[Importance of local antibiotics in the prophylaxis and treatment of fracture-associated infections]. / Stellenwert lokaler Antibiotika für die Prophylaxe und Therapie frakturassoziierter Infektionen.

BACKGROUND: Fracture-associated infections (FRI) are a severe complication that lead to higher morbidity and high costs for the healthcare system. An effective prophylaxis and treatment of FRI are therefore of great interest. OBJECTIVE: The aim of this review is to summarize the available evidence on the use of local antibiotics for the prophylaxis and treatment of FRI. MATERIAL AND METHODS: A thorough search and a narrative synthesis of the available literature were performed. Their depiction is supplemented by an illustrative presentation of a case report. RESULTS: A robust consensus definition of FRI has existed since 2018. The current use of local antibiotics for the prophylaxis and treatment of FRI in Germany is heterogeneous. There is no consensus on local antibiotic treatment of FRI. The available literature shows an advantage for the additive local antibiotic treatment of open fractures. In closed fractures there is a tendency towards an advantage especially in the presence of further risk factors (long duration of external fixation, higher degree of closed tissue damage, compartment syndrome). According to analogous data from the field of endoprosthetics, additive local antibiotic treatment could also be advantageous under closed soft tissue conditions. The evidence is insufficient to enable the recommendation for a specific antibiotic or a specific mode of application. Local and systemic adverse reactions are frequently discussed in the literature but their incidence is low. CONCLUSION: Overall, additive local antibiotic treatment is to be recommended for open fractures and in closed fractures in the presence of other risk factors. Local and systemic adverse reactions as well as the development of antibiotic resistance must be weighed up in individual cases.

Surgical method and clinical effect of modified LC-II screws for fragility fractures of the pelvis in the elderly / 中华骨科杂志

Objective:To investigate the surgical method of LC-II screws for fragility fractures of the pelvis (FFP) in the elderly and evaluate its clinical efficacy.Methods:A retrospective analysis was performed on 45 patients with FFPs operated in our department from January 2011 to January 2022. The clinical information was as follows. The FFP classification of pelvic fracture was IIIA in 26 cases and IIIB in 19 cases. Among them, 22 cases were fixed with closed reduction and modified LC-II screws (experimental group), and 23 cases were fixed with open reduction and reconstruction plates (control group). In the experimental group, there were 6 males and 16 females. The age range was 62-90 years, with an average of 73.2±9.2 years. The FFP classification of pelvic fracture was IIIA in 12 cases and IIIB in 10 cases. In the control group, there were 8 males and 15 females. The age range was 60-87 years, with an average of 72.8±6.6 years. FFP classification of pelvic fracture was IIIA in 14 cases and IIIB in 9 cases. After admission, pelvic X-ray and CT scan were performed, and the surgery was prepared. In the experimental group, after closed reduction of the posterior ring, the modified LC-II screw was inserted below the anterior inferior iliac spine (AIIS) toward the sacroiliac joint and penetrated the sacroiliac joint. For combined anterior ring fractures, the INFIX was used for anterior ring fixation. In the control group, the posterior ring was fixed with a reconstruction plate and/or sacroiliac screw after open reduction through the lateral rectus approach (LRA). The clinical efficacy was evaluated between the experimental group and the control group.Results:All 45 patients were successfully operated and followed up for 6 months to 3 years. All the pelvic fractures healed. In the experimental group of 22 cases, the time from injury to operation was 3-9 days, with an average of 5.8±1.9 days; the operation time was 25-70 min, with an average of 42.0±12.9 min. The intraoperative bleeding was 20-40 ml, with an average of 29.1±6.7 ml. According to the X-ray reduction evaluation criteria of Matta, 7 cases were excellent, 11 cases were good and 4 cases were medium, with an excellent and good rate of 81.8%. According to rehabilitation criteria of Majeed, 10 cases were excellent, 6 cases were good and 6 cases were fair, with a total excellent and good rate of 72.7%. At the last follow-up, sacroiliac joint pain was evaluated by VAS score: 0 in 10 cases, <3 in 7 cases, and 4-6 in 5 cases. No internal fixation loosening occurred. In the control group, the time from injury to operation was 5-20 days, with an average of 9.9±3.8 days; the operation time was 50-150 min, with an average of 89.1±29.5 min; the intraoperative bleeding was 220-1 000 ml, with an average of 509.2±214.3 ml. According to the X-ray reduction evaluation criteria of Matta, 16 cases were excellent, 4 cases were good and 3 cases was medium, with an excellent and good rate of 87.0%. According to rehabilitation criteria of Majeed, 12 cases were excellent, 6 cases were good and 7 cases were fair, with a total excellent and good rate of 78.3%. At the last follow-up, sacroiliac joint pain was evaluated by VAS score: 0 in 14 cases, <3 in 6 cases, and 4-6 in 3 cases. In the control group, posterior ring plate loosening was found in 2 cases and anterior ring pubic ramus plate and screw loosening was found in 4 cases, but there was no reduction loss.Conclusion:The modified LC-II screw is theoretically feasible in the treatment of FFP. Preliminary clinical results show good safety and efficacy, providing a new idea for minimally invasive treatment of FFP.

