Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.11.005
Li Jie, W. Qian, W. Pengfei, L. Yao, Zhang Binfei, Li Zhong, Yang Na, Tian Ding, Z. Kun
Objective To investigate the regularity in and risk factors for perioperative deep venous thrombosis (DVT) and the changes in plasma D-dimer in patients with tibiofibular fracture. Methods A retrospective analysis was done of the 180 patients with tibiofibular fracture who had been treated at Department of Orthopaedics and Trauma, Xi'an Honghui Hospital from September 2014 to February 2018. They were 114 males and 66 females, aged from 16 to 83 years (average, 47.6 years). The levels of plasma D-dimer were detected at admission, one day preoperation, and 1, 3, 5 days postoperation. B-ultrasound examination of both lower extremities was performed before and after surgery. According to the results of B-ultrasound, the patients were divided into a DVT group and a non-DVT group. The 2 groups were compared in the plasma D-dimer levels measured at different time points. DVT risk factors were screened by univariate analysis, and multivariate logistic regression analysis was used to determine independent risk factors. Results Of this cohort, 54 cases (30%) developed DVT and 39 cases (21.7%) did preoperation. Of the 39 cases (mixed DVT in one and distal DVT in 38 ones), DVT disappeared in 14 postoperation. Of the 40 cases (22.2%) of postoperative DVT (proximal DVT in one, mixed DVT in one and distal DVT in 38 ones), 15 developed newly postoperation. Multivariate logistic regression analysis showed that age, time from injury to operation, pre-operative and postoperative D-dimer elevation were independent risk factors for DVT in the patients. The D-dimer levels in the DVT group were significantly higher than in the non-DVT group at one day preoperation, and 1, 3, 5 days postoperation (P<0.05). The area under the receiver operating characteristic curve was 0.704. When the critical value of D-dimer was 1.4 mg/L, its sensitivity for DVT diagnosis was 0.944 and its specificity 0.246 (poor). When the concentration of D-dimer was 4.45 mg/L, its sensitivity for DVT diagnosis was 0.574 and its specificity 0.817 (the highest). Conclusions Perioperative DVT may happen in patients with tibiofibular fracture, mostly at the distal end beyond the popliteal vein. Clinically, patients who are advanced in age, have plasma D-dimer elevation at admission and after operation, and have waited long for operation should be alert to the occurrence of DVT. The plasma D-dimer level with a recommended threshold of 4.45 mg/L may have a certain diagnostic value for patients with tibiofibular fracture. Key words: Tibia; Fibula; Fractures, bone; Deep vein thrombosis; Risk factors; D-dimer
{"title":"Perioperative deep venous thrombosis in patients with tibiofibular fracture","authors":"Li Jie, W. Qian, W. Pengfei, L. Yao, Zhang Binfei, Li Zhong, Yang Na, Tian Ding, Z. Kun","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.11.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.11.005","url":null,"abstract":"Objective \u0000To investigate the regularity in and risk factors for perioperative deep venous thrombosis (DVT) and the changes in plasma D-dimer in patients with tibiofibular fracture. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was done of the 180 patients with tibiofibular fracture who had been treated at Department of Orthopaedics and Trauma, Xi'an Honghui Hospital from September 2014 to February 2018. They were 114 males and 66 females, aged from 16 to 83 years (average, 47.6 years). The levels of plasma D-dimer were detected at admission, one day preoperation, and 1, 3, 5 days postoperation. B-ultrasound examination of both lower extremities was performed before and after surgery. According to the results of B-ultrasound, the patients were divided into a DVT group and a non-DVT group. The 2 groups were compared in the plasma D-dimer levels measured at different time points. DVT risk factors were screened by univariate analysis, and multivariate logistic regression analysis was used to determine independent risk factors. \u0000 \u0000 \u0000Results \u0000Of this cohort, 54 cases (30%) developed DVT and 39 cases (21.7%) did preoperation. Of the 39 cases (mixed DVT in one and distal DVT in 38 ones), DVT disappeared in 14 postoperation. Of the 40 cases (22.2%) of postoperative DVT (proximal DVT in one, mixed DVT in one and distal DVT in 38 ones), 15 developed newly postoperation. Multivariate logistic regression analysis showed that age, time from injury to operation, pre-operative and postoperative D-dimer elevation were independent risk factors for DVT in the patients. The D-dimer levels in the DVT group were significantly higher than in the non-DVT group at one day preoperation, and 1, 3, 5 days postoperation (P<0.05). The area under the receiver operating characteristic curve was 0.704. When the critical value of D-dimer was 1.4 mg/L, its sensitivity for DVT diagnosis was 0.944 and its specificity 0.246 (poor). When the concentration of D-dimer was 4.45 mg/L, its sensitivity for DVT diagnosis was 0.574 and its specificity 0.817 (the highest). \u0000 \u0000 \u0000Conclusions \u0000Perioperative DVT may happen in patients with tibiofibular fracture, mostly at the distal end beyond the popliteal vein. Clinically, patients who are advanced in age, have plasma D-dimer elevation at admission and after operation, and have waited long for operation should be alert to the occurrence of DVT. The plasma D-dimer level with a recommended threshold of 4.45 mg/L may have a certain diagnostic value for patients with tibiofibular fracture. \u0000 \u0000 \u0000Key words: \u0000Tibia; Fibula; Fractures, bone; Deep vein thrombosis; Risk factors; D-dimer","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"952-958"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44952942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.11.015
