Preoperative estimation of humerus intramedullary nail length using clinical landmarks / 中华创伤杂志(英文版)

PURPOSE@#Intramedullary interlocking nailing is one of the accepted methods of treating humerus diaphyseal fractures. Appropriate nail length and diameter are of paramount importance to achieve a stable fracture fixation. Estimating the nail length can be as challenging in certain cases as it is important. This study aims to provide an easy-to-use formula utilizing clinical measurements from contra lateral arm to accurately estimate humeral nail length.@*METHODS@#This descriptive cross-sectional study was conducted at 3 tertiary care hospitals in Mangalore, India. Patients above the age of 18 years coming to the outpatient department with elbow, shoulder or arm complaints requiring radiological investigation from July 2021 to July 2022 were included. Patients with fractures or dislocations of upper limbs, malunited or non-united fractures of upper limbs, congenital or developmental deformities and patients with open growth plates were excluded. Patients' variables (like age and gender), radiological humerus length and contralateral arm clinical measurements were recorded. An independent samples t-test was used for univariate analysis, and linear regression analysis was done to estimate the desired nail length using the clinical measurement of the humerus (cm) in both genders separately. The significance level was set at p < 0.05.@*RESULTS@#Our study included 204 participants of which 108 were male and 96 were female. The formula for predicting humeral nail length in males is (-2.029) + (0.883 × clinical measurement). The formula for females is 1.862 + (0.741 × clinical measurement). A simplified formula to determine humeral nail length is 0.9 clinical length - 2 cm (in males) and 0.7 × clinical length + 2 cm (in females).@*CONCLUSION@#To improve the stability of fixation with intramedullary nails it is imperative to select the appropriate nail length. There have been studies that devised reliable methods of determining nail lengths in the tibia and femur using preoperative clinical measurements. A similar clinical method of determining humeral nail length is lacking in the literature. Our study was able to correlate radiological lengths of the humerus medullary canal with clinical measurements performed using anatomical landmarks to arrive at a formula. This allows for a reliable and easy nail length determination preoperatively.

CLINICAL AND FUNCTIONAL OUTCOME OF PROXIMAL HUMERAL FRACTURE FIXATION WITH RUSHNAIL AND K WIRE FIXATOR VS PHILOS PLATING : A STUDY OF 30 CASES

Introduction- Aim- Proximal humerus fractures represent one of the most common fracture type in upper extremity. this study aimed to see clinical and functional outcome of proximal humeral fracture fixation with Rushnail and K-wire fixator vs PHILOS plating. A prospective study was conducted over 6 months of a tot Material And Method- al of 30 patients with proximal humerus fracture. Patients were divided into two groups by randomized controlled trial .Group 1 included 15 patients who were treated with closed reduction and Rushnail with percutaneous k wire fixation. Group 2 included 15 patients who were treated with ORIF with PHILOS plate .All these 30 patients were followed up for mean duration of 6 months. Mean neer s Results- core at final follow up was 90 in group 1 patients while it was 80 in group 2 patients As per the Neers scoring system. Mean neer score at final follow up was 90 in group 1 patients while it was 82 in group 2 patients. As per the Neers scoring system; 8 patients (54%) in group1 had excellent results, 7 patients(46%) had satisfactory Results. For Group 2 ,as per Neers scoring system 6 patients (40%)had excellent results,7 patients (47%) had satisfactory results,2 patients (13%) had unsatisfactory result with poor outcome. In conclusion it was found that Rushnail wit Conclusion- h K- wires fixation for proximal humerus fractures type II and type III (Neer's) gives superior results than proximal humerus interlocking system (PHILOS).

