Comparison of pre- and postoperative orbital volume using three dimensional CT imaging in zygoma fracture patients

The aims of this study were (1) to assess the difference between the volume of the traumatized and non-traumatized orbit, (2) to determine the critical change in orbital volume that will result in enophthalmos, and (3) to analyze the correlation between volume discrepancy and clinical outcome in maxillofacial trauma patients. Twenty-seven surgically managed patients with a fracture of the orbitozygomatic complex were included in this study. Preoperative and postoperative volume measurements of both orbits were compared, using software whose accuracy was confirmed in a preliminary experimental study in dry skulls. The correlation between volume discrepancy and clinical enophthalmos was statistically assessed before and after surgery. Preoperatively, there was an increase in orbital volume in 26 of 27 cases, with a range of 0.04–6.02 cc compared with the intact orbits. The mean volume difference between the orbits was 3.01±1.64 cm³ in the preoperative period, and this decreased to 1.02±1.29 cm³ following operation (P<0.01). Five patients (19%) showed clinical enophthalmos with a mean volume difference of 4.77±0.18 cm³ preoperatively. Clinical enophthalmos persisted postoperatively in only one of five enophthalmic patients, in whom the volume discrepancy was greater than 4 cm³. Our data suggested that the technique described here is an easy and accurate method of assessing the volume of the orbit. Orbital volume measurement may help the surgeon to predict volume to be restored and to avoid probable complications. Received: 15 March 2000 / Accepted: 2 August 2000     

Comparison of the postoperative outcome in pure medial orbital fracture among three groups: using porous polyethylene or hydroxyapatite through subciliary approach and transnasal endoscopic correction

Many methods of surgical repair of pure medial orbital fractures have been reported. In this study, we discuss the outcome from the surgical corrections of hydroxyapatite (Biocoral) or porous polyethylene (Medpor) through subciliary approach, and the transnasal endoscopic corrections. Between March 1993 and July 2003, 63 patients were treated with porous polyethylene and 48 patients were treated with hydroxyapatite. Between August 2003 and December 2005, 50 patients were treated with transnasal endoscopic approach. Patients had at least 6 months' follow-up, and the records for diplopia, enophthalmos, and other postoperative complications were reviewed retrospectively. As a result, 1 patient from the group using porous polyethylene, 2 patients from the group using hydroxyapatite, and 1 patient from the endoscopic correction group had enophthalmos. Besides enophthalmos, no other complications were observed. There was no significant statistical correlation among 3 groups. In conclusion, a transnasal endoscopic correction may be considered a useful method for surgical repair of pure medial orbital fractures, with no external facial scar and excellent visualization and accuracy comparable to that of the subciliary approach.     

Foreign-body reactions to fracture fixation implants of biodegradable synthetic polymers

Biodegradable rods of polyglycolide or lactide-glycolide copolymer were used in the internal fixation of a variety of fractures and osteotomies in 516 patients. A clinically manifest foreign-body reaction occurred in 41 patients (7.9%), producing a fluctuant swelling at the implantation site after an average of 12 weeks. Spontaneous sinus formation or surgical drainage yielded a sterile exudate containing liquid remnants of the degrading implants. After prompt drainage this discharge subsided within three weeks. Histological examination showed a typical nonspecific foreign-body reaction with abundant giant cells both in patients with the reaction and in some patients with an uneventful clinical course. The factors determining the nature of the reaction were probably related to the local capacity of the tissues to clear the polymeric debris. The reactions did not influence the clinical or radiographic results, but recognition of the incidence and the features of the reaction is necessary in view of the increasing use of such implants.     

Functional outcome of ankle fracture patients treated with biodegradable implants

BackgroundBiodegradable devices have been developed to overcome the disadvantages of metallic implants especially the need for their subsequent removal, though they have their own drawbacks like poor mechanical properties and tissue reactions. Aim of this prospective study was to access the outcome of bimalleolar fractures fixed with biodegradable plates and screws.MethodsA prospective study was conducted between July 2006 and November 2008 comprising of sixteen patients with unilateral bimalleolar fractures. Fibula fractures were fixed with biodegradable plates and medial malleoli with screws. Patients were followed at two weeks, six weeks, three months, six months, twelve months and eighteen months. Final evaluation was done using Olerud Molander ankle score.ResultsSix patients had excellent results; four patients had good results and six patients had fair performance. No patient in this series had a poor outcome. One patient had both pain and swelling at 14 weeks postoperatively which settled down with debridement and antibiotics. None of the patients needed implant removal.ConclusionBiodegradable plates and screws when used to fix bimalleolar fracture along with restricted weight bearing, provide satisfactory fracture healing, good functional results and reduce the need of implant removal.     

