One-year mortality risk in older individuals with femoral intertrochanteric fracture: a tertiary center in China.

BACKGROUND: The accelerated growth of older individuals worldwide has increased the number of patients presenting with fragility hip fractures. Having a hip fracture can cause excess mortality, and patients with hip fracture have a higher risk of death than those without hip fracture. Most studies have treated hip fracture as a single, homogeneous condition, but hip fracture includes two major anatomic types: intertrochanteric fracture and femoral neck fracture. Few studies have specifically evaluated 1-year mortality risk in older individuals with femoral intertrochanteric fracture. The aim of this study was to evaluate 1-year mortality and factors associated with mortality in older individuals with femoral intertrochanteric fracture. METHODS: A retrospective review was conducted of 563 patients ≥ 65 years old who underwent surgery for femoral intertrochanteric fractures at our institution between January 2010 and August 2018. Patient demographics, comorbidities, and treatment were collected by retrospective chart review. Age, sex, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) classification, Charlson comorbidity index (CCI), Arbeitsgemeinschaft Für Osteosynthesefragen (AO) fracture classification, haemoglobin value at admission, time to surgery, operation time, and intraoperative blood loss were risk factors to be tested. Multivariable logistic regression was used to evaluate associations between variables and death. RESULTS: Among the 563 patients, 49 died within 1 year after surgery, and the 1-year mortality rate was 8.7%. Multivariate analysis identified age > 80 years (OR = 4.038, P = 0.011), haemoglobin < 100 g/l (OR = 2.732, P = 0.002), ASA score ≥ 3 (OR = 2.551, P = 0.005), CCI ≥ 3 (OR = 18.412, P = 0.018) and time to surgery > 14 d (OR = 3.907, P = 0.030) as independent risk factors for 1-year mortality. Comorbidities such as myocardial infarction and chronic pulmonary disease were associated with 1-year mortality after adjusting for age > 80 years and time to surgery > 14 days. CONCLUSIONS: Patients over 80 years old with haemoglobin < 100 g/l, ASA score ≥ 3, CCI ≥ 3, and multiple comorbidities, especially myocardial infarction and chronic pulmonary disease before surgery, are at a higher risk of 1-year mortality. Doctors should pay more attention to these vulnerable patients, and a surgical delay greater than 14 days should be avoided.

Clinical predictors for deep vein thrombosis on admission in patients with intertrochanteric fractures: a retrospective study.

BACKGROUND: Limited studies were available to investigate the prevalence of deep vein thrombosis (DVT) on admission in elderly patients with intertrochanteric fractures. The aim of present study was to evaluate risk factors and the prevalence of pre-admission DVT in elderly patients with intertrochanteric fractures. METHODS: This retrospective study included 788 elderly patients with intertrochanteric fracture who were eligible for this study from January 1, 2010, to December 31, 2019. Color doppler ultrasonography was performed for DVT detection at admission. All patients' clinical data were collected. Univariate analysis and stepwise backward multivariate logistic regression were used to identify the risk factors contributing to the occurrence of DVT. RESULTS: The overall prevalence of pre-admission DVT in patients with intertrochanteric fractures was 20.81% (164 of 788 patients). The mean time from injury to admission was 2.1 days in the total population, 2.96 and 1.87 days in patients with and without DVT. Univariate analysis showed that significantly elevated risk of DVT were found in patients with longer time from injury to admission, high energy injury, lower Hb value, higher BMI, diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation, dementia, varicose veins, higher age-adjusted CCI, higher ASA class and A3 type intertrochanteric fractures (P < 0.05). The adjusted multivariate logistic regression analysis demonstrated that longer time from injury to admission, high energy trauma, COPD, lower Hb, diabetes and A3 type intertrochanteric fractures were independent risk factors of pre-admission DVT. CONCLUSIONS: A high prevalence of pre-admission DVT was found in elderly Chinese patients with intertrochanteric fractures. Therefore, surgeons should be aware of the high prevalence of DVT for elderly patients with intertrochanteric fractures in order to prevent intraoperative and postoperative PE and other lethal complications.

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery.

