Impacted femoral neck fractures should be treated operatively as displaced fracture. Many authors suggested emergency operation. The principle of treatment of femoral neck fractures is anatomic reduction, fragmental compression,and rigid fixation. Closed reduction must be done in most cases. When close anatomic reduction can not be achieved, open reduction should be considered.Implants used recently consist of pins , screws,hook pins and gliding screws with side plate. Every implant has its own advantages, disadvantages and indications. The principle of treatment of femoral neck fractures in young patients is emergency operation (within 12h after trauma), anatomic reduction (open reduction when necessary), and rigid fixation with screws. Some authors stated the necessity of anterior capsularoctomy.

Osteoporosis is considered as the most important factor which causes the fracture of the femoral neck. Comminution of fracture and rigidity of fixation are greatly affected by the degree of osteoporosis. Femoral neck fractures in young patients are mainly caused by severe trauma. Although Garden classification is widely accepted in classifying femoral neck fractures, in the recent decades some doctors have found out some shortcomings in Garden classification in practical application. It has been suggested to classify the femoral neck fractures simply into displaced and undisplaced ones. Arthroplasty used to be thought as the choice of treatment of femoral neck fractures in the elderly. Application of arthroplasty must accord with the indications, not only with the age of the patient or the degree of the displacement of the fracture. There is no X ray diagnosis specially for the avascular necrosis of femoral head secondary to femoral neck fracture, other than Ficat Arlet grade system. MRI is considered to be the only method to diagnose the avascular necrosis of femoral head at an early stage and to defect its extent and location.

Employment ; Humans ; Japan ; Surveys and Questionnaires

Background Suprachoroidal hemorrhage (SCH)is a rare but devastating complication of ophthalmic surgery,and it is crucial to be aware of the risk factors and select effective treatment. Objective Present study was to assess the treatment and risk factors of SCH induced by intraocular surgery. Methods Retrospective case series were carried out to investigate the clinical data of 15 eyes from 15 patients with SCH at Peking Union Medical College Hospital.The risk factors of SCH were analyzed.Written informed consent was obtained before any medical examination and treatment.SCH was occurred in 10 eyes during intraocular surgery,while the SCH was diagnosed in other 5 eyes 1-3 days after operation.Surgical drainage was carried out in 8 eyes,of which 3 eyes combined with vitrectomy besides surgical drainage and other 5 eyes were treated with medication alone.Results SCH was completely removed and absorbed in 12 eyes.The visual acuity was improved in 6 eyes,unchanged in 6 eyes and decreased in 3 eyes.Nine eyes complicated with retinal detachment and reattached in 6 eyes after treatment.Seven eyes combined with hypermyopia,6 eyes combined with glaucoma,and 1 eye was aphakia.Four patients combined with hypertension,and 2 patients had diabetes mellitus. Conclusions SCH induced by intraocular surgery develops rapidly and violently,and it can result in vision loss without effective treatment.Suturing surgical incision immediately,applying hypertonic agents and sclerotomy drainage are the urgent approaches to treat SCH.Medicines and/or sclerotomy could be optional according to the amount of bleeding and other ocular complication.The risk factors of SCH include myopia,glaucoma and the instantly dropping of intraocular pressure.

RhoA, a small GTPase, is involved in a wide array of cellular functions in the central nervous system, such as cell motility, cytoskeleton rearrangement, transcriptional regulation, phagocytosis and cell growth. It is not known how spinal cord injury (SCI) affects the expression of RhoA in different nerve cells. In the present study, we investigated the changes of RhoA expression in remote areas of the injury at the 3rd, 7th and 30th day after SCI, which was established by T10 contusion method. Moreover, we examine its expression profile in neurons, astrocytes and microglia. RhoA was found to be weakly expressed in these nerve cells in normal spinal cord. Western blotting showed that, after SCI, the total RhoA expression was up-regulated, and the RhoA expression was increased and peaked at the 7th day. Double immunostaining revealed specific and temporal expression patterns of RhoA in different nerve cells. The expression of RhoA in neurons started to increase at day 3, peaked at day 7 and then decreased slightly at day 30. Expression of RhoA in astrocytes increased moderately after SCI and peaked at day 7. There was no obvious change in RhoA expression in microglia after SCI in remote areas. This study demonstrated that, after SCI, RhoA expression exhibited different patterns with different nerve cells of spinal cord. RhoA expression patterns also changed with time after SCI, and among different nerve cells in the injured spinal cord. These findings can help us better understand the roles of RhoA in SCI.

