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Objective:To study the clinical efficacy of modified open elbow arthrolysis in the treatment of traumatic elbow stiffness.Methods:A retrospective analysis was performed on 120 patients who underwent modified open elbow arthrolysis in Beijing Jishuitan Hospital from January 2018 to December 2020. The age of the included patients was (37.7±12.4) years (ranged 18-64 years), including 54 males and 66 females. The medical records were reviewed, the range of motion (ROM) and functional status of the patients before operation and at the last follow-up were compared including visual analogue scale (VAS), Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) score. Complications and secondary operations were also recorded. Measurement data with normal distribution were presented as mean ± standard deviation( ± s) and comparison between groups was conducted using the t-test; Measurement data of skewed distribution were expressed as M ( Q1, Q3), and Rank-sum test was used for inter-group comparison. Results:The preoperative extension of 120 patients was 43.6° (33.8°, 60.1°), the flexion was 78.7° (59.8°, 98.1°), and the flexion-extension ROM was 25.6° (0.0°, 54.5°); the preoperative pronation was 51.8° (33.0°, 67.0°), the supination was 85.1° (65.7°, 90.0°), and the rotation ROM was 136.9° (99.1°, 157.5°). Postoperative extension was 14.2° (7.0°, 24.8°), flexion was 129.5° (120.0°, 138.1°), flexion-extension ROM was 115.5° (94.4°, 127.3°); postoperative pronation was 65.0° (47.1°, 75.0°), the supination was 88.3° (78.6°, 90.0°), and the rotation ROM was 151.9° (131.7°, 163.4°). Postoperative extension, flexion, flexion-extension ROM, pronation, supination, and rotation ROM were all higher than those before operation, and the differences were statistically significant ( P<0.001). The VAS of 120 patients was 1.0 (0.0, 3.0) scores before operation and 0.0 (0.0, 1.0) scores after operation. The MEPS was 60.0 (50.0, 75.0) scores before operation and 100.0 (85.0, 100.0) scores after operation. The preoperative DASH was 37.5 (20.1, 51.3) scores, and the postoperative DASH was 7.9 (3.3, 13.3) scores. The postoperative VAS, MEPS, and DASH were significantly improved compared with those before operation, and the differences were statistically significant ( P<0.001). Residual ulnar nerve symptoms occurred in 18 cases, recurrence of heterotopic ossification in 42 cases, and hematoma in 3 cases. Conclusions:Modified open elbow arthrolysis is a safe and effective surgical method for the treatment of traumatic elbow stiffness. It can significantly improve the function of the patient, reduce the occurrence of elbow instability, avoid the use of external fixators, and reduce the cost of the patient.
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Objective:To study the locational distribution characteristics of the heterotopic ossification (HO) following traumatic elbow stiffness and the risk factors for HO development at different locations.Methods:Consecutively included according to our inclusion criteria in the present study were the patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from January 2018 to December 2018 for elbow release due to traumatic elbow stiffness but developed postoperative HO. Their baseline data and CT data were collected and processed using Mimics 20.0. The HO distribution for each patient was characterized at the anteromedial, anterolateral, posteromedial, posterolateral, posterior, medial, lateral, and proximal radioulnar locations. The patient's original injury was categorized into 5 types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. After the univariate analysis with the HO occurrence at a specific location as the dependent variable and the original injury and baseline data as the independent variables, the factors with P value less than 0.1 were included in the logistic regression analysis to determine the risk factors for HO at each location.Results:A total of 91 patients were included in this study. Of them, 88 had posteromedial HO (96.7%, 88/91), 62 posterior HO (68.1%, 62/91), 60 posterolateral HO (65.9%, 60/91), 41 anteromedial HO (45.1%, 41/91), 26 anterolateral HO (28.6%, 26/91), 13 proximal radioulnar HO (14.3%, 13/91), 8 lateral HO (8.8%, 8/91), and 7 medial HO (7.7%, 7/91). Logistic regression analysis showed that presence of ulnar nerve symptoms ( OR=4.354, P=0.017) and presence of original elbow dislocation ( OR=2.927, P=0.042) were the independent risk factors for the anteromedial HO development and that presence of original olecranon fracture ( OR=0.277, P=0.023) was the protective factor for the anteromedial HO development. Presence of original radial head fracture was the independent risk factor for the anterolateral HO development ( OR=2.891, P=0.033) and the posterolateral HO development ( OR=3.123, P=0.043). Conclusions:HO development in patients with post-traumatic elbow stiffness is closely related to their original injury. Posteromedial HO may develop in almost all the patients. Patients with ulnar nerve symptoms and original elbow dislocation are more prone to anteromedial HO development, but patients with original olecranon fracture are less likely to develop anteromedial HO. Patients with original radial head fracture are more likely to develop anterolateral and posterolateral HO.
