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Objective:To analyze the relationship between preoperative deep vein thrombosis (DVT) and parameters of conventional coagulation tests (CCTs) and thromboelastography (TEG) in patients with acute trauma, and to establish a prediction model to screen out high-risk patients with preoperative DVT.Methods:The clinical data of patients with acute traumatic fracture admitted to the Emergency Intensive Care Unit of Shanghai Sixth People’s Hospital from January 2021 to June 2021 were retrospectively collected. According to whether preoperative DVT occurred, the patients were divided into the DVT group and non-DVT group. The differences of CCTs and TEG parameters at the same time were compared between the two groups. Logistic regression analysis was applied to identify independent risk factors for DVT after trauma. The receiver-operating characteristic curve analysis was employed to analyze the clinical value of those parameters to predict preoperative DVT.Results:Among 123 patients with acute traumatic fracture, 101 patients were treated with anticoagulation before operation, and 51 patients were diagnosed with DVT. There were significant differences in activated partial thromboplastin time, fibrinogen (Fib), D-Dimer, fibrinogen degradation products (FDPs), reaction time, clotting time, α angle, maximum amplitude (MA) and coagulation index between the DVT and non-DVT groups. D-Dimer and MA were independent risk factors for preoperative DVT in patients with traumatic fracture. Logistic regression equation was used to establish a prediction model: the predicting index = 0.101×D-Dimer +0.241×MA + (-18.190). The α angle (AUC=0.833, P<0.001), MA (AUC=0.904, P<0.001), coagulation index (AUC=0.914, P<0.001) of TEG versus Fib (AUC=0.684, P=0.001), D-Dimer (AUC=0.685, P<0.001) and FDPs (AUC=0.656, P=0.003) of CCTs had a higher diagnostic efficacy in developing DVT of lower extremity in patients with traumatic fracture, and of all the coagulation index was the best. However, the predictor of D-Dimer combined with MA had a better predictive value (AUC=0.926, P<0.001), and the best cut-off value was 0.32 with a sensitivity and specificity of 90.2% and 79.8%, respectively. Conclusions:Compared with CCTs, TEG has more advantages in predicting preoperative DVT in patients with traumatic fracture, and the predictor of D-Dimer combined with MA can screen out patients with high risk of DVT, which can be recommended for clinical application.
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Objective:To explore the clinical significance of patient for patient safety strategy in inpatients with traumatic fracture.Methods:Convenience sampling method was used to randomly select 120 patients with traumatic fracture from September to December 2019 in the Department of Orthopaedics and Traumatology of a third-class hospital of Zibo city. Sixty patients with traumatic fracture treated from September to October 2019 were the control group, and 60 patients with traumatic fracture treated from November to December 2019 were the intervention group. The control group implemented routine safety management, and the intervention group implemented patient for patient safety strategy on the basis of routine safety management. The general information questionnaire, Hamilton Anxiety Scale (HAMA), patient for patient safety attitude questionnaire, incidence of adverse events during hospitalization and inpatient satisfaction scale were used to evaluate the effect after application.Results:HAMA score was 17.6±3.4,11.5±2.7 3 days after operation and at discharge in the intervention group, whcih were significantly lower than 23.3±4.3, 14.3±3.2 in the control group ( t values were 7.919, 6.912, P<0.001). The score of patients for patient safety attitude questionnaire was significantly higher in the intervention group at discharge compared with one day after operation ( t values were 3.246-6.558, P<0.001), as well as compared with those in the control group ( t values were 2.251-6.445, P<0.05). The total incidence rate of adverse events during hospitalization and satisfaction degree was 6.7%(4/60) and 95.0% (57/60) in the intervention,better than 13.3%(8/60), 90.0% (54/60) in the control group ( χ2 values were 7.260,16.008, P<0.001). Conclusions:The patient for patient safety strategy can effectively alleviate patients' negative psychological emotions, enhance patients' attitude to participate in safety behaviors, increase their enthusiasm to participate in safety behaviors, reduce the occurrence of adverse events during hospitalization, and improve patients' satisfaction with hospitalization.
