Effect of "Teddy Bear Simulation Hospital" in cultivating the humanistic care ability for pre-clinical medical students / 中华医学教育探索杂志

The cultivation of medical students' humanistic care ability is one of the most important tasks of medical education. In this study, "Teddy Bear Simulation Hospital" was launched to cultivate humanistic care ability for pre-clinical medical students in the early stage. Firstly, pre-clinical students were organized to visit clinical functional zoning and diagnosis and treatment processes, listen to pediatrician lectures, and understand the diagnosis and treatment process of pediatric patients. Then, students were organized to build a simulated hospital for kids in the kindergarten with reference to the actual situation and carry out simulated diagnosis and treatment. In the process of implementation, students divide the labor, make the plan and take the action independently. After the simulation scenario was created, the kids played the role of parents of the sick children, and their favorite plush toy was pretended to be the sick baby; the medical students played the various roles of the medical staffs in the simulated hospital to carry out various diagnosis and treatment activities in an orderly manner. The results showed that the activity has provided a safe and friendly simulation diagnosis and treatment platform for pre-clinical students. In the interaction with children, the humanistic care ability of the students was significantly improved.

Application of an innovational hybrid simulation-based education of bone traction with co-Debriefer for medical students / 中华医学教育探索杂志

Objective:To develop an innovational hybrid simulation-based education of bone traction with co-Debriefer for medical students and to evaluate its effectiveness.Methods:This study was designed as a cross-controlled study. From June 2018 to June 2019, 28 medical students were randomized into two groups. The two groups adopted simulation-based education and traditional teaching method respectively. In the second week of internship, the teaching methods of the two groups exchanged. Scores rating of the skill were used to assess the students' performance in the end of each teaching methods. SPSS 23.0 software was used to analyze the collected data.Results:In the first weekend of orthopedic-internship, students in the experimental group scored significantly higher than the control group, with an average score of 85.07 points versus 67.92 points. In the second weekend of practice, there was no obvious change in the skill score of the experimental group, but the score of the control group was significantly improved, and there was no obvious difference with the experimental group.Conclusion:The hybrid simulation-based education with co-debriefing is a reliable teaching method for medical interns to learn skills of bone traction, which can effectively help improve students' skills, reduce their errors, and ensure patient's safety.

The application of distal aiming system in humeral intramedullary nailing / 中华骨科杂志

Objective To investigate the value of electromagnetic field real-time system (EFRTS) in the distal locking of intramedullary nailing for humeral shaft fractures.Methods From April 2015 to January 2017,data of 32 consequent patients with humeral shaft fracture (22 males,10 females;ranged from 18 years to 78 years old,average of 40.4 years;9 domestic falls,15 traffic accidents,6 fall from height,and 2 sports injury;AO12 A1:9 cases;A2:14 cases;A3:4 cases;B2:5 cases) were retrospectively analyzed.All were treated with Humeral Antegrade Locking Nail.For inserting the two distal locking screws,the SURESHOT Distal Targeting System was used.Results Accurate placement of the distal screws was accomplished in all 32 cases,which meant one drilling and one screw locking.The mean duration of the two distal screw locking was 197±30 s (range,156-253 s) in the preparation phase and 393±39 s (range,336-481 s) in the operation phase.The mean follow-up period was 18 months,ranging from 11 to 25 months.All the fractures were healed in an average time of 15.9 weeks,ranging from 12 to 20 weeks.The range of motion was:80° to 180° in abduction (155° in average),80° to 180° in anteflexion (160° in average),60° to 100° in external rotation (80° in average),and 17 cases internal rotation to L3 level,10 to T12 level and 5 to T7 level.The mean score of ConstantMurley was 89,ranging from 74 to 96.All the patients obtained good results.27 patients restored self-care ability within 3 months after surgery.Shoulder discomfort occurred in 2 patients because of nail tail outside the articular surface.The symptom recovered after removal of the nail as well as joint release in arthroscopy.Conclusion The distal aiming device can be used in humeral intramedullary nailing,by which the distal screw can be inserted by one time.Meanwhile,it has the advantages of short time-consuming,secure operation,and no X-ray radiation.

