Objective:To explore our self-designed classification system of irreducible intertrochanteric fractures based on reduction stage and bone block position and to evaluate the reduction techniques guided by the classification system.Methods:A retrospective study was conducted to analyze the data of 115 patients with irreducible intertrochanteric fracture who had been admitted to Department of Orthopedics, Beijing Hospital from September 2014 to November 2022. There were 24 males and 91 females with a mean age of (80.9±11.0) years. The reduction for the fractures was divided into a diaphysis reduction stage (Phase Ⅰ) and a cortical reduction stage (Phase Ⅱ). Based on the relative positions of the intraoperative bone blocks, Phase Ⅰ was divided into an anterior and posterior interlocking type (Phase Ⅰa) and a distal bone block sinking displacement type (Phase Ⅰb) while Phase Ⅱ into a proximal lifting type (Phase Ⅱa), a posterior angulation type (Phase Ⅱb), a positive support type (Phase Ⅱc), and a negative support type (Phase Ⅱd). Depending on the difficulties encountered in different reduction stages, corresponding close reduction strategies (such as top rod support, percutaneous prying, and Joystick technique) were adopted to restore the proximal femoral neck shaft angle, anteversion angle, anterior medial cortex, and length of the affected limb before fixation with intramedullary nails. Recorded were the patient's surgical time, intraoperative bleeding, quality of postoperative reduction, fracture union time, and complications.Results:The surgical time for this group of patients was 70.0(60.0, 92.0) minutes, and the intraoperative blood loss 200.0 (170.0, 200.0) mL. According to the standards by Baumgaertner et al., the quality of postoperative reduction was evaluated as excellent in 103 cases and as good in 12 cases, with an excellent and good rate of 100.0% (115/115). Of the 115 patients, 86 were followed up for more than 6 months to reveal fracture union in all after a duration of 6.0 (4.0, 8.0) months. One patient died of an acute cardiovascular event in the hospital 5 days after surgery. Two patients lost their mobility within 3 months after surgery due to acute cerebral infarction. There was no internal fixation failure requiring secondary surgery or no incision infection.Conclusion:Guided by our self-designed classification system of irreducible intertrochanteric fractures based on the intraoperative reduction stage and the relative position of bone block, real time intraoperative fluoroscopy images can be used to effectively clarify the difficulty of fracture reduction in stages so that corresponding reduction strategies can be adopted, leading to fine clinical efficacy.

Objective:To analyze the epidemiological characteristics of geriatric hip fractures.Methods:This study retrospectively analyzed the clinical characteristics of 2 054 elderly patients with hip fracture aged 60 years and over who were admitted to Beijing Hospital from January 2011 to December 2020.The epidemiological characteristics of geriatric hip fractures were analyzed from the aspects of age, gender, fracture type, length of stay, surgical method and surgical complications.Results:The total number of hip fractures patients admitted from 2011 to 2020 showed a general upward trend in quantity.Among them, there were 1 177 femoral neck fractures(57.3%, 1 177/2 054), and 877 intertrochanteric femoral fractures(42.7%, 877/2 054)with statistical differences in the distribution of fracture types between patients at different ages( χ2=61.727, P<0.001). A total of 1 839 patients chose surgical treatment, accounting for 89.5% of the total number of patients.Artificial femoral head arthroplasty was the most common operation mode for patients with femoral neck fractures(783 cases, 75.4%).534 patients with intertrochanteric femoral fractures(66.8%)were treated with closed reduction and femoral intramedullary nailing.There was a statistically significant difference in operation modes among different fracture types( χ2=1 480.800, P<0.001). The length of hospital stay in patients with femoral neck fracture was(14.2±8.3)days, which was significantly longer than in patients with femoral neck fracture(13.2±10.9)days( t=2.417, P=0.016). There was no significant difference in the time from admission to operation between the two groups[(5.7±3.5)days vs.(5.4±3.3)days]( t=1.954, P=0.051). Among all the comorbidities of hip fracture patients, the top 5 diseases were cardiovascular system diseases(2 001 cases, 97.4%), nervous system diseases(1 105 cases, 53.8%), endocrine system diseases(814 cases, 39.6%), skeletal and muscular system diseases(623 cases, 30.3%), digestive system diseases(472 cases, 23.0%).1 485 patients(72.3%)had 3 or more comorbidities. Conclusions:Hip fractures in the elderly have some epidemiological distribution characteristics in terms of age, gender, length of hospitalization, injury mechanism and comorbidities, which is conducive to further improve the prevention and treatment strategies for hip fractures and promote the rational allocation of medical resources.

