Risk factors for symptomatic venous thromboembolism following surgery for closed ankle fractures: A case-control study

BackgroundWe analyzed risk factors for venous thromboembolism (VTE) within 6 months after surgery for closed ankle fractures.MethodsThis was a case-control study based on data from chart review in a cohort of patients having open reduction and internal fixation (ORIF) for closed ankle fractures in two large general hospitals 2009–2011. Cases with symptomatic VTE (pulmonary embolism or deep venous thrombosis) were identified in the cohort, and additional cases of VTE were identified by computerized search of discharge diagnoses in the same hospitals in 2004–2008 and 2012–2016. In total, we identified 60 cases with VTE and compared with 240 randomly selected controls among 998 patients without VTE in the cohort. Risk factors were assessed using logistic regression analysis.ResultsAmong cases, 27 (45%) had pulmonary embolism, 33 (55%) deep venous thrombosis. Those with VTE were older, had higher BMI, had more often a family history of VTE, and more often had antibiotic prophylaxis during surgery than controls. In multivariable logistic regression analysis age/10 (OR 25.75, 95%CI 3.52–188.44, p = 0.001), (age/10)² (OR 0.77, 95%CI 0.65–0.93, p = 0.005), BMI (1.15 per kg/m², 95%CI 1.07–1.24, p < 0.001) and Charlson comorbidity index ≥2 vs.0 (OR 0.27, 95%CI 0.08–0.92, p = 0.036) and 1 vs. 0 (OR 0.27, 95%CI 0.09–0.86, p = 0.026) were associated with VTE within 6 months of surgery.ConclusionsThe odds of symptomatic VTE within 6 months of ORIF increased with increasing age and BMI, but were lower with increasing comorbidity.     

髋部骨折术前双下肢深静脉血栓发生率及其危险因素分析

目的 探讨髋部骨折术前双下肢深静脉血栓形成（deep vein thrombosis, DVT）的发生率及其危险因素。方法 回顾性分析2014年9月至2017年10月西安红会医院收治的997例髋部骨折病人资料,男382例,女615例;平均年龄为72.3（17~102）岁。其中股骨颈骨折493例,股骨转子间骨折470例,股骨转子下骨折34例。根据术前双下肢静脉彩超结果分为双下肢血栓组、非双下肢血栓组。对年龄、性别、骨折类型、受伤至手术的时间、术前的实验室检查（血红蛋白、红细胞比容、纤维蛋白原、D-二聚体）、合并内科疾病（原发性高血压、糖尿病、冠状动脉粥样硬化性心脏病、合并两种以上的内科疾病、无内科疾病）等可能危险因素进行单因素分析,再采用多因素Logistic回归分析确定其独立危险因素。结果 997例髋部骨折病人中66例（6.62%）术前发生双下肢DVT。双下肢血栓组与非双下肢血栓组病人的性别、骨折类型、术前D-二聚体水平、术前纤维蛋白原水平、合并内科疾病比较,差异均无统计学意义（P均＞0.05）;而两组病人年龄、受伤至手术时间、术前血红蛋白水平、术前红细胞比容比较,差异均有统计学意义（P均＜0.05）。多因素Logistic回归分析结果显示：年龄＞60岁［95%CI（1.153,12.367）,P=0.028］、受伤至手术时间＞7 d［95%CI（1.087,3.178）,P=0.023］为髋部骨折术前双下肢DVT的独立危险因素。结论 髋部骨折术前双下肢DVT的发生率约为6.62%;病人的年龄＞60岁、受伤至手术时间＞7 d是髋部骨折术前双下肢DVT的独立危险因素。     

老年髋部骨折患者术后2年内再发对侧髋部骨折的危险因素研究

目的:探讨老年髋部骨折患者术后2年内再发对侧髋部骨折的相关危险因素。方法:回顾性分析2015年5月至2018年4月期间北京积水潭医院创伤骨科采用手术治疗的1 962例老年髋部骨折患者资料。男573例,女1 389例;首次骨折时的年龄中位数为81（75,86）岁。根据术后2年内是否发生对侧髋部骨折分为两组：对侧髋部骨折组...     