Suprapatellar nailing for treatment of segmental tibial fractures / 中华创伤骨科杂志

Objective To explore the therapeutic advantages of suprapatellar nailing for treatment of segmental tibial fractures. Methods Twenty-one tibial segmental fractures were managed and followed-up regularly in our hospital from March 2012 to August 2018. They were 15 males and 6 females, with an average age of 46.0 years (range, from 26 to 71 years). There were 13 cases of type Ⅰ,4 cases of type Ⅱ, 2 cases of typeⅢand 2 cases of typeⅣ, according to Melis classification. There were totally 10 open fractures (5 cases of type Ⅰ, 2 cases of type Ⅱ, one case of type ⅢA and 2 cases of type ⅢB, according to Gustilo classification). All the cases received closed reduction and internal fixation with suprapatellar locked tibial nailing of the third generation. Non-weight-bearing exercises of the knee and ankle and muscular strength training for the low ex-tremity commenced 3 days after internal fixation. The knee functions were evaluated postoperatively using the Lysholm knee scoring. Results All the 21 cases were followed up for 10 to 36 months (average, 17.8 months; more than 3 times during at least 10 months). X-ray revealed occurrence of the callus from 2 to 11 months (average, 7.1 months) after operation. One case of nonunion occurred at the tibial mid-shaft. There was no wound infection, soft tissue necrosis or osteomyelitis. Two cases complained of knee pain and 5 cases of ankle pain, with VAS scores ranging from 2 to 3. After symptomatic management, the knee pain was relieved in 2 cases after 5 months and the ankle pain was relieved in 3 cases. The average Lysholm score 10 months after surgery was 95 points (range, from 87 to 99 points). Conclusion Suprapatellar nailing is an effective treatment for segmental tibial shaft fractures, especially for those involving injuries to the metaphyseal region and peripatellar soft tissue, because it can provide effective fixation of the multiple metaphyseal fractures and avoid disadvantages of conventional intramedullary nailing, leading to limited postoperative knee pain.

Research advances in the mechanism of osteoarthritis caused by the mechanical instability / 上海交通大学学报（医学版）

Osteoarthritis is a common articular cartilage degenerative disease and the main cause is mechanical instability. The mechanical instability can reduce the number of chondrocytes and destroy extracellular matrix through direct injury, inducing cell apoptosis, and stimulating the production of inflammatory factors, leading to decrease of matrix typeⅡ collagen and proteoglycan and degeneration of cartilage. Long-term cartilage degeneration can result in osteoarthritis. Therefore, understanding how mechanical instability leads to the incidence of osteoarthritis can better improve the course of osteoarthritis from the perspective of mechanics.

Treatment of early infection after fracture internal fixation by water jet debridement combined with negative pressure wound therapy / 中华创伤骨科杂志

Objective To evaluate the effectiveness of water jet debridement combined with negative pressure wound therapy (NPWT) for the treatment of early infection after fracture internal fixation.Methods The study cohort included 6 men and one woman with an average age of 43.6 years (range,from 36 to 58 years) who had presented with early infection after fracture internal fixation from October 2013 to March 2015.All the patients sustained closed fractures initially.The wound debridement was done within 3 to 5 days after the infection was confirmed.The length and depth of an incision was determined by the methylene staining range.Water jet was used to eliminate the dying tissues thoroughly from a shallower layer to a deeper layer while the internal fixator was retained.The wound was closed by full thickness sutures in a sparse fashion for drainage.Sensitive antibiotics were systematically administered for all the patients.The NPWT device was kept for 5 days.Results All the wounds healed uneventfully after an average of 18 days (range,from 10 to 25 days).The mean follow-up time was 12 months (range,from 8 to 24 months).No antibiotics were used during follow-up.There were no local or systematical symptoms like new sinus,broken wound or fever.Bony callus formed at the fracture sites after an average of 4.3 months (range,from 2.5 to 8.0 months) and no fracture nonunion happened.All the fractures healed after an average of 10.1 months (range,from 5.5 to 16.0 months).All the patients were satisfied with their treatment outcomes.Conclusion Since water jet provides simple,rapid and radical debridement while NPWT simplifies operative procedures and promotes wound healing,combination of the two can be an effective treatment for early infection after fracture internal fixation.

