Objective:To compare the clinical efficacy between femoral neck system (FNS) and inverted cannulated compression screws (ICCS) in the fixation of adult femoral neck fracture.Methods:The clinical data were retrospectively analyzed of the 119 patients with femoral neck fracture who had received FNS or ICCS internal fixation at Department of Traumatic Orthopedics, West China Hospital from September 2019 to June 2020. They were divided into 2 groups according to their internal fixation methods. In the FNS group of 62 patients, there were 38 males and 24 females, with an age of (54.0±13.0) years, and 13 cases of type Ⅱ, 34 cases of type Ⅲ and 15 cases of type Ⅳ according to the Garden classification; in the ICCS group of 57 patients, there were 42 males and 15 females, with an age of (53.2±11.3) years, and 9 cases of type Ⅱ, 33 cases of type Ⅲ and 15 cases of type Ⅳ according to the Garden classification. The operation time, intraoperative blood loss, fluoroscopy frequency, hospitalization time, fracture healing time, Harris hip score and incidence of complications were compared between the 2 groups.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data or follow-up duration ( P>0.05). There were significant differences between the FNS and ICCS groups in fluoroscopy frequency [(8.8±2.9) times versus (15.6±3.4) times], operation time [(45.2±10.1) min versus (51.8±11.7) min], fracture healing time [(3.2±0.4) months versus (4.0±0.6) months], Harris hip score at the last follow-up [(91.8±4.4) points versus (84.6±3.3) points], and femoral neck shortening at the last follow-up, favoring the FNS group (all P<0.05). There were no significant differences in follow-up time, hospitalization time, intraoperative blood loss or incidence of complications between the 2 groups ( P>0.05). Conclusions:In the fixation of adult femoral neck fractures, compared with ICCS, FNS can significantly reduce fluoroscopy frequency, shorten fracture healing and operation time, reduce risk of femoral neck shortening and hospitalization time, and promote functional recovery of the hip.

Objective:To understand the status quo of perception control, self-management and cancer-related fatigue (CRF) in breast cancer patients receiving chemotherapy, and to investigate the impacts of perception control and self-management on CRF.Methods:In this study, 246 breast cancer patients undergoing chemotherapy from Shandong Cancer Hospital and Institute were investigated by means of cross-sectional survey. Cancer experience and efficiency scale was used to evaluate the patients′ perception control; cancer patients′ self-management scale was used to assess their self-management; and Piper Fatigue Scale was used to evaluate their CRF. Finally, the scores of CRF among the patients with different demographic data were compared, and the effects of perception control and self-management behavior on CRF were analyzed.Results:In univariate analysis, there were statistically significant differences of CRF scores resulting from different educational backgrounds ( F=3.392, P=0.019), sources of medical cost ( F=4.368, P=0.005), disease stages ( F=4.376, P=0.005), chemotherapy periods ( F=3.865, P=0.010) and courses of disease ( F=3.094, P=0.028). The differences in each dimension of perceived control cancer experience ( F=7.248, P=0.001), control efficacy ( F=96.595, P<0.001), self-management level of cancer patients ( F=65.009, P<0.001) and CRF ( F=130.973, P<0.001) were statistically significant. Cancer experience in perception control was positively correlated with CRF ( r=0.467, P<0.001); control effectiveness and self-management of cancer patients were negatively correlated with CRF ( r=-0.505, P<0.001; r=-0.564, P<0.001). Multiple linear regression showed that source of medical expenses (setting commercial insurance as the reference group), chemotherapy cycle (setting chemotherapy cycle ≥ 6 cycles as the reference group), cancer experience, control effectiveness, and self-management were entered in regression models, which could explain 55.5% of the total variation in CRF scores, and there was a significant linear relationship ( F=17.100, P<0.001). Conclusion:Medical staff should focus on CRF in patients at their own expense and in the 2-5 chemotherapy cycles. Cancer experience is positively correlated with CRF. Control effectiveness and self-management behavior are negatively correlated with CRF.