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Introducción Tanto las fracturas traumáticas del acromion, así como las fracturas acromiales por insuficiencia posterior a artroplastia reversa del hombro, son entidades poco frecuentes. Con la ampliación des los criterios operativos para la artroplastia reversa del hombro, es de suponer un aumento en el caso des las fracturas acromiales por insuficiencia posteriores a dicho procedimiento quirúrgico. Al ser estas entidades poco frecuentes hacen falta en la literatura recomendaciones basadas en la evidencia para el manejo de estas, las cuales representan un reto para el especialista tratante. Materiales y Métodos Reporte de seis casos entre 2013 y 2016 en el hospital cantonal de Frauenfeld (Suiza) de dos grupos de pacientes con fracturas del Acromion. En el grupo A se clasificaron tres pacientes que presentaron fractura por insuficiencia del acromion posterior a artroplastia reversa del Hombro. En el grupo B clasificaron tres pacientes con fracturas traumáticas del acromion en las cuales el manejo conservador no fue exitoso. Los dos grupos de pacientes fueron sometidos al mismo método quirúrgico con reducción abierta y reconstrucción anatómica del Acromion por medio de fijación con placa y tornillos interfragmentarios. Resultados Posterior a la intervención quirúrgica, la función del hombro se recuperó en todos los pacientes del Grupo A. La flexión anterior aumentó en promedio de 53° a 127°, y la abducción mejoró de 52° a 125°. Las mediciones posteriores al año de la intervención mostraron puntajes constantes entre 55-71, así como un valor subjetivo de hombro (SSV) de 50-90. En el Grupo B, el rango de movimiento preoperatorio se mantuvo constante. La flexión hacia delante mejoró de 133° a 157° y la abducción aumentó de 147° a 153°. Un año después de la cirugía, los puntajes de Constant en el grupo B variaron de 70 a 86 y el SSV se encontró entre 80 a 100. Los tres pacientes del Grupo B consiguieron retomar sus actividades diarias sin dolor y pudieron regresar al trabajo. La extracción de la placa fue necesaria en la mitad de los pacientes de la cohorte (Grupo A n=1, Grupo B n=2). Discusión La fractura del acromion es una condición seria que puede causar daño significativo al funcionamiento del hombro. Tanto en pacientes con ARH así como en pacientes sin ARH previa, nuestra técnica operativa abierta de reconstrucción anatómica del acromion mostró buenos resultados. Recomendamos el manejo quirúrgico por medio de reconstrucción con placa y clavos de fijación. Nivel de evidencia: IV
Aim To propose a surgical technique to treat the traumatic acromion fractures, as well as acromion fractures before reverse total Shoulder Replacement (TSR). Methods Six patients were treated with the same fixation technique between December 2013 and December 2016. Three patients had acromial insufficiency fractures (type II) following TSR (Group A). The other three patients, who had traumatic acromion fractures, underwent unsuccessful conservative treatment (Group B). Surgical treatment involved reconstruction of the acromion using an open technique with plate and interfragmentary screw fixation. Results Following reconstruction, shoulder function was regained in all patients in Group A. Forward flexion increased, on average, from 53° to 127°, and abduction improved from 52° to 125°. Measurements at one-year follow-up were Constant scores from 55-71, and subjective shoulder value (SSV) from 50-90. In Group B, preoperative range of motion was not substantially diminished. Forward flexion improved from 133° to 157°, and abduction increased from 147° to 153°. One year following surgery, the Constant scores in Group B ranged from 70-86, and SSV was 80-100. All three patients performed daily activities without pain, and were able to return to work. Plate removal was necessary in half the patients in the cohort (Group A n=1; Group B n=2). Conclusion An acromion fracture is a serious condition that can cause significant damage to shoulder functioning. In patients with or without previous TSR, this fixation technique was used successfully to reconstruct the anatomic lateral and basal acromion. Evidence Level: IV
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Acromion/surgery , Acromion/injuries , Fractures, Bone/surgery , Arthroplasty, Replacement, Shoulder , Follow-Up Studies , Fractures, Bone/etiology , Arthroplasty, Replacement, Shoulder/adverse effects , Shoulder Prosthesis , Fracture Fixation, InternalABSTRACT
Objective To investigate the X-ray gray scale changes of calcium sulfate and evaluate its clini-cal effect in traumatic fracture treatment. Methods 23 traumatic fracture cases were treated from September 2014 to January 2016 in our hospital. The degradation rate of calcium sulfate was evaluated by X ray assay. Results Af-ter surgery,about 69%remnants at 1 week,53%remnants at 2 weeks,26%remnants at 4 weeks,7%remnants at 6 weeks were observed,while no remnants were found at 8 weeks after surgery. The initial time window of callus appearance was 3 to 9 weeks and the mean time was(6.5 ± 1.6)weeks. The fracture union time was 8 to 24 weeks and the mean time was(15.0 ± 5.2)weeks. One patient with distal humeral comminuted fracture had non-infec-tious delayed healing wound.One case of hemolytic staphylococcus in incision was cultured. Conclusion Calcium sulfate degrades rapidly,cautions should be taken for the application in the superficial bone.