Comparison of risk factors for postoperative complications across age groups in patients undergoing ORIF of the ankle

IntroductionRisk factors associated with various adverse outcomes for patients undergoing open reduction and internal fixation (ORIF) of the ankle, and how these risks differ between younger and older patient populations, has not been clearly established. Objective quantitative data may aid physicians in surgical decision making, individualizing postoperative management, and targeting interventions for reducing postoperative comorbidity. The purpose of this study is to compare the incidence of and risk factors for adverse postoperative outcomes following ORIF of ankle fractures across patient age groups.Materials and methodsCharts of patients age 18 years and older who underwent open reduction and internal fixation (ORIF) for any closed, non-polytraumatic, non-pilon ankle fracture at a single institution between the years 2008 and 2018 were reviewed. Demographic information, comorbidities, and postoperative outcomes were collected. Relative risks for adverse outcomes were calculated and compared between patients younger than 50 and patients 50 years and older.ResultsA total of 886 patients were included, 375 (42.3%) of which were over age 50. In both age groups, risk of infection was significantly increased among patients with hypertension, although risk among older patients (RR = 3.52, p = 0.004) was greater than that among younger patients (RR = 2.46, p = 0.017). In patients younger than 50, significant risk of wound dehiscence was associated with tobacco use (RR = 3.39, p = 0.022), substance use (RR = 3.07, p = 0.020), and CHF (RR = 12.77, p < 0.001). Risk of implant failure was significantly increased among younger patients with HIV (RR = 4.33, p = 0.026), CHF (RR = 10.54, p < 0.001), and CKD (RR = 10.54, p < 0.001), and among older patients with HTN (RR = 4.51, p = 0.006), CHF (RR = 5.83, p < 0.001), and tobacco use (RR = 3.82, P = 0.001).ConclusionPatients undergoing ORIF of the ankle should be well-informed of the potential risks of surgery as they pertain to specific comorbidities. Multidisciplinary approaches are warranted for appropriate management of patients with multiple comorbidities.     

Clinical and Patient reported outcomes following open reduction and internal fixation for distal tibial intra-articular fractures

IntroductionIntra-articular distal tibial plafond fractures are rare injuries, provide a challenge for the surgeon and can often have poor outcomes. The aim of this paper was to report long term patient reported functional outcomes, health related quality of life (QoL) scores and rates of complications in order to fully counsel the patient on likely outcomes and set realistic post-operative expectations for the patient.MethodsWe conducted a retrospective review of 20 patients with distal tibial intra-articular fractures that presented to our institution between September 2014 and September 2020. All patients underwent open reduction and internal fixation (ORIF). Clinical, radiological and patient reported outcome measures (PROMS), quality of life (QoL) scores and complications were collected.ResultsThe mean age of the patients at the time of surgery was 50.6 years (24−71). There were 7 males and 13 females. There were 4 open and 16 closed fractures. There were 7 Rüedi and Allgöwer (RA) Type 1, 9 Type 2 and 4 Type 3 fractures. The mean follow-up was 3.8 years [1–7]. The mean OMAS score was 54.3, reaching a peak at 2 years from injury. The mean QoL score (EQ5D5L) was 0.602, representing only 70 % of aged matched, UK population based norms.ConclusionsWhilst clinical outcomes are comparable with other studies, this report highlights this is a devastating injury, with most people taking 2 years to reach peak recovery. QoL outcome scores only reach 70 % normal and only 35 % of patients return to within 10 % of age matched population based norms.     