Gang Wang, Shiyuan Lin
{"title":"Current management and grading diagnosis and treatment of acetabular fracture","authors":"Gang Wang, Shiyuan Lin","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.11.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.11.015","url":null,"abstract":"","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"1009-1012"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47936136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.11.013
Rongbin Lu, D. Seligson, D. Hagan, XiaoFei Ding, Jinmin Zhao
The Kickstand technique is an extension added to the basic frame of modern external fixation to elevate an affected extremity. It is an affordable and modified external fixation in orthopedic trauma. Orthopedic physicians use this technique to prevent formation of pressure sores and relieve swelling in lower extremity of patients who require prolonged bed rest, because this technique makes the heel apart from the supporting surface and promotes circulation of venous blood lymph fluid. This paper briefly introduces the development of this technique and its efforts to improve quality of care and solve a clinical problem. To relieve the burden of healthcare for pressure sores and swelling in an affected lower extremity after surgery, this technique should be popularized. Key words: External fixators; Wounds and injuries; Edema; Pressure sores; Prevention; Kickstand technique
{"title":"Kickstand extended external fixation for prevention of pressure sores and swelling in the post-traumatic lower extremity","authors":"Rongbin Lu, D. Seligson, D. Hagan, XiaoFei Ding, Jinmin Zhao","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.11.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.11.013","url":null,"abstract":"The Kickstand technique is an extension added to the basic frame of modern external fixation to elevate an affected extremity. It is an affordable and modified external fixation in orthopedic trauma. Orthopedic physicians use this technique to prevent formation of pressure sores and relieve swelling in lower extremity of patients who require prolonged bed rest, because this technique makes the heel apart from the supporting surface and promotes circulation of venous blood lymph fluid. This paper briefly introduces the development of this technique and its efforts to improve quality of care and solve a clinical problem. To relieve the burden of healthcare for pressure sores and swelling in an affected lower extremity after surgery, this technique should be popularized. \u0000 \u0000 \u0000Key words: \u0000External fixators; Wounds and injuries; Edema; Pressure sores; Prevention; Kickstand technique","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"1000-1004"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42719768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.11.007
Kehan Hua, Chen Chen, Ting Li, Xieyuan Jiang, Y. Zha, M. Gong, Weitong Sun
Objective To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus. Methods From January 2013 to May 2017, 159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating. They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years). They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not. The stiffness group had extension-flexion and/or pronation-supination <100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥100° and no secondary elbow arthrolysis. Age, gender, fracture side, mechanism of injury, AO fracture classification, open/close fracture, additional fracture, preoperative nerve injury, time from injury to surgery, surgical approach, configuration of plating, medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis. Results The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months). The latest follow-up showed fracture union in all the patients. The stiffness group had 38 patients and the non-stiffness group 121. Multivariate regression analysis showed that high energy trauma (OR=3.141, 95%CI 1.396~7.070, P=0.006) and time from injury to surgery >one week (OR=2.596, 95%CI 1.123~6.000, P=0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus. Conclusion The patients with high energy trauma and time from injury to surgery >one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus. Key words: Elbow joint; Fracture fixation, internal; Risk factors; Intercondylar fractures
