A clinical randomized controlled trail of an intelligent robot-assisted minimally invasive reduction system for treatment of unstable pelvic fractures / 中华创伤骨科杂志

Objective:To compare the short-term efficacy between our self-designed intelligent robot-assisted minimally invasive reduction system and conventional freehand reduction assisted by fluoroscopy in the treatment of unstable pelvic fractures by robot or fluoroscopy-assisted internal fixation with percutaneous screws.Methods:A prospective randomized controlled trial was conducted to include eligible 35 patients with unstable pelvic fracture who were admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from December 2021 to October 2022. They were randomized into 2 groups. The observation group[17 cases, 10 males and 7 females with an age of (44.0±17.4) years] was treated with robot-assisted minimally invasive reduction, followed by robot-assisted or fluoroscopic internal fixation with percutaneous screws; the control group[18 cases, 12 males and 6 females with an age of (38.8±15.0) years] was treated with freehand reduction assisted by fluoroscopy, followed by robot-assisted or fluoroscopic internal fixation with percutaneous screws. The 2 groups were compared in terms of operation time, intraoperative bleeding, successful reduction, reduction quality, incidence of surgical complications and postoperative functional scores.Results:The 2 groups were comparable because there were no significant differences in the preoperative general data between them ( P>0.05). The intraoperative fluoroscopy frequency[(32.4±17.5) times] and fluoroscopy time [(19.8±10.4) s] in the observation group were significantly lower or shorter than those in the control group [(60.8±26.6) times and (38.2±16.1) s], and the rate of successful reduction in the observation group was 100.0% (17/17), significantly higher than that in the control group[72.2% (13/18)] ( P<0.05). There was no significant difference between the 2 groups in intraoperative bleeding, operation time, reduction error, excellent and good rate of reduction after operation by Matta scoring, or Majeed functional score at 12 weeks after operation ( P>0.05). Conclusion:In the treatment of unstable pelvic fractures, since our self-designed intelligent robot-assisted minimally invasive reduction system can plan autonomously the reduction paths and accomplish minimally invasive reduction of the fracture with 3D images real-time monitoring, it is advantageous over conventional reduction methods in a higher success rate and less radiation exposure.

Evaluation of Comprehensive Management Protocol for Reduction of the Risk of Fragility Fractures Among Osteoporosis Individuals, Visiting Teaching Hospital, Kolkata

@#Introduction: Fragility fracture from osteoporosis is a major challenging health problem in aging population in developing countries. In order to reduce the risk of development of osteoporotic fragility fractures authors made a study with high risk individuals, divided into two groups and a comprehensive management protocol had been offered in one group where as conventional management protocol had been offered in other to see the efficacy of such comprehensive management protocol to reduce the risk of occurring fragility fracture over at least three months period among the patients, attended in orthopaedic out patient department of state medical college, West Bengal. Methods: The authors selected 30 diagnosed osteoporosis clients of 50 to 90 years age as per inclusion and exclusion criteria, who attended in orthopaedic OPD in SSKM Hospital, Kolkata, West Bengal, India from 2021April to July2021, carrying highest risk factors of developing osteoporosis. Results: In experimental group, mean post test BMD score is higher than the mean pre test BMD, which is statistically significant as calculated t value is 3.666 at 14 df at 0.05 (p<0.05) level of significances. It indicates that comprehensive management protocol is effective to increase the bone strength. Conclusion: The study of comparison of mean difference values of two groups conclude that comprehensive management protocol can reduce the risk of osteoporotic fracture much efficiently in compared to standard pharmaceutical treatment in a short span of time which is applicable for long term management of osteoporosis.

Close reduction and internal fixation assisted by a 3D printed guide plate for Sanders type Ⅱ calcaneal fracture / 中华创伤骨科杂志

