对侧股骨远端锁定钢板治疗骨质疏松患者髋部骨折的临床应用

目的 探讨国产股骨远端锁定钢板治疗骨质疏松老年患者髋部骨折的适应征以及临床效果. 方法 应用对侧国产股骨远端锁定钢板治疗老年人骨质疏松性股骨粗隆部骨折32例,观察骨折愈合及内固定物稳定情况. 结果 切口均Ⅰ期愈合,除1例患者末遵医嘱过早负重,引起内固定切割股骨头、髋内翻畸形,再次入院行关节置换外,其他所有病例患肢无畸形愈合、骨折再移位,内固定物无松动、切出及失败,无髋内翻畸形,无股骨头坏死,无切口感染及骨不连.根据Sanders髋关节评分标准:优18例,良12例,差2例. 结论 采用国产对侧股骨远端锁定钢板治疗髋部骨折,能够满足股骨近端骨折内固定要求,尤其适用于老年人骨质疏松较重的患者.     

福州地区老年骨折患者回顾性分析

目的回顾分析福建省第二人民医院老年骨折的流行病学特征,以大致推断福州地区的流行病学特征,为该地区骨质疏松性骨折的防治提供理论依据。方法回顾性收集2012年6月至2017年6月福建省第二人民医院老年骨折住院患者(≥50岁),统计骨折部位构成情况,并分析其随年龄、性别变化趋势。结果共收集老年骨折1535例,男性467例(30.42%),女性1068例(69.58%),男女比例12.29,75~79岁骨折患者最多。骨折部位以胸腰椎(36.48%)最多,其次为股骨近端骨折(20.65%)(股骨粗隆间骨折11.01%,股骨颈骨折9.19%)和尺桡骨远端(7.23%)。女性以胸腰椎骨折(40.17%)最多,其次为股骨粗隆间骨折(10.21%)和尺桡骨远端骨折(9.74%);男性同样以胸腰椎骨折(28.05%)最多,其次为股骨粗隆间骨折(12.85%)和股骨颈骨折(8.35%)。老年骨折患者中骨质疏松患者占比59.54%,女性(47.82%),男性(11.72%),并以跌倒所致骨折居多(68.62%)。结论福州地区老年骨折患者中女性多于男性,骨折主要集中于胸腰椎、股骨近端和尺桡骨远端,且男女骨折的好发部位有所不同。跌倒是老年人骨折的一个重要原因,而绝经后骨质疏松加大了老年女性骨折的风险,预防应主要加强对老年人的抗骨质疏松治疗,并加强看护、陪伴及采取相应防护措施。     

LISS治疗老年骨质疏松性股骨远端骨折疗效分析

目的 通过前瞻性研究探讨微创内固定系统(USS)治疗老年骨质疏松性股骨远端骨折的疗效.方法 采用USS微创治疗18例老年骨质疏松性股骨远端骨折,对膝关节功能及并发症等资料进行分析.结果 本组随访15～36个月,骨折均获愈合,无切口感染及再骨折等并发症.膝关节功能按Merchant评分:优12例,良4例,可2例,优良率88.89%.结论 熟知LISS的生物力学原则及技术要点、恢复股骨内侧皮质支持、积极抗骨质疏松是提高骨质疏松性股骨远端骨折固定稳定性的重要因素,有助于减少术后并发症并获得良好的膝关节功能.     

老年股骨转子间骨折骨量变化及治疗

股骨转子间骨折多见于老年人，随着人口的老龄化，因骨质疏松而发生的股骨转子间骨折发病率正在逐年增高，成为骨科临床的常见症，也是导致老年人致残率及死亡率相当高的疾病，早已引起临床医生的高度重视。从上个世纪初至今关于本病的治疗方法多种多样，笔者对116例50岁以上伴有骨质疏松股骨转子间骨折病人的治疗进行回顾性分析，予以探讨。     

