Objective:To investigate the impact of multidisciplinary diagnosis and treatment on postoperative 30-day mortality and complications in elderly patients with hip fracture.Methods:A retrospective analysis was conducted of the 260 elderly patients with hip fracture who had been treated by the mode of multidisciplinary diagnosis and treatment at Department of Orthopedics, Shenzhen Second People's Hospital from June 2018 to October 2019. The multidisciplinary group consisted of 66 males and 194 females with an age of 78.7 years ± 5.1 years, and 141 femoral neck fractures, 114 intertrochanteric fractures and 5 subtrochanteric fractures. They were compared with the 242 elderly patients with hip fracture (traditional group) who had been treated by the traditional mode from January 2017 to May 2018. The 2 groups were compared in terms of preoperative waiting time, 48-hour operation rate, 30-day mortality, and incidences of postoperative pneumonia and pressure ulcer.Results:There were no statistically significant differences in the preoperative general data or operative procedures between the 2 groups, showing comparability ( P>0.05). For the multidisciplinary group, preoperative waiting time was 41.9 h ± 36.5 h, significantly shorter than that for the traditional group (71.4 h ± 13.9 h), 48-hour operation rate 66.5% (173/260), significantly higher than that for the traditional group(8.7%, 21/242), incidence of postoperative pneumonia 3.1%(8/260), significantly lower than that for the traditional group(9.9%, 24/242), incidence of postoperative pressure ulcer (5.4%, 14/260), significantly lower than that for the traditional group(11.2%, 27/242), and 30-day mortality(2.3%, 6/260), significantly lower than that for the traditional group(5.8%, 14/242) (all P<0.05). Conclusions:Establishment of a mode of multidisciplinary diagnosis and treatment can significantly reduce the prolonged preoperative waiting time for elderly patients with hip fracture, thereby greatly reducing postoperative complications and postoperative 30-day mortality.

BACKGROUND: The etiology of lumbar muscle strain is unclear, and it is a kind of specific disease. Lumbar muscles strain not only affects quality of life and work, but also causes heavy medical burden and indirect social costs. OBJECTIVE: To explore the effect of electropuncture and core strength training on lumbar muscle strain in college students. METHODS: The study was in accordance with the ethics requirements of Guangxi Normal University. Eighty college students with lumbar muscle strain were selected, and they signed the informed consents. The participants were randomized into control group (no intervention), electropuncture group, core strength training group, electropuncture with core strength training group. The intervention time was 7 weeks. The Visual Analogue Scale scores and pain system scores at baseline and after treatment were recorded. The recurrence was measured after 4 months of follow-up. RESULTSANDCONCLUSION: (1) The Visual Analogue Scale scores and pain system scores in the electropuncture, core strength training, and electropuncture with core strength training groups were significantly decreased compared with the baseline scores (P < 0.05). (2) The Visual Analogue Scale scores and pain system scores in the electropuncture, core strength training, and electropuncture with core strength training groups were significantly lower than those in the control group after intervention, and the scores in the electropuncture with core strength training group were significantly lower than those in the electropuncture and core strength training groups (P< 0.05). (3) The healing rate in the core strength training and electropuncture with core strength training groups was significantly higher than that in the electropuncture group, and the treatment efficacy in the core strength training and electropuncture with core strength training groups was significantly superior to the electropuncture group (P＜0.05). (4) The recurrence in the core strength training and electropuncture with core strength training groups was significantly lower than that in the electropuncture group (P＜0.05). (5) These results indicate that electropuncture and core strength training both have certain treatment efficacy for lumbar muscle strain in college students and core strength training is better than electropuncture, with lower recurrence. The synergistic effect of the combination of core strength training and electropuncture for lumbar muscle strain in college students is remarkable.

