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Objective:To investigate the effects of lengths of intramedullary nails on the treatment efficacy of osteoporotic unstable intertrochanteric fracture.Methods:Retrospectively analyzed were the data of patients with osteoporotic unstable intertrochanteric fracture who had been admitted to Department of Orthopedics, China-Japan Friendship Hospital from January 2017 to December 2019. According to the lengths of intramedullary nails, the patients were divided into 2 groups. In the short nail group of 135 cases, there were 38 males and 97 females with an age of (82.2 ± 7.7) years and an intramedullary nail with a length of 170 mm was used. In the long nail group of 32 cases, there were 8 males and 24 females with an age of (81.5±7.1) years and an intramedullary nail longer than 300 mm was used. The amount of intraoperative hemoglobin drop value, operation time, Harris hip score at 6 months after surgery, incidence of complications and mortality were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability between groups ( P>0.05). There were no significant differences between the 2 groups in intraoperative hemoglobin drop value [(19.8±2.2) g/L versus (20.0±2.1) g/L], Harris hip score (72.0±3.0 versus 71.2±3.6), incidence of complications [3.0% (4/135) versus 6.2 (2/32)] or mortality [14.3% (19/135) versus 15.6% (5/32)] ( P>0.05). The long nail group needed significantly longer operation time than the short nail group [(84.6±5.6) min versus (92.0±7.2) min] ( P<0.05). Conclusions:In the treatment of osteoporotic unstable intertrochanteric fracture, short and long intramedullary nails show no significant difference in hemoglobin drop value, functional score, complications or mortality, indicating they can both lead to safe and reliable curative efficacy. However, long nails need longer operation time.
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Objective:To analyze the influence of comprehensive rehabilitation on postoperative functions in the elderly patients with femoral intertrochanteric fracture.Methods:From June 2015 to June 2019, 144 elderly patients were treated at Department of Orthopedics, China-Japan Friendship Hospital for femoral intertrochanteric fractures by internal fixation with proximal femoral nail anti-rotation (PFNA). Of them, 65 received comprehensive rehabilitation, including intervention measures for details, prevention and management of comorbidities and complications and active exercise of the injured limb, while 79 conventional rehabilitation. In the comprehensive rehabilitation group, there were 22 males and 43 females with an age of (76.6±6.7) years, and 18 cases of type 31-A1, 35 cases of type 31-A2 and 12 cases of type 31-A3 by the AO type. In the control group, there were 23 males and 56 females with an age of (75.2±7.0) years, and 25 cases of type 31-A1, 39 cases of type 31-A2 and 15 cases of type 31-A3 by the AO type. The 2 groups were compared in terms of visual analog scale (VAS), Harris hip score, Barthel index, postoperative ambulation time and complications at 6 months after operation.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative or intraoperative general data ( P>0.05). The comprehensive rehabilitation group had a significantly lower VAS score (1.5±1.0), a significantly higher Harris hip score(83.9±5.4), a significantly higher Barthel index (81.6±5.4), significantly shorter postoperative ambulation time [(2.6±1.0) d], and a significantly lower incidence of complications [4.6% (3/65)] than the control group did [1.9±1.2, 80.2±7.9, 78.2±7.9, (3.2±1.4) d, 16.5%(13/79), respectively] (all P< 0.05). Conclusion:For elderly patients with femoral intertrochanteric fracture, comprehensive rehabilitation can significantly reduce complications, promote functional recovery of the hip, and speed up recovery of capabilities of daily living compared with conventional rehabilitation.
