Objective To explore an improved method of surgical operation for reposition of the articular surface with Type Ⅲ Pilon fractures. Methods From January 1999 to December 2005, 20 patients (22 sides) with Type Ⅲ Pilon fractures were treated with the delayed open reduction and the internal fixation, which took the superior articular surface of the talus as a templet so as to reposition the lower articular surface of the tibia, strengthen the bone transplantation, fasten the internal fixation, and make an early functional exercise possible. Complete data were obtained from 16 of the patients with 18 sides (13 males,15 sides; 3 females, 3 sides; age, 14-48 years). The injury due to a fallingaccident was found in 12 patients (14 sides), and due to a traffic accident in 4patients (4 sides). Results The healing of the first intention was achieved in 14 sides, the delayed healing in 3 sides, and the infection in 1 side. The follow-up of all the 16 patients for 971 months (average, 22 months) including the X-ray examinations revealed that no screw for the internal fixation entering the articular cavity. According to the Teeny’s judging standards of radiology evaluating the result of the surgery for Pilon fractures, the anatomical reduction of the related articular surface was found in 77.8% of the sides (14/18) and thehealing of the first intention (stage Ⅰ) in 94.4% (17/18). According to the Mazur’s criteria, an excellent result was obtained in 5 sides, good in 7, fair in 5, and poor in 1. The excellent and good result was 66.7%. Conclusion Propermanagement of the injured soft tissues, prompt recovery of the tibial distant plateau height, and accurate reposition of the articular surface, enough transplant bone for the solid support, b internal fixation for the distant tibial anatomical structure, and early functional exercise are the key points to the successful operation.
Forty cases of intertrochanteric fractures of femur were treated with percutaneous nonmetallic external fixator. The patients were followed up for 6 months to 3 years, and the fractures were all united without coxa vara or shirtening deformities. There was no mortality in this series. This method had the advantages ofbeing simple, save time and effort, less traumatic and early ambulation. The design of the apparatus tallied with the biomechanics of the neck and shaft of the femur.
ObjectiveTo summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion.MethodsBetween January 2013 and January 2017, 11 patients of old scaphoid fracture and nonunion were treated with nitinol memory alloy two foot fixator and autologous cancellous bone grafting. All patients were male with an average age of 26.1 years (range, 18-42 years). The fractures were caused by sport in 3 cases, falling in 7 cases, and a crashing object in 1 case. The interval between injury and operation was 6-18 months (mean, 8.9 months). Postoperative outcome measures included operation time, fracture healing time, grip strength, range of motion (ROM) of flexion, extension, ulnar deviation, and radial deviation, Mayo score, visual analogue scale (VAS) score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe operation time was 35-63 minutes (mean, 48 minutes). All incisions had primary healing with no infection and loosening or breakage of internal fixator. All patients were followed up 12-30 months (mean, 20.7 months). X-ray films showed that fracture healing was achieved in all patients with an average time of 15 weeks (range, 12-25 weeks). All internal fixators were removed after 10-12 months of operation (mean, 11.2 months). At last follow-up, the grip strength, ROMs of flexion, ulnar deviation, and radial deviation were superior to those before operation (P<0.05), no significant difference was found in ROM of extension between pre- and post-operation (t=0.229, P=0.824). There were significant differences in above indexes between affected and normal sides (P<0.05). At last follow-up, the Mayo, VAS, DASH scores were also significantly superior to those before operation (P<0.05).ConclusionFor the old scaphoid fracture and nonunion, Ni-Ti arched shape-memory alloy fixator and autologous cancellous bone grafting can obtain good effectiveness, which is an effective treatment.
Objective To develop a deep learning system for CT images to assist in the diagnosis of thoracolumbar fractures and analyze the feasibility of its clinical application. Methods Collected from West China Hospital of Sichuan University from January 2019 to March 2020, a total of 1256 CT images of thoracolumbar fractures were annotated with a unified standard through the Imaging LabelImg system. All CT images were classified according to the AO Spine thoracolumbar spine injury classification. The deep learning system in diagnosing ABC fracture types was optimized using 1039 CT images for training and validation, of which 1004 were used as the training set and 35 as the validation set; the rest 217 CT images were used as the test set to compare the deep learning system with the clinician’s diagnosis. The deep learning system in subtyping A was optimized using 581 CT images for training and validation, of which 556 were used as the training set and 25 as the validation set; the rest 104 CT images were used as the test set to compare the deep learning system with the clinician’s diagnosis. Results The accuracy and Kappa coefficient of the deep learning system in diagnosing ABC fracture types were 89.4% and 0.849 (P<0.001), respectively. The accuracy and Kappa coefficient of subtyping A were 87.5% and 0.817 (P<0.001), respectively. Conclusions The classification accuracy of the deep learning system for thoracolumbar fractures is high. This approach can be used to assist in the intelligent diagnosis of CT images of thoracolumbar fractures and improve the current manual and complex diagnostic process.