Mechanical Properties of Novel Interlocking Intramedullary Nail for Fixing Transverse Olecranon Fractures / 医用生物力学

Objective To study the effect of interlocking intramedullary nail on fixing transverse olecranon fracture. Methods Nine pairs of fresh ulna specimens were collected and the transverse fracture model of olecranon was established. Kirschner wire tension band and interlocking intramedullary nail were used to repair the fracture. Cyclic dynamic tension loads with amplitude of 25 N, mean value of 45 N and frequency of 05 Hz were applied to the triceps tendon under simulated elbow flexion conditions of 30°, 45° and 60°, respectively. The fracture displacements of specimens within 300 cycles were recorded in three groups. ResultsAt 30° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.831±0.333) mm and (3.723±2.390) mm, respectively. At 45° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.167±0.374) mm and (2.455±0.609) mm, respectively. At 60° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.407±0.342) mm and (3.112±1.025) mm, respectively. The fracture displacement of interlocking intramedullary nail was smaller. Conclusions The mechanical properties of interlocking intramedullary nail are better than those of Kirschner wire tension band, and the interlocking intramedullary nail is more stable and firmer for fixing transverse olecranon fracture. Moreover, the interlocking intramedullary nail is installed with the operating tool, thus the operation is more accurate and faster, and the operation efficiency is greatly improved.

Novo olhar ao board interlocking: evidências a partir das redes sociais corporativas / Nueva mirada al board interlocking: evidencias a partir de las redes sociales corporativas / A new look at board interlocking: evidence from corporate social networks

Resumo Este estudo teve por objetivo avaliar as estruturas de interligações pelos membros do conselho de administração (CA) com expertise política e financeira de empresas listadas na B3. A amostra foi composta por 2.474 observações no período de 2010 a 2015. Por meio da Teoria da Agência, sugere-se que o board interlocking (BI) pela expertise financeira pode auxiliar o monitoramento corporativo e servir como mitigador dos conflitos da agência. Por outro lado, o BI pela expertise política pode maximizar o comportamento oportunista. Na visão da Teoria da Dependência de Recursos, o BI pela expertise financeira pode auxiliar as empresas na captação de recursos financeiros, enquanto o BI pela expertise política pode maximizar os resultados mediante contratos mais lucrativos e vantagens oferecidas pelos políticos. Conclui-se que a sistematização do BI pelos diferentes tipos de expertise pode ser utilizada em futuras pesquisas para explicar as estratégias, as decisões e os fenômenos corporativos, bem como para avaliar as causas e os efeitos de tais estruturas na gestão das organizações.

Resumen El estudio tiene como objetivo evaluar las estructuras de interconexiones entre los miembros del Consejo de Administración (CA) con experiencia política y financiera de empresas que cotizan en la B3. La muestra se compuso de 2.474 observaciones en el período 2010-2015. Por medio de la Teoría de la Agencia, se sugiere que el board interlocking (BI) por la experiencia financiera puede auxiliar al monitoreo corporativo y servir como mitigador de los conflictos de la agencia. Por otro lado, el BI por la experiencia política puede maximizar el comportamiento oportunista. En la visión de la Teoría de la Dependencia de Recursos, el BI por la experiencia financiera puede auxiliar a las empresas en la captación de recursos financieros, mientras que el BI por la experiencia política puede maximizar los resultados mediante contratos más lucrativos y ventajas ofrecidas por los políticos. Se concluye que la sistematización del BI por las diferentes experiencias puede ser utilizada en las investigaciones futuras para explicar las estrategias, decisiones y fenómenos corporativos, así como para evaluar las causas y los efectos de tales estructuras en la gestión de las organizaciones.

Absract The study aims to evaluate the interconnection structures by members of the Board of Directors with political and financial expertise of companies listed in the Brazilian stock market B3. The sample consisted of 2,474 observations in the period from 2010 to 2015. It is suggested by the Agency Theory that board interlocking (BI) for financial expertise can help in corporate monitoring and mitigates the agency's conflicts. On the other hand, BI by political expertise can maximize opportunistic behavior. In the view of Resource Dependency Theory, BI for financial expertise can assist companies in attracting financial resources, while BI for policy expertise can maximize results through more lucrative contracts and advantages offered by policymakers. It is concluded that the systematization of BI by different expertise can be used in future research to explain corporate strategies, decisions, and phenomena, as well as to evaluate the causes and effects of such structures in the management of organizations.