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Objective:To investigate the efficacy of TiRobot navigation for hinged external fixation in elbow arthrolysis.Methods:The 11 patients were retrospectively analyzed who had been treated by elbow arthrolysis at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital using TiRobot navigation for hinged external fixation. There were 9 males and 2 females with a mean age of 39.3 years (from 21 to 66 years). Their elbow range of motion (ROM) was compared between preoperation and the final follow-up. Their visual analogue scale (VAS) and Mayo elbow performance score (MEPS) and complications were documented at the final follow-up.Results:The rotation axis of the elbow joint was positioned with the aid of intraoperative robot navigation in 11 patients.The deviation of entry point averaged 0.21 mm (from 0.05 to 0.41 mm) and the deviation of exit point 0.23 mm (from 0.06 to 0.38 mm). The follow-up time for the 11 patients averaged 25.8 months (from 16 to 32 months). Their elbow flexion and extension was 133.0° (134.9°, 138.7°) and rotation 164.6° ±17.5° at the final follow-up, significantly improved compared with their preoperative values [0.8°(0°, 33.7°) and 122.9°±49.0°] ( P<0.05). Their VAS averaged 0.2 (from 0 to 1) and MEPS 96.8 (from 85 to 100) at the final follow-up, giving 9 excellent and 2 good cases. There was no case of radial nerve injury, pin instability, pin breakage, pin infection or peri-pin fracture. Conclusion:When TiRobot navigation is used for hinged external fixation in elbow arthrolysis, the axis of rotation can be accurately located, leading to satisfactory functional outcomes for the patients.
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Objective:To compare the clinical outcomes between OTA/AO-C open and closed fractures of the distal humerus treated by open reduction and internal fixation.Methods:The clinical data were retrospectively analyzed of the 70 patients who had been treated at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital for OTA/AO-C fractures of the distal humerus from January 2014 to June 2017. Of them, 22 suffered from open fractures (Gustilo types Ⅰ/Ⅱ) and 48 closed fractures. There were 18 males and 4 females with an age of (42.6±13.0) years in the open group and 21 males and 27 females with an age of (42.2±17.1) years in the closed group. Analyzed were interval from injury to surgery, hospitalization time, injury energy and functional outcomes which included range of motion (ROM) in elbow flexion and extension, ROM in elbow rotation, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH), complications and rate of secondary surgery.Results:There was no significant difference between the 2 groups in age, injury energy or interval from injury to surgery ( P>0.05), but there were significantly more males in the open group than in the closed group ( P=0.011). The follow-up time for all the patients averaged 34.0 months (from 25 to 54 months). There were no statistically significant differences between the 2 groups in hospitalization time [9.5(6.0, 13.0) d versus 8.5 (6.0, 11.0) d], ROM in flexion and extension [120.0° (100.0°, 137.8°) versus 128.5° (110.0°, 140.0°)], ROM in rotation [155.0° (151.3°, 155.0°) versus 155.0° (155.0°, 155.0°)], MEPS [95.0 (80.0, 100.0) versus 95.0 (80.0, 100.0)] or DASH [2.6 (0.63, 9.2) versus 1.7 (0.0, 8.5)] ( P>0.05). There were no statistically significant differences between the 2 groups either in rate of secondary surgery [36.4% (8/22) versus 33.3% (16/48)], ulnar nerve symptoms [54.5% (12/22) versus 60.4% (29/48)], local irritability in the region of internal fixation [9.1% (2/22) versus 6.3% (3/48)] or elbow stiffness [13.6% (3/22) versus 10.4% (5/48)] ( P>0.05). Conclusion:Open reduction and internal fixation can lead to similar clinical outcomes in the treatment of both open (Gustilo types Ⅰ/Ⅱ) and closed distal humeral fractures of OTA/AO-C, with no significant differences in postoperative ROM, functional scores or complications.
