Prevalence and risk factors of preoperative deep venous thrombosis in closed patella fracture: a prospective cohort study.

BACKGROUND: The preoperative prevalence of deep venous thromboembolism (DVT) of patella fracture is not well established. The study aimed to investigate the preoperative prevalence, the associated risk factors, and the locations of deep venous thrombosis (DVT) in patients with closed patella fracture. METHODS: Patients who sustained closed patella fracture between January 1, 2016, and April 1, 2019, were included. Blood analyses and ultrasonography of bilateral lower extremities were routinely performed. Data of demographics, comorbidities, mechanism of injury, fracture type, total hospital stay, time from injury to DVT, and laboratory indexes were prospectively collected and compared between groups with and with non-DVT. Multivariate logistic regression analyses were performed to determine the independent risk factors of DVT. RESULTS: Among the study cohort of 790 patients, 35 cases occurred in preoperative DVTs, indicating a prevalence of 4.4%, with 3.2% distal and 1.2% proximal DVT. Age ≥ 65 years old (OR, 3.0, 95% CI, 1.1-8.1), D-dimer > 0.5 mg/L (OR, 2.3, 95% CI, 1.1-4.8), and albumin < 35 g/L (OR, 2.5, 95% CI, 1.2-5.3) were identified to be risk factors of DVT in closed patella fracture. Among the DVTs, 30 cases (85.7%) occurred in the injured extremity, 3 cases (8.6%) in bilateral extremities, and 2 cases (5.7%) solely in the uninjured extremity. CONCLUSION: The prevalence of preoperative DVT in closed patella fracture was 4.4%, with 3.2% for distal and 1.2% for proximal DVT. We recommend individualized risk stratification and early anticoagulation for patients with risk factors (age ≥ 65 years, D-dimer > 0.5 mg/L and albumin < 35g/L).

[Analysis of the effects of different medicines on hypercoagulability state variations of femoral shaft fracture and after its operation].

OBJECTIVE: To explore the role of Tong Mai Tang & Lornoxicam on the serum concentrations of tumor necrosis factor alpha (TNF-alpha), interleukin (IL-6) , D-dipolymer( D-Di), Platelet count (PLC) in treatment of femoral shaft fracture among period surgery time. METHODS: We selected 120 cases of traumatic femoral shaft fracture patients according to the inclusion criteria and exclusion criteria, which were randomized dividend into four groups (I, II, III, IV respectively) of the same size based on the random number table method of 30 patients each. Therapeutic methods of four groups following as: Group I, Tpanax Notoginseng Pills PO; Group II, Tpanax Notoginseng Pills PO, Lornoxicam For Injection, 8 mg IM; Group III, Tpanax Notoginseng Pills PO, Tong Mai Decoctions 200 mL PO; Group IV, Tpanax Notoginseng Pills PO, Lornoxicam For Injection 8 mg IM, Tong Mai Decoctions 200 mL PO. The above medications were administered to the four groups after admission to hospital the next day. Peripheral blood samples were taken for immune determination of pro-inflammatory cytokines of TNF-alpha, IL-6, D-Di, PLC in blood serum on the 2nd and 6th day before operation and on the 8th and 13th day after operation in the morning. And all patients received liver and kidney function examination 2nd and 13th day after admission. Analysis of variance and least significant difference-test were done with the help of SPSS 17.0 statistic software. RESULTS: The difference among four groups in TNF-alpha and IL-6 were significant (P < 0.05). And there were also significant statistic difference between group II/III/IV and group I group (P < 0.05). But the difference between group II and group III was insignificant (P > 0.05). However, the group contrast result between group IV and group II/III had statistics difference (P < 0.05). The difference in D-Di PLC at 6th day and 8th day were significant (P < 0.05). The group comparisons in group I/II/IV were also significant. There were non-statistics significance in group II compared 6th day/8th day with 2nd day (P > 0.05). The comparison between the 13th day with the first three time sections had statistics significance. And there were statistics significance at the 13th day between group IV and group II (P < 0.05). CONCLUSION: The serum concentrations of TNF-alpha, IL-6, D-Di and PLC level were significantly increased in peroperative period, These results seem to indicate that the Tong Mai Decoctions & Lornoxicam may play an important role in inhibiting the release of TNF-alpha, IL-6, D-Di and PLC into the blood stream and decreasing the incunabula complication at early traumatic stage. The Tong Mai Decoctions & Lornoxicam was the worth promoting screened China and the West union medication combination.

