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Minimally invasive treatment is the development trend in surgical techniques for pelvic fractures. There have been numerous minimally invasive techniques for pelvic fractures, each having its own advantages. This paper reviews the literature recently published at home and abroad concerning minimally invasive treatment of pelvic fractures so as to summarize the existing minimally invasive techniques for the fractures and their supporting theories, hoping traumatic orthopedists to know more about the minimally invasive techniques. As a result, Chinese traumatic orthopedists may formulate personalized treatment protocols to suit the specific condition of each patient so that the surgical invasion can be minimized and the intraoperative and postoperative complications reduced.
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Objective:To explore the epidemiological characteristics of geriatric hip fractures in Beijing so as to provide evidence for effective prevention and control measures.Methods:This multicenter study was conducted in 3 urban (Beijing Jishuitan Hospital, Beijing Hospital and Beijing Anzhen Hospital) and 3 suburban hospitals (Beijing Shunyi District Hospital, Beijing Changping District Hospital and Beijing Liangxiang Hospital) in Beijing from November 2018 to November 2019. Eligible patients were those aged ≥ 65 years with hip fracture confirmed by X-ray and being admitted to hospital within 21 days of injury. To explore the epidemiological characteristics of geriatric hip fractures in Beijing, such data were collected as patients' age, gender, comorbidities, as well as type, site, time and cause of the fracture.Results:① A total of 2,071 patients were included in this suevey. They were 653 males and 1,418 females (M∶F=1∶2.17). Their age ranged from 65 to 102 years (average, 79.8 years). The patients aged from 75 to 84 years were the most common, accounting for 44.81% (928/2,071). ② Femoral neck fractures accounted for 43.41% (899/2,071), and intertrochanteric fractures accounted for 56.59% (1,172/2,071). The age of the patients with femoral neck fracture was (78.6±7.7) years, which was significantly younger than that of those with intertrochanteric fracture [(80.7±7.4) years] ( P<0.05). ③ 94.69% of the hip fractures (1,961/2,071) were caused by falling, and 71.27% fractures (1,476/2,071) happened at home. ④ Approximately 83.00% of the patients (1,719/2,071) had one or more comorbid conditions. Hypertension was the most prevalent disease (57.89%, 1,199/2,071), followed by diabetes (27.09%, 561/2,071), and coronary atherosclerotic heart disease (22.02%, 456/2,071). Conclusions:In Beijing, significantly more geriatric females sustain a hip fracture than males, and the proportion of those aged from 75 to 84 year is the largest. The proportion of intertrochanteric fractures increases with age. Falls are the leading cause for geriatric hip fractures. Most of the patients have one or more chronic comorbid conditions. Corresponding prevention and intervention measures should be formulated according to the distribution characteristics of elderly hip fractures in Beijing.
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With technological innovations in computer, navigation and robotics, more and more robot-assisted orthopaedic surgeries have been put into clinical practice, such as joint replacement surgery, spine surgery, bone tumor surgery, arthroscopy and fracture fixation surgery, providing a new direction for minimally invasive, precise and personalized treatment of diseases in clinic. TiRobot, an orthopedic robotic system independently developed by China, has been widely used in spine and trauma orthopedic surgery. This article reviews the applications of TiRobot in fracture surgery and in remote surgery, and introduces the progress in application of TiRobot to assist treatments of spinal and cervical fractures, thoracolumbar fractures, pelvic and acetabular fractures, hip fractures, and hand and foot fractures.
