Autologous osteoperiosteal transplantation (AOPT) is one of the most feasible and effective techniques for cystic osteochondral lesions of the talus (OLT). However, few reports have been reported about the process of graft-host bone healing and bone articular surface reconstruction, which help us to further understand the actual situation of bone healing and modify surgical methods.
Methods
The case series study retrospectively evaluated 33 osteochondral lesions in 30 patients undertaking AOPT for OLT with subchondral cysts from December 2016 to October 2021. According to CT observation, we used 4 variables to describe the bony articular repair, including the integration of the articular surface, the height of the bone filling, the status of bone union, and the appearance of bone resorption or cystic change. We also analyzed the demographic data and clinical function. Descriptive statistics were used for demographic and clinical variables. Normally distributed data were presented as mean ± SD, and non-normally distributed data were presented as median (Q1, Q3). Associations between these variables and the primary clinical outcomes were examined using t-test or one-way ANOVA test for continuous variables.
Results
The patients’ mean age was (41.7 ± 14.0) years old and the mean follow-up time was (29.6 ± 17.8) months. The chondral lesion size was (14.3 ± 4.1) mm. The cyst depth was (10.9 ± 3.7) mm. Significant improvements were observed in functional outcomes (according to the numeric rating scale for pain when walking and the American orthopedic foot and ankle society score) between the preoperative and latest follow-up evaluations, from 4.2 ± 2.1 to 2.2 ± 2.0 (p < 0.001), and from 66.8 ± 12.9 to 83.2 ± 10.4, respectively (p < 0.001). The overall satisfaction reached 8.3 of 10 points. All patients returned to sports and their median daily steps reached 8000 steps with 27 (81.8%) patients walking over 6000 steps daily. According to CT observation, “discontinuous bony articular surface and gap > 1 mm” was found in 27 grafts (81.8%), and “below the level of the adjacent articular surface, ≤ 1 mm” in a third of the grafts. Abnormal height of bone filling affected numeric rating scale score (p = 0.049) and American Orthopedic Foot and Ankle Society score (p = 0.027). Of note, bone resorption or cystic changes appeared in up to 13 autografts (39.4%).
Conclusions
AOPT is an effective and acceptable technique for cystic OLT. Bone reconstruction is essential for large cystic OLT. How to get better bony articular reconstruction and avoid cyst recurrence should still be paid more attention.
{"title":"Autologous osteoperiosteal transplantation for cystic osteochondral lesions of the talus: Bone reconstruction is essential","authors":"Yuxuan Wei , Zhuhong Chen , Nian Sun , Zhu Tang , Hao Guo , Canjun Zeng","doi":"10.1016/j.cjtee.2024.08.006","DOIUrl":"10.1016/j.cjtee.2024.08.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Autologous osteoperiosteal transplantation (AOPT) is one of the most feasible and effective techniques for cystic osteochondral lesions of the talus (OLT). However, few reports have been reported about the process of graft-host bone healing and bone articular surface reconstruction, which help us to further understand the actual situation of bone healing and modify surgical methods.</div></div><div><h3>Methods</h3><div>The case series study retrospectively evaluated 33 osteochondral lesions in 30 patients undertaking AOPT for OLT with subchondral cysts from December 2016 to October 2021. According to CT observation, we used 4 variables to describe the bony articular repair, including the integration of the articular surface, the height of the bone filling, the status of bone union, and the appearance of bone resorption or cystic change. We also analyzed the demographic data and clinical function. Descriptive statistics were used for demographic and clinical variables. Normally distributed data were presented as mean ± SD, and non-normally distributed data were presented as median (Q<sub>1</sub>, Q<sub>3</sub>). Associations between these variables and the primary clinical outcomes were examined using <em>t</em>-test or one-way ANOVA test for continuous variables.</div></div><div><h3>Results</h3><div>The patients’ mean age was (41.7 ± 14.0) years old and the mean follow-up time was (29.6 ± 17.8) months. The chondral lesion size was (14.3 ± 4.1) mm. The cyst depth was (10.9 ± 3.7) mm. Significant improvements were observed in functional outcomes (according to the numeric rating scale for pain when walking and the American orthopedic foot and ankle society score) between the preoperative and latest follow-up evaluations, from 4.2 ± 2.1 to 2.2 ± 2.0 (<em>p</em> < 0.001), and from 66.8 ± 12.9 to 83.2 ± 10.4, respectively (<em>p</em> < 0.001). The overall satisfaction reached 8.3 of 10 points. All patients returned to sports and their median daily steps reached 8000 steps with 27 (81.8%) patients walking over 6000 steps daily. According to CT observation, “discontinuous bony articular surface and gap > 1 mm” was found in 27 grafts (81.8%), and “below the level of the adjacent articular surface, ≤ 1 mm” in a third of the grafts. Abnormal height of bone filling affected numeric rating scale score (<em>p</em> = 0.049) and American Orthopedic Foot and Ankle Society score (<em>p</em> = 0.027). Of note, bone resorption or cystic changes appeared in up to 13 autografts (39.4%).