倒置LISS治疗老年人骨质疏松性股骨粗隆部骨折

目的探讨微创内固定系统(LISS)治疗老年人骨质疏松性股骨粗隆部骨折的适应证及近期临床疗效。方法应用LISS接骨板治疗老年人骨质疏松性股骨粗隆部骨折40例,采用倒置对侧股骨远端LISS接骨板进行内固定。观察骨折愈合及内固定物稳定情况。结果切口均一期愈合,患肢均无畸形愈合、骨折再移位,内固定物无松动、切出及失败,无髋内翻畸形,无股骨头坏死、切口感染及骨不连。根据Sanders髋关节评分标准:优22例(55%),良12例(30%),中6例(15%)。结论采用倒置对侧股骨远端LISS接骨板治疗股骨粗隆部骨折,能够满足股骨近端骨折内固定要求,尤其适用于老年人骨质疏松较重的患者。     

锁定钢板联合内侧异体骨板内固定治疗老年骨质疏松性股骨远端骨折

目的探讨股骨远端外侧锁定钢板联合内侧异体骨板内固定治疗老年重度骨质疏松性股骨远端骨折的临床疗效。方法回顾性分析自2009-01—2016-12采用股骨远端外侧解剖型锁定钢板联合内侧异体骨板内固定治疗的23例老年重度骨质疏松性股骨远端骨折。术中均采用MIPPO技术将钢板、异体骨板分别置入股骨远端外侧和内侧固定。结果23例均获得随访,随访时间平均23(12~39)个月。骨折愈合时间平均6.7(4~12)个月,无内固定松动、骨折不愈合及再骨折。末次随访时按Merchan标准评定膝关节功能:优9例,良11例,可3例,优良率86.9%。结论股骨远端外侧解剖型锁定钢板联合内侧异体骨板内固定为内侧皮质有缺损的重度骨质疏松性股骨远端骨折提供了一种有效的固定方式,配合术后有效抗骨质疏松治疗及积极的康复训练,患者膝关节功能恢复良好,可取得满意疗效。     

老年股骨远端粉碎性骨折手术非手术治疗的对比研究

目的：老年人骨质疏松性骨折治疗较为困难，为比较老年股骨远端粉碎性骨折手术与非手术治疗的效果。方法：作者对４０ 例老年股骨远端粉碎性骨折进行了前瞻性随机性的控制性研究。结果：手术组优良率达５４－５ ％ ，而非手术组的优良率仅为３５ ％ ，且术后并发症明显多于前者（ Ｐ＜ ０－０５） 。结论：提示老年股骨远端粉碎性骨折应考虑手术治疗。     

LISS钢板治疗老年骨质疏松的下肢骨折

AO微创内固定系统（Less invasive stabilization sysem，LISS）在本院用于治疗股骨远端骨折和胫骨近端骨折，取得较满意的效果。2004年8月至2007年8月应用Ao—Liss钢板治疗治疗老年骨质疏松股骨远侧骨折或胫骨近侧骨折13例，参考相关文献结合临床体会，对Liss手术治疗下肢骨质疏松性骨折的技术优势、适应征进行讨论。     

老年骨质疏松性骨折的危险因素及其护理干预

目的了解老年人骨质疏松性骨折的危险因素．提高其生活质量。方法对132例老年骨质疏松性骨折患者按年龄段分成三组，根据X线摄片结果确定骨折部位．询问患者骨折发生时的状态和诱发因素。结果女性骨折占68．94％，男性占31．06％，骨折发生频率高的部位依次为股骨颈、椎体、前臂远端。跌倒是导致老年人骨质疏松性骨折的主要危险因素。结论老年骨质疏松患者受轻微的外力撞击或震动即可发生骨折，护理人员应针对骨质疏松性骨折的危险因素，采取有效的干预措施和健康教育，降低骨质疏松性骨折的发生率。     

家庭病床治疗老年股骨粗隆间骨折24例报告

股骨粗隆间骨折是一种常见的多发于老年人的疾病。由于老年人骨皮质变薄,骨质疏松,加之老年人行动不便易摔跤,轻度外伤则易导致骨折。如何处理好老年股骨粗隆间骨折,近几年来,许多作者报道手术治疗能使患者早期活动,减少长期卧床带来的并发症,降低死亡率。笔者从1991年至1997年,利用设立家庭病床采用股骨髁上骨牵引的方法治疗老年粗隆间骨折共24例,取得满意效果。因此,我们认为,在贫困地区设家庭病床保守治疗是一种行之有效而又容易被老年患者接     