Analysis on the risk factors of second fracture in osteoporosis-related fractures

Objective: To explore the clinical characteristics and risk factors of refracture in patients suffering from osteoporosis-related fractures as well as effective interventions.Methods: From January 2006 to January 2008, both out-patients and in-patients in our hospital who were over 50 years old and suffered from osteoporosis-related fractures were selected for this research. They were divided into fracture group and refracture group. The refracture rate was followed up for 2 years, during which 11 patients developed refracture, thus were included in the refracture group.Therefore, 273 patients, 225 first-fracture cases, aged (67.7±8.5) years, and 48 refracture cases, aged (72.7-9.5) years,were included in this study. General data including age and sex, fracture types, femoral neck bone mineral density (BMD) T-scores tested by dual-energy X-rays absorptiometry (DEXA), Charlson index, time-frame between two fractures as well as mobility skill assessment were collected and analyzed by single-factor and multivariate statistical methods.Results: Females accounted for 70.2% of the fracture group and 77.1% of the refracture group. The most common refracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the followup. The second fracture happened 3.7 years after the first one on average. The refracture rate was 2.12% within one year, and 4.66% within two years. Risk factors for a second fracture in osteoporotic fracture patients included age (＞75years, HR=1.23, 95%CI 1.18-1.29; ＞85 years, HR=1.68, 95%CI 1.60-1.76), female sex (HR=1.36, 95%CI 1.32-1.40), prior vertebral fractures (HR=1.62, 95%CI 1.01-2.07), prior hip fractures (HR=1.27, 95%CI 0.89-2.42), BMD T-score＜-3.5(HR=1.38, 95%CI 1.17-1.72) and weakened motor skills (HR=1.27,95%CI 1.09-1.40).Conclusions: The risks of second fracture among patients with initial brittle fracture are substantial. There is adequate time between the first and second fractures for interventions to reduce the risks of refracture, especially for the old women with a vertebral or hip fracture. Medication,motor functional rehabilitation and fall-down prevention training are helpful.     

Incidence and risk factors for surgical site infection after open reduction and internal fixation of intra‐articular fractures of distal femur: A multicentre study

There remains a lack of data on the epidemiological characteristics of surgical site infection (SSI) following the open reduction and internal fixation (ORIF) of intra‐articular fractures of distal femur, and the aim of this study was to solve this key clinical issue. The electronic medical records (EMRs) of patients who underwent ORIF for distal femoral fracture from January 2013 to December 2017 were reviewed to identify those who developed a SSI. Then, we conducted univariate Chi‐square analyses and used a multivariate logistic regression analysis model to determine the adjusted risk factors associated with SSI. A total of 724 patients who underwent ORIF of intra‐articular fractures of the distal femur were studied retrospectively, and 29 patients had postoperative SSIs. The overall incidence of SSIs was 4.0% (29/724), with deep SSIs being 1.5% (11/724), and superficial SSIs being 2.5% (18/724). Staphylococcus aureus was the most common causative pathogen (8, 42.1%), followed by mixed bacterial pathogens (5, 26.3%). Open fracture, obesity, smoking, and diabetes mellitus were identified as the adjusted risk factors associated with SSIs. Although modification of these risk factors may be difficult, patients and families should be counselled regarding their increased risk of SSI because these patients potentially benefit from focused perioperative medical optimisation.     

Fragility fractures of the ankle in the elderly: Open reduction and internal fixation versus tibio-talo-calcaneal nailing: Short-term results of a prospective randomized-controlled study