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Chronic elbow dislocation has a low incidence, but high disability rate, often leads to complications such as stiffness and instability, whose management is still a huge challenge in orthopedics traumatology. The mainstream strategy now is to reduce the elbow after extensive soft tissue release, repair or reconstruct collateral ligaments, stabilize the elbow with a hinged external fixator, and start rehabilitation as soon as possible. However, as evidence supporting treatment approaches comes mostly from small case series and case reports, controversies still remain in some intraoperative issues, such as the choice of surgical approach, the indications and methods of triceps lengthening and the reconstruction of ligaments. Combining relevant literature and clinical experience, the authors discussed the research progress in diagnosis and treatment of chronic elbow dislocation, suggesting that clinical doctors should focus on prevention rather than treatment of this disease, and advocated further reducing the incidence and disability rate of chronic elbow dislocation.
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Total elbow arthroplasty (TEA) is an effective surgical method for treatment of end-stage elbow arthritis. However, compared with hip and knee arthroplasties, the implant survival rate of TEA remains low, with a high postoperative complications rate and a high revision rate. The main reasons for revision include aseptic loosening, periprosthetic infection, periprosthetic fracture, component failure, and postoperative instability, of which the most common cause is aseptic loosening. Unlike the initial TEA, revision surgery usually needs to deal with complicated conditions such as infection, scars, bone defects, prosthetic stem extraction and cement removal, making the operation more difficult. There are few clinical studies related to TEA revision in China. Therefore, the authors review the reasons for postoperative revision, the management of key intraoperative issues, and the outcomes of treatment to provide the basis for future clinical application and academic research of TEA revision surgery in China.
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Objective@#To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate.@*Methods@#From January 2013 to December 2017, 54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma, Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration). According to their age, the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5±3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1±5.8 years. The 2 groups were compared in terms of perioperative data, ranges of motion (flextion, extension and rotation), numeric rating scale for pain (NRS), Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) at the last follow-up, complications and secondary surgery.@*Results@#The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy, combined injury and gender between them (P>0.05). The young group had significantly more cases of high-energy injury and combined injuries than the elderly group(P<0.05). All patients were followed up for 33.6±15.0 months (from 12 to 63 months). The total blood loss in the elderly group (643.9±298.7 mL) was significantly less than that in the young group (953.9±554.6 mL) (P<0.05). At the last follow-up, there were no significant differences between the 2 groups in ranges of motion, NRS or MEPS (P>0.05), but the elderly group had significantly higher Quick-DASH scores (13.9±14.4 points) than the young group (5.7±8.9 points) (P<0.05). There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P>0.05), but the rate of secondary surgery in the young group (37.9%, 11/29) was significantly higher than that in the elderly group (4.0%, 1/25) (P<0.05).@*Conclusions@#In the treatment of humeral intercondylar fractures, ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.