BACKGROUND: We aimed to distinguish the preoperative radiological indicators to predict the application of assistant techniques during intubation for patients undergoing selective cervical surgery. METHODS: A total of 104 patients were enrolled in this study. According to whether intubation was successfully accomplished by simple Macintosh laryngoscopy, patients were divided into Macintosh laryngoscopy group (n = 78) and Assistant technique group (n = 26). We measured patients' radiographical data via their preoperative X-ray and MRI images, and compared the differences between two groups. Binary logistic regression model was applied to distinguish the meaningful predictors. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. The highest Youden's index corresponded to an optimal cut-off value. RESULTS: Ten variables exhibited significant statistical differences between two groups (P <  0.05). Based on logistic regression model, four further showed correlation with the application of assistant techniques, namely, perpendicular distance from hard palate to tip of upper incisor (X2), atlanto-occipital gap (X9), angle between a line passing through posterior-superior point of hard palate and the lowest point of the occipital bone and a line passing through the anterior-inferior point and the posterior-inferior point of the second cervical vertebral body (Angle E), and distance from skin to hyoid bone (MRI 7). Angle E owned the largest AUC (0.929), and its optimal cut-off value was 19.9° (sensitivity = 88.5%, specificity = 91.0%). the optimal cut-off value, sensitivity and specificity of other three variables were X2 (30.1 mm, 76.9, 76.9%), MRI7 (16.3 mm, 69.2, 87.2%), and X9 (7.3 mm, 73.1, 56.4%). CONCLUSIONS: Four radiological variables possessed potential ability to predict the application of assistant intubation techniques. Anaesthesiologists are recommended to apply assistant techniques more positively once encountering the mentioned cut-off values.

An innovative strategy to treat large metaphyseal segmental femoral bone defect using customized design and 3D printed micro-porous prosthesis: a prospective clinical study.

Five patients with segmental irregular-shaped bone defect of the femur were recruited in this study from 2017.12 to 2018.11. All patients were treated by customized design and 3D printed micro-porous prosthesis. And the procedure was divided into stages: radical debridement and temporary fixation (the first stage); the membrane formation and virtual surgery (intervening period for 6-8 weeks); definite reconstruction the defects (the second stage). Routine clinical follow-up and radiographic evaluation were done to assess bone incorporation and complications of internal fixation. The weight-bearing time and the joint function of the patients were recorded. The patients were followed up for an average of 16.4 months. The average length of bone defect and the distal residual bone was 12 cm and 6.5 cm. The average time of partial weight-bearing and full weight-bearing was 12.7 days and 2.6 months. X-ray demonstrated good osseous integration of the implant/bone interface. No complications occurred such as implant loosening, subsidence, loss of correction and infection. At the last follow-up, Harris score of hip joint was excellent in 2 cases, good in 2 cases, fair in 1 case; HSS score of knee joint was good in 4 cases, middle in 1 case. From our study, we concluded that meticulous customized design 3D printed micro-porous prosthesis combined with intramedullary nail may be a promising and an alternative strategy to treat metaphyseal segmental irregular-shaped femoral bone defect, especially for cases with massive juxta-articular bone loss.

[Comparison of curative effects between minimally invasive locking plate internal fixation and open reduction with internal fixation for the treatment of proximal humerus fractures].

OBJECTIVE: To investigate the comparison of curative effects in treating proximal humerus fractures' patients between minimally invasive locking plate internal fixation and open reduction with internal fixation, and to provide guidance for the operation method of the proximal humerus fracture patients. METHODS: In the study, 157 patients of proximal humerus fractures from May 2006 to December 2012 in Peking University Third Hospital were analyzed retrospectively, of whom 78 were followed up, including 19 males and 59 females. They were from 15 to 90 years old, with the mean age of 60.5 years. According to Neer classification, there were 53 cases of two-part fractures, 19 cases of three-part fractures and 6 cases of four-part fractures. According to AO classification, there were 49 cases of type A,21 cases of type B and 8 cases of type C. There were 24 cases treated with minimally invasive locking plate internal fixation operation and 54 cases treated with open reduction with internal fixation operation. The patients were followed up with postoperative physical examinations and X ray examinations. Postoperative shoulder pain after 1 week and more than 6 months was assessed using the VAS score. Postoperative shoulder joint function with the use of Constant-Murley score and ASES score were evaluated after 3 months and more than 6 months. The results were analyzed by SPSS 18.0. RESULTS: The follow-up time was 6 to 85 months, with the mean time of 33.8 months. According to the rank sum test: there were significant differences in operation time (P=0.002), postoperative hospital day (P=0.001), the satisfaction of patients (P=0.029), postoperative shoulder pain after 1 week (P=0.024), postoperative Constant-Murley score after 3 months (P=0.012) and postoperative ASES score after 3 months (P=0.001) between minimally invasive group and non-minimally invasive group. There weren't significant differences in clinical union time of bone (P=0.446), postoperative shoulder pain after more than 6 months (P=0.894), postoperative Constant-Murley score after more than 6 months (P=0.122) and postoperative ASES score after more than 6 months (P=0.351) between minimally invasive group and non-minimally invasive group. There were no breakage of the internal fixation and humeral head osteonecrosis. Minimally invasive group had 2 cases with internal fixation loosening (8.3%) and 1 case with complete limitation of abduction (4.2%). Non-minimally invasive group had 1 case with tracture nonunion (1.9%), 1 case with internal fixation loosening (1.9%) and 1 case with complete limitation of abduction (1.9%). CONCLUSION: The operation method of proximal humerus fractures is an important factor affecting the recovery of shoulder joint function. Minimally invasive locking plate internal fixation operation in early stage (1 week) of pain control, early (3 months) functional recovery, operation time, postoperative hospital day and patient satisfaction are better than those of traditional operation.