</div></div><div><h3>Conclusions</h3><div>AOPT is an effective and acceptable technique for cystic OLT. Bone reconstruction is essential for large cystic OLT. How to get better bony articular reconstruction and avoid cyst recurrence should still be paid more attention.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 6","pages":"Pages 395-402"},"PeriodicalIF":1.8,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146859","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 : 2024-08-17DOI: 10.1016/j.cjtee.2024.08.005
Wen-Hui Liu, Xin-Min Lin, Xin-Yu Lu, Hai Han, Liang-Zhi Zhang, Hai-Xian Lin, Zi-Wen Liu
Spinal intradural (subdural and subarachnoid) hematoma following percutaneous kyphoplasty is an extremely rare complication. In this report, we described a case of 2 episodes of subarachnoid hemorrhage with delayed paralysis after kyphoplasty. A 73-year-old man underwent percutaneous kyphoplasty in our hospital an osteoporotic vertebral fracture at the T12 level. On the 55 h after kyphoplasty for T12 osteoporotic vertebral fracture, he developed paralysis of the lower limbs. An emergency posterior decompression from T8 to L2 was performed. And the subarachnoid hematomas were removed. Postoperatively, the neurological symptoms improved rapidly. However, 2 weeks after the operation, the patient experienced a setback with severe neurological decline (paraplegia with sensory and autonomic dysfunction). An emergency posterior decompression from T5 to L2 was performed. The subarachnoid hematomas were removed. This case reflects the cause and progression of spinal subdural hematoma. Previous literature has debated the best treatment approach for spinal subarachnoid hemorrhage, but the prognosis of patients is heavily dependent on precise symptom evaluation and localization.
{"title":"Recurrent spinal subdural hematoma following percutaneous kyphoplasty: A unique case report","authors":"Wen-Hui Liu, Xin-Min Lin, Xin-Yu Lu, Hai Han, Liang-Zhi Zhang, Hai-Xian Lin, Zi-Wen Liu","doi":"10.1016/j.cjtee.2024.08.005","DOIUrl":"10.1016/j.cjtee.2024.08.005","url":null,"abstract":"<div><div>Spinal intradural (subdural and subarachnoid) hematoma following percutaneous kyphoplasty is an extremely rare complication. In this report, we described a case of 2 episodes of subarachnoid hemorrhage with delayed paralysis after kyphoplasty. A 73-year-old man underwent percutaneous kyphoplasty in our hospital an osteoporotic vertebral fracture at the T12 level. On the 55 h after kyphoplasty for T12 osteoporotic vertebral fracture, he developed paralysis of the lower limbs. An emergency posterior decompression from T8 to L2 was performed. And the subarachnoid hematomas were removed. Postoperatively, the neurological symptoms improved rapidly. However, 2 weeks after the operation, the patient experienced a setback with severe neurological decline (paraplegia with sensory and autonomic dysfunction). An emergency posterior decompression from T5 to L2 was performed. The subarachnoid hematomas were removed. This case reflects the cause and progression of spinal subdural hematoma. Previous literature has debated the best treatment approach for spinal subarachnoid hemorrhage, but the prognosis of patients is heavily dependent on precise symptom evaluation and localization.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 6","pages":"Pages 354-358"},"PeriodicalIF":1.8,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047452","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 : 2024-08-15DOI: 10.1016/j.cjtee.2024.08.004
Meng Wang, Jian-Min Liu, Xing-Bo Dang, Long-Yang Ma, Gong-Liang Du, Wei Hu
Trauma is an important cause of death in young- and middle-aged people. Trauma is comprehensive and includes many surgical specialties, and the surgical techniques of these specialties have long been mature. To reduce the mortality and disability rate of trauma patients, it is necessary to improve trauma management. Trauma has attracted attention in China and trauma treatment and care developed rapidly in recent years. To decrease traumatic mortality and disability rates, our team is committed to building an efficient trauma system in Shaanxi province and has successfully developed a trauma limb salvage map to address the high rates of amputation and disability in patients with limb injuries. This article elaborates on the construction experience of a trauma limb salvage map and its application details in Shaanxi province of China.
