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Objective:To explore the feasibility and advantages and disadvantages of local anesthesia for TiRobot-assisted removal of sacroiliac screws by comparison with general anesthesia for TiRobot-assisted removal of sacroiliac screws.Methods:A retrospective study was performed in 39 patients with posterior pelvic ring fracture-dislocation who had undergone removal of percutaneous sacroiliac screws after fracture union from January 2017 to December 2020 at Department of Orthopaedic Surgery, Hospital Affiliated to Chengdu University. Their sacroiliac screws were removed with TiRobot assistance under local anesthesia (LA group) or general anesthesia (GA group). In the LA group of 18 cases, there were 10 males and 8 females, aged (43.3 ± 8.4) years (from 25 to 58 years); in the GA group of 21 cases, there were 12 males and 9 females, aged (44.9 ± 9.0) years (from 23 to 60 years). The 2 groups were compared in terms of time for planning screw removal path, fluoroscopy frequency, fluoroscopy time, operation time, anesthesia time, anesthesia cost, postoperative visual analogue scale (VAS) and postoperative ambulation time.Results:There was no statistically significant difference in baseline data between the 2 groups, showing comparability ( P>0.05). Follow-ups revealed grade A wound healing in all patients. There were no significant differences between the 2 groups in time for planning screw removal path, fluoroscopy frequency, fluoroscopy time or operation time ( P>0.05). The anesthesia time [(41.6 ± 8.3) min], anesthesia cost [(653.5 ± 102.6) yuan] and postoperative ambulation time [(2.6 ± 0.6) h] in the LA group were significantly less than those in the GA group [(52.3 ± 9.5) min, (2,475.6 ± 261.8) yuan and (8.7 ± 2.4) h] while the VAS score in the former group (3.8 ± 1.5) was significantly higher than that in the latter group (2.5 ± 1.3) (all P<0.05). Conclusions:It is feasible to use local anesthesia for TiRobot-assisted removal of sacroiliac screws. In TiRobot-assisted removal of sacroiliac screws, compared with general anesthesia, local anesthesia may lead to shorter anesthesia time, lower anesthesia cast and shorter ambulation time, but the patients need to be compliant enough.
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Objective To study the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fracture and construct a risk assessment model.Methods A retrospective analysis was performed on 251 patients with intramedullary nail fractures of the femoral subtrochanteric fracture from February 2006 to January 2018.According to the different treatment time,the 251 patients included in this study were divided into the modeling group and the verification group.In the modeling group,postoperative fracture nonunion rate,general data,fracture related factors,surgical reduction related factors,mechanical and biological factors were calculated,and the influencing factors of fracture nonunion were screened by univariate analysis.Indicators with statistical differences in univariate analysis were analyzed using Logistic regression model for multivariate analysis to build the risk assessment model.The influencing factors were re-evaluated through the verification group,and the differentiation and calibration of the model were evaluated.Results Fracture nonunion occurred in 34 of 149 patients in the modeling group.Among the 13 potential influencing factors,univariate analysis and logistic regression analysis showed that postoperative hip varus,intramedullary nail fixation failure and complete open reduction were the risk factors of fracture nonunion.Postoperative reduction of medial cortex was a protective factor for fracture nonunion,and a regression equation was established.Based on the logistic regression model,the Nomogram diagram was drawn.In the verification group,fracture nonunion occurred in 24 of 149 patients.The area under the ROC curve was AUC=0.883 ＞ 0.7,indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation.The goodness of fit test:the H-L test (x2=2.921,P=0.712) showed that the model had a good calibration.Conclusion The risk factors of fracture nonunion were hip varus,failure of intramedullary nail fixation and complete open reduction after intramedullary nailing of subtrochanteric fracture,and postoperative reduction of medial cortex was the protective factor.The risk assessment model has moderate differentiation and good calibration,which can provide reference for the risk assessment of fracture nonunion after subtrochanteric fracture operation.
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CT three-dimensional reconstruction has been widely used in the diagnosis and classification of fractures. Fracture mapping based on the CT three-dimensional reconstruction can visually display the morphology of fracture lines by drawing a fracture model, showing the starting and ending points, progress and area of the fracture lines. It provides a new method for diagnosis and classification of fractures, operative plan and design of implants for fractures, statistic analyses of predominant fracture sites, and developing standardized fracture models. This review gives a brief introduction of the research progress at home and abroad in fracture mapping for scapular fracture, pilon fracture, ulnar coronoid fracture, tibial plateau fracture, radial head fracture, intertrochanteric lateral wall fracture and acetabular quadrilateral surface fracture, summarizes the likely sites in the above fracture models and clinical application of fracture mapping in fracture classification, and discusses the prospects and problems of this technique in clinical application.