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Objective@#To investigate expert opinions on the recommendations in Expert Consensus on Optimized Treatments of Ankle Fracture in Light of Enhanced Recovery after Surgery and Expert Consensus on Optimized Treatments of Distal Radius Fracture in Light of Enhanced Recovery after Surgery so as to provide a reference for orthopaedic surgeons when they refer to the 2 documents.@*Methods@#At the symposium in November 2018, all members of Orthopaedic Trauma Committee of Bethune Public Welfare Foundation were interviewed through questionnaires. The questionnaires involved 30 recommendations from the 2 documents concerning optimized perioperative managements. The rates of recommendation and strong recommendation by these experts were calculated about the 30 recommendations from the 2 above documents.@*Results@#A total of 68 experts from the 89 members of Orthopaedic Trauma Committee of Bethune Public Welfare Foundation finished the questionnaires. Of the 30 recommendations, 26 obtained recommendation from these experts at a rate of above 95%, and 4 recommendation from these experts at a rate from 80% to 90%. The rates of strong recommendation were not high, ranging from 60% to 80% in 26 recommendations and <60% in 4.@*Conclusions@#The recommendations from the above 2 documents have been highly agreed upon by these experts we investigated but obtained a relatively low rate of strong recommendation. The present investigation may serve as a significant complement for recommendations from the 2 documents of expert consensus and a necessary reference for orthopaedic surgeons.
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Objective To investigate expert opinions on the recommendations in Expert Consensus on Optimized Treatments of Ankle Fracture in Light of Enhanced Recovery after Surgery and Expert Consensus on Optimized Treatments of Distal Radius Fracture in Light of Enhanced Recovery after Surgery so as to provide a reference for orthopaedic surgeons when they refer to the 2 documents.Methods At the symposium in November 2018,all members of Orthopaedic Trauma Committee of Bethune Public Welfare Foundation were interviewed through questionnaires.The questionnaires involved 30 recommendations from the 2 documents concerning optimized perioperative managements.The rates of recommendation and strong recommendation by these experts were calculated about the 30 recommendations from the 2 above documents.Results A total of 68 experts from the 89 members of Orthopaedic Trauma Committee of Bethune Public Welfare Foundation finished the questionnaires.Of the 30 recommendations,26 obtained recommendation from these experts at a rate of above 95％,and 4 recommendation from these experts at a rate from 80％ to 90％.The rates of strong recommendation were not high,ranging from 60％ to 80％ in 26 recommendations and ＜ 60％ in 4.Conclusions The recommendations from the above 2 documents have been highly agreed upon by these experts we investigated but obtained a relatively low rate of strong recommendation.The present investigation may serve as a significant complement for recommendations from the 2 documents of expert consensus and a necessary reference for orthopaedic surgeons.
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Objective To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate.Methods From January 2013 to December 2017,54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma,Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration).According to their age,the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5 ± 3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1 ± 5.8 years.The 2 groups were compared in terms of perioperative data,ranges of motion (flextion,extension and rotation),numeric rating scale for pain (NRS),Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm,Shoulder and Hand (Quick-DASH) at the last follow-up,complications and secondary surgery.Results The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy,combined injury and gender between them (P ＞ 0.05).The young group had significantly more cases of high-energy injury and combined injuries than the elderly group (P ＜ 0.05).All patients were followed up for 33.6 ± 15.0 months (from 12 to 63 months).The total blood loss in the elderly group (643.9 ± 298.7 mL)was significantly less than that in the young group (953.9 ± 554.6 mL) (P ＜ 0.05).At the last follow-up,there were no significant differences between the 2 groups in ranges of motion,NRS or MEPS (P ＞ 0.05),but the elderly group had significantly higher Quick-DASH scores (13.9 ± 14.4 points) than the young group (5.7 ± 8.9 points) (P ＜ 0.05).There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P ＞ 0.05),but the rate of secondary surgery in the young group (37.9％,11/29) was significantly higher than that in the elderly group (4.0％,1/25)(P ＜ 0.05).Conclusions In the treatment of humeral intercondylar fractures,ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.
