Objective:To investigate the association between quantitative CT-derived hip bone mineral density (BMD) and all-cause mortality in elderly women after hip fracture surgery.Methods:A retrospective study was conducted to analyze the clinical data of the 254 elderly women with hip fracture who had been surgically treated at Department of Orthopaedics and Traumatology, Shunyi District Hospital between December 2018 and December 2019. Their average age was (79.3±7.7) years. There were 128 femoral neck fractures and 126 intertrochanteric fractures. CT images of their proximal femurs on the healthy side were analyzed using quantitative CT Pro software to assess the BMDs at the femoral neck, greater trochanter, intertrochanteric region, and total hip. The primary endpoint was all-cause mortality during follow-up. The patients were classified into a death group and a censored group (survivors and those lost to follow-up). The secondary outcome was recovery of pre-fracture ambulation. Multivariable Cox proportional hazards regression was performed to evaluate the association between regional hip BMD and mortality risk.Results:Of the patients, 236 obtained a follow-up of 36.9 (32.7, 42.6) months and 18 were lost to the follow-up. A total of 28.3% (72/254) of the patients died within 3 years after surgery. The overall hip BMD [(0.510 9±0.094 3) g/cm 2], the greater trochanter BMD [(0.351 0±0.079 6) g/cm 2], and the intertrochanteric BMD[(0.629 5±0.116 9) g/cm 2] in the death group were significantly lower than those in the censored group [(0.565 8±0.104 1) g/cm 2, (0.398 6±0.092 1) g/cm 2, and (0.685 6±0.126 6) g/cm 2]( P<0.05). The multivariate Cox regression analysis showed that a lower BMD at all hip sites measured was significantly associated with a higher mortality risk before adjustments ( P<0.05), but after confounding variables were adjusted, only the greater trochanter BMD ( HR=1.789, 95% CI: 1.035 to 3.092, P=0.037) and the intertrochanteric BMD ( HR=1.758, 95% CI: 1.018 to 3.037, P=0.043) were significantly associated with a higher mortality risk. Furthermore, follow-ups showed that 54 patients (56.3%, 54/96) in the high trochanter BMD group regained their pre-fracture ambulatory status, significantly more than the 22 patients in the low BMD group (32.4%, 22/68), showing an increased odds of ambulation recovery ( OR=2.688, 95% CI: 1.405 to 5.143, P=0.003). Conclusion:In elderly women with hip fracture, quantitative CT-derived measurement of the hip BMD, particularly in the trochanteric region, can serve as an early warning indicator of all-cause mortality after hip fracture surgery.

Objective Exploring the efficacy and prognostic analysis of open reduction and internal fixation combined with ligament repair in the treatment of ankle joint fractures with anterior tibiofibular ligament rupture.Methods Ninety-two patients with ankle fracture combined with lower tibiofibular anterior ligament rupture admitted to our hospital from January 2020 to August 2022 were selected to implement the prospective study,and they were divided into 46 cases in the study group and 46 cases in the control group according to the different treatment modalities.The control group only received open reduction and internal fixation surgery,while the research group received open reduction and internal fixation surgery combined with ligament repair treatment.The differences in surgical indicators and recovery,pain level(VAS score),ankle joint function recovery(AOFAS score,ankle ROM),bone metabolism indicators,postoperative complications,and long-term prognosis between the two groups were compared.Results Compared with the control group,the study group had longer operation time,shorter hospitalization time,and shorter fracture healing time(P＜0.05).Repeated measures showed that there were differences in the comparison of time-point effects,between-group effects,and interaction effects of VAS scores(P＜0.05),and VAS scores were lower in both groups at 1 month and 3 months postoperatively compared with preoperatively,and were better in the study group than in the control group(P＜0.05).Compared with preoperative,AOFAS score and ankle ROM were increased in both groups at 6 months postoperatively,and the study group was better than the control group(P＜0.05).Compared with preoperative,collagen type Ⅰ N-terminal peptide(PINP),osteocalcin(BGP),bone alkaline phosphatase(BALP)were elevated in both groups at 6 months postoperatively,and the level of β-collagen degradation product(β-CTX)β-CTX was reduced in the former(P＜0.05);and the study group was better than the control group(P＜0.05).Compared with the control group,there was no significant difference in the comparison of postoperative complication status(P＞0.05),but the study group had a better long-term prognosis(P＜0.05).Conclusion The combination of open reduction and internal fixation surgery with ligament repair for the treatment of ankle fracture combined with anterior tibiofibular ligament rupture has good clinical efficacy,can effectively reduce pain,improve ankle function,regulate bone metabolism level,promote fracture healing,and has good safety and long-term prognosis.