IntroductionThe management of ankle fractures in the elderly remains unpredictable, secondary to their various co-morbidities. Although tibiotalocalcaneal (TTC) nailing has been an effective option for ankle arthrodesis due to ankle arthritis or Charcot arthropathy there are few reports regarding the use of TTC nail for the treatment of ankle fractures.PurposeAim of this study was to compare the results of ORIF versus TTC nailing for the treatment of unstable ankle fractures in the elderly. We hypothesized that the elderly may benefit from TTC nailing, as it allows the patient to be mobilized immediately after surgery and minimizes the risk of wound or bone problems.Patients and methodsThis was a prospective, randomized-controlled, comparative study. Between 2009 and 2015, 43 patients were treated with a TTC nail (Group A) and 44 with ORIF (Group B). The Olerud-Molander ankle score was obtained and intraoperative-postoperative complications, length of hospital stay, mobility status and reoperation rate were recorded. The nail fixation was performed with the TrigenR hindfoot nail after closed reduction. ORIF was performed, using a 1/3 tubular plate and 3.5 mm screws for the lateral malleolus and two 4.0 mm cannulated screws for the medial.ResultsMortality rate at one year was 13.9% for Group A and 18.1% for Group B. Mean follow-up was 14 months (12–18 m). There were no intraoperative complications. Three complications in Group A (8.1%) and twelve (33.3%) in Group B were encountered postoperatively (p < 0.05). There was significant shorter hospital stay in Group A (5.2 ± 3.1d) than in Group B (8.4 ± 5.2d). In Group A, 28 patients returned to their pre-injury mobility status (75.6%) while 9 declined one level of the mobility scale (24.3%). In Group B, 26 patients remained at the same mobility level (72.2%) and 10 declined one level (27.7%). There was no significant difference between the postoperative OMAS scores in the two Groups (56.9 ± 9.85 and 56.6 ± 9.3 respectively).ConclusionsWe believe that TTC nailing is a safe and effective method of treatment of unstable ankle fractures in the elderly because it has a low risk of complications and restores function and mobility allowing an immediate return to full weight-bearing.     

Incidence and risk factors of occult posterior malleolar fracture in patients with spiral distal tibial fracture: Reexamination and analysis

ObjectiveTo evaluate the incidence and risk factors for posterior malleolar fractures (PMFs) in patients with spiral distal tibial fractures (SDTFs).MethodsIn a retrospective study, 248 adults with SDTFs who underwent treatment were enrolled between November 2017 and May 2020. In a prospective study, we recruited 113 consecutive, skeletally mature patients with SDTFs who were identified from the trauma clinic of our hospital between June 2020 and May 2021. Radiographs and CT scans of the ankle region on the affected side were obtained to determine the presence of PMFs. If the CT scan was negative, additional MRI examination of the ankle was performed as a supplementary protocol in the prospective study. Univariate analysis and multivariate analysis were conducted to analyze the risk factors.ResultsIn the retrospective study, the incidence of PMFs associated with simple SDTFs was 74.0% (105/142), which was significantly lower than 90.8% (69/76) in the prospective study. Independent predictors of PMFs in patients with simple SDTFs identified by multivariate analysis in the retrospective study were age (OR = 1.07; P = 0.001) and external rotation of the proximal tibia (OR = 3.36; P = 0.027) and those in the prospective study were osteoporosis (OR = 0.04; P = 0.007) and spiral fibula fractures (OR = 16.05; P = 0.046).ConclusionThis study reexamined the high incidence of concurrent PMFs. Additionally, ankle radiographs and CT scans were recommended for all simple SDTF patients. For simple SDTF patients with negative CT scans, especially those caused by external rotation of the proximal tibia, combined with nonosteoporotic or spiral fibula fractures, additional MRI examinations are recommended.     

Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study

Surgical site infection (SSI) is a challenging complication after intertrochanteric fracture surgery but without a large‐sample size study to investigate the incidence and risk factors of it. The present study was to investigate the incidence and risk factors of SSI after intertrochanteric fracture surgery. A total of 1941 patients underwent intertrochanteric fracture surgery between October 2014 and December 2018 were included. Demographic data, surgical variables, and preoperative laboratory indexes were obtained from a prospective database and reviewed by hospital records. The optimum cut‐off value for quantitative data was detected by receiver operating characteristic analysis. The univariate analysis and multivariable analysis were conducted to analyse the risk factors. In total, 25 patients (1.3%) developed SSI, including 22(1.1%) superficial infection and 3(0.2%) deep infection. After adjustment of multiple variables, gender (odds ratio[OR] 2.64, P = .024), time to surgery>4 days (OR 2.41, P = .046), implant (intramedullary or extramedullary devices) (OR 2.96, P = .036), ALB<35 g/L (OR 2.88, P = .031) remained significant factors. In conclusion, the incidence of SSI after intertrochanteric fractures surgery was 1.3%, with 1.1% for superficial and 0.2% for deep infection. Gender, time to surgery>4 days, the implant (intramedullary or extramedullary devices), and ALB<35 g/L were independent risk factors for the rate of SSI.     