The value of fibroblast growth factor 2 and microRNA-206 in predicting postoperative delayed union of closed tibial shaft fractures / 中国基层医药

Objective:To investigate the value of fibroblast growth factor 2 (FGF-2) and microRNA-206 (miR-206) in predicting postoperative delayed union of closed tibial shaft fractures.Methods:The clinical data of 136 patients who underwent closed tibial shaft fracture surgery in Hospital of the 80 th Group Army of Chinese People's Liberation Army Ground Forces from May 2018 to May 2021 were retrospectively analyzed. Eighty-six patients who had delayed union of closed tibial shaft fractures were included in the observation group, and fifty patients who had normal union of closed tibial shaft fractures were included in the control group. Serum FGF-2 level was measured using the enzyme-linked immunosorbent assay, and serum miR-206 expression was detected using the real-time fluorescence polymerase chain reaction. The relationship between FGF-2 expression and miR-206 expression and closed tibial shaft fractures was analyzed. Results:At 1 day, 1, and 4 weeks after surgery, serum FGF-2 level was significantly lower in the observation group than the control group [(14.24 ± 2.15) ng/L vs. (20.36 ± 3.42) ng/L, (21.38 ± 3.27) ng/L vs. (30.45 ± 4.29) ng/L, (23.59 ± 4.36) ng/L vs. (36.67 ± 4.51) ng/L, t = 7.42, 8.42, 16.66, all P < 0.001]. Serum FGF-2 level gradually increased with time in each group. At 1 day after surgery, serum miR-206 expression was significantly lower in the observation group than the control group ( t = 7.50, P < 0.001). At 4 weeks after surgery, serum miR-206 expression was significantly higher in the observation group than the control group ( t = 17.24, P < 0.001). At 1 week after surgery, there was no significant difference in serum miR-206 expression between the two groups ( P > 0.05). Univariate analysis results showed that postoperative infection, FGF-2, and miR-206 were closely related to the delayed union of closed tibial shaft fractures after surgery (all P < 0.05). Multivariate logistic regression analysis results showed that postoperative infection ( OR = 1.93, 95% CI: 1.20-3.07), FGF-2 ( OR = 2.10, 95% CI: 1.31-3.36), miR-206 ( OR = 2.30, 95% CI: 1.35-3.89) were independent risk factors for delayed union of closed tibial shaft fractures after surgery (all P < 0.05). The receiver operating characteristic (ROC) curves plotting serum FGF-2 level and serum miR-206 expression after closed tibial shaft fractures showed that at 4 weeks after surgery, the optimal cut-off value of FGF-2 for predicting delayed union of closed tibial shaft fractures was 29.83 ng/L, with the area under the curve, sensitivity, and specificity of 0.76 (95% CI: 1.23-3.25), 79.34%, and 68.82%, respectively; at 4 weeks after surgery, the optimal cut-off value of miR-206 for predicting delayed union of closed tibial shaft fractures was 0.63, with the area under the curve, sensitivity and specificity of 0.72 (95% CI: 1.10-2.45), 75.33%, and 67.25%, respectively. The area under the curve, the sensitivity, and specificity of combined use of FGF-2 and miR-206 in predicting delayed union of closed tibial shaft fractures were 0.81 (95% CI: 1.35-3.26), sensitivity and specificity were 83.45% and 67.36% respectively. Conclusion:The decrease in serum FGF-2 level and the increase in serum miR-206 expression at 4 weeks after surgery are independent risk factors for delayed union of closed tibial shaft fractures. Combined use of FGF-2 and miR-206 can better predict the delayed union of closed tibial shaft fractures.

Functional and radiological outcomes following plating for displaced fractures of patella: A pilot study.

INTRODUCTION: Patellar fractures constitute almost 1% of total skeletal injuries. Existing common operative methods include the use of different types of Tension band wiring techniques like cannulated screws and K-wires. The Patellar plating construct is a relatively newer operative method for patellar fracture fixation with promising outcomes with fewer complications. METHOD: We conducted a pilot prospective study at our Apex Trauma center in twenty patients aged 18-65years with displaced patellar fractures, AO type A2, A3, B2, B3, C1, C2, C3. Fractures were fixed with low profile patellar plates (1.8 mm). Radiological and functional follow-up was done using X-rays, CT scans and BKS scoring (Bostman-Knee-Scale), Knee Society Score(KSS), and Tegner Lysholm knee scores respectively for two years. RESULT: Mean functional outcome scores at 6 weeks, 3 months, 6 months and 2 years was 25.5, 28.3, 29.05 and 29.9 for BKS; 64.62, 84.12, 90.6, and 97.5 for KSS; 73.75, 89.7,94.8, and 99.3 for Tegner Lysholm knee score respectively. Radiological union, confirmed by CT scan, was observed in all patients at 3 months. Two patients had superficial surgical site infection (SSI) at 2 weeks. Implant impingement was also found in 2 patients at 3 months. None of the patients had a failure of fixation at the end of the study. CONCLUSION: Patients with low profile patellar plate constructs have favorable clinical and radiological outcomes with minimal non-specific complications.

