Objective To discuss the clinical results of lateral locking plate combined with bone grafting in the treatment of distal femoral fractures in the elderly.Methods Between January 2006 and December 2013,112 senile patients with distal femoral fracture were treated at our department by lateral locking plate combined with bone grafting.They were 16 men and 96 women,aged from 67 to 85 years (average,76.1 years).By AO classification,48 cases were type 33-A1,11 type 33-A2,3 type 33-A3,7 type 33-B1,4 type 33-B2,32 type 33-C1,and 7 type 33-C2.All of them had a previous history of osteopenia.By the Singh index classification,22 cases were rated as grade Ⅰ,74 as grade Ⅱ,13 as grade Ⅲ,and 3 as grade Ⅳ.Postoperatively,the patients conformed to regular follow-up,accepted functional rehabilitation and continued medication for osteopenia.Radiographic examinations were conducted to observe fracture healing.At the last follow-up,the function of involved knee was assessed according to the criteria by Karlstrom and Olerud.Results All the 112 patients completed their follow-ups,ranging from 10 to 48 months (average,16 months).All fractures united primarily after an average of 4.2 months (range,from 3.5 to 5.0 months).According to the criteria by Karlstrom and Olerud,93 cases were rated as excellent,10 as good and 9 as fair,giving a good-to-excellent rate of 92.0％.No such complications as nonunion,malunion,plate breakage,or screw loosening were observed during the follow-ups.Conclusion Lateral locking plate combined with bone grafting is effective for the treatment of distal femoral fractures in the elderly,if followed by postoperative anti-osteopenia therapy and early functional exercises.

Objective To evaluate the effect of community management of diabetic patients with hypertension in Beijing Cuigezhuang community in last three years.Methods A community diabetic management program was started from 2007 in Beijing Cuigezhuang community.Three hundred and seventy six patients who participated in the program for more than 3 years were enrolled in the study, including 196 with type 2 diabetes mellitus (T2DM) only (DM group) and 180 with T2DM and hypertension (DMH). The control rate of blood glucose, blood pressure, lipids and the comprehensive control rate were compared between two groups after 3-year intervention.Results There were no significant differences in age, gender ratio, course of diabetes, education background, monthly income and the history of stoke between two groups;while prevalence of dyslipidemia in DMH group was significantly higher than that in DM group [41.7%(75/180) vs.24.5%(48 196),χ2 =11.938,P=0.001].Compared with the baseline data, the types of antidiabetic drugs used were not significantly changed in two groups after 3-year intervention ( DM group:1.32 ±0.81 vs.1.31 ±0.93, t=-0.155, P=0.877, DMH group:1.43 ±0.72 vs.1.48 ±0.82, t=0,831, P =0.407) .The types of antihypertensive drug in DMH group were significantly decrease. (1.12 ±0.77 vs.1.25 ±0.45, t=2.484, P=0.014), while the rate of statins usage in DM group was significantly increased [13.3%(26/196) vs.5.1%(10/196),χ2 =7.830, P=0.005].The hemoglobin A1c (HbA1c) levels in DM group was decreased [(7.4 ±1.5)% vs.(7.8 ±2.1)%, t=2.586, P=0.011].The systolic pressure [(129 ±12) mmHg (1 mmHg=0.133 kPa) vs.(133 ±16) mmHg, t=3.503, P=0.001] and the diastolic pressure [(80 ±8) mmHg ratio (82 ±10) mmHg, t=2.436, P=0.016] in DMH group were significantly declined. The average LDL-C level [ DM group: ( 3.0 ± 0.9) mmol/L vs.(3.2 ±1.0) mmol/L, t =2.165, P=0.032; DMH group (2.9 ±1.0) mmol/L vs. (3.2 ±1.1) mmol/L, t=3.210, P=0.002] were also significantly decrease.Compared with the baseline, the comprehensive control rates of blood glucose, blood pressure and lipid level were increased in both groups [DM group:9.7% (19/196) vs.6.1%(12/196),χ2 =1.716, P=0.190, DMH group 13.9%(25/180) vs.5.0%(9/180),χ2 =8.315, P =0.004] .Conclusions The community management program is effective for improvement of comprehensive control rates of blood glucose, blood pressure and blood lipids in diabetic patients with hypertension in Beijing Cuigezhuang community.