( 63.6 ±9.7 ) s respectively.In conventional PFNA group, they were ( 80.6 ±17.1 ) min, (47.8 ±6.7) mL, (68.5 ±8.7) s respectively.There were significant differences in the above respects between the two groups (P were 0.006, 0.013, and 0.022 respectively).There were no significant differences in TAD, fracture healing time, postoperative hip scores between the two groups (P>0.05). Conclusion:Fracture line is a natural entry point for some cases of femoral intertrochanteric fractures when we use proximal femoral nail anti-rotation to fix the fracture.Applying percutaneous insertion of the guide pin combined with true lateral view could reduce the operation time, amount of bleeding, and fluo-roscopy time significantly, make the procedures simpler and acquire satisfactory results .
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ObjectiveTo investigate the epidemiological features and risk factors of road traffic injury in Beijing.MethodsData of road traffic injuries of Beijing Changping Hospital in 2010 was collected for statistical analysis of the epidemiological features. ResultsA total of 990 cases of road traffic injuries were treated in Beijing Changping Hospital in 2010,with a male/female ratio of 2.57:1 and at average age of 45 yeats.There were 21 cases aged ＜ 18 years,703 cases aged 18-55 years and 266 cases aged ≥56 years.Self-employed individuals and fanning production staffs were the risky population that were easily subjected to road traffic injuries.Summer and autumn were the accident-prone seasons.The most common injury site was the lower limbs,next with the neck and head.The hospital stay was mainly in a range of 5-10 days (12.8 days on average).ConclusionsMale self-employed individuals and agricultural producers are the high-risk groups of road traffie accidents in the area,where shows a high occurrence of road traffic accidents in the summer and autumn.Thereby,traffic safety education and prevention-control measures based on these characteristics should be carried out to effectively reduce the number and severity of the local traffic injuries.
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Objective To analyze the injury characteristics in 2004-2009 road traffic accidents (RTAS) of 0-25 years old adolescents treated in Beijing 120 Emergency Center so as to provide scientific basis for making effective measures in prevention and control of RTAs. Methods The data of all the adolescents with traffic injuries treated in Beijing 120 Medical Emergency Center were collected for a retrospective analysis on sex,age,traffic injury time,wound regions,injury characteristics and death condition of the injured adolescents. Results( 1 ) There were 17 232 injuries and 259 deaths according to the traffic reports from 2004 to 2009. Among the total injury cases,there were 4 229 cases of 0-25 years old adolescents (24.5％),at (20.13 ± 4.43 ) years of age.The injury number showed a significant rising trend with the increase of age and the injury number of 20 years old group were obvious more than that of other age groups.(2) There were 2 252 males and 1 677 females,with ratio of males to females for 1.5:1 ( P ＜ 0.05 ).( 3 ) Total number of patients was decreased yearly.The high incidence of adolescent RTAs could be seen in September,October and May in one year; Friday,Saturday and Sunday in one week; and between 8:00 am and 11:00 pm in one day.The low incidence of adolescent RTAs could be seen in Tuesday in one week,and 3:00-6:00 am in one day (P ＜0.05).(4) Cases of limb and arthrosis wounds (53.4％) were more than those of head and neck wounds (35％).Most of the cases were pedestrians (49.1％ ).(5) There were 38 deaths,including 28 males and 10 females,at ageof (19.29 ± 5.30) years.The death were mainly resulted from craniocerebral injuries (87％),which mainly concentrated in July ( 13.2％ ) and August ( 15.8％ ). Conclusions The present condition ofadolescent traffic injuries is not good enough.We should strengthen traffic security education,increase executive powers in the traffic rush and promote cooperation and communication in pre-hospital emergency,as may be beneficial for decreasing adolescent RTA.