Effect of postoperative delirium on outcome after hip fracture

Nine-hundred twenty-one community-dwelling patients 65 years of age or older, who sustained an operatively treated hip fracture from July 1, 1987 to June 30, 1998 were followed up for the development of postoperative delirium. The outcomes examined in the current study were postoperative complication rates, in-hospital mortality, hospital length of stay, hospital discharge status, 1-year mortality rate, place of residence, recovery of ambulatory ability, and activities of daily living 1 year after surgery. Forty-seven (5.1%) patients were diagnosed with postoperative delirium. Patients who had delirium develop were more likely to be male, have a history of mild dementia, and have had surgery under general anesthesia. Patients who had postoperative delirium develop had a significantly longer length of hospitalization. They also had significantly higher rates of mortality at 1 year, were less likely to recover their prefracture level of ambulation, and were more likely to show a decline in level of independence in basic activities of daily living at the 1-year followup. There was no difference in the rate of postoperative complications, in-hospital mortality, discharge residence, and recovery of instrumental activities of daily living at 1 year.     

Brief postoperative delirium in hip fracture patients affects functional outcome at three months

It is unclear how brief postoperative delirium (DEL) affects functional outcomes. In this study, we sought to determine if patients with brief postoperative DEL (<6-wk duration) have different living situations when compared with non-DEL patients after hip fracture repair. In a prospective study, patients admitted to the geriatric hip fracture service were assessed every postoperative day for the presence of DEL using the confusion assessment method (CAM) score. Patients were reassessed at 6 wk and 3 mo postoperatively for CAM score, current living situation, and activities of daily living. Group comparisons were tested after dividing patients into two groups: DEL (DEL; [+] CAM at any time during the postoperative period while in the hospital); no-DEL (no DEL; [-] CAM throughout the postoperative period while in the hospital). The study included 92 patients of whom 26 (28%) were CAM (+) after surgery. At 6 wk follow-up, n = 81; at 3 mo follow-up, n = 76. Eight patients died during the study. At 6 wk and 3 mo, a larger percentage of DEL patients were not living with a family member (27% versus 8% patients not living with a family member at 3 mo follow-up in DEL and no-DEL, respectively). There was no difference in activities of daily living by 3 mo. We conclude that brief postoperative DEL lasting <6 wk is a determining factor for poor long-term functional outcome after hip fracture repair, because it significantly impacts the ability to live independently. IMPLICATIONS: Brief postoperative delirium lasting <6 wk is a determining factor for poor long-term functional outcome after hip fracture repair, because it significantly impacts the ability to live independently.     

髋臼骨折术后并发症分析

目的：分析髋臼骨折术后并发症发生的原因，探讨减少、减轻并发症的措施。方法：回顾性研究本院1994年以来所进行手术治疗的57例病例，随访51例。结果：优良率占75％，有并发症25例，占49％。其中坐骨神经损伤3例，股神经损伤3例，下肢继发性血栓性静脉炎2例，股骨头缺血性坏死5例，股骨颈骨折1例，股骨头下部假关节1例，髋关节创伤性关节炎10例。结论：尽早确诊，选择恰当的手术入路，解剖复位，良好的内固定，微创技术及术后正确康复锻炼和指导是减少、减轻并发症的关键和措施。     

Growing skull fracture of the orbital roof

In this report, the authors describe two cases of growing fracture of the orbital roof. The aim is to draw attention to this rare complication and discuss the role of three-dimensional computed tomography in radiological findings and surgical planning. Relevant literature is also reviewed.     

Short-term daily teriparatide improve postoperative functional outcome and fracture healing in unstable intertrochanteric fractures