[Effects of Tongmai decoction on the perioperative changes of plasma TNF-alpha and IL-6 in patients with femoral fractures].

OBJECTIVE: To explore the effects of Tongmai decoction on the perioperative changes of serum concentrations of tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-6 in patients with femoral fractures, and conform the effectiveness of Tongmai decoction on inflammatory factors in patients with femoral fractures, providing the theoretical evidence for the clinical use of Tongmai decoction. METHODS: From October 2007 to May 2009, 60 patients with closed traumatic femoral fractures were selected according to the inclusion criterias and exclusion criterias. All the patients were randomly divided into three groups (group A, group B and group C). Twenty patients in group A (Tpanax Notoginseng pill group), 13 patients were male and 7 patients were female; ranging in age from 20 to 45 years, averaged 32.0 years; the disease course ranged from 2.0 to 26.0 h, with an average of 9.5 h. Twenty patients in group B (Tpanax Notoginseng pills and Lornoxicam injection group),12 patients were male and 8 patients were female; ranging in age from 23 to 42 years, averaged 31.0 years; the disease course ranged from 3.5 to 25.0 h, with an average of 13.6 h. Twenty patients in group C (Tpanax Notoginseng pill, Lornoxicam injection and Tongmai decoction group), 14 patients were male and 6 patients were female; ranging in age from 21 to 44 years, averaged 31.5 years; the disease course ranged from 4.6 to 29.0 h, with an average of 13.3 h. Among all the patients, 42 patients with fractures were fixed with femoral intramedullary nailing, and other 18 patients with femoral locking plate fixation. The patients in group A took Tpanax Notoginseng pills orally, 4 g each time and twice daily; the patients in group B took Tpanax Notoginseng pills orally as group A, and at the same time received intramuscular injection of Lornoxicam, 8 mg each time and once daily; the patients in group C took Tpanax Notoginseng pills orally and received intramuscular injection of Lornoxicam as group B, and at the same time took Tongmai decoction (R ) orally, 200 ml each time and twice daily. The above medications were administered to the three groups on the second day after admission to hospital. Peripheral blood samples were taken for determination of pro-inflammatory cytokines of TNF-alpha and IL-6 in blood serum on the 2nd and 6th days before operation and on the 8th and 13th days after operation. And all the patients were evaluated liver and kidney function at the 2nd and 7th days after admission. Analysis of variance and least significant difference-test were done with the help of SPSS 17.0 statistic software. RESULTS: The differences among three groups of TNF-alpha and IL-6 in blood serum at the 2nd day after admission and 2 days after operation had no statistical significance (P > 0.05). The TNF-alpha and IL-6 levels among 3 groups had statistical differences at the 7th day after admission and at the 7th day after operation (P < 0.05, P < 0.01). There were significant differences of TNF-alpha and IL-6 levels between the 7th day after admission and the 2nd day after admission, the 7th day after operation and the 2nd day after admission (P < 0.01). There were also significant differences of TNF-alpha and IL-6 levels between group C compared with group A and B at the 7th day after admission and the 7th day after operation(P < 0.05, P < 0.01). CONCLUSION: The serum concentrations of TNF-alpha and IL-6 level significantly increased in perioperative period. The results indicate that the Tongmai decoction may play an important role in inhibiting the release of TNF-alpha and IL-6 into the blood stream and decreasing the incunabula complication at early traumatic stage.

[Diagnostics of septic complications after long tubular bones fractures].