ObjectiveTo investigate the effectiveness of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric patients with hip fractures.MethodsThe clinical data of 489 geriatric patients with hip fractures (femoral neck fracture and intertrochanteric fracture) between January 1st 2016 and January 1st 2018 was retrospectively analyzed. Among them, 279 patients were treated with the multidisciplinary doctor-nurse collaboration care (observation group) and 210 patients were treated with the conventional therapeutics and nursing care (control group). There was no significant difference in gender, age, cause of injury, type and classification of fracture, the interval between injury and admission, and Charlson index between the two groups (P>0.05). The surgery rates, time from hospitalization to operation, length of stay, and the incidences of perioperative complications were compared between the two groups.ResultsThe surgery rate was 90.32% (252/279) in observation group and 80.48% (169/210) in control group, showing significant difference between the two groups (χ2=9.703, P=0.002). The time from hospitalization to operation and length of stay in observation group [(5.39±2.47), (10.56±3.76) days] were significant shorter than those in control group [(6.13±2.79), (12.27±3.11) days] (t=−3.075, P=0.002; t=−5.330, P=0.000). The incidence of respiratory complications was 46.15% in control group and 30.56% in observation group; the incidence of cardiovascular system complications was 69.23% in control group and 51.19% in observation group; the incidence of cerebrovascular system complications was 20.12% in control group and 11.11% in observation group; the incidence of deep venous thrombosis was 40.24% in control group and 25.40% in observation group. The incidences of perioperative complications were significantly lower in observation group than in control group (P<0.05).ConclusionMultidisciplinary doctor-nurse collaboration team is conducive not only to improve the surgery rates, but also to reduce perioperative complications as well as shorten the length of stay and preoperative waiting time.
ObjectiveTo compare the clinical effect of day surgery mode and inpatient operation mode for intertrochanteric fracture in elderly patients.MethodsThirty-seven elderly patients with intertrochanteric fracture treated in day surgery mode in the Second Hospital of Shanxi Medical University from July 2018 to July 2019 were retrospectively included. At the same time, another 37 elderly patients with intertrochanteric fracture treated in general inpatient operation mode in the same period were randomly selected. The preoperative waiting time, operation time, length of hospital stay, hospital expenses, postoperative complications, and clinical effect were compared between the two groups.ResultsThere was no significant difference in operation time [(56.21±10.75) vs. (58.81±12.56) min] or postoperative Harris hip scores (1 month after surgery: 61.03±7.74 vs. 59.47±7.42; 3 months after surgery: 85.40±4.22 vs. 85.03±4.33) between the two groups (P>0.05). In terms of the preoperative waiting time [(23.17±3.18) vs. (52.64±10.12) h], length of hospital stay [(2.01±0.97) vs. (8.34±4.22) d], hospital expenses [(4.012±0.771)×104 vs. (4.679±1.117)×104 yuan], and the incidence of deep venous thrombosis during perioperative period (10.8% vs.37.8%), the day surgery mode group had more obvious advantages than general inpatient operation mode group (P<0.05).ConclusionsDay surgery mode is safe and effective for intertrochanteric fracture in elderly patients. It is worthy of great application for clinical work in the future.
