External fixation in proximal Humerus Fracture in elderly and co- morbid patients

Fractures around proximal humerus are common injuries occurring in predominantly elderly female population associated with osteoporosis. Elderly age group associated with comorbidity gives good outcome with minimal intervention with external stabilization of the fracture avoiding major surgical procedure on proximal humerus. Objective:to study the outcomes of fixation of proximal humerus fracture by external stabilizing system in elderly, osteoporotic and comorbid patients. Methodology:we did study of 30 Neers type 3 and type 4 fracture patients in span of 12 months from fracture in which 17 were female and 13 were male patients. The age group was 50 to 75. The results external fixation of fracture was evaluated as per Neers criteria. Results:all 30 patients were followed till fracture got union. In Neers type 3 fracture 13 (81.25%) patients got good results while in type 4 fractures 09 (64.28%) patients got good results. Conclusion: external stabilization of Neers type 3 and 4 proximal humerus fracture patients who are elderly, osteoporotic and comorbid shows excellent outcome with this minimally invasive stabilizing system.

Risk Factors Associated with Failure of Cephalomedullary Nail Fixation in the Treatment of Trochanteric Hip Fractures

BACKGROUND: Intramedullary (IM) nailing is widely performed in elderly patients with trochanteric fractures. Thus, it is important to identify causative factors associated with fixation failure. We investigated fixation failures after IM nailing in elderly patients with trochanteric fractures and compared the failure group with nonfailure group to identify risk factors of fixation failure.METHODS: A total of 396 patients aged 65 years or older underwent IM nailing for trochanteric fractures between January 2012 and August 2016 at our institution. Of those, 194 patients who were followed up for more than 12 months were enrolled in this study; 202 patients were excluded due to death during follow-up, bedridden status before injury, and loss to follow-up. All patients underwent plain radiography and preoperative computed tomography (CT).RESULTS: Fixation failure occurred in 11 patients (5.7%). Seven patients had stable fractures (AO/OTA); eight patients had basicervical fractures (confirmed by CT). Five patients had comminution in the greater trochanter (confirmed by CT). Regarding fracture reduction, eight patients showed discontinuity in the anterior cortex. The position of the lag screw on the lateral view was in the center in six patients and in a posterior area in the other five patients. On the basis of comparison with the 183 patients without fixation failure, risk factors of fixation failure were higher body mass index (BMI; p = 0.003), basicervical type of fracture (p = 0.037), posterior placement of the lag screw on the lateral view (p < 0.001), and inaccurate reduction of the anterior cortex (p = 0.011).CONCLUSIONS: Among the risk factors of fixation failure after IM nailing in elderly patients with trochanteric fractures, discontinuity of the anterior cortex and posterior position of the lag screw are modifiable surgeon factors, whereas higher BMI and basicervical type of fracture are nonmodifiable patient factors. Therefore, care should be taken to avoid fixation failure in IM nailing for patients with a basicervical type of fracture or higher BMI or both.

Impact of intertrochanteric cortical thickness on hip fracture types under dynamic load: A finite element analysis / 医学研究生学报

Objective The influence of intertrochanteric cortical thickness on hip fracture can be investigated by the finite element method (FEM), but few dynamic FEMs have been established to manifest the extension of the crack. This study aimed to investigate the influence of intertrochanteric cortical thickness on the proximal femoral fracture types by FEM.Methods We recruited a healthy male volunteer from the Department of Traumatic Orthopedics, the First Affiliated Hospital of Guangzhou University of Chinese Medicine in October 2017, established a 3-dimention model, and reconstructed thick, middle and thin intertrochanteric cortex proximal femur models by meshing, defining material properties and setting boundary conditions. We measured the crack moment and von Mises stress, distribution of the fracture line, and the time-stress curves of the earliest damage element.Results Fracture occurred the earliest in the thin-cortex femur model but the latest in the thick one. The von Mises stress contour plot showed that, when damage started, the stress was concentrated on the posterior femoral neck and intertrochanteric region, extending to the posterior inferior part of the lesser trochanter in all the three models and, with the decline of the intertrochanteric cortex thickness, the concentration of the von Mises stress gradually narrowed down and shifted to the intertrochanteric region. The narrowing of the von Mises stress was the most obvious in the thin-cortex model, mainly distributed on the junction of the basal femoral neck and the intertrochanteric region. With the thinning of the cortex, the lesser trochanter became the region of stress concentration. The time-stress curves showed that fracture occurred the earliest in the thin-cortex model, with the maximum stress of 51.6 Mpa, but the latest in the thick-cortex model, with the maximum stress of 96.4 Mpa, and the maximum stress was 89.7 Mpa in the middle cortex model.Conclusion The thickness of the intertrochanteric cortex may be a determinant in the types of hip fracture.

