Subtrochanteric femur fracture treated by intramedullary fixation / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To discuss surgical technique, operative efficacy and clinical outcome of intramedullary fixation in the treatment of subtrochanteric femur fractures.</p><p><b>METHODS</b>From February 2011 to February 2013, 76 cases of subtrochanteric femur fractures were treated by intramedullary fixation in our hospital, including 53 males and 23 females, with the age range of 37 -72 years (mean 53.5 years). According to Seinsheimer classification, there were 2 cases of type I, 7 type II, 15 type III, 23 type IV and 29 type V. Firstly, all patients underwent closed reduction with the guidance of C-arm fluoroscopy in a traction table. Two cases of type I and 3 cases of type III fractures had ideal closed reduction followed by internal fixation. The others needed additional limited open reduction. Radiographic examination was used to evaluate callus formation and fracture healing in postoperative 1, 3, 6 and 12 months follow-up. Functional recovery was evaluated by Harris Hip Scoring (HHS) system.</p><p><b>RESULTS</b>Patients were followed up for 6-12 months. All fractures were healed except one patient with delayed union. The average bone union time was 4.5 months. According to HHS system, 65 cases were considered as excellent in functional recovery, 8 good, 2 fair and 1 poor. The proportion of the patients with excellent and good recovery was 96.05%.</p><p><b>CONCLUSION</b>Intramedullary fixation is feasible for the treatment of subtrochanteric femur fracture. The accuracy of intraoperative reduction and surgical skill are important for the clinical outcome and the patients' prognosis.</p>

Application of inferior vena cava filters in prevention of peri-operative pulmonary embolism in patients with bone fracture combined with deep venous thrombosis: a report of 572 cases / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the application of inferior vena cava filter (IVCF) in prevention of peri-operative pulmonary embolism in patients with bone fracture combined with deep venous thrombosis (DVT).</p><p><b>METHODS</b>From July 2007 to April 2011, 572 cases of bone fractures consequent with DVT that confirmed by Duplex were deployed IVCF to avoid fatal pulmonary embolism in the para-operative period. There were 318 male and 254 female patients with a mean age of (51±23) years (ranging from 16 to 94 years).</p><p><b>RESULTS</b>All the operations of deployment of the IVCFs were successfully. There were 174 permanent and 399 temporary IVCFs deployed. In all 399 temporary filters, 389 filters were taken out successfully. The mean station time in the IVC of the temporary filters was 22.8 days (7 to 60 days), among which, 118 were found of captured thrombus. After the follow-up of mean 16 months (3 to 40 months) of 566 patients, no pulmonary embolism occurred, but symptomatic DVT were revealed in 15 patients, and the conditions were improved after anticoagulation treatment. No serious complication of post thrombotic syndrome occurred.</p><p><b>CONCLUSION</b>IVCF deployment can prevent the trauma patients with deep vein thrombosis of fatal pulmonary embolism in the peri-operative period, which may also offer a safe condition to the orthopedic operations.</p>

Imaging evaluation of the contribution of the deep circumflex iliac arterial vascularized iliac bone grafting to the reconstruction of blood supply of the femoral head / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the contribution of the deep circumflex iliac arterial vascularized iliac bone grafting to the reconstruction of the blood supply of the femoral head through the digital subtraction angiography (DSA) or computied tomographic scanning angiography (CTA) of the both deep circumflex iliac artery and ECT, MRI judgement.</p><p><b>METHODS</b>Forty-five patients with the intracapsular fracture of femoral neck included 30 males and 15 females with an average age of 36.5 years ranging from 16 to 50. The course was from 6 to 25 days(means 10.2 days). There were 20 cases of sub-headfractures, 10 cases of head-neck, 15 cases of trans-neck. All patients were treated by 3 titanium alloy cannulated screws and deep circumflex iliac arterial vascularized iliac bone grafting. A follow-up for an average of 3 years and 6 months was performed. The engorging of the artery and reconstruction of the blood supply of the femoral head was viewed dynamicly,using digital subtraction angiography (DSA) or computied tomographic scanning angiography (CTA) of the both deep circumflex iliac artery and ECT, MRI judgement of the femoral head.</p><p><b>RESULTS</b>Three weeks after operation, 38 transferred arteries were engorging via DSA, 2 of 7 not via CTA, but engorging via DSA. One year later after operation, all arteries were engorging via DSA or CTA. ECT examination in 3, 6, 12 months after operation displayed nuclide enriching in the femoral head and distributing uniformity. The region of interest (ROI) ratios of the fractured head of femur to contralateral counterpart (D/N) in all cases > 1.0. The average D/N after 3 months was (2.12 +/- 0.21), (2.04 +/- 0.14) after 6 months, (l1.71 +/- 0.11) after 12 months. There was statistical differation between D/N after 12 months and 3 or 6 months (P < 0.05), but not between 3 and 6 months (P > 0.05), and MRI examination in all cases no founded decreasing of the density and changing of the form of the femoral head.</p><p><b>CONCLUSION</b>DSA, CTA, ECT, MRI confirmed that the deep circumflex iliac arterial vascularized iliac bone can provide effective blood supply and is profit to the reconstruction of the blood supply of the femoral head after the fracture of the femoral neck.</p>