Objective:To compare minimally invasive treatment with versus without a 3D printed guide plate for Sanders type Ⅱ calcaneal fractures.Methods:A retrospective analysis was done of the 74 patients with Sanders type Ⅱ displaced intra-articular calcaneal fracture who had been treated at Foot and Ankle Surgery Center, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2018 to January 2020. They were divided into 2 groups according to whether a 3D printed guide plate was used or not. In the 3D printing group of 38 patients treated by minimally invasive surgery assisted by a 3D printed guide plate, there were 22 males and 16 females with an age of (41.5±3.5) years; in the control group of 36 patients treated by traditional minimally invasive surgery, there were 24 males and 12 females with an age of (40.3±7.2) years. The 2 groups were compared in terms of operation time, intraoperative fluoroscopy, American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS), Short Form 36 (SF-36), B?hler angle, Gissane angle, calcaneal length, width and height and postoperative complications.Results:There was no significant difference in the preoperative demographic data between the 2 groups, indicating comparability between groups ( P>0.05). All patients were available for a follow-up of (12.6±3.6) months (from 6 to 24 months) after surgery. The operation time [(55.3±7.1) min] and intraoperative fluoroscopy [(8.1±2.6) times] in the 3D printing group were significantly less than those in the control group [(71.2±8.7) min and (21.2±8.7) times] ( P<0.01) while the AOFAS score in the former group (81.4±6.3) was significantly higher than that in the latter (77.9±6.2) ( P<0.01). There were no statistically significant differences between the 2 groups in VAS, SF-36, B?hler angle, Gissane angle, calcaneal length, calcaneal width or calcaneus height ( P>0.05). In the control group, 4 screws were found to be too long with possible impingement on the medial structures of the foot, and 3 screws to penetrate the subtalar joint; in the 3D printing group, there were no too long or off-target screws in the sustentaculum tali. Conclusion:The minimally invasive treatment of Sanders type Ⅱ calcaneal fractures assisted by a 3D printing guide plate can reduce operation time, intraoperative fluoroscopy and potential complications, improving the clinical efficacy.

Application of corrective calcaneal osteotomy in treatment of malunited calcaneal fractures / 中华创伤骨科杂志

Malunion is a common complication following a calcaneal fracture which was not treated or treated inappropriately.It is a therapeutic target and a great challenge as well to relieve pain, correct deformity and restore the function of the affected foot in clinical treatment of calcaneal malunion. As a result of researches by scholars at home and abroad focusing on the biomechanical mechanisms underlying the symptoms caused by calcaneal malunion, a variety of corrective calcaneal osteotomy has been widely applied in clinical practice to specifically correct the calcaneal deformity and restore normal calcaneal morphology. This review expounds on the techniques, outcomes, indications and complications of corrective calcaneal osteotomies commonly used in clinic.

Do the changes of scapulothoracic angle affect winged scapula development and functional scores during clavicle fracture treatment? / As alterações do ângulo escapulotorácico afetam o desenvolvimento de escápula alada e escores funcionais durante o tratamento de fratura de clavícula?

ABSTRACT Introduction: To compare surgical and conservative management of midshaft clavicle fractures according with scapulothoracic joint angle change, considering clinical, functional, and radiological outcomes. Methods: A total of 95 midshaft clavicle fracture patients aged between 18-70 years with a minimum follow-up duration of 12 months were included in this study. Patients were treated either conservatively (Group I) or surgically (Group 2). Plane deformities, scapulothoracic joint angle, shortness and isokinetic muscle strength were measured. Shoulder Pain, Disability Index (SPADI) and Short Form-36 (SF36) were assessed. Results: Scapulothoracic joint angles were higher in the conservative treatment group than in surgery group (p=0.036). Consequently, winged scapula was seen more commonly in the conservative treatment group than in the surgery group (p=0.001). Surgical treatment was associated with significantly better SF-36 physical scores and with SPADI pain and disability scores. However, the two groups did not differ in terms of isokinetic muscle strength. Negative anteroposterior plane deformity (p<0.001) and negative axial plane deformity (p=0.004) were more frequent in the conservative treatment group. Clavicle shortness was more common in the conservative treatment group. Conclusion: According to our findings scapulothoracic joint angle changes were seen in the conservative treatment group more than in the surgery group. Consequently, winged scapula was seen more commonly in the conservative treatment group than in the surgery group (p=0.001). Level of Evidence III; Retrospective comparative study .

RESUMO Introdução: Comparar o manejo cirúrgico e conservador das fraturas da diáfise da clavícula conforme alteração do ângulo escapulotorácico, considerando resultados clínicos, funcionais e radiológicos. Métodos: Um total de 95 pacientes com fratura do terço médio da clavícula com idade entre 18-70 anos, com um tempo mínimo de seguimento de 12 meses, foram incluídos neste estudo. Os pacientes foram tratados conservadoramente (Grupo I) ou cirurgicamente (Grupo 2). Deformidades planas, ângulo escapulotorácico, encurtamento e força muscular isocinética foram medidos. O Índice de Dor e Incapacidade do Ombro (SPADI) e a Short Form-36 (SF36) foram avaliados. Resultados: Os ângulos da articulação escapulotorácica foram maiores no grupo de tratamento conservador do que no grupo de cirurgia (p=0,036). Consequentemente, a escápula alada foi vista mais comumente no grupo de tratamento conservador do que no grupo de cirurgia (p=0,001). O tratamento cirúrgico foi associado a escores físicos SF-36 significativamente melhores e escores SPADI de dor e incapacidade. No entanto, os dois grupos não diferiram em termos de força muscular isocinética. A deformidade no plano anteroposterior negativo (p<0,001) e a deformidade no plano axial negativo (p=0,004) foram mais frequentes no grupo de tratamento conservador. O encurtamento da clavícula foi mais comum no grupo de tratamento conservador. Conclusão: De acordo com nossos achados, as alterações do ângulo escapulotorácico foram mais observadas no grupo de tratamento conservador do que no grupo de cirurgia. Consequentemente, a escápula alada foi vista mais comumente no grupo de tratamento conservador do que no grupo de cirurgia (p=0,001). Nível de Evidência III; Estudo comparativo retrospectivo .

