Pub Date : 2025-04-09DOI: 10.1016/j.cjtee.2024.10.008
Konstantin Lipatov, Arthur Asatryan, George Melkonyan, Aleksandr D Kazantcev, Ekaterina Solov'eva, Irina Gorbacheva, Alexander S Vorotyntsev, Andrey Y Emelyanov
Purpose: Pyogenic flexor tenosynovitis is one of the most severe purulent diseases of the hand and is characterized by a high level of development of stiffness and contractures.
Methods: This is a retrospective study conducted on patients hospitalized in our center in 2022. Patients diagnosed with pyogenic flexor tenosynovitis, aged from 18 to 90 years were included. Exclusion criteria are pregnancy or breastfeeding, concomitant oncological diseases, and collagen diseases. All patients were operated on urgently. Debridement, drainage and irrigation were performed. On the 4th-5th day after the operation, when the inflammation subsided, rehabilitation began. The long-term outcome was assessed throughout 3-12 months after discharge and was based on the restoration of the volume of active movements. The results are assessed according to the total active motion scale. Continuous variables were presented as median (Q1, Q3), and were compared using the Mann-Whitney U test. Categorical variables were expressed as n (%), and comparisons were made between the 3 groups using the Spearman's rank correlation coefficient. Statistical significance was defined as a 2-sided p < 0.05.
Results: The results of the examination and treatment of 60 patients were analyzed. The frequency of pyogenic flexor tenosynovitis was 5.3% among all patients with purulent diseases of the hand during this period. Tendon necrosis was noted in 8 (13.3%) cases. Surgical treatment in 37 (61.7%) patients was completed with drainage and primary suture. The rest of the patients (23, 38.3%) underwent repeated debridement, which ended in 10 (16.7%) cases with the imposition of secondary sutures. The best recovery of function was noted in cases of maintaining the viability of the tendon.
Conclusions: Timely diagnosis and provision of comprehensive surgical care for patients with pyogenic flexor tenosynovitis in combination with early rehabilitation should be considered the key to successful treatment of this complex category of patients.
{"title":"Pyogenic flexor tenosynovitis: A current problem of hand surgery.","authors":"Konstantin Lipatov, Arthur Asatryan, George Melkonyan, Aleksandr D Kazantcev, Ekaterina Solov'eva, Irina Gorbacheva, Alexander S Vorotyntsev, Andrey Y Emelyanov","doi":"10.1016/j.cjtee.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.10.008","url":null,"abstract":"<p><strong>Purpose: </strong>Pyogenic flexor tenosynovitis is one of the most severe purulent diseases of the hand and is characterized by a high level of development of stiffness and contractures.</p><p><strong>Methods: </strong>This is a retrospective study conducted on patients hospitalized in our center in 2022. Patients diagnosed with pyogenic flexor tenosynovitis, aged from 18 to 90 years were included. Exclusion criteria are pregnancy or breastfeeding, concomitant oncological diseases, and collagen diseases. All patients were operated on urgently. Debridement, drainage and irrigation were performed. On the 4th-5th day after the operation, when the inflammation subsided, rehabilitation began. The long-term outcome was assessed throughout 3-12 months after discharge and was based on the restoration of the volume of active movements. The results are assessed according to the total active motion scale. Continuous variables were presented as median (Q<sub>1</sub>, Q<sub>3</sub>), and were compared using the Mann-Whitney U test. Categorical variables were expressed as n (%), and comparisons were made between the 3 groups using the Spearman's rank correlation coefficient. Statistical significance was defined as a 2-sided p < 0.05.</p><p><strong>Results: </strong>The results of the examination and treatment of 60 patients were analyzed. The frequency of pyogenic flexor tenosynovitis was 5.3% among all patients with purulent diseases of the hand during this period. Tendon necrosis was noted in 8 (13.3%) cases. Surgical treatment in 37 (61.7%) patients was completed with drainage and primary suture. The rest of the patients (23, 38.3%) underwent repeated debridement, which ended in 10 (16.7%) cases with the imposition of secondary sutures. The best recovery of function was noted in cases of maintaining the viability of the tendon.</p><p><strong>Conclusions: </strong>Timely diagnosis and provision of comprehensive surgical care for patients with pyogenic flexor tenosynovitis in combination with early rehabilitation should be considered the key to successful treatment of this complex category of patients.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-15DOI: 10.1016/j.cjtee.2024.10.006