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Objective To investigate the correlation between the coagulation function and fibrinolytic activity with deep venous thrombosis (DVT) after traumatic fracture operation.Methods One hundred and thirty-four cases of traumatic fracture from April 2010 to May 2014 were divided into the DVT group(24 cases) and non-DVT group,and at the same time 110 healthy people were selected as the control group.The venous blood at different time points was collected for observing the levels change of prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB),platelet aggregation rate (PAgT),dipolymer (D-D),thrombin antithrombin complex (TAT),plasminogen activity (PIg) by using appropriate methods.Results There was no difference in APTT and PT groups among the groups(P>0.05).Preoperative FIB,PAgT,D-D and TAT levels was the DVT group >non-DVT group > control group,while the level of PIg was the DVT group0.05).Conclusion The increase of D-D and TAT is closely related with DVT in traumatic fracture and,which is an independent risk factor.
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OBJECTIVE:To systematically review the therapeutic efficacy and safety of modified Taohong siwu decoction in adjuvant therapy of traumatic fracture,and to provide evidence-based reference in clinic.METHODS:Retrieved from CJFD,CBM,Wanfang database and PubMed,related studies about fracture restitution combined with modified Taohong siwu decoction (trial group) vs.fracture restitution alone (control group) in the treatment of traumatic fracture were collected.Meta-analysis was conducted by using Rev Man 5.3 statistical software after data extraction and quality evaluation according to Cochrane systematic review.RESULTS:A total of 6 RCTs and 3 clinical control trials were included,involving 929 patients.Meta-analysis showed that clinical total response rate [RR =1.35,95 ％ Cl (1.24,1.47),P ＜ 0.001] and the incidence of gastrointestinal ADR [RR =5.59,95 ％ Cl (1.30,24.14),P=0.02] in trial group were significantly higher than control group;symptom and sign score [MD =-5.50,95 ％ Cl(-6.45,-4.54),P＜0.001],erythrocyte sedimentation [MD=-13.78,95％ Cl(-15.97,-11.60),P＜0.01],whole blood viscosity [MD=-1.03,95％Cl(-1.11,-0.95),P＜0.001],plasma viscosity [MD=-0.24,95％Cl(-0.27,-0.21),P＜0.01],hematocrit [MD=-12.12,95％Cl(-13.37,-10.86),P＜0.01] and erythrocyte electrophoresis time [MD=-7.12,95％Cl(-7.88,-6.35),P＜ 0.01] of trial group were significantly lower than those of control group,with statistical significance.CONCLUSIONS:For adjunctive therapy of traumatic fracture,modified Taohong siwu decoction can improve clinical efficacy,reduce the inflammatory reaction, improve blood rheology but aggravate gastrointestinal reaction.
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Objective To explore the resilience characteristics of the traumatic fracture patients and its influence on acute stress disorder(ASD),and provide the basis for improving the population's ability to cope with stressful events and resilience level for clinic.Methods 440 cases of traumatic fracture patients hospitalized in Tangshan Second Hospital were selected in this study.All subjects were assessed with SAS-RQ,CD-RISC,AIS-ISS,VAS and the general condition of investigations.Results The resilience level of traumatic fracture patients was at the middle,the resilience total score was(51.13±14.81) points,and lower than that of the national norm(t=-20.217,P＜0.01).Sex,age,personality and injury severity had the impact on resilience (P＜0.05).Resilience dimensions and total scores had negative correlation with SASRQ dimen sions and its total score (r=-0.587--0.739,P＜0.01).High-leveled resilience patients have lower ASD scores and lighter symptoms(P＜ 0.05).The multivariate analysis appeaed that resilience and the degree of pain were the main factors affecting ASD (P＜ 0.05).Conclusion The resilience level of the traumatic frac ture patients should be further improved and the construction of resilience should be strengthened in order to prevent the occurrence of ASD.
