Paraplegia in an Ankylosing Spondylitis Patient with a Neglected Spine Fracture after Osteosynthesis for Fracture of the Femur: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of paraplegia in a patient with thoracic kyphosis after osteosynthesis for a fracture of the femur. SUMMARY OF LITERATURE REVIEW: There are few reports about cases of paraplegia after low extremity fracture surgery in patients with thoracic kyphosis with ankylosing spondylitis. MATERIALS AND METHODS: An 86-year-old female patient presented with right hip pain. She had undergone surgery for an intertrochanteric fracture of the femur in the supine position under general anesthesia. Immediately after surgery, she showed paraplegia. Postoperative thoracolumbar spine images revealed a fracture through the disc at T12 and L1. However, she did not complain of back pain or any neurologic deficits before surgery. RESULTS: Although the patient underwent emergent posterior decompression and fusion surgery, her neurologic compromise did not improve during 1 year of follow-up. CONCLUSIONS: It is necessary to check preoperative spine radiographs before surgery in elderly patients who have a kyphotic deformity and lower extremity fractures. Surgeons should consider changing the position of the patient and the type of anesthesia used during surgery when spine stability is in doubt.

Effect of low molecular weight heparin on prevention of central venous catheter related deep venous thrombosis in patients with lower limb fracture / 中国生化药物杂志

Objective To investigate the effect of low molecular weight heparin (LMWH) on the prevention of deep venous thrombosis in patients with lower limb fracture.Methods 213 cases of peripherally inserted central venous catheter after deep venous thrombosis of lower extremity fractures from February 2014 to October 2016 in our hospital orthopedic surgery were retrospectively analyzed,according to whether patients with low molecular weight heparin were divided into two groups,which did not use low molecular weight heparin in patients with 104 cases as control group,using the low molecular weight heparin in 109 patients as study group,with seven days of treatment as the observation period, the blood rheology indexes of the two groups of patients and the incidence of deep vein thrombosis were analyzed.Results After treatment, the blood viscosity, fibrinogen, and plasma D-dimer levels of the whole blood decreased in both groups, and the levels of plasma D-dimer were significantly lower in the study group than in the control group (P<0.05);the plasma viscosity of the study group was significantly lower than that of the control group (P <0.05).After treatment,the recurrence rate of deep venous thrombosis in the study group was significantly lower than that in the control group ( P<0.05 ); The effective rate of treatment group was 96.33%was significantly higher than the control group 76.92%(P<0.05);study group incidence of adverse reactions 1.83%was significantly lower than the control group 7.69%( P <0.05 ) .Conclusion Low molecular weight heparin can effectively improve the indexes of Hemorheology in patients with lower limb fracture after central venous catheter puncture, reduce the risk of deep vein thrombosis, and have a clear preventive effect.

Application of low molecular weight heparin combined with psychological intervention in prevention of deep venous thrombosis after lower limb fracture surgery / 中国生化药物杂志

Objective To study the clinical application of low molecular weight heparin combined with psychological intervention in the prevention of deep venous thrombosis after lower limb fracture surgery.Methods 100 patients with lower limb fracture treated in our hospital from January 2013 to December 2016 were selected as the research object in the course of the study, and randomly divided into control group and experimental group, with 50 cases in each group,.The patients in control group were treated with routine lower limb physical pressure to prevent deep venous thrombosis after lower limb fracture.The patients in the experimental group were treated with low molecular heparin combined with psychological intervention to prevent deep vein thrombosis after lower limb fracture.Comparative analysis of patients with prothrombin time and platelet and the experimental group and the control of activated partial thromboplastin time index.Results After different treatment, the platelet index of the experimental group was(189.23±36.23)×109 /L, significantly better than that of the control group(264.34±39.56)×109/L,the difference was statistically significant(P<0.05).After treatment, the patients in the experimental group the activated partial thromboplastin time and prothrombin time index respectively(35.62±4.23)s and(16.12±2.19)s, significantly better than the control group, the difference was statistically significant(P<0.05).Conclusion low molecular weight heparin combined with application of psychological intervention in prevention of deep venous thrombosis after lower limb fracture surgery, can improve clinical curative effect on prevention of deep vein thrombosis in a large extent, improve blood hypercoagulable state of patients after surgery, with further clinical promotion and application significance.

