OBJECTIVE: To investigate the incidence of perioperative deep venous thrombosis (DVT) of lower extremities and its risk factors in elderly patients with femoral neck fracture. METHODS: The clinical data of 4 109 elderly patients with femoral neck fracture admitted between August 2012 and November 2020 and met the selection criteria were retrospectively analyzed. Among them, there were 1 137 males and 2 972 females; their ages ranged from 65 to 101 years, with an average of 77.0 years. The time from fracture to admission ranged from 1 to 360 hours, with an average of 35.2 hours. There were 1 858 cases of hemiarthroplasty, 1 617 cases of total hip arthroplasty, and 634 cases of internal fixation surgery. The preoperative age-adjusted Charlson comorbidity index (aCCI) was 4 (3, 5). Perioperative DVT occurred in 857 cases (20.9%). Univariate analysis was performed on age, gender, body mass index, fracture side, time from fracture to admission, operation type, anesthesia type, blood transfusion, blood pressure after admission, and preoperative aCCI in patients with and without perioperative DVT, and logistic regression analysis was used to screen the risk factors of perioperative DVT in elderly patients with femoral neck fracture. RESULTS: Univariate analysis showed that there were significant differences in age, gender, time from fracture to admission, operation type, and preoperative aCCI between the two groups ( P<0.05). Further logistic regression analysis showed that age>75 years, female patients, time from fracture to admission>24 hours, and preoperative aCCI>5 were risk factors for perioperative DVT ( P<0.05). CONCLUSION Elderly patients with femoral neck fracture have a higher incidence of perioperative DVT. The advanced aged and female patients, patients with longer fracture time and more comorbidities need to pay special attention to the prevention of perioperative DVT to minimize the occurrence of DVT during femoral neck fractures.
Humans ; Femoral Neck Fractures/complications* ; Female ; Male ; Aged ; Venous Thrombosis/epidemiology* ; Risk Factors ; Aged, 80 and over ; Retrospective Studies ; Lower Extremity/blood supply* ; Arthroplasty, Replacement, Hip/adverse effects* ; Incidence ; Fracture Fixation, Internal/methods* ; Postoperative Complications/etiology* ; Perioperative Period ; Logistic Models ; Hemiarthroplasty/adverse effects*

PURPOSE: Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods. METHODS: This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0). RESULTS: Average malunion (degrees) in the MIPPO group was 5 (3-7) ± 1.41 vs. 10.22 (8-14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001). CONCLUSION Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.
Bone Plates/adverse effects* ; Fracture Fixation, Internal/methods* ; Fracture Fixation, Intramedullary/methods* ; Fracture Healing ; Humans ; Minimally Invasive Surgical Procedures/methods* ; Prospective Studies ; Tibia/surgery* ; Tibial Fractures ; Treatment Outcome

OBJECTIVE: To explore clinical effect of lateral locking compression plate combined with medial buttress plate in treating osteoporotic comminuted fractures of proximal humerus. METHODS: From May 2017 to December 2021, 12 patients with osteoporotic comminution of proximal humerus were treated by lateral locking compression plates combined with medial buttress plates, including 5 males and 7 females, aged from 55 to 78 years old, bone mineral density(BMD) less than -2.5 g/cm3, the time from injury to operation was from 2 to 6 days. According to Neer classification, 7 patients were type Ⅲ, 4 patients were type Ⅳ and 1 patient was type Ⅵ. Postoperative complications, fracture healing and internal fixation were observed and Constant-Murley score of shoulder joint was used to evaluate clinical effects at 6 months after operation. RESULTS: Postoperative wound healed well at stage I. All patients were followed up from 6 to 18 months. Humeral head collapse and necrosis occurred in 1 patient and humeral head varus in 1 patient. No impact of shoulder joint, internal fixation loosening occurred. Constant-Murley score at 6 months ranged from 45 to 90 points, and 6 patients got excellent result, 3 good, and 3 poor. CONCLUSION Locking compression plate combined with medial buttress plate could effectively reconstruct medial humeral column support and enhance fracture stability, and receive satisfactory clinical results. However, no control group was established in this study, and function of shoulder joint has not been evaluated many times after operation, so it cannot dynamically reflect changes of shoulder joint function.
Aged ; Female ; Humans ; Male ; Middle Aged ; Bone Plates/adverse effects* ; Fracture Fixation, Internal/methods* ; Fractures, Comminuted/surgery* ; Humeral Fractures/complications* ; Humeral Head ; Humerus ; Shoulder Fractures/surgery* ; Treatment Outcome ; Osteoporotic Fractures/surgery*

PURPOSETo compare the clinical efficacy and complications of limited internal fixation combined with external fixation (LIFEF) and open reduction and internal fixation (ORIF) in the treatment of Pilon fracture.

