The improved oval forceps suture-guiding method for minimally invasive Achilles tendon repair

ObjectiveTo discuss the effect and advantage of the improved oval forceps suture-guiding method combined with anchor nail in the treatment of acute Achilles tendon rupture.MethodsA retrospective research was performed on 35 cases of acute Achilles tendon rupture treated with the improved oval forceps suture-guiding method from January 2013 to October 2016. Instead of the Achillon device, we perform the Achillon technique with the use of simple oval forceps, combined with absorbable anchor nail, percutaneously to repair the acute Achilles tendon rupture.ResultsAll patients were followed up for at least 12 months (range, 12–19 months), and all the patients underwent successful repair of their acute Achilles tendon rupture using the improved oval forceps suture-guiding method without any major intra- or postoperative complications. All the patients returned to work with pre-injury levels of activity at a mean of 12.51 ± 0.76 weeks. Mean AOFAS ankle-hindfoot scores improved from 63.95 (range, 51–78) preoperatively to 98.59 (range, 91–100) at last follow-up. This was statistically significant difference (P < 0.001). Mean Achilles Tendon Total Rupture Score (ATRS) at final follow-up was 94.87 (range, 90–100).ConclusionThe improved oval forceps suture-guiding method could make the advantage of minimally invasive repair with less complications, reduced surgical time and similar functional outcomes compared with the traditional open surgery. In addition, our new technique could save the cost of surgery with the compare of the Achillon device. At the same time for the cases which the remote broken tendon ends were within 2 cm from the calcaneal nodules, because of the less tendon tissue was left in the remote side, traditional percutaneous methods are incapable to ensure the reconstruction strength. By using the anchor nail, the improved technique has better repair capacity and expands the operation indication of oval forceps method.     

Application of pre-contoured anatomic locking plate for treatment of humerus split type greater tuberosity fractures: A prospective review of 68 cases with an average follow-up of 2.5 years

ObjectivesAlthough various implants exist for 3- and 4-part proximal humerus fractures, few implants are appropriate for humerus split type greater tuberosity fractures. The goal of this study was to assess the efficacy of pre-contoured anatomic locking plate for humerus split type greater tuberosity fractures.MethodsA retrospective review of 68 patients with humerus split type greater tuberosity fractures treated with open reduction and internal fixation using anatomic locking plates between January 2014 and October 2016. Postoperatively, patient radiographs, functional results, and complications were reviewed.ResultsAll patients got a mean follow-up of 30.5 months (range 14–46 months). Average fracture healing time was 9.4 weeks (range, 8–14 weeks). Overall mean Constant score was 86.8% (range, 70%–96%). The result was rated as excellent in 25 patients (Constant score: 92.1%), good in 38 patients (Constant score: 85.3%) moderate in 5 patients (Constant score: 71.8%) and poor in 0 cases. The excellent-good rate was 92.6%. No recurrence of dislocation occurred in the 30 cases with shoulder dislocation. All fractures healed without the complications of wound infection, subacromial impingement syndrome, nonunion, secondary displacement, and implant loosening.ConclusionPre-contoured anatomic locking plate is a reliable option in treating humerus split type greater tuberosity fractures as it provides stable fixation with an early return to function. The surgical technique is easy and efficient.     

Are the current guidelines for surgical delay in hip fractures too rigid? A single center assessment of mortality and economics

