Incidence of complex regional pain syndrome type I after fractures of the distal radius.

Aim of this study was to analyse the incidence CRPS-I after a fracture of the distal radius and to analyse risk factors. Patients who visited the Emergency Unit of the University Hospital, with a fracture of distal radius were asked to participate. As risk factors for CRPS-I, number of repositions (with or without local anaesthesia), additional cast changes and pain during the cast period, were assessed. In a structured interview social life events (SLEs) and psychological and/or psychiatric history were assessed. The patients filled out the Symptom Checklist-90 (SCL-90). In total 88 patients participated in the study. One female (1%, 95% CI: 0.2 to 6%), age 69 years with the following characteristics developed CRPS-I: one set of local anaesthetics, one repositioning attempt, no additional cast changes, average pain scores, no life events and her total score on the SCL-90 of 117, was slightly above average. Based on the results of this study it is concluded that the incidence of CRPS-I may be low (1%, 95% CI: 0.2 to 6%) after fractures of the distal radius. Further the risk factors described in literature play a minor role in the development of CRPS-I.     

Simultaneous distal radius and hip fractures in elderly patients--implications to rehabilitation

Purpose : The reasons for fractures in the elderly patients are multifactorial. Osteoporosis is considered to be the main pathology. Other reasons are the increase in fall frequency and the protective response to trauma. The most common sites at which these fractures occur are the hip, vertebra and distal radius. A combination of these is uncommon.

Methods : All patients who were treated between January 1990 and December 2000 with a combination of distal radius and hip fractures and were older than 65-years were retrospectively evaluated. The following parameters were evaluated: age; sex; pre fall function; use of drugs; chronic and acute comorbidity; circumstance of the fall; hospitalization length of stay; treatment procedure; complications; and post-hospitalization rehabilitation.

Results : Forty-six patients met the study's criteria. Group I consisted of 16 patients between 65-80 years, and group II consisted of the remaining 30 patients older than 80 years. All patients suffered low energy trauma. Ten out of the 16 patients in group I, and eight out of the 30 patients in group II were totally independent, while the remaining patients needed some help with activity of daily living (ADL). In all patients the simultaneous fractures were ipsilaterally. For 45 patients hospital stay ranged from 5-23 days. Twenty-eight patients were transferred to a geriatric rehabilitation centre. Twenty-six of them returned to their previous ADL after a period of 60 days on average. Among the 18 remaining patients, 11 gained full recovery (6 from group I and 5 from group II) and seven patients (5 from group II) had a slight reduction in ADL.

Conclusions : A combination of these fractures is probably more traumatic and occurs in the higher-age group. It is always located in the ipsilateral side. The double trauma represents a better pre-morbid condition relative to patients in the same age group, and thus it may serve as a prognostic indicator for success in rehabilitation.     

Good functional recovery after bilateral elbow dislocation associated with bilateral distal radius and ulna fractures

Bilateral elbow dislocation associated with bilateral distal forearm fractures is extremely rare, therefore its optimal treatment, complications, and outcomes remain unclear. We present an illustrative case with a 2‐year follow up of a patient who sustained a complex injury of the upper extremity and underwent combined surgical and conservative treatment.     

掌侧与背侧入路钢板置入固定修复桡骨远端骨折并发症的Meta分析

背景：掌背侧入路钢板置入固定修复桡骨远端骨折是临床常用的钢板置入固定形式,其固定后并发症是否存在差异目前尚有争议。目的：比较掌侧入路与背侧入路钢板置入固定修复桡骨远端骨折并发症的差异。方法：计算机检索PubMed数据库以及手工检索相关文献的参考文献,所有检索截止至2012年8月25日。收集国内外公开发表的有关掌背侧入路钢板置入固定治疗桡骨远端骨折并发症比较的临床对照试验,采用STATA 11.0统计学软件进行数据分析,同时使用RevMan 5.2软件对其进行meta分析。结果与结论：纳入meta分析的研究共12个,累计952例患者。结果显示,两种入路钢板置入固定后并发症的总体发生率差异无显著性意义,掌侧入路置入钢板置入固定比背侧入路置入钢板固易发生神经病变[相对危险度=2.19,95%置信区间：1.27-3.76,P〈0.05]与腕管综合征[相对危险度=4.56,95%置信区间（1.02-20.44）,P〈0.05],较少发生肌腱刺激症[相对危险度=0.38,95%置信区间（0.17-0.86）,P〈0.05]。结果说明,与掌侧入路钢板置入相比,背侧入路钢板置入固定后并发神经病变与腕管综合征的概率较低,而肌腱刺激症则较高,而其他并发症两者无显著差异。     

