Treatment of open fractures in seafarers.

322 cases of closed fracture and 69 cases of open fracture in Russian seafarers injured on ships were treated. Most of open fracture cases occurred among engine room crew members. This type of injury occurred more frequently among young and inexperienced seamen than among those with long period of service at sea. In 52% there were open fractures of wrist, and in 16% skull fractures. Methods of treatment were discussed.     

Management of fragility fractures in India

Osteoporosis and fragility fractures have become a major healthcare challenge globally in the recent years. However, this problem has only recently been accorded its due importance in developing countries such as India. India is a model case study for the management of osteoporosis and fragility fractures in a resource-limited setting, as it harbors a large geriatric population and has the highest prevalence of osteopenia globally. It is imperative to identify the myriad factors contributing to poor bone health and understand the many hurdles encountered to tackle this healthcare problem in a developing country. Innovative methods for managing fragility fractures are commonly seen. Collaborative multidisciplinary care and structured, evidence-based management has finally found its place in India with the establishment of a regional fragility fracture network. This chapter outlines the current status of management of fragility fractures in India by focusing on the disease burden, hurdles, innovative treatment methods, and the challenges lying ahead.     

Management of sternal fractures: 239 cases

A review of the management of 239 patients with sternal fractures in a busy trauma center between October 1989 and May 2000 was undertaken to determine the incidence, significance, morbidity, and mortality of this injury. There were 140 men and 99 women with a mean age of 50.3 years (range, 15 to 93 years). Sternal fractures accounted for 8% of admissions for thoracic trauma. The causes were motor vehicle collisions in 215 patients (90%) and falls or direct blows in 24 (10%). Only 64 of 204 car accident patients (31%), 28 men and 36 women, were restrained by seat belts. Complications developed in 13 patients (5.4%). Mortality rate was 0.8%. Mean length of stay in the ward was 6.4 days (range, 1 to 32 days). Four patients (1.7%) underwent surgery. The results show that isolated sternal fractures have low associated morbidity and mortality. Admission is justified for the management of pain and treatment of cardiac complications and concomitant injuries.     

开放性下肢长骨骨折并发肺血栓栓塞临床分析简

目的 探讨开放性下肢长骨骨折并发肺血栓栓塞临床特点及干预效果.方法 选取110例开放性下肢长骨骨折手术患者,对其术后是否发生下肢静脉血栓形成的两组患者的临床资料进行分析.结果 开放性不同长骨骨折静脉血栓形成与患者的年龄、性别、合并糖尿病、体重指数偏高、血脂异常、受伤程度评分、卧床时间长等有关（P〈0.05）.结论 年龄、高血压病、糖尿病、血脂异常是开放性长骨骨折并发肺血栓栓塞的危险因素,而加强干预则有助于降低肺血栓栓塞的发生.     

Diversity of coryneforms found in infections following prosthetic joint insertion and open fractures

Summary In a 5-year period, 73 coryneform isolates from prosthetic joint and open fracture infections in 60 patients treated in a hospital specialized in orthopedic surgery were speciated. The most frequent species wereCorynebacterium amycolatum, Corynebacterium striatum, Corynebacterium diphtheriae biotypemitis, andCorynebacterium jeikeium. At least 14 isolates were deemed clinically significant as sole agents of infection.     

开放性骨折伤口感染创面细菌学观察及耐药性研究

目的探讨开放性骨折患者手术后伤口的细菌学特点及对抗生素的耐药性分析。方法为回顾性病例分析,本院2010年2月-2013年2月收治的开放性骨折手术后伤口感染患者152例,取伤口分泌物,做细菌学检查及药敏试验,分析不同细菌对抗生素的耐药情况。结果开放性伤口创面感染的细菌以G-杆菌为主,占51.45%,其中铜绿假单胞细菌占19.67%;G+球菌中以金黄色葡萄球菌为主,占19.32%,不同细菌对青霉素的耐药率较高,G+球菌对万古霉素敏感性最高,万古霉素为100%,即未发现耐药菌株;G-杆菌中大肠埃希菌菌数比例最高,13.5%,其对青霉素的耐药率为87.6%,对亚胺培南敏感性最高,为97.4%。结论开放性骨折患者手术伤口感染的细菌以G-杆菌多见,该组菌对万古霉素及亚胺培南均敏感。但不同种类的细菌其致病毒理有所变化,应结合临床经验,根据不同细菌学特点和药敏试验结果制定外伤后及术前、术中、术后的抗生素应用方案,并加强对患者伤口的护理,以控制或减少开放性骨折手术后伤口感染的发生。     