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Objective:To evaluate the efficacy and safety of perioperative rehabilitation approaches based on the concept of Enhanced Recovery After Surgery (ERAS) for pelvic fractures.Methods:A prospective randomized control trial was conducted to include 114 emergency patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for surgical treatment of pelvic fractures from June 2019 to December 2020. Of them, 57 were assigned into an intervention group according to a random digits table. They were 42 males and 15 females, aged from 18 to 77 years and subjected to management of pelvic fractures with tentative perioperative ERAS approaches which were adjusted at different stages. The other random 57 patients were assigned into a control group. They were 40 males and 17 females, aged from 17 to 70 years and subjected to management of pelvic fractures with conventional rehabilitation approaches which included postoperative in-hospital consultation and guidance by rehabilitation physicians. The 2 groups were compared in terms of Majeed pelvis scores and Barthel indexes at postoperative 2, 6, 12 and 24 weeks, and visual analogue scale (VAS) pain scores and SF36 scores at postoperative 12 and 24 weeks.Results:A total of 105 patients (55 in the intervention group and 50 in the control group) were completely followed up for 151 to 254 d (mean, 177 d). The 2 groups were comparable due to no significant difference between them in the preoperative general data ( P>0.05). The Majeed scores (44±13, 67±16, 86±14 and 98±7) and Barthel indexes (57±13, 79±16, 95±8 and 100±2) at postoperative 2, 6, 12 and 24 weeks in the intervention group were significantly higher than those in the control group [(35±16, 51±16, 73±14 and 91±12) and (45±19, 67±18, 86±12 and 98±4)] (all P<0.05). At postoperative 12 and 24 weeks, the SF-36 scores (129±15 and 141±6) in the intervention group were significantly higher than those in the control group (114±15 and 131±12) ( P<0.05). There was no significant difference in the pain degree between the 2 groups ( P>0.05). Conclusion:In management of pelvic fractures, compared with conventional perioperative rehabilitation approaches, the perioperative ERAS rehabilitation approaches may improve early functional outcomes and thus help the patients restore their activities of daily living earlier.
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Objective:To compare the perioperative data between the pararectus and ilioinguinal approaches in the internal fixation of acetabular fractures.Methods:A randomized controlled trial was conducted to enroll 74 patients with acetabular fracture who were admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from June 2018 to January 2021. They were randomly divided into 2 groups. In group A of 37 cases, there were 28 males and 9 females with an age of (55.8±15.2) years, and 10 anterior column fractures, 7 anterior+posterior hemi-transverse fractures, one transverse fracture, 3 T-shaped fractures and 16 both column fractures according to Letournel-Judet classification. In group B of 37 cases, there were 28 males and 9 females with an age of (49.4±14.6) years, and 8 anterior column fractures, 6 anterior+ posterior hemi-transverse fractures, 2 transverse fractures, 2 T-shaped fractures and 19 both column fractures according to Letournel-Judet classification. Group A was subjected to open reduction and plate fixation via the pararectus approach while group B to open reduction and plate fixation via the ilioinguinal approach. The 2 groups were compared in terms of operation time, intraoperative blood loss, postoperative reduction and perioperative complications.Results:There were no significant differences in baseline data between the 2 groups, showing comparability between them ( P>0.05). The operation time in group A [150 (120, 180) min] was significantly shorter than that in group B [180 (150, 225) min] ( P<0.05). There were no significance differences between the 2 groups in intraoperative blood loss [800 (600, 1, 000) mL versus 1, 000(600, 1, 300) mL], rate of good to excellent reduction [91.9%(34/37) versus 78.4%(29/37)], or incidence of complications [24.3%(9/37) versus 45.9%(17/37)] ( P>0.05). Conclusion:Compared with the ilioinguinal approach, the pararectus approach can reduce operation time significantly in the internal fixation of acetabular fractures.
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Objective:To explore the feasibility and therapeutic efficacy of using the Henry approach to expose and place a metaphyseal bone plate laterally to fixate a proximal radial shaft fracture.Methods:A retrospective analysis was done of the 5 proximal radial shaft fractures (defined as the fracture involving the extent between the radial tuberosity to the insertion of the pronator teres) which had been treated from April 2018 to June 2019 at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital through the Henry approach to place a metaphyseal plate laterally to the radius for fixation. There were 2 males and 3 females, aged from 16 to 59 years (average, 41.4 years), with 3 cases on the left side and 2 cases on the right side. The imaging data, fracture healing time, forearm pronation-supination, and visual analogue scale (VAS) of the patients were regularly followed up; the therapeutic efficacy was evaluated at the last follow-up using Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH), Anderson and Grace-Eversmann evaluations.Results:The 5 patients were followed up for 7 to 16 months (average, 10.6 months). Their fracture healing time averaged 4.6 months, elbow flexion 146°, extension -2°, pronation 77°, and supination 88°. In postoperative VAS, 4 cases scored a 0 point and one case 1 point. At the last follow-up, their Quick-DASH scores averaged 4.1 points; by the Anderson evaluation, 5 cases were excellent; by the Grace-Eversmann evaluation, 4 cases were excellent and one case was good. No postoperative complication was observed.Conclusion:It is an effective treatment of proximal radial shaft fracture to use the Henry approach to expose and place a 3.5mm metaphyseal plate laterally to the radius for fixation.