METHODSWe searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the rate of nonunion, malunion/delayed union and the excellent/good rate assessed by Mazur ankle score. The complications including infections and arthritis symptoms after surgery were also investigated.

RESULTSNine trials including 498 pilon fractures of 494 patients were identified. The meta-analysis found no significant differences in nonunion rate (RR = 1.60, 95% CI: 0.66 to 3.86, p = 0.30), and the excellent/good rate (RR = 0.95, 95% CI: 0.86 to 1.04, p = 0.28) between LIFEF group and ORIF group. For assessment of infections, there were significant differences in the rate of deep infection (RR = 2.18, 95% CI: 1.34 to 3.55, p = 0.002), and the rate of arthritis (RR = 1.26, 95% CI: 1.03 to 1.53, p = 0.02) between LIFEF group and ORIF group.

CONCLUSIONLIFEF has similar effect as ORIF in the treatment of pilon fractures, however, LIFEF group has significantly higher risk of complications than ORIF group does. So LIFEF is not recommended in the treatment of pilon fracture.

Combined Modality Therapy ; External Fixators ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Tibial Fractures ; surgery

BACKGROUND: The Stoppa (intrapelvic) approach has been introduced for the treatment of pelvic-acetabular fractures; it allows easy exposure of the pelvic brim, where the bone quality is optimal for screw fixation. The purpose of our study was to investigate the surgical outcomes of unstable pelvic ring injuries treated using the Stoppa approach for stable anterior ring fixation. METHODS: We analyzed 22 cases of unstable pelvic ring injury treated with plate fixation of the anterior ring with the Stoppa approach. We excluded cases of nondisplaced rami fracture, simple symphyseal diastasis, and parasymphyseal fractures, which can be easily treated with other techniques. The average age of the study patients was 41 years (range, 23 to 61 years). There were 10 males and 12 females. According to the Young and Burgess classification, there were 12 lateral compression, 4 anteroposterior compression, and 6 vertical shear fracture patterns. The fracture location on the anterior ring was near the iliopectineal eminence in all cases and exposure of the pelvic brim was required for plate fixation. All patients were placed in the supine position. For anterior plate fixation, all screws were applied to the anterior ramus distally and directed above the hip joint proximally. Radiologic outcomes were assessed by union time and quality of reduction by Matta method. The Merle d'Aubigne-Postel score was used to evaluate the functional results. RESULTS: The average radiologic follow-up period was 16 months (range, 10 to 51 months). All fractures united at an average of 3.5 months (range, 3 to 5 months). According to the Matta method, the quality of reduction was classified as follows: 16 anatomical (73%) and 6 nearly anatomical (27%) reductions. There were no cases of screw or implant loosening before bone healing. The functional results were classified as 7 excellent (32%), 12 good (55%), and 3 fair (13%) by the Merle d'Aubigne-Postel score. There were no wound complications, neurovascular injuries, or other complications related to the surgical approach. CONCLUSIONS: Stable anterior ring fixation placed via the Stoppa approach can result in excellent reduction and stable screw fixation with a low complication rate.
Adult ; Female ; Fracture Fixation, Internal/adverse effects/*methods ; Hip Fractures/*surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones/injuries/*surgery ; Pelvis/injuries/*surgery ; Retrospective Studies ; Young Adult

OBJECTIVETo explore the therapeutic effects of internal fixation with Herbert screws for the treatment of Pipkin type I and type II femoral head fractures.

METHODSFrom January 2008 to December 2012, 23 patients with Pipkin type I and type II femoral head fractures were treated with open reduction and internal fixation by Herbert screws through Kocher-Langenbeck approach. Twenty-three patients (aged 18 to 52 years with a mean of 35.5 years, including 18 males and 5 females patients, 8 left hips and 15 right hips) with femoral head fractures and posterior hip dislocation. The fracture was classified according to Pipkin classification based on the radiographic findings, 5 patients had type I and 18 had type II fractures. The duration time from admission to the operation ranged from 6 to 72 h (averaged 32 h). The clinical and radiographic outcomes of the patients were measured using Thompson-Epstein scoring scale. The Harris hip score(HHS) was used to evaluate and compare hip functions at the latest follow-up between affected and healthy sides.

RESULTSAll the patients were followed up, and the duration ranged from 20 to 48 months (averaged 30 months). According to Thompson-Epstein system, 12 patients got an excellent result, 6 good, 4 fair and 1 poor. The average HHS at the finial follow-up was 87.80 ± 8.46 (ranged from 66 to 95), which is similar to that in the healthy side 90.10 ± 6.35 (ranged from 72 to 98) (t = 1.044, P = 0.302). The complications such as deep infection, and deep vein thrombosis were not found. At the 3rd year during follow-up,4 patients had avascular necrosis of femoral head. At the 1st year of follow-up, 1 patient had hip pain after walking,screws loosening and shift after trauma,and serious complications of traumatic arthritis. All the 5 patients were treated with total hip arthroplasties.