Towards optimization of volar plate fixations of distal radius fractures: Using finite element analyses to reduce the number of screws

BackgroundUsing fewer distal screws in volar plate fixation of distal radius fractures could reduce treatment costs and complications. However, there is currently no consensus on the ideal screw configuration, likely due to experimental limitations and its subject-specific nature. In this study, finite element analysis was used to investigate (1) if reducing the number of screws is biomechanically feasible and (2) if an optimal screw configuration is subject-specific.MethodsValidated subject-specific finite element models of 16 human radii with extra articular distal radius fractures and volar plate fixation with six distal screws were used as a baseline. 41 additional configurations with three to six distal screws were simulated for each subject. Axial stiffness and peri-implant strains around the distal screws were evaluated. Subject-specific optimum configurations were determined using a lower bound for the axial stiffness and minimizing peri-implant strains.FindingsEven using three distal screws led to only minor deterioration of the biomechanical properties in the best configuration (axial stiffness: −11.2%, peri-implant strains: −35.0%), but a considerable deterioration in the worst configuration (axial stiffness: −46.2%, peri-implant strains: +112.4%). The optimization showed that the ideal screw configuration is subject-specific and on average 1.9 screws could be saved based on the herein used optimization criterion.InterpretationThis study highlights that not only how many, but which screws are used in volar plate fixation of distal radius fractures is critical. Using a patient-specific selection of distal screws bears potential to save costs and reduce complications.     

Pulmonary thromboembolism after distal ulna and radius fractures surgery: A case report and a literature review

BACKGROUNDPulmonary thromboembolism (PTE) is a serious postoperative complication that can occur after a fracture. Generally, PTE is caused by the falling off of lower extremity deep vein thrombosis (LEDVT) after lower limb fracture surgery. LEDVT and PTE after upper extremity fracture surgery are very rare. PTE is one of the most common clinical causes of sudden death. Venous thromboembolism includes PTE and DVT. We experienced one case of LEDVT and PTE after distal ulna and radius fracture surgery. The purpose of our report is to raise awareness for orthopedic surgeons that PTE can occur after distal ulna and radius fracture surgery, and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.CASE SUMMARYWe report a 51-year-old Chinese male who had severe fractures of the left distal ulna, radius and little finger after a motorcycle accident. The patient underwent external fixation, open reduction and internal fixation. On the third post-operative day, computed tomographic pulmonary angiography showed PTE. Doppler ultrasonography showed thrombus formation in the bilateral posterior tibial veins. After a period of anticoagulation therapy, on the 25^th d after the PTE, computed tomographic pulmonary angiography showed that thrombus in both sides of the pulmonary artery disappeared. Furthermore, about 4 mo after the PTE, thrombosis in the deep veins of the lower limbs disappeared. About 1 year after the surgery, X-rays showed good fracture healing, and the function of the wrist joint recovered well.CONCLUSIONThough rare, PTE can occur after distal ulna and radius fracture surgery and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.     

Relaxation and music reduce pain after gynecologic surgery.

The purpose of this randomized controlled trial was to investigate the effect of three nonpharmacologic nursing interventions: relaxation, music, and the combination of relaxation and music on pain following gynecologic (GYN) surgery. A total of 311 patients, ages 18 to 70, from five Midwestern hospitals, were randomly assigned using minimization to either three intervention groups or a control group and were tested during ambulation and rest on postoperative days 1 and 2. Pain sensation and distress were measured using visual analogue scales. Multivariate analysis of covariance of posttest sensation and distress was used with pretest control and a priori contrasts. The intervention groups had significantly less posttest pain than the control group (p =.022-.001) on both days. The three interventions were similar in their effect on pain. Patients who received the interventions plus patient-controlled analgesia (PCA) had 9% to 29% less pain than controls who used PCA alone. Reduced pain was related to amount of activity (ambulation or rest), mastery of the use of the intervention, and decreased pulse and respiration. Those who slept well had less pain the following day. Nurses who care for GYN surgical patients can provide soft music and relaxation tapes and instruct patients to use them during postoperative ambulation and also at rest on days 1 and 2.     

