A systemic review and a meta-analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings.

We performed a meta-analysis to evaluate the influences of closed incisions in orthopaedic trauma surgery (OTS) by negative pressure wound treatment (NPWT) compared with conventional dressings. A systematic literature search up to March 2022 was done and 14 studies included 3935 subjects with OTS at the start of the study; 2023 of them used NPWT and 1912 were conventional dressings. They were reporting relationships between the influences of closed incisions in OTS by NPWT compared with conventional dressings. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the influences of closed incisions in OTS by NPWT compared with conventional dressings using the dichotomous methods with a random or fixed-effect model. NPWT had significantly lower deep surgical site infections (SSIs) (OR, 0.65; 95% CI, 0.48-0.87, P = .004), superficial SSIs (OR, 0.34; 95% CI, 0.19-0.61, P < .001), and wound dehiscence (OR, 0.41; 95% CI, 0.21-0.80, P = .009) compared with conventional dressings in subjects with closed incisions in OTS. NPWT showed a beneficial effect on deep SSIs, superficial SSIs, and wound dehiscence compared with conventional dressings in subjects with closed incisions in OTS. Further studies are required to validate these findings.

Calcifediol (25-hydroxyvitamin D) improvement and calcium-phosphate metabolism of alendronate sodium/vitamin D3 combination in Chinese women with postmenopausal osteoporosis: a post hoc efficacy analysis and safety reappraisal.

BACKGROUND: Vitamin D (VD) insufficiency or deficiency is a frequent comorbidity in Chinese women with postmenopausal osteoporosis (PMO). The present study aimed to investigate 25-hydroxyvitamin D [25(OH) D] improvement and calcium-phosphate metabolism in Chinese PMO patients treated with 70 mg of alendronate sodium and 5600 IU of vitamin D3 (ALN/D5600). METHODS: Chinese PMO women (n = 219) were treated with 12-month ALN/D5600 (n = 111) or calcitriol (n = 108). Changes in 25(OH) D at month 12 were post hoc analyzed by the baseline 25 (OH) D status using the longitudinal analysis. The main safety outcome measures included serum calcium and phosphate and 24-h urine calcium, and the repeated measures mixed model was used to assess the frequencies of the calcium-phosphate metabolic disorders. RESULTS: Absolute change in mean serum 25(OH) D level was the greatest in VD-deficient patients and least in VD-sufficient patients at months six and 12 (both, P < 0.01). Serum calcium level remained significantly lower in the ALN/D5600 treatment group than in the calcitriol treatment group throughout the 12 months. Mean 24-h urine calcium slightly increased in the ALN/D5600 treatment group and significantly increased in the calcitriol treatment group (+ 1.1 and + 0.9 mmol/L at months six and 12; both, P < 0.05). Calcitriol treatment was associated with more frequent hypercalciuria at month six (9.4% vs. 18.5%, P = 0.05), but not at month 12 (12.3% vs. 13.0%). CONCLUSION: Baseline VD status predicted 25(OH) D improvement in PMO patients on 12-month ALN/D5600 treatment. The daily use of 0.25 µg of calcitriol was associated with more frequent hypercalciuria at month six, compared to ALN/5600 treatment, necessitating the safety re-evaluation of calcitriol at a higher dosage.

[Diagnosis and management of atypical femoral fractures: clinical efficacy in 11 cases].

OBJECTIVE: To evaluate the clinical efficacy of intramedullary nail fixation in atypical femoral fractures and explore the management approach. METHOD: From January 2010 to December 2014, a total of 116 patients over 60 years old with femoral intertrochanteric fractures or femoral shaft fractures were treated in Department of Orthopaedics and Traumatology. Among the patients, 11 with atypical femoral fractures, aged from 62 to 82 ( 69.3±5.6) years old, received surgical treatments. There were 2 males (18.2%) and 9 females (81.8%). 5 patients (45.5%) had the prodromal symptom of thigh pain. 9 patients (81.8%) had the history of long-term use of bisphosphonates with the duration of 3 to 9 (5.3±2.1) years. All the fractures received close reduction and antegrade intramedullary nail fixation. The Thoresen score and EuroQol 5 dimensions scores (EQ-5D) were applied to evaluate the extremity function and life quality after surgery. RESULT: All the operations were performed successfully. At least 1 years follow-up was accomplished with the follow-up period of 1 to 4 (1.8±0.9) years. There were 8 (72.7%) excellent, 2 (18.2%) good, 1 (9.1%) fair according to the Thoresen score with total excellent to good rate up to 90.9% at the last follow-up. The EQ-5D scores showed the life quality was similar with that before injury (P>0.05). Fracture healing was achieved in all 11 cases with time from 3 to 8 (5.7±1.6) month. There was no case complicated with infection, nonunion or implant failure during the follow-up period. No contralateral atypical femoral fracture was observed. CONCLUSION: Atypical femoral fractures are uncommon in the clinical practice. Accurate diagnosis and appropriate management approach are the keys of satisfactory outcomes.