Anterior subcutaneous internal fixation with triple pedicle screws for treatment of Tile type B pelvic fractures / 中华创伤杂志

Objective To evaluate the clinical outcome of anterior subcutaneous internal fixator (ASIF) system with triple pedicle screws in stabilizing Tile type B pelvic fractures.Methods From August 2013 to April 2015,38 cases of pelvic fractures were stabilized with the ASIF system using triple pedicle screws.There were 24 male and 14 female cases,with the age range of 16-74 years [(41.5 ±5.5) years].Causes of injury were traffic accidents (n =28),crushing injury (n =6) and fall from height (n =4).All cases had Tile type B fractures,including 5 cases of type B1,29 type B2 and 4 type B3.Intraoperative blood loss,operation time,length of hospitalization and complications were detected.Postoperative function evaluation was done using the Majeed score.Results All cases were available for follow-up of 6.5-13.5 months (mean,10.5 months).Intraoperative blood loss was (30.8 ± 7.1)ml,operation time was (51.5 ± 9.2) minutes,and length of hospitalization was (5.0 ± 3.1) days.Among them,34 cases showed bilateral hip flexion over 95 degrees after operation,and 24 cases were able to squat fully 1.5 months after operation.No cases experienced nonunion,delayed union,superficial or deep surgical wound infection,urethral injury and dysuresia.Two cases developed temporary lateral femoral cutaneous nerve numbness.According to the Majeed score,excellent results were found in 32 cases (84％) and good results in 6 cases (16％).Conclusion ASIF system with triple pedicle screws results in high healing rate and few complications in the treatment of Tile type B pelvic fractures,and hence deserves popularization in clinic.

Inferior displacement sign in fracture of humeral greater tuberosity / 中华创伤骨科杂志

Objective To explore the clinical significance of the inferior displacement sign on the initial anterioposterior (AP) view X-ray for fractures of humeral greater tuberosity.Methods This study retrospectively analyzed the imaging and clinical data of 24 patients with isolated fracture of humeral greater tuberosity who had sought medical treatment during the period from January 2008 to June 2015.They were 10 males and 14 females,with an average age of 54 years (from 19 to 68 years).Laterality:8 left sides and 16 right sides.The AP view X-ray films of the 24 patients present the inferior displacement sign defined as the inferior cortical margin of the greater tuberosity overlapping the proximal humeral shaft on the initial AP view.The patients received further CT examination to determine the displacement direction and whether the humeral neck fracture was complicated.Results A slight displacement of humeral anatomic neck fracture was shown on the initial AP view X-ray in 10 patients.Further CT examination revealed that humeral anatomic neck fracture was confirmed in 23 patients,the greater tuberosity was displaced posteriorly in 22 patients and posteroinferiorly in 2 patients.Radiographic measurements showed:the mean posterior displacement was 10.5 ±4.5 mm;the displacement between the humeral head and the humeral shaft was 2.5 ± 1.5 mm;the neck shaft angle was 147.2° ± 9.2°;the distance between the humeral head and greater tuberosity was 10.8 ± 3.4 mm;the overlap between the inferior edge of greater tuberosity and the upper edge of lateral humeral shaft was 12.5±5.9 mm.Pearson correlation analysis showed no correlation between the overlap and the head-tuberosity distance (P ＞ 0.05),but a significant correlation between the overlap and the neck-shaft angle (P ＜ 0.05).Conclusions The inferior displacement sign on the initial AP view X-ray is actually the overlap of posterior displaced greater tuberosity fracture shown on the X-ray.The posterior displaced greater tuberosity fracture complicated with slight displaced anatomic neck fracture is a presentation of the valgus impacted fracture of the proximal humerus.The inferior displacement sign in the fracture of humeral greater tuberosity can highly suggest the presence of occult or slight displacement of the humeral anatomic neck fracture.