Manejo cirúrgico de fratura cominutiva de mandíbula por ferimento de arma de fogo: relato de caso / Surgical management of comminuted jaw fracture by firearms injury: case report

Os ferimentos por arma de fogo (FAF) são um grande problema de saúde pública. Na face, a mandíbula é o local de maior incidência, sendo a região de corpo mandibular a mais atingida e as lesões aos tecidos moles frequentemente a ela associadas. Em alguns casos, tais ferimentos apresentam-se de difícil resolução, sobretudo, em casos de fraturas cominutivas e lesões de tecidos moles com alta complexidade. Isso torna o atendimento desses pacientes um desafio para cirurgiões buco-maxilo-faciais. Desta forma, o objetivo deste artigo é relatar um caso de FAF em terço inferior da face, com comprometimento de tecidos moles e mandíbula, pela equipe de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Geral do Estado - Bahia. Paciente de 28 anos de idade, sexo feminino, vítima de FAF em terço inferior da face, por disparo acidental de espingarda. Ao exame clínico, pode-se observar ferimento perfuro-contuso em região de mandíbula e fratura cominutiva de corpo e ângulo mandibular à direita. A paciente foi submetida à cirurgia para remoção de fragmentos ósseos/corpos estranhos, fixação dos cotos com placa de reconstrução 2.4mm e sutura dos planos, em mesmo tempo cirúrgico, reestabelecendo a função da mandíbula. Portanto, devido à fisiopatologia variável dos FAF na mandíbula, não se indica um único padrão de tratamento para as fraturas cominutivas. Além disso, é indispensável o emprego de protocolos de limpeza cirúrgica imediata e antibioticoterapia nos casos com alto grau de cominuição, bem como, sugere-se realizar o tratamento definitivo o mais breve possível(AU)

Firearm injuries (FIs) are a major public health problem. On the face, the mandible is the place with the highest incidence of this trauma, with the mandibular body region being the most affected and the lesions to the soft tissues frequently associated with it. In some cases, such injuries are difficult to resolve, especially in cases of comminuted fractures and soft tissue injuries with high complexity. This makes the care of these patients a challenge for oral and maxillofacial surgeons. Thus, the objective of this article is to report a case of care for a FAF victim in the lower third of the face, with soft tissue and mandible involvement, by the Maxillofacial Surgery and Traumatology team at the Hospital Geral do Estado - Bahia. 28-year-old female patient, victim of FAF in the lower third of the face, due to acidental shotgun firing. On clinical examination, a perforated-blunt wound can be seen in the mandible region and comminuted fracture of the body and angle of the mandible on the right. The patient underwent surgery to remove bone fragments / foreign bodies, fix the stumps with a 2.4 mm reconstruction plate and suture the planes, at the same surgical time, reestablishing the function of the mandible. Therefore, due to the variable pathophysiology of FAF in the mandible, a single treatment pattern is not indicated for comminuted fractures. In addition, it is essential to use immediate surgical cleaning protocols and antibiotic therapy in cases with a high degree of comminution, as well as, it is suggested to carry out the definitive treatment as soon as possible(AU)

Arthroscopic surgery plus one or more posterior small incisions for calcaneal fractures / 中华创伤骨科杂志