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ObjectiveTo analyze the obvious and hidden preoperative and intraoperative blood loss during treatment of the intertrochanter fracture with proximal femoral nail anti-rotation (PFNA) so as to provide necessary data support for clinical perioperative treatment.MethodsThe clinical data of 216 patients with intertrochanteric fractured treated with PFNA between December 2005 and September 2010 were analyzed retrospectively.An analysis was done on preoperative and postoperative blood routine, perioperative and postoperative blood loss and transfusion, perioperative obvious and hidden blood loss and perioperative and postoperative blood transfusion.ResultsThe average blood loss was 48.9ml during operation, with no blood transfusion.Obvious hemochrome decrease (＜9 g/L) was found in 42 patients at 2-4 days after operation and the patients received blood transfusion for mean 300 ml.The mean obvious blood loss was 62.3 ml, while the mean hidden blood loss was 385 ml in all the patients.There was no obvious difference between males and females.ConclusionThe intertrochanter fracture is mostly seen in the elder patients.Compared with the minimal invasive operation, PFNA has more hidden blood loss, as indicates that much attention should be paid to the vital signs of the patients after surgery for prevention of the complications.
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Objective To assess the efficienty of operation in humeral intercondylar fractures by section, reposition, internal fixation by composition nail and replacement of elbow joint. Methods From January, 1999 to May, 2009, Forty-six cases of the humeral intercondylar fracture were treated with operation. Thirty-eight cases were followed for 17 months. Their affected elbow joint function were evaluated by Cassebaum rating system, patients treated with total elbow replacement evaluated by Mayo elbow score, DASH score additionally. Results According to Cassebaum rating system,there were 22 cases rated as excellent,eight cases rated as good,five cases rated as poor,three case rated as poor. The fineness rate is 78. 9% (30/38). Mayo score in patients with joint replacement ranged from 75.0 - 90. 0, averaged 84. 4 ± 1.7. DASH score ranged from 25.0 to 75.0,averaged 41. 1 ±0. 8. There was 1 case of superficial soft tissue nonhealing and 2 cases of ulna nerve symptoms. Myodynamia in elbow joint bend and stretch was Ⅳ in 1 cases. Conclusion It is a good method to treat the humeral intercondylar fracture with rational use of open reduction or elbow replacement according to fracture type and patient condition.
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Objective To study the effect of activated Notch signaling system on Schwann cells in vitro. Methods Schwann cells were isolated from sciatic nerves of adult SD rats. Recombinant rat jagged1/FC chimera, an activator of the Notch signaling system, and γ-secretase inhibitor (DAPT), an inhibitor of the Notch signaling system, were added into the culture medium respectively. The cells in the medium added with phosphate buffered saline were used as control group. Then the cultured cells were collected. NICD, as a mark of activated Notch system, was detected by immunofluorescence methods. MTT method was used to calculate the growth curve. The level of NGF in the cell supernatant was assayed by using ELISA. Results Schwann cells in recombinant rat jagged/FC chimera group grew better than those in the control groups. MTT method showed that activated Notch signaling significantly promote the proliferation of the cells(P ＜ 0.05). After cultured for 48 h, the amount of NGF in cell supernatant of recombinant rat jagged1/FC chimera group was significantly increased (P ＜ 0.05). Conclusion When the Notch signaling system is activated, Schwann cells not only proliferate but also secret more NGF.
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Objective To evaluate the treatment of radial head fracture of different type. Methods The clinical data of 80 radial head fracture cases from November, 1999 to December,2009 were collected and analyzed retrospectively. Among the 80 cases,12 cases received conservative treatment( all type Mason Ⅰ ) ;48 cases received open reduction internal fixation (ORIF) (4 case type Mason Ⅰ ,15 cases type Mason Ⅱ ,24 cases type Mason Ⅲ,5 cases type Mason Ⅳ ); 12 cases received removing radial head ( 4 cases type Mason Ⅲ and 8 cases type Ⅳ ).8 cases received artificial joint replacement ( 8 cases type Mason Ⅳ ). Results All cases were followed up for 1.0 -4. 1 years. According to the Mayo Elbow Performance Index, the excellent and good rate of treatment in nonoperative,ORIF,excision of the radial head as well as artificial joint replacement was 83.3 % (10/12) ,87.5 %(42/48) ,75.0% (9/12) and 100. 0% (8/8) ,respectively. Conclusions Conservative treatment can be selected for type Mason Ⅰ ;Open reduction and internal fixation can be selected for type Mason Ⅱ , type Mason Ⅲ and part of type Mason Ⅳ. The excision of radial head or mental prosthesis replacement is alternative for type Mason Ⅳ for those can not be treated with open reduction and internal fixation.