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Although internal fixation is still a standard treatment for geriatric Garden Ⅰ/Ⅱ femoral neck fractures, it is reported to lead to a high rate of reoperation. Therefore, identification of risk factors for internal fixation failure can help a sensible decision-making in initial treatment. In recent years, many studies have suggested that posterior tilt of the femoral head before surgery may affect the rates of internal fixation failure and reoperation. Some studies have even recommended hip arthroplasty for geriatric Garden Ⅰ/Ⅱ femoral neck fractures. However, different studies adopted different measurement methods and thus obtained inconsistent results. By literature review, this article expounds on various measurement methods for femoral head tilt and correlation between posterior tilt of femoral head and prognosis after internal fixation, and compares therapeutic efficacy between internal fixation and hip arthroplasty, hoping to provide useful information and data for clinical treatment of geriatric Garden Ⅰ/Ⅱ femoral neck fractures.
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Objective:To investigate the safety of early hip fracture surgery for elderly patients on clopidogrel.Methods:This retrospective study included 242 consecutive elderly patients (≥65 years) with acute hip fracture who had undergone surgery at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital between November 2016 and April 2017. Of them, 20 were assigned into the study group who had taken clopidogrel before injury but discontinued its use within 4 days before surgery. They were 6 males and 14 females, with a median age of 80 years (77, 81). Their operation procedures for hip fracture included internal fixation with cannulated screws for femoral neck fracture in 2 cases, hemiarthroplasty for displaced femoral neck fracture in 11 cases, and internal fixation for intertrochanteric fracture in 7 cases. The control group included 222 patients who had undergone the same operative procedures but not taken any antiplatelet or anticoagulant drugs. The 2 groups were compared in terms of time between admission and operation, operation duration, intraoperative blood loss, perioperative transfusion and complications related to bleeding to analyze the safety of early surgery.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There was no significant difference between the 2 groups in the time between admission and operation [42.5 (36.3, 48.0) h for the study group versus 43.0 (28.0, 61.0) h for the control group] ( P=0.870). The median time between the last use of clopidogrel and operation was 55.0 (30.5, 71.0) h. There were no significant differences between the 2 groups in preoperative hemoglobin, operation duration, intraoperative blood loss, rate or amount of perioperative blood transfusion, or rate or amount of wound drainage ( P>0.05). The rate of general anesthesia was significantly higher for the study group (45.0%, 9/20) than for the control group (18.5%,41/222) ( P=0.012). No complications related to spinal hematoma occurred in the patients receiving spinal anesthesia from the study group. Wound hematoma and subsequent infection occurred in 2 patients from the control group. Conclusion:Early hip fracture surgery is safe for elderly patients on clopidogrel.
