Biomechanical comparison of three internal fixation configurations for low transcondylar fractures of the distal humerus

BackgroundWe aimed to evaluate the biomechanical stiffness and strength of different internal fixation configurations and find suitable treatment strategies for low transcondylar fractures of the distal humerus.Methods and materialsThirty 4^th generation composite humeri were used to create low transcondylar fracture models that were fixed by orthogonal and parallel double plates as well as posterolateral plate and medial screw (PPMS) configurations (n=10 in each group) using an anatomical locking compression plate-screw system and fully threaded medial cortical screws. Posterior bending (maximum 50 N), axial loading (maximum 200 N) and internal rotation (maximum 10 N·m) were tested, in that order, for each specimen. Stiffness under different biomechanical settings among different configurations were compared. Another 18 sets of fracture models were created using these three configurations (n=6 in each group) and the load to failure under axial loading among different configurations was compared.ResultsUnder posterior bending, the stiffness of parallel group was higher than orthogonal group (P<0.001), and orthogonal group was higher than PPMS group (P<0.001). Under axial loading, the stiffness of parallel group was higher than orthogonal group (P=0.001) and PPMS group (P<0.001); however, the difference between orthogonal and PPMS group was not statistically significant (P>0.05). Under internal rotation, the stiffness of parallel group was higher than orthogonal group (P=0.044), and orthogonal group was higher than PPMS group (P=0.029). In failure test under axial loading, the load to failure in the orthogonal group was lower than parallel group (P=0.009) and PPMS group (P=0.021), but the difference between parallel group and PPMS group was not statistically significant (P>0.05). All specimens in orthogonal group demonstrated “distal medial failure”; most specimens had “distal medial and trochlear failure” in the parallel group; most specimens exhibited “contact failure” in the PPMS group.ConclusionFor treating low transcondylar fractures, the overall stiffness and strength of the parallel configuration were superior to those of the orthogonal and PPMS configurations. Nevertheless, the PPMS configuration can provide adequate stability and stiffness comparable to double-plate configurations under axial loading. Therefore, the PPMS construct may have certain clinical value.     

Effect of two intensive insulin therapy regimens on perioperative glycemic control in bone fracture patients with type 2 diabetes mellitus

Background Currently,there are no uniform standards and methods for perioperative glycemic control in bone fracture patients with Type 2 diabetes mellitus (T2DM).We retrospectively analyzed the efficac...     

加速康复外科理念下桡骨远端骨折规范化无痛闭合整复与石膏固定方案优化的专家共识

桡骨远端骨折是急诊最常见的骨折类型。无论是采取保守治疗或是作为手术前的处理,闭合整复石膏固定都具有重要意义。在加速康复外科(ERAS)理念的指导下,规范的无痛闭合整复及石膏固定可以减少患者应激,进一步优化此流程可以提高治疗效果。经全国创伤骨科专家讨论,以循证医学证据为基础,以ERAS理念为指导,特制定该共识,为医务人员在治疗此类骨折时提供指导。该共识适用于新鲜闭合桡骨远端骨折患者。     

中国创伤骨科患者围手术期静脉血栓栓塞症预防指南(2021)

静脉血栓栓塞症(venous thromboembolism,VTE)是创伤骨科患者的常见并发症,也是导致患者围手术期死亡的主要原因之一。对创伤患者施以有效的预防措施,可以降低VTE的发生风险,减轻患者痛苦,减少医疗费用。因此,参照2016版"中国骨科大手术静脉血栓栓塞症预防指南"、2018版"中国血栓性疾病防治指南"及最新的循证证据,在2012版"中国骨科创伤患者围手术期静脉血栓栓塞症预防的专家共识"基础上,制定本指南。     

加速康复外科理念下开放性骨折诊疗规范专家共识

开放性骨折的治疗对于任何创伤骨科医师都是一个挑战。在诸多问题上仍然需要通过研究提供更高等级证据,随着加速康复外科(ERAS)理念的引入以及循证医学的发展,可以在现有基础上做出多方面的改进,以使患者的主观体验及客观治疗效果得到改善。经过全国创伤骨科专家的讨论后达成本共识,为在急诊情况下处理开放性骨折提供参考。     

The protective effect of Irisin against ischemia-reperfusion injury after perforator flap grafting in rats

BackgroundIschemia-reperfusion injury is one of the reasons for failure of flap grafting. In the present study, we investigated the protective effect of irisin on the survival of perforator flaps in rats.MethodsA total of 48 adult Sprague-Dawley rats were divided into 2 groups and subjected to vascular clipping of perforator flap. Rats in the experimental group (n = 24) received daily tail intravenous injection of irisin (2 ng/g) for 3 days, while the rest rats in the control group (n = 24) received injection of saline solution of the same dose. On the 7th post-operative day, the surviving area of the flaps were recorded as the percentage of the total flap area. Histology study with haematoxylin and eosin staining were performed in all flaps. Flaps were also evaluated with lead oxide-gelatine-enhanced flap angiography. Immunohistochemical study was performed to evaluate the expression of ErG, a marker of vascular endothelial cells. The tissue of “choke vessels” was excised for quantification of p-Akt/Akt by western blot assay on the 7th post-operative day.ResultsOn the 7th post-operative day, the percentage of surviving flap area was significantly larger in the rats with irisin administration (experimental group), compared with the control group (P = 0.011). The density of microvessels was significantly higher in the experimental group (P = 0.03) in the histological study and angiography, with a higher expression level of ErG in the immunochemical study (P = 0.01). The p-Akt/Akt was also higher in the experimental group in Western blotting analysis (P < 0.001).ConclusionIrisin has a beneficial effect on protecting perforator flaps from ischemic-reperfusion injury following the flap grafting surgery. It was potentially achieved by promoting proliferation of vascular endothelial cells after flap revascularization. Upregulation of the PI3K/Akt signaling pathway was potentially related with this process.     