Comparative Study of External Fixator versus Internal Fixation Using Interlocking Nail in Open Diaphyseal Fractures of Tibia: An Hospital Based Prospective Study

Background: External fixation and internal fixation usingintramedullary nails are two well-accepted and effectivemethods, but each has been historically related tocomplications. We therefore performed a prospective study tocompare the early functional recovery and overall results withthese two methods of management.Materials & Methods: This prospective randomized study wascarried out on the patients admitted in the Department ofOrthopaedics, Dr S.N. Medical College, Jodhpur. The studyincluded 30 patients of Open Diaphyseal Fractures of Tibia. Ofthese, 15 patients were treated by intramedullary interlockingnailing and the remaining 15 patients by External Fixator asprimary fixation method. Patient able to walk without supportwithout pain were considered union clinically. Johner AndWruhs Criteria, 1983 were used to evaluate functionaloutcome.Results: Our study showed that the mean age was 32.4 yearsin ILN group and 34 years in external fixation group. The maleto female ratio was approximate 4:1. In present study showedthat the road traffic accident were most of the injury (80%) ingroup A as compared to group B (93.33%). The farmer & laborwas higher incidence of tibial fractures, which are higherdemanding activity and lower incidence of fractures wasoccurred in low demanding activity occupation. The outcome ofour study showed that excellent in 73.33% cases in group A ascompared to 53.33% in group B. Poor outcome maximum ingroup B was 20% cases as compared to 6.66% in group A.Conclusion: We concluded that in open tibial shaft fractureintramedullary interlocked nailing is excellent modalities,leading to accepted union with a mild delay but permissibleearly weight bearing and low patient morbidity

Treatment of Unstable Diaphyseal Fracture Femur with Femur Intramedullary Interlocking Nailing

Introduction: Fractures of shaft of femur are among themost common fractures encountered in orthopaedic practice.The femur is the largest and strongest bone in the bodyarticulating with hip joint proximally forming knee joint withtibia at its distal end. As industrialization and urbanizationare progressing year to year with rapid increase in traffic,incidence of high energy trauma increasing with samespeed. Hence, the aim of the present study was to assess thetreatment of unstable diaphyseal fracture femur with femurintramedullary interlocking nailing.Material and methods: The present study was done among40 patients where skin traction or upper tibial traction forskeletal traction was given with the link supported in a BohlerBraun splint. All routine investigation and surgical fitnesswere asked for intramedullary nailing was chosen for fracturebelow the lesser trochanter and distally fracture within 8 cmfrom the femoral articular surface were chosen.Results: About 60% fractures involved upper 3rd as the site offracture. The pattern of fracture was found to be comminutedwhich was around 35%. The oblique pattern was around32.5% and transverse pattern of fracture was observed to be22.5%.The complications included were implant bending andbreaking, infection,delayed and nonunion,rotational deformityand shortening.Conclusion: Unstable diaphyseal fractures with femurintramedullary interlocking nailing gives excellent result withthis system there are minimal complications which help earlyreturn of patients to activity and work.

Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture / 中国修复重建外科杂志

Objective: To explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation. Methods: The clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness. Results: Both groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction ( P0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant ( P<0.05). Conclusion: Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.

A meta-analysis of expandable intramedullary nail versus interlocking intramedullary nail for treatment of femoral shaft fracture / 中国组织工程研究