CONCLUSIONThe treatment of internal fixation with Herbert screws through the Kocher-Langenbeck approach is effective for Pipkin type I and type II femoral head fracture. The method is reliable and valuable for recommendation. However, such fracture may have avascular necrosis of femoral head and complication of traumatic arthritis, which should be observed carefully in clinic with preparation of the prevention and treatment measures.

Adolescent ; Adult ; Bone Screws ; Female ; Femoral Neck Fractures ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Male ; Middle Aged

Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures (OVCFs) after kyphoplasty. This finite element study was to examine whether short segment pedicle screw fixation (PSF) with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs. By simulating cement augmentation with or without short segment pedicle screw fixation (PSF), two tridimensional, anatomically detailed finite element models of the T10-L2 functional spinal junction were developed. The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations. The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra. The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae. Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.
Computer Simulation ; Finite Element Analysis ; Fracture Fixation, Internal ; adverse effects ; instrumentation ; methods ; Humans ; Kyphoplasty ; adverse effects ; instrumentation ; methods ; Osteoporotic Fractures ; etiology ; prevention & control ; Pedicle Screws ; adverse effects ; Postoperative Complications ; prevention & control ; Spinal Fractures ; etiology ; prevention & control ; Spine ; diagnostic imaging ; surgery

PURPOSETo compare the efficacy of percutaneous poking reduction and fixationwith open reduction and fixation in the treatment of displaced calcaneal fractures.

METHODSReports of studies using case-controlled trials (CCT) to compare the percutaneous poking reduction and fixation with the open reduction and fixation in the management of calcaneal fractures were retrieved from the Cochrane Library, PubMed Database, CNKI, Chinese Biomedical Database, Wanfang Data (from January of 2005 to August of 2015). Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.0 was used for data-analysis.

RESULTSFifteen articles were included in the meta-analysis. Comparison of the efficacy of percutaneous poking reduction and fixation with open reduction and fixation in the treatment of calcaneal fractures revealed statistical significance in the incidence of complications after operation [RR = 0.32, 95% CI (0.20, 0.5), p < 0.05]. However, there were neither statistical significance in the degrees of recovery for calcaneal Bohler angle [WMD = -1.65, 95% CI (-3.43, 0.14), p > 0.05] and calcaneal Gissane angle [WMD = -3.21, 95% CI (-6.75, 0.33), p > 0.05], nor statistical significance in the rate of good foot function after operation [RR= 0.95, 95% CI (0.90, 1.00), p > 0.05].

CONCLUSIONFor the treatment of calcaneal fractures, percutaneous poking reduction and fixation is su- perior to open reduction and fixation in terms of the incidence of postoperative complications. But both techniques can obtain satisfactory clinical function.

Calcaneus ; injuries ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Fractures, Bone ; surgery ; Humans ; Open Fracture Reduction ; adverse effects ; methods ; Postoperative Complications ; epidemiology ; Publication Bias

PURPOSETo describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis (MIPPO) of tibial shaft fractures with the use of a distraction support.

METHODSBetween March 2011 and October 2014, 52 patients with a mean age of 48 years (16-72 years) sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goni- ometer measurement on preoperative and postoperative images.

RESULTSPreoperative radiographs revealed a mean of 7.6°(1.2°-28°) angulation in coronal plane and a mean of 6.8°(0.5°-19°) angulation in sagittal plane. Postoperative anteroposterior and lateral radio- graphs showed a mean of 0.8°(0°-4.0°) and 0.6°(0°-3.6°) of varus/valgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted.

CONCLUSIONSThis study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.

Adolescent ; Adult ; Aged ; Bone Plates ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Tibial Fractures ; surgery

PURPOSETibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation (ExFix) and open reduction and internal fixation (ORIF) are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications.

METHODSA computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library (before December 2014) for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference (WMD), risk ratio (RR) and corresponding 95% confidence intervals (CI) were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2.

RESULTSTen cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection (p = 0.13), reduction (p = 0.11), clinical evaluation (p = 0.82), post-traumatic arthrosis (p = 0.87), and union time (p = 0.35). Besides, ExFix group was found to have a higher rate of superficial infection (p =0.001), malunion (p = 0.01) and nonunion (p = 0.02), but have a lower risk of unplanned hardware removal (p = 0.0002).

CONCLUSIONSWe suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, but a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation, post-traumatic arthrosis and union time.

External Fixators ; adverse effects ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Tibial Fractures ; surgery