Objective:To evaluate the effects of percutaneous kyphoplasty(PKP)and percutaneous vertebroplasty(PVP)operation in elderly patients with osteoporotic vertebral compression fracture(OVCF).Methods:From June 2019 to June 2020, a total of 58 patients with OVCF aged over 60 and under 80 years who had a loss of more than one-third of the anterior margin height of vertebral and agreed to participate in the study were randomly divided into PKP group and PVP group.The visual analogue pain scale(VAS)score, SF-36 quality of life score, anterior height of fractured vertebral body, leakage of bone cement, refracture and cost of high-value consumables were observed at the time point before operation, 1 day, 1 month, 3 month, 6 month, 12 month after operation.Results:VAS scores in PKP and PVP groups were decreased after operation as compared with preoperation( F=115.380, 175.010, both P<0.001). VAS score was lower in the PKP group than in the PVP group at 6 months after operation with statistically significant difference( t=2.219, P=0.031), and no statistically significant difference at other time points between the two groups(all P>0.05). In the PKP and PVP groups, the height of the anterior edge of the vertebral body recovered significantly on the first day after operation, and there was a significant difference in the height compared with that before operation( F=43.020, 51.010, both P<0.001). The SF-36 scores at the latter time point in PKP and PVP groups were increased as compared with the previous time point.The increment of the SF-36 scores was statistically significant at 1 month after operation than pre-operation, and also at 3 months after operation than at 1 month after operation.The leakage rate of bone cement was 37.0%(10/27)in PKP group and 25.0%(7/28)in PVP group, with no significant difference between the two groups( χ2=0.930, P=0.391). The refracture rate was 3.7%(1/27)in PKP group and 7.1%(2/28)in PVP group, with no significant difference between the two groups( χ2=0.000, P=1.000). The cost of high-value consumables for single segment fracture was 46 490 yuan in PKP group, and 36 700 yuan in PVP group.The cost of PKP group was higher than that of PVP group. Conclusions:PKP and PVP operation in the treatment of osteoporotic vertebral compression fractures have good effects in aspect of analgesia, restoring vertebral height and improving patients' quality of life.The analgesic effect is slightly better in PKP group than in PVP group.PVP group has more advantages in health economics.

Objective:To investigate the clinical characteristics and prognosis of hip fractures in patients aged 90 and over.Methods:Clinical data of hip fracture patients aged 90 years and older admitted to Beijing Hospital from January 2016 to June 2020 were retrospectively analyzed.Patients were divided into a surgical treatment group and a conservative treatment group according to treatment received.Mortality and walking function 30 days and 1 year after injury were followed up.The mortality and walking function 1 year after injury in the two groups of patients were compared and analyzed, and related factors affecting the 1-year mortality rate of the surgical treatment group were analyzed.Results:Eventually 114 cases were included, with 18 in the conservative treatment group and 96 in the surgical treatment group.There were no significant differences in age, sex, American Society of Anesthesiologists(ASA)score, comorbidities, fracture type, hemoglobin, total protein, albumin and coagulation function at admission, walking ability before injury, and length of stay between the two groups(all P>0.05). Of the 18 conservatively treated patients, 9 died within 1 year(50.0%). Among 96 surgically treated patients, 20 died within 1 year(20.8%). The difference between the two groups was statistically significant( χ2=6.789, P=0.016). Among the 9 patients who survived 1 year after injury under conservative treatment, 1(11.1%)was able to walk independently, 2(22.2%)were able to walk with a walker, and 6(66.7%)were unable to walk; Among the 76 surviving patients 1 year after injury under surgical treatment, 16(21.1%)were able to walk independently, 50(65.8%)were able to walk with a walker, and 10(13.1%)were unable to walk.There was a statistically significant difference in walking ability between the two groups( χ2=20.030, P<0.001). Univariate analysis results showed that ASA score, walking ability before injury and total protein were correlated with 1-year mortality after injury( χ2 or t=5.803, -2.176, 29.400, all P<0.05). Multivariate logistic regression results showed that the inability to walk independently before injury was an independent risk factor for death within 1 year after injury[ HR(95% CI)=15.95(4.42-57.55), P<0.001]. Conclusions:The prognosis of surgical treatment of hip fractures in patients aged 90 and over is better than that of conservative treatment.The inability to walk independently before injury is an independent risk factor for death within 1 year after injury.