{"title":"The construction and application of a trauma limb salvage map in Shaanxi province.","authors":"Meng Wang, Jian-Min Liu, Xing-Bo Dang, Long-Yang Ma, Gong-Liang Du, Wei Hu","doi":"10.1016/j.cjtee.2024.08.004","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.08.004","url":null,"abstract":"<p><p>Trauma is an important cause of death in young- and middle-aged people. Trauma is comprehensive and includes many surgical specialties, and the surgical techniques of these specialties have long been mature. To reduce the mortality and disability rate of trauma patients, it is necessary to improve trauma management. Trauma has attracted attention in China and trauma treatment and care developed rapidly in recent years. To decrease traumatic mortality and disability rates, our team is committed to building an efficient trauma system in Shaanxi province and has successfully developed a trauma limb salvage map to address the high rates of amputation and disability in patients with limb injuries. This article elaborates on the construction experience of a trauma limb salvage map and its application details in Shaanxi province of China.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300510","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}
Traumatic main bronchus rupture is a relatively rare injury in thoracic trauma, which is extremely critical, with a mortality rate as high as 70% - 80%. The complete rupture and displacement of the traumatic cervical trachea can lead to asphyxia, hypoxia, and cardiac arrest, even death of the patient in a short time. We performed emergency surgery with the support of extracorporeal membrane oxygenation for a case of traumatic cervical tracheal trunk complete rupture and displacement combined with cardiac arrest and achieved a successful rescue. We summarized our experience and found that timely surgical reconstruction of the airway is the key to increasing the traumatic main bronchus rupture survival of patients.
{"title":"Traumatic cervical tracheal trunk complete rupture combined with cardiac arrest: A case report.","authors":"Cheng Yang, Da-Liang Wang, Yang-Lin Du, Qiang-Fei Wang, Yuan Suo, Hui-Jie Yu","doi":"10.1016/j.cjtee.2024.08.003","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.08.003","url":null,"abstract":"<p><p>Traumatic main bronchus rupture is a relatively rare injury in thoracic trauma, which is extremely critical, with a mortality rate as high as 70% - 80%. The complete rupture and displacement of the traumatic cervical trachea can lead to asphyxia, hypoxia, and cardiac arrest, even death of the patient in a short time. We performed emergency surgery with the support of extracorporeal membrane oxygenation for a case of traumatic cervical tracheal trunk complete rupture and displacement combined with cardiac arrest and achieved a successful rescue. We summarized our experience and found that timely surgical reconstruction of the airway is the key to increasing the traumatic main bronchus rupture survival of patients.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127189","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 : 2024-07-09DOI: 10.1016/j.cjtee.2024.06.002
Zhi-Qiang Hu , Tai-Qiang Dai , Lu Zhao , Xun Li , Xu Gong , Hao Jia , Hai-Tao Kong , Bo-Lei Cai , Shi-Ping Chang , Lei Tian
<div><h3>Purpose</h3><p>Shaping and assembling contemporary external fixators rapidly for the severe mandibular fractures remains a challenge, especially in emergency circumstance. We designed a novel external fixator that incorporates universal joints to provide the stabilization for mandibular comminuted fractures. This study aims to confirm the efficacy of this novel external fixator through biomechanical tests <em>in vitro</em> and animal experiments.</p></div><div><h3>Methods</h3><p><em>In vitro</em> biomechanical tests were conducted using 6 fresh canine with mandibular defect to simulate critical comminuted fractures. Three mandibles were stabilized by the novel external fixator and other mandibles were fixed by 2.5 mm reconstruction plates. All fixed mandibles were subjected to loads of 350 N on the anterior regions of teeth and 550 N on the first molar of the unaffected side. The stability was evaluated based on the maximum displacement and the slope of the load-displacement curve. In animal experiments, 9 beagles with comminuted mandibular fractures were divided into 3 groups, which were treated with the novel external fixation, reconstruction plate, and dental arch bar, respectively. The general observation, the changes in animals’ weight, and the surgical duration were recorded and compared among 3 groups. The CT scans were performed at various intervals of 0 day (immediately after the surgery), 3 days, 7 days, 14 days, 21 days, and 28 days to analyze the displacement of feature points on the canine mandible and situation of fracture healing at 28 days. The statistical significance was assessed by the two-way analysis of variance test followed by the Bonferroni test, enabling multiple comparisons for all tests using GraphPad Prism10.1.0 (GraphPad Inc, USA).