Objective To compare the effects of arthroscopic surgery plus one or more posterior small incisions and the sinus tarsi approach in the treatment of calcaneal fracture.Methods A retrospective analysis was conducted of the 85 patients with calcaneal fracture who had been treated from January 2017 to June 2017 at Department of Foot & Ankle Surgery,Guangzhou Orthopaedic Hospital.They were 43 men and 42 women,32 to 58 years of age (average,46.0 years).Arthroscopic surgery plus one or more posterior small incisions was performed in 40 of them while the sinus tarsi approach was used in the other 45 cases.The 2 groups were compared in terms of operation time,fracture healing time,incision complications and functions of the affected foot by the American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot scores.Results There were no significant differences in the preoperative general data between the 2 groups,showing they were comparable (P ＞ 0.05).The average follow-up period for all the patients was 8 months (from 6 to 12 months).For the arthroscopic surgery group and sinus tarsi approach group,the fracture healing time was 8.6 ± 2.4 weeks and 8.9 ± 1.8 weeks,and the AOFAS ankle-hindfoot scores were 82.5 ± 5.6 and 85.1 ± 4.0,respectively,showing no significant differences between them (P ＞ O.05).The operation time in the arthroscopic surgery group (43.6 ±5.4 min) was significantly less than in the sinus tarsi approach group (56.5 ±6.4 minutes),and the rate of complications in the former[2.5％ (1/40)] significantly lower than in the latter[15.6％ (7/45)] (P ＜0.05).Conclusion Arthroscopic surgery plus one or more posterior small incisions may be a fine treatment for calcaneal fractures because postoperative incision complications can be reduced.

Clinical significance of thromboelastography and D-dimer in the assessment of thrombosis after vertebral augmentation / 中华老年医学杂志

Objective To explore changes in coagulation function,assessed by thromboelastography (TEG) combined with D-dimer (D-D),in patients undergoing percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP).Methods A total of 52 elderly patients with osteoporosis-associated vertebral compression fractures admitted into our hospital from May 2016 to November were enrolled in this study,including 13 men aged 64-91 years,with a mean age of(74.3 ± 10.5) years,and 39 women aged 60-89 years,with a mean age of(71.4 ± 7.3) years.Patients received vertebroplasty under local anesthesia,with 29 patients undergoing PVP and 23 cases taking PKP.Thromboelastography(TEG)and D-dimer(D-D)levels were measured at 1 h before,0.5 h,1 h and 3 h after bone cement injections,in order to analyze changes in patients' coagulation function.Results Compared with the coagulation parameters in patients 1 h before bone cement injections,the values of R,K,Angle,Ma,CI,EPL,LY30 and D-D had no significant difference in patients 0.5 h after bone cement injections (P ＞ 0.05);the values of R,Angle,CI,EPL and LY30 were significantly different(P ＜0.05),but the values of K,Ma and D-D had no significant difference(P ＞0.05)in patients 1 h after bone cement injections;the values of R,K,Angle,Ma,CI,LY30 and D-D had no significant difference(P＞0.05),but the value of EPL was significantly different in patients 3 h after bone cement injections(P ＜0.05).Conclusions The blood is in a transient hypercoagulable state during the time of 0.5 h to 3 h after PVP or PKP,which reaches the peak at the time of 1 h after operation,thereby increasing the risk of thrombosis.Therefore,some interventions such as anticoagulants could be carried out during the preoperative and postoperative period.Changes in coagulation function should be closely monitored after operation.Patients should start postoperative exercise early.

A preoperative risk scoring system for elderly patients with hip fracture / 中华创伤骨科杂志

Objective To verify the effectiveness of a self-designed preoperative risk scoring system for elderly patients with hip fracture.Methods A total of 286 elderly patients with hip fracture were included for this prospective study who had been admitted from February 1,2014 to February 1,2016 to Department of Trauma and Orthopedics,Peking University People's Hospital.They were divided into 5 groups according to their scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture:0 to 10 points,11 to 20 points,21 to 30 points,31 to 40 points and above 41 points.Postoperative complications and deaths were recorded.The correlations between their preoperative scores and postoperative medical complications or death were analyzed to verify the effectiveness of the preoperative risk scoring system for elderly patients with hip fracture.Results The 286 patients scored 24.9 ± 11.0 (from 0 to 69) preoperatively.The femoral neck fractures scored 24.0±11.0 and femoral intertrochanteric fractures 26.3±10.8.The incidence of medical complications was 4.00％ (1/25) in the 0 to 10 points group,4.17％ (3/72) in the 11 to 20 points group,14.66％ (17/116) in the 21 to 30 points group,23.53％ (12/51) in the 31 to 40 points group and 50.00％ (11/22) in the above 41 pints group.Conclusion As the incidence of postoperative medical complications in elderly patients with hip fracture is positively correlated with the scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture,the preoperative risk scoring system can provide an effective prediction of surgical risks.