Incidence and Prevention of Venous Thromboembolism in Severely Injured Patients with Lower Extremity Fracture / 대한정형외과학회잡지

PURPOSE: To compare the incidence of venous thromboembolism (VTE) in severely injured patients with lower extremity fracture in a prophylactic group with that in a non-prophylactic group during a retrospective study. MATERIALS AND METHODS: Severely injured patients with lower extremity fracture were enrolled in this study and were divided into the following two groups: Group I, non-prophylactic group, and Group II, prophylactic group using anticoagulants and mechanical prophylaxis. RESULTS: Symptomatic VTE occurred in 5 cases (16.1%) among the 31 cases in Group I; i.e., deep vein thrombosis in one case and pulmonary embolism (PE) in four cases, including life threatening PE 2 cases. There were no patients with symptomatic VTE among the 32 cases in Group II. CONCLUSION: The incidence of symptomatic VTE without the use of prophylaxis was 16.1%. This rate dramatically decreased with the use of prophylaxis. Therefore, we believe that prophylaxis with anticoagulants and mechanical device is necessary in order to prevent VTE in severely injured patients with lower extremity fracture.

Influence of nursing interventoin on complications of elderly patients with lower extremity bone fracture / 中国实用护理杂志

Objective To discuss influence of nursing intervention on complications of elderly patients with lower extremity bone fracture. Methods 105 elderly patients with lower extremity bone fracture were randomly divided into the nursing intervention group and random nursing group with 52 patients in each group. χ2 test and t test were used to compare the nursing effect in the two groups. Results The incidence rate of complication and average hospitalization time in the nursing intervention group were evidently lower than those of the random nursing group. Conclusions Nursing intervention has profound significance on rehabilitation of elderly patients with lower extremity bone fractures.

The Callus Formation of Extremity Fracture in Head Injured Adult / 대한정형외과학회잡지

Among multple injured patients, the incidence of head injuries combined with long bone fracture is high. In adults who present with long bone fracture and concomitant head injury, the exuberant callus at fracture site was formed. The authors analyzed 26 cases of lower extremity fracure with severe head injury from January 1987 to December 1988. For the control group, we analyzed each 20 patients of only femur and tibia fractures. The results of this study are as follows:1. The mean age of experimental and control group were 38.4 yrs old and 40.1 yrs old, respectively. The sex ratio between male and female of experimental and control group were 2.3:1 and 2.7:1, respectively. 2. The initial level of consciousness by Glasgow coma scale was mild impairement 12%, moderate impairement 65% and severe impairement 23%. 3. Serum calium and phosphate level were no specific difference between the head injury with lower extremity fractured patients and only lower extremity fractured patients, but there was increment of serum alkaline phosphatase level on post-trauma 1 month in head injury cases. 4. The pattern of callus formation in experimental group was different compared with control group. 5. The formation of callus was exuberant in the severe head iniury with femur fracture. 6. In experimental group, there was evidence of early bony union time compared with control group, but there was no statistical significance (p<0.05). In conclusion, the callus formation was exuberant in the head injury with femur fractured patient, there was different healing response compared with control group.

A Clinical Study for the Treatment of the Lower Extremity Fracture Concomitant with Head Injury / 대한정형외과학회잡지

The head patient with musculoskeletal trauma is a challenge to the orthopedic surgeon and its incidence is increasing markedly with the development of modern culture and a high velocity motor vehicle. So, for the purpose of studying the difference between lower extremity fracture concomitant with head injury and only lower extremity fractured patients, we studied the radiologic bone union time, serologic test and heterotopic ossification. For the control group we analysed each 10 patients of only femur and tibia fractures. The following clinical results were obtained by analysis of 46 patients of lower extremity fracture concomitant with head injury, experienced in the Department of Orthopedic Surgery, Yonsei University College of Medicine in past 5 years from Jan. 1980 to Dec. 1984. 1. The mean age was 24.5 yrs old (2~6 yrs old) and the prevalent age was 1st and 3rd decade, and the sex ratio between males and females was 2.8: l. 2. The most common mode of injury was auto-pedestrian injury (84.8%) and the other was falling down injury(15.2%) . 3. The common brain injuries were cetebral contusion with skull fracture (37.0%) and cerebral contusion only(34.8%) . Among 26 patients whos mental states were not alert, 23 patients recovered mental states completely. 4. Serum Calcium, Phosphate, and Alkaline Phosphatase level were no difference between the head injury with lower extremity fractured patients and only lower extremity fractured patients. 5. There were no evidence of early bony union in the patients with head injury. 6. The formation of callus were abundant in the patients of lower extremity fracture with head injury rather than the only lower extremity fractured patients. 7. The incidence of heterotopic ossification was 10.9% and all patients with heterotopic ossification were treated with physiotherapy and all patients recovered fully. 8. The incidence of complication was 17.3% and there was no fat embolic patients. In conclusion, there was no evidence of early bony union, but the callus formation was abundant in the patients of lower extremity fracture concomitant with head injury.