Ascending cluster pinning of the humerus inserted through the deltoid tuberosity

Summary Goal of Surgery Stable internal fixation of extraarticular proximal humeral fractures. Indications Extraarticular fractures angulated more than 30° which can be reduced closely or through a small incision. Epiphysiolysis. Fracture-dislocation of the humeral head. Contraindications Pathological fractures. Four part fractures. Segmental fractures of the humerus. Positioning and Anaesthesia Supine; the affected shoulder overhanging the edge of the table and supported by a radiolucent board. General or regional anaesthesia. Surgical Technique Closed pinning of two part and certain three part fractures of the proximal humerus being displaced, unstable, and mainly at the metaphyseal level. Introduction of Kirschner wires through a diaphyseal window and advancement into the proximal fragments after reduction which is controlled by image intensification. Postoperative Management Temporary immobilization in a sling. Passive and active assisted movements after a few days. Active movements after 2 weeks. Removal of wires after 3 months. Possible Complications Fracture of the humerus at the site of the cortical window. Injury to the radial nerve. Results 32 patients, mean age 49 years, 30 two part fractures and 2 three part fractures. Number of Kirschner wires used: 3 to 6, mean 4. Two out of 3 patients complained of pain at the site of wire insertion. All fractures consolidated. No avascular necrosis nor infection. Complications: Partial loss of internal fixation in 3 patients. One fracture of the humeral shaft. Sympathetic reflex dystrophy in 3 patients. Half of the patients had a normal range of motion. Time of follow-up: 6 to 24 (mean 10) months. Division of Orthopaedics and Traumatology, Purpan Hospital, Toulouse, France.     

sCD14、Ang2、CRP与急诊创伤骨折伴多发伤患者病情转归关系探究

目的 探讨可溶性白细胞分化抗原14（soluble cluster of differentiation antigen 14,sCD14）、血管生成素2（angiopoietin 2,Ang2）、C反应蛋白（C-reactive protein,CRP）与急诊创伤骨折伴多发伤患者病情转归的关系及意义。 方法 选取创伤骨折伴多发伤患者324例,根据患者出院时病情转归情况分为良好组（275例）、不良组（49例）,比较2组一般资料、sCD14、Ang2、CRP水平,应用Pearson分析sCD14、Ang2、CRP与损伤严重程度评分（injury severity score,ISS）关系,采用Cox回归分析急诊创伤骨折伴多发伤患者病情转归的相关影响因素,采用受试者工作特征曲线（receiver operating characteristic,ROC）分析sCD14、Ang2、CRP对病情转归预测价值。 结果 不良组ISS评分高于良好组（P＜0.05）;不良组sCD14、Ang2、CRP高于良好组（P＜0.05）;sCD14（r=0.785）、Ang2（r=0.778）、CRP（r=0.842）与ISS评分呈正相关（P＜0.05）;sCD14、Ang2、CRP均是预后相关独立危险因素（P＜0.05）;sCD14、Ang2、CRP预测病情转归的ROC下面积（area under the curve,AUC）依次为0.813、0.757、0.749;挑选出预测敏感度最高（sCD14）、特异度最高（Ang2）的两个指标进行sCD14+Ang2的联合ROC分析显示,两者联合预测病情转归的AUC为0.935,大于任一单一指标（P＜0.05）。 结论 sCD14、Ang2、CRP与急诊创伤骨折伴多发伤患者病情严重程度及病情转归有关,均可作为预测病情转归的标志物,但联合检测sCD14、Ang2能提高预测可靠性,为临床诊疗及护理提供更准确的参考信息。     

股骨粗隆间骨折采用改良L形钢板内固定的生物力学原理与临床应用

作者自1994年始采用自行设计L形钢板内固定治疗不稳定股骨粗隆间骨折60例，平均随访25个月，X线片显示骨折愈合时间6～13周，平均8．9周，伤肢功能在3个月内基本恢复正常，无骨折延迟愈合及髋内翻现象。为论证改良L形钢板的优点，本文采用8具新鲜尸股骨沿着它的外侧、内侧骨皮质粘贴6个应变片，观察股骨近端应变和位移分布，以检验改良L形钢板固定粗隆间骨折的效果。在实验前后将股骨粗隆造成二部分或四部分骨折。利用实验结果给制成应变和位移图，并与鹅头打固定组相比较。在载荷加至1800N时比较两种内固定器械的生物力学性能。结果表明，在治疗不稳定粗隆间骨折中，L形钢板比鹅头钉更具有生物力学的优势。     

External fixation of unstable pelvic ring fractures: comparative rigidity of some current frame configurations

The effectiveness of external fixation in the stabilisation of pelvic ring fractures was studied in a laboratory cadaveric series. Shearing displacements occurring at sacroiliac joint and symphysis pubis dislocation sites, due to simplified longitudinal loading of the sacrum in an Instron unit, were monitored using variable-impedence transducers. The rigidity of fixation was compared for the Slätis and the Bonnel single anterior frames, for coupled and uncoupled double anterior frames, and for combined anterior-plus-posterior fixation achieved with separate transfixation pin clusters, with through-and-through pin clusters, or with a posterior screw plate. The data showed that the use of posterior fixation provided greatly enhanced stabilisation compared to that achieved with anterior fixation alone. The complex double anterior frames performed only slightly better than did the simpler single anterior frames. In no case, however, was it possible to recover rigidity levels approaching those of the intact pelvis. The results suggest that the transfixation pin arrangement is the most important determinant of pelvic fixation stability, and that further investigation of posterior screw-plate fixation is warranted.     