{"title":"Risk factors for elbow stiffness after open reduction and internal fixation for intercondylar fractures of the distal humerus","authors":"Kehan Hua, Chen Chen, Ting Li, Xieyuan Jiang, Y. Zha, M. Gong, Weitong Sun","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.11.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.11.007","url":null,"abstract":"Objective \u0000To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus. \u0000 \u0000 \u0000Methods \u0000From January 2013 to May 2017, 159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating. They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years). They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not. The stiffness group had extension-flexion and/or pronation-supination <100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥100° and no secondary elbow arthrolysis. Age, gender, fracture side, mechanism of injury, AO fracture classification, open/close fracture, additional fracture, preoperative nerve injury, time from injury to surgery, surgical approach, configuration of plating, medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis. \u0000 \u0000 \u0000Results \u0000The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months). The latest follow-up showed fracture union in all the patients. The stiffness group had 38 patients and the non-stiffness group 121. Multivariate regression analysis showed that high energy trauma (OR=3.141, 95%CI 1.396~7.070, P=0.006) and time from injury to surgery >one week (OR=2.596, 95%CI 1.123~6.000, P=0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus. \u0000 \u0000 \u0000Conclusion \u0000The patients with high energy trauma and time from injury to surgery >one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus. \u0000 \u0000 \u0000Key words: \u0000Elbow joint; Fracture fixation, internal; Risk factors; Intercondylar fractures","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"966-972"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46960897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.11.009
Zhongmin Shi, Xiaokang Wang, Jiantao Jiang, Zhendong Li, W. Gu, G. Mei, J. Xue, J. Zou, Qi Wang, Kai-yong Zhang, Min Zhang, Yan Su
Objective To compare instrumentation with 3D-printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis. Methods A retrospective analysis was done of the 21 patients with varus ankle osteoarthritis who had been treated at Department of Orthopaedics, Shanghai JiaoTong University Affiliated Sixth People's Hospital from January 2017 to December 2018. They were divided into 2 groups by their treatment methods. In the 9 patients treated by instrumentation with 3D-printed patient-specific guides, there were 6 males and 3 females with an age of 54.6±8.6 years, 4 left and 5 right sides involved, and one case of Takakura stage 1, 3 cases of Takakura stage 2 and 5 cases of Takakura stage 3a. In the 12 patients treated by conventional techniques, there were 7 males and 5 females with an age of 53.0±6.5 years, 7 left and 5 right sides involved, and one case of Takakura stage 1, 5 cases of Takakura stage 2 and 6 cases of Takakura stage 3a. The 3D printed guide group and the conventional group were compared in terms of operation time, intraoperative blood loss and frequency of intraoperative fluoroscopy, tibial anterior surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS). The differences in TAS, TT and TLS between pre- and post-operation in the 3D printed guide group were also evaluated. Results There were no significant differences in the preoperative general data between the 2 groups (P>0.05), indicating they were comparable. All the patients were available for follow-up for an average of 7.8 months (from 3 to 15 months). The 3D printed guide group incurred significantly shorter operation time (106.2±10.6 min), less intraoperative blood loss (207.2±16.0 mL) and lower fluoroscopy frequency (2±0) than the conventional osteotomy group (all P 0.05). Conclusions Compared with conventional techniques, instrumentation with 3D-printed patient-specific guides can shorten operation time and reduce intraoperative blood loss and fluoroscopy frequency. The 3D printed patient-specific guides in osteotomy can facilitate accurate correction of varus deformity, leading to similar efficacy compared with conventional osteotomy. Key words: Ankle joint; Ostearthritis; Osteotomy; 3D printing; Patient-specific guide; Supramalleolar osteotomy
{"title":"Instrumentation with 3D printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis","authors":"Zhongmin Shi, Xiaokang Wang, Jiantao Jiang, Zhendong Li, W. Gu, G. Mei, J. Xue, J. Zou, Qi Wang, Kai-yong Zhang, Min Zhang, Yan Su","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.11.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.11.009","url":null,"abstract":"Objective \u0000To compare instrumentation with 3D-printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was done of the 21 patients with varus ankle osteoarthritis who had been treated at Department of Orthopaedics, Shanghai JiaoTong University Affiliated Sixth People's Hospital from January 2017 to December 2018. They were divided into 2 groups by their treatment methods. In the 9 patients treated by instrumentation with 3D-printed patient-specific guides, there were 6 males and 3 females with an age of 54.6±8.6 years, 4 left and 5 right sides involved, and one case of Takakura stage 1, 3 cases of Takakura stage 2 and 5 cases of Takakura stage 3a. In the 12 patients treated by conventional techniques, there were 7 males and 5 females with an age of 53.0±6.5 years, 7 left and 5 right sides involved, and one case of Takakura stage 1, 5 cases of Takakura stage 2 and 6 cases of Takakura stage 3a. The 3D