BACKGROUND: A large number of studies have confirmed that expandable intramedullary nails and interlocking intramedullary nails have a good effect in repairing limb fractures. However, for the treatment of femoral shaft fractures, the advantages and disadvantages of the two kinds of fixation methods are not inconclusive. OBJECTIVE: To systematically review the safety and effectiveness of expandable intramedullary nail and interlocking intramedullary nail for treatment of femoral shaft fracture. METHODS: A computer-based online search was conducted in PubMed, Web of Science, EBSCO, The Cochrane Library, CNKI, VIP and Wanfang databases to screen the relevant clinical controlled trials of expandable intramedullary nail versus interlocking intramedullary nail for the treatment of femoral shaft fractures. Two reviewers screened the literature according to the strict inclusion criteria, and assessed the research quality of the finally included literatures, and extracted the data. Meta-analysis was performed using Stata 13. 0 software. RESULTS AND CONCLUSION: (1) A total of 7 studies (3 randomized controlled and 4 non-randomized controlled trials) were included, involving 492 patients. Expandable intramedullary nailing group contained 246 patients. Interlocking intramedullary nailing contained 246 patients. (2) The results of meta-analysis showed that compared with the interlocking intramedullary nailing group, fracture healing time, operation time, fluoroscopy time and hospital stay were shorter in the expandable intramedullary nailing group [SMD=-0. 87, 95%CI(-1. 20, -0. 54), P=0; SMD=-2. 45, 95%CI(-3. 33, -1. 58), P=0; SMD=-2. 83, 95%CI(-3. 68, -1. 97), P=0; SMD=-0. 96, 95%CI(-1. 73, -0. 18), P=0. 016]. Intraoperative blood loss was less in the expandable intramedullary nailing group than that in the interlocking intramedullary nailing group [SMD=-4. 12, 95%CI(-6. 38, -1. 87), P=0]. There was no significant difference in the rate of bone nonunion or delayed healing and the overall incidence of complications between the two groups. (3) Therefore, we theoretically believe that expandable intramedullary nailing is more advantageous than interlocking intramedullary nailing in the treatment of femoral shaft fractures, but the postoperative recovery is similar. Limited to the quality of the methodology of this study, it fails to consider the effect of the type of fracture and the interference of the field. The results need to be treated with caution, and more randomized controlled trials are needed to confirm.

Management Of Comminuted Tibial Diaphyseal Fractures By Means Of Interlocking Nails

Introduction:This study assesses the outcome of interlocking tibia nail in comminuted fractures of tibial diaphysis. Objectives: To study the functional outcomes of interlocking tibia nail in comminuted tibial diaphyseal fractures, with respect to time to bony union, mobility achieved, complications of the procedure and secondary procedures. Material and Methods: The present prospective study included 25 patients of comminuted fracture shaft of tibia admitted to the Department of Orthopaedics at MMIMSR, Mullana and at Civil Hospital, Rajpura who were managed with interlocking tibia nail. Results:All 25 cases united with interlocking nailing. 1 case needed additional exchange nailing and bone grafting. 3 cases had a malunion but had an acceptable functional outcome. Conclusions: Due to the simple surgical technique, good healing rate and minimum complications, it is recommended that interlocking tibia nail should be used in comminuted fractures of tibial diaphysis

Comparative study of functional outcome of dynamic compression plating with interlocking nailing for fracture shaft humerus in adults

A prospective observational study was conducted in Government Victoria Hospital, Visakhapatnam from 2013 to 2018 to evaluate Arogyasri scheme. Arogyasri scheme provides end to end cashless services for identified diseases in Andhra Pradesh. During this period, 891 gynecological surgeries were conducted under this scheme. Out of them, 44 were not approved for claim. A total of 10,880,238 rupees were claimed.

Efficacy analysis of inverted intramedullary nail combined with medial minimally invasive plate in treatment of type C2 and C3 distal femoral fractures / 中华创伤杂志