Objective To develop a quantitative assessment of the severity of femoral neck fractures with CT scan.Methods The preoperative X-ray and CT data were reviewed of 229 patients with femoral neck fracture who had been treated in our department from December 2008 to April 2012.Posterior fracture fragment,posterior angulation,longitudinal maximum displacement,location of fracture line,and difference in neck-shaft angle were measured in the 3-D reconstruction images of CT scans.The severity of the fracture was categorized as slight,(score ≤5,grade Ⅰ),moderate (score 6 to 8,grade Ⅱ) and severe (score ≥9,grade Ⅲ) according to the measurements of the above 5 indexes.A comminuted fracture was categorized into grade Ⅲ.Results Posterior comminutions were found in 35 cases (15.3％),but not in the other 194 ones (84.7 ％).No posterior angulation was observed in 27 cases (11.8％).Posterior angulation ≤30° was found in 44 cases (19.2％),that from 30° to 60° in 115 cases (50.2％),and that ≥60° in 43 cases (18.8％).Twenty patients(8.7％) had no displacement.Fracture displacement ≤ 10 mm was observed in 96 cases (41.9％),that from 10 to 20 mm in 96 cases (41.9％),and that ≥20mmin 17 cases (7.4％).The facture line was located below the head in 131 cases (57.2％),at the head-neck in 88 cases (38.4％),and across the neck in 9 cases (3.9％).The difference in neck-shaft angle was 0° in 12 cases (5.2％),≤ 10° in 105 cases (43.4％),10° to 20° in 84 cases (35.3％) and ≥20° in 28 cases (17.6％).In the 229 cases,our severity scores were related to Garden classification in the following manners:all Garden Ⅰ cases belonged to grade Ⅰ; Garden Ⅱcases contained grade Ⅰ in 15 cases (45.5％) and grade Ⅱ in 18 cases (54.5％);Garden Ⅲ cases included grade Ⅰ in 6 cases (3.1％),grade Ⅱ in 123 cases (64.7％) and Grade Ⅲ in 61 cases (32.2％); all Garden Ⅳ cases were Grade Ⅲ.Conclusion In assessment of the severity of femoral neck fractures,CT scans can be more accurate,objective and reliable,and can be quantified as well.

Objective To investigate incidence and onset of deep vein thrombosis (DVT) in elderly patients with hip fracture, and to evaluate the laboratory tests of plasma levels of D-Dimer, fibrinogen(FIB)and platelet(PLT) in diagnosing DVT. Methods From January, 2005 to December, 2006, 112 patients, 47 men and 65 women, aged 65 and over, were recruited into this study. Their mean age was 75.5 (range, 65 to 90) years. D-Dimer, FIB and PLT, as high specific fibrin degradation products, were detected via laboratory testing. The incidence, onset and distribution of DVT in these cases were observed. Univariate analysis was used to determine the associations between laboratory values and DVT. Influences of sex and type of hip fracture on the concentration of D-Dimer were studied as well. Results DVT was detected in 18 patients by means of B-mode ultrasonography and venography. The incidence rate of DVT in the elderly was 16. 1%. The onset of DVT took place between the second day and sixth day of hospitalization (average, 5.4 days), apparently earlier than the time of surgery (11. 6 days). Serum D-Dimer level was found significantly higher in the DVT group (P ＜ 0. 05) whereas levels of plasma FIB and PLT showed no significant influence on DVT(P ＞ 0. 05) . The D-Dirmer level was strongly influenced by type of fracture but not by sex.Conclusions Elderly patients with hip fracture have a high incidence of DVT. Since the onset of DVT usually happens before surgery, emergent operation is strongly indicated. A normal level of serum D-Dimer may be clinically significant in excluding the onset of DWT, but a simple rise in plasma D-Dimer level may not indicate DWT. The plasma levels of FIB and PLT may have no clinical significance in diagnosing DVT.D-Dimer level is not associated with sex of patients but with type of fracture.

Apoptosis ; Apoptosis Regulatory Proteins ; genetics ; Genetic Vectors ; Humans ; K562 Cells ; Transfection

Objective To present a self-designed self-guided driver for clinical removal of cannulated screws. Methods The diameter of the selfguided rod is 2.8 mm and its length is 50 mm.The hexagonal driver head is 4 mm in height,2 mm in width and 5 mm in length.The other parts are similar to those of a solid driver.We then tested the stabilization of the selfdesigned driver by measuring the lateral load and displacement in 5 different experimental groups.Next we put it into use in the 26 patients who had been treated in our department from July 2008 to July 2009.They had been divided into 2 groups randomly.In the self-guided group,there were 9 males and 4 females,with an average age of 36 years and an interval of 30 months after the first operation.In the solid driver group.there were 7 males and 6 females.with an average age of 43 years and an interval of 21 months after the first operation. Results The mechanical tests revealed that the instrument designed by us was stable and could prevent lateral displacement.In clinic.the 39 screws were removed saccessfully in the self-guide driver group.The mean surgical time and incision in the self-guided driver group were significantly less and smaller than in the solid driver group.Conclnsions The self-guided driver is as stiff as a common solid driver and as stable as a cannulated driver.It can reduce the likelihood of screw invalidation which may make the operation very difficult and timeconsuming.It is a simple,timesaving,and less traumatic instrument,especially fit for removal of cannulated screws of the femoral neck.

Objective The purpose of this study is to compare the most comfortable levels and neural re-sponse imaging threshold between children of cochlear implants with large vestibular aqueduct syndrome and normal inner ears. Methods Thirty-eight implanted children participated in this study and were divided into two groups. Group A consisted of 32 patients with normal inner ears and group B 6 patients with radiographically proven large vestibular aqueduct syndrome. All of the patients were the recipients of the cochlear implants by Advanced Bionics. The initial time for the first programming session was approximately one month after surgery. The psychophysical tests included M- level tests. Programming techniques used in the test were suitable for the age of patients. Sound-Wave 1.4 software was used to test tNRI. Results Using the rank sum test, M-level and tNRI of electrode 3,7,11 and 15 did not differ significantly between group A and B(P>0. 05). Conclusion The parameters of mapping are not significantly different between the implanted children with large vestibular aqueduct syndrome and normal inner ear. The management and procedures of mapping used to the subjects with normal inner ear can be applied to the children with large vestibular aqueduct syndrome.