BackgroundThere has been heightened interest in the effect of osteoanabolic agents on acceleration of fracture healing.ObjectivesThe purpose of this study was to identify whether short-term daily teriparatide prescribed for osteoporosis treatment would improve postoperative outcomes including clinical scores, radiographic healing, and complication rates.MethodsBetween 2014 and 2017, we retrospectively assessed 112 patients who underwent closed reduction and internal fixation with proximal femoral nail (PFN) for unstable intertrochanteric fractures. In 60 of 112 patients, patients were treated with a PFN alone (group I). These patients were compared with 52 patients for whom the same device was used and a daily subcutaneous injection of teriparatide (1–34 PTH, Forsteo®) was prescribed postoperatively (group II). Teriparatide was administered by nurses during a hospital stay and then self-injection was monitored by follow-up visits to the outpatient clinic after discharge. Questionnaire surveys were conducted and patients completed a self-report Harris hip score (HHS) and visual analog scale (VAS) scores.ResultsTeriparatide therapy significantly increased HHS (p = 0.02) and decreased VAS pain scores (p = 0.008). The mean time to fracture healing post-operatively was 14.8 weeks (SD 7.1) and 12.1 weeks (SD 6.4) in group I and II, respectively (p = 0.002). The frequency of patients reporting postoperative complications was also markedly reduced in the teriparatide-treated groups (p = 0.028).ConclusionsShort-term daily teriparatide used for osteoporosis treatment improved radiographic fracture healing of a hip fracture and reduced complication rates. However, because of the limited power of the study, additional randomized placebo-controlled trials are needed to determine the potential benefit of PTH as an adjunct to enhance fracture healing and its efficacy in broader populations with varying comorbidities and fracture types.     

Scaphoid fracture in the young athlete--therapeutic outcome of internal fixation using the Herbert screw

BACKGROUND: A fractured scaphoid is a common disabling injury occurring in contact sports. This study was designed to evaluate the therapeutic outcome of Herbert screw fixation for scaphoid fracture in young athletes. METHODS: Thirty athletes with 30 scaphoid fractures were treated. According to the Herbert classification, 10 were classified as acute fracture (group I), 6 as fibrous union (group II) and 14 as pseudoarthrosis (group III). Twenty scaphoid non-unions were due to missed diagnosis or unsuccessful immobilisation. RESULTS: Bony union was evident at an average of 9.2, 8.0 and 11.9 weeks postoperatively in groups I, II and III, respectively, and times for returning to sports were 10.7, 14.0 and 22.9 weeks. The clinical outcome assessed using the Mayo wrist score was excellent in groups I (97.5 points) and II (93.3) and good in group III (85.4). CONCLUSION: Early definitive diagnosis and treatment can allow early return to sports in young athletes. The Herbert screw technique produces an excellent clinical result for scaphoid fracture.     

膝关节周围骨折术后膝内翻原因分析

[目的]探讨膝关节周围骨折术后膝内翻的原因。[方法]回顾分析本院2002年5月～2008年6月收治的226例膝关节周围骨折患者的手术方式及效果,并分析产生膝内翻的相关因素。[结果]本组226例患者中共17例发生术后膝内翻。[结论]骨折的粉碎程度、能否坚强的内固定和有效处理骨缺损是发生术后膝内翻的主要原因。重视膝关节周围软组织的修复和围手术期处理可减少术后膝内翻的发生。     

肱骨内上髁骨折23例治疗分析

肱骨内上髁骨骺撕脱骨折多发生在7～15岁之间的儿童，占肘部骨折的10％，距第3位。治疗上有保守和手术两种不同的意见，文献报道的较少。我院小儿骨科自2001—2002年共收治26例儿童肱骨内上髁骨折，对其中23例进行了手术治疗，效果满意，报告如下。     

门脉高压症术后近期死亡病例分析

本文分析了47例门脉高压症术后近期死亡病例。主要死亡原因有器官衰竭(肝、肾衰竭,ARDS、MOF等)、再出血以及腹腔感染。造成器官衰竭的主要原因是手术打击和出血。影响术后近期死亡率的主要因素是术前病人的肝功能分级和手术时机。肝功能ⅠⅡⅢ级的死亡率分别为:8.1％,11.3％和52.1％;急诊手术术后近期死亡率明显高于择期手术。手术方式对术后近期死亡率无明显影响。文章对减少死亡的措施进行了讨论。     

583例髋部骨折的致伤因素分析

[目的]通过分析髋部骨折病例资料，了解髋部骨折的致伤因素，为预防髋部骨折提供依据。[方法]查阅四川大学华西医院2000—2005年期间所有髋部骨折住院病例，根据致伤因素等分组讨论。[结果]50岁及50岁以上患者致伤因素以跌倒为主，其发病女性较男性多见。50岁以下患者其病因以暴力为主；老年髋部骨折主要致伤因素为骨质疏松和跌倒，同时老年痴呆、心脑血管意外事件、偏瘫、帕金森氏病等内科性疾病与环境因素也大大增加了其发病的风险。[结论]不同程度的骨质疏松和跌倒是老年髋部骨折最主要的致伤因素，因此作者应重视老年骨质疏松、跌倒等致伤因素的防治。