Factors Influencing on Pressure Ulcer Incidence among Older Patients with Hip Fracture in a Hospital

PURPOSE: This study aimed to identify the incidence and risks for pressure ulcer among older patients with hip fracture. METHODS: The subject were 215 older patients suffering from hip fracture who were admitted for surgical operation from January 1, 2012 to April 30, 2016 in a university-affiliated hospital. The incidence of pressure ulcer was collected retrospectively through medical record review and the risk factors were analyzed using Cox's proportional hazard model. RESULTS: Out of the total, 32 patients (14.9%) developed pressure ulcer with the average occurrence period being 4.72 (±3.81) days. Stage II pressure ulcer was the most common at 72.0%. Risk factors included ambulation status before injury (p=.039), spinal anesthesia (p=.029), and stay at intensive care unit after operation (p=.009). CONCLUSION: Despite pressure ulcer prevention efforts, the incidence remained relatively high. Considering the identified risk factors, more efforts is needed for early detection and prevention of pressure ulcers in such patients.

Fracture Non-Union: A Review of Clinical Challenges and Future Research Needs

@#Non-union of bone following fracture is an orthopaedic condition with a high morbidity and clinical burden. Despite its estimated global prevalence of nine million annually, the limit of bone regeneration therapy still results in patients living with pain, a reduced quality of life and associated psychological, social and financial repercussions. This review provides an overview of the current epidemiological and aetiological data, and highlights where the clinical challenges in treating non-union lie. Current treatment strategies are discussed as well as promising future research foci. Development in biotechnologies to treat non-union provides exciting scope for more effective treatment for this debilitating condition.

Formulating a preoperative risk scoring system for elderly patients with hip fracture / 中华创伤骨科杂志

Objective To establish a preoperative risk scoring system for elderly patients with hip fracture on the basis of investigation into the factors influencing their mortality during hospitalization. Methods The data were collected from the database of hospitalization summary reports ( HSR ) of Beijing Public Health Commission concerning the 14, 577 patients who had been 55 years old or older and hospitalized for hip fracture from January 1, 2006 throughout December 31, 2010 at the 35 top-rank hospitals in Beijing. They were divided into a surgery group and a non-surgery group. Two multivariable risk-adjustment models were established for the 2 groups on the basis of an investigation into the factors influencing their mor-tality during hospitalization. Finally a preoperative risk scoring system for elderly patients with hip frac-ture was formulated according to the valuation of the least common multiples of β coefficients of the risk factors.Results Besides senior age and male gender, 10 different comorbidities were independently associated with in-hospital mortality, particularly pulmonary embolism, respiratory failure, renal failure and diabetes. The risk for inpatient mortality associated with a specific comorbidity was relatively higher in the surgery group than in the non-surgery group. The risk-adjustment models based on the variables had better accuracy in predicting in-hospital mortality ( ROC＝0.91 in surgery group versus ROC＝0.85 in non-surgery group ). In our preoperative risk scoring system for elderly patients with hip fracture, 10 points were for an age of 65 to 74 years old, 14 points for an age of 75 to 84 years old, 18 points for an age beyond 85 years old, 4 points for male gender, 20 points for pulmonary embolism, 18 points for respiratory failure, 10 points for renal insufficiency, 8 points for diabetes, 8 points for heart failure, 7 points for malignant tumor, 7 points for lung infection, 7 points for disturbance of water, electrolyte and acid-base balance, 6 points for arrhythmia, and 6 points for cerebral infarction, totaling 119 points. Conclusions The primary risk factors for in-hospital mortality in the elderly patients with hip fracture seem to be senior age, male gender and 10 different comorbidi-ties. A preoperative risk scoring system has been successfully established for elderly patients with hip fracture.

Preoperative deep venous thrombosis in female patients with lower extremity fracture in menstrual phase / 中华创伤骨科杂志

Objective To investigate the factors associated with preoperative deep venous thrombosis (DVT) in female patients with lower extremity fracture in menstrual phase.Methods A retrospective analysis was conducted of the 119 women with lower extremity fracture in childbearing age who had been treated at Traumatic Orthopaedics Center,Red Cross Hospital,Xi'an Jiaotong University Health Science College from October 2016 to October 2017.Of them,41 were in menstral phase,aged from 20 to 50 years (average,37.1 ± 8.9 years),and 78 were not,aged from 19 to 50 years (average,36.9 ± 8.0 years).The 2 groups were compared in terms of DVT incidence,D-dimer level,prothrombin time,partial prothrombin time,thrombin time,fibrinogen level,and preoperative bed time.Results The patients with menstruation had significantly higher incidence of lower extremity DVT (82.9％) and significantly longer preoperative bed time (9.1 ± 3.4 d) than those without menstruation did (14.1％ and 3.8 ± 2.2 d,respectively) (P ＜0.05).There were no significant differences between the 2 groups in the preoperative coagulation indexes:D-dimer,prothrombin time,partial prothrombin time,thrombin time or fibrinogen (P ＞ 0.05).Conclusions The incidence of preoperative DVT may be high the female patients with lower extremity fracture in menstrual phase,chiefly because of long preoperative bed time.Detection of D-dimer level is of limited significance in the screening for thrombosis in menstrual phase.Menstruation may not be a surgical contraindication.