Due to the complex anatomical structure of ankle and the various mechanisms of ankle injury, manyeponyms and systematic classifications of ankle fracture have been developed in the past centuries. Before the emergence and constant improvement of classifications of ankle fracture, ankle fractures were most commonly named afterthe physicians who first described them. Now,these ankle fracture eponyms are still found in medical literature, textbooks and even mass media. Many special named ankle fractures can be explained by the Lauge-Hansen classification now, and they may have little practical use. However, it is still necessary to summarize and review these ankle fracture eponyms, in order to correct the wrong usage of these and to remember the sages in this field.We reviewed both common and less frequently used ankle fracture eponyms, focusing on imaging features to identify and differentiate these injuries. We also briefly reviewed the mechanism of each injury, associated complications, its diagnosis and treatment.

Objective To compare elastic intramedullary nail (EIN) and plate-screw (P+S) system in the treatment of fibular diaphyseal fractures. Methods From January 2014 to April 2017, 48 tibiofibular fractures were treated with internal fixation using EIN (21 cases) or plate-screw (27 cases). The 2 groups were compared in terms of intraoperative blood loss, operative time, fibular healing time, fibular union rate, ankle function and postoperative complications.Results All the patients were followed up for 3 to 24 months (average, 14.0 months). The intraoperative blood loss (17.9 ± 4.9 mL), operative time (23.2 ± 5.8 min) and fibular healing time(10.3 ± 1.8 weeks)for the EIN group were significantly less than those for the plate-screw group (28.9 ± 9.6 mL, 30.0 ± 10.7 min and 11.6 ± 2.0 weeks)(P <0.05). There were no significant differences be-tween the 2 groups in fibular union rate(95.2% versus 92.6%) or incision infection(0 versus 7.4%)(P> 0.05) . The AOFAS ankle-hindfoot scoring revealed 12 excellent, 8 good and one fair cases (91.0 ± 5.3 points on aver-age) in the EIN group, and 14 excellent, 10 good and 3 fair cases(90.1 ± 6.1 points on average) in the plate-screw group, showing no significant difference between the 2 groups(P=0.594). Conclusions Compared with plate-screw system, elastic intramedullary nail for fibular diaphyseal fractures may be in line with the biome-chanical characteristics of the fibula and with the basic principles of minimally invasive surgery. It may be ad-vantageous in blood loss, operative time and fracture healing but not in fibular union rate or functional recovery of the ankle. An appropriate way of internal fixation for a fibular diaphyseal fracture should be chosen according to the specific conditions of the patient.

Objective To explore the experiences and expectations of parents whose children undergoing laparoscopic inguinal hernia surgery in order to make the preoperative visiting scheme and improve the effects of preoperative visiting.Methods From October to November 2017, in-depth interviews with parents of 9 inguinal hernia children were conducted, using purposive sampling methods. Using the method of explanatory phenomenology in qualitative research, the authentic feelings of parents were analyzed, and the information obtained was analyzed, sorted out and refined.Results The experience and expectation of preoperative visit of parents were summarized into three topics: the necessity and proper time of preoperative visit of children with laparoscopic hypospadias, the contents of preoperative visits of children undergoing laparoscopic inguinal hernia surgery and the methods of preoperative visits of children undergoing laparoscopic inguinal hernia surgery.Conclusions Operating room nurses should pay more attention to the preoperative visits of children and parents. Choosing appropriate visiting time, setting reasonable visiting content and adopting effective visiting means can provide scientific and humanized preoperative visiting for children and their parents, effectively alleviate their anxiety and improve their satisfaction.

