Objective To explore the significant risk factors in patients with Tile C pelvic frac-tures.Methods We conducted a retrospective review of all patients with Tile C pelvic fractures in Nanjing First Hospital from January 2010 to December 2014.The data gathered on each patient in-cluded:age,sex,mechanism of injury,visiting time after injury,shock index,Injury severity scale (ISS),Revised trauma score (RTS),Glasgowcoma scale (GCS),lowest PaO2/FiO2 ,6 h lactate clearance rate,concomitant injures and interventious of Tile C pelvic fractures.The data were tested using Student’t-test,χ2 test and logistic regression method.Results The study include 139 consecutive patients.The total mortality was 29.5%.Among them,36 (25.9%)patients died within 48 hours after admission.Multivariate regression analysis showed that shock index (OR=2.591,95%CI 1.041-4.216), ISS (OR = 47.96,95%,CI 15.89-147.23 ),RTS (OR = 6.917,95% CI 1.147-13.862 ),GCS (OR =4.172,95%CI 2.962-6.268),lowest PaO2/FiO2 (OR= 117.016,95% CI 51.011-176.032),6 h lactate clearance rate (OR=2.785,95%CI 1.191-4.892),concurrent head (OR=6.302,95%CI 2.270-13.175)or chest (OR=12.233,95%CI 5.193-33.985)injures were associated with high morality of Tile C pelvic frac-ture (P <0.01).The performing digital subtraction angiography with intravascular embolization can cut the mortality (OR=0.887,95%CI 0.875-0.899).Conclusion In our study,high trauma score,serious shock, coma,PaO2/FiO2 decreased and 6 h lactate clearance rate decreased,combined with the head and chest inju-ry are the important reasons of mortality in patients with Tile C pelvic fracture.It’s vital to control shock actively,use trauma scale and emphasize multidisciplinary cooperation to reduce mortality in patients with Tile C pelvic fractures.

Apoptosis and autophagy are common life phenomenon in various cells, which widely involve in physiological and path-ological processes, and interact with one another by many factors and multiple pathways. This intricate relationship runs through a vari-ety of cardiovascular diseases, and plays an important role in the occurrence, development and prognosis of many cardiovascular disea-ses. The effects of apoptosis and autophagy and their interrelationship in cardiovascular diseases were reviewed and summarized in this paper.

OBJECTIVETo investigate the preliminary effects of modified percutaneous compression plate in treating femoral neck fractures of Pauwels type III.

METHODSFrom March 2012 to March 2016, 35 patients with femoral neck fracture were treated by closed reduction and internal fixation with a modified percutaneous compression plate, including 21 males and 14 females with an average age of 45 years old ranging from 23 to 62 years old. The anatomical position of fracture was divided into 8 cases of lower head type, 27 cases of head and neck. According to the Garden classification, there were 8 cases of type II, 18 of type III, and 9 of type IV fractures. All patients were closed injury. The general information, reduction quality, fracture healing time, postoperative complications were recorded and evaluated. Harris scoring was used to evaluate the hip joint function.

RESULTSAll patients were followed up for 15 to 24 months with an average of 20 months. All the incisions were primary healing. The reduction quality of the femoral neck fracture was evaluated according to the Garden's alignment Index, and the quality of reduction was grade I reduction in 29 cases and grade II reduction in 6 cases. No nonunion, femoral avascular necrosis, implant failure and hip varus was observed during follow-up. Harris score was(92.70±4.60) points at final follow-up, the results of the treatment was evaluated as excellent in 26 cases, good in 8 cases, fair in 1 case. No complications such as internal fixation loosening, nail breaking, and heterotopic ossification occurred.

CONCLUSIONSInternal fixation with modified percutaneous compression plate has an advantages of decreased trauma, simple operation, rigid fixation, good function outcome, and low risk of complications.

OBJECTIVETo evaluate the therapy and the key points of the tarsometatarsal joint injury combined with metatarsal fracture.

