Risk factors and nomogram predictive model of surgical site infection in closed pilon fractures.

OBJECTIVES: In this study, we try to investigate the risk factors of postoperative surgical site infection (SSI) in closed pilon fractures and establish a nomogram prediction model. METHODS: From January 2012 to June 2021, 516 closed pilon fracture patients were included in this study. Of these, 387 patients were randomly assigned to the training group and 129 patients were assigned to the validation group (3:1). By univariate and multivariate Cox analysis, we identified independent risk factors for postoperative SSI after Pilon fracture. We established a nomogram model and used receiver operating characteristic (ROC) and calibration chart to evaluate its discriminant and calibration. RESULTS: SSI occurred in 71 patients in the training group and 23 patients in the validation group. Ultimately, age, preoperative blood sugar, operative time, Tscherne classification and fracture classification were identified as independent risk factors for SSI. The AUC values for SSI of the training and validation group were 0.898 and 0.880, and the P value of the Hosmer-Lemeshow test was 0.125. We established a nomogram prediction model based on age, preoperative blood sugar, operative time, Tscherne classification and fracture classification. CONCLUSION: Our nomogram model had good discrimination and calibration power, so it could be used to predict SSI risk in patients with pilon fracture.

The efficacy of Schroth exercises combined with the Chêneau brace for the treatment of adolescent idiopathic scoliosis: a retrospective controlled study.

PURPOSE: We aimed to determine the global effects of the Chêneau brace combined with Schroth exercises on adolescent idiopathic scoliosis (AIS). METHODS: We analyzed 192 patients with AIS who underwent the Chêneau brace treatment alone or combined with Schroth best practice (SBP) from June 2013 to October 2019. There were 138 patients in the Brace group and 54 patients in the Brace + SBP group. Radiographs were obtained at various treatment durations. Answers to the health-related quality of life (HRQoL) questionnaire were recorded before the intervention and at the time of treatment wean. RESULTS: The Cobb angle (-3.55°; p < 0.001) and C7-CSVL (-3.03 mm; p < 0.001) significantly decreased in the Brace + SBP group. Thoracic kyphosis (TK) decreased in both the Brace + SBP group (-1.85°; p = 0.0152) and the Brace group (-5.06; p < 0.001). Changes before and after treatment of TK were significantly different between groups (p < 0.001). The 22-item Scoliosis Research Society function score, self-image, mental health, and EuroQol 5-Dimension scores were significantly higher in the Brace + SBP group. The satisfaction score was higher in the Brace + SBP group (3.77 ± 0.63 vs. 3.13 ± 0.79; p < 0.001). CONCLUSIONS: Compared to bracing alone, the Schroth exercises plus bracing had a better effect on coronal balance. Schroth exercises improve flatback deformity caused by bracing and positively influence the HRQoL in AIS patients who received the Chêneau brace treatment.Implications for RehabilitationBracing and physiotherapy are common treatments for adolescent idiopathic scoliosis (AIS).The Chêneau brace treatment causes flatback deformity and muscle stiffness in AIS patients.The Schroth method helps patients increase muscle strength, halt curve progression, increase vital capacity, and maintain improved posture.The Schroth exercises could improve flatback deformity caused by bracing and positively influence the health-related quality of life in AIS patients who received the Chêneau brace treatment.

A nomogram for predicting reduction loss risk after locking plate fixation for proximal humeral fractures.

PURPOSE: The purpose of our study was to determine the risk factors for reduction loss in patients with proximal humeral fractures after locking plate fixation and establish a nomogram prediction model. METHODS: We retrospectively analyzed the clinical data of proximal humeral fractures patients who had been surgically treated for locking plate in our institution from January 2016 to December 2018. Perioperative information was obtained through the electronic medial record system, univariate and multivariate analyzes were performed to determine the risk factors of reduction loss, and a nomogram model was constructed to predict the risk of reduction loss. The predictive performance and consistency of the model were evaluated by the consistency coefficient (C-index) and the calibration curve, respectively. RESULTS: 115 patients were finally enrolled in our study. Multivariate analysis results showed that age, fracture classification, medial comminution, and calcar screw status were independent risk factors for reduction loss. The accuracy of the contour map for predicting transfusion risk was 0.944. CONCLUSION: We found a correlation between reduction loss and age, fracture classification, medial comminution, and calcar screw status after locking plate fixation for proximal humeral fractures patients. Our nomogram is helpful for clinicians to identify high-risk patients, early intervention and reduce the incidence of reduction loss.

Changes in perioperative hemoglobin and hematocrit in patients undergoing total knee arthroplasty: a prospective observational study of optimal timing of measurement.

OBJECTIVE: This study was performed to depict the patterns of change in the perioperative hemoglobin (Hb) concentration and hematocrit (Hct) and to identify the optimal timing of Hb and Hct measurement in patients undergoing total knee arthroplasty (TKA). METHODS: This prospective observational study involved 302 consecutive patients who underwent TKA. The patients were kept in hospital for 1 full week postoperatively. Hb and Hct measurements were performed preoperatively and on days 1 to 7 postoperatively and then during clinic visits at 1, 3, and 6 months postoperatively. RESULTS: The Hb concentration and Hct decreased during the first few days postoperatively and reached a nadir on postoperative day 4 and 3, respectively; they then recovered in the following days. Significant differences in the Hb concentration and Hct were detected between the preoperative period and day 1, between days 1 and 2, between days 2 and 3, between day 7 and 1 month, and between 1 and 3 months. A significant difference in the Hct was also detected between 3 and 6 months. CONCLUSION: The optimal timing of Hb and Hct measurement is on postoperative day 3 or 4. This timing accurately reflects ongoing hidden blood loss to better guide blood transfusions.

