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11.
《Injury》2019,50(7):1333-1338
IntroductionFor trochanteric fractures, helical blade placement is crucial to the prognosis of operations. Existing measurement methods used for blade placement include the Cleveland zone, the tip-apex distance (TAD), the calcar-referenced tip-apex distance (CalTAD), and the Parker's ratio. These methods all lack a direct view on blade direction. The current study proposed the axis-blade angle (ABA) to solve direction problem and investigated its clinical applicability.MethodsA retrospective study collected 156 patients between May 2014 and February 2018. The occurrence of mechanical complications was analyzed in relation to age, gender, fracture side, American Society of Anesthesiologists classification, fracture classification, reduction quality, bone quality, the Cleveland zone, the Parker's ratio, the TAD, the CalTAD, and the ABA.Results119 patients, including 25 with mechanical complications, were suitable for full analysis. In the univariate analysis, the Cleveland zone, reduction quality, the TAD, the CalTAD and the ABA were statistically associated with mechanical complications. In the multivariate analysis, reduction quality (p = 0.008) and the ABA (p < 0.001; adjusted OR 0.86;95% CI 0.77 to 0.96) showed significant results, which indicated that reduction quality and the ABA were two independent influencing factors for mechanical complications. Calculation of the receiver operating characteristic (ROC) curve indicated that the ABA was a reliable predictor of mechanical complications at the cut-off of −10°.ConclusionsThe ABA provides instruction for the intraoperative adjustment of guide wire direction. Placing the helical blade with an ABA > −10° can effectively reduce the risk of mechanical complications. 相似文献
12.
K. Young A. Aquilina T.J.S. Chesser M.L. Costa S. Hettiaratchy M.B. Kelly C.G. Moran I. Pallister M. Woodford 《Injury》2019,50(2):497-502
Aims
To assess current national practice in the management of severe open tibial fractures against national standards, using data collected by the Trauma and Audit Research Network.Materials and methods
Demographic, injury-specific, and outcome data were obtained for all grade IIIB/C fractures admitted to Major Trauma Centres in England from October 2014 to January 2016.Results
Data was available for 646 patients with recorded grade IIIB/C fractures. The male to female ratio was 2.3:1, mean age 47 years. 77% received antibiotics within 3?h of admission, 82% were debrided within 24?h. Soft tissue coverage was achieved within 72?h of admission in 71%. The amputation rate was 8.7%. 4.3% of patients required further theatre visits for infection during the index admission. The timing of antibiotics and surgery could not be correlated with returns to theatre for early infection. There were significant differences in the management and outcomes of patients aged 65 and over, with an increase in mortality and amputation rates.Conclusions
Good outcomes are reported from the management of IIIB/C fractures in Major Trauma Centres in England. Overall compliance with national standards is particularly poor in the elderly. Compliance did not appear to affect rates of returning to theatre or early infection. Appropriately applied patient reported outcome measures are needed to enhance the evidence-base for management of these injuries. 相似文献13.
Insufficiency fractures are a type of stress fractures that occur due to physiological stress on weakened bones. These have certain sites of predilection of which an uncommon site is fibular shaft. Isolated bilateral fibular fractures have previously only been reported twice, where the causes were repeated trauma and fatigue fracture. Insufficiency fractures of both fibula in isolation have not previously been reported. We present this case where a young patient presented with these fractures and was found to have vitamin D deficiency on subsequent investigations. 相似文献
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《Journal of Clinical Orthopaedics and Trauma》2021,12(6):976-982
ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients. 相似文献
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目的探讨关节镜辅助下轴向螺钉内固定术治疗Sanders-2型跟骨骨折的临床疗效。方法将50例Sanders-2型跟骨骨折患者按照随机数字表法分为研究组与对照组,各25例。研究组给予关节镜辅助下轴向螺钉内固定术治疗,对照组给予传统切开复位内固定术治疗。术后观察3个月。比较两组手术时间、住院时间、骨折愈合时间、术前与术后3个月末两组Bohler角、Gissane角度数及跟骨高度、宽度,以及两组Maryland足功能评分、手术疗效。结果研究组手术时间、住院时间及骨折愈合时间均显著短于对照组(P<0.05或0.01)。术后3个月末两组Bohler角及Gissane角度数均较术前显著增大(P<0.01),研究组较对照组增大更显著(P<0.05或0.01)。术后3个月末研究组跟骨高度显著>术前(P<0.01),两组跟骨宽度均显著>术前(P<0.01),两组间比较差异无统计学意义(P>0.05)。术后3个月末两组Maryland足功能评分均较术前显著升高(P<0.01),研究组较对照组升高更显著(P<0.01)。研究组手术治疗总有效率显著高于对照组(P<0.05),并发症发生率显著低于对照组(P<0.05)。结论关节镜辅助下轴向螺钉内固定术治疗Sanders-2型跟骨骨折效果显著,能有效促进患者足踝功能恢复,安全性较高,值得临床推广应用。 相似文献
19.
目的研究续筋接骨方治疗骨折的临床疗效。方法选取2018年1月—2018年6月在辽宁中医药大学附属第三医院就诊的骨折患者60例,所有患者按照随机数字表法分为对照组与观察组,每组30例。观察组口服续筋接骨方联合正骨后小夹板固定治疗,对照组患者采用正骨后小夹板固定治疗。分析2组患者干预3个月后的血清骨代谢指标、骨密度、生活质量改善情况以及疗效判定。结果干预前,2组的血清Ⅰ型前胶原羧基端肽β特殊序列(β-CTX)、血清Ⅰ型前胶原氨端肽原(PINP)、骨特异性碱性磷酸酶(ALP)水平、钙、磷及骨密度比较,差异无统计学意义(P>0.05);干预后,2组的β-CTX、PINP、骨特异性ALP水平、钙、磷及骨密度较干预前改善,观察组的改善效果优于对照组,差异均有统计学意义(P<0.05)。干预前,2组的物质生活、社会功能、躯体健康以及心理健康评分比较,差异无统计学意义(P>0.05);干预后,2组的物质生活、社会功能、躯体健康以及心理健康评分较干预前升高,观察组的各项生活质量评分高于对照组,差异均有统计学意义(P<0.05)。观察组的治疗恢复率高于对照组,差异有统计学意义(P<0.05)。结论续筋接骨方可以改善骨折患者骨代谢功能及生活质量。 相似文献
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