Objective To investigate the alignment of the elbow after Coonrad-Morrey (CM) total elbow arthroplasty (TEA),and to establish normal radiographic parameters correlated with prosthesis design in Chinese adults,as well as to detect whether CM prosthesis fits for Chinese.Methods Forty-two healthy volunteers were recruited and underwent radiographs of bilateral elbows in a standardized anterior-posterior (AP) fashion.Furthermore,99 AP radiographs of normal elbows and 54 AP radiographs of elbows after CM TEA were both collected from Picture Archiving and Communication System.The following radiographic parameters were measured:humerus-elbow-wrist (HEW) angle,the angle between the axis of humerus medullary cavity and the hinge axis of elbow (H-H angle),the angle between the axis of middle ulna medullary cavity and the hinge axis of elbow (MU-H angle),the angle between the axis of proximal ulna medullary cavity and the hinge axis of elbow (PU-H angle),the horizontal distance between the axis of humerus medullary cavity and the axis of proximal ulna medullary cavity (medullary translation).The differences in above parameters between normal elbows and elbows after CM TEA were compared.For normal elbows,the radiographic differences between male and female and that between right and left were analyzed,as well as the correlation with height.Results HEW angle (2.71°±8.08°) and medullary translation (1.79±3.49 mm) in patients after CM TEA were significantly less than that in normal (11.30°±7.21°,5.25±2.55 mm respectively),while H-H angle (89.92°±3.64°),MU-H angle (93.34°±6.30°) and PU-H angle (78.87°±4.79°) were significantly larger than that in normal (87.59°±5.62°,89.23°±5.66°,76.22°±4.69° respectively).The right HH angle of female was significantly larger than that in male.There were no significant difference in other parameters between male and female,and between right and left.All of the correlations between these parameters and height were not significant.Conclusion Elbow valgus decreases and forearm translates laterally after CM TEA in Chinese patients.Currently,the CM prosthesis can theoretically cause decreasing elbow valgns and lateral translation of forearm.

Objective:To study a new positioning method of elbow external fixation rotation axis,and to evaluate its feasibility.Methods:Four normal adult volunteers and six Sawbone elbow models were brought into this experiment.The kinematic data of five elbow flexion were collected respectively by opti-cal positioning system.The rotation axes of the elbow joints were fitted by the least square method.The kinematic data and fitting results were visually displayed.According to the fitting results,the average moving planes and rotation axes were calculated.Thus,the rotation axes of new kinematic methods were obtained .By using standard clinical methods,the entrance and exit points of rotation axes of six Sawbone elbow models were located under X-ray.And The kirschner wires were placed as the representatives of rotation axes using traditional positioning methods.Then,the entrance point deviation,the exit point de-viation and the angle deviation of two kinds of located rotation axes were compared.Results:As to the four volunteers,the indicators represented circular degree and coplanarity of elbow flexion movement tra-jectory of each volunteer were both about 1 mm.All the distance deviations of the moving axes to the ave-rage moving rotation axes of the five volunteers were less than 3 mm.All the angle deviations of the mo-ving axes to the average moving rotation axes of the five volunteers were less than 5 °.As to the six Saw-bone models,the average entrance point deviations,the average exit point deviations and the average angle deviations of two different rotation axes determined by two kinds of located methods were respective-ly 1.697 2 mm,1.838 3 mm and 1.321 7°.All the deviations were very small.They were all in an ac-cep-table range of clinical practice.Conclusion:The values that represent circular degree and coplanari-ty of volunteer's elbow single curvature movement trajectory are very small.The result shows that the elbow single curvature movement can be regarded as the approximate fixed axis movement.The new method can replace the traditional method in accuracy.It can make up the deficiency of the traditional fixed axis method.

Objective To report the early surgical outcomes of treating elbow varus posteromedialrotational instability (EVPRI),a pattern of traumatic elbow instability which has been recently described but incompletely understood. MethodsFrom December 2009 to April 2011,11 male patients with an EVPRI pattern were surgically treated in our hospital.Their average age was 33.8(from 22 to 40) years.They had 4 left and 7 right elbows affected.All had tenderness at the medial and lateral sides of the elbow and varus angulation of the elbow without dislocation.Their preoperative stress view X-rays and CT scans showed widened humeroradial joint space and fracture of the anteromedial facet of the coronoid process.We confirmed the diagnosis by applying yarus,pronated and axial stresses onto the forearm to evoke elbow dislocation,under fluoroscopy after anesthesia.In the initial operative treatment,the coronoid was repaired with a plate and K-wires applied to the medial surface of the coronoid,and a hinged external fixator was applied at the lateral side without repairing the lateral collateral ligament.Early rehabilitation was encouraged. Results All were followed up for an average of 14.4 (from 6 to 26) months.Each obtained an excellent result according to the Mayo Elbow Performance Index and recovered excellent elbow function.The average flexion was 137.8° ± 4.4° (from 130°to 140°), average extension 5.6°±7.3° (from 0 to 20°), average range of extension-flexion 132.2°±9.7°(from 120° to 140°),average pronation 87.8°±6.7°(from 70° to 90°),average supination 88.9° ± 3.3° (from 80° to 90°),and average range of rotation 176.7° ± 10.0° (from 150° to 180°).No complications such as varus subluxation of the elbow,infection and arthrosis occurred in this group. Conclusions Since EVPRI is a distinct type of elbow fracture-dislocation that must be recognized and adequately treated to restore good elbow function,inadequate or conservative treatment may cause subluxation,arthrosis or a poor outcome.Surgical treatment can achieve an excellent early outcome and avoid severe complications.