Objective Exploring the efficacy and prognostic analysis of open reduction and internal fixation combined with ligament repair in the treatment of ankle joint fractures with anterior tibiofibular ligament rupture.Methods Ninety-two patients with ankle fracture combined with lower tibiofibular anterior ligament rupture admitted to our hospital from January 2020 to August 2022 were selected to implement the prospective study,and they were divided into 46 cases in the study group and 46 cases in the control group according to the different treatment modalities.The control group only received open reduction and internal fixation surgery,while the research group received open reduction and internal fixation surgery combined with ligament repair treatment.The differences in surgical indicators and recovery,pain level(VAS score),ankle joint function recovery(AOFAS score,ankle ROM),bone metabolism indicators,postoperative complications,and long-term prognosis between the two groups were compared.Results Compared with the control group,the study group had longer operation time,shorter hospitalization time,and shorter fracture healing time(P＜0.05).Repeated measures showed that there were differences in the comparison of time-point effects,between-group effects,and interaction effects of VAS scores(P＜0.05),and VAS scores were lower in both groups at 1 month and 3 months postoperatively compared with preoperatively,and were better in the study group than in the control group(P＜0.05).Compared with preoperative,AOFAS score and ankle ROM were increased in both groups at 6 months postoperatively,and the study group was better than the control group(P＜0.05).Compared with preoperative,collagen type Ⅰ N-terminal peptide(PINP),osteocalcin(BGP),bone alkaline phosphatase(BALP)were elevated in both groups at 6 months postoperatively,and the level of β-collagen degradation product(β-CTX)β-CTX was reduced in the former(P＜0.05);and the study group was better than the control group(P＜0.05).Compared with the control group,there was no significant difference in the comparison of postoperative complication status(P＞0.05),but the study group had a better long-term prognosis(P＜0.05).Conclusion The combination of open reduction and internal fixation surgery with ligament repair for the treatment of ankle fracture combined with anterior tibiofibular ligament rupture has good clinical efficacy,can effectively reduce pain,improve ankle function,regulate bone metabolism level,promote fracture healing,and has good safety and long-term prognosis.

Objective:To investigate the association between quantitative CT-derived hip bone mineral density (BMD) and all-cause mortality in elderly women after hip fracture surgery.Methods:A retrospective study was conducted to analyze the clinical data of the 254 elderly women with hip fracture who had been surgically treated at Department of Orthopaedics and Traumatology, Shunyi District Hospital between December 2018 and December 2019. Their average age was (79.3±7.7) years. There were 128 femoral neck fractures and 126 intertrochanteric fractures. CT images of their proximal femurs on the healthy side were analyzed using quantitative CT Pro software to assess the BMDs at the femoral neck, greater trochanter, intertrochanteric region, and total hip. The primary endpoint was all-cause mortality during follow-up. The patients were classified into a death group and a censored group (survivors and those lost to follow-up). The secondary outcome was recovery of pre-fracture ambulation. Multivariable Cox proportional hazards regression was performed to evaluate the association between regional hip BMD and mortality risk.Results:Of the patients, 236 obtained a follow-up of 36.9 (32.7, 42.6) months and 18 were lost to the follow-up. A total of 28.3% (72/254) of the patients died within 3 years after surgery. The overall hip BMD [(0.510 9±0.094 3) g/cm 2], the greater trochanter BMD [(0.351 0±0.079 6) g/cm 2], and the intertrochanteric BMD[(0.629 5±0.116 9) g/cm 2] in the death group were significantly lower than those in the censored group [(0.565 8±0.104 1) g/cm 2, (0.398 6±0.092 1) g/cm 2, and (0.685 6±0.126 6) g/cm 2]( P<0.05). The multivariate Cox regression analysis showed that a lower BMD at all hip sites measured was significantly associated with a higher mortality risk before adjustments ( P<0.05), but after confounding variables were adjusted, only the greater trochanter BMD ( HR=1.789, 95% CI: 1.035 to 3.092, P=0.037) and the intertrochanteric BMD ( HR=1.758, 95% CI: 1.018 to 3.037, P=0.043) were significantly associated with a higher mortality risk. Furthermore, follow-ups showed that 54 patients (56.3%, 54/96) in the high trochanter BMD group regained their pre-fracture ambulatory status, significantly more than the 22 patients in the low BMD group (32.4%, 22/68), showing an increased odds of ambulation recovery ( OR=2.688, 95% CI: 1.405 to 5.143, P=0.003). Conclusion:In elderly women with hip fracture, quantitative CT-derived measurement of the hip BMD, particularly in the trochanteric region, can serve as an early warning indicator of all-cause mortality after hip fracture surgery.