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Objective:To explore the incidence and morphology of the posterolateral fracture fragment affecting the fibular notch in posterior pilon fracture.Methods:A retrospective analysis was conducted of the CT and clinical data of the 31 patients with posterior pilon fracture who had been treated at Department of Orthopaedic, China-Japan Friendship Hospital from May 2013 to May 2018. They were 17 men and 14 women, aged from 20 to 68 years (average, 42 years). The injury affected the left side in 13 cases and the right side in 18 ones. The incidence of the posterolateral fracture fragments affecting the fibular notch was counted. The morphologic indexes of the fragments were measured like axial angle of their fracture line, fragment area, fragment height, and sagittal angle of their fracture line.Results:A posterolateral fracture fragment affecting the fibular notch was found in all the 31 posterior pilon fractures, giving an incidence of 100% in the posterior pilon fracture. The fracture line of the fragments tended to be in the coronal plane. The axial angle of the fracture line was 20.25°±9.48°; the ratio of the fragment area to the distal tibial articular area was 15.78%±6.75%; the fragment height was 36.59 mm ± 10.70 mm; the sagittal angle of the fracture line was 18.37°±5.45°.Conclusions:A posterolateral fracture fragment affecting the fibular notch can be found in all the posterior pilon fractures. It does not affect a large articular area and its fracture line is usually located in the coronal plane. These data may help choose appropriate surgical approach and internal fixation.
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Objective To compare the outcomes of Dresden technique versus open surgery for acute Achilles tendon ruptures.Methods From January 2013 to June 2017,67 patients were operatively treated for acute Achilles tendon rupture at Department of Orthopaedics,China Japan Friendship Hospital.Of them,Dresden technique was used in 32(minimally invasive group) and open surgery in 35(open surgery group).The 2 groups were compared in terms of baseline characteristics,operation time,operative incision length,hospital stay,postoperative complications like incision infection and tendon re-rupture and the Achilles Tendon Total Rupture Score(ATRS).Results The 2 groups were compatible due to insignificant differences in the baseline characteristics(P>0.05).They were followed up for 18 months.The minimally invasive group had significant shorter operation time(40.0min),incision length(3.0cm) and hospital stay(5 d) than the open surgery group(42.5 min,10.0 cm and 6 d)(P<0.05).No sural nerve lesion was observed in either group.The rate of wound complications was 0% for the minimally invasive group and 8.6% for the open surgery group;the rate of re-rupture was 3.1% for the former and 2.9% for the latter;the ATRS at the final follow-up was 98.0 for the former and 98.5 for the latter.There were no significant differences between the 2 groups in the above comparisons(P>0.05).Conclusions Percutaneous suture of the Achilles tendon with the Dresden instruments is a safe,fast and standardized surgical procedure for acute Achilles tendon ruptures,leading to shorter operation time,incision length and hospital stay,better functional recovery and a tendency of decreased wound complications than the open surgery.
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Objective To investigate the effect of intraoperative dripping of intravenous tranexamic acid (TXA) on the perioperative blood loss in elderly patients undergoing hip arthroplasty for femoral neck fracture.Methods From January 2016 to August 2017,118 elderly patients with femoral neck fracture were treated with hip arthroplasty at Department of Orthopaedics,China-Japan Friendship Hospital.They were 45 males and 73 females,with an average age of 77.1 years.Of them,60 (TXA group) were subjected to intravenous TXA dripping over 10 minutes by 2 doses (15 mg/kg TXA dissolved in 100 mL of saline) with the first dose before incision and the second one at wound closure;58 (control group) were subjected to intravenous administration of 100 mL of saline solution in a similar fashion.Blood routine tests were carried out one day before operation,and the first and third days after operation.The transfusion rate and volume,and surgical blood loss were recorded.The total blood loss on postoperative 1-day and 3-day were calculated according to hemoglobin balance method.The 2 groups were compared in terms of blood loss and complications.Results The blood transfusion rate (21.7％),blood transfusion volume (310.8 ± 85.7 mL),surgical blood loss (424.3 ± 87.6 mL),total blood loss on postoperative 1-day (1,284.6 ±288.7 mL) and total blood loss on postoperative 3-day (1,501.2 ± 337.1 mL) in the TXA group were all significantly lower than those in the control group (41.4％,379.8 ± 110.2 mL,526.7 ± 113.8 mL,1,534.8 ± 279.2 mL and 1,887.4 ± 431.8 mL,respectively) (P ＜ 0.05).There was no significant difference between the 2 groups in postoperative complications (P ＞ 0.05).Conclusion In elderly patients undergoing hip arthroplasty for femoral neck fracture,intravenous TXA administration may lower transfusion rate,reduce transfusion volume,and decrease surgical blood loss and postoperative total blood loss without increasing the risks of surgery-related complications like thrombosis.