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Objective To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus.Methods From January 2013 to May 2017,159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating.They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years).They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not.The stiffness group had extension-flexion and/or pronation-supination ＜ 100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥ 100° and no secondary elbow arthrolysis.Age,gender,fracture side,mechanism of injury,AO fracture classification,open/close fracture,additional fracture,preoperative nerve injury,time from injury to surgery,surgical approach,configuration of plating,medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis.Results The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months).The latest follow-up showed fracture union in all the patients.The stiffness group had 38 patients and the non-stiffness group 121.Multivariate regression analysis showed that high energy trauma (OR =3.141,95％ CI 1.396 ～ 7.070,P =0.006) and time from injury to surgery ＞ one week (OR =2.596,95％ CI 1.123 ～ 6.000,P =0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus.Conclusion The patients with high energy trauma and time from injury to surgery ＞ one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.
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Objective@#To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus.@*Methods@#From January 2013 to May 2017, 159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating. They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years). They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not. The stiffness group had extension-flexion and/or pronation-supination <100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥100° and no secondary elbow arthrolysis. Age, gender, fracture side, mechanism of injury, AO fracture classification, open/close fracture, additional fracture, preoperative nerve injury, time from injury to surgery, surgical approach, configuration of plating, medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis.@*Results@#The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months). The latest follow-up showed fracture union in all the patients. The stiffness group had 38 patients and the non-stiffness group 121. Multivariate regression analysis showed that high energy trauma (OR=3.141, 95%CI 1.396~7.070, P=0.006) and time from injury to surgery >one week (OR=2.596, 95%CI 1.123~6.000, P=0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus.@*Conclusion@#The patients with high energy trauma and time from injury to surgery >one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.
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Hyperparathyroidism is a secondary or primary endocrine disorder.In recent years,the incidence of hyperparathyroidism in China is increasing.Clinical manifestations tend to be multi-systemic injuries,which poses challenges for patients and clinicians.At the same time,with the advancement of medical science and technology,new detection means and innovative therapies are emerging.In this paper,recent progress of diagnosis and treatments is reviewed to provide basis for clinical work.
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Objective To compare the function outcome and complication of emergency operation and staged operation with enhanced recovery after surgery (ERAS) for Gustilo type Ⅰ &Ⅱ open distal humeral fractures.Methods Retrospective analysis of 22 patients with Gustilo type Ⅰ & Ⅱ open distal humeral fractures who were treated in Department of Orthopeaedic Trauma,Beijing Jishuitan Hospital from July 2013 to June 2017 was conducted.There were 18 males and 4 females,aged (42.5± 13.0) years,with an age range of 14-65 years.According to different treatment methods,all patients were divided into two groups:emergency operation group (n =6),direct internal fixation after emergency debridement;staged operation group (n =16),emergency debridement and suture,performed the second period of fixed treatment after the soft tissue condition to improve.Patient's waiting time from emergency to surgery,fasting time,surgery time,intra-op blood loss,hospital stay time,elbow range of motion,Mayo elbow performance score (MEPS),secondary surgery rate and complication at the last outpatient visit at 1,3,6,12 and June 2018,post-operatively were recorded.The measurement data of normal distribution and homogeneity of variance were expressed as mean ± standard deviation (Mean ± SD),and the independent sample t test was used for comparison between the two groups;the measurement data not conforming to the normal distribution were expressed as [M(P25,P75)].The rank sum test was used for comparison between the two groups.Comparison of count data between the two groups was performed by x2 test or Fisher exact probability method.Results The time from emergency to surgery of emergency group and staged group was [5.1(4.5,7.3) h],[160.0(102.9,221.2) h],respectively,P ＜0.001.Fasting time was [5.1(4.5,7.3) h],[12.1(9.7,13.2)h],P＜0.001.Hospital stay time was [5.5(5.0,6.5) d],[11.5(9.0,13.0) d],P=0.001.These differences were significant.Surgery time was [3.0 (2.0,3.6) h,2.6 (2.0,3.4) h].Intra-op blood loss was [75.0(25.0,225.0)ml,100.0(100.0,200.0)ml].Elbow range of motion was [155.0(141.3,155.0)°,155.0 (143.8,155.0) °].MEPS was [95.0 (83.8,100.0) scores,90.0 (80.0,100.0) scores].Secondary surgery rate was(33.3％ vs.31.2％).Complication rate was (83.3％ vs.68.7％).These differences were not significant (P ＞0.05).Conclusions ERAS's quick emergency surgery for Gustilo type Ⅰ&Ⅱ open distal humeral fractures significantly reduces the waiting time from emergency to surgery,fasting time and hospital stay time.Function outcome is comparable to the staged group.Therefore,emergency surgical procedures are recommended for patients with Gustilo typeⅠ&Ⅱ open distal humeral fractures.