External fixators for open fractures of tibia and fibula in patients with haemophilia A

To evaluate the efficacy of external fixators(EFs) for management of open fractures of tibia and fibula in patients with haemophilia A. EFs are commonly used in the clinical management of infec‐ted or open fractures when internal fixation is contraindicated and plaster immobilization is inadequate. However, EFs have not been frequently used for these indications in haemophilic patients for fear of pin tract infection and bleeding. This is a retrospective therapeutic study. We describe the use of EF (Orthofix uniplanar fixators) in five patients (mean age: 31.4 years; range: 10–52) with haemophilia A suffering from open fracture of tibia and fibula (Gustilo classification ranging from II to IIIA). The average time to union was 23 weeks (range: 18–30 weeks). Much lower levels were subsequently maintained till wound healing. The average total factor consumption was 358.30 IU kg^?1 (range: 272–421 IU kg^?1), administered over a period of 14.2 days (range 9–21). There were no major complications related to EF. In summary, EFs can be used safely and effectively in management of open fractures of tibia and fibula in patients with haemophilia A.     

切开复位内固定治疗肋骨骨折25例的体会

目的了解肋骨骨折切开内固定手术治疗的效果。方法对25例肋骨骨折患者行肋骨切开复位和爪形肋骨接骨板内固定,判断其疗效。结果术后胸廓牢固稳定,肋骨断端错位、胸廓塌陷等畸形得到矫正,患者疼痛缓解,肺功能恢复正常,疗效满意。结论采用爪形肋骨接骨板对错位严重的部分肋骨骨折进行切开复位内固定是一种有效的方法。     

切开复位与闭合复位治疗老年桡骨远端骨折疗效比较

目的探讨切开复位与闭合复位治疗老年桡骨远端骨折的临床效果。方法以随机数字表法将66例老年桡骨远端骨折患者分为切开复位组(33例)与闭合复位组(33例),切开复位组予切开复位内固定治疗,闭合复位组予闭合复位石膏(夹板)外固定治疗。观察两组患者的骨折愈合情况、腕关节恢复与功能情况。结果切开复位组和闭合复位组骨折愈合时间分别为(11.2±2.3)周和(10.8±2.1)周,两组比较差异无统计学意义(P0.05)。切开复位组患者的掌倾角、尺偏角、桡骨恢复情况以及腕关节功能评价情况均优于闭合复位组。结论对于老年桡骨远端骨折,采用切开复位内固定治疗,能可靠恢复桡骨长度,可早期功能锻炼,缩短康复时间,获得理想的复位质量和疗效。     

Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study.

OBJECTIVE: To assess the efficacy and safety of percutaneous vertebroplasty in osteoporotic vertebral compression fractures responsible for severe and persistent pain. METHODS: Sixteen patients were included in this open prospective study. Inclusion criteria were: one or 2 vertebral fractures responsible for severe pain, i.e., higher than 50 mm on a visual analog scale (VAS: 0-100 mm), scores 3, 4 or 5 according to the McGill-Melzack scoring system, and evolving for more than 3 months. Assessment criteria were the changes over time (Days 3, 30, 90, 180) in VAS and McGill-Melzack scoring system. The changes over time in a generic health status instrument score [the Nottingham Health Profile (NHP)] were also assessed. Statistical comparisons were performed using the Wilcoxon T test. RESULTS: There were 9 women and 7 men: postmenopausal osteoporosis (n = 7), corticosteroid induced osteoporosis (n = 2), and male osteoporosis (n = 7). Vertebroplasty was performed in 20 vertebrae. A statistically significant decrease of both VAS (-53%, p < 0.0005) and McGill-Melzack scoring system (p < 0.005) was observed at Day 3. The results were also significant at Days 30, 90, and 180 for both scales (p < 0.005 and p < 0.01, respectively). A significant decrease over time for 5/6 dimensions of the NHP score was also noted: pain (p < 0.01), physical mobility (p < 0.05), emotional reactions (p < 0.05), social isolation (p < 0.05), and energy (p < 0.05). We observed no adverse event, and no vertebral fracture has occurred after 6 months of followup. CONCLUSION: Percutaneous vertebroplasty is a useful and safe procedure for treating persistent painful osteoporotic fractures. Controlled studies with longterm followup are required.     