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@#Objective To describe the rule of the phenotypic changes of schwann cells after peripheral nerve injury.Methods All experiments were performed on 18 male SD rats.Right midsciatic nerves were cut and were repaired by epineurium suture.At selected time points after injury(1 week,2 weeks,3weeks;n=6 rats for each time point),the proximal and distal sciatic nerve stumps(approximately a 2 mm length of nerve to the injured tip)were removed for detecting the expressions of GFAP,Sox2 and Krox20 by immunofluorescence methods. Results After sciatic nerve transection.there was expansion in the population of GFAP-labeled Schwann cells both in the proximal and distal stumps,and those expression reached the peak near to 7 d.Sox2 was neural stem cell markers and there was no Sox2-expressed cells stumps after nerve injury.And Krox20 positive Schwann cells continuously decreased in the first week,then had increased. Conclusion The differentiated stage of Schwann cells during peripheral nerve repair can be detected by using immunolabeling,and the observation above may be beneficial to find methods in improving nerve regeneration.
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Objective GAP-43 protein is a marker of peripheral nerve regeneration,To report the regeneration of rat proximal sciatic nerve were observed labeled by GAP-43 in two types of surgical repair model. Methods Right side of sciatic nerves of 64 SPF-class healthy adult male SD rats were cut at 5cm above the branch,32 rats were subjected to small gap(2mm)bridging repair with chitin conduit;others were subjected to traditionary epineurium suture.The general conditions of local tissue,sciatic nerve growth state and regenerative patterns of peripheral nerve fiber were observed at 1 d,3 d,7 d and 14 d respectively.Results The small gap bridging group had less local adhesion,immunofluorescencc staining showed that new axons Was in conic-sharp and homogeneously tidy.Local adhesion of traditionary epineurium suture group was more serious,distal new regenerated axons were irregular compared to the small gap bridging group.Immunofluorescence image analysis results showed that: early after the repair of rat sciatic nerve injury.the number of new axons of traditionary epineurium suture group was more compared with small gap bridging group(P<0.01);around 14 days after operation,the number of small gap bridging group was significantly higher than the traditionary epineurium suture group(P<0.05). Conclusion The small gap bridging group has less focal adhesion, better shape of nerve fibers and more regenerating axons than the traditionary epineurium suture group.The regenerative law of peripheral nerve fibers may further give us an explanation why regeneration results of small gap bridging group is better than traditionary epineurium suture group.
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Objective To analyze epidemiologie and injury characteristics of traffic injuries in Shenzhen through emergency department. Methods A questionnaire was pre-designed to collect data of patients admitted to six general emergency departments of six district in Shenzhen from January 2007 to December 2007 for clinical analysis. Results There were 1 328 patients with road traffic injuries, at age range of 2-84 years (average 31 years). According to occupation, most patients were local workers and migrant workers (57.8%). The accidental vehicles were mostly cars (48.5%). Most accidents (78.6%) occurred in urban streets. As for time distribution of traffic injuries, most injuries happened on Friday and Saturday (accounting for 17.8% and 18.7% respectively), especially on Friday (r = 0.166 0, P <0.01). There was central tendency around 15:35 p.m. in one day (r = 0.285 6, P < 0.01). The age of male was (32.36±8.70) years and that of female (29.96±4.32) years, with statis-tical differences (P < 0.05). Of patients followed up, 84.4% patients could work on their original jobs, 8.5% needed ehange of their jobs and 7.1% lost the ability of work. Conclusions It is neeessary to strengthen road safety education among local workers and migrant workers to improve their awareness of road safety. Traffic administrators and road safety marks should be added in the chief period and districts where road traffic injuries happen most frequently. Controlling the number of small cars may be effective to reduce traffic accidents.