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Objective:To summarize our experience in prevention of COVID-19 infection in emergency and confined operations during the first 3 weeks after Spring Festival in 2020.Methods:From February 3rd to 23rd, 2020, 151 patients were admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for emergency and confined operations. In this cohort, 125 patients were admitted to ordinary wards. They were 70 males and 55 females with an age of 51.1 years ± 14.9 years. Of them, 2 were subjected to emergency operation and 123 to confined operation. The mean time from injury to operation was 9.9 days ± 6.1 days. There were 26 cases in the senile wards, 7 males and 19 females with an age of 80.8 years ± 7.0 years all of whom underwent confined operations. The mean time from injury to operation was 8.4 days ± 6.3 days. The protocols for emergency diagnosis, admission, emergency and confined operations, postoperative rehabilitation and management of suspects with COVID-19 during the epidemic of COVID-19 were optimized according to Diagnosis and Treatment Protocols for Novel Coronavirus Pneumonia (Trial version 5), emergency responding pre-plans of our hospital, and our experience in Enhanced Recovery After Surgery (ERAS) as well.Results:The patients in the ordinary wards had a hospital stay of 6.8 days ± 4.6 days while those in the senile wards 5.1 days ± 2.0 days. Abnormal temperature (≥37.3 ℃) was observed perioperatively in 17 cases in the ordinary wards. It was absorption fever in all and appeared in 4 cases upon admission. Fever appeared in 11 patients in the senile wards and upon admission in 3 of them. One senile patient who had been diagnosed of normal pneumonia returned to normal temperature and remained stable conditions after antibiotic therapy. The other patients were free of complications related to COVID-19 during their hospital stay.Conclusion:The first-line medical staff working at emergency department, wards and surgical theaters must heighten their vigilance against COVID-19 infection and rigorously follow protocols for prevention of COVID-19 infection in their daily clinical practice.
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Hip fractures,with an increasing morbidity in the elderly patients,pose a serious threat to the health of the aged.At the moment,surgery is the preferred treatment for the vast majority of these patients.Early surgical intervention is strongly recommended by most guidelines and articles.It is still controversial,however,whether surgery should be postponed or performed and whether medication therapy should be withdrawn or continued in some of the elderly patients with hip fracture who are taking anticoagulant or antithrombotic drugs before they are injured.Clopidogrel is one of the anti-platelet drugs commonly used clinically.This article reviews the literature regarding the impact of clopidogrel on surgical timing for hip fractures in the aged,hoping to provide useful clues to the clinical study and practice.
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Objective To investigate the effects of drainage tube placement after fracture internal fixation.Methods A prospective cohort study was conducted of the 235 patients who were to undergo open reduction and internal fixation for tibia fracture,distal radial fracture or ankle joint fracture at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from March to August,2016.Of them,123 were assigned into an experimental group who were subjected to adequate hemostasis after releasing the tourniquet without drainage following surgery while 112 into a control group who were subjected to conventional hemostasis without relaxing the tourniquet and placement of drainage tubes.The 2 groups were compared in terms of postoperative hospital stay,wound condition,body temperature 3 days postoperatively,counts of hemoglobins,white blood cells and neutrophils,and postoperative visual analogue scale (VAS).Results High fever was not observed in all the patients postoperatively.There were no significant differences between the 2 groups in postoperative hospital stay[(3.3 ± 1.6) d versus (3.7 ± 1.7) d],wound reddening,wound swelling,hemoglobins,white blood cells,neutrophils,or VAS scores postoperatively (P ＞ 0.05).Conclusion Drainage tube placement is not routinely necessary after internal fixation of simple fractures if surgical invasion is limited and hemostasis is adequate after intraoperative release of the tourniquet.