Analysis of risk factors for incision complications after an enlarged lateral "L" incision for open reduction and internal fixation of closed calcaneal fracture / 中华创伤杂志

Objective:To investigate the risk factors for incision complications in open reduction and internal fixation of closed calcaneal fracture via an enlarged lateral L-shaped incision.Methods:A case-control study was used to analyze the clinical data of 128 patients (139 feet) with closed calcaneal fracture treated by open reduction and internal fixation via an enlarged lateral L-shaped incision in Fuzhou Second Hospital affiliated to Xiamen University from January 2019 to January 2022, including 113 males (123 feet) and 15 females (16 feet); aged 24-79 years [(48.2±10.8)years]. The fracture was on the one side in 117 patients and on both sides in 11 patients. According to Sanders classification, type I was noted in 3 feet, type II in 92, type III in 40, and type IV in 4. All patients were treated with an enlarged lateral L-shaped shaped incision for open reduction and internal fixation. The patients were divided into complication group (33 feet) and control group (106 feet), according to the occurrence of postoperative incisional complications. Data were recorded in both groups, including gender, age, side, fracture subtype, combined fractures, diabetes history, smoking history, local blistering, preoperative waiting time, bone graft, drainage, operative time, time of tourniquet use, number of prophylactic antibiotic use, postoperative treatment to improve microcirculation and preoperative and postoperative laboratory indices (white blood cell count, haemoglobin and albumin). The correlation between the above data and postoperative incisional complications was analyzed using the univariate analysis, followed by identification of independent risk factors by the multi-factor Logistic regression analysis.Results:Univariate analysis showed that diabetes history, smoking history, number of prophylactic antibiotic use, postoperative treatment to improve microcirculation, postoperative albumin and postoperative haemoglobin were associated with postoperative incisional complications (all P<0.05). On the contrary, gender, age, side, fracture subtype, combined fractures, local blistering, preoperative waiting time, bone graft, drainage, operative time, time of tourniquet use, preoperative white blood cell count, preoperative albumin, preoperative haemoglobin and postoperative white blood cell count were not associated with postoperative incisional complications (all P>0.05). Multi-factor Logistic regression analysis showed that diabetes history ( OR=3.51, 95% CI 1.29-9.50, P<0.05), smoking history ( OR=3.53, 95% CI 1.34-9.30, P<0.05), prophylactic antibiotic use<2 times ( OR=2.52, 95% CI 1.04-6.10, P<0.05) and lack of postoperative treatment to improve microcirculation ( OR=2.97, 95% CI 1.79-12.45, P<0.05) were significantly associated with postoperative incisional complications ( P<0.05). Conclusion:Diabetes history, smoking history, prophylactic antibiotic use<2 times and lack of postoperative treatment to improve microcirculation are independent risk factors for incisional complications in open reduction and internal fixation of closed calcaneal fracture via a lateral enlarged L-shaped shaped incision.

Influential factors of internal fixation for closed posterior ankle fractures / 中国基层医药

Objective:To investigate the influential factors of internal fixation for closed posterior ankle fractures.Methods:The clinical data of 352 patients with closed ankle fractures who received treatment in Yeda Hospital from January 2016 to June 2020 were retrospectively analyzed. Among the 352 patients, 232 patients had posterior ankle fractures. These patients were grouped according to whether they had undergone internal fixation. The factors that affect internal fixation for closed posterior ankle fractures were analyzed by univariate and multivariate analyses.Results:232 patients out of 352 patients with closed ankle fractures had closed posterior ankle fractures, accounting for 65.91%. A total of 102 (43.97%) patients with posterior ankle fractures underwent internal fixation. There were significant differences in Bartonicek classification, the proportion of the posterior subluxation of the talus, the proportion of posterior ankle bone area, the proportion of posterior ankle bone area ≥ 25% displayed on X-ray image, the proportion of posterior ankle bone area ≥ 15% displayed on CT scan, the proportion of outward displacement of bone mass (92.31% vs. 41.82%) and the proportion of die-punch bone mass (94.23% vs. 40.00%) between patients receiving and not receiving internal fixation ( χ2 = 3.89, 0.26, 1.51, 0.31, 9.27, 8.67, 1.68, 5.84, 10.33, 12.47, 11.48, 10.69, 1.39, all P < 0.05). Multivariate analysis of a logistic regression model showed that posterior subluxation of the talus and the proportion of posterior ankle bone area ≥ 15% displayed on CT scan were independent influential factors of internal fixation for closed posterior ankle fracture ( OR = 5.47, 9.29, 95% CI:1.62-9.75, 3.24-27.01, all P < 0.05). Conclusion:In patients with closed ankle fractures, posterior ankle fractures and internal fixation are more common. At the same time, the posterior subluxation of the talus and the proportion of posterior ankle bone area ≥ 15% displayed on CT scan are closely related to receiving internal fixation.