Interleukine (IL-1alpha, IL-4) blood levels and lipid peroxidation--antioxidant agents were assessed in 98 patients with fractures of long tubular bones. Using the data, an algorithm was worked out, which permits prediction of septic complications with a high level of accuracy.

Alloxan-induced diabetes delays repair in a rat model of closed tibial fracture.

A closed fracture was performed on the left tibia of 3-month-old Wistar rats weighing 250 to 350 g that were either healthy (N = 24) or made diabetic with alloxan (N = 24) to investigate the effect of alloxan-induced diabetes on the course of bone fracture healing. Histomorphometric analysis of the fracture site was performed at 7, 14, 25, and 35 days. After 7 days, diabetic rats had significantly less cartilage (P = 0.045) and greater fibrous connective (P = 0.006) tissue formation at the fracture site compared to controls. In contrast, marked callus formation was seen in diabetic rats with significant osteogenesis (P = 0.011, P = 0.010, P = 0.010, respectively, for 14, 25, and 35 days) and chondrogenesis (P = 0.028, P = 0.033, P = 0.019) compared to controls. Radiographic analysis revealed a displaced fracture with poor bone fragment alignment and delayed consolidation at these times in the diabetic group. The levels of alkaline phosphatase were significantly higher in diabetic rats at 25 days (P = 0.009). These results suggest that the initial excessive formation of fibrous connective tissue associated with delay in chondrogenesis and osteogenesis may not provide suitable stability of the fractured site, contributing to the inappropriate alignment of fragments and an increase in the volume of callus in later stages of repair. The resulting displaced fracture in diabetic rats requires long periods for remodeling and complete bone consolidation.

Alloxan-induced diabetes delays repair in a rat model of closed tibial fracture

A closed fracture was performed on the left tibia of 3-month-old Wistar rats weighing 250 to 350 g that were either healthy (N = 24) or made diabetic with alloxan (N = 24) to investigate the effect of alloxan-induced diabetes on the course of bone fracture healing. Histomorphometric analysis of the fracture site was performed at 7, 14, 25, and 35 days. After 7 days, diabetic rats had significantly less cartilage (P = 0.045) and greater fibrous connective (P = 0.006) tissue formation at the fracture site compared to controls. In contrast, marked callus formation was seen in diabetic rats with significant osteogenesis (P = 0.011, P = 0.010, P = 0.010, respectively, for 14, 25, and 35 days) and chondrogenesis (P = 0.028, P = 0.033, P = 0.019) compared to controls. Radiographic analysis revealed a displaced fracture with poor bone fragment alignment and delayed consolidation at these times in the diabetic group. The levels of alkaline phosphatase were significantly higher in diabetic rats at 25 days (P = 0.009). These results suggest that the initial excessive formation of fibrous connective tissue associated with delay in chondrogenesis and osteogenesis may not provide suitable stability of the fractured site, contributing to the inappropriate alignment of fragments and an increase in the volume of callus in later stages of repair. The resulting displaced fracture in diabetic rats requires long periods for remodeling and complete bone consolidation.

Immune function is more compromised after closed bone fracture and hemorrhagic shock than hemorrhage alone.

OBJECTIVE: To determine whether closed bone fracture in conjunction with hemorrhagic shock compromises immune functions more severely than hemorrhagic shock alone. DESIGN: In a randomized, controlled trial, closed bone fracture of the right lower leg and/or hemorrhagic shock (mean +/- SEM arterial blood pressure, 35 +/- 5 mm Hg for 90 minutes) were induced in male C3H/HeN mice (weight, 25 g). Animals subjected to hemorrhage were resuscitated with the shed blood and lactated Ringer solution. At 72 hours after the experiment, all animals were killed to obtain whole blood, splenocytes, and splenic and peritoneal macrophages. Macrophage interleukin-1 and splenocyte interleukin-2 and interleukin-3 release were determined by bioassay, and splenocyte proliferation was measured by tritiated thymidine incorporation. RESULTS: Closed bone fracture alone did not affect immune functions 72 hours after the trauma. Hemorrhagic shock, however, induced a significant depression of splenocyte and macrophage functions. Bone fracture followed by hemorrhagic shock further depressed splenocyte proliferation and splenocyte interleukin-2 and interleukin-3 release as well as interleukin-1 release. CONCLUSION: Since bone injury coupled with hemorrhagic shock produces more severe depression of immune functions than hemorrhage alone, bone injury appears to play a contributory role in further depressing immune functions in trauma patients who experience major blood loss.