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Objective To investigate the incidence and associated factors of rotator cuff injuries in patients surgically treated for proximal humerus fracture.Methods A retrospective investigation was conducted in the patients over 40 years old who had been surgically treated for proximal humeral fracture from April 10th 2017 to December 1st 2017 at Department of Traumatic Orthopaedics,Beijing Jishuitan Hospital.Intraoperative direct visualization was used to collect their clinical data concerning rotator cuff injuries in combination with proximal humeral fracture.All the data were analyzed to find the incidence,gender ratio,age distribution and fracture type distribution concerning rotator cuff injuries.Results A total of 143 eligible patients were included in this investigation.Their average age was 61.95 years and their male-female ratio 1:2.3.The incidence was 46.2％ (66/143) for all the rotator cuff injuries in proximal humerus fracture and 23.1％ (33/143) just for rotator cuff tears.There were no significant differences in age,male to female ratio or distribution of Neer fracture type between patients with rotator cuff injury and those without rotator cuff injury (P ＞ 0.05).There was no significant difference in the age and or distribution of Neer fracture type between patients with rotator cuff tear and patients without rotator cuff tear (P ＞ 0.05).The proportion of females in patients with rotator cuff tears (84.8％,28/33) was significantly higher than that in patients with no rotator cuff tears (63.6％,21/33) (P ＜ 0.05).There was no significant difference between different age groups of the patients in incidence of combined rotator cuff injury (P ＞ 0.05).Conclusions Concomitant rotator cuff injuries are relatively common in patients over 40 years old with a proximal humerus fracture.About half of the injuries may be simple wear or wear plus degeneration while the other half rotator cuff tear happening mostly in female patients.The incidence of concomitant rotator cuff injury may increase with the age of the patients with a proximal humerus fracture.
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Objective To investigate the current perioperative fasting management by Chinese traumatic surgeons for elective patients and the related awareness in Chinese traumatic surgeons.Methods Traumatic surgeons were interviewed through questionnaires which addressed the current pre-and post-operative fasting time for liquid and solid food in their hospitals,the postoperative practice to keep the patients in recumbent position without pillow,their reasons to choose perioperative fasting management and their knowledge of the current related guidelines.The associations between surgeons' information and their reasons to choose fasting management and their knowledge of the related guidelines were analyzed.Results A total of 187 valid questionnaires were collected.The percentages of the surgeons who indicated perioperative fasting time for liquid for at least 2 hours and for solid food for at least 6 hours were only 3.74％ and 27.27％,respectively.Nil by mouth from midnight for liquid or for solid food was actually indicated by 29.95％ and 31.55％ of the surgeons,respectively.64.71％ of the surgeons still required their patients to fast for liquid for at least 6 hours postoperatively,even longer for solid food.Only 1.6％ of the surgeons did not ask their patients to keep in recumbent position without pillow postoperatively whatever the anesthesia types were.Only 6.95％ of the surgeons chose a perioperative fasting protocol based on the related guidelines.Only 9.09％ of the surgeons knew the related guidelines very well.The reasons of the surgeons to choose a perioperative fasting protocol and the knowledge of the surgeons about the related guidelines were not associated with the professional ranks of the surgeons,hospital ranking or hospital location (P ＞ 0.05).Conclusions The current management of perioperative fasting is backward in the Chinese communities of traumatic orthopedics,and the related guidelines are not well implemented due to the poor awareness of them.