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Objective To evaluate the clinical outcomes of primary decompressive internal fixation versus delayed surgery for tibial plateau fractures combined with compartment syndrome.Methods From January 2012 to June 2014,a total of 39 patients were treated at our department for tibial plateau fracture combined with compartment syndrome.Early operation was adopted for 18 patients in whom decompression by incisions via the medial and lateral approaches combined with internal fixation with plate and screws was performed at the primary stage and dermoplasty or wound closure conducted at the secondary stage after conditions of soft tissue allowed.Delayed operation was adopted for 21 patients in whom external fixation and decompression by incisions via the medial and lateral approaches was performed in the emergency management followed by selective open reduction and internal fixation.The 2 groups were compared in terms of indexes associated with surgery and hospitalization,Lysholm scores,EuroQol 5 dimensions (EQ-5D) indexes and visual analogue scale (VAS) at final follow-ups.Results All the patients were followed up for more than 2 years.The early operation group incurred significantly less operation time (229.1 ± 43.7 min),intraoperative blood loss (297.5 ±51.5 mL),hospital stay (11.9 ± 1.9 d) and expenditure [144,700 (103,200,179,900) Yuan RMB] than the delayed operation group [322.1 ±62.2 min,385.9 ±56.4 mL,21.5 ±3.6 d,and 197,700 (137,200,234,300) Yuan RMB,respectively] (P ＜ 0.05).There were no significant differences between the 2 groups in rate of complications [22.2％ (4/18) versus 38.1％ (8/21)],fracture union time (6.1±1.1 mversus5.8±l.4m),Lysholmscores (83.9±9.7 versus 81.1±12.3),EQ-5Dindexes (0.85±0.09versus0.84±0.12),orVAS (1.3±1.2versus 1.5±1.4) (P＞ 0.05).Conclusions In the treatment of tibial plateau fractures combined with compartment syndrome,both primary decompressive internal fixation and delayed surgery can achieve satisfactory clinical outcomes.The former is more appropriate for those without obvious limb ischemia while the latter more appropriate for those whose priority is limb salvage due to serious osteofascial compartment syndrome.Surgeons should choose reasonable procedures according to the specific conditions of the patients and strict surgical indications.
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Objective To explore the management of postoperative infection following open reduction and internal fixation for acetabular fractures.Methods Ten patients were treated and completely followed up in Beijing Jishuitan Hospital from February 2012 to December 2016 for postoperative infection after open reduction and internal fixation for acetabular fracture.They were 9 males and one female,aged from 14 to 64 years(mean,40.6 years).According to Letournel classification,there were 2 double-column fractures,2 anterior descending transverse fractures,2 anterior column fractures,one posterior wall fracture,and one posterior wall fracture.Eight cases developed surgical regional infection within 2 weeks after internal fixation,and 2 presented with symptoms of infection more than 3 months after fracture fixation.Vacuum sealing drainage (VSD) was used to treat one case of acute superficial infection;open debridement surgery,carrier with sensitive antibiotics and intravenous antibiotics were used to treat 7 cases of acute deep infection and 2 cases of chronic deep infection.Results The infection symptoms disappeared 9 days after removal of VSD device in the one case of acute superficial infection.Normal fracture union was achieved in 6 cases after their infection was controlled;4 cases had to undergo total hip arthroplasty because their articular structure was damaged after control of infection.The 10 patients were followed up for 6 to 54 months (mean,25.7 months).Their Harris scores at the last follow-up averaged 74.8 (from 32 to 92).Conclusions Negative-pressure wound therapy is an effective management for acute superficial infection after acetabular fracture.Deep acute infection needs early repeated debridement combined with sensitive antibiotic carrier to protect joint function.For infection which is difficult to control or chronic infection associated with structural damage,repeated debridement combined with sensitive antibiotic spacer is effective for infection control at the first stage and artificial total hip arthroplasty can be carried out at the second stage when the infection is controlled.