Comparison of sinus tarsi approach and conventional extensile L shape approach in the management of Sanders type III calcaneal fractures / 中华骨科杂志

Objective This study is aimed to compare sinus tarsi approach and conventional extensile L shape approach in the management of Sanders type III calcaneal fractures. Methods A total of 36 cases of Sanders type III calcaneal fractures treated in our hospital between August 2011 to February 2014(35 patients, 27males, 8 females. Nineteen of them were performed a limited open reduction and internal fixation(ORIF) via the sinus tarsi approach(as minimal invasive group), while the other 17 cas?es were performed ORIF via conventional lateral extensile L shape approach(as conventional group). X?ray films were taken post?operatively to record the changes of B?hler angle and Gissane angle. The AOFAS ankle hind?foot scale, visual analogue scale and the MOS item short from health survey(SF?36) were adopted to assess the therapeutic effect. Results The average follow?up peri?od of minimal invasive group was 14.6 months. And conventional group were followed up for average period of 18.3 months. All the fractures in the series had a boney union at or before the final follow?up. The immediate correction and final correction of B?hler angle and Gissane angle were significantly increased in both minimal invasive group and conventional group, while there was sig?nificant difference between the two groups. The median AOFAS score ,VAS score and SF?36 score of the minimal invasive group were 84.74±8.14,1.68±0.95 and 89.36±4.69, while those in the conventional group were 82.06±10.95,1.94±1.43and 86.71±5.39. There was no significant statistically difference between the two groups. No wound problem happened in the minimal invasive group, 3 cases of subtalar joint stiffness were found, and 1 developed traumatic arthritis. Respectively, 2 cases in conventional group got hematoma and dehiscence for each, 8 cases of subtalar joint stiffness were found, and 2 cases developed traumatic arthri?tis finally. Conclusion Limited ORIF via a sinus tarsi incision have the familiar therapeutic effects to ORIF via a conventional extensile L shape incision in the management of type III calcaneal fractures. But the former has the advantage of lower incision complication rate and lower stiffness subtalar joint rate.

Practice of Clinical Pharmacists in the Antibacterial Treatment of One Case of Osteomyelitis / 中国药师

Objective: To discuss the role of clinical pharmacists played in the pharmaceutical care for osteomyelitis patients. Methods:Clinical pharmacists participated in the treatment for a special patient with osteomyelitis. Taking the disease features, medi-cal history, adverse drug reactions into account, clinical pharmacists provided consultant opinions for establishing and adjusting the ap-propriate therapeutic regimens and individualized pharmaceutical care. Results:The drug treatment regimens for the patient were safe, effective and rational. By the individualized pharmaceutical care, clinical pharmacists were able to find the problems in the drug treat-ment and implement the efficient solutions. Conclusion: Clinical pharmacists show their own advantages in individual pharmaceutical care, and play an important role in improving the rational drug use.

Clinical characteristic and therapeutic strategy of the super-proximal bicondylartibial plateau fracture / 中华骨科杂志

Objective To discuss the clinical character and the therapeutic strategy of the super-proximal bicondylartibial plateau fracture.Methods A review of 8 patients with an average age of 40.8 years old (range,28-56 years; 6 males,2 females) surgically treated from June 2007 to October 2012 was conducted.Conventional pre-operative three-dimensional CT scans were used to clarify the types of fractures and the locations of major displaced bone fragments.All patients received open reduction and internal fixation 7-14 days after injury for recovery of soft tissue.Anterolateral incision combined anteromedial incision was made on those with limited posterior column shift.Otherwise anterolateral incision combined posteromedial might be better for those with obvious displacement.Six of the patients were implanted autograft bone or allograft bone.The collateral ligaments could be repaired in one stage,but a routine repair of cruciate ligaments was not concerned,and an immobilization for six weeks with a plaster or a brace should be followed.Results All cases were followed-up for 12 to 26 months (median follow-up period,18.6 months).All the fractures in the series achieved bone union at or before the last follow-up,and the healing time ranged from 18 to 26 weeks (median healing period,21.5 weeks).The X-rays showed the smooth surface and good alignment of knee joint at the last follow-up.The median hospital for special surgery knee score (HSS) was 78.12 (range,56-90),with 3 excellent cases,3 good cases,1 fair cases and 1 poor case; the excellent and good rate was 75％ (6 of 8).The median Lysholm score was 81.37 (range,58-91),with 4 good cases,3 fair cases and 1 poor case; the excellent and good rate was 50％ (4 of 8).Conclusion Super-proximal bicondylartibial plateau fracture is a special fracture type accompanied with posterior dislocation of knee,which is predominantly presented as an anterior plateau fracture.And injuries of blood vessels and nerve are common.Conventional pre-operative three-dimensional CT scans,paying attention to the stability of the knee,restoring the alignment and joint surface and early analgesic exercises with brace might be commended in management of such plateau fracture.