Jin Li, Hao-Jie Shan, Xiao-Wei Yu
<p><strong>Purpose: </strong>Distal radius fracture is a common trauma fracture and timely preoperative diagnosis is crucial for the patient's recovery. With the rise of deep-learning applications in the medical field, utilizing deep-learning for diagnosing distal radius fractures has become a significant topic. However, previous research has suffered from low detection accuracy and poor identification of occult fractures. This study aims to design an improved deep-learning model to assist surgeons in diagnosing distal radius fractures more quickly and accurately.</p><p><strong>Methods: </strong>This study, inspired by the comprehensive analysis of anteroposterior and lateral X-ray images by surgeons in diagnosing distal radius fractures, designs a dual-channel feature fusion network for detecting distal radius fractures. Based on the Faster region-based convolutional neural network framework, an additional Residual Network 50, which is integrated with the Deformable and Separable Attention mechanism, was introduced to extract semantic information from lateral X-ray images of the distal radius. The features extracted from the 2 channels were then combined via feature fusion, thus enriching the network's feature information. The focal loss function was also employed to address the sample imbalance problem during the training process.The selection of cases in this study was based on distal radius X-ray images retrieved from the hospital's imaging database, which met the following criteria: inclusion criteria comprised clear anteroposterior and lateral X-ray images, which were diagnosed as distal radius fractures by experienced radiologists. The exclusion criteria encompassed poor image quality, the presence of severe multiple or complex fractures, as well as non-adult or special populations (e.g., pregnant women). All cases meeting the inclusion criteria were labeled as distal radius fracture cases for model training and evaluation. To assess the model's performance, this study employed several metrics, including accuracy, precision, recall, area under the precision-recall curve, and intersection over union.</p><p><strong>Results: </strong>The proposed dual-channel feature fusion network achieved an average precision (AP)50 of 98.5%, an AP75 of 78.4%, an accuracy of 96.5%, and a recall of 94.7%. When compared to traditional models, such as Faster region-based convolutional neural network, which achieved an AP50 of 94.1%, an AP75 of 70.6%, a precision of 91.1%, and a recall of 92.3%, our method shows notable improvements in all key metrics. Similarly, when compared to other classic object detection networks like You Only Look Once version 4 (AP50=95.2%, AP75=72.2 %, precision=91.2%, recall=92.4%) and You Only Look Once version 5s (AP50=95.1%, AP75=73.8%, precision=93.7%, recall=92.8%), the dual-channel feature fusion network outperforms them in precision, recall, and AP scores. These results highlight the superior accuracy and reliability of the pro
目的：桡骨远端骨折是一种常见的创伤性骨折，术前及时诊断对患者的康复至关重要。随着深度学习在医学领域应用的兴起，利用深度学习诊断桡骨远端骨折已成为一个重要的课题。然而，以往的研究存在检测精度低、对隐匿性骨折识别不佳的问题。本研究旨在设计一种改进的深度学习模型，以帮助外科医生更快、更准确地诊断桡骨远端骨折。方法：本研究在综合分析外科医生诊断桡骨远端骨折的正侧位x线图像的基础上，设计了一种用于桡骨远端骨折检测的双通道特征融合网络。在Faster基于区域的卷积神经网络框架的基础上，引入了一个附加的残差网络50，该网络集成了可变形可分离注意机制，用于提取桡骨远端侧位x线图像的语义信息。然后将两个通道提取的特征进行特征融合，从而丰富了网络的特征信息。为了解决训练过程中的样本不平衡问题，还采用了焦点损失函数。本研究病例的选择基于从医院影像数据库中检索到的桡骨远端x线图像，符合以下标准：纳入标准包括清晰的正位和侧位x线图像，由经验丰富的放射科医生诊断为桡骨远端骨折。排除标准包括图像质量差，存在严重的多发或复杂骨折，以及非成人或特殊人群（如孕妇）。所有符合纳入标准的病例被标记为桡骨远端骨折病例进行模型训练和评估。为了评估模型的性能，本研究采用了几个指标，包括准确率、精密度、召回率、召回率曲线下的面积和交集超过联合。结果：双通道特征融合网络的平均准确率（AP）50为98.5%，AP75为78.4%，准确率为96.5%，召回率为94.7%。与传统的基于更快区域的卷积神经网络模型（AP50为94.1%，AP75为70.6%，精度为91.1%，召回率为92.3%）相比，我们的方法在所有关键指标上都有显著提高。同样，与You Only Look Once version 4 （AP50=95.2%, AP75= 72.2%，准确率=91.2%，召回率=92.4%）和You Only Look Once version 5 （AP50=95.1%, AP75=73.8%，准确率=93.7%，召回率=92.8%）等经典目标检测网络相比，双通道特征融合网络在准确率、召回率和AP得分上都优于它们。这些结果突出了该方法的准确性和可靠性，特别是在识别明显和隐性桡骨远端骨折方面，证明了其在临床应用中的有效性，其中精确检测细微骨折至关重要。结论：本研究发现，结合桡骨远端正侧位x线图像作为深度学习算法的输入，可以更准确、高效地识别桡骨远端骨折，为桡骨远端骨折的研究提供参考。