OBJECTIVE: To observe the clinical results in the anterior stabile operation of spinal fracture using red blood salvage. METHODS: Nineteen cases with spinal fracture were performed the anterior decompress operation. Blood cell salvage were used during operation. Other 20 cases were also reviewed as control group, who were received the same operation without blood cell salvage. RESULTS: In the 19 cases, average volume of autologous transfusion was 536 ml. Only two cases had homologous transfusion requirements. In the control group, all cases needed homologous transfusion (averaged 947 ml). CONCLUSION: In the anterior decompress operation, the intraoperative blood salvage is highly effective in reducing transfusion and also improves the security of operation
ObjectiveTo investigate the safety and efficacy of sequential use of tranexamic acid (TXA) in the perioperative period of half hip replacement for femoral neck fracture in the elderly.MethodsPatients who underwent hemiarthroplasty due to femoral neck fracture in Meishan Traditional Chinese Medicine Hospital from January 2016 to October 2018 were retrospectively included. According to the use of TXA during the perioperative period, the patients were divided into group A (no use of TXA), group B (TXA use on the day of surgery), and group C (sequential therapy). The perioperative blood loss, blood transfusion rate and incidence of deep vein thrombosis (DVT) in the 3 groups were recorded and counted.ResultsA total of 113 patients were included, and 99 patients were finally included (31 in group A, 36 in group B, and 32 in group C). There were no statistically significant difference in age, sex, body mass index, hemoglobin (Hb) at admission, hematocrit at admission, blood volume, or blood transfusion among the three groups. The differences in total blood loss (F=43.613, P<0.001), preoperative blood loss (F=4.746, P=0.011), preoperative Hb (F=6.220, P=0.003), maximum Hb change (F=18.913, P<0.001), and postoperative length of hospital stay (F=43.511, P<0.001) among the three groups were statistically significant. There was no DVT of the lower extremities or pulmonary embolism found in the three groups. The differences in preoperative blood loss and preoperative Hb were not statistically significant between group A and group B. The difference in postoperative length of hospital stay was not statistically significant between group B and group C. The differences in other indexes between all the pairs of the three groups were statistically significant (P<0.05).ConclusionUsing TXA early after femoral neck fracture and sequentially to the day of surgery can reduce perioperative blood loss, including hidden blood loss before surgery and blood loss during and after the operation, which is beneficial to patients’ postoperative recovery without increasing the risk of DVT.
ObjectiveTo design an auto-compressive and anti-circumrotate intramedullary nail( ACACIN) and to evaluate the preliminary clinical efficacy on fixing adult femur fracture. Methods From January 1998 to June 2001, 23 patientswith femur fracture were stabilized with auto-compressive and anti-circumrotateintramedullary nail. 2-4 elastic blocks were installed into the proximal and distal different distance of quincunx nail to defend circumrotate and axis compress. Results Fracture healing were obtained in all 23 patients treated with auto-compresseiveand anti-circumrotate intramedullary nail, the time of fracture healing was 6-13 weeks in 21 cases and 15-22 weeks in 2 cases of old fracture. There was no complication related to infection, nail break, abnormal union and joint ankylosis. The results were excellent in 19 cases, good in 3 cases, and moderate in 1 case according Kolmert’s criterion for function ; the effective rate was 95.7%. Conclusion Auto-compressive and anti-circumrotate intramedullary nail has a suitable radian for adult femur, can afford stable fixation, anti-circumrotate andaxis compress.
Objective To investigate the early effectiveness of transiliac-transsacral screws internal fixation assisted by augmented reality navigation system HoloSight (hereinafter referred to as “computer navigation system”) in the treatment of posterior pelvic ring injuries. MethodsA retrospective analysis was made in the 41 patients with posterior pelvic ring injuries who had been treated surgically with transiliac-transsacral screws between June 2022 and June 2023. The patients were divided into navigation group (18 cases, using computer navigation system to assist screw implantation) and freehand group (23 cases, using C-arm X-ray fluoroscopy to guide screw implantation) according to the different methods of transiliac-transsacral screws placement. There was no significant difference in gender, age, body mass index, causes of injuries, Tile classification of pelvic fracture, days from injury to operation, usage of unlocking closed reduction technique between the two groups (P>0.05). The time of screw implantation, the fluoroscopy times, the guide wire adjustment times of each screw, and the incidence of complications were recorded and compared between the two groups. The position of the transiliac-transsacral screw was scanned by CT within 2 days after operation, and the position of the screw was classified according to Gras standard. ResultsThe operation was successfully completed in both groups. The time of screw implantation, the fluoroscopy times, and the guide wire adjustment times of each screw in the navigation group were significantly less than those in the freehand group (P<0.05). There were 2 cases of incision infection in the freehand group, and the incision healed by first intention after active dressing change; there was no screw-related complication in the navigation group during operation and early period after operation; the difference in incidence of complications between the two groups (8.7% vs. 0) was not significant (P=0.495). According to the Gras standard, the screw position of the navigation group was significantly better than that of the freehand group (P<0.05). ConclusionCompared with the traditional freehand method, the computer navigation system assisted transiliac-transsacral screws internal fixation in the treatment of posterior pelvic ring injuries has advantages of improving the accuracy of screw implantation and reducing radiation damage and the time of screw implantation.