Weight-bearing in ankle fractures: An audit of UK practice

IntroductionThe purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures.MethodsA multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, “early” weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and “delayed” weight-bearing as unrestricted weight-bearing permitted after 3 weeks.Results251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing.DiscussionThe majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures.ConclusionThis study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible.     

旋前旋后外旋型三踝骨折的手术治疗

目的：探讨旋前、旋后外旋型（IV度）三踝骨折的手术方法和临床疗效。方法：2000年3月至2006年7月,对42例旋前、旋后外旋型（IV度）三踝骨折行切开复位内固定术,男31例,女11例;年龄19～76岁,平均40.5岁。开放性损伤4例,闭和性损伤38例。根据Lauge-Hansen分类,旋前外旋型IV度三踝骨折18例,旋后外旋型IV度三踝骨折24例。受伤距手术时间2h～27d。内、外踝均采用标准内、外侧切口。如需行后踝骨折处理,则将内踝切口延长,同时显露内、外及后踝。整复固定的顺序是后踝、内踝、外踝和下胫腓联合。骨折复位固定完成后,行踝部正侧位及踝穴（Mortise）位X线检查。结果：全部患者均获得随访,时间6～24个月,平均13.5个月。骨折愈合时间12～16周,疗效根据梁军等改良Baird-Jackson的主客观及X线评价标准进行评定,包括疼痛、踝关节的稳定性、行走能力、跑步能力、踝关节活动范围、踝关节X线测量等。本组优20例,良16例,可4例,差2例,优良率85.7%。术后未发生感染、骨不连、骨折畸形愈合等并发症,但发生1例下胫腓骨三皮质固定螺钉断裂。结论：手术治疗的关键在于恢复并稳定踝关节的解剖关系,最大限度恢复踝关节功能。     

髋臼骨折合并同侧下肢骨折临床治疗分析

目的：探讨髋臼骨折合并同侧下肢骨折的创伤机制和治疗方法。方法：髋臼骨折并同侧下肢骨折14例,男9例,女5例;年龄18～65岁,平均35岁。髋臼骨折按Letournel分型,后壁伴后柱骨折11例,单纯后柱骨折3例,均行钢板内固定。伴同侧股骨转子间骨折3例,1例行起重机架外固定,2例行DHS固定;伴同侧股骨颈骨折3例,均行空心钉加压固定;伴同侧股骨干骨折6例,1例行钢板固定,余5例行带锁髓内钉固定;伴同侧胫骨平台骨折2例,行钢板内固定。结果：1例半年后死亡,余13例获得随访,随访时间18个月～5年,平均30个月。按照美国矫形外科研究院髋关节疗效评定标准,优9例,良3例,差1例。结论：髋臼骨折合并同侧下肢骨折受伤暴力大、机制复杂、合并创伤多、易漏诊,应早期明确诊断,合理内固定。     

多根骨圆针内固定治疗踝关节开放爆裂骨折7例

目的:探讨和分析手术方法治疗儿童陈旧性孟氏骨折的临床效果。方法:36例儿童,男28例,女8例;年龄4~14岁,平均9岁。按Bado分类法:Ⅰ型(伸直型)19例,Ⅱ型(屈曲型)9例,Ⅲ型(内收型)5例,Ⅳ型(特殊型)3例。根据不同病情分别行单纯切开复位治疗19例,尺骨截骨治疗10例,尺骨延长术治疗7例。结果:36例术后随访1~5年,平均3.5年,根据朱玉奎等评定标准,本组优24例,良6例,可3例,差3例,优良率83%。结论:恢复并维持正确的肱桡关系是手术后取得良好效果的关键,环状韧带可以不行修补或重建。     

FRACTURE OF ABUTMENT SCREW SUPPORTING A CEMENTED IMPLANT-RETAINED PROSTHESIS WITH EXTERNAL HEXAGON CONNECTION: A CASE REPORT WITH SEM EVALUATION

One of the causes of implant failures in cemented implant-retained prostheses is the fracture of abutment screw or UCLA abutment. This article reports a case of simultaneous fracture of two UCLA abutments screws occurring in an implant-supported prosthesis placed in the mandibular molar region. The fractured structures were examined under scanning electron microscopy to investigate the probable causes of the failure, which were not related to failures on materials or fabrication of the screws, but rather were due to shear forces. The misfit in cemented prostheses may be the most likely cause of shear force generation.     

股骨干重度粉碎骨折的治疗

我院自1990年以来，应用梅花髓内针(儿童用三角针)及钢丝内固定治疗股骨干重度粉碎性骨折36例，取得了较满意的疗效，现报告如下。     

Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: A 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study

The aim of this study was to evaluate whether a prevalent vertebral deformity predicts mortality and fractures in both men and women. In the city of Malmö, 598 individuals (298 men, 300 women; age 50–80 years) were selected from the city's population and were included in the Swedish part of the European Vertebral Osteoporosis Study (EVOS). At baseline the participants answered a questionnaire and lateral spine radiographs were performed. The prevalence of subjects with vertebral deformity was assessed using a morphometric method. The mortality during a 10-year follow-up period was determined through the register of the National Swedish Board of Health and Welfare. Eighty-five men and 43 women died during the study period. The subsequent fracture incidence during the follow-up period was ascertained by postal questionnaires, telephone interviews and by a survey of the archives of the Department of Radiology in the city hospital. Thirty-seven men and 69 women sustained a fracture during the study period. Data are presented as hazard ratios (HR) with 95% confidence interval (95% CI) within brackets. Prevalent vertebral deformity, defined as a reduction by more than 3 standard deviations (SD) in vertebral height ratio, predicted mortality during the forthcoming decade in both men [age-adjusted HR 2.4 (95% CI 1.6–3.9)] and women [age-adjusted HR 2.3 (95% CI 1.3–4.3)]. In men there was an increased mortality due to cardiovascular and pulmonary diseases and in women due to cancer. Prevalent vertebral deformity predicted an increased risk of any fracture during the forthcoming decade in both men [age-adjusted HR 2.7 (95% CI 1.4–5.3)] and women [age-adjusted HR 1.8 (95% CI 1.1–2.9)]. Prevalent vertebral deformity predicted an increased risk of any subsequent fragility fracture in women [age-adjusted HR 2.0 (95% CI 1.1–3.5)]; however, in men the increased risk was nonsignificant [age-adjusted HR 1.9 (95% CI 0.7–5.1)]. In summary, a prevalent vertebral deformity can predict both increased mortality and increased fracture incidence during the following decade in both men and women. We conclude that prevalent vertebral deformity could be used as a risk factor in both genders for mortality and future fracture.