BACKGROUND:There are many reports about clinical effect of femoral fractures with intramedul ary nail and distal femoral fractures with locking plate. However, there is less report about clinical effect of femoral and distal femoral fractures.
OBJECTIVE:To investigate the clinical effect of femoral and distal femoral fractures using intramedul ary nail combined with locking plate.
METHODEighteen patients with femoral and distal femoral fractures were treated by internal fixation with intramedul ary nail combined with locking plate. Among them, six cases had femoral and supracondylar fractures, seven cases had femoral and condylar fractures, and five cases had femoral and intercondylar fractures.
According to the AO classification, three cases were type 33A2, three cases were type 33A3, two cases were type 33B1, five cases were type 33B2, one case was type 33C1, three cases were type 33C2, and one case was type 33C3. The fractures union and complications were fol owed up and observed, and knee joint function was judged by HSS score.
RESULTS AND CONCLUSION:Al the 18 patients were fol owed up for 12-24 months. The time for fracture union ranged from 3 to 5 months, average 3.4 months. No infection and disunion, no fracture malunion, no internal fixation loosening and breaking, no refracture happened. The HSS score ranged from 68 to 96 points, average 86.8 points. There were 12 excellent cases, 5 good cases, and 1 common case. The excellent and good rate was 94.4%. The internal fixation using intramedul ary nail combined with locking plate is a good method for treatment of femoral and distal femoral fractures, due to less surgical trauma, simple and reliable fixation, high rate of fracture healing, low rate of complications, and excellent function.

Objective To investigate the curative effect of cocktail combined with tranexamic acid(TXA)on total knee arthroplasty(TKA)under the concept of enhanced recovery after surgery(ERAS).Methods Seventy patients with knee osteoarthritis who received unilateral TKA treatment admitted to the Second Affiliated Hospital of Bengbu Medical College from September 2020 to July 2022 were ret-rospectively analyzed.According to different treatment methods,they were divided into experimental group and control group,with 35 ca-ses in each group.Under the guidance of ERAS concept,the experimental group received injected intraarticular mixture of cocktail and TXA during the operation,while the control group received injected intraarticular mixture of cocktail and normal saline.Postoperative drainage volume,hemoglobin(Hb)decline and total blood loss at 3 days after operation,blood transfusion rate,first ambulation time,length of hospital stay,postoperative pain visual analogue scale(VAS)、knee range of motion(ROM)and HSS score at different time points after operation,delayed wound healing,wound infection and incidence of deep vein thrombosis were compared between the two groups.Results The postoperative drainage volume,decline of Hb and total blood loss at 3 days after operation,blood transfusion rate in the experimental group were less than those of the control group,the differences were statistically significant(P＜0.05).The first ambu-lation time and length of hospital stay in the experimental group were significantly lower than those of the control group,the difference were statistically significant(P＜0.05).There were no significant differences in pain VAS score at 1 day,2 days,3 days,7 days,14 days af-ter operation between two groups(P＞0.05).There were no significant differences in ROM at 7 days,14 days after operation and HSS score at 4 weeks,12 weeks after operation between two groups(P＞0.05).Conclusion Under the concept of ERAS,intraarticular in-jection of cocktail combined with TXA in TKA can effectively reduce postoperative blood loss,improve postoperative pain,reduce periop-erative risks,and promote better early postoperative rehabilitation,the clinical effect is significant.