Effect of pulsed electromagnetic field on nonspecific low back pain patients: a randomized controlled trial

BackgroundFurther research on pulsed electromagnetic field (PEMF) effects on the different conditions of low back pain was warranted due to lack of studies in this area.ObjectivesTo investigate the effects of pulsed electromagnetic field therapy with 50 Hz frequency, with low intensity of 20 Gauss compared to conventional non-invasive treatment modalities in patients with chronic non-specific low back pain.MethodsDesign – A prospective, randomized, patient-blinded, controlled trial. Setting – The study was conducted at Outpatient Physiotherapy Clinic in Cairo, Egypt. The study was conducted between May 2015 and September 2016. Participants – Fifty participants with non-specific low back pain enrolled into experimental and control groups. Interventions – The experimental group received the Conventional physical therapy Protocol as well as magnetic field, while the control group received the same Conventional physical therapy and sham electromagnetic field. Both groups received 12 sessions over 4 weeks’ period. Outcome measures – Primary outcome measures was pain intensity while the secondary outcome measures were disability and lumbar range of motion – ROM. There were no adverse events occurred during the study.ResultsFifty participants with non-specific low back pain (control group n = 25; experimental group n = 25) were randomized. There were significant between-group differences in pain scores (mean difference – MD 1.52; 95%CI −0.34 to 3.35), function disability (MD 8.14; 95%CI 6.5 to 9.96), Range of Motion (ROM) of lumbar flexion (MD −1.27; 95%CI −1.09 to −1.45), ROM of lumbar extension (MD −1.1; 95%CI −0.97 to −1.23), ROM of lumbar right side bending (MD 8.2; 95%CI 6.56 to 9.84) and ROM of lumbar left side bending (MD 10.4; 95%CI 8.81 to 11.99) in favour of the experimental group.ConclusionAdding pulsed electromagnetic field to Conventional physical therapy Protocol yields superior clinical improvement in pain, functional disability, and lumbar ROM in patients with non-specific low back pain than Conventional physical therapy alone.     

桡骨远端骨折疗效的评估及影响疗效的因素研究进展

目前国际上对于桡骨远端骨折疗效的评估没有统一的金标准,疗效的客观评估也不能全面反映患者的主观满意程度。同时在临床中存在着诸多影响疗效的评估的因素。针对目前存在有关于桡骨远端骨折疗效评估标准及影响疗效因素的争议,该文对评估标准及各种影响疗效的因素进行了综述分析,以期为临床同道提供参考。     

高压氧治疗减轻肢体撕脱伤肿胀、疼痛效果的临床分析

Background: In recent years, most major avulsion of limb skin were caused by traffic accidents, industry accidents and mechanical traumas, the tissue damage, the operational elimination of subcutaneous fat or skin flap transfer may cause ischemia and hypoxia at the wound, the limb swelling and pain were obvious, the routine treatment was slow and of long recovering time. Objective: To discuss the effects of hyperbaric oxygen to reduce the swelling and pain caused by limb avulsion. Unit: The People's Hospital of Sanshui.     

脉冲电磁场对成骨和破骨代谢的影响

背景:脉冲电磁场对成骨细胞、破骨细胞、骨基质合成均有明显作用。目的:旨在探究脉冲电磁场在成骨和破骨代谢中的作用以及治疗骨质疏松的机制,以促进其临床应用。方法:由第一作者应用计算机检索PubMed、中国期刊全文数据库(CNKI)、维普数据库和万方数据库1997-05/2011-08相关文献。在标题、摘要、关键词中以"pulsed electromagnetic field(PEMFs),bone metabolism,osteoporosis,osteoblast,osteoclast,bone marrow mesenchymal stem cells(BMMSCs)"或"脉冲电磁场,骨代谢,骨质疏松,成骨细胞,破骨细胞,骨髓间充质干细胞"为检索词进行检索。选择文章内容与脉冲电磁场有关者,同一领域文献则选择近期发表在权威杂志文章进行分析。结果与结论:初检得到389篇文献,根据纳入标准选择关于假体无菌性松动分析及处理的46篇文献进行综述。脉冲电磁场可促进成骨代谢,抑制破骨代谢,参与调节转化生长因子β,白细胞介素6等骨代谢相关的细胞因子,促进骨基质形成,改善骨生长微环境,对骨髓间充质干细胞的增殖分化亦有促进作用。推测脉冲电磁场治疗骨质疏松及其并发症有重要的临床价值。     