</p></div><div><h3>Results</h3><p>The outcomes of the biomechanical tests indicated that no statistically significant differences were found in terms of the maximum displacement (<em>p</em> = 0.496, 0.079) and the slope of load displacement curves (<em>p</em> = 0.374, 0.349) under 2 load modes between the external and internal fixation groups. The animal experiment data showed that there were minor displacements of feature points between the external and internal fixation groups without statistic difference, while the arch bar group demonstrated inferior stability. The CT analysis revealed that the best fracture healing happened in the internal fixation group, followed by the external fixation and arch baring at 28 days after fixation. The external fixation group had the shortest fixation duration (25.67 ± 3.79) min compared to internal fixation ((70.67 ± 4.51) min, <em>p</em> < 0.001) and arch baring ((42.00 ± 3.00) min, <em>p</em> = 0.046).</p></div><div><h3>Conclusion</h3><p>The conclusion of this study highlighted the efficacy and reliability of this novel external fixator in managing mandibular fractures rapidly, offering a viable option for the initial stabilization of comm
{"title":"An experimental study of a novel external fixator based on universal joints for the rapid initial stabilization of mandibular comminuted fractures","authors":"Zhi-Qiang Hu , Tai-Qiang Dai , Lu Zhao , Xun Li , Xu Gong , Hao Jia , Hai-Tao Kong , Bo-Lei Cai , Shi-Ping Chang , Lei Tian","doi":"10.1016/j.cjtee.2024.06.002","DOIUrl":"10.1016/j.cjtee.2024.06.002","url":null,"abstract":"<div><h3>Purpose</h3><p>Shaping and assembling contemporary external fixators rapidly for the severe mandibular fractures remains a challenge, especially in emergency circumstance. We designed a novel external fixator that incorporates universal joints to provide the stabilization for mandibular comminuted fractures. This study aims to confirm the efficacy of this novel external fixator through biomechanical tests <em>in vitro</em> and animal experiments.</p></div><div><h3>Methods</h3><p><em>In vitro</em> biomechanical tests were conducted using 6 fresh canine with mandibular defect to simulate critical comminuted fractures. Three mandibles were stabilized by the novel external fixator and other mandibles were fixed by 2.5 mm reconstruction plates. All fixed mandibles were subjected to loads of 350 N on the anterior regions of teeth and 550 N on the first molar of the unaffected side. The stability was evaluated based on the maximum displacement and the slope of the load-displacement curve. In animal experiments, 9 beagles with comminuted mandibular fractures were divided into 3 groups, which were treated with the novel external fixation, reconstruction plate, and dental arch bar, respectively. The general observation, the changes in animals’ weight, and the surgical duration were recorded and compared among 3 groups. The CT scans were performed at various intervals of 0 day (immediately after the surgery), 3 days, 7 days, 14 days, 21 days, and 28 days to analyze the displacement of feature points on the canine mandible and situation of fracture healing at 28 days. The statistical significance was assessed by the two-way analysis of variance test followed by the Bonferroni test, enabling multiple comparisons for all tests using GraphPad Prism10.1.0 (GraphPad Inc, USA).</p></div><div><h3>Results</h3><p>The outcomes of the biomechanical tests indicated that no statistically significant differences were found in terms of the maximum displacement (<em>p</em> = 0.496, 0.079) and the slope of load displacement curves (<em>p</em> = 0.374, 0.349) under 2 load modes between the external and internal fixation groups. The animal experiment data showed that there were minor displacements of feature points between the external and internal fixation groups without statistic difference, while the arch bar group demonstrated inferior stability. The CT analysis revealed that the best fracture healing happened in the internal fixation group, followed by the external fixation and arch baring at 28 days after fixation. The external fixation group had the shortest fixation duration (25.67 ± 3.79) min compared to internal fixation ((70.67 ± 4.51) min, <em>p</em> < 0.001) and arch baring ((42.00 ± 3.00) min, <em>p</em> = 0.046).</p></div><div><h3>Conclusion</h3><p>The conclusion of this study highlighted the efficacy and reliability of this novel external fixator in managing mandibular fractures rapidly, offering a viable option for the initial stabilization of comm","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 5","pages":"Pages 254-262"},"PeriodicalIF":1.8,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127524000786/pdfft?md5=6cc6bd0bf0faeffec971383e3b68797c&pid=1-s2.0-S1008127524000786-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702826","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 : 2024-07-05DOI: 10.1016/j.cjtee.2024.07.005
Dong-Yang Ma , Shu-Meng Zhang , Chao-Yuan Pang , Wen-Kai Zhang , Bing-Wu Wang
Purpose
The removal of small foreign bodies embedded within the deep soft tissues of the maxillofacial region is a complex and challenging task for maxillofacial surgeons. The purpose of this study was to explore the efficacy of the combination of intraoperative CT and surgical navigation for the removal of small foreign objects in the maxillofacial region.