printed guide group and the conventional group were compared in terms of operation time, intraoperative blood loss and frequency of intraoperative fluoroscopy, tibial anterior surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS). The differences in TAS, TT and TLS between pre- and post-operation in the 3D printed guide group were also evaluated. \u0000 \u0000 \u0000Results \u0000There were no significant differences in the preoperative general data between the 2 groups (P>0.05), indicating they were comparable. All the patients were available for follow-up for an average of 7.8 months (from 3 to 15 months). The 3D printed guide group incurred significantly shorter operation time (106.2±10.6 min), less intraoperative blood loss (207.2±16.0 mL) and lower fluoroscopy frequency (2±0) than the conventional osteotomy group (all P 0.05). \u0000 \u0000 \u0000Conclusions \u0000Compared with conventional techniques, instrumentation with 3D-printed patient-specific guides can shorten operation time and reduce intraoperative blood loss and fluoroscopy frequency. The 3D printed patient-specific guides in osteotomy can facilitate accurate correction of varus deformity, leading to similar efficacy compared with conventional osteotomy. \u0000 \u0000 \u0000Key words: \u0000Ankle joint; Ostearthritis; Osteotomy; 3D printing; Patient-specific guide; Supramalleolar osteotomy","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"978-985"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47257063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.11.004
Hong-wei Xiao, Ting Li, Meng Mi, Zhou Li, Hongbo Liu, Zhi-yang Gao, Ruofei Ma, Bo Sun, Bo Li
Objective To compare the therapeutic effects between the anesthetic and non-anesthetic closed reduction protocols for distal radius fractures based on the concept of Enhanced Recovery After Surgery (ERAS). Methods A prospective study was conducted in a cohort of 186 patients with distal radius fracture who had been admitted to the Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from September 2018 to January 2019. The patients were divided into 2 groups depending on the choice by themselves. Of them, 72 (intervention group) underwent the standardized closed reduction under brachial block anesthesia based on the concept of ERAS while the other 114 (control group) conventional closed reduction under no anesthesia. The 2 groups were compared in terms of emergency reduction times, swelling scores, reoperation rate, splint removal time, functional outcomes by the Patient-Rated Wrist Evaluation (PRWE) and radiographic outcomes by the Lidstrom criteria. Results The patients in both groups were followed up for 6 months. The reduction times were fewer in the intervention group than in the control group (1.1±0.1 versus 1.6±0.1, P 0.05). Conclusion Compared with conventional closed reduction, the closed reduction under anesthesia based on the ERAS concept is an effective method for the emergency treatment of distal radius fracture, because it may minimize the patients’ pain experience, increase the rate of successful reduction, decrease the rate of reoperation, shorten the splint fixation time and gain better functional outcomes. Key words: Radius fractures; Anesthesia; Ultrasonography; Brachial plexus; Closed reduction
{"title":"Enhanced Recovery After Surgery used in close reduction of distal radius fracture in emergency traumatic patients: a prospective cohort study","authors":"Hong-wei Xiao, Ting Li, Meng Mi, Zhou Li, Hongbo Liu, Zhi-yang Gao, Ruofei Ma, Bo Sun, Bo Li","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.11.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.11.004","url":null,"abstract":"Objective \u0000To compare the therapeutic effects between the anesthetic and non-anesthetic closed reduction protocols for distal radius fractures based on the concept of Enhanced Recovery After Surgery (ERAS). \u0000 \u0000 \u0000Methods \u0000A prospective study was conducted in a cohort of 186 patients with distal radius fracture who had been admitted to the Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from September 2018 to January 2019. The patients were divided into 2 groups depending on the choice by themselves. Of them, 72 (intervention group) underwent the standardized closed reduction under brachial block anesthesia based on the concept of ERAS while the other 114 (control group) conventional closed reduction under no anesthesia. The 2 groups were compared in terms of emergency reduction times, swelling scores, reoperation rate, splint removal time, functional outcomes by the Patient-Rated Wrist Evaluation (PRWE) and radiographic outcomes by the Lidstrom criteria. \u0000 \u0000 \u0000Results \u0000The patients in both groups were followed up for 6 months. The reduction times were fewer in the intervention group than in the control group (1.1±0.1 versus 1.6±0.1, P 0.05). \u0000 \u0000 \u0000Conclusion \u0000Compared with conventional closed reduction, the closed reduction under anesthesia based on the ERAS concept is an effective method for the emergency treatment of distal radius fracture, because it may minimize the patients’ pain experience, increase the rate of successful reduction, decrease the rate of reoperation, shorten the splint fixation time and gain better functional outcomes. \u0000 \u0000 \u0000Key words: \u0000Radius fractures; Anesthesia; Ultrasonography; Brachial plexus; Closed reduction","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"945-951"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43726272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.11.010