[Analysis of the blood loss in perioperative period of femoral intertrochanteric fractures in old patients treated with different internal fixations].

OBJECTIVE: To analyze blood loss in perioperative period of femoral intertrochanteric fractures in old patients treated with Gamma interlocking intramedullary nail (Gamma3), proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS), and to comprehend the character of blood loss in perioperative period of femoral intertrochanteric fractures. METHODS: A retrospective analysis was made of the medical records of 408 old patients with femoral intertrochanteric fractures admitted to our hospital between January 1, 2007 and to December 31, 2012. The estimated blood loss was calculated by Gross equation, according to the height, weight and changes of blood test pre- and post-operation and the differences of blood loss among Gamma3 group, PFNA group and DHS group were compared. The statistical analysis was conducted using One-Way ANOVA analysis with SPSS 13.0. A P value less than 0.05 was considered statistically significant. RESULTS: In the Gamma3 group (96 cases, 39 males, 57 females), the average operation time was (74.7 ± 25.0) min, the mean obvious blood loss was (103.5 ± 83.0) mL, the mean total blood loss was (831.9 ± 474.8) mL, and the mean hidden blood loss was (728.3 ± 455.5) mL. In the PFNA group (84 cases,31 males, 53 females), the average operation time was (69.0 ± 27.1) min, the mean obvious blood loss was (91.5 ± 111.4) mL, the mean total blood loss was (825.7 ± 478.0) mL, and the mean hidden blood loss was (734.2 ± 455.7) mL. In the DHS group (40 cases, 14 males, 26 females), the average operation time was (97.5 ± 25.0) min, the mean obvious blood loss was (283.6 ± 142.1) mL, the mean total blood loss was (695.7 ± 502.4) mL, and the mean hidden blood loss was (412.1 ± 457.6) mL. CONCLUSION: By comparing the three kinds of internal fixation methods we find that the Gamma3 and PFNA groups have a smaller size of incision, shorter time of operation and less intraoperative bleeding than the DHS group, but there is a considerable perioperative hidden blood loss. We should give enough attention to reducing the incidence of postoperative complications.

A Novel Classification of Cervical Spine Trauma in Ankylosing Spondylitis and Corresponding Surgical Outcomes.