老年性骨折及其治疗

老年性骨折最主要的危险因素是骨质疏松和跌倒．老年性骨折的常见部位包括脊柱、髋部、桡骨远端等。老年性骨折重在预防，主要预防措施包括适当的运动、营养、避免酗酒、吸烟和药物的滥用等。通过骨密度测量可以预测髋部骨折的危险性，老年性骨折的愈合过程不发生改变，但新骨形成迟缓，后期愈合时间延长．本文还介绍了老年骨折的治疗原则、方法及难点。     

Intramedullary locked nailing for distal femoral fractures

Surgical Principles Distal femoral fractures, supracondylar and condylar fractures which can be successfully reduced by closed methods are treated with a modified method of intramedullary locked nails. Closed reduction is obtained by adducting the distal fragment and by adjusting the degree of knee flexion and extension. Condylar fractures, if present, are reduced closed and fixed with percutaneous lag screws. After preparing the medullary cavity, the distal 15 mm of the locked nail is cut away and the tip of the nail is driven to the subchondral bone of the distal femur. The advantage of this technique is the minimal dissection for these difficult fractures. The splinting effect of the intramedullary nail decreases the incidence of refracture in the geriatric patient in whom refractures are relatively common. However, this technique may not be applicable in very distal fracture and condylar fracture which cannot be reduced by closed methods, and condylar fracture in the sagittal plane.     

Use of 2 column screws to treat transcondylar distal humeral fractures in geriatric patients

We describe fixation of transcondylar distal humeral fractures with column screws in geriatric patients and review our initial results. We conducted a retrospective review of a prospectively collected database at a Level I trauma center. Six patients met inclusion criteria of age older than 65 years and treatment of minimally or nondisplaced transcondylar distal humeral fracture with column screws only. All were closed fractures with no associated nerve injuries. One patient was lost to follow-up. The mechanism of injury was low-energy fall for the 5 remaining patients (average age, 74 y; age range, 70 to 83 y; average follow-up duration, 10.6 wk). One patient had a traumatic brain injury and a contralateral metacarpal fracture that was treated with internal fixation. The remaining 4 patients sustained isolated distal humeral fractures. No complications were noted, and all fractures healed at an average radiographic union time of 7.2 weeks. Average range of motion was 22 degrees extension [95% CI (-1.47, 45.47)], 114 degrees flexion [95% CI (89.4, 138.6)], and 92 degrees arc of motion [95% CI (58.68, 125.38)]. Treatment of select transcondylar distal humeral fractures with column screws in geriatric patients provides an option for stable fixation that allows early range of motion with minimal surgical morbidity.     

Cost-effectiveness of fixation versus arthroplasty for geriatric distal femur fractures

IntroductionGeriatric distal femur fractures are challenging to treat. The high mortality rate associated with a loss of mobility in this population has led some authors to compare distal femur fractures to femoral neck fractures with respect to the importance of rapidly regaining mobility in the geriatric population. Acute distal femur replacement has been advocated by some as a preferred treatment over internal fixation because arthroplasty may facilitate a more rapid return to a patient's baseline mobility level. The purpose of this study was to systematically review the literature on the costs and outcomes of fixation and arthroplasty in the geriatric distal femur fracture population and to employ decision modeling techniques to generate evidence-based treatment recommendations.MethodsA systematic literature review of clinical studies published since 2000 was conducted to synthesize the available data on outcomes, reoperation rates, and mortality rates after fixation or arthroplasty for distal femur fractures in patients with an average age greater than 70 years. A Markov decision analysis model was created. Costs, health state utilities, reoperation rates, and mortality rates were derived from the systematic literature review and publicly available data. The model was analyzed via probabilistic statistical analysis as well as sensitivity analyses with a willingness-to-pay threshold set at $100,000 per QALY and a 5-year time horizon.ResultsFrom a US societal perspective, fixation was associated with a greater quality of life benefit (2.44 QALYs vs. 2.34 QALYs) and lower cost ($25,556 vs. $65,536) compared with distal femur replacement for geriatric distal femur fractures. Probabilistic analysis demonstrated that 82 in 100 model outcomes favored fixation over arthroplasty and 18 in 100 model outcomes favored distal femur replacement. Sensitivity analyses demonstrated that this result was robust to small deviations in the cost and functional outcome variables in the model.ConclusionCompared to distal femur replacement, ORIF is likely to be a more cost-effective treatment for distal femur fractures in the geriatric patient population, though this recommendation is tempered by the relatively low quality of evidence available on the comparative functional outcomes of these treatments.     