Can ultrasound-guided infraclavicular block be an alternative option for forearm reduction in the emergency department? A prospective randomized study.

OBJECTIVE: Ultrasound-guided infraclavicular nerve block (IB) has become a well-established method in several outpatient procedures; however, its use in emergency departments (EDs) remains limited. The aim of this study was to compare procedural sedation and anlagesia (PSA) and IB in the pain management for patients who underwent forearm fracture reduction in the ED. METHODS: This prospective randomized study included 60 patients aged 18 to 65 years, who visited the ED with forearm fractures. They were randomly divided into two groups: Group PSA (n=30) and Group IB (n=30). The pain scores of patients were evaluated before and during the procedure with the visual analog scale. Complications and patient and operator satisfaction levels were recorded. RESULTS: There was no difference between the two groups in terms of demographic characteristics. The median (interquartile range) pain scores observed during the procedures were significantly higher in Group PSA than in Group IB (4 [4-6] vs. 2 [0-2], respectively; P<0.001). Patient and operator satisfaction levels were significantly higher in Group IB (P<0.001). Oxygen desaturation was statistically higher in Group PSA than in Group IB (40.00% vs. 3.33%, respectively; P=0.002). CONCLUSION: IB was an effective alternative for reducing pain and increasing patient satisfaction in ED patients undergoing forearm fracture reduction.

[Advances in internal fixation for the treatment of extra-articular distal tibial fracture].

Extra-articular distal tibial fractures as a result of high-energy damage are often comminuted or displaced, frequently accompanied by severe soft tissue injuries.Poor blood supply and various complications make the treatment more difficult,affecting life quality of the patients.The main goals of the treatment are to abtain a healed,well-aligned fracture,functional range of motion of the ankle joint and minimizing complications.It is generally recommended that surgical treatment be performed in the proper context of local conditions to facilitate early functional exercise.Plate fixation and intramedullary nail fixation are the common options for closed fractures.This article focuses on the two treatment methods and some important auxiliary technologies in both domestic and foreign, hoping to provide some references for clinical treatment.

Effect of bone trauma therapeutic instrument combined with Guyuling capsule on traumatic fracture / 国际中医中药杂志

Objective@#To investigate the effects of bone trauma therapy instrument combined with Guyuling capsule in the treatment of traumatic fractures and the effects on the levels of serum epidermal growth factor (EGF), transforming growth factor-1 (TGF-β1) and vascular endothelial growth factor (VEGF).@*Methods@#The clinical data of 168 patients with traumatic fractures admitted to our hospital from January 2015 to December 2017 were retrospectively analyzed. According to different treatment methods, the patients were divided into the bone trauma treatment instrument group (54 cases), the bone Guyuling capsule group (52 cases) and the combined group (62 cases). All patients were treated with open internal fixation and routine anti-infection, detumescence, analgesic and other symptomatic treatment. The bone trauma therapeutic instrument group was given auxiliary treatment with bone trauma therapeutic instrument on the basis of conventional treatment, the bone healing capsule group was added with bone healing capsule treatment on the basis of conventional treatment, and the bone trauma therapeutic instrument and bone healing capsule combined treatment were given in the combined group at the same time. The clinical efficacy was compared and the serum levels of EGF, TGF-β1 and VEGF in the three groups were detected.@*Results@#The detumescence time (8.37 ± 2.84 d vs. 10.76 ± 4.17 d, 11.64 ± 3.98 d, F=12.329) and the healing time (11.73 ± 3.44 week vs. 14.23 ± 4.62 week, 14.76 ± 5.17 week, F=7.835) of the combined group were significantly shorter than those of the bone trauma therapy group and the Guyuling capsule group (P<0.01). After treatment, the serum EGF (0.60 ± 0.27 μg/L vs. 0.75 ± 0.35 μg/L, 0.72 ± 0.37 μg/L, F=3.406), TGF-β1 (9.28 ± 4.19 μg/L vs. 12.36 ± 4.21 μg/L, 12.86 ± 4.69 µg/L, F=11.568), VEGF (92.58 ± 26.01 pg/ml vs. 132.69 ± 28.01 pg/ml, 127.63 ± 29.85 pg/ml, F=36.053) were significantly lower than those in the bone trauma therapy group and the Guyuling capsule group (P<0.01). Three months after operation, the cure rate was 35.2% (19/54) and the total effective rate was 81.5% (44/54) in all three groups. The cure rate and total effective rate in the combined group were better than those in the bone trauma therapy group and the Guyuling capsule group (χ2=6.373, 4.669, P=0.041, 0.031).@*Conclusions@#The treatment of traumatic fractures with bone trauma therapy instrument combined with Guyuling capsule can promote the healing of fractures, reduce the stress response caused by fractures, and improve the clinical efficacy.