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Objective To discuss the application of Chinese version of Stanford Acute Stress Reaction Questionnaire (SASRQ) in trau-matic fracture patients. Methods 96 patients with traumatic fracture in the Second Hospital of Tangshan City were recruited in the early stage. All the subjects were assessed with SASRQ in 2 weeks after trauma for the first time, and then they were assessed with SASRQ for the second time after an interval of 2 days. 496 patients with traumatic fracture completed SASRQ and Abbreviated Injury Scale-Injury Se-verity Score (AIS-ISS) assessment. Results The Cronbach's alpha was 0.930 in SASRQ, and were 0.729~0.812 in each dimension (P<0.01). Test-retest reliability at 2-day intervals was 0.980 (P<0.01). 133 cases (26.8%) were detected with acute stress disorder (ASD). According to a single entry≥3 as a positive screening, 31.7%suffered separation symptoms, 49.6%suffered re-experience traumatic symptoms, 39.5%suffered avoidance symptoms, 75.6%suffered symptoms of anxiety or increased awareness. The scores of SASRQ (t=37.807, P<0.05) and each dimension (t=36.503, 29.019, 31.111, 19.369, respectively, P<0.001) was significantly higher in the ASD positive group than in the neg-ative group. There was significantly difference in the score of SASRQ and each dimension in different age groups (F=112.319, 94.109, 95.099, 103.291, 61.497, respectively, P<0.001), the acute stress symptoms were lighter in the older group than in the other groups. There was significantly difference in the score of SASRQ and each dimension between men and women (t=7.707,-6.190,-8.944,-7.221,-9.949, respectively, P<0.001), the acute stress symptoms were lighter in men than women. There was sig-nificantly difference in the score of SASRQ and each dimension in different trauma types (F=68.516, 44.464, 59.725, 48.966, 54.827, P<0.001), the acute stress symptoms were severer in the traffic accident patients group than in the other groups. There was significantly differ-ence in the score of SASRQ and each dimension in different trauma degrees (F=63.584, 69.704, 51.569, 43.669, 33.911, respectively, P<0.001), the acute stress symptoms were lighter in the lighter group than in the other groups. Conclusion There is a high incidence and clear gender and age differences of ASD in patients with traumatic fracture.
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OBJECTIVE: To report a rare non traumatic fracture of femur after a partial secondarily generalized tonic seizure in a infant. DESCRIPTION: A 7-month-old female patient was referred to the Pediatric Hospital with two complaints: 1) frequent epileptic seizures since the age of 3 months and 2) intermittent crying when the left leg is moved or manipulated after last seizures. Computerized tomography of the hipbone revealed left spontaneous transepiphyseal fracture of the femur (Delbet type 1). Clinical, metabolic and radiological investigation did not reveal osteopenia or rickets. A family study ruled out battered-child syndrome. CONCLUSION: Given the non-traumatic nature of the fracture, a rare comorbidity in epileptic children mainly in infant, the authors describe the case calling attention to a complication that may be overlooked.
OBJETIVO: Descrever uma fratura não traumática do fêmur, num lactente, após uma crise focal com generalização secundaria. DESCRIÇÃO: Uma menina de 7 meses de idade foi encaminha ao hospital de pediatria com duas queixas: 1) crises epilépticas frequentes desde idade de 3 meses; 2) passou apresentar choro a movimentação do membro inferior esquerdo após última crise . A tomografia computadorizada do quadril revelou fratura espontânea transepifisária do fêmur esquerdo (Delbet Tipo I). A investigação clínica, metabólica e radiológica não revelou osteopenia ou raquitismo. O estudo da família afastou síndrome da criança espancada. CONCLUSÃO: Por se tratar de uma fratura não traumática, comorbidade rara em criança com epilepsia e na fase de lactente, os autores descrevem o caso chamando a atenção para uma complicação que pode estar sendo subdiagnosticada.