Future treatment and research directions in distal radius fracture

Whether or not they will have their lives dramatically extended in the next few decades, it is clear that people are living longer, healthier, and more active lives. The two peak incidences of distal radius fractures will remain within the pediatric and geriatric age groups, with the latter experiencing a substantial increase in the coming years. This article attempts to project future developments with regard to epidemiology, risk and prevention, fracture assessment, and treatment of distal radius fractures, and the ever increasing concern for the economic impact of this prevalent injury.     

Elderly patients with two episodes of fragility hip fractures form a special subgroup

PURPOSE. To identify the demographic features of patients aged 65 years or older admitted with 2 episodes of fragility hip fractures. METHODS. From July 2003 to December 2004 inclusive, 50 consecutive elderly patients underwent surgery for a second episode of hip fracture. Patients in a very poor physical condition and therefore unfit for surgery were excluded. Risk factors of fractures in both episodes and whether risk factors were corrected after the first episode were analysed. Detailed radiological assessment and charting of elderly mobility scores and Barthel index were completed and the one-year mortality rate documented. The rehabilitation periods for the 2 episodes of hip fracture were compared. RESULTS. Most patients were female and had trochanteric fractures. In patients aged 65 to 75 years, the incidence of femoral neck fracture occurred as often as trochanteric fracture; while trochanteric fracture was predominant in older patients. Subclinical osteomalacia and undiagnosed hyperthyroidism was found in 3 of the 7 younger patients. Only 30% of them were on treatment for osteoporosis after the first fracture, which underlines the importance of osteoporosis treatment in these patients. CONCLUSION. Elderly patients with 2 episodes of fragility hip fractures form a special subgroup among geriatric hip fracture patients. Fall prevention programmes and treatment for osteoporosis are recommended.     

Management of distal humeral fractures in the elderly

Although relatively uncommon, fractures of the distal humerus in the elderly patient population are significant injuries of which optimal management is a subject of debate in orthopaedic literature. The combination of complex anatomy, poor bone quality and extensive comminution often seen with these fractures makes successful treatment difficult. Currently, most surgeons support surgical fixation of distal humeral fractures with the belief that restoration of the patient's native elbow joint provides the best opportunity for a good functional outcome. Others have proposed the use of total elbow arthroplasty as a primary treatment method for geriatric distal humeral fractures based on the difficulties associated with ORIF and the relatively low demands of this patient population. To date, there have been no prospective randomised trials comparing these two treatment alternatives, and a comparison of available outcome data shows good functional outcome for both forms of fracture management. With the aging of the population and an associated increase in the incidence of distal humeral fractures, the debate over the optimal treatment regime will undoubtedly continue.     

Acetabulum fractures in elderly: A systematic review of fracture pattern and treatment