OBJECTIVE: Currently, there are no reports on the specific classification of cervical spine trauma (CST) in ankylosing spondylitis (AS) based on the trauma mechanism. In this study, we aimed to describe a novel classification of CST in AS with more details, and put forward the corresponding surgical outcomes related to different types, hoping to provide a practical reference for clinical decision-making and academic communication. METHODS: From January 2008 to December 2021, AS patients who experienced CST were retrospectively reviewed and included. Clinical data including gender, age, reason of trauma, time interval between AS diagnosis and trauma were collected. The American Spinal Injury Association (ASIA) grade system was used to describe patients' neurological status. Based on the combination of surgical experience and follow-up observation, the lower cervical spine trauma in AS patients was divided into three main types, namely single level fracture-dislocation (type 1), spinal cord injury without fracture-dislocation (type 2), and Andersson lesion (type 3). Furthermore, we performed detailed subtypes according to whether cervical spine was completely fused and the location of injury. Meanwhile, according to different approaches, surgical methods mainly included Anterior Cervical Discectomy and Fusion (ACDF), Anterior Cervical Corpectomy and Fusion (ACCF), Posterior Expansive Open-door Cervical Laminoplasty (PEOLP), Posterior Cervical Laminectomy Decompression and Fusion (PCLDF), and their combination. Postoperative general and surgery-related complications were also recorded. RESULTS: A total of 102 patients were enrolled, including 91 males and 11 females, with an average age of 51.9 years. Their average interval time between AS diagnosis and injury was 27.8 years. Patients with high-energy and low-energy trauma were 54 and 48 respectively. There were 79 patients suffering spinal cord nerve impairment after trauma. With regard to the distribution of different types, the number of patients in type 1, type 2, and type 3 were 86, 14, and two, respectively. For different types, PCLDF was the most commonly used surgical method, accounting for 55.9%, while ACCF was only applied for one time. In type 1, the frequencies of ACDF, ACCF, PCLDF, and ACDF+PCLDF were 10.5%, 1.2%, 55.8%, and 32.5%. In type 2, the frequencies of ACDF, PCLDF, ACDF+PCLDF, and PEOLP were 7.1%, 50.0%, 7.1%, 35.8%. Postoperatively, 21 patients achieved neurological function improvement. The incidences of general and surgery-related complications were 19.6% and 5.9%, respectively. All patients achieved bone fusion and durable decompression at the last follow-up. CONCLUSIONS: Our novel classification could enrich the scope of CST in AS patients and provide valuable references to the corresponding clinical management. Besides, there are strict indications of different surgical methods, factors like patient's physical condition, trauma type, surgical purpose, and expected efficacy were all required to consider before making a clinical decision.

Trochanteric and subtrochanteric fractures irreducible by closed reduction: a retrospective study.

AIM: To explore the preoperative radiographic features and reduction methods of irreducible trochanteric and subtrochanteric fractures of the femur and to compare the perioperative characteristics and prognoses of irreducible and reducible fractures. METHODS: The data of 1235 patients with femoral trochanteric fractures surgically treated in our hospital between January 2010 and January 2021 were retrospectively analyzed. According to the inclusion criteria and exclusion criteria, 1163 cases of femoral trochanteric and subtrochanteric fractures were included in this study. Fractures in which good or acceptable reduction could not be reached by closed manipulation were defined as irreducible fractures. The preoperative radiographic features, fracture displacement patterns after closed manipulation and intraoperative reduction methods used to treat irreducible fractures were analyzed, and the perioperative characteristics and prognoses of irreducible fractures and reducible fractures were compared. RESULTS: There were 224 patients in the irreducible group and 939 patients in the reducible group. According to the radiographic features of fractures, irreducible fractures could be divided into four types: those with interlocking of the fracture, sagging of the femoral shaft, splitting of the lateral wall or medial wall, and comminution of the subtrochanteric area. Various kinds of reduction techniques were needed for different types. CONCLUSIONS: The incidence of irreducible trochanteric fractures was 15.4%, while the incidence of irreducible subtrochanteric fractures was 84.6%. According to the radiographic features of fractures, they can be divided into four types. It is important to identify irreducible fractures preoperatively and make comprehensive plans to the greatest extent possible to shorten the operation time, reduce intraoperative blood loss, and reduce the incidence of complications.

Comparison of femoral neck system to multiple cancellous screws and dynamic hip screws in the treatment of femoral neck fractures.