Management of fragility fractures in Switzerland: results of a nationwide survey

A nationwide survey was conducted in Switzerland to assess the quality level of osteoporosis management in patients aged 50 years or older presenting with a fragility fracture to the emergency ward of the participating hospitals. Eight centres recruited 4966 consecutive patients who presented with one or more fractures between 2004 and 2006. Of these, 3667 (2797 women, 73.8 years old and 870 men, 73.0 years old in average) were considered as having a fragility fracture and included in the survey. Included patients presented with a fracture of the upper limbs (30.7%), lower limbs (26.4%), axial skeleton (19.5%) or another localisation, including malleolar fractures (23.4%). Thirty-two percent reported one or more previous fractures during adulthood. Of the 2941 (80.2%) hospitalised women and men, only half returned home after discharge. During diagnostic workup, dual x-ray absorptiometry (DXA) measurement was performed in 31.4% of the patients only. Of those 46.0% had a T-score < or =-2.5 SD and 81.1% < or =-1.0 SD. Osteoporosis treatment rate increased from 26.3% before fracture to 46.9% after fracture in women and from 13.0% to 30.3% in men. However, only 24.0% of the women and 13.8% of the men were finally adequately treated with a bone active substance, generally an oral bisphosphonate, with or without calcium / vitamin D supplements. A positive history of previous fracture vs none increased the likelihood of getting treatment with a bone active substance (36.6 vs 17.9%, ? 18.7%, 95% CI 15.1 to 22.3, and 22.6 vs 9.9%, ? 12.7%, CI 7.3 to 18.5, in women and men, respectively). In Switzerland, osteoporosis remains underdiagnosed and undertreated in patients aged 50 years and older presenting with a fragility fracture.     

骨水泥成形术与降钙素等药物治疗骨质疏松性椎体压缩骨折对比

目的 探讨骨水泥成形术及降钙素等药物治疗骨质疏松性椎体压缩骨折的临床疗效.材料与方法共68例患者,骨水泥成形术组46例,降钙素组22例.记录对比VAS及SF-12评分,记录骨水泥成形术组椎体高度变化和Cobb角改善情况,降钙素组骨密度变化情况,比较两组治疗用时及费用.结果 VAS评分及SF-12健康调查评分:降钙素组有波动,总体评分差于骨水泥成形术组.伤椎压缩恢复程度:椎体成形术组Cobb角平均改善11°,后凸成行术组Cobb角平均改善18°,椎体高度有所恢复.骨密度变化:降钙素组骨密度治疗后有提高.治疗用时及治疗费用:骨水泥成形术组治疗用时明显短于降钙素组,但治疗费用相对较高.结论 骨水泥成形术治疗骨质疏松性椎体压缩骨折能够迅速缓解疼痛,改善椎体高度和Cobb角,增加脊柱稳定性、提高患者生活质量;降钙素等药物治疗早期也可缓解疼痛,但止疼效果较骨水泥成形术滞后四周,长期应用止痛作用相对减弱,且其增加骨密度能力有限,治疗费用相比较低.     

不扩髓带锁髓内钉治疗开放性胫腓骨骨折26例分析

目的探讨不扩髓带锁髓内钉治疗开放性胫腓骨骨折的疗效。方法 2007-01～2011-10应用不扩髓带锁髓内钉治疗开放性胫腓骨骨折26例。结果 26例经5～18个月的术后随访,平均12个月,平均愈合时间16周。按Johner-Wruh评分标准,优23例,良2例,可1例,差0例,骨折全部愈合。结论不扩髓带锁髓内钉治疗开放性胫腓骨骨折是一种较好的内固定方式,具有创伤小、固定相对稳固、感染率低、骨折愈合率高等优点。