Femoral neck fracture following ipsilateral total knee replacement: an analysis of associations and risk factors

There have been case reports of ipsilateral femoral neck fracture after total knee replacement. This occurrence has been attributed to risk factors such as rheumatoid arthritis, osteoporosis, steroid use and poor mobility. The aim of this study was to see if total knee replacement is a risk factor for neck of femur fracture and to study the associated risk factors. Twenty two patients who had sustained subsequent ipsilateral femoral neck fracture were identified from 1,362 patients who had previously undergone a posterior cruciate ligament-substituting total knee replacement. Clinical chart review and radiological assessment were performed. The average age of the patients was 77(±7) years and the fracture occurred 35(±27) months following the total knee replacement. Positive associations were identified between ipsilateral neck of femur fracture and total knee replacement (P < 0.01), age (P < 0.01), female sex (P < 0.025) and rheumatoid arthritis (P < 0.05). We did not find an association between ipsilateral neck of femur fracture following total knee replacement and preoperative knee deformity (P > 0.5). We also observed an increased risk of supracondylar fracture of the ipsilateral femur in patients who had sustained a neck of femur fracture following total knee replacement (P < 0.001).     

Potentially modifiable risk factors for atrial fibrillation following lung resection surgery: a retrospective cohort study

Atrial fibrillation is the most frequent arrhythmia after thoracic surgery and is associated with increased hospital costs, morbidity and mortality. In this study, we aimed to identify potentially modifiable risk factors for postoperative atrial fibrillation following lung resection surgery and to suggest possible measures to reduce risk. We retrospectively reviewed the medical records of 4731 patients who underwent lobectomy or more major lung resection over a 6‐year period. Patients who developed atrial fibrillation postoperatively and required treatment were included in the postoperative atrial fibrillation group, while the remaining patients were assigned to the non‐postoperative atrial fibrillation group. Risk factors for postoperative atrial fibrillation were analysed by multivariate analysis and propensity score matching. Overall, 12% of patients developed postoperative atrial fibrillation. Potentially modifiable risk factors for postoperative atrial fibrillation were excessive alcohol consumption (odds ratio (OR) = 1.48, 95% CI 1.08–2.02, p = 0.0140), red cell transfusion (2.70(2.13–3.43), p < 0.0001), use of inotropes (1.81(1.42–2.31), p < 0.0001) and open (vs. thoracoscopic) surgery (1.59(1.23–2.05), p < 0.0001). Compared with inotrope use, vasopressor administration was not related to postoperative atrial fibrillation. Use of steroids or thoracic epidural anaesthesia did not reduce the incidence of postoperative atrial fibrillation. We conclude that high alcohol consumption, red cell transfusion, use of inotropes and open surgery are potentially modifiable risk factors for postoperative atrial fibrillation. Pre‐operative alcohol consumption needs to be addressed. Avoiding red cell transfusion and performing lung resection via video‐assisted thoracoscopic surgery may reduce the incidence of postoperative atrial fibrillation and the administration of vasopressors rather than inotropes is preferred.     

老年髋部骨折手术疗效的危险因素分析

目的探讨影响老年髋部骨折手术疗效的相关危险因素。 方法回顾性分析2006年1月至2008年1月采用手术治疗且获得随访的127例髋部骨折患者（年龄≥75岁）资料,以术后1年死亡情况和独立生活能力恢复情况作为评定手术疗效的指标,统计可能对疗效产生影响的因素。 结果患者年龄、性别、骨折类型、心脏疾病、慢性呼吸系统疾病、合...     