Chen Wang, N. Yang, Lisong Heng, F. Wei, Yang-jun Zhu, Kun Zhang
Objective To determine the role of acromioclavicular ligament in maintaining the stability of acromioclavicular joint. Methods In 12 cadaveric specimens of normal shoulder joint which had been routinely treated by formalin, the coracoclavicular ligaments (trapezium and conical ligaments) were dissected and exposed after soft tissue was removed from the surface. The distribution of the insertion and starting points, appearance and attachment area of the trapezium and conical ligaments were observed. The lengths of the 2 ligaments, the coronal and sagittal lengths of the clavicular attachment area, the distances from the most lateral point to the distal end of the clavicle, and the angles at the coronal and sagittal positions of the 2 ligaments were measured. Subsequently, the 12 cadaveric specimens were randomly divided into 4 groups (n=3). Group A retained the intact acromioclavicular ligament, group B the intact coracoclavicular ligament, group C the intact trapezium ligament and group D the intact conical ligament. In an electronic machine for versatile mechanical tests, a 100 mm/min load speed was applied for destructive static stretching of the ligament specimens in the vertical direction. The load-displacement curves were recorded and drawn by a computer in connection with the biomechanical testing machine. The rupture strengths of the 4 ligaments were recorded. Results The average lengths of the conical and trapezium ligaments were 10.6 mm and 12.5 mm, respectively. The coronal and sagittal lengths of the clavicular attachment area of the conical ligament averaged 13.4 mm and 5.8 mm, respectively. The coronal and sagittal lengths of the clavicular attachment area of the trapezium ligament averaged 14.2 mm and 8.7 mm, respectively. The distances from the most lateral points of the conical and trapezium ligaments to the distal clavicle averaged 35.5 mm and 23.6 mm, respectively. The average angles at the coronal and sagittal positions were 6.2° and 11.3° for the conical ligament and 38.7°and 6.9° for the trapezium ligament, respectively. The average tensile force was 201.3±1.9 N for the acromioclavicular ligament rupture, 374.6±1.4 N for the coracoclavicular ligament rupture, 192.3±4.3 N for the trapezium ligament rupture, and 345.7±1.1 N for the conical ligament rupture. Conclusions The roles and contributions of the conical, trapezium and acromioclavicular ligaments are different in maintaining the stability of the acromioclavicular joint. In anatomical reconstruction of the acromioclavicular joint, it is more important to reconstruct the conical ligament and to repair the acromioclavicular ligament simultaneously as much as possible. Key words: Acromioclavicular joint; Anatomy; Biomechanics; Coracoid ligament; Acromioclavicular ligament
{"title":"Functional anatomy and vertical biomechanics of the acromioclavicular joint","authors":"Chen Wang, N. Yang, Lisong Heng, F. Wei, Yang-jun Zhu, Kun Zhang","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.11.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.11.010","url":null,"abstract":"Objective \u0000To determine the role of acromioclavicular ligament in maintaining the stability of acromioclavicular joint. \u0000 \u0000 \u0000Methods \u0000In 12 cadaveric specimens of normal shoulder joint which had been routinely treated by formalin, the coracoclavicular ligaments (trapezium and conical ligaments) were dissected and exposed after soft tissue was removed from the surface. The distribution of the insertion and starting points, appearance and attachment area of the trapezium and conical ligaments were observed. The lengths of the 2 ligaments, the coronal and sagittal lengths of the clavicular attachment area, the distances from the most lateral point to the distal end of the clavicle, and the angles at the coronal and sagittal positions of the 2 ligaments were measured. Subsequently, the 12 cadaveric specimens were randomly divided into 4 groups (n=3). Group A retained the intact acromioclavicular ligament, group B the intact coracoclavicular ligament, group C the intact trapezium ligament and group D the intact conical ligament. In an electronic machine for versatile mechanical tests, a 100 mm/min load speed was applied for destructive static stretching of the ligament specimens in the vertical direction. The load-displacement curves were recorded and drawn by a computer in connection with the biomechanical testing machine. The rupture strengths of the 4 ligaments were recorded. \u0000 \u0000 \u0000Results \u0000The average lengths of the conical and trapezium ligaments were 10.6 mm and 12.5 mm, respectively. The coronal and sagittal lengths of the clavicular attachment area of the conical ligament averaged 13.4 mm and 5.8 mm, respectively. The coronal and sagittal lengths of the clavicular attachment area of the trapezium ligament averaged 14.2 mm and 8.7 mm, respectively. The distances from the most lateral points of the conical and trapezium ligaments to the distal