Analysis of pathogenic characteristics of incision infection after closed fracture / 中国基层医药

Objective@#To investigate the etiological characteristics of incision infection after closed fracture surgery.@*Methods@#From January 2012 to December 2017, 20 closed fracture patients with postoperative incision infection in Lanxi Ruikang Hospital were selected in the research.The wound infection and secretion samples after closed fracture surgery were collected for isolation and identification of pathogenic bacteria and drug sensitivity test.@*Results@#A total of 33 strains of pathogenic bacteria were isolated and cultured in 20 cases of wound infection after closed fracture operation, including 21 Gram-negative bacteria, 11 Gram-positive bacteria and 1 fungi.Among Gram-negative bacteria, 8 strains of Pseudomonas aeruginosa and 6 strains of Escherichia coli were found.Among Gram-positive bacteria, 6 strains of Staphylococcus aureus were found.The resistance rates of Pseudomonas aeruginosa to ceftriaxone, ceftazidime and cefoperazone were 87.50%, 87.50% and 75.00%, respectively, and the resistance rates of Escherichia coli to ceftriaxone and ceftazidime were 100.00% and 83.33%, respectively.The resistance rates of Staphylococcus aureus to penicillin G and erythromycin were 100.00% and 83.33%, respectively.@*Conclusion@#The pathogenic bacteria of closed fracture postoperative incision infection are Gram-negative bacteria, three pathogenic bacteria were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli, the drug resistance rate of Gram negative bacteria to cephalosporin is high, the resistance rate of main Gram positive bacteria to penicillin and erythromycin G is high.

Advances in internal fixation for the treatment of extra-articular distal tibial fracture / 中华外科杂志

Extra-articular distal tibial fractures as a result of high-energy damage are often comminuted or displaced, frequently accompanied by severe soft tissue injuries.Poor blood supply and various complications make the treatment more difficult,affecting life quality of the patients.The main goals of the treatment are to abtain a healed,well-aligned fracture,functional range of motion of the ankle joint and minimizing complications.It is generally recommended that surgical treatment be performed in the proper context of local conditions to facilitate early functional exercise.Plate fixation and intramedullary nail fixation are the common options for closed fractures.This article focuses on the two treatment methods and some important auxiliary technologies in both domestic and foreign, hoping to provide some references for clinical treatment.

Effect of bone trauma therapeutic instrument combined with Guyuling capsule on traumatic fracture / 国际中医中药杂志

Objective To investigate the effects of bone trauma therapy instrument combined with Guyuling capsule in the treatment of traumatic fractures and the effects on the levels of serum epidermal growth factor (EGF), transforming growth factor-1 (TGF-β1) and vascular endothelial growth factor (VEGF). Methods The clinical data of 168 patients with traumatic fractures admitted to our hospital from January 2015 to December 2017 were retrospectively analyzed. According to different treatment methods, the patients were divided into the bone trauma treatment instrument group (54 cases), the bone Guyuling capsule group (52 cases) and the combined group (62 cases). All patients were treated with open internal fixation and routine anti-infection, detumescence, analgesic and other symptomatic treatment. The bone trauma therapeutic instrument group was given auxiliary treatment with bone trauma therapeutic instrument on the basis of conventional treatment, the bone healing capsule group was added with bone healing capsule treatment on the basis of conventional treatment, and the bone trauma therapeutic instrument and bone healing capsule combined treatment were given in the combined group at the same time. The clinical efficacy was compared and the serum levels of EGF, TGF-β1 and VEGF in the three groups were detected. Results The detumescence time (8.37 ±2.84 d vs. 10.76 ±4.17 d, 11.64 ±3.98 d, F=12.329) and the healing time (11.73 ±3.44 week vs. 14.23 ± 4.62 week, 14.76 ± 5.17 week, F=7.835) of the combined group were significantly shorter than those of the bone trauma therapy group and the Guyuling capsule group ( P<0.01). After treatment, the serum EGF (0.60 ± 0.27 μg/L vs. 0.75 ± 0.35 μg/L, 0.72 ± 0.37 μg/L, F=3.406), TGF-β1 (9.28 ± 4.19 μg/L vs. 12.36 ± 4.21 μg/L, 12.86 ± 4.69 μg/L, F=11.568), VEGF (92.58 ± 26.01 pg/ml vs. 132.69 ± 28.01 pg/ml, 127.63 ± 29.85 pg/ml, F=36.053) were significantly lower than those in the bone trauma therapy group and the Guyuling capsule group (P<0.01). Three months after operation, the cure rate was 35.2% (19/54) and the total effective rate was 81.5% (44/54) in all three groups. The cure rate and total effective rate in the combined group were better than those in the bone trauma therapy group and the Guyuling capsule group ( χ 2=6.373, 4.669, P=0.041, 0.031). Conclusions The treatment of traumatic fractures with bone trauma therapy instrument combined with Guyuling capsule can promote the healing of fractures, reduce the stress response caused by fractures, and improve the clinical efficacy.