Objective:To analyze the risk factor of postoperative delirium in the elderly hip fracture patients.Methods:A total of 1051 patients with hip fracture aged 60 years and over, admitted to Beijing Hospital from January 2010 to December 2017 were retrospectively analyzed.They were divided into a postoperative delirium group(n=156)with 56 males and 100 females, 81 femoral neck fractures and 75 intertrochanteric fractures, and the control group(n=895)with no delirium, receiving the corresponding treatment in the same period.The complications, laboratory tests, fracture types, operation methods, the time from fracture to operation, operation time, intraoperative blood loss, intraoperative blood transfusion were compared between the two groups.Risk factors of postoperative delirium in the elderly hip fracture patients were screened using the binary multi-factor logistic regression analysis.Results:Of the 1 051 patients, 156 cases(14.8%)delirium occurred.There was no significant difference in fracture type and operation methods( P>0.05)between the 2 groups.The age was significantly older in the observation group(82.9±6.6)years than in the control group(79.9±7.2)years.The serum albumin before operation(37.1±2.9)g/L, creatinine clearance rate(52.4±22.2)ml·min -1·(1.73 m 2) -1in the observation group were significantly lower than in the control group[(37.8±3.8)g/L, (59.0±30.0)ml·min -1·(1.73 m 2) -1]( P<0.05). The past dementia rate was higher in delirium group[19.8%(31 cases)]than in control group[2.2%(20 cases)], with statistically significant difference( χ2=89.503, P<0.01). The proportion of patients with more than two medical diseases was higher in delirium group[51.9%(81 cases)]than in control group[40.3%(361)]( χ2=7.320, P<0.01). There were no significant differences(all P>0.05)between.the two groups in hemoglobin, white blood cell, serum K and Na, American Society of Anesthesiologists(ASA)grade, and the incidences of Parkinson's disease, pulmonary diseases and cardiovascular diseases(all P>0.05). The binary multi-factor Logistic regression analysis showed that the age, past dementia and kidney dysfunction were the risk factors for the postoperative delirium in the elderly hip fracture patients(all P>0.05). Conclusions:The incidence of postoperative delirium in the elderly hip fractures patients is high.Age, past dementia and kidney dysfunction are the risk factors for postoperative delirium in the elderly hip fracture patients, which should be prevented and improved preoperatively.

Objective:To evaluate our self-designed stick supporting reposition which was used to treat irreducible intertrochanteric fractures.Methods:A retrospective study was conducted of the 138 patients with irreducible intertrochanteric fracture (an observational group) who had been treated by stick supporting reposition followed by intramedullary nailing at Department of Orthopaedics, Beijing Hospital between April 2015 and December 2019. They were 45 males and 93 females with an age of (79.9±8.2) years; by AO classification, there were 25 cases of type 31-A1, 98 cases of type 31-A2 and 15 cases of type 31-A3. The other 142 patients with irreducible intertrochanteric fracture were included as a control group who had been treated by open or limited open reduction and intramedullary nailing between January 2010 and March 2015. The 2 groups were compared in terms of reduction time, operation time, intraoperative blood loss, reduction quality, fracture union time and complications.Results:The 2 groups were comparable because there was no significant difference between them in preoperative general data or follow-up time ( P>0.05). The reduction time [(12.0±3.4) min], operation time [(64.1±6.5) min], and intraoperative blood loss [(228.0±40.0) mL] in the observational group were significantly less than those in the control group [(18.3±8.9) min, (72.3±11.2) min and (319.1±95.0) mL] ( P<0.05). The reduction quality in the observational group (82 excellent and 56 acceptable cases) was significantly better than that in the control group (63 excellent, 65 acceptable and 14 poor cases) ( P<0.05). The fracture union time for the observational group [(3.8±0.9) months] was significantly shorter than that for the control group [(4.0±0.9) months] ( P>0.05). There were 6 cases of internal fixation failure and 8 cases of hip varus deformity in the control group, but no such complications occurred in the observational group. Conclusion:In the treatment of irreducible intertrochanteric fractures, compared with open or limited open reduction, our stick supporting reposition may shorten operation time, reduce intraoperative blood loss and improve quality of fracture reduction.

Objective:To analyze the risk factors for death within one year after non-operative treatment of hip fractures in the elderly.Methods:Clinical data of 83 elderly patients with hip fractures treated non-operatively from March 2012 to March 2017 who had met the criteria of inclusion and exclusion were included.They were divided into the death group and the survival group according to whether they had died within one year after non-operative treatment.Univariate and multivariate regression analysis were used to screen risk factors for death within one year after non-operative treatment.Results:Of the 83 patients, 26(31.3%)died within one year, including 10(38.5%)from pulmonary infections and 6(23.1%)from acute myocardial infarction.Univariate analysis showed that age, gender, walking ability before a fracture, number of comorbidities, coronary heart disease and COPD each had a significant impact on the death of patients within one year after receiving non-operative treatment( P<0.05). Multivariate Logistic regression analysis showed that age(≥76 years old)( OR=12.704, P=0.001), COPD( OR=5.870, P=0.042)and coronary heart disease( OR=7.451, P=0.007)were independent risk factors for death within one year after non-operative treatment. Conclusions:The mortality is as high as 31.3% in elderly patients with hip fractures within one year after non-operative treatment.The main cause of death is pulmonary infections.Age(≥76 years old), COPD and coronary heart disease are independent risk factors for death within one year after non-operative treatment.