Methods
A serial case study was conducted involving all consecutive patients who underwent surgical removal of small foreign bodies in the maxillofacial region. The combination of intraoperative CT and a surgical navigation system was used at a single medical institution from January 2018 to December 2022. Comprehensive data, including patient demographics, characteristics of the foreign bodies, previous surgical interventions, duration of the surgical procedure, and removal success rate were collected for this study. Relevant data were recorded into Microsoft Excel sheet and analyzed using SPSS version 22.0.
Results
Nine patients (6 males and 3 females) were included in this study, with an average age of 37 years. Each patient had previously undergone an unsuccessful removal attempt utilizing conventional surgical methods based on preoperative CT imaging or C-arm guidance at a local healthcare facility. Four patients also experienced unsuccessful attempts with preoperative CT image-based navigation systems. However, by employing the combined approach of intraoperative CT and surgical navigation, the foreign bodies were successfully removed in all 9 patients. The mean duration of the surgical procedure was 59 min, and the average size of the foreign bodies was approximately 26 mm³. Postoperative follow-up exceeding 6 months revealed no complications.
Conclusion
The combined use of a surgical navigation system and intraoperative CT represents a potent and effective strategy for the precise localization and subsequent removal of small foreign bodies from the soft tissue structures of the maxillofacial region. This integrative approach appears to increase the success rate of surgical interventions in such cases.
{"title":"A serial case study of the combined use of intraoperative CT and surgical navigation system for the removal of small foreign bodies in the maxillofacial region","authors":"Dong-Yang Ma , Shu-Meng Zhang , Chao-Yuan Pang , Wen-Kai Zhang , Bing-Wu Wang","doi":"10.1016/j.cjtee.2024.07.005","DOIUrl":"10.1016/j.cjtee.2024.07.005","url":null,"abstract":"<div><h3>Purpose</h3><p>The removal of small foreign bodies embedded within the deep soft tissues of the maxillofacial region is a complex and challenging task for maxillofacial surgeons. The purpose of this study was to explore the efficacy of the combination of intraoperative CT and surgical navigation for the removal of small foreign objects in the maxillofacial region.</p></div><div><h3>Methods</h3><p>A serial case study was conducted involving all consecutive patients who underwent surgical removal of small foreign bodies in the maxillofacial region. The combination of intraoperative CT and a surgical navigation system was used at a single medical institution from January 2018 to December 2022. Comprehensive data, including patient demographics, characteristics of the foreign bodies, previous surgical interventions, duration of the surgical procedure, and removal success rate were collected for this study. Relevant data were recorded into Microsoft Excel sheet and analyzed using SPSS version 22.0.</p></div><div><h3>Results</h3><p>Nine patients (6 males and 3 females) were included in this study, with an average age of 37 years. Each patient had previously undergone an unsuccessful removal attempt utilizing conventional surgical methods based on preoperative CT imaging or C-arm guidance at a local healthcare facility. Four patients also experienced unsuccessful attempts with preoperative CT image-based navigation systems. However, by employing the combined approach of intraoperative CT and surgical navigation, the foreign bodies were successfully removed in all 9 patients. The mean duration of the surgical procedure was 59 min, and the average size of the foreign bodies was approximately 26 mm³. Postoperative follow-up exceeding 6 months revealed no complications.</p></div><div><h3>Conclusion</h3><p>The combined use of a surgical navigation system and intraoperative CT represents a potent and effective strategy for the precise localization and subsequent removal of small foreign bodies from the soft tissue structures of the maxillofacial region. This integrative approach appears to increase the success rate of surgical interventions in such cases.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 5","pages":"Pages 279-283"},"PeriodicalIF":1.8,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127524000774/pdfft?md5=0847c8cbc1ff91a7e3af144edf367cf5&pid=1-s2.0-S1008127524000774-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700246","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 : 2024-07-05DOI: 10.1016/j.cjtee.2024.07.004
Hui Li, Tao Ai, Guang-Bin Huang, Jun Yang, Gong-Bin Wei, Jin-Mou Gao, Ping He, Xue-Mei Cao, Ding-Yuan Du
Purpose
Internal iliac artery ligation (IIAL) has been used as a damage control procedure to treat hemodynamically unstable pelvic fracture for many years. However, there is ongoing debate regarding the effectiveness and safety of this hemostatic method. Therefore, we performed a systematic literature review to assess the efficacy and safety of IIAL for pelvic fracture hemostasis.