Superior border of the arcuate line: Three dimension reconstruction and digital measurements of the fixation route for pelvic and acetabular fractures.

PURPOSE: To obtain a series of parameters describing the shape and bone thickness of the fixation route along the superior border of the arcuate line, so as to provide references for pelvic and acetabular surgery and design pelvic anatomic internal fixators. METHOD: A total of 175 complete pelvic computed tomography (CT) scans of normal adult pelvises were collected. Each person's CT scans were reconstructed to create a three-dimensional pelvic model. A curve of the fixation route was delineated and divided into 11 equal parts. The total length of the curve, the radius of curvature, and the bone thickness at each decile point were all measured. The position of the pelvic inlet, the anterior and posterior sagittal diameter were measured. RESULTS: The radius of curvature at each decile point were 29.18 ± 15.53, 55.27 ± 29.48, 43.04 ± 14.42, 59.62 ± 21.02, 91.67 ± 52.01, 78.9 ± 38.66, 75.76 ± 25.87, 61.75 ± 16.68, 54.62 ± 14.88, and 43.61 ± 19.10 mm, respectively. The anterior and posterior sagittal diameter of the pelvic inlet was 66.01 ± 9.15 and 41.36 ± 8.19 mm, respectively. For all groups divided by the ratio of the posterior and the anterior sagittal diameter, the decile points 1, 3, and 10 had smaller radii of curvature than the before and after points, respectively. CONCLUSIONS: The curve of the fixation route along superior border of arcuate line has a relatively greater bending degree at the pubic tubercle, iliopubic eminence and close to the sacroiliac joint. With the transition of the pelvic inlet shape from android to gynecoid and platypelloid type, the bone surface at the iliopubic eminence becomes flatter. Pelvic and acetabular surgery could be more accurate by referring to the previous key bending points and the change of the pelvic inlet shape.

Special operative techniques for intertrochanteric fractures without lesser trochanter fracture / 中华骨科杂志

Objective To explore the operative techniques for AO/OTA type 31-A3.1 and 31-A3.2 intertrochanteric fractures fixed with intrameduallary nail.Methods Seventy-four cases of unstable intertrochanteric fracture (AO/OTA type 31-A3.1 and 31-A3.2) from January 2007 to December 2010 were analyzed retrospectively.There were 33 males and 41 females,aged from 36-87 years (mean,71 years).The right hip was involved in 34 patients and the left in 40 patients.The mechanism of injury was traffic injuries in 27 cases,fall damage in 43 cases,injury by falling in 3 case and crush injury in 6 cases.Percutaneous joystick technique,Homann retractor technique,clamp technique and mini-incision was applied to aid reduction during the surgery.All cases were fixed with proximal intrameduallary nail.Clinical and radiographic outcomes were recorded.The postoperative hip function was evaluated using Harris score.Results With the aid of C-arm,closed reduction was performed in 73 cases.Only one patient experienced open reduction because of failure of closed reduction.Sixty-five cases were followed up for 8 to 23 months (mean,14.5 months).Bone union was observed in all cases with the average time of 7.4 months (range,8-23).The operation time,blood loss,the frequency of X-ray exposure was 75±4 minutes,135±5 ml and 24±3 times,respectively.At final follow-up,29 cases were classified as excellent,31 as good,and 5 as fair.The mean Harris hip score was 91.4 points (range,87-95).The overall rate of excellent or good result was 92.3％.Conclusion It is difficult to perform close reduction for unstable intertrochanteric hip fracture (AO/OTA type 31-A3.1and 31-A3.2),especially in relatively young patients.Special operative skills are necessary in some cases.