Objeetive To investigate the clinical efficacy of inverted intmmedullary nail combined with medial minimally invasive plate in treatment of type C2 and C3 distal femoral fractures.Methods A retrospective case control study was conducted on 38 patients with complex distal fractures of the femur treated from January 2015 to January 2017.There were 22 males and 16 females,aged 24-72 years [(45.6 ± 2.5)years].AO fracture classification was type C2 in 24 patients and type C3 in 14.All of them were fresh closed fractures.The time duration from injury to operation was 4-16 days (average,7.5 days).Based on the different surgical methods,the patients were divided into lateral single plate fixation group (single plate group,20 patients) and inverted intramedullary nail combined with medial minimally invasive locked plate fixation group (locked plate group,18 patients).The two groups were compared in terms of operation condition,early weight bearing time,fracture healing time,postoperative complications,postoperative knee function and activity of living.Hospital for Special Surgery (HSS) score was used for evaluating postoperative knee function and Barthel index for activity of living.Results The patients were followed up for 10-24 months [(12.2 ± 1.8) months].The operation duration was (110.5 ± 35.4) min for single plate group and (116.7 ± 42.3) min min for locked plate group(P ＞0.05).Intraoperative blood loss in single plate group was [(450.5 ± 120.7)ml] and [(455.2 ± 130.4) ml] in locked plate group (P ＞ 0.05).The early weight bearing time in single plate group was (28.5 ± 8.6)days and 18.7 ± 4.9 (P ＜ 0.01)days in the locked plate group.The fracture healing time in single plate group was (8.5 ± 2.2) months,and [(6.5 ± 1.6) months] in locked plate group (P ＜ 0.01).After 3 weeks,6 months and 12 months,HSS scores of knee joint function of the locked plate group was significantly better than that of single plate group (P ＜ 0.01).At 6 months and 12 months after operation,Barthel index score of locked plate group was significantly better than that of single plate group (P ＜ 0.01).No infection occurred in two groups after operation.There were no complications such as internal fixation failure,knee valgus,external rotation deformity or fat embolism in locked plate group.There were two cases of internal fixation failure,one knee eversion,and two knee varus in single plate group (P ＜ 0.01).Conclusion Compared with single plate fixation,the therapeutic method of inverted intramedullary nail combined with medial minimally invasive locked plate has the advantages of early weight bearing time,quick recovery,better function restoration and fewer complications,and hence is a preferable choice for treatment of type C2 and C3 complex distal femoral fractures.

Observation of the curative effect of ganglioside intravenous injection combined with intrathecal injection after operation on incomplete spinal injury / 中国综合临床

Objective To investigate the clinical effect on incomplete spinal injury by ganglioside intravenous injection combined with intrathecal injection.Methods From January 2011 to January 2015, seventy-nine cases with irreducible articular process interlocking of cervical spine fracture with dislocation of cervical spinal cord injury,underwent one stage anterior and posterior surgical treatment,postoperative routine use of antibiotics to prevent infection,and the hormone,dehydration to promote bone cell growth and neurotrophic drugs treatment.The patients were randomly divided into the intravenous injection group(42 cases),given intravenous injection of monalsialic acid four hexose ganglioside sodium(GM-1)40 mg/d,mecobalamin tablets 0.5 mg/time,3 times/d,30 d oral;the combined intrathecal injection group(37 cases)was given GM-1 40 mg/d,intravenous injection at 15 d after intrathecal injection,1 time a week 40 mg,with a total of 4 weeks.The degree of spinal cord injury was evaluated according to Frankel classification; cervical function was evaluated according to JOA score; bone graft fusion,stability of cervical spine and degree of spinal cord injury were evaluated by imaging.Results The operation time in the intravenous injection group and the combined intrathecal injection group were(4.15 ± 0.65)h and(4.10 ± 0.85)h,and the intraoperative blood loss was(850.50±35.10)ml and(858.60±25.20)ml,respectively,and there were no significant differences between the two groups(t=1.375,1.452,P>0.05).The total dose of GM-1 in the combined intrathecal injection group was(785.20 ± 3.28)mg,significantly higher than that in the intravenous injection group((610.55 ± 5.28) mg),the difference was statistically significant(t=12.542,P<0.05);79 patients were followed up for 12-24 months,with an average of(15.2 ± 1.3)months.The improvement rate of nerve function of the combined intrathecal injection group was(64.35±4.33)%,significantly higher than that in the intravenous injection group (55.50±5.44)%,the difference was statistically significant(t=8.813,P<0.05);the postoperative JOA scores of the intravenous injection group((13.55 ± 1.75)points)and combined intrathecal injection group((12.85 ±1.97)points)were significantly higher than those before the surgery((7.25± 0.83)points,(7.19± 0.93) points),the differences were statistically significant(P<0.05).There was no significant difference in the JOA scores between the two groups before and after the operation(P>0.05).At the last follow-up,X-ray showed bone fusion at the bone graft site,and the internal fixation was good and firm.MR showed that the degeneration signal area of the cervical spinal cord decreased in varying degrees,and edema and inflammatory reaction disappeared.Conclusion Postoperative treatment of ganglioside intravenous injection combined with intrathecal injection is safe and feasible in the treatment of incomplete cervical spinal cord injury caused by cervical fracture dislocation with irreducible articular process interlocking.