脉冲电磁场对成骨和破骨代谢的影响

背景：脉冲电磁场对成骨细胞、破骨细胞、骨基质合成均有明显作用。目的：旨在探究脉冲电磁场在成骨和破骨代谢中的作用以及治疗骨质疏松的机制,以促进其临床应用。方法：由第一作者应用计算机检索PubMed、中国期刊全文数据库（CNKI）、维普数据库和万方数据库1997-05/2011-08相关文献。在标题、摘要、关键词中以＂pulsed electromagnetic field（PEMFs）,bone metabolism,osteoporosis,osteoblast,osteoclast,bone marrow mesenchymal stem cells（BMMSCs）＂或＂脉冲电磁场,骨代谢,骨质疏松,成骨细胞,破骨细胞,骨髓间充质干细胞＂为检索词进行检索。选择文章内容与脉冲电磁场有关者,同一领域文献则选择近期发表在权威杂志文章进行分析。结果与结论：初检得到389篇文献,根据纳入标准选择关于假体无菌性松动分析及处理的46篇文献进行综述。脉冲电磁场可促进成骨代谢,抑制破骨代谢,参与调节转化生长因子β,白细胞介素6等骨代谢相关的细胞因子,促进骨基质形成,改善骨生长微环境,对骨髓间充质干细胞的增殖分化亦有促进作用。推测脉冲电磁场治疗骨质疏松及其并发症有重要的临床价值。     

Analysis of risk factors associated with flexor pollicis longus injury after volar plating of distal radius fractures

ObjectiveThis study was performed to analyze the risk factors associated with flexor pollicis longus (FPL) attrition or rupture after volar plating of distal radius fractures.MethodsThree hundred thirty-eight patients with distal radius fractures were included in this retrospective study. Univariate analysis and multivariate logistic regression analysis were performed to predict risk factors.ResultsUnivariate analysis showed that sex, volar tilt, the Soong grade, the plate-to-critical line distance (PCLD), the plate-to-volar rim distance (PVRD), and the time of plate removal were significantly associated with FPL attrition or rupture. Multivariate logistic regression analysis demonstrated that decreased volar tilt, Soong grade 2, PCLD of >2 mm, PVRD of <3 mm, and plate removal at ≥1 year were the risk factors significantly associated with FPL attrition or rupture.ConclusionsReduced volar tilt, Soong grade 2, PCLD of >2 mm, and PVRD of <3 mm appear to be risk factors that are significantly associated with FPL attrition or rupture. The findings of this study also suggest that the risk of tendon rupture is lower if a Soong grade 2 plate is removed, the PCLD is >2 mm, the PVRD is <3 mm, or reduced volar tilt is achieved earlier (at <1 year).     

Clinical effect analysis of hyperbaric oxygen to reduce the swelling and pain caused by limb avulsion

Background：Inrecentyears,mostmajoravulsionoflimbskinwerecausedbytrafficaccidents,industryaccidentsandme－chanicaltraumas,thetissuedamage,theoperationaleliminationofsubcutaneousfatorskinflaptransfermaycauseischemiaandhy－poxiaatthewound,thelimbswellingandpainwereobvious,theroutinetreatmentwasslowandoflongrecoveringtime．Objective：Todiscusstheeffectsofhyperbaricoxygentore－ducetheswellingandpaincausedbylimbavulsion．Unit：ThePeople＇sHospitalofSanshui．Subject：Therewere３２casesinthe…     

Management of scrotal swelling after pelvic and acetabular fractures

Complex pelvic and acetabular fractures are usually associated with high-energy trauma and often present with substantial perineal soft tissue swelling. This is the result of the significant haemorrhage that develops into the retroperitoneal space, which dissects along fascial planes to extend into the scrotum. Other factors that could contribute to the progression of the soft tissue swelling include the extensive approaches used for surgical stabilization of the fractures, the prolonged traction using a perineal post and the early typical catabolic responses after major trauma. This article describes a successful protocol for the management of scrotal swelling associated with complex pelvic and acetabular fractures. Rapid reduction of the swelling in the scrotal region prevents the onset of perineal wound slough. It also minimizes the risk of infection in case of skin breakdown by isolation from the perianal region. Furthermore, it precludes friction of the scrotum with the skin of the thigh, thus allowing adequate pain relief and faster rehabilitation.