{"title":"Fracture detection of distal radius using deep- learning-based dual-channel feature fusion algorithm.","authors":"Jin Li, Hao-Jie Shan, Xiao-Wei Yu","doi":"10.1016/j.cjtee.2024.10.006","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.10.006","url":null,"abstract":"<p><strong>Purpose: </strong>Distal radius fracture is a common trauma fracture and timely preoperative diagnosis is crucial for the patient's recovery. With the rise of deep-learning applications in the medical field, utilizing deep-learning for diagnosing distal radius fractures has become a significant topic. However, previous research has suffered from low detection accuracy and poor identification of occult fractures. This study aims to design an improved deep-learning model to assist surgeons in diagnosing distal radius fractures more quickly and accurately.</p><p><strong>Methods: </strong>This study, inspired by the comprehensive analysis of anteroposterior and lateral X-ray images by surgeons in diagnosing distal radius fractures, designs a dual-channel feature fusion network for detecting distal radius fractures. Based on the Faster region-based convolutional neural network framework, an additional Residual Network 50, which is integrated with the Deformable and Separable Attention mechanism, was introduced to extract semantic information from lateral X-ray images of the distal radius. The features extracted from the 2 channels were then combined via feature fusion, thus enriching the network's feature information. The focal loss function was also employed to address the sample imbalance problem during the training process.The selection of cases in this study was based on distal radius X-ray images retrieved from the hospital's imaging database, which met the following criteria: inclusion criteria comprised clear anteroposterior and lateral X-ray images, which were diagnosed as distal radius fractures by experienced radiologists. The exclusion criteria encompassed poor image quality, the presence of severe multiple or complex fractures, as well as non-adult or special populations (e.g., pregnant women). All cases meeting the inclusion criteria were labeled as distal radius fracture cases for model training and evaluation. To assess the model's performance, this study employed several metrics, including accuracy, precision, recall, area under the precision-recall curve, and intersection over union.</p><p><strong>Results: </strong>The proposed dual-channel feature fusion network achieved an average precision (AP)50 of 98.5%, an AP75 of 78.4%, an accuracy of 96.5%, and a recall of 94.7%. When compared to traditional models, such as Faster region-based convolutional neural network, which achieved an AP50 of 94.1%, an AP75 of 70.6%, a precision of 91.1%, and a recall of 92.3%, our method shows notable improvements in all key metrics. Similarly, when compared to other classic object detection networks like You Only Look Once version 4 (AP50=95.2%, AP75=72.2 %, precision=91.2%, recall=92.4%) and You Only Look Once version 5s (AP50=95.1%, AP75=73.8%, precision=93.7%, recall=92.8%), the dual-channel feature fusion network outperforms them in precision, recall, and AP scores. These results highlight the superior accuracy and reliability of the pro","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The study aimed to examine the pattern of motorization and the mortality rate related to road traffic crashes in Zunyi (a city in northern Guizhou province of China) from 2013 to 2022, and to identify the epidemiological characteristics of these crashes with to provide insights that could help improve road safety.
Methods
Data were obtained from the Zunyi traffic management data platform, and the mortality rates were calculated. We deployed various analytical methods, including descriptive analysis, Chi-square test or Fisher's exact test for categorical variables, circular distribution map analysis, and Rayleigh test to characterize the traits of road traffic crashes in the region.
Results
During the 10-year study period, 7488 people died due to road traffic accidents, with males accounting for 70.4% and females 29.6% (χ2 = 101.97, p < 0.001). The mortality rate increased from 7.80 deaths per 100,000 people in 2013 to 10.70 deaths per 100,000 people in 2016, but then decreased to 9.54 deaths per 100,000 people in 2019. A notable finding was that the death rate per 10,000 vehicles declined from 16.09 deaths per 10,000 vehicles in 2013 to 5.48 deaths per 10,000 vehicles in 2022. The study also found that vulnerable road users represented nearly half (48.76%) of all accident fatalities, and unlicensed or inexperienced driving contributed significantly to the occurrence of road traffic accidents.
Conclusion
Although the number of road traffic accidents in Zunyi has decreased, there are still some critical issues that need to be addressed, particularly for vulnerable road users and unlicensed drivers. Our results highlight the need for targeted interventions to address the specific risk factors of road traffic crashes, particularly those affecting vulnerable road users and drivers without sufficient experience or license.