Haste intramedular bloqueada em comparação com placa de compressão dinâmica na estabilização de osteotomia intertrocantérica varizante em cães: estudo ex vivo / Interlocking nail system in comparison with dynamic compression plate in the stabilization of intertrochanteric varus osteotomy in dogs: study in cadavers

Tendo em vista as vantagens das hastes intramedulares bloqueadas (HIB) em relação às placas ósseas na estabilização femoral, o presente estudo objetivou avaliar a exequibilidade e eficácia da aplicação da HIB pós osteotomia intertrocantérica varizante (OIV). Submeteu-se 10 cadáveres caninos à OIV. Nos antímeros esquerdos obteve-se a estabilização por meio de HIB (grupo HIB) e, nos direitos, com placas de compressão dinâmica (grupo placa). Foram comparados os ângulos de Norberg e de inclinação da cabeça e colo femoral (ICF) antes (T0) e após (T1) a OIV. O tempo dispendido para a colocação dos implantes e resultados de resistência biomecânica à compressão e torção também foram confrontados entre os grupos. Houve aumento do ângulo de Norberg entre T0 (106,84®5,55o) e T1 (111,22o®3,89), apenas no grupo HIB (p<0,05). No entanto, redução do ângulo de ICF após OIV (T1) foi observada tanto no grupo placa (T0=127,6®4,70o e T1=110,06®10,61o, p<0,05) quanto no grupo HIB (T0=126,43®5,87o e T1=116,87®8,62o, p<0,05). Os tempos de colocação dos implantes não diferiram estatisticamente e apenas o teste biomecânico de compressão revelou diferença entre os grupos, com maior resistência (P=0,033) do grupo placa (863,3®74,46N/mm) em relação ao grupo HIB (586,7®44,10N/mm). Deste modo, a estabilização por meio de HIB foi factível e eficaz. Embora o resultado biomecânico de compressão tenha demonstrado maior fragilidade da HIB em relação à placa de compressão, seus valores estão acima das forças atuantes, reportadas na literatura, na deambulação normal de cão.(AU)

Considering the advantages of the interlocking intramedullary nail (IN) in relation to bone plates in the femoral stabilization, this study aimed to evaluate the feasibility and effectiveness of IN application post intertrochanteric varus osteotomy (IVO). For this purpose, 10 canines cadavers were used. On the left femurs, the fixation was obtained with IN (IN group) and rights fixed with dynamic compression plates and screws (plate group). Was compared the angles of Norberg and inclination of the head and femoral neck (IHF) before (T0) and after (T1) IVO. The results of time spent for placement of implants and biomechanical resistance to compression and torsion were also confronted between groups. There was an increase of the Norberg angle between T0 (106.84®5.55o) and T1 (111.22o®3.89), only in IN group (p<0.05). However, reduction of IHF angle after IVO (T1) was observed in both, the plate group (T0=127.6®4.70o e T1=110.06®10.61o, p<0.05) and IN group (T0=126.43®5.87o e T1=116.87® 8.62 o, p<0.05). The placement times of the implants did not differ statistically and only the compression biomechanical test revealed differences between groups, with greater resistance (P=0.033) of the plate group (863.3®74.46N/mm) compared to IN group (586.7®44.10N/mm). Thus, stabilization through IN was feasible and effective. Although the compression biomechanical results has demonstrated a higher fragility of IN in relation to the compression plate, their values are above the forces, reported in literature, acting in normal dog gait.(AU)

Interlocking Nailing in Comminuted Femoral Shaft Fractures: A Prospective Study in a tertiary care hospital