Methods
Three major databases, PubMed, Embase, and Google Scholar, were searched to screen eligible original studies published in English journals. Two reviewers independently read the titles, abstracts, and full texts of all literature. Articles were included if they reported the use and effects of IIAL.
Results
A total of 171 articles were initially identified, with 22 fully meeting the inclusion criteria. Among the analyzed cases, up to 66.7% of patients had associated abdominal and pelvic organ injuries, with the urethra being the most frequently injured organ, followed by the bowel. The outcomes of IIAL for achieving hemostasis in pelvic fractures were found to be satisfactory, with an effective rate of 80%. Hemorrhagic shock was the leading cause of death, followed by craniocerebral injury. Notably, no reports of ischemic complications involving the pelvic organs due to IIAL were found.
Conclusion
IIAL has a good effect in treating hemodynamically unstable pelvic fracture without the risk of pelvic organ ischemia. This procedure should be considered a priority for hemodynamically unstable pelvic fracture patients with abdominal organ injuries.
{"title":"Internal iliac artery ligation as a damage control method in hemodynamically unstable pelvic fractures: A systematic review of the literature","authors":"Hui Li, Tao Ai, Guang-Bin Huang, Jun Yang, Gong-Bin Wei, Jin-Mou Gao, Ping He, Xue-Mei Cao, Ding-Yuan Du","doi":"10.1016/j.cjtee.2024.07.004","DOIUrl":"10.1016/j.cjtee.2024.07.004","url":null,"abstract":"<div><h3>Purpose</h3><p>Internal iliac artery ligation (IIAL) has been used as a damage control procedure to treat hemodynamically unstable pelvic fracture for many years. However, there is ongoing debate regarding the effectiveness and safety of this hemostatic method. Therefore, we performed a systematic literature review to assess the efficacy and safety of IIAL for pelvic fracture hemostasis.</p></div><div><h3>Methods</h3><p>Three major databases, PubMed, Embase, and Google Scholar, were searched to screen eligible original studies published in English journals. Two reviewers independently read the titles, abstracts, and full texts of all literature. Articles were included if they reported the use and effects of IIAL.</p></div><div><h3>Results</h3><p>A total of 171 articles were initially identified, with 22 fully meeting the inclusion criteria. Among the analyzed cases, up to 66.7% of patients had associated abdominal and pelvic organ injuries, with the urethra being the most frequently injured organ, followed by the bowel. The outcomes of IIAL for achieving hemostasis in pelvic fractures were found to be satisfactory, with an effective rate of 80%. Hemorrhagic shock was the leading cause of death, followed by craniocerebral injury. Notably, no reports of ischemic complications involving the pelvic organs due to IIAL were found.</p></div><div><h3>Conclusion</h3><p>IIAL has a good effect in treating hemodynamically unstable pelvic fracture without the risk of pelvic organ ischemia. This procedure should be considered a priority for hemodynamically unstable pelvic fracture patients with abdominal organ injuries.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 5","pages":"Pages 288-294"},"PeriodicalIF":1.8,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127524000762/pdfft?md5=baf39e90eba1df71efed5ca7247d451b&pid=1-s2.0-S1008127524000762-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697990","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 : 2024-07-03DOI: 10.1016/j.cjtee.2024.07.003
<div><h3>Purpose</h3><p><em>Vibrio vulnificus</em> (<em>V. Vulnificus</em>) infection is characterized by rapid onset, aggressive progression, and challenging treatment. Bacterial resistance poses a significant challenge for clinical anti-infection treatment and is thus the subject of research. Enhancing host infection tolerance represents a novel infection prevention strategy to improve patient survival. Our team initially identified cytochrome P4501A1 (CYP1A1) as an important target owing to its negative modulation of the body's infection tolerance. This study explored the superior effects of the CYP1A1 inhibitor bergamottin compared to antibiotic combination therapy on the survival of mice infected with multidrug-resistant <em>V. Vulnificus</em> and the protection of their vital organs.</p></div><div><h3>Methods</h3><p>An increasing concentration gradient method was used to induce multidrug-resistant <em>V. Vulnificus</em> development. We established a lethal infection model in C57BL/6J male mice and evaluated the effect of bergamottin on mouse survival. A mild infection model was established in C57BL/6J male mice, and the serum levels of creatinine, urea nitrogen, aspartate aminotransferase, and alanine aminotransferase were determined using enzyme-linked immunosorbent assay to evaluate the effect of bergamottin on liver and kidney function. The morphological changes induced in the presence of bergamottin in mouse organs were evaluated by hematoxylin and eosin staining of liver and kidney tissues. The bacterial growth curve and organ load determination were used to evaluate whether bergamottin has a direct antibacterial effect on multidrug-resistant <em>V. Vulnificus</em>. Quantification of inflammatory factors in serum by enzyme-linked immunosorbent assay and the expression levels of inflammatory factors in liver and kidney tissues by real-time quantitative polymerase chain reaction were performed to evaluate the effect of bergamottin on inflammatory factor levels. Western blot analysis of IκBα, phosphorylated IκBα, p65, and phosphorylated p65 protein expression in liver and kidney tissues and in human hepatocellular carcinomas-2 and human kidney-2 cell lines was used to evaluate the effect of bergamottin on the nuclear factor kappa-B signaling pathway. One-way ANOVA and Kaplan-Meier analysis were used for statistical analysis.