Objective To evaluate open reduction and internal fixation (ORIF) combined with Ilizarov joint distraction in the treatment of comminuted talar body fractures.Methods Between July 2010 and May 2016,16 patients with comminuted talar body fracture underwent ORIF followed by ankle joint distraction by Ilizarov external fixator at our department.They were 9 males and 7 females,aged from 17 to 56 years (average,35.6 years).Radiological assessments were conducted by plain radiographs and computed tomography (CT) scans pre-and post-operatively.Clinical outcomes were evaluated according to visual analogue scale (VAS),American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score,the short form (SF)-36 health survey scores and patients' satisfaction.Results Two patients were lost to follow-up.The remaining 14 patients were followed up for an average duration of 33.3 months (from 13 to 52 months).All the fractures united.Superficial wound infection occurred in one case.Eight patients developed post-traumatic osteoarthris;4 patients presented with avascular necrosis.At final follow-ups,the AOFAS scores ranged from 30 to 97 points (mean,69.8 points),the VAS scores from 0 to 6 points (mean,2.5 points),the physical component summary in SF-36 from 18.0 to 55 points (mean,41.7 points),and the mental component summary from 40 to 70 points (mean,54.1 points).Two patients reported strong satisfaction,5 satisfaction,4 moderate satisfaction,and 3 dissatisfaction.Conclusion For comminuted talar body fractures,ORIF combined with Ilizarov joint distraction is a new and effective treatment which can not only provide adequate fixation strength but also reduce the incidence of post-traumatic osteoarthris or avascular necrosis.

Objective To evaluate the clinical outcomes of treating Freiberg's disease with dorsal wedge osteotomy and Charlotte breakage screw fixation.Methods From June 2010 to June 2014,11 patients with Freiberg's disease were treated at our department.They were 5 males and 6 females at an average age of 32 years(range,from 15 to 52 years).X-ray revealed osteosclerosis and collapse of the metatarsal head.According to Smillie classification system,there were 5 cases of stage Ⅱ and 6 ones of stage Ⅲ.The duration of symptoms was from 7 to 48 months (average,23 months).The metatarsal heads were rotated to reconstruct the joint surface.After dorsal closed V-shaped osteotomy,Charlotte breakage screws were implanted.Results All wounds healed with no complications in the early postoperative period.The 11 patients were followed up for 14 to 48 months (average,19 months),showing obvious pain relief.X-ray showed that the osteotomy sites got solid union in all patients at an average time of 10 weeks (range,from 8 to 13 weeks) after operation.Average shortening of the metatarsal was 1.5 mm (range,from 1.1 to 1.8 mm).The American Orthopaedic Foot and Ankle Society(AOFAS) score,Lesser Metatarsophalangeal-Interphalangeal Scale(LMIS) score,and range of motion at one day,one month and one year after operation were significantly improved compared with the preoperative ones (P ＜ 0.05).Significant differences were also observed between all postoperative time points (P ＜ 0.05).No such complications happened as referred pain from the adjacent metatarsophalangeal joint,displacement,nonunion,necrosis or infection.All patients returned to sports and recreational activities at 6 months after operation,except one case of stage Ⅲ who had constant swelling in the metatarsophalangeal joint but eventually recovered at 10 months after operation.According to patients' satisfaction at the last follow-ups,including 7 cases were excellent,3 good and one poor.Conclusion Dorsal closed V-shaped osteotomy with Charlotte breakage screw fixation is an effective procedure for Freiberg' s disease of stages Ⅱ and Ⅲ,because it leads to effective reconstruction of the metatarsophalangeal joint,allows early joint motion and avoids a second operation.