Pilon骨折手术部位感染的危险因素分析

目的：探讨Pilon骨折手术部位感染的相关危险因素.方法：从创伤骨科资料室收集自2006年1月至2012年12月共561例采用切开复位钢板接骨术治疗的Pilon骨折,感染组33例,男23例,女10例,年龄21～69岁,平均（45.50±4.40）岁;非感染组528例,男296例,女232例,年龄16～76岁,平均（43.50±7.19）岁.年龄、性别、吸烟、糖尿病、饮酒、开放性骨折、骨筋膜室综合征及手术时间纳入可能的危险因素作为研究对象,统计学方法先采用单变量分析,有显著意义的危险因素再采用多变量的Logistic回归分析.结果：Pilon骨折手术部位感染率为5.88％,单变量分析发现感染组与非感染组之间的手术时间、开放性骨折以及骨筋膜室综合征差异有统计学意义,而多变量的Logistic回归分析却发现仅手术时间与手术部位感染显著相关（P=0.005,OR=44.92）.结论：手术时间是Pilon骨折切开复位钢板接骨术后手术部位感染的独立预测指标,而开放性骨折和骨筋膜综合征虽能增加手术部位感染率,却不是Pilon骨折切开复位钢板接骨术后手术部位感染的独立预测指标.     

手法整复与手术治疗老年人踝关节旋后外旋IV型骨折

目的比较老年人踝关节旋后外旋IV型骨折的手法整复与手术治疗效果。 方法回顾性分析青海省人民医院于2016年2月至2017年6月收治的老年踝关节旋后外旋IV型骨折患者,按照纳入排除标准,共有54纳入本研究,手法整复组21人,手术治疗组33人。评估两组治疗后12个月的Mazur踝关节症状与功能评价分级、Leeds影像学评价分级。采用秩和检验比较两组之间的差异。 结果治疗后12个月,两组的Mazur踝关节症状与功能评价分级差异无明显统计学意义(Z＝－0.496,P>0.05);手术治疗组的Leeds影像学评价分级明显优于手法整复组,差异具有统计学意义(Z＝－3.641,P<0.01)。 结论手法整复与手术治疗老年人踝关节旋后外旋IV型骨折,在治疗后12个月均可获得满意的踝关节症状及功能改善,但手法整复组的影像学复查结果差于手术治疗组。     

老年髋部骨折术后健侧骨折的危险因素分析

目的: 探讨老年髋部骨折术后健侧骨折的发生率及其相关危险因素为预防再次骨折提供依据。方法: 回顾分析2012年6月至2017年6月接受髋关节置换术或股骨近端髓内钉固定术治疗的65岁以上股骨颈骨折或转子间骨折452例患者的临床资料,男168例,女284例;年龄65~97(75.5±7.5)岁;股骨颈骨折191例,股骨转子间骨折261例;按照术后健侧髋部是否存在骨折,分为骨折组和无骨折组,记录两组患者性别、年龄、体质量指数、骨折类型、初次治疗方式、骨密度、医疗依从性、术后是否短期谵妄、伤前是否并存内科疾病及末次随访髋关节Harris评分。应用单因素Logostic回归分析筛选出术后健侧骨折的危险因素,再将有统计学意义的危险因素纳入多因素Logostic回归分析,筛选出老年髋部骨折术后健侧骨折的独立危险因素。结果: 452例患者中42例发生健侧髋部骨折,发生率为9.3%,两次骨折发生相隔时间平均(2.9±2.1)年。单因素Logistic回归分析结果示年龄、骨密度、医疗依从性、术后短期谵妄、伤前合并内科疾病及末次随访髋关节Harris评分差异均有统计学意义(P<0.05)。多因素Logistic分析显示年龄(OR=4.227)、骨密度(OR=4.313)、合并内科疾病(OR=5.616),以及末次随访髋关节Harris评分分级低(OR=3.891),是老年髋部骨折术后健侧骨折的独立危险因素(P<0.05)。结论: 年龄、骨密度、合并内科疾病以及末次随访髋关节Harris评分分级低是老年髋部骨折术后健侧骨折的主要危险因素,术后3年内要加强内科疾病的治疗,抗骨质疏松,改善髋关节功能,以预防健侧髋部骨折的发生。     