Endothelial stimulating angiogenic factor in early fracture healing.

The early vascular response is essential for the normal progress of fracture healing and fracture site blood flow has been shown to reach a peak in the first two weeks after injury. Angiogenesis is an important step in this response as new vessel formation is necessary to vascularize the fracture haematoma and the fracture gap. Changes in serum levels of a low molecular weight endothelial stimulating angiogenic factor (ESAF) have been previously reported in a group of four patients with tibial fractures. In this group, ESAF levels were measured on three occasions only and at different time intervals. We present a more detailed profile of serum ESAF level changes in the first 14 days after the fracture.

Fracture of the humerus in ball throwers. A consequence of idiopathic juvenile osteoporosis in a female handball player?

We report a case of a spontaneous humeral shaft fracture sustained during pitching by a 22-year-old previously healthy female European team handball player. The fracture was treated by closed reposition followed by immobilization in a hanging cast. The fracture healed uneventfully, and normal function and range of motion were reached within 6 months. Between 1 and 2 years after the fracture, bone mineral measurements showed a decreased bone mass (1.43-2.56 SD below mean values of normal women) at all measuring sites; proximal tibia bilaterally (bone mineral content (right) = 2.68 g/cm, bone mineral content (left) = 2.79 g/cm), lumbar spine (bone mineral density (L2-4) = 0.814 g/cm2), and right hip (bone mineral density (neck) = 0.697 g/cm2, bone mineral density (Ward's) = 0.626 g/cm2). A thorough endocrinological examination indicated that a state of bone loss existed, but no specific endocrine disease was found. The unusual fracture presented must be considered the result of the torsional forces transmitted to a severely osteoporotic bone.

Pulse oximetry in closed limb fractures.

Recent sporadic reports have described the role pulse oximetry might play in monitoring trauma victims, and specifically in the assessment of patients with limb fractures where doubt exists concerning the adequacy of limb blood flow distal to the fracture after manipulation. The results of a prospective study to determine the changes in arterial oxygen saturation as shown by pulse oximetry before and after manipulation are presented. The results suggest that the pulse oximeter may be of use in confirming the presence or absence of adequate blood flow distal to a fracture, but that this information should be considered in the light of the clinical findings. The role of pulse oximetry in the early detection of a compartment syndrome complicating a closed limb fracture has yet to be determined.

[Erythropoiesis and osteogenesis (I. The interaction of the reparative processes of bone and hematopoietic tissues)]. / Eritropoéz i osteogenez (I. Vzaimodeistvie protsessov reparatsii kostnoi i krovetvornoi tkanei).

The dynamics of erythropoiesis during the bone restoration and under the conditions of perturbing influence: fracture and hemolytic anemia have been studied in the experiment. It is found that under the conditions of callus formation the process of proliferation and differentiation of red cells in the bone marrow is inhibited. The observed effect of erythropoiesis inhibition may be caused by the intercellular interaction of regenerating tissues in their "struggle" for microphages, which, while being the centre of the erythroid insula secure the maturation of erythroid precursors, and at the same time they can take part in the bone formation process.

[Erythropoiesis and osteogenesis (II. The mechanism of the suppression of erythropoiesis during the reparative process in bone tissue)]. / Eritropoéz i osteogenez (II. Mekhanizm ugneteniia éritropoéza pri reparativnom protsesse v kostnoi tkani).

The experiment on rats and mice has shown that the presence of a developing callus in the organism after fracture of the tubular bones inhibits erythropoiesis. Inhibition of erythropoiesis is due to delay of erythropoietin biosynthesis by serotonin. A problem on two-fold serotonin effect is under discussion: on the one hand, serotonin inhibits the erythropoietin formation and delays erythropoiesis, on the other hand, it intensifies the effect of ready erythropoietin on the developing bone marrow erythroid cells.