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Objective@#To study the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fracture and construct a risk assessment model.@*Methods@#A retrospective analysis was performed on 251 patients with intramedullary nail fractures of the femoral subtrochanteric fracture from February 2006 to January 2018. According to the different treatment time, the 251 patients included in this study were divided into the modeling group and the verification group. In the modeling group, postoperative fracture nonunion rate, general data, fracture related factors, surgical reduction related factors, mechanical and biological factors were calculated, and the influencing factors of fracture nonunion were screened by univariate analysis. Indicators with statistical differences in univariate analysis were analyzed using Logistic regression model for multivariate analysis to build the risk assessment model. The influencing factors were re-evaluated through the verification group, and the differentiation and calibration of the model were evaluated.@*Results@#Fracture nonunion occurred in 34 of 149 patients in the modeling group. Among the 13 potential influencing factors, univariate analysis and logistic regression analysis showed that postoperative hip varus, intramedullary nail fixation failure and complete open reduction were the risk factors of fracture nonunion. Postoperative reduction of medial cortex was a protective factor for fracture nonunion, and a regression equation was established. Based on the logistic regression model, the Nomogram diagram was drawn. In the verification group, fracture nonunion occurred in 24 of 149 patients. The area under the ROC curve was AUC=0.883>0.7, indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation. The goodness of fit test: the H-L test (χ2=2.921, P=0.712) showed that the model had a good calibration.@*Conclusion@#The risk factors of fracture nonunion were hip varus, failure of intramedullary nail fixation and complete open reduction after intramedullary nailing of subtrochanteric fracture, and postoperative reduction of medial cortex was the protective factor. The risk assessment model has moderate differentiation and good calibration, which can provide reference for the risk assessment of fracture nonunion after subtrochanteric fracture operation.
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Objective To propose a novel regional injury classification for open pelvic fractures and characterize its application in clinical treatment.Methods The clinical data of 67 open pelvic fractures were retrospectively analyzed which had been treated from January 2001 through December 2017 at Department of Orthopedics,Affiliated Hospital to Chengdu University.They were 48 males and 19 females,from 12 to 68 years of age (average,34 years).According to the Tile classification,23 cases were type A,19 Type B and 25 Type C.Their main injuries were located at pubic perineum in 29 cases,at ilioinguinal region in 20,at sacroiliac region in 7,at ilioinguinal-perineum in 5 and at sacroiliac-perineum in 6.Our novel regional injury classification was proposed according to the assessment of soft tissue injuries at the Faringer regions.The mortalities and complications were compared between types of our regional injury classification to find associations between them.Results Despite active treatment 28 patients died,giving a mortality of 41.8％ (28/67).Our regional injury classification grouped the open pelvic fractures into 4 types:perineal type (type Ⅰ),ilioinguinal type (type Ⅱ),sacroiliac type (type Ⅲ) and composite type (type Ⅳ).The mortalities for the 4 types were respectively 20.7％ (6/29),45.0％ (9/20),71.4％ (5/7) and72.7％ (8/11).The mortality of open pelvic fractures was positively correlated with our classification (y =0.620,P =0.001).Type Ⅰ mainly included cystourethral injury,anorectal injury and infection,type Ⅱ and Ⅲ injury to iliac vessels and Type Ⅳ injury to iliac vessels and infection.The incidences of complications for type Ⅲ (100.0％,7/7) and type Ⅳ (100.0％,11/11) were significantly higher than those for type Ⅰ (82.8％,24/29) and type Ⅱ (85.0％,17/20) (P ＜ 0.05).Conclusions Our regional injury classification gives clear criteria.The mortality increases gradually with the 4 types.The incidence of complications for each type varies and thus leads to different therapies.
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Objective@#To investigate the distribution characteristics of the fracture lines on the posteromedial wall by mapping the femoral intertrochanteric fractures involving the posteromedial wall on 3D CT.@*Methods@#A retrospective study was conducted of the 136 patients with femoral intertrochanteric fracture who had been treated at Department of Orthopaedics, Affiliated Hospital to Chengdu University from January 2009 to October 2018. They were 57 men and 79 women with an average age of 64 years (from 48 to 81 years). By the AO classification, 101 cases were type 31-A2 and 35 type 31-A3. Their CT data were collected for 3D reconstruction. By comparing the specific markers on the femoral shaft and lesser trochanter, the 3D CT reconstruction images were superimposed and orientated to the standard models of intertrochanteric posteromedial wall to create a map of the fracture. The width, height, area, and fracture deviation angle of the fracture of posteromedial wall were measured to characterize the distribution of the fracture lines.@*Results@#In the 136 femoral intertrochanteric fractures involving the posteromedial wall, the height of the posteromedial wall fracture was 48.76±4.11 mm, the width 29.78±3.29 mm, the area 1,468.47±75.26 mm2, and the fracture deviation angle 49.93°±13.05°. The fracture area ratio (fracture area/posteromedial wall area) was 38.34%±16.58%. On the map of the posteromedial wall fracture, the fracture lines were densely distributed in the lesser trochanter and in front of it. In the fractures of type 31-A2, the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and below it, going obliquely from anterosuperior to posteroinferior to affect the lower calcar femorale. In the fractures of type 31-A3, the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and above it, going obliquely from anteroinferior to posterosuperior to affect the upper calcar femorale.@*Conclusion@#The fracture map can help visual understanding of the intertrochanteric fracture involving the posteromedial wall, and provide further characterization of the posteromedial wall fracture in the fractures of AO types 31-A2 and 31-A3.