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Objective To evaluate preventive effect of polysaccharides from Lycium ruthenicum Murray against photodamage in HaCaT cells,and to explore its possible mechanism.Methods Ultrasoundassisted extraction was used to extract polysaccharides from Lycium ruthenicum Murray in Qaidam Basin.In vitro cultured HaCaT cells were randomly divided into 3 groups:control group receiving no treatment,ultraviolet B (UVB) group irradiated with 30 nJ/cm2 UVB alone for 1 hour,experimental group pretreated with 2 g/L Lyeium ruthenicum polysaccharide solution followed 6 hours later by 30 mJ/cm2 UVB radiation for 1 hour.At twelve hours after UVB radiation,an inverted microscope was used to observe cell morphology.Then,MTS assay was performed to estimate cell proliferation,flow cytometry to detect cell apoptosis,an enzyme-labeled antigen method to detect levels of malondialdehyde (MDA) and glutathione peroxidase (GSH-Px),as well as to evaluate the activity of superoxide dismutase (SOD) and catalase (CAT),and enzyme-linked immunosorbent assay (ELISA) to measure levels of intedeukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α) in HaCaT cells and their culture supernatant.Results Compared with the control group,the UVB group showed obscure cell morphology,cell death and floating phenomenon,while cells became swollen but renained morphologically distinct in the experimental group.MTS assay revealed that the cell proliferative activity significantly differed among the above 3 groups (F =48.88,P ＜ 0.01),and the cell proliferative activity was significantly lower in the UVB group (1.72 ± 0.12) than in the control group (2.34 ± 0.11,P ＜ 0.05) and experimental group (2.11 ± 0.10,P ＜ 0.05).Moreover,the apoptosis rate was significantly higher in the UVB group (82.41％ ± 2.49％) than in the control group (3.98％ ± 0.19％,P ＜ 0.05) and experimental group (22.79％ ± 0.97％,P ＜ 0.05),as well as higher in the experimental group than in the control group (P ＜ 0.05).Compared with the control group,the UVB group showed significantly higher levels of MDA,supernatant levels of IL-1 and TNF-α,and intracellular levels of TNF-α,but significantly lower GSH-Px levels and activity of SOl and CAT (all P ＜ 0.05).However,there was no signifi-cant difference in the intracellular level of TNF-α between the UVB group and control group (P ＞ 0.05).Conclusion Lycium ruthenicum polysaccharide has protective effects against photodamage in HaCaT cells,likely by reducing the synthesis and secretion of inflammatory substances as well as free radicals.
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Objective:To investigate the feasibility,surgical technique and effect of osteosynthesis for proximal humerus fractures through the minimal incision anterolateral acromion.Methods: In this study,32 patients of proximal humeral fractures were selected and treated through the minimal incision antero-lateral acromion between January 2012 and October 2014.Of these patients,there were 19 males and 13 females,with mean age 46 years old (range: 22-78 years).The mechanism of injury was a trauma of simple fall for 21 patients and motor vehicle accident for 11 patients.According to Neer classification,18 cases had two-part fractures,12 had three-part fractures,and 2 had four-part fractures.All patients were sustained operation of open reduction and internal fixation.The average delay between trauma and surgery was 4 d (0.5-10.0 d).The operations were performed in invariable operating room with general anesthesia.The fractures were reduced and immobilized with anatomical locking plate through the minimal incision anterolateral acromion during operation.Patients were received passive motion after operation.Results: All the 32 cases were followed up ranging from 3 to 34 months with an average of 11 months.All the fractures were healed.There was neither failure of internal fixation nor incision infection case.The functional results of the shoulder,according to Constant-Murley score was on an average 86 (range: 69-100).Conclusion: The treatment for proximal humeral fractures through the minimal incision anterola-teral acromion approach is a feasible and effective method,which shows good results for treating proximal humerus fractures with correct indication.There are several advantages compared with conventional deltopectoral approach.They are minimal soft tissue disruption,minimal blood loss and easily to manipulate technique.But it required selection of indication strictly and surgeon's experience.
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Objective To discuss the clinical outcomes of trochanteric digastric osteotomy and surgical hip dislocation for treatment of Pipkin Ⅳ fractures. Methods We retrospectively reviewed the 12 patients with Pipkin Ⅳ fracture who had been treated by trochanteric digastric osteotomy and surgical hip dislocation from February 2012 to June 2016. They were 10 males and 2 females, with an average age of 44. 1 years ( from 24 to 63 years ) . According to the Pipkin classification for femoral head fractures, 9 fractures were type Ⅰand 3 type Ⅱ; according to Letournel-Judet classification for acetabular fractures, 10 were posterior wall fractures ( 9 belonging to the posterior superior subgroup ) and 2 transverse plus posterior wall fractures ( one involving the posterior wall belonging to the posterior superior subgroup ) . The operation time, blood loss, complications and functional results were recorded. Results The operation time averaged 165 min ( from 150 to 195 min ); the blood loss averaged 850 mL ( from 500 to 1, 200 mL ) . A spring plate was used additionally for posterior wall fracture in 7 cases. All the 12 cases obtained an average follow-up of 19 months ( from 6 to 52 months ) . Motion function was fully recovered from 6 weeks to 4 months after operation in 2 cases of preoperative incomplete sciatic nerve injury and in one case of iatrogenic incomplete sciatic nerve injury. Anatomical reduction was achieved in all femoral head fractures. According to the Matta criteria for acetabular fractures, anatomical reduction was achieved in 9 cases, good reduction in 2 and poor reduction in one. Heterotopic ossification occurred in 4 cases ( gradeⅠin one, gradeⅡin 2 and gradeⅢin one by the Brooker grading system ) . The trochanteric osteotomy was repeated in one case. No femoral head avascular necrosis was found. According to the modified Merle d'Aubigné and Postel scoring at the final follow-ups, the functional results of the affected hip were excellent in 4 cases, good in 7 and poor in one. Conclusion Trochanteric digastric osteotomy and surgical hip dislocation is a safe and effective treatment for Pipkin Ⅳ fractures.