OBJECTIVE: To compare the short-term outcomes of the femoral neck system (FNS) with multiple cancellous screws (MCS) and dynamic hip screws (DHS) in the treatment of femoral neck fractures. METHODS: A retrospective analysis was performed on 157 patients with fresh femoral neck fractures treated with FNS (from September 2019 to October 2020), MCS, and DHS (from January 2018 to October 2020). According to internal fixation methods, all patients were divided into the FNS group (54 cases), MCS group (51 cases), and DHS group (52 cases). Demographic data were also collected, recorded, and compared, including the follow-up time, days of hospitalization, operation time, blood loss, intraoperative fluoroscopy times (IFT), weight-bearing time (WBT), length of femoral neck shortening (LFNS), Harris hip score, and complications (such as internal fixation failure, bone nonunion, and avascular necrosis of the femoral head) between the three groups. RESULTS: Overall, 157 patients with a mean age of 61.8 (range, 18-89) years were analyzed. In the FNS group, IFT (median 10.5) was significantly lower than that in the MCS group (median 21) and DHS group (median 20.5) (P<0.05), and WBT was significantly earlier than that of the MCS group (P<0.05). In the FNS group, the median hospitalization time, operation time, and blood loss were 2 (2, 4) days, 45 (40-59) min, and 30 (20, 50) ml, respectively. They were all significantly less than 3.5 (3, 6) days, 72 (55-88.75) min, and 50 (30, 50) ml in the DHS group, respectively (P < 0.05). There was no statistical difference in LFNS, quality of reduction, internal fixation failure rate, and Harris hip score at the latest follow-up (P>0.05). No surgical complications such as incision infection, deep infection, pulmonary embolism, or femoral head necrosis were found in any of the three groups. CONCLUSION: FNS, MCS, and DHS are all effective for femoral neck fractures. However, a lower IFT of FNS shortens the operation time. Compared to MCS, FNS has the advantages of being a simple operation, with early WBT; compared to DHS, a minimally invasive operation is the main advantage of FNS.

Management of Tracheal Perforation following Anterior Cervical Spine Surgery: Report of Two Cases and Review of the Literature.

Background: Tracheal perforation is a complication very rare but challenging that follows anterior cervical spine surgery. This article describes the management of tracheal perforation due to instrument failure after anterior cervical spine surgery performed in two patients because of fracture dislocation of the subaxial cervical spine. Case Presentation. Two patients who suffered from a subaxial cervical fracture and dislocation were subjected to anterior cervical spine surgery for fracture reduction and cervical fusion. However, instrumentation failure occurred in both patients, resulting in implant displacement and penetration into the posterior tracheal wall. Revision surgery consisted of fracture reduction, multilevel posterior fixation, and removal of the displaced anterior cervical implants. Tracheal perforation was bypassed by placing a tracheostomy tube in a caudal position for the diversion of the airflow and tracheal hygiene. The thorough debridement and drainage performed in both patients allowed a complete healing of the anterior wound in both of them, with no sign of infection or subcutaneous emphysema, as confirmed by postoperative CT scan and flexible bronchoscopy. Both patients acquired a solid fusion of the cervical spine at last follow-up (16 months and 24 months). Conclusions: The perforation of the trachea after anterior cervical spine surgery due to the displacement of the implants could be managed using posterior cervical instrumentation and fusion, the removal of the anterior implant, debridement and drainage, and the use of a distal bypassing tracheostomy tube.

Is It Necessary to Remove the Implants After Fixation of Thoracolumbar and Lumbar Burst Fractures Without Fusion? A Retrospective Cohort Study of Elderly Patients.

Objective: Fractures of the thoracolumbar spine are the most common fractures of the spinal column. This retrospective cohort study aimed to determine whether it is necessary to remove implants of patients aged over 65 years after the fixation of thoracolumbar and lumbar burst fractures without fusion. Methods: This retrospective cohort study included 107 consecutive patients aged ≥65 years without neurological deficits, who underwent non-fusion short posterior segmental fixation for thoracolumbar or lumbar burst fractures. Outcome measures included the visual analog score (VAS), Oswestry Disability Index (ODI), residual symptoms, complications, and imaging parameters. Patients were divided into groups A (underwent implant removal) and B (implant retention) and were examined clinically at 1, 3, 6, and 12 months postoperatively and annually thereafter, with a final follow-up at 48.5 months. Results: Overall, 96 patients with a mean age of 69.4 (range, 65-77) years were analyzed. At the latest follow-up, no significant differences were observed in functional outcomes and radiological parameters between both groups, except in the local motion range (LMR) (P = 0.006). Similarly, between preimplant removal and the latest follow-up in group A, significant differences were found only in LMR (P < 0.001). Two patients experienced screw breakage without clinical symptoms. Significant differences were only found in operation time, blood loss, ODI, and fracture type between minimally invasive group and open group. Conclusions: Similar radiological and functional outcomes were observed in elderly patients, regardless of implant removal. Implant removal may not be necessary after weighing the risks and benefits for elderly patients. Patients should be informed about the possibility of implant breakage and accelerating degeneration of adjacent segments in advance.