Analysis of pathogenic characteristics of incision infection after closed fracture / 中国基层医药

Objective To investigate the etiological characteristics of incision infection after closed fracture surgery.Methods From January 2012 to December 2017,20 closed fracture patients with postoperative incision infection in Lanxi Ruikang Hospital were selected in the research.The wound infection and secretion samples after closed fracture surgery were collected for isolation and identification of pathogenic bacteria and drug sensitivity test.Results A total of 33 strains of pathogenic bacteria were isolated and cultured in 20 cases of wound infection after closed fracture operation,including 21 Gram-negative bacteria,11 Gram-positive bacteria and 1 fungi.Among Gram -negative bacteria,8 strains of Pseudomonas aeruginosa and 6 strains of Escherichia coli were found.Among Gram-positive bacteria,6 strains of Staphylococcus aureus were found.The resistance rates of Pseudomonas aeruginosa to ceftriaxone,ceftazidime and cefoperazone were 87.50％,87.50％ and 75.00％,respectively,and the resistance rates of Escherichia coli to ceftriaxone and ceftazidime were 100.00％ and 83.33％,respectively.The resistance rates of Staphylococcus aureus to penicillin G and erythromycin were 100.00％ and 83.33％,respectively.Conclusion The pathogenic bacteria of closed fracture postoperative incision infection are Gram-negative bacteria,three pathogenic bacteria were Staphylococcus aureus,Pseudomonas aeruginosa and Escherichia coli,the drug resistance rate of Gram negative bacteria to cephalosporin is high,the resistance rate of main Gram positive bacteria to penicillin and erythromycin G is high.

EVALUATION AND COMPARISON OF OPEN AND CLOSED TIBIA SHAFT FRACTURES IN A QUATERNARY REFERENCE CENTER.

INTRODUCTION: Tibia shaft fractures are among the most common in orthopedic practice, but Brazilian literature remains limited on the subject. OBJECTIVE: To evaluate the characteristics of tibia shaft fractures and conduct a comparison between exposed and closed fractures of the tibia. METHODS: This comparative prospective study examined all tibia shaft fractures admitted to our services over a twelve-month period. The cases were evaluated according to age, trauma mechanism, sex, associated fractures, treatment, hospital stay, and readmission rate during the six months after discharge. RESULTS: Fifty-three cases met the inclusion criteria. The average age was 36 years (SD 14.3) and 83% were males (p<0.001). Traffic accidents were responsible for 73.6% of fractures (p<0.001). Exposed fractures were found in 52.8% of the cases (p=0.56). When initial treatment consisted of stabilization with external fixation, these cases were more likely to be rehospitalized (p=0.009). Cases of open fracture also had longer hospital stays (p<0.001) and a higher readmission rate (p=0.028). CONCLUSION: Open fractures are associated with more severe trauma, expressed in longer hospital stays and high rates of readmission. Cases of fracture which were initially treated with external fixation had a higher readmission rate. Level of Evidence II; Prospective comparative study.

INTRODUÇÃO: Fratura diafisária de tíbia é uma das fraturas mais comuns na prática ortopédica, porém a literatura brasileira ainda é limitada na sua avaliação. OBJETIVO: Avaliar as características das fraturas diafisárias de tíbia e realizar uma comparação entre as expostas e fechadas. MATERIAL E MÉTODOS: Foi realizado um estudo, prospectivo comparativo por 12 meses, com todas as fraturas diafisárias de tíbia admitidas. Os pacientes foram avaliados nos seguintes critérios: idade, mecanismo de trauma, sexo, fraturas associadas, tratamento, tempo de internação e índice de reinternação nos seis meses subsequentes à alta. RESULTADOS: Foram avaliados 53 casos que se encaixavam nos critérios de inclusão. A idade média dos pacientes avaliados no nosso estudo era de 36 anos (DP14,3), 83% eram homens (p<0,001). Acidente de tráfego foi responsável por 73,6% (p<0,001). Lesões expostas foram encontradas em 52,8% (p=0,56). O fixador externo, quando utilizado como método de estabilização inicial, apresentou maior índice de reinternação (p=0,009). As lesões expostas apresentaram tempo de internação (p<0,001) e índice de reinternação superior as fechadas (p=0,028). CONCLUSÕES: As fraturas expostas estão envolvidas com traumas de maior gravidade, tanto pelo tempo aumentado de internação hospitalar quanto pelo alto índice de reinternação. Fraturas tratadas inicialmente com fixador externo apresentam maior taxa de reinternação. Nível de Evidência II; Estudo prospectivo comparativo.

Evaluation and comparison of open and closed tibia shaft fractures in a quaternary reference center / Comparação das fraturas diafisárias de tibia expostas e fechadas em um serviço quaternário

ABSTRACT Introduction Tibia shaft fractures are among the most common in orthopedic practice, but Brazilian literature remains limited on the subject. Objective To evaluate the characteristics of tibia shaft fractures and conduct a comparison between exposed and closed fractures of the tibia. Methods This comparative prospective study examined all tibia shaft fractures admitted to our services over a twelve-month period. The cases were evaluated according to age, trauma mechanism, sex, associated fractures, treatment, hospital stay, and readmission rate during the six months after discharge. Results Fifty-three cases met the inclusion criteria. The average age was 36 years (SD 14.3) and 83% were males (p<0.001). Traffic accidents were responsible for 73.6% of fractures (p<0.001). Exposed fractures were found in 52.8% of the cases (p=0.56). When initial treatment consisted of stabilization with external fixation, these cases were more likely to be rehospitalized (p=0.009). Cases of open fracture also had longer hospital stays (p<0.001) and a higher readmission rate (p=0.028). Conclusion Open fractures are associated with more severe trauma, expressed in longer hospital stays and high rates of readmission. Cases of fracture which were initially treated with external fixation had a higher readmission rate. Level of Evidence II; Prospective comparative study.