{"title":"Road traffic mortality in Zunyi city, China: A 10 – year data analysis (2013–2022)","authors":"Tian-Jing Sun, Xiao-Fei Huang, Fang-Ke Xie, Ji Zhang, Xu-Heng Jiang, An-Yong Yu","doi":"10.1016/j.cjtee.2023.09.007","DOIUrl":"10.1016/j.cjtee.2023.09.007","url":null,"abstract":"<div><h3>Purpose</h3><div>The study aimed to examine the pattern of motorization and the mortality rate related to road traffic crashes in Zunyi (a city in northern Guizhou province of China) from 2013 to 2022, and to identify the epidemiological characteristics of these crashes with to provide insights that could help improve road safety.</div></div><div><h3>Methods</h3><div>Data were obtained from the Zunyi traffic management data platform, and the mortality rates were calculated. We deployed various analytical methods, including descriptive analysis, Chi-square test or Fisher's exact test for categorical variables, circular distribution map analysis, and Rayleigh test to characterize the traits of road traffic crashes in the region.</div></div><div><h3>Results</h3><div>During the 10-year study period, 7488 people died due to road traffic accidents, with males accounting for 70.4% and females 29.6% (χ<sup>2</sup> = 101.97, <em>p</em> < 0.001). The mortality rate increased from 7.80 deaths per 100,000 people in 2013 to 10.70 deaths per 100,000 people in 2016, but then decreased to 9.54 deaths per 100,000 people in 2019. A notable finding was that the death rate per 10,000 vehicles declined from 16.09 deaths per 10,000 vehicles in 2013 to 5.48 deaths per 10,000 vehicles in 2022. The study also found that vulnerable road users represented nearly half (48.76%) of all accident fatalities, and unlicensed or inexperienced driving contributed significantly to the occurrence of road traffic accidents.</div></div><div><h3>Conclusion</h3><div>Although the number of road traffic accidents in Zunyi has decreased, there are still some critical issues that need to be addressed, particularly for vulnerable road users and unlicensed drivers. Our results highlight the need for targeted interventions to address the specific risk factors of road traffic crashes, particularly those affecting vulnerable road users and drivers without sufficient experience or license.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 2","pages":"Pages 145-150"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.cjtee.2024.06.001
Sheng-Ye Hu , Mu-Min Cao , Yuan-Wei Zhang , Liu Shi , Guang-Chun Dai , Ya-Kuan Zhao , Tian Xie , Hui Chen , Yun-Feng Rui
Purpose
To assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures.
Methods
A retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18 – 65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥ 2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American Orthopedic Foot and Ankle Society ankle hindfoot score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square or t-test.
Results
During the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, diabetes, or smoking history, preoperative waiting time, operation time, and length of hospital stay (all p > 0.05), but a significantly higher Lauge-Hansen injury grade (p < 0.001) and syndesmotic screw fixation rate (p = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale (p < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain (p = 0.042) and sport/rec scales (p < 0.001) for those with dislocations. American Orthopedic Foot and Ankle Society ankle hindfoot score revealed no significant difference between dislocation and no-dislocation patients.
Conclusion
Dislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.
{"title":"Dislocations deteriorate postoperative functional outcomes in supination-external rotation ankle fractures","authors":"Sheng-Ye Hu , Mu-Min Cao , Yuan-Wei Zhang , Liu Shi , Guang-Chun Dai , Ya-Kuan Zhao , Tian Xie , Hui Chen , Yun-Feng Rui","doi":"10.1016/j.cjtee.2024.06.001","DOIUrl":"10.1016/j.cjtee.2024.06.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures.</div></div><div><h3>Methods</h3><div>A retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18 – 65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥ 2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American Orthopedic Foot and Ankle Society ankle hindfoot score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square or <em>t-</em>test.</div></div><div><h3>Results</h3><div>During the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, diabetes, or smoking history, preoperative waiting time, operation time, and length of hospital stay (all <em>p</em> > 0.05), but a significantly higher Lauge-Hansen injury grade (<em>p</em> < 0.001) and syndesmotic screw fixation rate (<em>p</em> = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale (<em>p</em> < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain (<em>p</em> = 0.042) and sport/rec scales (<em>p</em> < 0.001) for those with dislocations. American Orthopedic Foot and Ankle Society ankle hindfoot score revealed no significant difference between dislocation and no-dislocation patients.</div></div><div><h3>Conclusion</h3><div>Dislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 2","pages":"Pages 124-129"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141396562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.cjtee.2023.08.004
Piyush Gupta , Parvez Mohi Ud Din Dar , Sahil Gupta , Siddhart Jain , Subodh Kumar , Amit Gupta , Sushma Sagar