clavicle averaged 35.5 mm and 23.6 mm, respectively. The average angles at the coronal and sagittal positions were 6.2° and 11.3° for the conical ligament and 38.7°and 6.9° for the trapezium ligament, respectively. The average tensile force was 201.3±1.9 N for the acromioclavicular ligament rupture, 374.6±1.4 N for the coracoclavicular ligament rupture, 192.3±4.3 N for the trapezium ligament rupture, and 345.7±1.1 N for the conical ligament rupture. \u0000 \u0000 \u0000Conclusions \u0000The roles and contributions of the conical, trapezium and acromioclavicular ligaments are different in maintaining the stability of the acromioclavicular joint. In anatomical reconstruction of the acromioclavicular joint, it is more important to reconstruct the conical ligament and to repair the acromioclavicular ligament simultaneously as much as possible. \u0000 \u0000 \u0000Key words: \u0000Acromioclavicular joint; Anatomy; Biomechanics; Coracoid ligament; Acromioclavicular ligament","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"986-990"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44851544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.11.006
H. Yuan, W. Zhigang, J. Long, W. Zhaolin, Z. Kai, Du Gangqiang, Peng Li, Shengyuan Jiang
Objective To investigate the clinical efficacy of minimally invasive plate oseoynthesis (MIPO) assisted by a self-designed lower limb axial tractor in the treatment of complex tibial plateau fractures. Methods The data were retrospectively analyzed of the 31 patients who had undergone surgical treatment for complex tibial plateau fractures from June 2015 to April 2018 at Department of Orthopeadics, Hospital Affiliated to Binzhou Medical College. MIPO was conducted with the assistance of the axial tractor in 17 of them. They were 12 men and 5 women with an age of 50.8±14.7 years, with 8 cases of Schatzker type Ⅴ and 9 ones of Schatzker type Ⅵ. MIPO was conducted without the assistance of the axial tractor but with the assistance of manipulation reduction in the other 14 patients. They were 9 men and 5 women with an age of 48.9±9.5 years, with 6 cases of Schatzker type Ⅴ and 8 ones of Schatzker type Ⅵ. The 2 groups were compared in terms of operation time, intraoperative bleeding, and Rasmussen scores for knee function and medial angle of the proximal tibia at the last follow-up. Results The 2 groups were comparable due to insignificant differences in the preoperative general data between them (P>0.05). The tractor and manipulation groups were followed up for a mean of 9.8 months and 10.9 months respectively. Bone healing was achieved in all patients. For the tractor and manipulation groups, respectively, the operation time was127.8±40.8 min and 174.1±66.8 min, and the intraoperative bleeding 115.6±41.7 mL and 184.3±91.4 mL, showing significant differences between them (P 0.05). Loss of force line was observed in none of the patients at the last follow-up. Conclusion Compared with conventional manipulation reduction, use of our self-designed lower limb axial tractor can shorten operation time, reduce bleeding and facilitate reduction of fracture fragments in the treatment of tibial plateau fractures of Schatzker types Ⅴ and Ⅵ. Key words: Knee joint; Fracture fixation, internal; Surgerical procedures, minimally invasive; Traction; Tibial plateau fracture
{"title":"Minimally invasive plate oseosynthesis assisted by a self-designed lower limb axial tractor for treatment of complex tibial plateau fractures","authors":"H. Yuan, W. Zhigang, J. Long, W. Zhaolin, Z. Kai, Du Gangqiang, Peng Li, Shengyuan Jiang","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.11.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.11.006","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of minimally invasive plate oseoynthesis (MIPO) assisted by a self-designed lower limb axial tractor in the treatment of complex tibial plateau fractures. \u0000 \u0000 \u0000Methods \u0000The data were retrospectively analyzed of the 31 patients who had undergone surgical treatment for complex tibial plateau fractures from June 2015 to April 2018 at Department of Orthopeadics, Hospital Affiliated to Binzhou Medical College. MIPO was conducted with the assistance of the axial tractor in 17 of them. They were 12 men and 5 women with an age of 50.8±14.7 years, with 8 cases of Schatzker type Ⅴ and 9 ones of Schatzker type Ⅵ. MIPO was conducted without the assistance of the axial tractor but with the assistance of manipulation reduction in the other 14 patients. They were 9 men and 5 women with an age of 48.9±9.5 years, with 6 cases of Schatzker type Ⅴ and 8 ones of Schatzker type Ⅵ. The 2 groups were compared in terms of operation time, intraoperative bleeding, and Rasmussen scores for knee function and medial angle of the proximal tibia at the last follow-up. \u0000 \u0000 \u0000Results \u0000The 2 groups were comparable due to insignificant differences in the preoperative general data between them (P>0.05). The tractor and manipulation groups were followed up for a mean of 9.8 months and 10.9 months respectively. Bone healing was achieved in all patients. For the tractor and manipulation groups, respectively, the operation time was127.8±40.8 min and 174.1±66.8 min, and the intraoperative bleeding 115.6±41.7 mL and 184.3±91.4 mL, showing significant differences between them (P 0.05). Loss of force line was observed in none of the patients at the last follow-up. \u0000 \u0000 \u0000Conclusion \u0000Compared with conventional manipulation reduction, use of our self-designed lower limb axial tractor can shorten operation time, reduce bleeding and facilitate reduction of fracture fragments in the treatment of tibial plateau fractures of Schatzker types Ⅴ and Ⅵ. \u0000 \u0000 \u0000Key words: \u0000Knee joint; Fracture fixation, internal; Surgerical procedures, minimally invasive; Traction; Tibial plateau fracture","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"959-965"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43471553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.11.008