</p></div><div><h3>Results</h3><p>In mice infected with multidrug-resistant <em>V. Vulnificus</em>, bergamottin prolonged survival (<em>p</em> = 0.014), reduced the serum creatinine (<em>p</em> = 0.002), urea nitrogen (<em>p</em> = 0.030), aspartate aminotransferase (<em>p</em> = 0.029), and alanine aminotransferase (<em>p</em> = 0.003) levels, and protected the cellular morphology of liver and kidney tissues. Bergamottin inhibited interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α expression in serum (IL-1β: <em>p</em> = 0.010, IL-6: <em>p</em> = 0.029, TNF-α: <em>p</em> = 0.025) and inhibited the protein ex
{"title":"The cytochrome P4501A1 (CYP1A1) inhibitor bergamottin enhances host tolerance to multidrug-resistant Vibrio vulnificus infection","authors":"","doi":"10.1016/j.cjtee.2024.07.003","DOIUrl":"10.1016/j.cjtee.2024.07.003","url":null,"abstract":"<div><h3>Purpose</h3><p><em>Vibrio vulnificus</em> (<em>V. Vulnificus</em>) infection is characterized by rapid onset, aggressive progression, and challenging treatment. Bacterial resistance poses a significant challenge for clinical anti-infection treatment and is thus the subject of research. Enhancing host infection tolerance represents a novel infection prevention strategy to improve patient survival. Our team initially identified cytochrome P4501A1 (CYP1A1) as an important target owing to its negative modulation of the body's infection tolerance. This study explored the superior effects of the CYP1A1 inhibitor bergamottin compared to antibiotic combination therapy on the survival of mice infected with multidrug-resistant <em>V. Vulnificus</em> and the protection of their vital organs.</p></div><div><h3>Methods</h3><p>An increasing concentration gradient method was used to induce multidrug-resistant <em>V. Vulnificus</em> development. We established a lethal infection model in C57BL/6J male mice and evaluated the effect of bergamottin on mouse survival. A mild infection model was established in C57BL/6J male mice, and the serum levels of creatinine, urea nitrogen, aspartate aminotransferase, and alanine aminotransferase were determined using enzyme-linked immunosorbent assay to evaluate the effect of bergamottin on liver and kidney function. The morphological changes induced in the presence of bergamottin in mouse organs were evaluated by hematoxylin and eosin staining of liver and kidney tissues. The bacterial growth curve and organ load determination were used to evaluate whether bergamottin has a direct antibacterial effect on multidrug-resistant <em>V. Vulnificus</em>. Quantification of inflammatory factors in serum by enzyme-linked immunosorbent assay and the expression levels of inflammatory factors in liver and kidney tissues by real-time quantitative polymerase chain reaction were performed to evaluate the effect of bergamottin on inflammatory factor levels. Western blot analysis of IκBα, phosphorylated IκBα, p65, and phosphorylated p65 protein expression in liver and kidney tissues and in human hepatocellular carcinomas-2 and human kidney-2 cell lines was used to evaluate the effect of bergamottin on the nuclear factor kappa-B signaling pathway. One-way ANOVA and Kaplan-Meier analysis were used for statistical analysis.</p></div><div><h3>Results</h3><p>In mice infected with multidrug-resistant <em>V. Vulnificus</em>, bergamottin prolonged survival (<em>p</em> = 0.014), reduced the serum creatinine (<em>p</em> = 0.002), urea nitrogen (<em>p</em> = 0.030), aspartate aminotransferase (<em>p</em> = 0.029), and alanine aminotransferase (<em>p</em> = 0.003) levels, and protected the cellular morphology of liver and kidney tissues. Bergamottin inhibited interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α expression in serum (IL-1β: <em>p</em> = 0.010, IL-6: <em>p</em> = 0.029, TNF-α: <em>p</em> = 0.025) and inhibited the protein ex","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 5","pages":"Pages 295-304"},"PeriodicalIF":1.8,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127524000750/pdfft?md5=7d7b6b24fda2023f231b875abf634c03&pid=1-s2.0-S1008127524000750-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565096","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}
Purpose: Lateral compression (LC) injuries account for more than two-thirds of all pelvic fractures. The goal of surgical treatment is to provide adequate stability and early mobilization. The consensus on posterior fixation of such injuries is strong in the literature; however, the necessity of anterior ring fixation is not clear. Therefore, this study was formulated to determine the practicability of posterior-only fixation in LC injuries.
