Objective To compare hip arthroplasty versus internal fixation for treatment of displaced femoral neck fractures in the elderly patients in terms of reoperation,surgery-related complications and postoperative 1-2-year mortality.Methods All the randomized controlled trials (RCTs) up to May 2013 on hip arthroplasty versus internal fixation for displaced femoral neck fractures in the elderly were electronically searched for in Pubmed/Medline,EMBASE,Cochrane CENTRAL,CNKI,WanFang and VIP databases.The 2 treatments were compared in terms of reoperation,surgery-related complications and postoperative 1-2-year mortality.The Meta analysis was performed with RevMan 5.2.5 software.Results Five eligible RCTs involving 1 288 cases were included for this review.The rate of reoperation (including implant removal and other operations),either within 2 years or over 2 years,in the internal fixation group was significantly higher than that in the arthroplasty group (P ＜ 0.05).The surgery-related complications in the internal fixation group was significantly higher than that in the hip arthroplasty group [OR =8.82,95％ CI (6.45,12.07),P ＜0.001].No significant difference was found in the postoperative 1-2-year mortality between the 2 groups (P ＞0.05).Conclusion In the treatment of displaced femoral neck fractures in the elderly,compared with internal fixation,arthroplasty should be recommended as the first choice,because it can significantly reduce surgery-related complications and reoperations though it cannot decrease the postoperative 1-2-year mortality.

Objective To retrospectively study postoperative nonunion of femoral neck fractures so as to identify high risk factors for their nonunion.Methods A total of 965 patients with complete clinical data out of the 1 323 patients with femoral neck fractures treated by internal fixation with cannulated compression screws from January 2003 to January 2011 were included in the study.Logistic muhiple regression method was used to analyze five factors including patients' age,gender,injury mechanism (whether high energy injury or not),fracture type (with or without displacement) and medical comorbidities [American Society of Anesthesiologists Physical Score (ASAS) grade] and their correlation with fracture healing to investigate the high risk factors for the nonunion of femoral neck fractures.Results Quantitative assay of the factors affecting healing of femoral neck fractures was ranged as follows:medical comorbidities (ASAS grade),injury mechanism (whether high energy injury or not),fracturc type (with or without displacement),gender and age.Conclusion Age ＞ 50 years,females,displacement fracture,high energy injury,and ASAS grade above Ⅲ are high risk factors for nonunion of femoral neck fractures.

Objective To introduce the operation method of a rotational support plate through a traditional anterolateral approach for posterolateral tibial plateau fractures and analyze the postoperative outcome.Methods From May 2016 to September 2017,10 patients with posterolateral tibial plateau fractures who underwent surgery with the rotational support plate were retrospectively analyzed.There were 6 males and 4 females,aged from 23-66 years (average,46.2 years).The causes of the fractures included traffic accident in 4 cases,fall from height in 5 cases and falling injury in 1 case.According to AO-OTA classification,there were 1 case of 41-B2,8 cases of 41-B3 and 1 case of 41-C3.According to Schatzker classification,there were 6 cases of type Ⅱ,1 was of type Ⅲ,2 were of type Ⅴ,and 1 was of type Ⅵ.Four cases suffered multiple fractures.One patient suffered pelvic fracture,ipsilateral femoral shaft and medial malleolus fracture;One patient suffered ipsilateral tibiofibular fracture;1 patient suffered ipsilateral fibular head and medial femoral epicondyle fracture;One patient suffered ipsilateral fibular head fracture.Fracture healing time,complications,knee range of motion,Hospital for Special Surgery (HSS) knee score were recorded to evaluate postoperative outcomes.Results All 10 patients were followed up for 15.25 months (range,12-27 months).The bony union time ranged from 3.0-4.5 months (average,3.2 months).The range of motion of the knee joint was 105°-161.4° (average,139.9°).According to the HSS system,the score was 64-98 (average,88),including 8 of excellent and 2 of fair.No skin necrosis,incision infections,or fixation failure occurred during follow-up.Conclusion Fixation of posterolateral tibial plateau fracture was successfully achieved using the newly designed plate through a traditional anterolateral approach.It has many advantages such as reliable fixation,satisfying recovery,simplicity of operator,and small tissue damage.