METHODSFrom Jan. 2006 to Jul. 2008,19 patients with tarsometatarsal joint injury combined with metatarsal fracture were treated with opened reduction and internal fixation of Kirschner wire or screws, included 13 males and 6 females with an average age of 38.1 years ranging from 21 to 56 years. The classification of tarsometatarsal joint injury showed that there were 2 cases of inner column injury, 5 cases of inner and medial column injury, 3 cases of lateral and medial column injury, 9 cases of tri-column injury. There were 8 cases of shaft fracture, 7 of neck fracture, 19 of foundation fracture.

RESULTSAll the incisions were first stage healed without skin necrosis. The healing time of fracture was 11.2 weeks on average. All the patients were followed-up for 6 to 17 months with an average of 12.8 months. According to the standard of AOFAS, the average score was (84.500 +/- 8.553), the results were excellent in 4 cases, good in 9 cases, fair in 3, and poor in 3. The regular daily life was recovered after 6.4 months, 3 patients suffer from mild osteoarthritis.

CONCLUSIONNo matter which fixed mode was used, the anatomical reduction was the most important to rebuild arches of the foot and recover medial longitudinal and lateral arch. Rebuilding arches of the foot guaranteed the integrity of the stress point scaffold and avoided the pain and limp. The anatomical reduction of tarsometatarsal joint and metatarsal was also important to rebuild the function of foot.

Adult ; Female ; Foot Joints ; injuries ; physiopathology ; surgery ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; physiopathology ; surgery ; Humans ; Male ; Metatarsal Bones ; injuries ; physiopathology ; surgery ; Middle Aged ; Recovery of Function ; Young Adult

OBJECTIVETo investigate the operative management and surgical techniques for lumber disc herniation (LDH) in aged patients (>or=65 years).

METHODSFrom 2005 to 2010,the data of 43 patients with LDH underwent surgical treatment were retrospectively analyzed. There were 25 males and 18 females,aged from 65 to 70 years old with an average of 67.6 years. The course of disease was from 6 weeks to 7 years with an average of 10.2 years. Fenestratiodn discectomy or extended fenestration discectomy and unilateral or bilateral fenestration were used according to the conditions of location,type of herniated macleos polposus and nerve root compression. Among the patients,the nerve root canal was enlarged,hyperplastic osteophyma and soft tissue were removed, bilateral articular process was reserved in order to maintain the stability of the lumbar segment.

RESULTSAll the patients were followed up from 1.2 to 5.2 years. According to the criteria of HU you-gu, 25 cases got excellent results, 15 good, 2 fair and 1 poor. No infection or nerve injury was found. Nerve function of patients had a normal or near normal recovery.

CONCLUSIONFor the treatment of LDH in aged patents,it is key that reasonably choose the operative method, completely remove the hyperplasy of diseased region and enlarge the nerve root canal, thoroughly loose the nerve root.

Aged ; Female ; Humans ; Intervertebral Disc Displacement ; physiopathology ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Retrospective Studies