Serum somatomedin activity following adult tibial shaft fractures.

Serum somatomedin (SM) activity was measured serially in 27 adults with closed tibial shaft fractures. SM activity was found to be normal in all but one specimen. The results indicate that SM activity does not reflect severity of trauma or the ability to heal on time in these fractures.

Effect of bone injury on circadian periodicity of plasma 17-hydroxy corticosteroids (17-OHCS) in rabbits.

Bone injury inflicted at varying time intervals during 24 hr day-night cycle caused significant varying increase in plasma 17-OHCS levels in all traumatized animals and the levels remained elevated up to 24 hr after trauma. The level of plasma 17-OHCS was found to be aberrated in all the traumatized animals. Thus, adequate adrenocortical response to trauma and aberration in the adrenocortical secretory activity appears inevitable irrespective of the time at which the trauma is produced. However, the degree of response depends on the particular time at which the trauma is inflicted.

Serum osteocalcin and total alkaline phosphatase levels as prognostic indicators in tibial shaft fractures.

Serum samples were obtained periodically from 50 adult patients with closed tibial shaft fractures. Total alkaline phosphatase activity was measured in all cases and osteocalcin activity was measured in 14 patients. Fractures produced by high-energy violence generally had lower values of osteocalcin activity. This could be due to depressed circulating vitamin K levels throughout the healing period in the former fractures. In addition, normally uniting fractures had generally higher values of osteocalcin activity compared with fractures exhibiting delayed union. This indicates depressed osteoblastic activity in slowly healing fractures. The results suggest that measurement of osteocalcin activity after fracture could provide a useful prognostic indicator. By contrast, total serum alkaline phosphatase activity was not significantly different between the injury groups and between the healing groups.

Response to injury in children with closed femur fractures.

Fifty children admitted with closed femur fracture as a single major injury were monitored for change in vital signs and hematocrit. Hypotension was not observed. No child required blood replacement. Only 33% of the children had a measurable change in hematocrit, averaging a four-point drop. There was a marked febrile response to injury in 80% of the children which lasted an average of 4 days. Children admitted with femur fractures who develop hypotension or rapid drop in hematocrit should be promptly evaluated for another source of blood loss.

[Changes in parathyroid hormone levels during the treatment of fractures of long tubular bones using the Ilizarov method]. / Izmenenie kontsentratsii paratireoidnogo gormona pri lechenii perelomov dlinnykh trubchatykh kostei po metodu G. A. Ilizarova.

Content of parathyroid hormone in blood plasma was studied in the course os treatment of 62 patients with fractures of crus bones. Alterations in the hormone content, depending on the type of trauma, were observed: the most severe injures caused the most distinct alterations. Maximal increase in the hormone content were observed during the initial period of the treatment, contributing to lysis of bone fragments and to formation of bone organic matrix. Decrease in the parathyroid hormone content coincided with complete consolidation of bone fragments. Content of the hormone was normalized within 35-42 days.

Lipoprotein electrophoresis in fat embolism: a preliminary report.

Serum lipoprotein electrophoresis and other laboratory tests were made on 14 injured patients over 10 days. Reduction in the pre-beta fraction to an average of 6 per cent, with an elevation of the alpha lipoprotein fraction to an average of 41 per cent, were recorded. The patients without complications regained their normal lipoprotein pattern within 48 hours, while in the two cases who developed fat embolism, the deranged pattern lasted for up to 10 days. The clinical diagnosis of fat embolism is based on signs that appear generally within 3 days following injury. As prognosis depends on early diagnosis, in order to start treatment before full blown clinical signs are present, there is the need for a laboratory test which gives early results and is reliable and easy to perform. This study shows an apparently distinct pattern of the serum lipoproteins which may provide us with a warning about which patients are at risk of developing fat embolism.