PurposeControversy remains around acceptable surgical delay of acute hip fractures with current guidelines ranging from 24 to 48 h. Increasing healthcare costs force us to consider the economic burden as well. We aimed to evaluate the adjusted effect of surgical delay for hip fracture surgery on early mortality, healthcare costs and readmission rate. We hypothesized that shorter delays resulted in lower early mortality and costs.MethodsIn this retrospective cohort study 2573 consecutive patients aged ≥50 years were included, who underwent surgery for acute hip fractures between 2009 and 2017. Main endpoints were thirty- and ninety-day mortality, total cost, and readmission rate. Multivariable regression included sex, age and ASA score as covariates.ResultsThirty-day mortality was 5% (n = 133), ninety-day mortality 12% (n = 304). Average total cost was €11960, dominated by hospitalization (59%) and honoraria (23%). Per 24 h delay, the adjusted odds ratio was 1.07 (95% CI 0.98–1.18) for thirty-day mortality, 1.12 (95% CI 1.04–1.19) for ninety-day mortality, and 0.99 (95% CI = 0.88–1.12) for readmission. Per 24 h delay, costs increased with 7% (95% CI 6–8%). For mortality, delay was a weaker predictor than sex, age, and ASA score. For costs, delay was the strongest predictor. We did not find clear cut-points for surgical delay after which mortality or costs increased abruptly.ConclusionsDespite only modest associations with mortality, we observed a steady increase in healthcare costs when delaying surgery. Hence, a more pragmatic approach with surgery as soon as medically and organizationally possible seems justifiable over rigorous implementation of the current guidelines.     

Pipkin骨折的治疗及并发症的防治

Pipkin骨折是指髋关节后脱位同时合并的股骨头骨折,约占髋关节脱位的1％～16．8％,多由强大暴力导致,处理不当易导致股骨头坏死、异位骨化、骨关节炎等一系列并发症。自2001年至2007年,共收治12例,根据不同骨折类型采用不同的治疗方法,取得了满意效果。     

Foot fractures in polytrauma patients: Injury characteristics and timing of diagnosis

BackgroundDue to prioritizing care and concomitant injuries, foot fractures in polytrauma patients often receive limited attention initially. However, as foot function is important, treatment and diagnosis of these fractures should be accurate. The aims of this study were to assess the incidence and distribution of foot fractures in polytrauma patients and to examine possible risk factors for delayed diagnosis of foot fractures.MethodsThis was a retrospective study on all adult (≥18 years) polytrauma (ISS ≥16) patients admitted to a single level 1 trauma center between 2006 and 2016. Patients with foot fractures were identified by diagnosis codes. Data on demographics and trauma characteristics were collected from the Trauma Quality Improvement Program (TQIP®) database. Data on foot fractures were gathered from electronic patient documentation.ResultsOut of 4409 polytrauma patients, 221 (5.0%) sustained a total of 511 foot fractures. Metatarsal fractures were most common (41%), followed by calcaneal (17%), and talar (16%) fractures. Thirty percent of the fractures in 33% of all patients were diagnosed in a delayed fashion. This had treatment consequences in 8%. Delayed diagnosed fractures were more common in older patients (p 0.025), patients with a higher ISS (p 0.012), ICU admission (p 0.015), and concomitant head injury (p 0.020).ConclusionsAs one in twenty polytrauma patients sustains at least one foot fracture and a substantial amount of these fractures are diagnosed in a delayed fashion, physicians, regardless of their specialty, should have a high index of suspicion for injuries of the feet in polytrauma patients.     

Viability and functionality of mesenchymal stromal cells loaded on collagen microspheres and incorporated into plasma clots for orthopaedic application: Effect of storage conditions

BackgroundThere is evidence showing that human mesenchymal stromal cells (MSC) seeded on collagen microspheres (CM) and incorporated into platelet rich plasma (PRP) clots induce bone formation. For clinical trials it is very important to establish standardization of storage and shipment conditions to ensure the viability and functionality of cellular products. We investigate the effect of storage temperature and time on the viability and functionality of human MSC seeded on CM and included into PRP clots for using in the further clinical application for bone regeneration.MethodsMSC/CM/PRP clots were stored at room temperature (RT), 4 °C and 37 °C for 12 h, 24 h and 48 h. At each period of time, MSC were evaluated for their viability and functionality.ResultsMSC from MSC/CM/PRP clots maintained at RT and 37 °C for 24 h showed a high viability (90%) and maintained their capacity of proliferation, migration and osteogenic differentiation. In contrast, MSC/CM/PRP maintained to 4 °C showed a significant reduction in their viability and migration capacity. MSC from MSC/CM/PRP clots maintained at RT for 24 h induce osteogenesis in the subcutaneous tissues of mice, after four months of transplantation.DiscussionOur results show that MSC incorporated into CM/PRP clots and maintained at RT can be utilized in bone regeneration protocols during the first 24 h after their processing.