Complications of the clavicle hook plate and corresponding managements / 中华骨科杂志

Object To analyze reasons of complications induced by the clavicle hook plate in treatment of acute distal clavicle fractures and acute acromioclavicular joint dislocations,and to investigate corresponding solutions.Methods Seventy nine clavicle hook plates were facilitated in the treatment of acuteb distal clavicle fractures (47 cases) and acute high grade acromioclavicular joint dislocations (32 cases) from May 2006 to May 2009.There were 51 males and 28 females,with an average age of 42.6 years(range,15 to 78 years).Seventy eight patients underwent plate removal operation.Forty patients agreed to accept the CT examination to evaluate the acromion erosion around the plates.Among them,7 patients received further CT examination 3 months after the removal surgery.The shoulder function was evaluated by the constant scores at the final follow-up.Results All patients were followed up for at least one year (range,12 to 30 months).The mean duration for retaining the hook plate was 8.3 months with the mean Constant scores 92 points in the acute distal clavicle group; 7.2 months with the mean Constant scores 95 points in the acute acromioclavicular joint dislocation group.There were 8 kinds,totally 105 complications happened in 78 patients (98.7％).The complications were classified into four groups: (1) Due to the specific working mechanism of the plate(88/105,83.8％);(2) Due to the iatrogenic errors(12/105,11.4 ％);(3) Due to insufficiency design of the plate(3/105,2.9％);(4) Due to the etiology of the injury itself(2/105,1.9％).Conclusion The complication rate is unexpected higher.Most complications are unavoidable due to specific working mechanism of the plate.The patients should be well informed about this preoperatively in order to avoid the possible legal trouble.The iatrogenic errors can be avoided with proper indications and improved surgical techniques.The design of the plate needs to be improved,and the hook plate should be removed as early as possible.

Construction of clinical database on pelvic trauma life cycle: a preliminary study / 中华创伤杂志

Objective To construct the clinical database on pelvic trauma life cycle so as to provide reference for epidemiological investigations and development of pelvic damage control plan. Methods The existing pelvic trauma data of the hospital information system was analyzed to discuss the main evaluation indicators and data types at different stages, including basic data, injury severity index, underlying disease, fracture classification, specialist treatment, rehabilitation and follow-up information. Results Based on the V3.0 trauma scoring system, the clinical pelvic trauma ACCESS database was developed. The data of 588 patients with pelvic trauma were collected from November 2007 to May 2009 and preliminarily analyzed. Conclusions Clinical database of pelvic trauma can be used as the specific modules of general network trauma database system and a large-scale, multi-center and standard pelvic trauma database may play an important role in preparation of the prospective damage control plans.

Supracetabular external fixation in treating pelvic fractures associated with injuries of abdominal organs / 中华骨科杂志

ObjectiveTo evaluate the technique and clinical outcomes of supra-acetabular external fixation in treating pelvic fractures associated with injuries of abdominal organs.MethodsThere were 17 cases of pelvic fractures associated with injuries of abdominal organs.Nine were males and 8 were females,with the average age of 42 years(range,21-75 years).The injury was caused by traffic accident in 9 cases,fall-down from height in 4,and crush by heavy objects in 6.According to Tile classification of pelvic fractures,7 were type B1,3 were type B2,2 were type B3,4 were type C1 and 1 was type C2.Fifteen cases suffered with hemorrhagic shock,2 with perineal injury and 12 with fractures of the limbs.All patients were treated with supra-acetabular external fixation and the outcomes were evaluated by Cole's clinical scoring,Matta and Tornetta's radiographic standards.ResultsAll 17 cases were followed up with the mean period of 6.5 months (range,2-18 months).The average time of operation was 15 min (range,9-25 min).The mean blood loss was 17 ml(range,5-25 ml).All fractures healed and the mean healing period was 9.2 weeks (range,8-12 weeks).Three had transient palsy of lateral femoral cutaneous nerve.Five had soft tissue infection while the bony structures were not involved.According to Cole's scoring for pelvic fractures,15 cases were excellent,1 case was good and 1 case was fair,with the good-excellent rate of 94.12％.According to Matta and Tornetta's standards of fracture reduction,12 were excellent,3 were good and 2 were fair,with the good-excellent rate of 88.24％.ConclusionSupra-acetabular external fixation is a minimal invasive and convenient method for treating pelvic fractures with abdominal organs injury which is mechanically stronger than traditional external fixation via iliac crest.

