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In order to provide more practicable and convenient continuing medical education for orthopedic surgeons in primary hospitals and expand the academic influence of expert lecturers and host hospitals in the region, our department hosted nine short-term training courses of orthopedic surgery jointly with primary hospitals, which lasted for 1 to 1.5 days on weekends from June 2001 to October 2017, with expert lectures as the main form. Traumatic orthopedics was the main topic, and most expert lecturers were orthopedic experts from famous hospitals within the province and the whole country, as well as the experts from the host hospital. More than 1200 orthopedic and surgical physicians in local districts and counties participated in the training, and excellent social effect has been achieved. For short-term orthopedic training jointly held with hospitals in prefecture-level cities, the topic of training should be carefully selected, and duration of the training and number of lecturers should be controlled, so as to achieve satisfactory social effects under the premise of low cost of administrative resources.
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<p><b>OBJECTIVE</b>To establish a preoperative deep venous thrombosis predictor score for patients with fresh lower extremity fractures by statistical analysis.</p><p><b>METHODS</b>From January 2011 to December 2012, 1 705 patients with fresh lower extremity fractures were admitted to department of orthopaedic trauma, Beijing Jishuitan Hospital. They were randomly divided into two groups, the group 1 (n = 879) was used to screen risk factors and derived a predictive models based on logistic regression, the group 2 (n = 826) validated the models.</p><p><b>RESULTS</b>Among the patients, there were 1 106 male and 599 female patients, with an average age of (50 ± 18) years.Variables related to preoperative deep venous thrombosis were age, length of time before surgery, cause of injury, low/high-energy injury, location of injury, history of cardiovascular and cerebrovascular diseases, and D-Dimer. The scores based on OR were: age ≤ 35 years: 1 point, > 35- < 65 years: 4 points, ≥ 65 years: 6 points; length of time before surgery, < 8 days:1 point, ≥ 8 days:2 points;low-energy injury:1 point, high energy injury:3 points;location of injury, foot and ankle:1 point, calf:3 points, around the knee: 5 points, femoral diaphysis and proximal femur:7 points, pelvis and acetabulum:4 points, ≥ 2 sites:6 point;history of cardiovascular and cerebrovascular diseases, yes:2 points, no:1 point. D-Dimer < 600 µg/L:1 point, ≥ 600 µg/L:3 points. Area under receiver operating characteristic curve was 0.79, critical point 15.5 points, sensitivity was 77.00%, specificity was 68.17%.</p><p><b>CONCLUSION</b>The score can predict the preoperative deep venous thrombosis for patients with fresh lower extremity fractures, but limited.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Fibrin Fibrinogen Degradation Products , Fractures, Bone , Leg , Leg Injuries , Logistic Models , Lower Extremity , ROC Curve , Risk Factors , Sensitivity and Specificity , Venous ThrombosisABSTRACT
Objective To introduce a new CT classification system we designed for Hoffa fractures and compare the interrater reliability between the CT and X-ray classification systems.Methods A total of 20 isolated Hoffa fractures from January 2008 to December 2011 were randomly selected for the present analysis of their imaging data (anteroposterior and lateral X-ray films of the knee joint and three-dimensional CT reconstruction of the femoral condyle).At the same time,a total of 20 independent observers (clinicians with junior,intermediate and senior professional qualifications) were selected for classification of the Hoffa fractures in the same manner respectively according to the Letenneur's X-ray system and our self-designed CT system.We used Kappa statistics to evaluate the interrater reliability among the clinicians between the 2 classification systems for Hoffa fractures.Results According to the CT classification of the 20 Hoffa fractures by the 20 clinicians,type Ⅰ,Ⅱ and Ⅲ fractures accounted for 66.0％,30.5％ and 3.5％ respectively.In type Ⅰ fractures,type Ⅰb involving zone b accounted for the most (50.0％),next by type Ⅰc(31.0％) and type Ⅰa (19.0％).In type Ⅱ comminuted fractures,fracture fragments were mostly seen in zone b.The overall incidence of fractures involving zone b by CT classification was 67％.According to the X-ray classification,type Ⅰ,Ⅱ,Ⅲ and Ⅳ fractures accounted for 31.4％,14.3％,28.0％ and 26.3％,respectively.The interrater reliability for CT classification agreement (Kappa =0.681) among clinicians was higher than that for X-ray agreement (Kappa =0.261).Conclusion For Hoffa fractures,communicated ones in particular,our CT classification system may be better than the X-ray classification system.