Objective To investigate the graduate students' mental pressure after the full im-plementation of the charging system and explore effective countermeasures of alleviating the psycho-logical pressure. Methods 413 full-time graduate students of Grade 2014 were randomly selected in a university of Shandong province. The graduate students' psychological pressure scale and self-designed questionnaire survey were used. The data were analyzed using SPSS 17.0 software, statistical descrip-tion of the survey data, independent sample t test, ANOVA. Results ①The psychological pressure of full-time graduate students at their own expense was in themedium pressure level; ②The economic pressure and academic pressure of the male graduate students were higher than those of the female graduate students (P=0.000,P=0.042), the rural economic pressures were greater than urban students graduate students graduate students (P=0.000); Professional graduate economic pressures were greater than academic graduate students (P=0.027);There is difference in the pressure of interpersonal commu-nication among different majors (P=0.016); ③78.75% (315/400) of the graduate students tuition fees, living expenses were mainly from their parents and the national and school awards; ④The percentage of those who completely agreed with the following view: full charge than at public expense is more advantageous to graduate education, comprehensive charge is advantageous to the education career development and comprehensive charge embodies the fairness of education was 84.75% (339/400), 71.25% (285/400) and 68.00% (272/400). Conclusion The full-time graduate students at their own expense have a more rational understanding of the charging policy; economic and academic pressures are the two outstanding pressure sources of the graduate students at the present stage. Graduate should improve their ability to cope with stress, and government and schools should take various measures to help students relieve stress.

Deep venous thrombosis (DVT) is an important cause of disability and mortality after major orthopedic surgery. The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who require major surgery have not yet been well explored in Chinese clinical practice. Here we report a case of calf muscular venous thrombosis in a 55-year-old woman with femoral neck fracture before surgery. Preventive and treatment measures including the administration of heparin sodium, application of venous foot pump and placement of inferior vena cava filter were taken. The condition of the patient was stable during the perioperative period and the surgery was successful. Besides, postoperative examination showed that the femur healed well and the functional recovery was satisfactory. Our results suggest that femoral neck fracture patients combined with DVT can receive surgery after accurate preoperative assessment and proper preoperative treatment.
Female ; Femoral Neck Fractures ; surgery ; Humans ; Middle Aged ; Perioperative Care ; Vena Cava Filters ; Venous Thrombosis ; therapy

Objective To evaluate the long-term efficacy of vascularized pisiform transfer for patients with Kienb(o)ck's disease in Lichtman stages Ⅲ-Ⅳ. Methods Eleven patients were reviewed to analyze results after lunate resection and vascularized pisiform transfer for Lichtman stages Ⅲ and Ⅳ. There were six men and five women. Age ranged from 20 to 67 years with a average of 41.0±14.3 years. According to Lichtman stage. There were 4 cases in stage Ⅲa, 5 cases in stage Ⅲb, and 2 cases in stage Ⅳ. Assessment criteria included subjective assessment of pain, visual analogue scale (VAS), range of motion (ROM), grip power,Cooney wrist score and radiographic changes on each follow-up visit. The radiographic changes including pis iform bone location, shape, sclerosis change, osteoarthritis, carpal height ratio, Nattrass index, Radioscaphoid angle and ulnar variance were recorded. Results The follow-up periods of all of cases were 61-202 months,with an average of 104.1 months. Pain had improved in 10 patients and disappeared in 7 cases. The VAS score was 2.2±1.9 at follow-up visit. Range of motion of injured wristw as only 65.3% of opposite side. Grip power was 84.3% of the contralateral hand. According to Cooney score, the results were excellent in 1 case, good in 7cases, fair in 2 cases and poor in 1 case, with the excellent and good rate of 72.7%. Radiologically, 8 cases had normal position of the pisiform bone, 2 had volar displacement and 1 had ulnar displacement which leaded to widen scaphopisiform space. Six pisiform bones had normal trabecular structure, three had degenerative changes. Bone sclerosis was seen in 2 cases and osteoarthritis was found in 3 patients. Compared with radiographic parameter before surgery, carpal height ratio and Nattrass index significantly lowered and radioscaphoid angle significantly increased. Conclusion Lunate resection and vascularized pisiform transfer is an effective method for Kienb(o)k′s disease in stages Ⅲ-Ⅳ. Although carpal collapse appeared postoperatively,the results show high patient satisfaction and good function after vascularized bone transplantation.