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Objective To investigate the current perioperative management of geriatric hip fractures in China.Methods The survey was performed between 15th to 21st of November,2017.An electric questionnaire was delivered to the orthopedic surgeons attending the 12th International Congress of Chinese Orthopedic Association (COA) and the orthopedic fellows attending grand round at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital.The questionnaire addressed the current perioperative management of geriatric hip fractures (≥ 65 years) at the departments where the participants worked,covering preoperative examination and preparation,postoperative rehabilitation and multidisciplinary collaboration.Results 171 valid questionnaires were collected for this study.Of the 171 orthopedic surgeons from 28 provinces in China,106 (62.0％) came from a tertiary hospital and 65 (38.0％) from a secondary hospital.In 74.3％ (127/171) of the hospitals,more than 100 geriatric hip fractures were treated annually.63.2％ (108/171) of the hospitals treated 100 to 500 cases annually,5.9％ (10/171) 500 to 1,000 cases and 5.3％ (9/171) more than 1,000 cases.Multidisciplinary collaboration was not established in most hospitals (71.9％,123/171) for geriatric hip fractures.Pulmonary function test (61.4％,105/171),Holter (38.0％,65/171) and ambulatory blood pressure monitoring (53.8％,92/171) were indicated as routine preoperative investigations.In 56.3 ％ (96 / 171) of the hospitals,traction was performed before operation.In 80.1％ (137 / 171) of the hospitals,the interval between admission to surgery was more than 48h for the patients.In 36.3％ (62/171)of the hospitals,patients were allowed to ambulate within one week after surgery.In 4.1％ (7/171) of the hospitals,patients were allowed full weight-bearing within one week after surgery.Conclusion Significant gaps exist in perioperative management of geriatric hip fractures between current practice in China and worldwide guidelines and consensus.
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Objective To investigate the situation of concomitant anxiety in posttraumatic elbow stiffness and analyze the risk factors for posttraumatic elbow stiffness.Methods Participants for this investigation were the outpatients who had sought special medical attention for elbow injury from September to October, 2017 and from May to June, 2018 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. Their demographic and injury-related data ( gender, age, education, injury time, injury type, treatment and rehabilitation ) were collected through questionnaires. Self-rating Anxiety Scale ( SAS ) was used to evaluate their anxiety. The range of motion ( ROM ) of the elbow was measured by the same qualified orthopedist. The relationship between posttraumatic elbow stiffness and anxiety and risk factors for stiffness were analyzed sta-tistically. Results The proportion of concomitant anxiety ( 39.2%) in the patients with posttraumatic elbow stiffness was significantly higher than that in those without posttraumatic elbow stiffness ( 10.5%, P＝0.021 ) . The SAS score for the patients with posttraumatic elbow stiffness ( 47.6 ± 11.6 ) was significantly higher than that ( 38.9 ± 8.2 ) for those without posttraumatic elbow stiffness ( P＝0.004 ). Passive rehabil-itation was a risk factor for flexion-extension stiffness. Complex intra-articular fracture, high-energy injury and passive rehabilitation were risk factors for limited forearm rotation. Conclusions Our study suggests the comorbidity of posttraumatic elbow stiffness and anxiety. Complex intra-articular fracture, high-energy injury and passive rehabilitation are risk factors for forearm rotational stiffness after elbow trauma. Passive rehabil-itation is also a predictor of less range of flexion-extension of the elbow.