<div><h3>Purpose</h3><div>Renal trauma constitutes 0.5% – 5% of all trauma patients, and 10% – 20% of abdominal trauma. It is the most commonly injured organ in the genitourinary tract. Road traffic crash (RTC) is the most common cause. In recent years due to the advances in radiological imaging and endovascular techniques, there has been an increase in the nonoperative management of renal trauma. We investigated a large trauma cohort at a level I trauma centre to evaluate patients' demographics with renal trauma, their management, and the outcomes.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of the prospectively collected data of renal trauma patients managed from January 2016 to December 2020. Patients who visited the level I trauma centre in north India with renal trauma were included in this study. Patients who were dead on arrival in the emergency department were excluded. Demographics, mechanism of injury, presence of hemorrhagic shock, associated injuries, complications, length of hospital stay (LOS), discharge, and mortality were recorded. The data were entered in Microsoft Excel 365 and analysed using SPSS version 21.</div></div><div><h3>Results</h3><div>This study collected data from 303 renal trauma patients. Males constituted 86.5% of the patients. Most patients were young, aged from 20 – 40 years. Blunt renal trauma was the predominant mode of injury (<em>n</em> = 270, 89.1%). RTCs (<em>n</em> = 190, 62.7%) and falls from height (<em>n</em> = 65, 21.4%) were the 2 most common mechanisms of injury. Focused assessment with sonography in trauma was positive in 68.4% of patients. Grade III (grading by the American Association for the Surgery of Trauma) renal trauma (30.4%) was the most common grade in our study. The liver (<em>n</em> = 104, 34.3%) and splenic trauma (<em>n</em> = 96, 31.7%) were the most commonly associated injuries. Of the 303 patients, 260 (85.8%) were managed nonoperatively. The mean (SD) of the patients’ LOS was 12.5 (6.5) days. There were 25 (8.3%) mortalities during the study period and all of them had associated other injuries. The comparison of LOS of isolated renal trauma group and renal trauma with associated injuries group was not statistically significant (<em>p</em> = 0.322). All the patients who died during the study period had renal trauma with associated other organ injuries. None of the patients with isolated renal trauma died during the study. The outcome comparison between both groups was not statistically significant (<em>p</em> = 0.110).</div></div><div><h3>Conclusion</h3><div>Renal trauma predominantly occurs in young males, especially due to RTCs followed by fall from height. Focused assessment with sonography in trauma is not reliable in detecting renal injuries, other diagnostic tools such as contrast enhanced computed tomography torso should be considered in diagnosing and grading these injuries. Renal trauma usually does not occur in isolation. Majority are associated
{"title":"Analysis and approach to renal trauma: A five-year experience at a level I trauma centre in north India","authors":"Piyush Gupta , Parvez Mohi Ud Din Dar , Sahil Gupta , Siddhart Jain , Subodh Kumar , Amit Gupta , Sushma Sagar","doi":"10.1016/j.cjtee.2023.08.004","DOIUrl":"10.1016/j.cjtee.2023.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Renal trauma constitutes 0.5% – 5% of all trauma patients, and 10% – 20% of abdominal trauma. It is the most commonly injured organ in the genitourinary tract. Road traffic crash (RTC) is the most common cause. In recent years due to the advances in radiological imaging and endovascular techniques, there has been an increase in the nonoperative management of renal trauma. We investigated a large trauma cohort at a level I trauma centre to evaluate patients' demographics with renal trauma, their management, and the outcomes.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of the prospectively collected data of renal trauma patients managed from January 2016 to December 2020. Patients who visited the level I trauma centre in north India with renal trauma were included in this study. Patients who were dead on arrival in the emergency department were excluded. Demographics, mechanism of injury, presence of hemorrhagic shock, associated injuries, complications, length of hospital stay (LOS), discharge, and mortality were recorded. The data were entered in Microsoft Excel 365 and analysed using SPSS version 21.</div></div><div><h3>Results</h3><div>This study collected data from 303 renal trauma patients. Males constituted 86.5% of the patients. Most patients were young, aged from 20 – 40 years. Blunt renal trauma was the predominant mode of injury (<em>n</em> = 270, 89.1%). RTCs (<em>n</em> = 190, 62.7%) and falls from height (<em>n</em> = 65, 21.4%) were the 2 most common mechanisms of injury. Focused assessment with sonography in trauma was positive in 68.4% of patients. Grade III (grading by the American Association for the Surgery of Trauma) renal trauma (30.4%) was the most common grade in our study. The liver (<em>n</em> = 104, 34.3%) and splenic trauma (<em>n</em> = 96, 31.7%) were the most commonly associated injuries. Of the 303 patients, 260 (85.8%) were managed nonoperatively. The mean (SD) of the patients’ LOS was 12.5 (6.5) days. There were 25 (8.3%) mortalities during the study period and all of them had associated other injuries. The comparison of LOS of isolated renal trauma group and renal trauma with associated injuries group was not statistically significant (<em>p</em> = 0.322). All the patients who died during the study period had renal trauma with associated other organ injuries. None of the patients with isolated renal trauma died during the study. The outcome comparison between both groups was not statistically significant (<em>p</em> = 0.110).