Relationship between the incidence of deep vein thrombosis during hospitalization and the energy of injury in tibial plateau fractures / 国际外科学杂志

Objective To investigate the relationship between the incidence of deep vein thrombosis (DVT) during hospitalization and the energy of injury in tibial plateau fractures (TPFs).Methods 140 patients were enrolled in the study between September,2014,and October,2017 in Honghui Hospital,Xi'an Jiaotong University.According to the Schatzker classification,the low-energy group (Schatzker Ⅰ-Ⅲ) X-ray showed a simple or lateral fracture or compression fracture of the lateral plateau (n =63);the high-energy group (Schatzker Ⅳ-Ⅵ) X-ray showed the medial tibia or double of the tibial plateau (n =77).Duplex Ultrasonography was performed in lower extremities before and after surgical intervention for DVT evaluation and record the incidence of DVT,the days during hospitalization,the blood loss during surgery and the level of D-Dimer.All patients received mechanical and chemical thromboprophylaxis.The patient was followed up for one month after surgery,and the lower extremity ultrasound was reviewed and recorded.The measurement data were expressed as ((x) ± s),and the categorical variables were expressed in composition ratio.The measurement data were all in accordance with the normal distribution and the variance was uniform.The t-test was used,and the Chi-square test was used for comparison between groups.Results The incidence of thrombosis of tibial plateau fracture in TPFs was 36.43％ and 46.43％ pre-operation and post-operation respectively.The thrombosis incidence was 31.75 ％ (20/63) in the low-energy group and 40.26％ (31/77) in the high-energy group pre-operation.The thrombosis incidence was 44.44％ (28/63) in the low-energy group and 48.05％ (37/77) in the high-energy group post-operation.Statistical analysis showed no significant difference between the two groups pre-operation (P =0.298) and post-operation(P =0.785).The days during hospitalization [(11.94 ± 4.18) d,(9.56 ± 2.54) d],the blood loss during surgery [(208.96 ±224.43) ml,(129.68 ± 142.14) ml] and the level of D-Dimer [(2.39 ± 3.38) mg/L,(1.21 ± 2.32) mg/L] at pre-operation showed differences in the high energy group and the low energy group,respectively.Conclusions The incidence of DVT in TPFs is high during the hospital,but most of DVT is concentrated in the distal to the knee.Although the incidence of high energy injury and low energy injury DVT is not significantly different in TPFs,we should also be alert to the occurrence of DVT.

Diagnosis and treatment of bipolar fracture-dislocation of the forearm / 中华创伤骨科杂志

Objective To investigate diagnosis and surgical treatment of bipolar fracture-dislocation of the forearm.Methods A retrospective study was conducted of 16 patients with forearm bipolar fracture-dislocation who had been treated and completely followed up at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from March 2011 to September 2017.They were 14 males and 2 females,aged from 17 to 48 years (average,35.8 years).Their injury involved 7 left and 9 right sides,and 10 dominant and 6 non-dominant sides as well.Their proximal injury was divergent elbow dislocation in 4 cases,convergent elbow dislocation in one case,Monteggia fracture-dislocation in 9 cases (2 ones of type Ⅰ,2 ones of type ⅡB,4 ones of type ⅡC and one of type Ⅳ),and upper radioulnar dislocation in 2 cases.Their distal injury was distal radial fracture (intra-articular) + lower radioulnar dislocation in 7 cases,distal radioulnar fracture + lower radioulnar dislocation in 2 cases,Galeazzi fracture (1/3 distal humeral shaft) in 3 cases,and middle and upper middle radial fracture + lower radioulnar dislocation in 4 cases.Open reduction and internal fixation was performed for all the shaft fractures and most of the distal radial fractures.One distal radius fracture was treated with closed reduction and external fixation,one case with external fixation,one case with needle insertion and external fixation,3 radial head fractures with internal fixation,3 cases with radial head replacement,2 cases untreated,5 cases with open ligament repair because their primary closed reduction failed,and 2 cases with hinged external fixation of the elbow.Their functional exercise started according to judgment of joint stability after surgery.At the last follow-up,the overall function of the forearm was evaluated according to the Anderson's scoring.Results The 16 patients were followed up for an average of 26.0 months (from 6 to 60 months).All fractures healed at the internal fixation sites after operation with no abnormality affecting the function.No infection occurred.All the elbow joints and upper and lower radioulnar joints were stable.All the radial head replacements were in good position.The range of elbow flexion and extension averaged 123.2° (from 60° to 140°),the range of wrist flexion and extension 150.3° (from 120° to 160°),and the rotational mobility of the forearm 144.4° (from 70° to 170°).At the last follow-up,according to the Anderson's scores,11 cases were rated as excellent,3 cases as satisfactory,one case as unsatisfactory and one case as failure.Conclusions Most of the forearm bipolar fractures and dislocations are high-energy injury.The key to treatment is to achieve good reduction of distal and proximal dislocations and to start rehabilitative exercise as early as possible.Intraoperative fixation of fractures should be based on stable reduction of the dislocation.Fine reduction of bipolar dislocations and early rehabilitation can lead to good functional recovery.

Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage

PURPOSE: To find out the efficiency of two staged operation of patients with high energy proximal tibia fracture with severe soft tissue damage, the first step being external fixation, and the second, internal fixation with plates. MATERIALS AND METHODS: The study group was the 42 patients who had followed for one year out of a group of 56, performed the first step external fixation and the second step internal fixation with plates retrospectively, from March 2003 to March 2007. The average age of the study group was 51.4, 26 men, and 16 women participating in this study. The average time of follow up was 32 months. In the final follow up, investigations of the radiological assessments and functional abilities of the bony fusion were carried out along with the complications of the soft tissue. RESULTS: The duration after the first step external fixation until second step internal fixation to be performed was 14.9 (6~40) days in average. The final bone fusion took about 15 weeks, and according to the final follow up, the range of motion of the knee was around 110.8 degrees (6.2~117 degrees). In 31 cases, only the internal fixation was performed, while in 11 cases, soft tissue reconstruction was carried out with the internal fixations. As for the complications there were 2 cases of deep soft tissue infection, 2 cases of nonunion, 1 case of malunion and 1 case of knee joint stiffness. CONCLUSION: In cases of proximal tibia fracture with severe soft tissue damage, external fixation was important to secure the safety of the fracture, carry forward the anatomical alignment, plan the soft tissue safety and manage the wound to decrease the number of microbial in the next operation, which is the internal fixation with plates.

Fractures and Soft Tissue Injuries

Until recently, the fracture was regarded as the dominant element of high energy injuries, probably because trauma and orthopedic training was, by tradition, centered on the care of bone and joint injuries. Nowadays, however, orthopedic and trauma surgeons consider soft tissue injuries to be the most important component of high-energy trauma. High energy injuries such as polytrauma that may lead to dysfunction or failure of remote organs and vital systems, open fractures indicating a communication between the fracture and the external environment, pelvic fractures comprised of pelvic ring injuries and acetabular fractures are mostly associated with soft tissue injuries and are different from low energy injuries in their mechanism. Treatments of high energy injuries are more difficult than those of low energy injuries. Meticulous care should be taken to evaluate complications such as compartment syndrome, deep vein thrombosis, pulmonary embolism, and fat embolism, which tend to be easily neglected. Fractures with soft tissue injuries that are mostly high energy injuries need focusing on the patient as a whole and comprehensive approach. Close observations to establish early diagnosis of complications and to take timely, appropriate measures are also necessary.

Treatment of high energy injury of tibial plateau with Hybrid external fixation / 中华创伤骨科杂志

Objective To evaluate the results of less invasive surgical treatment of high energy tibial plateau fracture, which involves limited open reduction, percutaneous screw fixation and Hybrid external fixation. Methods From 1999 to 2002, 12 cases of high energy tibial plateau fracture were treated with Hybrid external fixation. They were 8 males and 4 females. According to Schatzker classification, there were 9 cases of Type Ⅴand 3 cases of Type Ⅵin the group. The average age of the patients was 39.3 years old (ranging from 27 to 48). Results All were followed up for an average of 15 months (ranging from 6 to 27). All the fractures got united, with an average healing time of 3.2 months. All patients achieved 0 to 5 degrees of extension and more than 100 degrees of flexion. The patients had an average knee score of 88.7 and an average functional score of 85.2(Knee Society clinical rating system). 1 case had infection of pin holes, and 2 knees had Grade 2 arthrosis at radiographic check up two years after the operation. Conclusion Hybrid external fixation combined with limited open reduction is appropriate for treatment of the complex tibial fractures, especially those with a poor soft tissue envelope.