L. Yue, Haolin Sun
Objective To explore the short-term effects of fresh vertebral compression fracture on blood coagulation in middle-aged and elderly osteoporotic patients. Methods A retrospective analysis was conducted of the 140 middle-aged and elderly patients (70 ones with fresh vertebral compression fracture and 70 ones with degenerative spinal disease) who had been treated at Department of Orthopaedics, The First Affiliated Hospital to Peking University between January 2016 and December 2018. Collected were their baseline parameters including age, gender and American Society of Anesthesiologists (ASA) scores, preoperative blood parameters including coagulation indicators [D-Dimer, fibrinogen degradation product (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR) and thrombin time (TT)] and platelets indicators, and fracture parameters including number of fractured vertebrae and duration of fracture. The 2 patients groups were divided into 5 age groups: 4 age groups for each 10 between 50 and 90 years and one age group for >90 years. The values of D-Dimer and FDP were compared between the 2 patient groups in each corresponding age group. The proportions of patients with D-Dimer negative and correlations between coagulation parameters and platelets before and after age adjustment were statistically analyzed. Results There were no statistically significant differences in the baseline parameters between the 2 patient groups(P>0.05). The mean onset time for the fracture group was 6.7 days. The values of D-Dimer, FDP, PT, INR, TT and FIB in the fracture group were significantly higher than those in the degenerative disease group(P<0.001). After the D-Dimer threshold adjusted by age, 75.71%(53/70) of the patients in the fracture group were negative while 98.57%(69/70) of those in the degenerative disease group were negative. Meanwhile, the values of D-Dimer and FDP showed a significant correlation (P<0.001) with a Pearson correlation coefficient of 0.932. Compared with the degenerative disease group, the values of D-Dimer and FDP in the fracture group increased significantly in the age groups from 61 to 90 years(P< 0.001). Conclusions Fresh vertebral compression fractures may have a significant effect on the blood coagulation in osteoporotic patients. It is therefore presumed that the middle-aged and elderly patients with fresh vertebral compression fracture may face a higher risk of deep vein thrombosis than those with degenerative spinal disease. Key words: Osteoporosis; Aged; Spinal fractures; Blood coagulation; Deep vein thrombosis; D-Dimer
{"title":"Changes in blood coagulation in middle-aged and elderly patients with fresh vertebral compression fractures","authors":"L. Yue, Haolin Sun","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.11.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.11.008","url":null,"abstract":"Objective \u0000To explore the short-term effects of fresh vertebral compression fracture on blood coagulation in middle-aged and elderly osteoporotic patients. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted of the 140 middle-aged and elderly patients (70 ones with fresh vertebral compression fracture and 70 ones with degenerative spinal disease) who had been treated at Department of Orthopaedics, The First Affiliated Hospital to Peking University between January 2016 and December 2018. Collected were their baseline parameters including age, gender and American Society of Anesthesiologists (ASA) scores, preoperative blood parameters including coagulation indicators [D-Dimer, fibrinogen degradation product (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR) and thrombin time (TT)] and platelets indicators, and fracture parameters including number of fractured vertebrae and duration of fracture. The 2 patients groups were divided into 5 age groups: 4 age groups for each 10 between 50 and 90 years and one age group for >90 years. The values of D-Dimer and FDP were compared between the 2 patient groups in each corresponding age group. The proportions of patients with D-Dimer negative and correlations between coagulation parameters and platelets before and after age adjustment were statistically analyzed. \u0000 \u0000 \u0000Results \u0000There were no statistically significant differences in the baseline parameters between the 2 patient groups(P>0.05). The mean onset time for the fracture group was 6.7 days. The values of D-Dimer, FDP, PT, INR, TT and FIB in the fracture group were significantly higher than those in the degenerative disease group(P<0.001). After the D-Dimer threshold adjusted by age, 