</div></div><div><h3>Conclusion</h3><div>Renal trauma predominantly occurs in young males, especially due to RTCs followed by fall from height. Focused assessment with sonography in trauma is not reliable in detecting renal injuries, other diagnostic tools such as contrast enhanced computed tomography torso should be considered in diagnosing and grading these injuries. Renal trauma usually does not occur in isolation. Majority are associated","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 2","pages":"Pages 138-144"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41221795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.cjtee.2024.07.013
Li Cao , Hong-Jie Xu , Yi-Kang Yu , Huan-Huan Tang , Bo-Hao Fang , Ke Chen
<div><h3>Purpose</h3><div>Bone cement-reinforced fenestrated pedicle screws (FPSs) have been widely used in the internal fixation and repair of the spine with osteoporosis in recent years and show significant improvement in fixation strength and stability. However, compared with conventional reinforcement methods, the advantages of bone cement-reinforced FPSs remain undetermined. This article compares the effects of fenestrated and conventional pedicle screws (CPSs) combined with bone cement in the treatment of osteoporosis.</div></div><div><h3>Methods</h3><div>A clinical control study of FPSs and CPSs combined with bone cement reinforcement in osteoporotic vertebral internal fixation was performed using the database PubMed, Embase, Cochrane Library, CNKI, the Wanfang, and the China Biomedical Literature Service System. Two evaluators screened the relevant literature in strict accordance with the inclusion criteria (diagnosis of participants, type of clinical study, treatment with FPS and CPS, and outcome indicators) and exclusion criteria (duplicate literature and missing or incorrect data) and independently conducted data extraction and quality evaluation. Clinical control studies of direct comparison between FPS and CPS combined with bone cement reinforcement in patients who were definitively diagnosed with thoracolumbar fractures or spinal degenerative diseases were included. Quality evaluation was conducted using the Cochrane risk bias evaluation tool for randomized controlled studies and using the Newcastle-Ottawa scale for retrospective case-control studies. RevMan software (version 5.3) was used for the meta-analysis to compare the clinical efficacy, radiological results, and related complications of the 2 methods.</div></div><div><h3>Results</h3><div>A total of 13 articles were included, including 7 randomized controlled studies and 6 retrospective case-control studies. There were 909 patients in these studies, 451 in the FPS and polymethyl methacrylate (FPS & PMMA) group and 458 in the CPS and polymethyl methacrylate (CPS & PMMA) group. The results of the meta-analysis showed that there was no significant difference between the 2 groups in operation time, hospital stay, visual analogue score, Japanese orthopaedic association score, Oswestry disability index score, Cobb angle, vertebral body deformation index and fusion rate (<em>p</em> > 0.05). The mean difference of intraoperative bleeding volume was −10.45, (95% confidence intervals (<em>CI</em>) (−16.92, −3.98), <em>p</em> = 0.002), the mean difference of loss height of the anterior edge of the vertebral body after surgery was −0.69 (95% <em>CI</em> (−0.93, −0.44), <em>p</em> < 0.001), and the relative risk (<em>RR</em>) of overall complication rate was 0.43 (95% <em>CI</em> (0.27, 0.68), <em>p</em> < 0.001), including the <em>RR</em> of bone cement leakage rate was 0.57 (95% <em>CI</em> (0.39, 0.85), <em>p</em> = 0.005). The screw loosening rate (<em>RR</em> = 0.26,
目的：骨水泥增强开窗椎弓根螺钉（FPSs）近年来广泛应用于骨质疏松脊柱的内固定和修复，其固定强度和稳定性均有显著提高。然而，与传统的加固方法相比，骨水泥增强FPSs的优势尚不确定。本文比较了开窗椎弓根螺钉与常规椎弓根螺钉联合骨水泥治疗骨质疏松症的疗效。方法：采用PubMed、Embase、Cochrane图书馆、中国知网、万方、中国生物医学文献服务系统等数据库，对FPSs和cps联合骨水泥加固治疗骨质疏松性椎体内固定进行临床对照研究。两名评价员严格按照纳入标准（受试者诊断、临床研究类型、FPS和CPS治疗、结局指标）和排除标准（文献重复、缺失或错误）筛选相关文献，独立进行资料提取和质量评价。对明确诊断为胸腰椎骨折或脊柱退行性疾病的患者进行FPS与CPS联合骨水泥加固直接比较的临床对照研究。随机对照研究采用Cochrane风险偏倚评价工具，回顾性病例对照研究采用Newcastle-Ottawa量表进行质量评价。采用RevMan软件（version 5.3）进行meta分析，比较两种方法的临床疗效、影像学结果及相关并发症。结果：共纳入文献13篇，其中随机对照研究7篇，回顾性病例对照研究6篇。本研究共909例患者，其中FPS +聚甲基丙烯酸甲酯（FPS + PMMA）组451例，CPS +聚甲基丙烯酸甲酯（CPS + PMMA）组458例。meta分析结果显示，两组患者手术时间、住院时间、视觉模拟评分、日本骨科协会评分、Oswestry残疾指数评分、Cobb角、椎体变形指数、融合率比较，差异均无统计学意义（p < 0.05）。术中出血量平均差值为-10.45,(95%可信区间（CI） （-16.92, -3.98）， p = 0.002)，术后椎体前端损失高度平均差值为-0.69,(95% CI (-0.93, -0.44), p现有临床证据表明，与CPS联合骨水泥相比，在骨质疏松性椎体内固定中使用FPS修复可以减少术中出血量，更有利于保持椎体高度，并显著减少术后骨水泥渗漏、螺钉松动等并发症的发生。