Comparison of antero-posterior and anterior approaches for unstable thoracolumbar fractures / 中华创伤骨科杂志

Objective To compare the clinical efficacy of anteroposterior approach (APA) versus anterior approach (AA) for decompression,fusion and fixation for single-level unstable thoracolumbar vertebrae fractures concomitant with incomplete neurologic symptoms and injury to posterior ligament complex (PLC).Methods From February 2006 to June 2012,55 patients were treated for single-level unstable thoracolumbar vertebrae fractures.Of them,27 were treated by only anterior decompression and lateral screw-rod instrumentation and 28 by anterior decompression and fusion combined with open posterior pedicle fixation of one to two segments above and below the fracture position.The 2 groups were compared at postoperative 3 and 12 months in terms of visual analogue scale (VAS),overall score of short-form health survey (SF-36),Japanese Orthopaedics Association (JOA) score of lower back,Oswestry disability index (ODI),loss ratio of anterior margin of vertebral height,endplate angle of kyphotic deformity of superior-inferior adjacent vertebrae,wedge angle of fractured vertebra via radiographic measurement and canal compromise rate.The neurologic functional recovery was analyzed using the American Spine Injury Association (ASIA) evaluation system at postoperative 12 months.Results There were no significant differcnces in operative time,amount of blood loss or postoperative drainage between the 2 groups (P ＞ 0.05).At postoperative 3 months,the VAS and JOA scores in the APA group were significantly better than those in the AA group (P ＜ 0.05).At 12 months after surgery,the VAS,kyphotic angle of adjacent vertebra,wedge angle of fractured vertebra and the ASIA improvements in the APA group were significantly better than those in the AA group (P ＜ 0.05).There were no significant differences between the 2 groups in the other indexes at postoperative 3 or 12 months (P ＞ 0.05).All the comparative indexes were significantly improved than the preoperative values in all the patients in the 2 groups at both 3 and 12 months (P ＜ 0.05).Conclusions Compared with the merely anterior approach,the combined antero-posterior approach may have advantages of better immediate and persistent reduction,steadily rebuilding fractured alignment,continuously maintaining injured biomechanical stability,and obviously improving neurological function.As the antero-posterior approach allows for combination of posterior auxiliary reduction and fixation with anterior definitive support and decompression,it may lead to a safe and effective treatment of unstable single-level thoracolumbar fracture concomitant with incomplete neurologic and PLC impairments.

A prospective comparative study of high versus low viscosity bone cement in vertebroplasty for severe osteoporotic vertebral compression fractures / 中华创伤骨科杂志

Objective To prospectively compare the clinical efficacy between high versus low viscosity bone cement in percutaneous vertebroplasty (PVP) for severe osteoporotic vertebral compression fractures (OVCF).Methods A prospective study was conducted in 61 old patients with single severe OVCF who had sought medical attention in our hospital from August 2014 to October 2015.They were randomly assigned to group H (n =30) to receive PVP using high viscosity bone cement and group L (n =31) to receive PVP using low viscosity bone cement.The 2 groups were compared preoperatively and postoperatively in terms of visual analogue scale (VAS),Oswestry disability index(ODI),short Form-36 General Health Survey(SF-36),Kyphosis cobb's angle,height of the injured vertebra,and volume and leakage of bone cement.Results Significant improvements in VAS,ODI and SF-36 score were noted after operation in both groups,but there were no significant differences between the 2 groups (P ＞ 0.05).The 2 groups made significant improvements after operation in cobb's angle and height recovery rate of the injured vertebra;improvements in group H (14.7° ± 3.4° and 28％ ± 8％) were significantly greater than in group L (16.5° ± 2.5° and 22％ ± 7％) (P ＜ 0.05).The bone cement volumes in groups H and L were 4.94 ± 0.72 mL and 4.89 ±0.75 mL respectively,showing no statistically significant difference between the 2 groups (P ＞ 0.05).The leakage rate in group H was significantly lower than that in group L (13.33％ versus 35.48％) (P ＜ 0.05).All the patients were followed up for a mean time of 12 months (range,from 3 to 17 months).Cauda equina symptoms were observed in one patient and compression fracture of the adjacent vertebra happened in 2 patients,but no infection or pulmonary embolism occurred in any patient.Conclusions Both high viscosity cement PVP and low viscosity cement PVP can relieve back pain and improve quality of life in patients with severe OVCF,but the former may increase the efficacy and safety of PVP obviously in correction of cobb's angle,height restoration of the injured vertebra and reduction of cement leakage.