解剖钢板结合连续被动运动功能锻炼治疗胫骨平台骨折

目的 评价解剖钢板结合连续被动运动(CPM)功能锻炼在治疗胫骨平台骨折中的应用价值.方法 2003年5月至2005年10月本院34例胫骨平台骨折行解剖复位、解剖钢板内固定并在术后进行CPM功能锻炼.结果 术后对患者行X线检查示骨折实现解剖复位或接近解剖复位.23例患者经5～30个月随访骨折均愈合,无植骨坏死发生.CPM功能锻炼后运动功能恢复优良率为82.6%(19/23).结论 采用关节面的解剖复位、解剖钢板及牢固固定后配合术后CPM功能锻炼对于胫骨平台骨折有很好的疗效.     

跟骨关节内移位骨折的手术治疗

目的探讨切开复位内固定治疗跟骨关节内移位骨折的临床效果。方法骨折采用Sanders分型法，43例52侧采用切开复位内固定治疗，有37例45侧获得3～37个月随访，平均随访时间15个月。结果所有骨折均愈合。按Maryland足部评分系统评价，本组优19侧（42．2％），良21侧（46．7％），可5侧（11．1％），优良率88．9％。结论切开复位内固定是治疗跟骨关节内移位骨折的有效方法。应尽量恢复关节面的平整和跟骨的外形。     

Factors That Predict 1-Year Incident Hip and Non-Hip Fractures for Home Care Recipients: A Linked-Data Retrospective Cohort Study

ObjectivesThe purpose of our study was to identify factors that predict 1-year incident hip and major osteoporotic non-hip fractures (ie, wrist, spine, pelvis, humerus) for home care recipients while accounting for the competing risk of death.DesignWe conducted a retrospective cohort study with linked population data.Setting and ParticipantsAll home care recipients in Ontario, Canada, receiving services for more than 6 months with an admission assessment between April 1, 2011, and March 31, 2015, were included.MethodsClinical data from the Resident Assessment Instrument Home Care were linked to fracture data from the Discharge Abstract Database and the National Acute Care Reporting System. Competing risk proportional hazard regressions using the Fine and Grey method were performed to model the association between potential risk factors and fracture.ResultsPrevious fall, previous fracture, cognitive impairment, unsteady gait, alcohol use, tobacco use, and Parkinson disease were consistently associated with all fracture types. Cognitive impairment (hazard ratio 2.09; 95% confidence interval 1.86–2.36) and wandering [1.66 (1.06–1.27)] were most predictive of hip fractures and being female [1.86 (1.76–1.98)] and experiencing a previous fracture [1.86 (1.76–1.98)] were most predictive of non-hip fractures. Risk factors unique to non-hip fractures as compared with hip fractures were locomotion ability outdoors and psychotropic medication use.Conclusions and ImplicationsOur results indicate that, in addition to typical fracture risk factors, home care recipients have unique characteristics that increase their risk. Fracture risk assessment tools and subsequent prevention strategies should be modified to accurately identify home care recipients at risk for imminent 1-year fracture.     

多发性创伤骨折手术部位感染影响因素巢式病例对照研究

目的应用巢式病例对照研究模式分析多发性创伤骨折患者手术部位感染(SSI)的影响因素,为多发性创伤骨折患者SSI防治提供参考依据。方法以入院确诊多发性创伤骨折为起点、出院为终点,应用巢式病例对照研究方式,将2018年1月-2019年7月发生SSI的患者纳入SSI组,当队列内每出现1例SSI患者时,在该队列尚未出现SSI的患者中同步选取入院间隔时间<1周、骨折部位数量相近(±1个)、性别相同的患者,按1∶2比例匹配非SSI组。32例发生SSI患者纳入SSI组,按巢式病例对照研究方式选取同队列的64例患者作为非SSI组;采集患者一般资料、手术资料,归纳多发性创伤骨折患者SSI的影响因素。结果单因素分析结果显示,年龄、营养风险、免疫功能障碍、低温、非手术区域感染、住院时间、引流导管留置时间、卧床时间和创伤指数对多发性创伤骨折患者手术部位感染有一定影响(P<0.05);多因素Logistic回归分析显示年龄、营养风险、低温均是多发性创伤骨折患者SSI的影响因素(P<0.001)。结论多发性创伤骨折患者SSI的发生与年龄、营养风险、低温等密切相关,临床应重视具备以上影响因素的患者,积极应对可控因素,降低SSI风险。     

52例全髋关节和人工股骨头置换治疗老年股骨颈骨折的比较

目的：比较全髋关节和人工股骨头置换治疗股骨颈骨折的手术治疗效果。方法：自1994－2000年主要以Moore型人工股骨头和全髋关节置换治疗59例股骨颈骨折。随诊时间1－6a,平均3．0a,随诊52例,手术时平均年龄72．5岁,全髋关节置换24例,人工股骨头置换28例,结果：人工股骨头置换术后中心性脱位2例,人工股骨头置换28例,髋臼软骨磨损髋部明显疼痛6例,全髋关节置换术后髋部轻度疼痛2例,假体轻微下沉1例,结果：人工股骨头置换治疗股骨颈骨折的并发症高于全髋关节置换术。     

复杂性面骨骨折的处理

（1）目的 探讨复杂性面骨骨折临床治疗方法及效果。（2）方法 对18例面骨多处骨折或多发。陈旧性骨折的病人采用冠状切口加口内切口、面部小切口加口内切口相结合的术式及正颌外科,微小夹板固定技术。进行再骨折复位或截骨复位、固定。（3）结果 全部病人术后张口无受限,咬He关系良好,功能及形态满意,复视消失,2例出现再次脑脊液鼻漏,经7-8d后愈合。无其他严重并发症出现。（4）结论 复杂性面骨骨折应选择合适时机,根据病情采用不同的术式治疗,可达到满意的效果。