Objective:To explore the epidemiological characteristics of geriatric hip fractures in Beijing so as to provide evidence for effective prevention and control measures.Methods:This multicenter study was conducted in 3 urban (Beijing Jishuitan Hospital, Beijing Hospital and Beijing Anzhen Hospital) and 3 suburban hospitals (Beijing Shunyi District Hospital, Beijing Changping District Hospital and Beijing Liangxiang Hospital) in Beijing from November 2018 to November 2019. Eligible patients were those aged ≥ 65 years with hip fracture confirmed by X-ray and being admitted to hospital within 21 days of injury. To explore the epidemiological characteristics of geriatric hip fractures in Beijing, such data were collected as patients' age, gender, comorbidities, as well as type, site, time and cause of the fracture.Results:① A total of 2,071 patients were included in this suevey. They were 653 males and 1,418 females (M∶F=1∶2.17). Their age ranged from 65 to 102 years (average, 79.8 years). The patients aged from 75 to 84 years were the most common, accounting for 44.81% (928/2,071). ② Femoral neck fractures accounted for 43.41% (899/2,071), and intertrochanteric fractures accounted for 56.59% (1,172/2,071). The age of the patients with femoral neck fracture was (78.6±7.7) years, which was significantly younger than that of those with intertrochanteric fracture [(80.7±7.4) years] ( P<0.05). ③ 94.69% of the hip fractures (1,961/2,071) were caused by falling, and 71.27% fractures (1,476/2,071) happened at home. ④ Approximately 83.00% of the patients (1,719/2,071) had one or more comorbid conditions. Hypertension was the most prevalent disease (57.89%, 1,199/2,071), followed by diabetes (27.09%, 561/2,071), and coronary atherosclerotic heart disease (22.02%, 456/2,071). Conclusions:In Beijing, significantly more geriatric females sustain a hip fracture than males, and the proportion of those aged from 75 to 84 year is the largest. The proportion of intertrochanteric fractures increases with age. Falls are the leading cause for geriatric hip fractures. Most of the patients have one or more chronic comorbid conditions. Corresponding prevention and intervention measures should be formulated according to the distribution characteristics of elderly hip fractures in Beijing.

Objective: To investigate the expression of programmed death receptor-1 (PD-1) and its value in predicting the infectious complications in elderly patients with hip fracture. Methods: A total of 119 elderly patients with intertrochanteric fracture(observation group) were prospectively enrolled for this study from August 2015 to August 2016 at Department of Orthopaedics, The Seventh Medical Center of PLA. They were 86 males and 33 females with an age of 80.7±8.1 years. Another 20 elderly out-patients with gonarthritis but without trauma or major medical disease were enrolled as a control group. The observation group received closed reduction and internal fixation with proximal femoral intramedullary nails. The PD-1 expression in peripheral blood T cells was detected at preoperation, 1, 3 and 5 days postoperation in the patients of observation group. They were further divided into an infection group and a non-infection group depending on whether infectious complications occurred during the follow-up period. The association between PD-1 and infectious complications was analyzed and its predictive value was calculated. Results: The observation group and the control group, as well as the infection group and the non-infection group, were compatible due to their insignificant differences in baseline data(P>0.05).Compared with the control group, the expression of PD-1 in the peripheral blood T cells in the observation group was all significantly increased at preoperation, 1, 3 and 5 days postoperation (P<0.05). The PD-1 expression in patients of the infection group (24 cases) increased significantly higher at 1, 3 and 5 days postoperation (33.60%±2.44%, 35.68%±4.05% and 30.36%±4.42%) than in those of the non-infection group (29.57%±3.20%, 21.45%±2.20% and 20.94%±2.30%) (P<0.05). The PD-1 expression in the infection group reached its peak at 3 days postoperation and did not fall to the preoperative level at 5 days postoperation. However, the PD-1 expression in patients of the non-infection group (95 cases) showed a transient rise only on the first day postoperation. The cutoff value of the difference in PD-1 expression between 1 and 3 days postoperation that could predict the infectious complications was 3.4%, with a sensitivity of 95.6% and a specificity of 92.6%. Conclusions The expression of PD-1 may significantly increase after intramedullary fixation of hip fracture in elderly patients. The patients with infectious complications may exhibit a greater and longer increase in PD-1 expression than those without infectious complications. The difference in PD-1 expression between 1 and 3 days postoperation has a good predictive value for infectious complications because its high sensitivity and specificity.

Objective To evaluate the results of patients operatively treated transverse plus posterior wall fractures of the acetabulum.Methods Review forty-five patients who had operated for transverse plus posterior wall fractures of the acetabulum 1 retrospectively with fracture displacement,from August 1993 to January 2005 in Department of Orthopaedics,Beijing Shunyi Hospital.The radiographs were graded according to the criteria described by Matta.The functional outcome was evaluated using a modification of the clinical grading system developed by Merle d'Aubigné and Postel.Result Forty-five patients were followed up 16 to 48 months with an average of 34 months.The radiographic result was excellent in seventeen patients,good in eighteen,fair in seven,and poor in four.The clinical outcome at the time of final follow- up was graded as excellent in fourteen patients,good in twenty- two,fair in eight,and poor in two.Conclusion Operative treatment for transverse plus posterior wall fractures of the acetabulum has a satisfying therapeutic effect.The appropriate operation time,reasonable operation approach,anatomic reduction and stable internal fixation is the key to obtain good results.