Analysis of clinical outcome of kyphoplasty on costal pain related to thoracic osteoporotic compression fractures / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the clinical outcome of kyphoplasty on costal pain which develops following thoracic osteoporotic compression fractures and evaluate the factors related to costal pain.</p><p><b>METHODS</b>From May 2014 to May 2016, a total of 188 patients with thoracic osteoporotic compression fractures undergoing kyphoplasty were reviewed retrospectively. The patients were divided into two groups: the costal pain group included patients who had costal pain after a vertebral fracture and the no costal pain group included patients without costalgia. Visual analogue scale(VAS)and Oswestry Disability Index(ODI)of all patients were measured preoperatively and 3 days, 1 month, 6 months postoperatively respectively. Gender, age, the fracture level, bone mineral density, vertebral body fracture type, and fracture severity were compared between two groups, and the causes of costal pain were analyzed.</p><p><b>RESULTS</b>Among 188 patients, 38 patients (20.2%) complained of costal pain with back pain. The mean follow-up time was 8.3 months (ranged from 6 to 15 months). The VAS and ODI score of two groups decreased after operation, and there was significant difference between pre-operation and post-operation(<0.05). There was significant difference in VAS score and ODI score between two groups at 3 days and 1 month postoperatively (<0.05). There was no significant difference in VAS score and ODI score between two groups at 6 months postoperatively (<0.05). The incidence of applanation-type deformity and severe fracture in the costal group were higher. The fracture type and fracture severity showed significantly difference between two groups(<0.05).</p><p><b>CONCLUSIONS</b>The fracture type and fracture severity had significant relation to costal pain of thoracic osteoporotic compression fractures. The kyphoplasty effect on costal pain may not be effective, especially during early post-operation period.</p>

Analysis of related factors affecting in condylar buttress plate surgical treatment of distal femoral fractures / 国际生物医学工程杂志

Objective To analyze of related factors in affecting condylar buttress plate (CBP) surgical treatment of distal femoral fractures.Methods One hundred patients with distal femoral fractures were grouped according to eight related factors (gender,age,fracture type,fracture classification,surgical time,reset quality,whether bone graft and plaster braking),respectively.Operative efficacy was scored by the Neer knee functional score table,and score ≥ 72 was excellent,while ＜ 72 was good.Eight related factors were carried out single factor analysis with x2 test to compare the operative efficacy of each group,then the related factors with single factor analysis result of P＜0.05 were put in Logistic multifactor regression analysis,in order to clarify the independent risk factors for CBP treatment of distal femoral fractures.Results There was no significant difference (P＞0.05) in the operative efficacy between male and female group,open fracture and closed fracture group.The difference between youth,middle-aged and elderly group,type A and type C fracture group was statistically significant (P＜0.05).The operative efficacy of patients got surgery within 7 d was obviously better than those who got surgery 7 d later (P＜0.05).The operative efficacy of patients who had no intraoperative bone graft was better than those who had bone graft (P＜0.05).The operative efficacy of satisfactory reset group and none plaster braking group was better than that of unsatisfied reset group and plaster braking group (P＜0.05),respectively.Conclusions Age,fracture type and reset quality are CBP therapy independent risk factors for the efficacy of operation for patients with distal femoral fractures,which will provide some reference for improving the operative efficacy of CBP operation in treatment of distal femoral fractures.

Choosing the treatment strategy of inter-trochanteric femoral fracture according to Singh index and type of fracture / 中国综合临床

Objective To study the efficacy of Singhindex and fracture-type-based treatment strategy on inter-trochanter femoral fracture.Methods Sixty four patients who suffered from inter-trochanteric femoral fracture from 2007 to 2010 were recruited into this study.The pattern of fixation was determined according to the preoperative Singh index and fracture type.The efficacy of fixation was compared with that of the previously treated 127 cases in the same condition.Results The healing time of fracture in the study group was 10.5 ± 1.2 weeks,which was significantly shorter than 12.6 ± 2.4 weeks of the control group( t =4.27,P ＜ 0.05 ).Fixationrelated complications were observed in 3 cases in the study group and 17 cases in the control group,which was statistically different between the two groups ( x2 =5.74,P ＜ 0.05 ).The percentage of patients with excellent outcome in the study group was 91％ (58/64),significantly higher than 84％ ( 107/127 ) of the control group ( x2 =6.28,P ＜ 0.05 ).Conclusion Treating the inter-trochanteric femoral fracture according to Singh index and fracture type will create improved clinical efficacy.