Nomograms Predict Overall Survival and Cancer-Specific Survival in Patients with Fibrosarcoma: A SEER-Based Study.

PURPOSE: Due to the rarity, it is difficult to predict the survival of patients with fibrosarcoma. This study aimed to apply a nomogram to predict survival outcomes in patients with fibrosarcoma. METHODS: A total of 2235 patients with diagnoses of fibrosarcoma were registered in the Surveillance, Epidemiology, and End Results database, of whom 663 patients were eventually enrolled. Univariate and multivariate Cox analyses were used to identify independent prognostic factors. Nomograms were constructed to predict 3-year and 5-year overall survival and cancer-specific survival of patients with fibrosarcoma. RESULTS: In univariate and multivariate analyses of OS, age, sex, race, tumor stage, pathologic grade, use of surgery, and tumor size were identified as independent prognostic factors. Age, sex, tumor stage, pathologic grade, use of surgery, and tumor size were significantly associated with CSS. These characteristics were further included to establish the nomogram for predicting 3-year and 5-year OS and CSS. For the internal validation of the nomogram predictions of OS and CSS, the C-indices were 0.784 and 0.801. CONCLUSION: We developed the nomograms that estimated 3-year and 5-year OS and CSS. These nomograms not only have good discrimination performance and calibration but also provide patients with better clinical benefits.

A Nomogram for Prediction of Postoperative Pneumonia Risk in Elderly Hip Fracture Patients.

PURPOSE: Pneumonia is one of the common complications of hip fracture. This study aimed to evaluate the risk factors and apply a nomogram to predict postoperative pneumonia in elderly hip fracture patients. MATERIALS AND METHODS: From August 2014 to October 2019, 1113 hip fracture patients who were older than 65 years and underwent surgical treatment in our hospital were subjects of this study. Univariate and multivariate Cox analyses were used to identify independent risk factors. A predictive nomogram model was built, and the discrimination and calibration were determined by receiver operating characteristic and calibration plot. RESULTS: A total of 166 patients developed pneumonia after operation (14.91%, pneumonia group) while the remaining 947 patients did not (85.09%, non-pneumonia group). According to the results, body mass index (OR, 0.76, 95% CI, 0.70 to 0.84, P<0.001), serum albumin (OR, 0.86, 95% CI, 0.79 to 0.93, P<0.001), c-reactive protein (OR, 1.01, 95% CI, 1.00 to 1.92, P=0.011), functional status (OR, 2.94, 95% CI, 1.69 to 5.10, P<0.001) and time to surgery (OR, 4.56, 95% CI, 2.64 to 7.88, P<0.001) were identified as independent risk factors of pneumonia. The area under the curve value for postoperative pneumonia risk was 0.905, and the P-value of the Hosmer-Lemeshow calibration test was 0.529. CONCLUSION: Our nomogram model can be used to predict the risk of pneumonia in elderly hip fractures after surgery and provide clinicians with guidance for better perioperative intervention to improve prognosis and reduce mortality.

[Biomechanical assessment of newly-designed proximal femoral medial buttress plate for treatment of reverse oblique femoral intertrochanteric fracture].

Objective: To evaluate the biomechanical properties of proximal femoral medial buttress plate (PFMBP) for fixing the reverse oblique intertrochanteric fractures by comparing with proximal femoral locking compression plate (PFLCP) and proximal femoral nail antirotation (PFNA). Methods: Eighteen synthetic femoral bone models (Synbone) were divided into 3 groups (group PFLCP, group PFNA, and group PFMBP), 6 models in each group; an AO 31-A3.1 reverse oblique femoral intertrochanteric fracture was made based on the same criterion. After being fixed and embeded, the axial load testing, torsion testing, and axial load-to-failure testing were performed on each model. The axial displacement of different loads, torque of different torsion angles, and failure load of each model were recorded, and the stiffness of axial load and torsion were calculated. Results: The axial stiffness in groups PFLCP, PFNA, and PFMBP were (109.42±30.14), (119.13±29.14), and (162.05±22.05) N/mm respectively, showing significant differences between groups ( P<0.05). There were significant differences in torque between different torsion angles in the same group, as well as in the torque between groups at the same torsional angle ( P<0.05). The torsion stiffness in groups PFLCP, PFNA, and PFMBP were (1.45±0.44), (1.10±0.13), and (1.36±0.32) N·mm/deg respectively; there were significant differences when compared groups PFLCP and PFMBP with group PFNA ( P<0.05), but no significant difference was found between group PFLCP and group PFMBP ( P>0.05). The failure loads of groups PFLCP, PFNA, and PFMBP were (1 408.88± 0.17), (1 696.56±0.52), and (2 154.65±0.10) N respectively, showing significant differences between groups ( P<0.05). Conclusion: The newly-designed PFMBP is better than PFNA and PFLCP in axial load stiffness and torsion stiffness for fixing reverse oblique intertrochanteric fracture by biomechanical test, indicating that reconstruction of medial stability is a key element for unstable intertrochanteric fracture.