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Objective To explore the clinical effect of fibular hook application in the treatment of lower tib-iofibular combination injuries.Methods Clinical data 9 cases from January 2005 to December 2007 treated with ap-piication of fibular hook were retrospectively analyzed.Results All 9 cases were followed-by 6 months to 24 months and were assessed by AOFAS Ankle-Hindfoot Scale.7 cases were excellent, 1 case was nice and 1 case was good.Conclusion Operation is necessary when the ankle joint stability is affected by the lower tibiofibular combination injuries,in order to ensure the lower tibiofibular combination ligament recovery completely.
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ObjectiveSystematically evaluate the clinical efficacy and complications of olecranon osteotomy and bilateral approach through triceps brachii for the treatment of intercondylar humeral fractures. MethodsTo search the domestic and foreign literatures published from January 1980 to March 2008 about the treatment of intercondylar humeral fractures, which use olecranon osteotomy approach and bilateral ap-proach through triceps brachii. Systematically evaluate these literatures using the methods of systematic re-view provided by the Cochrane collaboration. ResultsAfter the screening and evaluation to the literatures, 33 published literatures that met the inclusive criteria of this study were collected. There were a total of 876 cases of patients whose follow-up data was integrity (olecranon osteotomy approach group for 509 cases;bilat-eral approach through triceps brachii group for 367 cases) and these cases had provided the postoperative scores of elbow joint function. The excellent and good rates of postoperative score of elbow joint function for the type C2 and C3 fracture patients in the olecranon osteotomy approach group were 82.32% and 79.38% respectively; while those in the bilateral approach through triceps brachii group were 70.59% and 64.71% respectively. The former was significantly higher than the latter. The excellent and good rate of the type C1 fracture patients between two approaches groups showed no statistical significant. Fourteen literatures provid-ed the data about postoperative complications, the incidence of complications of patients that received ole-cranon osteotomy approach was 4.72%(95%CI 4.70%-4.74%), and the results also showed that compared with bilateral approach through triceps brachii (8.17%, 95%CI 8.13%-8.21%). ConclusionTo treat inter-condylar humeral fractures, postoperative efficacy of olecranon osteotomy approach is better than that of the bilateral approach through triceps brachii. Using olecranon osteotomy approach can get adequate exposure, easy open reduction and internal fixation, quick recover and less complication.
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Objective To treat radial head fractures with open reduction and internal fixation, removal of the radial head and artificial joint replacement based on different fracture types to discuss the outcome of these methods and summarize optimal strategy for treatment of radial head fractures. Meth-ods A retrospective study was done on data of 47 patients with 48 radial head fractures treated in our de-partment from November 1999 to May 2008. Among them, nine patients were treated conservatively (all type Mason Ⅰ fractures), 28 treated with open reduction and internal fixation (one patient with type Ma-son Ⅰ fracture, 14 with type Mason Ⅱ and 13 with type Mason Ⅲ), eight with removal of radial head (three patients with type Mason Ⅲ fractures and five with type Ⅳ) and three with artificial joint replace-ment (all type Mason Ⅳ fractures). Results All patients were followed up for average 2.8 years (1-4.4 years). Two patients treated with artificial joint replacement were followed up for six months and three months respectively. According to the Mayo Elbow Performance Index, the excellence rate was 8/9 in conservative treatment, 82% (23/28) in open reduction and internal fixation, 6/8 in removal of the radial head and 3/3 in artificial joint replacement respectively. Conclusions The radial head fracture should be given anatomical reduction for early functional exercise. Conservative treatment can be used for type Mason Ⅰ fractures, open reduction and internal fixation for type Mason Ⅱ , type Mason Ⅲ fractures and part of type Mason Ⅳ fractures. The removal of radial head or mental prosthesis replacement are al-ternative for parte of type Mason Ⅳ fractures that can not attain stable fixation through open reduction and internal fixation.