OBJECTIVE: To investigate the short-term clinical effect of direct anterior approach (DAA) in total hip arthroplasty(THA). METHODS: From January 2018 to September 2018, the data of 30 patients(33 hips) who underwent the first THA using the side lying DAA completed by the same operation team were followed up and evaluated. There were 19 males and 11 females;the age was 58 to 80 (69.0±5.4) years old;the visual analogue scale (VAS) of pain was used, Harris scoring system, operation time, intraoperative blood loss, related complications and hip radiographs were evaluated in clinical and imaging aspects. RESULTS: Thirty patients (33 hips) were followed up for 12 to 20(14.3±3.7) months, operation time (66.0±7.2) min and intraoperativehemorrhage (156±32) ml. The position of acetabulum prosthesis was examined by imaging:anteversion angle (18.6±3.6)° and abduction angle (41.2±4.8)° respectively. The VAS score was improved from 7 to 9(8.1±1.4) before operation to 1 to 3(1.9±0.7) at 1 month after operation. Harris score of hip joint improved significantly, from 28 to 46(35.4±5.2) before operation to 76 to 92 (88.6±4.5) at 1 month after operation, 74 to 93 (85.6±6.9) at 6 months after operation, and 79 to 95 (90.7±8.1) at 12 months after operation, the difference was statistically significant(<0.05). Complications occurred in 3 cases of fracture of the proximal femur, including 1 case of hip sprain fracture due to careless walking one month after operation. Considering that incomplete fracture may have occurred during the operation, 1 case of avulsion fracture of anterior inferior iliac spine, no deep infection, no dislocation. There were 1 case of injury of lateral femoral cutaneous nerve and 2 cases of injury of tensor fascia lata, among which 1 case was complete incision of the edge of the hook. CONCLUSION The primary THA with DAA in lateral position has a good short;term clinical effect, can meet the needs of patients' rapid recovery, and is a safe and effective surgical approach.
Aged ; Aged, 80 and over ; Antiviral Agents ; Arthroplasty, Replacement, Hip ; Female ; Hepatitis C, Chronic ; Hip Joint ; Hip Prosthesis ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo discuss the value of one stage flap or musculocutaneous flap to repair the soft tissue defect in Pilon fracture.

METHODSTwelve cases with Pilon fracture included 9 male and 3 female with an average age of 39.2 years ranging from 21 to 61 years. All fractures were type III according to Rüedi and Allgöwer. According to Gustilo sysytem, III a were in 4 cases, III b were in 8. A thorough debridement was made before internal fixation. After the internal fixation implanted, the tourniquet was released and a thorough debridement was made again. Be sure of the wound cleansed of all dead and foreign material, the wound was covered with local flap, musculocutaneous or gastrocnemius flaps depending on the size and localization of wound.

RESULTSAll the patients were followed up from 6 to 36 months, 18 months in average. The function of ankle was assessed according Mazur system. The results were excellent in 6 cases, good in 3, fair in 2 and poor in 1. No infection or necrosis happened on flaps. Although necrosis happened in the wound margin of two patients, they all healled up by conservative methods.

CONCLUSIONPrimary closure of soft tissue defect in Pilon fracture using flap or musculocutaneous flap have ability to shorten the treating time and recover the function of ankle. It is important to have a thorough debridement of the dead tissue and free bone.

Adult ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Surgical Flaps ; Tissue Transplantation ; Treatment Outcome

Adult ; Female ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Spinal Cord Injuries ; surgery ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo analyze the reason of error diagnosis and inappropriate treatment of radius head fractures complicating distal radioulnar joint dislocation (Essex-Lopresti injury) and to seek for the reasonable treatment.

METHODSFrom 2008 to 2009, 2 male patients of radius head fractures complicating distal radioulnar joint dislocation were treated, the age was 56 and 66 years old respectively. The symptom included elbow swelling and limitation of forearm rotation. X-ray showed comminuted fractures of capitulum radius. There were 1 case of Mason type III and 1 cases of type IV. Two patients were treated by resection of capitulum radius and plaster fixation after operation.

RESULTSBoth of the 2 cases had limited rotation of forearm and the distal radioulnar joint pain. The X-ray showed that the distal radioulnar joint was separated obviously and the proximal radius was translocated.

CONCLUSIONThe early diagnosis is very important for the Essex-Lopresti injury. Rebuilding the longth of the radius and reduction fixating the distal radioulnar joint after fixated is an effective treatment while the interosseous membranes can't be repaired and rebuilded.

Aged ; Diagnostic Errors ; Elbow Joint ; injuries ; Humans ; Joint Dislocations ; diagnosis ; therapy ; Male ; Middle Aged ; Radius Fractures ; complications ; Ulna Fractures ; complications

Adult ; Casts, Surgical ; Diagnostic Errors ; Female ; Fractures, Bone ; diagnosis ; diagnostic imaging ; pathology ; surgery ; Humans ; Male ; Metatarsus ; diagnostic imaging ; injuries ; surgery ; Middle Aged ; Tomography, X-Ray Computed