Efficacy of damage control orthopedics strategy in the management of lower limb trauma.

Background: Little is known about the efficacy of damage control (DC) surgery in the management of lower limb trauma. Here we compared the clinical parameters and complication rates of such patients received either DC or emergency comprehensive (EC) surgery treatment. Methods: This study is a retrospective study on patients with lower limb trauma that received surgical treatment. Data of 120 patients were divided into DC and EC surgery groups. Clinical parameters obtained at hospital admission and complications during follow-up were analyzed. Injury Severity Score (ISS), Gustilo classification and Mangled Extremity Severity Score (MESS) were used to assess trauma severity, open fractures and viability of injured limb, respectively. Results: Age, sex, ISS, fracture type, injury site, MESS, operation time, blood loss, pulmonary and cranial injuries were compared. We found that patients in the DC group had more severe injury as reflected by the higher injury severity score (ISS) (28.1 ± 10.9 vs 21.3 ± 7.4, P < 0.001). ISS was also identified as a significant influencer for the treatment selection (P < 0.001). In addition, patients treated with DC surgery demonstrated less complications (7 cases vs 27 cases), which was supported by the propensity score logistic regression analysis (Odd ratio 4.667). Conclusions: DC surgery is more often selected to treat patients with more severe lower limb injuries, which leads to lower complication rates.

Promotion of a damage control concept in repairing orthopedic lower limb trauma.

OBJECTIVE: To explore the application value of the concept of damage control orthopaedics (DCO) in clinical treatment of lower limb fractures. METHODS: In this retrospective analysis, 157 patients with lower extremity fracture, who received surgery in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine (Cangzhou Orthopaedic Hospital) during March 2019 and August 2020, were chosen as research subjects. Among them, 73 patients admitted from March to December 2019 were included in the control group, and the other 84 patients admitted from January to August 2020 were included in the observation group. The control group received conventional fracture treatment scheme, and the observation group was treated under the DCO concept. The operation time, postoperative hospital stay, fracture reduction quality, incidence of complications, and bone metabolism and bone healing pre- and post-treatment were compared between the groups. RESULTS: The operation time, time to achieve stable vital signs and hospital stay of the observation group were apparently shorter than those of the control group (P<0.05). Visual analog score (VAS) of patients in both groups on postoperative day 3 and 7 were substantially lower than those on postoperative day 1 (P<0.05), and VAS scores of patients in the observation group were markedly lower than those in the control group (P<0.05). Serum Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the two groups were significantly reduced on 14th day after surgery compared to those before surgery (P<0.05), and the indexes of observation group were lower than those of control group (P<0.05). Serum Osteocalcin (BGP), carboxyterminal of type I procollagen (PICP), alkaline phosphatase (ALP), Soluble intercellular adhesion molecule-1 (sICAM-1) and Insulin like growth factor-1 (IGF-1) in the two groups postoperative day 14 were obviously higher than those before operation (P<0.05), and the indicators in the observation group were higher than those of the control group (P<0.05). The incidence of complications in the control group was significantly higher than that in the observation group (P<0.05). CONCLUSION: The application of the DCO concept in the clinical treatment of lower extremity trauma can effectively promote the rehabilitation of patients with lower extremity trauma, minimize their complications, improve the bone metabolism and bone healing degree, and reduce the degree of pain.

[Study on the correlative factors of the pain under the second metatarsal in patients with hallux valgus].

OBJECTIVE: To analyze the correlation between the hallux valgus angle and arch X-ray parameters change, plantar pressure by measuring the X-ray indexes and foot-pressure indexes in patients with hallux valgus, as well as to study the main cause factors for the pain under the second metatarsal head. METHODS: A retrospective study of 254 patients(477 feet) treated in Wangjing Hospital from January 2012 to June 2013 was performed. The pain under the second metatarsal head and age distribution were recorded. All the patients were divided into two groups according to the second plantar bone pain: pain group and no pain group. The following indexes were measured and compared: HAVA(hallux abductor valgus angle), IMA1-2(the inter-metatarsal angle between the first and second metatarsals), IMA1-5(the inter-metatarsal angle between the first and fifth metatarsals), TAOTMLA (top angle of the medial longitudinal arch), AAOTMLA (anterior angle of the medial longitudinal arch), SMRL (the second metatarsal relative length than the first), and the plantar pressure indicators including TPUM (touch the ground time percentage under the second metatarsal head), PPUM (peak pressure under the second metatarsal head), and IUM(impulse under the second metatarsal head). All the factors were evaluated by Logistic regression analysis. RESULTS: Spearman rank correlation test showed that there were statistical significance in correlation between HAVA and IMA1-2, IMA1-5, TAOTMLA, AAOTMLA, TPUM(P<0.05, r=0.647, 0.553, 0.127, -0.165, 0.158). Factors including the HAVA, SMRL and the TPUM were the risks for the pain under the second metatarsal head in patients with hallux valgus(P<0.05, ORj=1.030, 1.069, 1.060). CONCLUSIONS: Increase of the hallux valgus angle causes the collapse of hallux valgus arch, extending the weight bearing time of the second metatarsal and increasing the possibility of the pain under the second metatarsal.

[Correlative analysis on metatarsalgia and the X-ray measurement indexes under weight-bearing and non-weight-bearing of hallux valgus].

OBJECTIVE: To study changes in the radiographic appearance during weight-bearing and non-weigh-bearing in hallux valgus, and to analyse the correlation between the elasticity of plantar soft tissue of hallux valgus and the pain under the metatarsal head. METHODS: From May 2012 to October 2012, 240 feet of 120 patients with hallux valgus were enrolled in the study. The degrees of the pian under the metatarsal head of all the patients were observed. AP and lateral X-ray films of feet were taken on the condition of weight-bearing and non-weight-bearing. So the hallux valgus angle (HVA), the inter-metatarsal angle between the first and second metatarsals (IM1-2), the inter-metatarsal angle between the first and fifth metatarsals (IM1-5), top angle of the medial longitudinal arch (TAOTMLA),and anterior angle of the medial longitudinal arch (AAOTMLA) were measured on the X-ray films. The differences of HVA, IM1-2, IM1-5, TAOTMLA and AAOTMLA between two groups were compared, and the correlation between the changes of IM1-2, IM 1-5, TAOTMLA, AAOTMLA and the degree of the pain under the metatarsal head were analysed. RESULTS: One hundred and forty-eight feet had the pain under the metatarsal head. The IM1-2, IM1-5 and TAOTMLA increased on weight-bearing position compared with those on non-weight-bearing position, but the HVA and AAOTMLA decreased on weight-bearing position compared with those on non-weight-bearing position. There was a moderate relationship between the changes of IM 1-2,IM1-5 and the degree of the hallux valgus deformity, as well as the relationship between the different of IM1-5 and the degree of the pian under the metatarsal head. CONCLUSION: The degree of the collapse of the arch of foot with hallux valgus becomes serious with its deformity increasing. The pain under the metatarsal head of hallux valgus increases with the increased changes of IM 1-2,IM 1-5 and TAOTMLA. Analysis of the X-ray observation indexes of hallux valgus on weight-bearing position and non-weight-bearing position has important significance in evaluating the degree of the collapse of the arch of foot with hallux valgus,preventing and curing the the pain under the metatarsal head.