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Objective:To analyze the clinical parameters of the patients with femoral neck fracture such as general condition,therapy method,hospitalized expense so as to provide more effective management plan for the clinical work.Methods:The patients with femoral neck fracture above 50 years who received in-patient treatment from 2008 January to 2012 December were admitted into this study.We collected and analyzed the information,such as age,chronic medical disease,therapy method,hospitalized duration and expense and so on.Results:There were 1 794 femoral neck fracture patients above 50 years (male/female=1/2.06)in our hospital in recent 5 years and the annual average rate of increase was 7.3%. The average age of the patients was (69.9 ±10.7)years and the annual average rate of increase was 0.6%.The chronic medical disease diagnosis ratio was 55.0%.The average waiting time for operation was (6.8 ±4.2)days and the average hospitalized duration was (12.9 ±4.9)days which showed down-ward trend in recent years. The most popular operations were cannulated screw internal fixation (41.8%)and artificial femoral head replacement (34.1%).In the study,146 cases (7.9%)received nonsurgical treatment which showed downward trend.The average hospitalized expense was (35 075 .7 ± 1 1 343.2)yuan which showed no obvious change in recent years.The cost for the females was more than that for the males.The expense for hemiarthroplasty and total hip arthroplasty increased while that for cannulated screw internal fixation decreased gradually.Conclusion:The cannulated screw internal fixa-tion and artificial femoral head replacement were the most important operations for the patients with femo-ral neck fracture.The number and the average age of the patients were on the rise while the expense showed no obvious change in recent years.
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Objective To classify tibial plateau fractures based on the analysis of the morphology and injury mechanisms of 200 cases of tibial plateau feature.Methods We collected the X-ray and CT images of 200 consecutive cases of tibial plateau fracture in i99 patients who had been treated at our department from January 2010 to April 2011.They were 134 males and 65 females,from 15 to 77 years of age (average,45.7 years).According to the Schatzker classification,9 cases were type Ⅰ (4.5％),105 type Ⅱ (52.5％),19type Ⅳ (9.5％),37type Ⅴ (18.5％),30type Ⅵ (15.0％),and none type m.The fracture morphology and injury mechanism of each case were analyzed to propose a new classification system.Results Fractures of tibial plateau can be classified into the following five types:(a) Lateral condylar fracture and valgus injury (100 cases,50％).The injury mechanism is the axial force on the valgus and extended knee joint.(b) Fracture-dislocation injury (24 cases,12.0％).This type includes typical Schatzker type Ⅳ,and some cases of Schatzker type Ⅵ associated with lateral subluxation.Its mechanism is a compound force of valgus,varus,rotational and axial stresses.The rotational force is the key factor leading to subluxation of the knee joint.(c) Double-condylar fracture (40 cases,20.0％).This type is caused by an axial force on the extended knee,including Schatzker type Ⅴ and some cases of Schatzker type Ⅵ not associated with knee subluxation.(d) Posterior condylar fracture and flexion injury (32 cases,16.0％).This type only involves the posterior condylar plateau,and is caused by an axial force on the flexed knee.Based on the morphology,posterior condylar fractures can be further divided into three subtypes:simple split of posteromedial condyle,simple collapse of posterolateral condyle,and a combination of the two.(e) Frontal plateau compression fracture and hyperextension injury (4 cases,2.0％).This type is caused by an axial force on the hyper-extended knee.It is characterized by significant compression of the anterior plateau and intact posterior plateau.Conclusion Based on the morphological features and injury mechanisms,tibial plateau fractures can be classified into 5 types:lateral condylar fracture,fracture-dislocation injury,double-condylar fracture,posterior condylar fracture,and frontal plateau compression fracture.