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Objective To investigate the distribution characteristics of the fracture lines on the posteromedial wall by mapping the femoral intertrochanteric fractures involving the posteromedial wall on 3D CT.Methods A retrospective study was conducted of the 136 patients with femoral intertrochanteric fracture who had been treated at Department of Orthopaedics,Affiliated Hospital to Chengdu University from January 2009 to October 2018.They were 57 men and 79 women with an average age of 64 years (from 48 to 81 years).By the AO classification,101 cases were type 31-A2 and 35 type 31-A3.Their CT data were collected for 3D reconstruction.By comparing the specific markers on the femoral shaft and lesser trochanter,the 3D CT reconstruction images were superimposed and orientated to the standard models of intertrochanteric posteromedial wall to create a map of the fracture.The width,height,area,and fracture deviation angle of the fracture of posteromedial wall were measured to characterize the distribution of the fracture lines.Results In the 136 femoral intertrochanteric fractures involving the posteromedial wall,the height of the posteromedial wall fracture was 48.76 ± 4.11 mm,the width 29.78 ± 3.29 mm,the area 1,468.47 ± 75.26 mm2,and the fracture deviation angle 49.93° ± 13.05°.The fracture area ratio (fracture area/posteromedial wall area) was 38.34％ ± 16.58％.On the map of the posteromedial wall fracture,the fracture lines were densely distributed in the lesser trochanter and in front of it.In the fractures of type 31-A2,the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and below it,going obliquely from anterosuperior to posteroinferior to affect the lower calcar femorale.In the fractures of type 31-A3,the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and above it,going obliquely from anteroinferior to posterosuperior to affect the upper calcar femorale.Conclusion The fracture map can help visual understanding of the inteetrochanteric fracture involving the posteromedial wall,and provide further characterization ofthe posteromedial wall fracture in the fractures of AO types 31-A2 and 31-A3.
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Objective@#To map OTA/AO type B and type C distal radial fractures according to three-dimensional (3D) CT scan data, and to describe the morphological distribution of fracture lines.@*Methods@#A total of 468 cases of distal radius fractures admitted to the Affiliated Hospital of Chengdu University from January 2016 to March 2019 were analyzed and AO classification were performed. AO type B and type C fractures meet the inclusion criteria and then CT data were 3D reconstructed, and morphological description were performed on the fracture lines of each joint surface, including fracture shape angle, fracture area and fracture ratio. At the same time, the articular surface fracture model was superimposed on the standard model, then fracture line and fracture area distribution map were drawn to create the fracture map of intra-articular distal radial fractures.@*Result@#Intra-articular fractures of the distal radius were 209 cases, accounting for 44.7% (209/468) of the distal radius fractures, among which 67 cases of AO type B fracture. In type B fractures, average fracture height were 20.30±11.26 mm, average fracture width were 12.24±6.83 mm, average fracture area were 189.61±101.84 mm2, average angle were 57.23°±14.95°, and average area ratio of fracture (fracture zone area/joint surface area ratio) were 32.42%±10.24%. 142 cases were OA type C fracture, the average fracture height were 24.43±11.37 mm, average fracture width were 20.38±7.59 mm, average fracture area were 425.26±314.31 mm2, average angle were 51.26°±13.17°, and average area ratio of fracture were 73.81%±26.29%. According to fracture map formed by main fracture lines, five different fracture areas were identified: ① 63 cases in central area; ② 25 cases in Lister's nodule area; ③ 59 cases in scaphoid area; ④ 36 cases in lumbar fossa area; ⑤ 26 cases in lower iliac area. Main fracture lines were concentrated in the area on the dorsal side of the central area and the scaphoid area. The fracture lines of type B fracture mainly concentrated in scaphoid region, which accounted for 29.85% (20/67), and dorsal side and central area accounted for 26.87% (18/67). The fracture lines of type C fracture accounted for 27.46% (39/142) in scaphoid area and 31.69% (45/142) in central area. The fracture line of type C fracture increased in the lumbar fossa region (17.61%, 25/142) and the lower ulnar region (12.68%, 18/142) compared with type B fracture (28.69%). Compared with the type B fracture, the overall distribution of the fracture line of the type C fracture is more central.@*Conclusion@#The map of intra-articular fracture of distal radius was drawn and morphological distribution of fracture lines were quantified. Fracture-prone site and shape of fracture line were visually recognized. At the same time, description of articular surface fracture line and fracture area of type B and type C fractures of OA classification were improved, which may help with new classification and diagnosis.