PurposeAcetabulum fractures are being increasingly seen with low impact injuries in elderly patients. This article aimed to study systematically literature on geriatric acetabulum fractures. Objectives of this systematic review were to study (1) demography of patients, common mechanisms of injury and types of fracture patterns commonly seen in elderly patients, (2) treatment used for these fractures in literature and (3) mortality rates in elderly with these fractures.MethodsSystematic search was carried out in May 2020 using predefined search strategy for all studies published in the English language in last 20 years. Literature search and data abstraction was done by two independent reviewers.ResultsAfter screening of all abstracts, a total of 48 studies were included in the systematic review. In total there were 7876 geriatric patients with acetabulum fractures. Mean age of the patients was 72.47 years. There were 4841 males (61.5%). Fall from low heights was the most common mechanism of injury, present in 47.12% patients followed by motor vehicular accidents in 28.73%. Most common fracture pattern was both column fracture, seen in 19.03% patients, followed by anterior column and posterior hemitransverse fracture in 17.23%, anterior column fractures in 17.13%, and posterior wall fractures in 13.46% patients. Out of total 5160 patients for whom details of treatment were available, 2199 (42.62%) were given non-operative treatment, 2285 (44.28%) were treated with ORIF of acetabulum fracture, 161 (3.12%) were treated with percutaneous fixation and 515 (9.98%) were treated with primary THA. Gull sign, femoral head injury and posterior wall comminution were associated with poorer prognosis after ORIF and may form an indication for a primary THA.ConclusionLiterature on treatment of geriatric acetabulum fractures is not enough to draw any definite conclusions. There is limited evidence from current literature that surgery could be considered a safe treatment option for displaced acetabulum fractures in elderly. Primary THA can provide early mobility and reduce chances of resurgery in fracture patterns where restoration of joint surface may not be possible.     

Fractures about the knee in thegeriatric patient: fix them or replace them?

Displaced fractures of the distal femur are conventionally treated with open reduction and internal fixation to restore joint congruity, regain alignment, establish bony support, and retain limb function. Successful treatment with this approach preserves bone and maintains the native cartilage-bearing joint. However, fractures of the distal femur in the geriatric population are associated with a high incidence of postoperative complications and poor results. Nonunion, loss of fixation, and malunion of these fractures occur with many types of treatment. Many patients have preexisting osteoarthritis, which, even with successful fracture healing guarantees poor functional results. In addition, the postoperative management of these patients demands a lengthy period of limitation of weight bearing, which can increase the rate of many medical complications and overall loss of independence. Experience with these challenging fractures has led to an alternative approach utilizing a primary distal femur replacement total knee arthroplasty. These prosthesis, originally designed for tumor reconstruction, offer many advantages over open reduction of these fractures, including elimination of fracture healing issues, early mobilization, and immediate weight bearing. Potential disadvantages include concerns over longevity and cost of hardware, and surgeon inexperience with these implants.     

Acetabulum fractures in elderly: A systematic review of fracture pattern and treatment

PurposeAcetabulum fractures are being increasingly seen with low impact injuries in elderly patients. This article aimed to study systematically literature on geriatric acetabulum fractures. Objectives of this systematic review were to study (1) demography of patients, common mechanisms of injury and types of fracture patterns commonly seen in elderly patients, (2) treatment used for these fractures in literature and (3) mortality rates in elderly with these fractures.MethodsSystematic search was carried out in May 2020 using predefined search strategy for all studies published in the English language in last 20 years. Literature search and data abstraction was done by two independent reviewers.ResultsAfter screening of all abstracts, a total of 48 studies were included in the systematic review. In total there were 7876 geriatric patients with acetabulum fractures. Mean age of the patients was 72.47 years. There were 4841 males (61.5%). Fall from low heights was the most common mechanism of injury, present in 47.12% patients followed by motor vehicular accidents in 28.73%. Most common fracture pattern was both column fracture, seen in 19.03% patients, followed by anterior column and posterior hemitransverse fracture in 17.23%, anterior column fractures in 17.13%, and posterior wall fractures in 13.46% patients. Out of total 5160 patients for whom details of treatment were available, 2199 (42.62%) were given non-operative treatment, 2285 (44.28%) were treated with ORIF of acetabulum fracture, 161 (3.12%) were treated with percutaneous fixation and 515 (9.98%) were treated with primary THA. Gull sign, femoral head injury and posterior wall comminution were associated with poorer prognosis after ORIF and may form an indication for a primary THA.ConclusionLiterature on treatment of geriatric acetabulum fractures is not enough to draw any definite conclusions. There is limited evidence from current literature that surgery could be considered a safe treatment option for displaced acetabulum fractures in elderly. Primary THA can provide early mobility and reduce chances of resurgery in fracture patterns where restoration of joint surface may not be possible.