{"title":"Comparative analysis of the safety and efficacy of fenestrated pedicle screw with cement and conventional pedicle screw with cement in the treatment of osteoporotic vertebral fractures: A meta-analysis","authors":"Li Cao , Hong-Jie Xu , Yi-Kang Yu , Huan-Huan Tang , Bo-Hao Fang , Ke Chen","doi":"10.1016/j.cjtee.2024.07.013","DOIUrl":"10.1016/j.cjtee.2024.07.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Bone cement-reinforced fenestrated pedicle screws (FPSs) have been widely used in the internal fixation and repair of the spine with osteoporosis in recent years and show significant improvement in fixation strength and stability. However, compared with conventional reinforcement methods, the advantages of bone cement-reinforced FPSs remain undetermined. This article compares the effects of fenestrated and conventional pedicle screws (CPSs) combined with bone cement in the treatment of osteoporosis.</div></div><div><h3>Methods</h3><div>A clinical control study of FPSs and CPSs combined with bone cement reinforcement in osteoporotic vertebral internal fixation was performed using the database PubMed, Embase, Cochrane Library, CNKI, the Wanfang, and the China Biomedical Literature Service System. Two evaluators screened the relevant literature in strict accordance with the inclusion criteria (diagnosis of participants, type of clinical study, treatment with FPS and CPS, and outcome indicators) and exclusion criteria (duplicate literature and missing or incorrect data) and independently conducted data extraction and quality evaluation. Clinical control studies of direct comparison between FPS and CPS combined with bone cement reinforcement in patients who were definitively diagnosed with thoracolumbar fractures or spinal degenerative diseases were included. Quality evaluation was conducted using the Cochrane risk bias evaluation tool for randomized controlled studies and using the Newcastle-Ottawa scale for retrospective case-control studies. RevMan software (version 5.3) was used for the meta-analysis to compare the clinical efficacy, radiological results, and related complications of the 2 methods.</div></div><div><h3>Results</h3><div>A total of 13 articles were included, including 7 randomized controlled studies and 6 retrospective case-control studies. There were 909 patients in these studies, 451 in the FPS and polymethyl methacrylate (FPS & PMMA) group and 458 in the CPS and polymethyl methacrylate (CPS & PMMA) group. The results of the meta-analysis showed that there was no significant difference between the 2 groups in operation time, hospital stay, visual analogue score, Japanese orthopaedic association score, Oswestry disability index score, Cobb angle, vertebral body deformation index and fusion rate (<em>p</em> > 0.05). The mean difference of intraoperative bleeding volume was −10.45, (95% confidence intervals (<em>CI</em>) (−16.92, −3.98), <em>p</em> = 0.002), the mean difference of loss height of the anterior edge of the vertebral body after surgery was −0.69 (95% <em>CI</em> (−0.93, −0.44), <em>p</em> < 0.001), and the relative risk (<em>RR</em>) of overall complication rate was 0.43 (95% <em>CI</em> (0.27, 0.68), <em>p</em> < 0.001), including the <em>RR</em> of bone cement leakage rate was 0.57 (95% <em>CI</em> (0.39, 0.85), <em>p</em> = 0.005). The screw loosening rate (<em>RR</em> = 0.26,","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 2","pages":"Pages 101-112"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.cjtee.2025.01.001
Shuo Leng , Wentao Li , Yu Cai , Yi Zhang
Vasculature injury occurs rarely in traumatic brain injury but increases lifetime risk of ischemic or hemorrhage stroke. The diverse and nonspecific clinical manifestations make the diagnosis and treatment of these injuries highly challenging. With advancements in device design, endovascular treatments have become widely adopted, playing an increasingly vital role in the management of vascular diseases. The purpose of this review is to introduce and summarize endovascular treatments of traumatic cerebrovascular injury and other related pathological states after traumatic brain injury. Given the innovations of neuroendovascular devices and improvements in the techniques over the past decade, this review will outline several recent advancements in endovascular treatment strategies for cerebrovascular pathologies. Popularizing more treatment options to clinicians will benefit in dealing with a variety of clinical scenarios and reduce the overall morbidity of traumatic cerebrovascular injury.
{"title":"The endovascular treatment strategies of cerebrovascular injuries in traumatic brain injury","authors":"Shuo Leng , Wentao Li , Yu Cai , Yi Zhang","doi":"10.1016/j.cjtee.2025.01.001","DOIUrl":"10.1016/j.cjtee.2025.01.001","url":null,"abstract":"<div><div>Vasculature injury occurs rarely in traumatic brain injury but increases lifetime risk of ischemic or hemorrhage stroke. The diverse and nonspecific clinical manifestations make the diagnosis and treatment of these injuries highly challenging. With advancements in device design, endovascular treatments have become widely adopted, playing an increasingly vital role in the management of vascular diseases. The purpose of this review is to introduce and summarize endovascular treatments of traumatic cerebrovascular injury and other related pathological states after traumatic brain injury. Given the innovations of neuroendovascular devices and improvements in the techniques over the past decade, this review will outline several recent advancements in endovascular treatment strategies for cerebrovascular pathologies. Popularizing more treatment options to clinicians will benefit in dealing with a variety of clinical scenarios and reduce the overall morbidity of traumatic cerebrovascular injury.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 2","pages":"Pages 81-90"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.cjtee.2024.07.006
Yu Liu , Jing Fei , Xin-Ming Wan , Pei-Feng Wang , Zhen Li , Xiao-Ting Yang , Lin-Wei Zhang , Zhong-Hao Bai
Purpose
To judge the injury mode and injury severity of the real human body through the measured values of anthropomorphic test devices (ATD) injury indices, the mapping relationship of lumbar injury between ATD and human body model (HBM) was explored.