Objective To compare the clinical outcomes of open reduction and internal fixation (ORIF) with total elbow arthroplasty (TEA) for type C inter-condylar fractures of the distal humerus in the elderly. Methods Twenty-two patients who were treated with ORIF or TEA from April 2003 to September 2009 were included in the study. All fractures were OTA classification 13C. Among them, 10 patients who were treated with ORIF were follow up for 8-56 months, while 12 patients who were treated with TEA were followed up for 15-54 months. The Mayo elbow performance score (MEPS) and the complications were compared. Results Using the MEPS, there were 2 in excellent, 4 in good, 4 in fair in the patients treated with ORIF. Complications included heterotopic ossifications (2 cases) and ulnar nerve dysfunction (2 cases).There were 6 in excellent, 4 in good, 2 in fair in the patients treated with TEA. Complications included 1heterotopic ossification (1 case), ulnar nerve dysfunction (1 case), the weakness of musculus triceps brachii (1 case). The patients treated with TEA had significantly better range of motion (107.5° vs 84.5°, P=0.007),also had better MEPS (87.9 vs 75.5, P=0.047) than those with ORIF had ones. Conclusion TEA is a liable option for type C inter-condylar fractures of the distal humerus in the elderly.

Objective To evaluate the clinical results of arthroscopic repair of massive rotator cuff tear. Methods The study involved 16 patients with massive rotator cuff tears treated arthroscopically from September 2007 to June 2009. There were 6 males and 11 females at average age 61.5 years (45-75 years). The rotator cuff tears was repaired with arthroscopic double-row reconstruction. The range of motion, pain, strength of flexed elevation and function evaluation score were all recorded before operation and at final follow-up. The results were evaluated by t test and compared according to age and course of disease. Results All patients were healed without complications and the outcome was improved significantly ( P < 0.01 ). The mean VAS score was improved from preoperative 5.6 to postoperative 1.7,the average forward flexion from 69. 1°to 151.2°, the average external rotation from 14.7° to 32.2°, and internal rotation from L1 level to T10, the mean Constant-Murle from 39 to 85, the mean UCLA from 10.4 to 28, the mean SST from 2.8 to 8.8 and the strength of flexed elevation from 10.7% of normal side to 65.0%. Compared with preoperation, there was statistical difference in aspects of pain, range of motion, muscle strength and function in postoperation (P < 0.01 ). Conclusion Arthroscopic doublerow fixation can attain satisfactory results in repair of massive rotator cuff tear.

Objective To study advantages and disadvantages of the super-cutaneous calcaneal locking plate in the treatment of calcaneal fractures. Methods Between October 2007 to June 2008, 12cases of calcaneal fracture were treated with a super-cutaneous calcaneal locking plate. According to the Sanders classification system, 8 cases were of type ⅡA, one case of type ⅡB, one case of type ⅡC, one case of type Ⅲ AC, and one case of type Ⅳ. All the cases were fresh fractures. The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal. In direct observation of the posterior facet and anterior tuberosity, the articular fragments were reduced anatomically. Then the reduced calcaneus was fixed by a super-cutaneous calcaneal locking plate. After bone union was confirmed 3 months after the operation by the CT scans and X-ray films, the super-cutaneous plates and screws were removed in clinic. Results The average time of follow-up was 16 months with a span from 12 to 20 months. There were no incision or pin-hole infections. The reduction of the articular surface and bone union were good. One type ⅡA developed lateral wall exostosis which resulted in peroneal tendonitis and stenosis followed by obvious walking pain. The preoperative X-ray films of the 12 patients showed that the average B(o)hler angle was 11.9°±9.4° and the Gissane angle 86. 8°± 7. 7°. Their postoperative X-ray files demonstrated that the B(o)hler angle was improved to 29. 4°± 7.0° and the Gissane angle to 115.8°± 7.7°, with a significant difference ( P ＜ 0. 01 ). According to the Ankle Hindfoot Clinical Rating System of the American Orthopaedic Foot and Ankle Society (AOFAS),their average score was 91 points (68 to 100 points). Conclusions Using a super-cutaneous calcaneal locking plate to treat calcaneal fractures can result in limited invasion, a low rate of skin infection, satisfactory reduction of the articular surface and stable fixation. Since the fixation can be removed without re-hospitalization, it is a cheaper and less painful alternative for the treatment of displaced intra-articular calcaneal fractures.