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Objective To investigate clinical characteristics and treatment of Hoffa fractures.Methods Twenty patients with Hoffa fracture (24 condyles) were treated from January 2002 to April 2009.They were 14 men (18 condyles) and 6 women (6 condyles), aged from 20 to 70 years (average, 43. 3 years).There were 15 fractures of medial femoral condyle and 9 ones of lateral femoral condyle. Two rare cases were fractures of unilateral bi-condyles and one rare case fractures of unilateral bi-condyles plus contralateral single condyle. Four fractured condyles were old due to implant failure and 20 were fresh. According to the modified Letenneur's classification, there were 6 condyles of type Ⅰ, 4 condyles of type Ⅱ and 14 condyles of type Ⅲ.Fifteen condyles were fixed anteroposteriorly with 2 to 4 cancellous or canulated screws, 8 condyles were fixed posteroanteriorly with 2 to 4 screws, and one condyle was fixed with K wires. Five condyles were fixed with screws plus lateral supporting plates, and 3 condyles with screws plus posterior anti-sliding plates. Results All the patients were followed up for an average of 14. 4 months (6 to 84 months) . All the 24 condyles obtained bony union after an average of 18. 6 weeks (from 12 to 44 weeks). There was no infection, implant failure, nonunion or bone necrosis. According to Letenneur's functional assessment system, 16 condyles were excellent, 6 good and 2 poor, with a good-to-excellent rate of 91. 7%. Conclusions All Hoffa fractures should be treated with screws. Screw diameter, fixation direction and surgical incision should depend on facture type and size of fracture block. Unstable Hoffa fractures should be treated with screws combined with lateral supporting plates or posterior anti-sliding plates.
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Objective To analyze factors influencing the incidence of deep venous thrombosis (DVT) and discuss the prevention and treatment of DVT in hip fracture patients. Methods The present study enrolled 531 patients who received surgery between June, 2008 to June, 2010 for hip fractures. They were 242 men with a mean age of 56. 2 years and 289 women with a mean age of 65.2 years. There were 336 femoral neck fractures, 183 femoral intertrochanteric fractures, and 12 femoral subtrochanteric fractures. The associations between DVT incidence and fracture type, plasma D-Dimer, sex, age and preoperative duration of immobilization were statistically analyzed. Inferior yens cava filters were used for patients who suffered DVT while surgery was performed. Results The total incidence of DVT was 10. 4% in this series. DVT occurred in 21 cases of femoral neck fracture, 34 cases of femoral intertrochanteric fracture and 0 case of femoral subtrochanteric fracture. All DVT events happened before surgery. DVT incidence had no significant associations with age or sex (P =0. 347 and 0. 376, respectively), but did with plasma D-Dimer, fracture type and preoperative duration of immobilization (P = 0. 002, 0. 017 and 0. 037, respectively). All the 55 DVT patients underwent a successful surgery. Conclusions The DVT incidence in hip fracture patients may have no significant associations with age or sex, but may do with plasma D-Dimer, fracture type and preoperative duration of immobilization. Inferior vena cava filters can ensure a successful internal fixation of the fracture and an uneventful postoperative rehabilitation.
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Objective To evaluate the necessity and safety of implanting temporary vena eava fihers to prevent pulmonary emboli in patients of lower extremity fractures concomitant with acute deep venous thrombosis(DVT). Methods A total of 782 patients with lower extremity fractures were complicated with DVT perioperatively. Among them, 91 received temporary vena cava filters implantation before orthopedic operations for the prevention of pulmonary embolism. All patients were followed up post-operation. Results Vena cava filters were successfully implanted in 89 patients. Mean implantation time was 27 days (range from 14 to 42 days). Thrombus trapped within the filters were found in 78 patients (87.6%) after the filters removal. Eight-two filters (92.1%) were retrived successfully at the first attempt as scheduled. Seven filters(7.9%) with big trapped thrombi were removed at the 2nd attempt after additional thrombolytic therapy. No patients needed a permanent filter. No fetal pulmonary embolism (PE) or other major complications were detected during the three to six months follow-ups period. Conclusion Temporary vena cava filter can reduce the incidence and mortality of pulmonary embolism as well as the occurrence of mid- or long-term complications in lower limb fracture patients complicated with DVT.