Non-sliding Fixation Shows Improved Clinical Outcomes for Displaced Femoral Neck Fractures as Compared to Sliding Fixation.

Objective: To compare the clinical outcomes between use of sliding fixation (three cannulated screws, TCS) and non-sliding fixation (four cannulated screws, FCS) in the treatment of femoral neck fractures. Methods: We retrospectively analyzed 102 patients with fresh femoral neck fractures treated with TCS (60 cases) and FCS (42 cases) between January, 2018 and December, 2019. The demographic data, follow-up time, hospitalization time, operation time, blood loss, length of femoral neck shortening (LFNS), soft tissue irritation of the thigh (STIT), Harris hip score, and complications (such as internal fixation failure, non-union, and avascular necrosis of the femoral head) were also collected, recorded, and compared between the two groups. Results: A total of 102 patients with an average age of 60.9 (range, 18-86) years were analyzed. The median follow-up time was 25 (22 to 32) months. The LFNS in the FCS group (median 1.2 mm) was significantly lower than that in the TCS group (median 2.8 mm) (P < 0.05). In the Garden classification, the number of displaced fractures in the TCS group was significantly lower than that in the FCS group (P < 0.05). The median hospitalization time, operation time, blood loss, reduction quality, internal fixation failure rate (IFFR), STIT, and Harris hip score were not statistically different between the two groups (P > 0.05). However, in the subgroup analysis of displaced fractures, the LFNS (median 1.2 mm), STIT (2/22, 13.6%), and Harris hip score (median 91.5) of the FCS group at the last follow-up were significantly better than the LFNS (median 5.7 mm), STIT (7/16, 43.8%), and Harris hip score (median 89) of the TCS group (P < 0.05). No complications such as incision infection, deep infection, pulmonary embolism, or femoral head necrosis were found in either group. Conclusion: TCS and FCS are effective for treating femoral neck fractures. For non-displaced fractures, there was no significant difference in the clinical outcomes between the two groups. However, for displaced fractures, the LFNS of the FCS is significantly lower than that of the TCS, which may reduce the occurrence of STIT and improve the Harris hip score.

Evaluation of femoral head bone quality by Hounsfield units: A predictor of implant failure for intertrochanteric fractures after intramedullary nail fixation.

Purpose: The aim of present study is to evaluate the femoral head bone quality by Hounsfield units and its relationship to the occurrence of implant failure for intertrochanteric fractures after intramedullary nail fixation. Methods: This retrospective study assessed 160 intertrochanteric fractures treated with intramedullary fixation. Patients with and without implant failure were divided into failure and control groups, respectively. The demographic information, femoral head Hounsfield unit (HU) value, the reduction quality, status of posteromedial support and position of the screw/blade were collected and compared. The logistic regression analyses were performed to evaluate risk factors of implant failure in intertrochanteric fractures after intramedullary nail fixation. Results: Of the patients, 15 (9.38%) suffered from implant failure after intramedullary fixation. The mean HU value of femoral head was much lower in the failure group than the control group (133.25 ± 34.10 vs. 166.12 ± 42.68, p = 0.004). And the univariate analyses showed that A3 fracture and poor reduction quality were associated with implant failure (p < 0.05). After adjustment for confounding variables, the multivariable logistic regression analyzes showed that femoral head HU value (odds ratio [OR], 0.972; 95% CI, 0.952-0.993; p = 0.008) and poor reduction quality (OR, 7.614; 95% CI, 1.390-41.717; p = 0.019) were independent influencing factors for implant failure. Conclusion: The femoral head HU value was significantly correlated with the incidence of implant failure and can be used as an independent factor to predict implant failure for intertrochanteric fractures after intramedullary fixation.

Cervical Spine Fracture Prediction by Simple Plain X-Ray in Ankylosing Spondylitis Patients after Low-Energy Trauma.