Methods
Through the ATD model and HBM simulation, the mapping relationship of lumbar injury between the 2 subjects was explored. The sled environment consisted of a semi-rigid seat with an adjustable seatback angle and a 3-point seat belt system with a seatback-mounted D-ring. Three seatback recline states of 25°, 45°, and 65° were designed, and the seat pan angle was maintained at 15°. A 23 g, 47 km/h pulse was used. The validity of the finite element model of the sled was verified by the comparison of ATD simulation and test results. ATD model was the test device for human occupant restraint for autonomous vehicles (THOR-AV) dummy model and HBM was the total human model for safety (THUMS) v6.1. The posture of the 2 models was adjusted to adapt to the 3 seat states. The lumbar response of THOR-AV and the mechanical and biomechanical data on L1 – L5 vertebrae of THUMS were output, and the response relationship between THOR-AV and THUMS was descriptive statistically analyzed.
Results
Both THOR-AV and THUMS were submarined in the 65° seatback angle case. With the change of seatback angle, the lumbar spine axial compression force (Fz) of THOR-AV and THUMS changed in the similar trend. The maximum Fz ratio of THOR-AV to THUMS at 25° and 45° seatback angle cases were 1.6 and 1.7. The flexion moment (My) and the time when the maximum My occurred in the 2 subjects were very different. In particular, the form of moment experienced by the L1 − L5 vertebrae of THUMS also changed. The changing trend of My measured by THOR-AV over time can reflect the changing trend of maximum stress of L1 and L2 of THUMS.
Conclusion
The Fz of ATD and HBM presents a certain proportional relationship, and there is a mapping relationship between the 2 subjects on Fz. The mapping function can be further clarified by applying more pulses and adopting more seatback angles. It is difficult to map My directly because they are very different in ATD and HBM. The My of ATD and stress of HBM lumbar showed a similar change trend over time, and there may be a hidden mapping relationship.
{"title":"Research of injury mapping relationship of lumbar spine in reclined occupants between anthropomorphic test devices and human body model","authors":"Yu Liu , Jing Fei , Xin-Ming Wan , Pei-Feng Wang , Zhen Li , Xiao-Ting Yang , Lin-Wei Zhang , Zhong-Hao Bai","doi":"10.1016/j.cjtee.2024.07.006","DOIUrl":"10.1016/j.cjtee.2024.07.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To judge the injury mode and injury severity of the real human body through the measured values of anthropomorphic test devices (ATD) injury indices, the mapping relationship of lumbar injury between ATD and human body model (HBM) was explored.</div></div><div><h3>Methods</h3><div>Through the ATD model and HBM simulation, the mapping relationship of lumbar injury between the 2 subjects was explored. The sled environment consisted of a semi-rigid seat with an adjustable seatback angle and a 3-point seat belt system with a seatback-mounted D-ring. Three seatback recline states of 25°, 45°, and 65° were designed, and the seat pan angle was maintained at 15°. A 23 g, 47 km/h pulse was used. The validity of the finite element model of the sled was verified by the comparison of ATD simulation and test results. ATD model was the test device for human occupant restraint for autonomous vehicles (THOR-AV) dummy model and HBM was the total human model for safety (THUMS) v6.1. The posture of the 2 models was adjusted to adapt to the 3 seat states. The lumbar response of THOR-AV and the mechanical and biomechanical data on L1 – L5 vertebrae of THUMS were output, and the response relationship between THOR-AV and THUMS was descriptive statistically analyzed.</div></div><div><h3>Results</h3><div>Both THOR-AV and THUMS were submarined in the 65° seatback angle case. With the change of seatback angle, the lumbar spine axial compression force (F<sub>z</sub>) of THOR-AV and THUMS changed in the similar trend. The maximum F<sub>z</sub> ratio of THOR-AV to THUMS at 25° and 45° seatback angle cases were 1.6 and 1.7. The flexion moment (M<sub>y</sub>) and the time when the maximum M<sub>y</sub> occurred in the 2 subjects were very different. In particular, the form of moment experienced by the L1 − L5 vertebrae of THUMS also changed. The changing trend of M<sub>y</sub> measured by THOR-AV over time can reflect the changing trend of maximum stress of L1 and L2 of THUMS.</div></div><div><h3>Conclusion</h3><div>The F<sub>z</sub> of ATD and HBM presents a certain proportional relationship, and there is a mapping relationship between the 2 subjects on F<sub>z</sub>. The mapping function can be further clarified by applying more pulses and adopting more seatback angles. It is difficult to map M<sub>y</sub> directly because they are very different in ATD and HBM. The M<sub>y</sub> of ATD and stress of HBM lumbar showed a similar change trend over time, and there may be a hidden mapping relationship.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 2","pages":"Pages 130-137"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.cjtee.2025.02.002
Lei Li
{"title":"In Memory of Academician Wang Zhengguo - Founder of the Chinese Journal of Traumatology","authors":"Lei Li","doi":"10.1016/j.cjtee.2025.02.002","DOIUrl":"10.1016/j.cjtee.2025.02.002","url":null,"abstract":"","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"28 2","pages":"Page 80"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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