Modified donor blood flow-preserved cross-leg anterolateral thigh flap procedure for complex lower extremity reconstruction.

BACKGROUND: Complex lower limb reconstruction due to severe trauma remains a challenge for reconstructive surgeons. Here, we introduce a modified donor blood flow-preserved cross-leg anterolateral thigh flap procedure and evaluate its clinical efficacy. METHODS: Between January 2013 and December 2019, 22 patients (range 10 to 64 years old) with unilateral lower limb injury underwent modified donor blood flow-preserved cross-leg anterolateral thigh flap procedures. Among them, 16 cases were traffic accidents, 5 cases were persistent ulcers, and 1 case was a degloving injury. The arterial pedicle of the flap was prepared in a Y-shaped fashion and microanastomosed to the posterior tibial artery of intact leg in a flow-through style. A split-thickness skin graft was applied to wrap the vascular pedicle after anastomosis. The flap was designed in a single or bilobed fashion according to the shape of the tissue defect. The operation time, the intraoperative blood loss and the length of hospital stays were recorded. The vascular pedicle was divided 4 weeks after anastomosis. Doppler ultrasound was performed to evaluate the blood flow of the donor posterior tibial artery during postoperative follow-up. RESULTS: All 22 flaps survived. The tissue defects ranged from 12 × 6 to 21 × 18 cm2. The flap sizes ranged from 14 × 7.5 to 24 × 21 cm2. The average operation time, intraoperative blood loss and length of hospital stays were 6.73 ± 1.49 h, 280.95 ± 59.25 ml and 30.55 ± 2.52 days, respectively. Eighteen flaps were designed in a single fashion, while four were in bilobed fashion. Twenty patients underwent fasciocutaneous flap transplantations, while two underwent musculocutaneous flap transplantations. Two cases developed local lysis of the flap which healed after further debridement. Direct suture of the incision after flap harvest was performed in 16 cases, while additional full-thickness skin grafting was performed in the remaining 6 cases. Further bone transport procedures were performed in 15 patients who had severe tibia bone defects. The blood flow of donor posterior tibial artery was confirmed in all patients during follow-ups. All patients recovered flap sensation at the final follow-up. The postoperative follow-ups ranged from 18 to 84 months, and no long-term complications were observed. CONCLUSIONS: The modified donor blood flow-preserved cross-leg anterolateral thigh flap procedure is an ideal method to repair severe lower limb trauma with tibial artery occlusion which avoids sacrificing the major artery of the uninjured lower limb.

A Randomized Controlled Trial of FNB versus FICB for Patients with Femoral Neck Fractures Before Spinal Anesthesia.

BACKGROUND AND OBJECTIVES: Patients with femoral neck fractures often suffer severe pain. This randomized controlled clinical study compared the effect of femoral nerve block (FNB) and fascia iliaca compartment block (FICB) in this population. PATIENTS AND METHODS: Forty-six patients were randomly assigned to one of the two groups: FNB group (femoral nerve block, n=23) or FICB group (fascia iliaca compartment block, n=23). Before positioning for spinal anesthesia, patients received FNB with 15 mL of 0.5% ropivacaine or FICB with 40 mL of 0.5% ropivacaine. Pain was evaluated using a visual analogue scale (VAS) at rest and during hip flexion after admission to the operation room; at 3, 5, 8, and 10 min after analgesia intervention; and during positioning for spinal anesthesia. Positioning was attempted after 10 min of analgesia intervention in each group. Time required to perform spinal anesthesia, quality of positioning, and patient satisfaction were documented. RESULTS: The VAS scores in the FNB group were significantly lower than those in FICB group at 3 and 5 min after analgesia intervention (P=0.000). However, there were no significant differences in VAS between groups at 8 or 10 min or during positioning. CONCLUSION: FNB and FICB produce similar analgesic effects in patients with femoral neck fractures, but FNB has a more rapid onset of pain relief.

[Effect of schistosomiasis control in Jingzhou City from 2009 to 2013].