Objective To analyze biomechanical differences among quantity configurations of four common cannulated screws using three-dimensional finite element analysis.Methods The Dicom CT images of the right proximal femoral neck of a 65-year-old Chinese healthy volunteer were used to establish models of three kinds of different Pauwels types of femoral neck and four kinds of different quantity and configuration models (triangle,inverted triangle,rectangle,diamond) through three-dimensional virtual softwares.Models were imported into the finite element analysis software Ansys.After axial load application,the stress and displacement on the screws and femoral head were compared.The peak stresses on the screws,peak stresses on the femoral head break side and displacement peaks were observed.Results Four kinds of quantity and configuration models (triangle,inverted triangle,rectangle,rhombus) had different peak stress on the screws and femoral head break side and different displacement peak.Among Pauwels type Ⅰ fractures,the peak stresses on the screws were 46.382,32.159,43.985,and 24.342 MPa;the peak stresses on the femoral head break side were 5.840,7.440,3.731,and 6.311 MPa;the displacement peaks were 0.610,0.608,0.598,and 0.595 mm.Among Pauwels type Ⅱ fractures,the peak stresses on the screws were 46.763,39.979,49.619,and 25.692 MPa;the peak stresses on the femoral head break side were 4.971,7.332,3.161,and 5.734 MPa;the displacement peaks were 0.634,0.635,0.622,and 0.631 mm.Among Pauwels type Ⅲ fractures,the peak stresses on the screws were 51.432,39.477,51.515,and 26.949 MPa,and the peak stresses on the femoral head break side were 6.163,10.070,5.257,and 9.552 Mpa;the displacement peaks were 0.662,0.654,0.644,and 0.644 mm.Conclusion The fixation of femoral neck fractures with four screws in a diamond position can guide clinical application,for the procedure has better stress dispersion effects,ensure fracture stablility,provide effective sliding compression and anti-torsion and have biomechanical advantages.

Objective To raise awareness of the late-onset meningitis caused by group B streptococcus (GBS) which was homogenous to the maternal colonization.Methods The clinical data of late-onset GBS meningitis in neonates twins whose pathogens were homogenous to their maternal colonization were collected from Department of Neonatology,Guangzhou Women and Children's Medical Center.The general conditions,clinical symptoms,laboratory tests and drug treatment of the twins and their mother were retrospectively analyzed,and the GBS homology during inpatient care was tested.And the progress of the twins' condition was investigated by telephone follow-up.Results The mother had two pregnancies without prenatal GBS screening or intrapartum antimicrobial intervention for GBS,everything was normal during pregnancy and delivery.Twins were born through cesarean section.The elder sister was discharged with Linezolid taken orally after 167 days in hospital without convulsions,shaking or other discomfort.The elder sister was followed up for every 2 weeks,and in the last time of follow-up,cerebrospinal fluid white blood cell counts were 45 × 106/L,protein level was 1.52 g/L and Linezolid was withdrawn.The younger brother was discharged after 58 days in hospital with follow-up for every 2 weeks,and in the last time of follow-up,cerebrospinal fluid white blood cell counts were 30 × 106/L,protein level was 0.66 g/L.During the hospitalization and follow-up without convulsions and irritation,and the cranial magnetic resonance imaging of the twin brother was normal.Test results showed that the GBS bacteria strain for twins and their mother were all serotype Ⅲ.The possibility of the GBS homology was more than 90％.Conclusions The toxicity of serotype Ⅲ GBS strain was strong.More proactive precautions should be considered to apply for the mother whose first birth already had GBS infection.Early identification and intervention of infection risk factors would help optimize the anti-infection treatment program and reduce nerve system damage and other adverse outcomes caused by invasive GBS infection.

BACKGROUNDAlthough the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results, the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures. The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.

METHODSWe assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures. Eighteen patients were treated with a locking plate and an autologous crest bone graft (experimental group), and 22 were treated with only the locking plate and no bone graft (control group). Postoperative assessments included radiographic imaging, range of motion analysis, pain level based on the visual analogue scale (VAS), and the SF-36 (Short Form (36) Health Survey), as well as whether patients could return to their previous occupation.

RESULTSAll fractures healed both clinically and radiologically in the experimental group. There was no more than 2 mm collapse of the humeral head, and no osteonecrosis or screw penetration of the articular surface. In contrast, two patients had a nonunion in the control group, and they eventually accepted total shoulder replacements. The average time from surgery to radiographic union was significantly shorter in the experimental group ((4.66±1.63) months) compared with the control group ((5.98±1.57) months) (P < 0.05). For the experimental versus controls groups, the mean shoulder active flexion (148.00±18.59 vs. 121.73±17.20) degrees, extension (49.00±2.22 vs. 42.06±2.06) degrees, internal rotation (45.00±5.61 vs. 35.00±3.55) degrees, external rotation (64.00±9.17 vs. 52.14±5.73) degrees, and abduction (138.00±28.78 vs. 105.95±15.66) degrees were all significantly higher (all P < 0.001). The median SF-36 in the experimental group ((88.00±5.71) points) was significantly higher than that of the control group ((69.45±9.45) points; P < 0.001). The median VAS pain level (mean rank, 10.50) in the experimental group was lower than that (mean rank, 47.19) of the control group (P < 0.001). All but one patient (17 of 18, 94.4%) in the experimental group returned to their previous activities or occupations, and that one patient changed to a different occupation because of slight restrictions to activities. On the other hand, four patients could not return to their previous activities or occupations in the control group.

CONCLUSIONLocking plate fixation combined with an iliac crest bone graft is an effective technique for treating proximal humerus comminuted fractures.

Adult ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Shoulder Fractures ; surgery ; Transplantation, Autologous