Features and treatments of teardrop fracture of the axis / 中华创伤骨科杂志

Objective To investigate the features and treatments of teardrop fracture of the axis.Methods Of the 17 consecutive patients with teardrop fracture of the axis who had been managed between January 2008 and January 2016 at our trauma center,13 were included in this study according to our research criteria.On their lateral X-ray films of the skull base,the height,width,lateral displacement and rotation of the fracture fragments were measured.Continuity of the anterior longitudinal ligament and instability of C2-3 and posterior ligamentous complex were evaluated on their cervical MRI images.Seven patients were immobilized for 3 months with the Philadelphia collar or Halo-vest device and 6 ones underwent anterior C2-3 cervical surgery.Results For patients receiving conservative and operative treatments,at the sagittal view,the height,width,lateral displacement,anterior rotation and posterior displacement of the fracture fragments averaged 12.0 mm versus 14.8 mm,6.85 mm versus 8.33 mm,7.07 mm versus 8.50 mm,20.0° versus 30.1°,and 1.71 mm versus 3.0 mm,respectively.One patient suffered C2 disc injury and 6 ones C3 disc injury.All the patients were followed up for an average of 26.4 months (from 12 to 36 months).Complications included uncomfortable swallowing in 3 cases and mild residual neck pain in one.There was no delayed union,nonunion,or vertebral instability.At last follow-ups,the mean visual analogue score for pain was 1.7 and the Japanese Orthopaedic Association scores were 17 in 11 patients and 16 in 2 patients.Conclusions Most teardrop fractures can be treated conservatively because their small fracture fragments and minor displacements can be reduced after traction.However,those with large fragments and C2-3 vertebral injury and instability should be treated by anterior cervical discectomy and fusion.

Features and treatments of teardrop fracture of the axis / 中华创伤骨科杂志

Objective To investigate the features and treatments of teardrop fracture of the axis.Methods Of the 17 consecutive patients with teardrop fracture of the axis who had been managed between January 2008 and January 2016 at our trauma center,13 were included in this study according to our research criteria.On their lateral X-ray films of the skull base,the height,width,lateral displacement and rotation of the fracture fragments were measured.Continuity of the anterior longitudinal ligament and instability of C2-3 and posterior ligamentous complex were evaluated on their cervical MRI images.Seven patients were immobilized for 3 months with the Philadelphia collar or Halo-vest device and 6 ones underwent anterior C2-3 cervical surgery.Results For patients receiving conservative and operative treatments,at the sagittal view,the height,width,lateral displacement,anterior rotation and posterior displacement of the fracture fragments averaged 12.0 mm versus 14.8 mm,6.85 mm versus 8.33 mm,7.07 mm versus 8.50 mm,20.0° versus 30.1°,and 1.71 mm versus 3.0 mm,respectively.One patient suffered C2 disc injury and 6 ones C3 disc injury.All the patients were followed up for an average of 26.4 months (from 12 to 36 months).Complications included uncomfortable swallowing in 3 cases and mild residual neck pain in one.There was no delayed union,nonunion,or vertebral instability.At last follow-ups,the mean visual analogue score for pain was 1.7 and the Japanese Orthopaedic Association scores were 17 in 11 patients and 16 in 2 patients.Conclusions Most teardrop fractures can be treated conservatively because their small fracture fragments and minor displacements can be reduced after traction.However,those with large fragments and C2-3 vertebral injury and instability should be treated by anterior cervical discectomy and fusion.