新型冠状病毒肺炎疫情期间骨科急症处理原则的专家共识

自2019年12月以来,湖北省武汉市部分医院相继收治多个有华南海鲜市场暴露史的不明原因肺炎病例[1]。患者症状多为发热、乏力、干咳并逐渐出现呼吸困难,部分重症患者出现了急性呼吸窘迫综合征或脓毒症休克、甚至病死。2020年1月7日,我国研究人员首次从患者标本中检测出一种新型冠状病毒[2]。2020年1月20日,中华人民共和国国家卫生健康委员会发布2020年1号公告,将新型冠状病毒感染的肺炎纳入乙类传染病,并按照甲类传染病进行防疫、控制[3]。世界卫生组织将新型冠状病毒肺炎命名为"COVID-19"[4]。     

Trochleoplasty for severe trochlear dysplasia significantly improves the quality of life of patients with symptomatic patellar instability

BackgroundTrochleoplasty is a recognized surgical technique to address severe trochlear dysplasia. The clinical and radiological outcomes of trochleoplasty surgery in trochlear dysplasia have been well reported. There is a paucity in literature regarding the correlation between trochleoplasty and quality of life (QoL). The aim of this study is to measure the improvement in QoL, in patients with severe trochlear dysplasia and recurrent patellar instability following trochleoplasty.MethodsBetween 2013 and 2019, 51 trochleoplasty cases were performed in 48 patients. They were identified from our prospectively kept database. All operations were performed by a fellowship trained consultant sports knee surgeon. Functional outcomes and QoL scores were assessed using Kujala, IKDC and EQ-5D index. Objective outcomes were obtained following each patient’s latest follow-up assessment.ResultsThe mean age at operation was 22y (SD ± 4.7, range 14–37y) and the mean follow-up period was 21.6 months (SD ± 15.2, range 12–60 months). The mean Kujala score improved from 58.1 (SD 14.9) to 77.9 (SD 17.3) at latest follow-up (p < 0.001). The mean IKDC score improved from 40.5 (SD 14.2) to 69.5 (SD 22.8) at latest follow up (p < 0.001). The mean EQ-5D index also improved from 0.593 (SD 0.257) to 0.824 (SD 0.189) at latest follow-up (p = 0.003). A higher Body Mass Index (BMI; >30 kg/m²) was associated with inferior outcomes.ConclusionTrochleoplasty is an effective surgical technique which improves the QoL in patients suffering from patellar instability secondary to severe trochlear dysplasia. BMI can be used to predict post-operative outcomes.     

肘部创伤的治疗进展与思考

<正>近年来对肘关节损伤的重视日益增加,对其认识也不断加深,治疗上也有很多进步,具体表现在以下几个方面。1对肘部损伤的认识进一步加深对于以前就有很多认识和治疗经验的肱骨远端骨折、桡骨头骨折、尺骨鹰嘴骨折、孟氏骨折等损伤,随着认识的进一步加深,在损伤机制、损伤性质、损伤的共性和个性、诊断和鉴别诊断以及治疗的关键要点等方面,有了更深刻的理解与更清晰的鉴别,治     

Does routinely repairing deltoid ligament injuries in type B ankle joint fractures influence long term outcomes?

Deltoid ligament reconstruction following type B ankle fractures continues to generate a vivid discussion amongst trauma surgeons. There is a difference of opinion as to whether operative or non operative treatment should prevail. We therefore conducted a prospective comparative cohort study to determine whether it is necessary to routinely repair the injured deltoid ligaments. 41 Type B ankle joint fracture patients were enrolled, all the patients were associated with deltoid ligament ruptures and lateral/posterior-lateral dislocation of talus. After fixation of the lateral malleolus fracture, 12 patients were treated by superficial deltoid ligaments repairing, 16 patients with deep components augmentation, 13 patients had no direct surgical intervention. In the deep components group, the planter and the dorsi flexion was 3.2° (0-10°) and 8.8° (0-15°) less than the normal side. In the superficial components group, plantar and dorsi flexion was 0.8° (0-5°) and 4.2° (0-15°) less than the normal side. In the non-repairing group, the plantar and dorsi flexion was 2.4° (0-10°) and 5.6° (0-20°) less than the normal side. Overall, no significant statistical difference was observed comparing the 3 groups. In addition, no statistically significant inter-group differences were evident in terms of measurement of the ankle medial clear space and the clinical and functional outcomes recorded. In conclusion, the results of this study do not support routine exposure and repairing of the injured deltoid ligaments.