[Identification of fresh and old vertebral compression fractures by MRI].

OBJECTIVE: To analyze and explore the value of MRI in distinguishing fresh from old vertebral compression fractures. METHODS: The features of MRI in 43 cases with compression fractures of thoracic or lumbar vertebral bodies were analyzed. MRI sequences included T1WI, T2WI and STIR. RESULTS: Fifty-five vertebral bodies in total were found compression fractures in 43 cases. Forty-six vertebral bodies, which showed low signals or low signals mixing a few high signals on T1WI, high signals on T2WI and significantly high signals on STIR, were identified as fresh compression fractures. Nine vertebral bodies were identified as old compression fractures, because they showed the same signals as normal vertebral bodies on T1WI, T2WI and STIR. CONCLUSION: MRI could accurately distinguish fresh and old vertebral compression fractures, so it is valuable for the distinguishment in forensic identification.

[Replacement of humeral head prosthesis for four-part proximal humeral fractures or fracture-dislocations].

OBJECTIVE: To evaluate the short-term results of humeral head replacement for the treatment of four-part proximal humeral fractures or fracture-dislocations. METHODS: Twenty-five patients (11 male and 14 female)with four-part proximal humeral fractures or fracture-dislocations underwent humeral head replacement. The average age was 68.2 years (ranging from 56 to 77 years). All cases were followed up and evaluated the clinical results including pain, function and range of motion of shoulder with Neer scoring system. RESULTS: The follow-up ranged from 12 to 40 months with an average time of 29.3 months. No prosthesis loosening, prosthesis dislocation, postoperative infection, nerve injury or periprosthesis fractures occurred. The results were excellent in 8 cases, good in 11 cases and fair in 6 cases. The excellent and good rate was 76% according to Neer scoring system. CONCLUSION: Replacement of humeral head prosthesis could attain good short-term results for four-part proximal humeral fractures or fracture-dislocations. The key to improve the postoperative results is meticulous surgical techniques and appropriate correct consecutive physical therapy.

[Effectiveness of preoperative autologous plateletpheresis combined with intraoperative autotransfusion on the blood coagulation in orthopaedic patients].

OBJECTIVE: To investigate the effectiveness of preoperative plateletpheresis combined with intraoperative autotransfusion on the blood coagulation of orthopaedic patients. METHODS: Sixty patients (ASA I-II) undergoing selective orthopaedic surgery were randomized into three groups (n = 20), that is, preoperative plateletpheresis combined with intraoperative autotransfusion for group I, intraoperative autotransfusion for group II, and group III without any managements of blood conservation. Coagulation parameters (prothrombin time, partial thromboplastin time, fibrinogen), hemoglobin and hematocrit values, platelet counts and aggregability were evaluated before the anaesthesia, 10 minutes after plateletpheresis, 10 minutes before the infusion of platelet rich plasma or autologous blood, 10 minutes after infusion, 24 and 48 hours postoperation. Intra- and postoperation blood loss and homologous blood transfusion requirements were also recorded. RESULTS: Among three groups, there were no differences in intraoperative blood loss, perioperative haemoglobin level (Hb and Hct). As compared with group I, significant lower level of platelet counts and aggregability were observed in group II and III at the time of 24 and 48 hours after operation (P < 0.05), while postoperation blood loss and homologous blood-transfusion requirements increased at the same period (P < 0.01). CONCLUSIONS: Preoperative plateletpheresis combined with intraoperative autotransfusion can ameliorate the blood coagulation in orthopaedic patients, and it is an effective way to decrease blood loss and homologous blood-transfusions requirements.