75.71%(53/70) of the patients in the fracture group were negative while 98.57%(69/70) of those in the degenerative disease group were negative. Meanwhile, the values of D-Dimer and FDP showed a significant correlation (P<0.001) with a Pearson correlation coefficient of 0.932. Compared with the degenerative disease group, the values of D-Dimer and FDP in the fracture group increased significantly in the age groups from 61 to 90 years(P< 0.001). \u0000 \u0000 \u0000Conclusions \u0000Fresh vertebral compression fractures may have a significant effect on the blood coagulation in osteoporotic patients. It is therefore presumed that the middle-aged and elderly patients with fresh vertebral compression fracture may face a higher risk of deep vein thrombosis than those with degenerative spinal disease. \u0000 \u0000 \u0000Key words: \u0000Osteoporosis; Aged; Spinal fractures; Blood coagulation; Deep vein thrombosis; D-Dimer","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"973-977"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41585816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-15DOI: 10.3760/CMA.J.ISSN.1671-7600.2019.11.003
Jia-lang Hu, Lin Shaogang, Ming Chen, Kun Li, M. Xu, Jun‐wen Wang, Q. Zheng, Wu-sheng Kan
Objective To evaluate Kangli hollow screws with sliding compression locking plate system (KHS) in the treatment of femoral neck fractures. Methods From February 2015 to October 2016, 47 femoral neck fractures were treated at Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan Puai Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. They were 30 men and 17 women, aged from 26 to 68 years (average, 43.5 years). According to the Pauwels classification, there were 24 cases of type Ⅰ, 16 cases of type Ⅱ and 7 cases of type Ⅲ; according to the Garden classification, there were 23 cases of type Ⅱ, 19 cases of type Ⅲ and 5 cases of type Ⅳ. All the fractures were immobilized with KHS after closed reduction or open reduction (3 cases). The fracture union time, femoral head necrosis and femoral neck shortening were observed after operation. The Harris scores were used to evaluate therapeutic effects at the final follow-up. Results All the patients were followed up for an average of 29.7 months (from 22 to 39 months). All the fractures obtained solid bony union after 9 to 15 weeks(average, 12.2 weeks). Femoral head necrosis occurred in one case (2.1%). Femoral neck shortening ≤ 5 mm was observed in 6 cases and femoral neck shortening >5 mm <10 mm in 2 cases, giving a total shortening rate of 17.0%. The Harris scores at the final follow-up ranged from 77 to 98 points, averaging 92.2 points. There were 42 excellent, 3 good and 2 moderate cases, giving an excellent and good rate of 95.7%. Conclusion KHS can lead to excellent therapeutic effects in the treatment of femoral neck fractures. Key words: Femoral neck fractures; Fracture fixation, internal; Bone plates; Therapeutic effect
{"title":"Evaluation of Kangli hollow screws with sliding compression locking plate system for treatment of femoral neck fractures","authors":"Jia-lang Hu, Lin Shaogang, Ming Chen, Kun Li, M. Xu, Jun‐wen Wang, Q. Zheng, Wu-sheng Kan","doi":"10.3760/CMA.J.ISSN.1671-7600.2019.11.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-7600.2019.11.003","url":null,"abstract":"Objective \u0000To evaluate Kangli hollow screws with sliding compression locking plate system (KHS) in the treatment of femoral neck fractures. \u0000 \u0000 \u0000Methods \u0000From February 2015 to October 2016, 47 femoral neck fractures were treated at Department of Orthopaedics, Wuhan Fourth Hospital, Wuhan Puai Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. They were 30 men and 17 women, aged from 26 to 68 years (average, 43.5 years). According to the Pauwels classification, there were 24 cases of type Ⅰ, 16 cases of type Ⅱ and 7 cases of type Ⅲ; according to the Garden classification, there were 23 cases of type Ⅱ, 19 cases of type Ⅲ and 5 cases of type Ⅳ. All the fractures were immobilized with KHS after closed reduction or open reduction (3 cases). The fracture union time, femoral head necrosis and femoral neck shortening were observed after operation. The Harris scores were used to evaluate therapeutic effects at the final follow-up. \u0000 \u0000 \u0000Results \u0000All the patients were followed up for an average of 29.7 months (from 22 to 39 months). All the fractures obtained solid bony union after 9 to 15 weeks(average, 12.2 weeks). Femoral head necrosis occurred in one case (2.1%). Femoral neck shortening ≤ 5 mm was observed in 6 cases and femoral neck shortening >5 mm <10 mm in 2 cases, giving a total shortening rate of 17.0%. The Harris scores at the final follow-up ranged from 77 to 98 points, averaging 92.2 points. There were 42 excellent, 3 good and 2 moderate cases, giving an excellent and good rate of 95.7%. \u0000 \u0000 \u0000Conclusion \u0000KHS can lead to excellent therapeutic effects in the treatment of femoral neck fractures. \u0000 \u0000 \u0000Key words: \u0000Femoral neck fractures; Fracture fixation, internal; Bone plates; Therapeutic effect","PeriodicalId":10145,"journal":{"name":"Chinese Journal of Orthopaedic Trauma","volume":"21 1","pages":"939-944"},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41498121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：