Methods: Between March 2015 and May 2020, all patients with LC type pelvic ring fractures who were admitted and operated upon in a single level 1 trauma center were included in this cross-sectional observational study. Demographic data, co-morbidities, treatment, types of surgical fixation, concomitant injuries and surgeries, surgical complications, length of hospital stay, injury to weight bearing duration, and follow-up period were documented. Functional outcome and quality of life were assessed using Majeed score and SF-36 questionnaire. Non-normally distributed data were presented as median (Q1, Q3) and normally distributed data were presented as mean ± SD. Spearman's rank correlation coefficient was used for correlation analysis.
Results: A total of 25 patients were included, with a mean age of 29.8 years. All patients were managed operatively with posterior-only fixation. The median Majeed score was 90 (76, 95). The median physical component summary score was 69.37 (38.75, 85.62). The median mental component summary score was 63.95 (39.25, 87.87). There was no significant difference compared to population norms of both physical component summary and mental component summary. Injury to weight bearing time correlated significantly (p = 0.002) with Majeed score as well as SF-36 score (p = 0.044). No other variable had a significant association with outcomes.
Conclusion: Posterior-only fixation is sufficient for fixing LC injuries with up to 80% of cases having good to excellent functional outcomes. However, comparative studies with larger sample sizes are needed for further validation.
{"title":"Posterior-only fixation in pelvic fractures: Is it sufficient in lateral compression injuries?","authors":"Sameer Aggarwal, Sandeep Patel, Lav Mehta, Mohak Kataria, Vishal Kumar, Prasoon Kumar","doi":"10.1016/j.cjtee.2024.07.002","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.07.002","url":null,"abstract":"<p><strong>Purpose: </strong>Lateral compression (LC) injuries account for more than two-thirds of all pelvic fractures. The goal of surgical treatment is to provide adequate stability and early mobilization. The consensus on posterior fixation of such injuries is strong in the literature; however, the necessity of anterior ring fixation is not clear. Therefore, this study was formulated to determine the practicability of posterior-only fixation in LC injuries.</p><p><strong>Methods: </strong>Between March 2015 and May 2020, all patients with LC type pelvic ring fractures who were admitted and operated upon in a single level 1 trauma center were included in this cross-sectional observational study. Demographic data, co-morbidities, treatment, types of surgical fixation, concomitant injuries and surgeries, surgical complications, length of hospital stay, injury to weight bearing duration, and follow-up period were documented. Functional outcome and quality of life were assessed using Majeed score and SF-36 questionnaire. Non-normally distributed data were presented as median (Q<sub>1</sub>, Q<sub>3</sub>) and normally distributed data were presented as mean ± SD. Spearman's rank correlation coefficient was used for correlation analysis.</p><p><strong>Results: </strong>A total of 25 patients were included, with a mean age of 29.8 years. All patients were managed operatively with posterior-only fixation. The median Majeed score was 90 (76, 95). The median physical component summary score was 69.37 (38.75, 85.62). The median mental component summary score was 63.95 (39.25, 87.87). There was no significant difference compared to population norms of both physical component summary and mental component summary. Injury to weight bearing time correlated significantly (p = 0.002) with Majeed score as well as SF-36 score (p = 0.044). No other variable had a significant association with outcomes.</p><p><strong>Conclusion: </strong>Posterior-only fixation is sufficient for fixing LC injuries with up to 80% of cases having good to excellent functional outcomes. However, comparative studies with larger sample sizes are needed for further validation.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565095","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}
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