老年股骨转子间骨折术后一年死亡率及其危险因素分析

目的 总结老年股骨转子间骨折患者术后1年的死亡率,并探讨与死亡相关的危险因素.方法 回顾性分析2005年8月至2011年8月杭州地区6家医院经手术治疗且获得随访的1854例老年股骨转子间骨折患者资料,男705例,女1149例;年龄65 ～98岁,平均79.4岁.统计患者术后1年内的死亡率及主要死亡原因,并应用logistic回归模型分析与术后1年死亡相关的危险因素. 结果 术后1年内共有297例患者死亡,死亡率为16.0％ (297/1854).主要死亡原因包括感染93例,心脏疾患38例,神经系统疾患53例,肿瘤63例.Logistic回归分析结果显示:患者年龄[OR=5.053,95％CI(1.517,16.829),P=0.000]、性别[OR=0.376,95％ CI (0.122,1.161),P=0.002]、术前内科合并症[OR =3.236,95％CI (1.553,6.746),P=0.001]、美国麻醉医师协会(ASA)分级[OR=6.057,95％CI (1.968,18.641),P=0.000]、受伤至手术时间[OR=1.928,95％CI(0.979,3.796),P=0.009]和住院时间[OR=3.875,95％CI(0.368,6.542),P=0.001]是术后1年死亡的独立危险因素. 结论 年龄、性别、术前内科合并症、ASA分级、受伤至手术时间及住院时间为老年股骨转子间骨折患者术后1年死亡的独立危险因素.     

Risk factors for total ankle arthroplasty failure: A Dutch Arthroplasty Register study

BackgroundStudies concerning total ankle arthroplasty could be influenced by several forms of bias. Independent national arthroplasty registries represent objective data on survival and patient reported outcomes. The aim of this study was to determine survival and identify risk factors for early failure in a nationwide series of total ankle arthroplasties from the Dutch Arthroplasty Register (LROI).Patients and methodsData of 810 patients, who received 836 total ankle arthroplasties between 2014 and 2020 were obtained from the Dutch Arthroplasty Register (LROI) with a median follow-up of 38 months (range 1–84 months). Survival was expressed in Kaplan-Meier analysis and associated hazard ratios for implant failure were determined. Implant failure was defined as the need for revision surgery for any reason or (pan)arthrodesis.ResultsDuring follow-up, we recorded 39 failures (4.7%) resulting in a implant survival of 95.3% with a median follow-up of 38 months (range 1–84 months). Medial malleolus osteotomy (HR = 2.27), previous surgery (HR = 1.83), previous osteotomy (HR = 2.82) and previous ligament reconstruction (HR = 2.83) all showed potentially clinically meaningful associations with a higher incidence of implant failure, yet only previous OCD treatment (HR = 6.21), BMI (HR = 1.09) and age (HR = 0.71) were statistically significant.InterpretationExcellent short-term survival (95.3%) with a median follow-up of 38 months was reported for TAA patients from the Dutch Arthroplasty Register. Patients with a lower age, a higher BMI or who had a prior surgical OCD treatment before TAA surgery appear to have a higher risk for revision after short-term clinical follow-up. Thorough patient selection with emphasis on risk factors associated with early implant failure might be essential to improve TAA survivorship.     

螺钉内固定治疗踝部骨折68例

踝部骨折的内固定方法很多 ,以往我们采用过克氏针、张力带钢丝、螺钉及钢板等内固定。从 1998年 8月起我们开始单用松质骨螺钉固定骨折 ,取得了良好的治疗效果。1　临床资料自 1998年 8月 - 2 0 0 1年 5月手术治疗 68例 74侧踝部骨折 ,其中单侧 62例 ,双侧 6例 ;男 4 5例 ,女2 3例 ;年龄 17～ 63岁 ,平均 31 5岁。致伤原因 :车祸伤 2 6例 ,坠落伤 17例 ,砸伤 11例 ,扭伤 14例。按Ｄａｎｉｓ Ｗｅｂｅｒ分类法 :Ａ型 9例 ,Ｂ型 32例 ,Ｃ型 2 7例。2　手术方法对手法复位不佳的Ａ、Ｂ型骨折采用松质骨螺钉固定 ,术中应注意恢复外踝的生理外倾…