Background: Fracture shaft of femur is one of the most common fractures encountered in orthopaedic practice. Fracture shaft of femur is major cause of morbidity and mortality in patients who sustain high energy trauma. Methods: This prospective study was performed at Department of Orthopaedics, Varun Arjun Medical College, Banthra, Shahjahanpur, U.P, India. All patients aged 20 years or above, who presented with comminuted femur fracture and were treated with interlocking nailing was included in the study. Various clinical and radiological parameters were collected during the course of treatment. Results: N=30 patients were included in the study; 76% males. 88% aged 50 years or less. Road traffic accident was the most common mode of injury and 54% of patients had fracture in the middle one-third femur. 76% of the patients presented within 24 hours of injury. 52% of the patient’s demonstrated clinical union of the fracture in 12 to 14 weeks and majority showed radiological union in 16 to 18 weeks. Partial weight bearing was started in 38% patients in 10 weeks and full weight bearing in 48% patients  in  16 weeks. Majority of the patients stayed in hospital for 10 to 14 days and the functional outcome as measured by Klemm and Borner criteria was excellent in 69% patients. Conclusions: In our experience, interlocking nailing had very low complication rate and excellent functional outcome in two thirds patients of comminuted femur fracture.

In vivo experiment on treatment of vascular disconnection and defect of extremities with interlocking vascular shunt device / 医疗卫生装备

Objective To execute in vivo experiment on the treatment of vascular disconnection and defect of the extremities with interlocking vascular shunt device.Methods An animal model with vascular disconnection and defect of the extremities was established.The shunt device and silicone tube were used to connect the two ends of the disconnected vessel,and then canalization and thrombosis by the device were compared with them by sutures and silicon tube.Results The shunt device combined with silicon tube gained the same canalization as that by sutures and silicon tube, while had significantly shorter operation time (P＜0.05).Conchusion The interlocking shunt device restores efficiently blood supply of vascular disconnection and defect of the extremities,and thus facilitates blood vessel grafting in rear hospitals.

Comparative results of non-operative and operative treatment of humeral shaft fractures / 北京大学学报(医学版)

Objective:To compare the difference between non-operative and operative treatment of humeral shaft fractures.Methods:From March 2005 to October 2012,252 cases of humeral shaft fractures were treated and were adequately followed up.According to the treatment methods,the patients were divided into 2 groups:the non-operative group and the operative group.In the non-operative group,there were 76 cases treated with plaster/small splint fixation,meanwhile there were 176 cases treated with inter nal fixation either by plating or by nailing in the operative group.The follow-up parameters included:fracture healing rate,fracture union time,complications rate,Constant-Murley shoulder score and Mayo elbow score.Results:The mean follow-up period was (31.24 ± 20.06) months (ranging 6 to 103 months).There were no statistical differences in age,open fracture number,fracture site and Arbeitsgemeinschaft ftir Osteosynthesefragen (AO) classification between the non-operative group and the operative group.The fracture healing rate:the non-operative group:96.1％ (72/76),the operative group:97.7％ (172/176),P =0.46;the fracture union time:the non-operative group:(10.24 ± 2.93) weeks,the operative group:(10.69 ± 2.51) weeks,P =0.22;the complication rate:the non-operative group:5.3％ (4/76),the operative group:15.3％ (27/176),P =0.03.The complications included:nonunion:the non-operative group:3.95％ (3/76),the operative group:2.3％ (4/176),P =0.434;radial nerve palsies:the non-operative group:0％ (0/76),the operative group:5.7％ (10/176),P =0.035;bone split:the non-operative group:0％ (0/76),the operative group:1.7％ (3/176),P =0.556;elbow stiffness:the non-operative group:l.3％ (1/76),the operative group:0.6％ (1/176),P =1.000;shoulder pain:the non-operative group:0％ (0/76),the operative group:5.1％ (9/176),P =0.061.The Constant-Murley shoulder score:the non-operative group:97.37±4.94,the operative group:96.34 ± 6.88,P =0.244.The Mayo elbow score:the non-operative group:99.80 ± 1.72,the operative group:99.49 ± 2.73,P =0.923.Conclusion:The results of non-operative treatment of humeral shaft fractures appeared with excellent results with lower complications rate compared with that of the operative treatment.