OBJECTIVE: To evaluate the effect of schistosomiasis control in Jingzhou City of Hubei Province from 2009 to 2013, so as to provide the reference for the establishment of control strategy in the future. METHODS: The annual reports on schistosomiasis control from 2009 to 2013 in nine counties (cities, districts) in Jingzhou City were collected and analyzed sta- tistically. RESULTS: The estimated number of schistosomiasis patients in Jingzhou City dropped from 78 903 in 2009 to 28 034 in 2013, with a reduction rate of 63.37%. The schistosome infection rate of residents dropped from 2.21% in 2009 to 0.65% in 2013, which showed an exponential decline trend (y = 3.196e(-0.317x)). The number of cattle with schistosomiasis decreased from 2 132 in 2009 to 0 in 2013, and the infection rate of cattle dropped from 1.87% in 2009 to 0% in 2013. Only 2 cases with acute infection of schistosome were found in 2009, and no schistosome infected snails were found out in 2 consecutive years, 2012 and 2013. CONCLUSIONS: The endemic level of schistosomiasis in Jingzhou City has decreased significantly. In order to consolidate the achievement of control, the comprehensive strategy including infection source control, snail control with mol- luscicides and snail surveillance should be implemented.

[Investigation on field feces in schistosomiasis endemic areas in Jingzhou City].

OBJECTIVE: To understand the status of field feces in Jingzhou City, so as to provide the evidence for improving the control measures to interrupt the transmission routes of schistosomiasis. METHODS: The distribution of field feces was investigated in 27 schistosomiasis endemic villages in Gong' an, Jianli, Jiangling, Honghu and Shishou counties (cities) from 2010 to 2012. The schistosome positive status of the field feces was surveyed with the hatching method. RESULTS: There were 1366 field feces and the average density was 0.0892 feces per 100 square meters in this survey. The cattle feces, human feces, dog feces and elk feces respectively accounted for 99.71%, 0.07%, 0.15% and 0.07% in the survey. The infection rates of the field feces were 1.46% and 2.42% in the channels and bottomlands, respectively (P > 0.05). The average rate of infected field feces was 3.21% in 2010, 0.36% in 2011, and 1.60% in 2012, and the difference between 2010 and 2012 was not statistically significant (P > 0.05). CONCLUSIONS: The main field feces come from cattle, and the main distribution of infected field feces is in channels and bottom-lands. Therefore, the management of cattle and treatment of field feces should be strengthened.

[Comparative evaluation of models for infectious source control of schistosomiasis in lake and marshland regions].

OBJECTIVE: To compare the effect of different models for the control of infectious source of schistosomiasis, so as to explore the control models suitable for lake and marshland regions. METHODS: The models of "replacement of cattle with machine" and "grazing prohibition and establishing fixed pasture" were implemented in 2 towns of Gong'an and Jianli counties, Hubei Province, respectively, and the data of infection situation of human and livestock, Oncomelania hupensis snail situation and the contamination status of wild faeces were collected and analyzed from 2008 to 2010. RESULTS: In 2010, for the model of "replacement of cattle with machine", the infection rate of residents in the observation group decreased by 56.82% comparing to that in 2008, the difference had a statistical significance (chi2 = 78.197, P < 0.01), and the decrease extent in the observation group was larger than that in the control group; the infection rates of cattle and snails, and the density of infected snails of the former were all decreased to 0. No wild faeces were discovered in the observation group, while 58 pieces of wild faeces were discovered but no schistosome eggs were found in these faeces in the control group. In 2010, for the model of "grazing prohibition and establishing fixed pasture", the infection rate of residents in the observation group decreased by 39.00% without a statistic significance (chi2 = 1.594, P > 0.05), and the infection rate of cattle decreased by 43.98% without a statistically significant difference (chi2 = 0.751, P > 0.05) comparing to those in 2008. The density of living snails decreased by 89.83% in the observation group, while that in the control group increased by 6.80%. A total of 11 pieces of wild faeces were collected in the observation group, with a positive rate of 18.18%, and 7 pieces were collected in the control group, all of which were negative. During the 2 years, no acute and advanced schistosomiasis patients were newly discovered. CONCLUSIONS: "Replacement of cattle with machine" and "grazing prohibition and establishing fixed pasture" are the main measures for schistosomiasis control in lake and marshland regions, the former is suitable for inner embankment regions, while the latter is suitable for the outer-embankment areas.

[Evaluation of a compound with dan-shen root and azone for scar treatment].

OBJECTIVE: To evaluate the effect of the compound of Dan-shen root and azone for scar treatment. METHODS: The rat skin in vitro and the human skin in vitro and vivo were separately examined their permeability of the mixture of the Dan-shen root and azone. The 301 patients with hypertrophic scar were randomly divided into two groups: one treated with elastic cloth paste (including silicone) contained in Dan-shen root with azone, and the another treated with only elastic cloth paste (including silicone). RESULTS: The permeability of Dan-shen root with azone, passing through the rat skin in vitro and the human skin in vitro and vivo was significantly higher than both the distilled water and the normal saline (P < 0.05). In the clinical study for treatment of the hypertrophic scars, the efficient rate of the group with the Dan-shen root with azone was significantly higher than the control (91.4% vs. 71.3%) (P < 0.01). CONCLUSION: The Dan-shen root with azone could be easier to permeate the skin and more effective to treat the hypertrophic scar.