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Objective To explore the anti-sliding plating for Hoffa fractures by comparing the me-chanical properties of anti-sliding plates and cancellous bone screws. Methods Twenty cases of the same type of Hoffa fracture in the model femur were randomly divided into 4 even groups. Group A used 2 antegrade cancellous bone screws; Group B used 2 retrograde cancellous bone screws forwards; Group C used anti-sliding plate and locking screw fixation; Group D used anti-sliding plate and cancellous bone screw fixation. All the samples were subjected to the cycle fatigue and the maximum failure load tests. Results The fatigue test revealed no significant difference in the mean maximum displacements at the 10, 100, 1000, 10 000 cycles between the 4 groups. In the maximum failure load test, there were significant differences between Group A [(1224±72) N] and Groups C and D [(2183±227) N and (2124±235) N], as well as between Groups B [(1405±235) N] and Groups C and D; there was no significant difference between Group A and Group B, neither between Group C and Group D, Conclusions In the initial period after secure fixation for Hoffa fractures, anti-sliding plates and cancellous bone screws can all provide satisfactory mechanical stability and strength. But anti-sliding plating is recommended for cases of long healing expected, patients with great body mass index, and patients with poor compliance.
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Objective To evaluate the surgical method and results of the treatment of chronic rupture of the Achilles tendon using V Y tendinous flap. Methods Nine cases with old rupture of the Achilles tendon, with a mean course of illness of 112 days, were treated with V Y tendinous flap and the tendon gap was 3.2～ 6cm,averaging 4.6cm. Results The mean period of follow up was 2.7 years. The Arner Lindholm method was used to assess the results of surgical treatment, 7 cases of the 9 had excellent results (77.8% ) and 2 cases had good results (22.8% ), with the excellent and good rate being 100% . Conclusion The V Y tendinous flap is a simple and good method for treatment of old rupture of the Achilles tendon.
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Objective To investigate the treatment of radi us head fracture through internal fi xation.Methods 42cases of radius head fracture trea ted with internal fixation were foll owed up.Mason classification and Broberg and Morrey criteria were use d to analyze the correlation between the results and the factors of fractu re type and method of fixation.Results42cases were followed up for a mean time of 25months.Evaluation was done according to Broberg and Morrey score systems.The function recovered we ll in 76%of the cases.The results of minor plate group were better than th ose of the screw(P=0.01)or K wire group(P=0.04).The results of Mason typeⅡwere better than those of the typeⅣ(P=0.03).Conclusion Treatment of radius head fracture with internal fixation will improve the elbow function and has better result for Mason typeⅡ.Fixation with minor plate is better than with screw or K wi re.[
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Objective To study the surgical therapy and pre vention of the complications of the d istal femoral fractures.Methods From 1999to 2001,348patients with d istal femoral fractures were treate d oper-atively.Screw,DCP,condylar blade plate,DCS,condylar buttress plate and antegrade interlocking nail were used.Results13internal fixations failed,and 8c ases received second bone graft for d elayed union.Infection occurred in 14cases,late limb shortening(1～4cm)in 18cases,and 52cases underwent re leasing operations because the flexion of the knee was le ss than 90?.Conclusion An operation can get good results in t reatment of the distal femoral fractures.[
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<p><b>OBJECTIVE</b>To study the quantitative measurement of the extent of malrotation after interlocking intramedullary nailing of femoral shaft fracture.</p><p><b>METHOD</b>CT scan ("routine method") applied in 36 femoral shaft fractures that had been treated with close reduction and interlocking intramedullary nailing. For the judgement of the extent of malrotation, the anteversion of both fracture side and contralateral side were measured and the difference between the 2 sides was evaluated. The increase of anteversion represented internal rotation of the distal fragment, whereas the decrease of anteversion represented external rotation.</p><p><b>RESULTS</b>The maximum anteversion of the fracture sides, whereas 48 degrees, the minimum anteversion -10 degrees, the mean value, 15.04 degrees, and the standard error is 11.34 degrees. The maximum anteversion of the contralateral side, whereas 31.3 degrees, minimum -4.8 degrees, the mean value was 13.96 degrees and the standard error was 10.20 degrees (P < 0.001). Compared with the contralateral side, half of the 36 cases showed increased anteversion and the other half decreased anteversion. The mean value of internal rotation is 11.56 degrees, and external rotation 9.39 degrees. The maximum internal rotation was 37 degrees, the minimum 0.9 degrees. Eight cases had internal rotation less than 8 degrees, 6 between 10 degrees - 15 degrees, and 4 over 15 degrees. The maximum external rotation was 24.3 degrees, and the minimum 1.8 degrees. Eleven cases had external rotation less than 10 degrees, 4 between 10 degrees - 15 degrees and 3 over 15 degrees. The incidence of malrotation more than 10 degrees was 47% (17/36), and more than 15 degrees 19.4% (7/36).</p><p><b>CONCLUSION</b>The incidence of malrotation after femoral shaft fracture treated with close reduction and interlocking intramedullary nailing is high. Attention should be paid to clinical management and strict control for rotational reduction intra-operatively.</p>