In vivo experiment on treatment of vascular disconnection and defect of extremities with interlocking vascular shunt device / 医疗卫生装备

Objective To execute in vivo experiment on the treatment of vascular disconnection and defect of the extremities with interlocking vascular shunt device.Methods An animal model with vascular disconnection and defect of the extremities was established.The shunt device and silicone tube were used to connect the two ends of the disconnected vessel,and then canalization and thrombosis by the device were compared with them by sutures and silicon tube.Results The shunt device combined with silicon tube gained the same canalization as that by sutures and silicon tube, while had significantly shorter operation time (P＜0.05).Conchusion The interlocking shunt device restores efficiently blood supply of vascular disconnection and defect of the extremities,and thus facilitates blood vessel grafting in rear hospitals.

Incidence of Varus Malalignment Post Interlocking Nail in Proximal Femur Shaft Fractures Comparing Two Types of Entry Points

Introduction: Osteosynthesis of the femur using an interlocking nail is the gold standard for treating diaphyseal fractures of the femur. There are two established entry points for the antegrade interlocking nails which is the piriformis fossa or the greater trochanter. It has been reported that varus malalignment was frequently seen in proximal femur fracture which were treated with interlocking nail utilizing the greater trochanter entry point. The study was done to find out if the problem was of significance. Materials and Methods: This was a retrospective study which included 179 patients with femur fractures which were treated from January 2013 till September 2015 in one Hospital. They were treated with interlocking nail either by utilizing the piriformis fossa (PF) or the greater trochanter (GT) entry points. Post-operative radiographs of the femur were used to measure the varus deformity. Results: Out of 179 patients, there were 5 patients who were reported to have unacceptable varus malalignment (2.79%). These 5 patients were out of the 88 (5.68%) patients utilizing the greater trochanter as the entry point. The same 5 patients were out 90 patients that were diagnosed with proximal femur shaft fractures (5.55%). Analysis with logistic regression was statistically not significant. Conclusion: There was higher rate of varus malalignment seen in proximal femur shaft fractures treated with interlocking nails utilizing the greater trochanter entry point. The incidence of varus malalignment was not significant statistically. Key Words: interlocking nail; greater trochanter entry point; varus deformity; femur shaft fracture

Effect of two different suture methods on the degree of pain and corneal epithelium healing condition in pterygium excision combined with autologous conjunctival flap graft transplantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To assess the effect of two different suture methods on the degree of pain and corneal epithelium healing condition after pterygium excision combined with autologous conjunctival flap graft transplantation. ·METHODS: Retrospective case-series study. According to the suture method, a total of 92 patients (92 eyes) with pterygium who received treatment in the First Affiliated Hospital of Huzhou University from June 2015 to June 2016 were divided into two group. There were 48 patients ( 48 eyes) in Group A were received intermittent suture, and 44 patients ( 44 eyes ) in Group B were received continuous interlocking suture. The degree of pain after surgery were evaluated between the two groups at 2h, 1d and 1wk after surgery by visual analogue score ( VAS). The healing status of corneal epithelium were observed between the two groups at 1d and 1wk after surgery by fluorescent staining. ·RESULTS: There was no significant difference in the average pain value 2h after surgery between Group A and Group B (P>0. 05). The average pain values 1d and 1wk after surgery in Group B was lower than that in Group A respectively (P0. 05). · CONCLUSION: Compared to intermittent suture, continuous interlocking suture can release pain response after pterygium excision combined with autologous conjunctival flap graft transplantation and promote the healing status of corneal epithelium.

Design of interlocking-style vascular shunt device and its in vitro experiment / 医疗卫生装备

Objective To develop an interlocking-style vascular shunt device for the treatment of distal limb ischemia resulting from vascular disconnection and defect.Methods A one-way interlocking buckle was designed with the space between the clamping teeth being 0.5 mm,which prevented the device from moving backwards and fixed the vessel and shunt tube conveniently.The interlocking buckle combined with silicone tube was used to connect the two ends of the defected vessel,which was compared with conventional method by suture ligation and silicone tube by the tests on vessel bursting pressure and tensile biomechanics.Results The vessel repaired with the developed device behaved better than that by the conventional method in the tests on vessel bursting pressure and tensile biomechanics (P＜0.05).Conclusion The vascular shunt device can be used for the treatment of distal limb ischemia resulting from vascular disconnection and defect,and thus facilitates the vascular graft in rear hospital after evacuation.