Treatment of traumatic anterior sternoclavicular joint dislocation with Fastin anchors / 中华创伤骨科杂志

Objective To discuss the treatment of traumatic anterior sternoclavicular joint disloca-tion with Fastin anchors. Methods A retrospective analysis was done for 14 patients with traumatic anterior sternoclavicular joint dislocation who had been treated with Fastin anchors from March 2006 to April 2008. They were 9 males and 5 females, with an average age of 35 years (range, 21 to 46 years) . Their diagnoses were confirmed by X-ray and CT scan. After reduction and temporary Kirschner wire fixation of the sternoclavicular joint, the anchor was driven into the manubrium sterni, with the suture at the end of the anchor securely knotted after passing through the internal extremity of clavicle. The Kirschner wire was re-moved after 3 weeks. Results All the patients were followed up for 12 to 22 months (average, 17 months). The results were excellent in 11, good in 3 according to Rockwood scale. There was no loss of re-duction or implant loosening. Conclusion Fastin anchor can fix the sternoclavicular joint reliably, avoiding potential risk of Kirschner wire migration and ensuring fine functional recovery of the joint.

A binary logistic regression analysis of deep venous thrombosis after hip fracture surgery / 中华创伤骨科杂志

Objective To explore the incidence, etiological and protective factors, and preventive countermeasures of deep venous thrombosis (DVT) in patients undergoing hip surgery. Methods Four hundred and forty-one patients who had hip fracture surgery in our department from January, 2005 to May, 2010were analyzed retrospectively. They were 223 males and 218 females, aged 65.7 years. (range, 22 to 87). A binary logistic regression was performed, using gender, age, duration of surgery, surgery type, anesthesia type, blood transfusion, physical therapy, thrombo-prophylaxis and complication as covariates, taking DVT incidence as the dependant variable. Results The patients obtained a median follow-up of 17.2 months (range, 3 months to 4 years and 7 months). Sixty-nine patients developed DVT (incidence, 15.6%).Analysis of multiple variables showed that duration of surgery, anesthesia type, blood transfusion, hypertension and diabetes were risk factors to DVT. Physical therapy and thrombo-prophylaxis were protective factors.Age, gender and surgery type had no statistically significant influence on DVT (P ＞ 0.05). Conclusions The DVT incidence after hip fracture surgery is high. In order to decrease the DVT incidence, surgeons should try their best to estimate risk factors for every patient perioperatively, avoid general anesthesia or blood transfusion, shorten operating duration, effectively control complications, actively perform physical therapy or thrombo-prophylaxis, and prolong the anticoagulant therapy for patients with higher risk factors.

Surgical correction for post-traumatic Madelung deformity complicated with dorsal or volar angulation in the adults / 中华创伤杂志

Objective To explore surgical methods and their efficacy for post-traumatic Made-lung deformity complicated with dorsal or volar angulation in the adults. Methods Volar plate or exter-nal fixator, combined with the techniques osteotomy and bone grafting, were selected to treat adult pa-tients with post-traumatic Madelung deformity complicated with dorsal or volar angulation. The effects were preliminarily evaluated through comparing the volar tilting angle, ulnar inclination, radial shortening and the range of joint motion before and after the operation. Results All the patients were followed up for 6-27 months (mean 16 months). The volar tilting angle, radial inclination, radial shortening, range of joint motion of all patients were improved significantly (P<0.05). Conclusions For patients with Madelung deformity complicated with dorsal angulation, internal fixation of volar plate combined with volar osteotomy and bone grafting is recommended; while dynamic eternal fixator combined with combined with dorsal osteotomy and bone grafting is an ideal choice for patients with Madelung deformity complicated with volar angulation.