Objective To compare the posterior midline approach and the combined lateral and medial approach usually used in elbow arthrolysis. Methods From January to December in 2009, 41 cases of elbow stiffness were treated and fully followed up by the same team in our hospital. The posterior midline approach was used in 21 cases, 15 males and 6 females, with an average age of 35.8 years (16 to 70 years). In this group, the total flexion-extension arc was ＜ 30° in 12 cases, 31° to 60° in 7 cases, and 61° to 90° in 2 cases. Eight cases had ulnar symptoms. The combined lateral and medial approach was applied in 20 cases, 8 males and 12 females, with an average age of 38. 8 years (16 to 51 years). In this group, the total flexion-extension arc was ＜ 30° in 11 cases, 31° to 60° in 7 cases, and 61° to 90° in 2 cases. Five cases had ulnar symptoms. Results The 41 cases were followed up for 4 to 15 months (average, 7.9 months). In the posterior approach group, the mean preoperative flexion-extension ROM (27.6°± 25.7°) was improved to the postoperative 111.4°± 25.6°, the mean preoperative rotation ROM ( 152.9°± 46. 9°) to the postoperative 168.1°± 19. 1°, and the mean preoperative MEPS score (65.5 ± 11.5) to the postoperative 95.7 ±6.4. In the combined approach group, the mean flexion-extension ROM was improved from 35.5°± 25.0° preoperatively to 116. 5°± 19.1° postoperatively, the mean rotation ROM from 138.0°±55.7° preoperatively to 148.5°± 45.6° postoperatively, and the mean MEPS score from 66. 3 ± 13.0 preoperatively to 97.3 ± 7.0 postoperatively. The differences were statistically significant between preoperation and postoperation in both groups ( P ＜ 0. 05), but not statistically different between the 2 groups in the preoperative or postoperative values ( P ＞ 0. 05). In the posterior approach group, 5 patients had huge hematoma, 3 had wound dehiscence at the posterior elbow, and the others all had mild hematoma. But in the combined approach group, no wound complications were noted. Conclusion The combined lateral and medial approach should be used as far as possible in the elbow arthrolysis to avoid the likely complications when the posterior midline approach is used.

BACKGROUND: Artificial humeral head replacement is an effective method for the treatment of complex proximal humeral fractures, which has received good results in relieving pain. However, the final functional recovery is unpredictable. OBJECTIVE: To compare biomeshanical stability between anatomical and overlapping reconstruction of the greater tuberosity in cadaveric humeral head replacement models.METHODS: Eight pairs of fresh-frozen shoulder cadavers (16 shoulder joints) were match-paired into two groups. Standardized humeral head replacement procedure was performed in all specimens, and anatomical and overlapping reconstruction of thegreater tuberosity was adopted in each group respectively. For overlapping group, the greater tuberosity was reattached to the proximal humeral shaft in an overlapping style, which was achieved by an additional 5 mm bone osteotomized from the medial cortex of the humeral diaphysis. Custom mounting apparatus and fixation jigs were designed for designated shoulder motion.RESULTS AND CONCLUSION: When the shoulder was external rotated to neutral position, the mean displacement of greater tuberosity in the anatomical reconstruction group was smaller than that of the overlapping reconstruction group (P < 0.05). When the gleno-humeral joint was elevated to 30～ and 60～ forward flexion (accounting for 45° and 90° shoulder forward flexion), there was no significant difference of greater tuberosity displacement between the anatomical group and overlapping group. The findings demonstrated that, although overlapping reconstruction can increase the bone healing area between the greater tuberosity and the humeral diaphysis, there may be some loss in mechanical stability as the trade-off. Even though we strictly follow the standardized postoperative rehabilitation protocol after humeral head replacement, prominent displacement between the greater tuberosity relative to the humeral diaphysis was detected. Accordingly, postponing of the postoperative rehabilitation program after humeral head replacement for a decent period may improve tuberosity healing.