Prevalence of osteoporosis, osteopenia, fall and brittle fracture and their associated factors in men aged 80 years and over / 中华老年医学杂志

Objective To investigate the prevalence of osteoporosis,osteopenia,fall and brittle fracture and their associated factors in men aged 80 years and over.Methods In a prospective study,184 study subjects with good self-care ability aged 80 years and over were enrolled.The questionnaire included living habits,falls,comorbidities,related symptoms and medicines.The bone mineral density,hand-grip strength,gait speed,timed up and go test(TUG),chair rising test(CRT),bone turnover markers and related hormones were measured.Binary Logistic regression model was used to analyze associated factors for osteoporosis,osteopenia,fall and brittle fracture.Results The prevalence of osteoporosis (OP)and osteopenia(OPA) were 12.5 ％ (23/184) and 45.1％ (83/184) respectively in this study.The height,weight and body mass index were lower,and serum levels of procollagen type 1 N terminal propeptide(P1NP)and C-telopeptides of type 1 collagen(s-CTx)were higher in osteoporosis group than in normal bone mass(NBM) group(P＜0.05,P＜0.01).The estradiol levels were lower in OP and OPA group than in NBM group(P＜ 0.05).The risk factors for OP and OPA included smoking(OR =3.607,P＜0.05),decreased body weight (OR=0.823,P ＜ 0.05) and elevated S-CTx level (OR =12.427,P ＜ 0.01).55.4％ (102/184) of study subjects had fall history after 80-year old.The prevalence of fragile fracture was 17.4％ (4/23),18.1 ％ (15/ 83)and 3.8％(3/78)in OP,OPA and NBM groups respectively,with total prevalence of 12.0％ (22/184).The risk factors for fragile fracture were a decreased total hip BMD(OR 0.017,P＜0.05)and fall history after 80-year-old(OR 13.126,P ＜ 0.05).Conclusions Based on associated factors of osteoporosis,osteopenia,falls and fragile fracture in male aged 80 years and over,the primary and secondary prevention of osteoporosis may need a comprehensive geriatric intervention including lifestyle adjustment,fall prevention and pharmacologic treatments.

Audiologic Patterns of Otic Capsule Preserving Temporal Bone Fracture: Effects of the Affected Subsites

OBJECTIVES: This study was aimed to assess the relationship between the type of temporal bone area involved and conductive hearing loss. METHODS: We enrolled 97 patients who visited the otolaryngology clinics of Seoul National University Hospital or Boramae Medical Center, Seoul Metropolitan Government-Seoul National University with temporal bone fracture between January 2004 and January 2014. Audiometric parameters, including initial and improved air-bone (AB) conduction gap values, were reviewed in accordance with the temporal bone computed tomography (external auditory canal [EAC], middle ear [ME], mastoid [M], and ossicle [O]). RESULTS: Patients with ossicular chain involvement exhibited a larger AB gap compared to those with no ossicular chain involvement at 250, 1,000, 2,000, and 4,000 Hz. Among the groups without ossicular chain involvement, the initial AB gap was largest in patients with EAC+ME+M involvement, followed by the ME+M and M-only involvement groups. The greatest improvement in the AB gap was observed in the EAC+ME+M group followed by the ME+M and M-only groups, irrespective of ossicular chain involvement. Improvements in AB gap values were smallest at 2,000 Hz. CONCLUSION: Conductive hearing loss pattern differed according to the temporal bone area involved. Therefore, areas such as the hematoma and hemotympanum, as well as the fracture line of the temporal bone area, must be evaluated to predict audiologic patterns with otic capsule preserving temporal bone fracture.

Morphological characteristics of distal fibula and their clinical relevance: a research based on computer-assisted orthopaedic techniques / 中华创伤骨科杂志

Objective To provide references for anatomical reduction and correct implantation in treatment of distal fibular fracture by analyzing morphological characteristics of distal fibula on three-dimensional (3D) modes.Methods 16-row spiral CT scans of 126 normal ankle structures from May 2009 to June 2014 were collected.Surface shaded display technique was used to reconstruct 3-D images of bones around the ankle.The distal fibula was extracted using 3D segmentation technique.The parameters of distal fibula were measured by selecting points,lines and surfaces on the 3D models.Results The morphological characteristics of distal fibula were complicated.Significant differences were observed between males and females in most parameters (P ＜ 0.05),but not in the length between the plane of the most lateral point of the tibial anterior node and the most distal point of the fibula,the length between the midpoint of lateral border of the fibula and its opposite cortex on the plane of the most proximal border of the fibular fossa or the mean angle of posterior crest of the fibula (P ＞ 0.05).The intra and interclass correlation coefficients (ICC) were excellent.Conclusions When a lateral plate is used for internal fixation of distal fibula,the plate should be placed as proximally as possible.When a posterior-lateral plate is used,the screws to be inserted on the plane proximal to the initial point of anterior node of the tibia can be fixed bi-cortically.When a posterior plate is used,pre-contour of the plate before insertion is required.