Objective:To compare the short and medium-term effects of arthroscopic surgery versus intra-articular injections for rotator cuff tears with concomitant shoulder stiffness in elderly patients.Methods:We performed a retrospectively study that included 116 patients with rotator cuff tears combined with shoulder stiffness between January 2015 and June 2017, with 56 patients receiving arthroscopic surgery (the surgery group)and 60 patients given intra-articular injections (the control group). The visual analogue scale (VAS)score, range of motion (ROM), American Shoulder and Elbow Surgeons (ASES)score, University of California Los Angeles (UCLA)score were recorded before treatment and 3, 6 and 12 months after treatment.Results:Compared with pre-treatment, VAS scores were lower and ROM, ASES and UCLA scores were higher in both groups after treatment ( P<0.05). At 3 months after treatment, VAS scores were higher and ASES and UCLA scores were lower in the surgery group than in the control group ( P<0.05), while there was no significant difference in ROM between the two groups ( P>0.05). At 6 and 12 months after treatment, VAS scores were lower, ROM was larger, and ASES and UCLA scores were higher in the surgery group than in the control group ( P<0.05). Conclusions:In patients with rotator cuff tears combined with shoulder stiffness, both arthroscopic surgery and intra-articular injections can alleviate pain and improve ROM and shoulder joint function.After 6 months of treatment, greater improvement is achieved in patients undergoing arthroscopic surgery than in patients receiving intra-articular injections.

Objective To investigate the risk factors for postoperative cardiorespiratory complications within one month after operative treatment of hip fracture in the elderly. Methods Data of clinical examination ,samples test ,CT or MRI images were collected in 665 hip fracture patients aged 60 years and over who were admitted to our hospital from January 2010 to December 2014. Risk factors for postoperative cardiorespiratory complications within one month after operation were analyzed by correlation analysis and multiple regression analysis. Results The incidence of postoperative complications in cardiovascular system was 4.5% (30/665)in all patients.The risk factors for postoperative circulatory complications included gender ,high white blood cell(WBC)counts before operation ,hypoalbuminemia ,a low hemoglobin level (＜ 35 g/L ) ,renal insufficiency , hyponatremia ,pulmonary arterial hypertension ,segmental ventricular wall abnormal motion ,abnormal ST segment changes. The incidence of postoperative complications in respiratory system was 6.9% (46/665)in all patients. The risk factors for postoperative respiratory complications included high WBC counts before operation ,hypoalbuminemia ,chronic obstructive pulmonary disease (COPD ) , bronchiectasis and emphysema ,history of respiratory failure and abnormal lung markings (P＜0.05 or P＜ 0.01 ). Conclusions The elderly hip fracture patients have high incidence of postoperative respiratory and circulatory complications , and risk factors for these complications include accompanying diseases ,hypoalbuminemia ,abnormal echocardiography and electrocardiogram and hyponatremia.

Objective To investigate the causes and prognosis of conservative treatment for hip fracture in the elderly. Methods The 47 elderly patients undergoing conservative treatment for hip fracture were recruited and retrospectively analyzed in our hospital from July 2014 to June 2017. The causes of conservative treatment and corresponding therapeutic methods were analyzed ,and hip joint function ,complications ,survival situation at 12-36 months after fracture were followed up. Results A total of 47 hip fracture patients aged(80.0 ± 7.2)years(range ,63-92 years)with 25 females and 22 males included 30 cases with femoral neck fractures and 17 cases with intertrochanteric fractures.Details of prognosis of treatments in all (100% )patients followed for 12-36 months after fracture were as follows :(1 ) In treatment methods ,43 patients were treated with bed-rest immobilization after discharge from hospital and 4 patients were rehospitalized for surgery due to pain and intolerance of long-term bedridden. (2)There were 40 patients with three comorbidities or more , accounting for 85.1% of the total.11 cases had surgical contraindications.27 cases choose conservative treatment due to the high risk of surgery.9 cases gave up surgery due to psychological or economic reasons. (3)In complications and death ,complications were found in 43(91.5% ,43/47)patients with conservative treatment ,including pneumonia(37.2% ,16/43 cases ,)and bedsore(51.2% ,22/43 cases). (4)In fracture healing and hip joint function ,among the 43 patients receiving conservative treatment , hip fractures were not healed in 31 patients ,and fractures were malunited in 12 patients. Hip Harris score was poor in 31 cases and fair in 12 cases. The mortality rate within 1 year after fracture is high in the elderly hip fracture patients with conservative treatment and complication incidence rates are also high.Most of them have poor function recovery of hip joint ,and clinical results are not good. Conclusions The elderly hip fracture patients with conservative treatment have a high rate of complications and mortality within 1 year after fracture.Most of them have poor hip joint function recovery.