RESUMO Introdução Fratura diafisária de tíbia é uma das fraturas mais comuns na prática ortopédica, porém a literatura brasileira ainda é limitada na sua avaliação. Objetivo Avaliar as características das fraturas diafisárias de tíbia e realizar uma comparação entre as expostas e fechadas. Material e Métodos Foi realizado um estudo, prospectivo comparativo por 12 meses, com todas as fraturas diafisárias de tíbia admitidas. Os pacientes foram avaliados nos seguintes critérios: idade, mecanismo de trauma, sexo, fraturas associadas, tratamento, tempo de internação e índice de reinternação nos seis meses subsequentes à alta. Resultados Foram avaliados 53 casos que se encaixavam nos critérios de inclusão. A idade média dos pacientes avaliados no nosso estudo era de 36 anos (DP14,3), 83% eram homens (p<0,001). Acidente de tráfego foi responsável por 73,6% (p<0,001). Lesões expostas foram encontradas em 52,8% (p=0,56). O fixador externo, quando utilizado como método de estabilização inicial, apresentou maior índice de reinternação (p=0,009). As lesões expostas apresentaram tempo de internação (p<0,001) e índice de reinternação superior as fechadas (p=0,028). Conclusões As fraturas expostas estão envolvidas com traumas de maior gravidade, tanto pelo tempo aumentado de internação hospitalar quanto pelo alto índice de reinternação. Fraturas tratadas inicialmente com fixador externo apresentam maior taxa de reinternação. Nível de Evidência II; Estudo prospectivo comparativo.

Prediction of infection following internal fixation of closed fractures by serum inflammatory factors / 中华创伤骨科杂志

Objective To explore the role of serum inflammatory factors in prediction of infection following internal fixation of closed fractures and its significance for surgical timing and infection prophylaxis.Methods A retrospective study was conducted of the 100 patients who had been treated by internal fixation for closed fracture from January 2014 through July 2016.They were 52 men and 48 women,aged from 24 to 76 years (average,45 years).There were 14 femoral fractures,19 tibial plateau fractures,25 patella fractures,8 pilon fractures,22 tibiofibular shaft fractures,and 12 calcaneal fractures.Of them,21 were inflicted by wound infection.The preoperative and postoperative infection indexes,CRP,ESR,PCT and leukocyte count,were recorded.Logistic regression analysis was conducted to test the correlation between the infection indexes and postoperative infection.The optimal cut-off value was determined by the receiver operating characteristic curve.Results CRP showed a significant correlation with postoperative infection while other indexes did not.The optimal cut-off value was 25 mg/L at one day before operation.Conclusions Preoperative determination of CRP may predict the risk of postoperative infection.CRP ＞ 25 mg/L at one day before operation may indicate the following day is not suitable for surgery and active infection prophylaxis should be conducted after surgery.

Treatment of Proximal Humerus Fractures using PHILOS Plate.

INTRODUCTION: Treatment of proximal humerus fractures always holds a dilemma for the treating surgeon. AIM: To assess the functional outcome of proximal humerus fractures treated with Proximal Humerus Internal Locking System (PHILOS) plating. MATERIAL AND METHODS: Fifty three consecutive patients were treated with PHILOS plating between August 2013 and August 2014. The inclusion criteria were skeletally matured patients with closed fracture proximal humerus with displacement >1 cm and varus angulation of >450. Severely comminuted fractures, open fractures and valgus impacted fractures were excluded from the study. The outcome was assessed using Neer's scoring system. RESULTS: The average age was 54.3±5.8 years. As per the Neers classification system, there were 6 (11.32%) 1-part, 19 (35.85%) 2-part, 17 (32.085) and 11 (20.75%) 3 and 4-part fracture respectively. Average surgical duration was 94±10.2 minutes. Radiological union was seen at 12±4.6 weeks. There were 2 (3.77%) cases of varus collapse. Three (5.66%) cases had screw back out, which was later revised and had a favourable outcome. As per the Neer's scoring system, 7 (13.21%) cases had excellent results, 37 (69.81%) had satisfactory, 6 (11.32%) had unsatisfactory while 3 (05.66%) cases had poor outcomes. CONCLUSION: PHILOS plating has a good functional outcome. However, proper patient selection, thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery.