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Objective To observe the short-,mid-and long-term surgical complications of complex acetabular fractures treated by the Kocher-Langenbeck (K-L) approach combined with digastric trochanteric flip osteotomy (DTFO).Methods We reviewed the 40 cases of complex acetabular fracture that were treated at our department from December 2009 through December 2013.They were 34 men and 6 women,from 17 to 73 years of age (average,47.6 years).Of them,19 were treated by K-L approach combined with DTFO,including 17 males and 2 females,with a mean age of 44.7 ± 11.7 years.The other 21 controls were treated simply through the K-L approach,including 17 males and 4 females,with a mean age of 42.8 ± 14.4 years.The 2 groups were compared in terms of intraoperative results,postoperative outcomes and surgical complications like infection,sciatic nerve injury,heterotopic ossification,femoral avascular necrosis,and post-traumatic arthritis.Results The 40 cases were followed up for an average of 29.7 months (range,from 18 to 59 months).The operation time for the DTFO group (248.2 ± 123.2 min) was significantly shorter than that for the control group (276.1 ±50.6 min),the satisfactory reduction rate for the DTFO group (100.0％) was significantly higher than that for the control group (90.5％),the hip intorsion (19.7° ± 3.5°),hip extorsion (26.1° ±4.3°),and hip abduction (40.5° ±4.7°) at one year postoperation in the DTFO group were significantly superior to those in the control group (14.3°± 6.0°,21.0°± 7.2°,31.9°± 10.8°,respectively),and the hospital stay for the for the DTFO group (19.0 ±7.1 d) was significantly longer than that for the control group (13.6 ±4.9 d) (P ＜ 0.05).The intraoperative bleeding and transfusion for the DTFO group were insignificantly greater than those for the control group (P ＞ 0.05).Infection or iatrogenic sciatic nerve injury occurred in none of the patients.There were no significant differences between the 2 groups in terms of positive Trendelenburg test,hip function,heterotopic ossification,femoral avascular necrosis,or post-traumatic arthritis at the last follow-ups(P＞ 0.05).Conclusions In the surgical treatment of complex acetabular fractures,especially those involving the acetabular dome area and the femoral head,K-L approach combined with DTFO can obtain larger surgical exposure field,good fracture reduction and functional recovery,without obviously increasing surgical complications.This technique only slightly increases intraoperative bleeding and transfusion,and results in longer hospital stay.
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Objective To evaluate the results of patients operatively treated transverse plus posterior wall fractures of the acetabulum.Methods Review forty-five patients who had operated for transverse plus posterior wall fractures of the acetabulum 1 retrospectively with fracture displacement,from August 1993 to January 2005 in Department of Orthopaedics,Beijing Shunyi Hospital.The radiographs were graded according to the criteria described by Matta.The functional outcome was evaluated using a modification of the clinical grading system developed by Merle d'Aubigné and Postel.Result Forty-five patients were followed up 16 to 48 months with an average of 34 months.The radiographic result was excellent in seventeen patients,good in eighteen,fair in seven,and poor in four.The clinical outcome at the time of final follow- up was graded as excellent in fourteen patients,good in twenty- two,fair in eight,and poor in two.Conclusion Operative treatment for transverse plus posterior wall fractures of the acetabulum has a satisfying therapeutic effect.The appropriate operation time,reasonable operation approach,anatomic reduction and stable internal fixation is the key to obtain good results.