Curative effects of suture anchor tenodesis in repairing acute closed distal achilles tendon injuries / 天津医药

Objective To evaluate the effectiveness of the suture anchor in the treatment of acute closed distal achilles tendon rupture. Methods A retrospective review of clinical data in 25 patients with acute achilles tendon rupture was performed in the department of orthopedic trauma of Tianjin Hospital between October 2012 to January 2014. The operation was performed by standard approach, with the suture anchors to reconstruct the achilles tendon insertion, and the Krachow technique was used to suture the achilles tendon. All patients were followed up for 19~35 months. The situation of the wound healing, heel pain, and achilles tendon re-rupture were observed and analyzed. According to the passive range of motion of the bilateral ankle joint, the achilles tendon total rupture score (ATRS), the American orthopaedic foot and ankle society (AOFAS) score and functional recovery were assessed one year after operation. Results The operation was successfully completed in this group. The operation time was 25-35 min, the average time was (30.4 ± 4.8) min. No major vascular and nerve injury occurred in the operation. All patients were followed up. The wound healed well. No infection and skin necrosis, no heel pain and achilles tendon re-rupture were found during follow-up. There was no significant difference in mean passive plantar flexion between injured ankles and uninjured ankles one year after operation (44.36° ± 3.33° vs. 46.40°±4.53°, P>0.05). But mean passive dorsiflexion was lower in injured ankles than that of uninjured ankles (16.88°± 4.10° vs. 20.12°±3.21°,P<0.05). The mean ATRS score was 88.7±6.1 (range 79-97), and the mean AOFAS score was 92.4± 5.6 (range 76-100) at first postoperative year. According to the AOFAS scale, the results were excellent in 20 cases and good in 5 cases. Conclusion It was successful to repair the acute closed distal achilles tendon injuries with the suture anchors.

Influence of perioperative antibiotics use on incision healing of simple upper limb closed fracture / 中华创伤杂志

Objective To respectively investigate the impact of perioperative use of antibiotics on incision healing of simple upper limb closed fracture.Methods The study enrolled 124 patients with simple upper limb closed fracture treated from October 2012 to June 2013,including fracture of humerus (surgical neck,shaft,and supracondyla),fracture of forearm (ulna,olecranon,and radius)and fracture of metacarpus.The patients were allocated to non-antibiotic group (n =73) and antibiotictreated group (n =51) according to the random number table.Between-group analysis was made on body temperature,peripheral white blood cell count,C-reactive protein level,drainage fluid culture and incision healing.Results Sex,age,disease entity and operation time were similar between the two groups (P ＞ 0.05).Non-antibiotic and antibiotic-treated groups showed no significant differences in body temperature [preoperation:(36.50 ± 0.27) ℃ vs (36.70 ± 0.39) ℃ ; postoperation:(37.64 ± 0.37) ℃vs (37.41 ±0.41)℃],peripheral white blood cell count [preoperation:(6.1 ±1.0) × 109 mol/L vs (6.5 ±0.8) × 109 mol/L; postoperation:(12.1 ±0.7) × 109 mol/L vs (11.3 ±0.6) × 109mol/L] and C-reactive protein level [preoperation:(7.2 ±0.9)mg/L vs (6.7 ±0.7)mg/L; postoperation:(12.0 ± 1.3) mg/L vs (13.4 ±0.9)mg/L] (P ＞0.05).Incisional infection occurred in 1 case (1％) in non-antibiotic group,but none in antibiotic-treated group (P ＞ 0.05).Conclusions For simple upper limb closed fracture,perioperative use of antibiotic has advantages of slight trauma,short operation time and few bleeding.Likewise,satisfactory bone healing is achieved in the absence of antibiotics during perioperative period.

Comparison between Intramedullary Nailing and Percutaneous K-Wire Fixation for Fractures in the Distal Third of the Metacarpal Bone.

BACKGROUND: To compare clinical and radiographic outcomes between intramedullary nail fixation and percutaneous K-wire fixation for fractures in the distal third portion of the metacarpal bone. METHODS: A single-institutional retrospective review identified 41 consecutive cases of metacarpal fractures between September 2009 and August 2013. Each of the cases met the inclusion criteria for closed, extra-articular fractures of the distal third of the metacarpal bone. The patients were divided by the method of fixation (intramedullary nailing or K-wire). Outcomes were compared for mean and median total active motion of the digit, radiographic parameters, and period until return to work. Complications and symptoms were determined by a questionnaire. RESULTS: During the period under review, 41 patients met the inclusion criteria, and the fractures were managed with either intramedullary nailing (n=19) or percutaneous K-wire fixation (n=22). The mean and median total active range of motion and radiographic healing showed no statistically significant difference between the two groups. No union failures were observed in either group. The mean operation time was shorter by an average of 14 minutes for the percutaneous K-wire fixation group. However, the intramedullary nailing group returned to work earlier by an average of 2.3 weeks. Complications were reported only in the K-wire fixation group. CONCLUSIONS: Intramedullary nailing fixation is advisable for fractures in the distal third of the metacarpal bone. It provides early recovery of the range of motion, an earlier return to work, and lower complication rates, despite potentially requiring a wire removal procedure at the patient's request.