OBJECTIVE: Timely diagnosis is essential in the management of cervical spine fracture (CSF) in ankylosing spondylitis (AS) patients. However, the value of simple plain X-ray in the early management of ASCSF has not been well-studied. This study aimed to explore the prediction ability of simple plain X-ray for CSF in AS patients who suffer from low-energy trauma (LET). METHODS: From January 2010 to December 2020, AS patients who experienced LET were retrospectively reviewed. Clinical data including gender, age, body mass index, time interval between AS diagnosis and trauma, smoking or not, and a presence of continuous bony bridge between anterior margin of C1 and C2 body or not were collected. Morphological features including atlanto-occipital gap, Pavlov ratio of C2-7, Angle A-D, Borden's index, and Harrison's value were measured by the lateral cervical X-ray. All data was compared between patients who had CSF and those who did not. Binary logistic regression analysis and receiver operator characteristic (ROC) curves were applied to discriminate and assess the predictive parameters. RESULTS: A total of 129 AS patients were divided into Fracture group (41 cases) and Non-fracture group (88 cases) based on whether CSF existed. Twelve parameters showed significant differences between two groups (p < 0.05). According to the binary logistic regression model, four of the 12 parameters showed a further correlation with the occurrence of CSF, namely, mean Pavlov ratio (p < 0.001, OR = 0.067, 95% CI: 0.023 to 0.194), Angle D (p = 0.031, OR = 1.057, 95% CI: 1.005 to 1.112), Borden's index (p = 0.042, OR = 1.131, 95% CI: 0.994 to 1.287), the time interval between the AS diagnosis and the trauma (p < 0.020, OR = 0.935, 95% CI: 0.883 to 0.990). The ROC curve further revealed the mean Pavlov ratio had the largest AUC (0.793) with the cut-off of 0.72. While the optimal cut-off value was 45.65° for Angle D (sensitivity = 61.0%, specificity = 78.4%), 9.79 for Borden's index (sensitivity = 87.8%, specificity = 37.5%), 15.50 years for the time interval between AS diagnosis and trauma (sensitivity = 70.7%, specificity = 56.8%). CONCLUSIONS: The time interval between the AS diagnosis and the trauma, mean Pavlov ratio, Angle D, and Borden's index showed predictive ability for the occurrence of CSF in AS patients who encounter LET. Surgeons should consider measuring these parameters in the management of AS patient.

Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures.

BACKGROUND: Although the modified tension band technique (eg, tension band supplemented by longitudinal Kirschner wires) has long been the mainstay for fixation of transverse fractures of the patella, it has shortcomings, such as bad reduction, loosening of implants, and skin irritation. QUESTIONS/PURPOSES: We conducted a retrospective comparison of the modified tension band technique and the titanium cable-cannulated screw tension band technique. PATIENTS AND METHODS: We retrospectively reviewed 101 patients aged 22 to 85 years (mean, 56.6 years) with AO/OTA 34-C1 fractures (n = 68) and 34-C2 fractures (n = 33). Fifty-two patients were in the modified tension band group and 49 were in the titanium cable-cannulated screw tension band group. Followup was at least 1 year (range, 1-3 years). Comparison criteria were fracture reduction, fracture healing time, and the Iowa score for knee function. RESULTS: The titanium cable-cannulated screw tension band group showed improved fracture reduction, reduced healing time, and better Iowa score, compared with the modified tension band group. In the modified tension band group, eight patients experienced wire migration, three of these requiring a second operation. There were no complications in the titanium cable-cannulated screw tension band group. CONCLUSIONS: The titanium cable-cannulated screw tension band technique showed superior results and should be considered as an alternative method for treatment of transverse patellar fractures. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

[Analysis of the failure reason of internal fixation in peritrochanteric fractures].

OBJECTIVE: To analyze the reasons and precautions for the failure of internal fixation in peritrochanteric fractures. METHODS: A retrospective study of 256 patients treated in surgical way during the period of May 2005 to June 2009 in our hospital was utilized by Logistic regression via analyzing age, sex, type of fracture, bone quality, type of internal fixation device, neck-shaft angle, Garden index and the initial load time. RESULTS: The ages of 256 patients ranged from 14 to 103 years. All the patients were treated by internal fixation, of whom 194 were followed up after surgery. The follow-up rate was 75.8% and follow-up time 12-53 months, with an average of 17.8 months. Ten cases failed after surgery because of penetration, cut and break-up of screw and bone non-union. The failure rate was 5.15%. The failure cases were 31-A2.2 (4 cases, 1.56%), 31-A2.3 (5 cases, 1.95%), and 31-A3.1 (1 cases, 0.39%). The type of failure devices: Dynamic hip screw (DHS) 3 cases, proximal femoral nail (PFN) 2 cases, proximal femoral nail anti-rotation (PFNA) 1 case, less invasive stabilization system (LISS) 4 cases. According to statistic results, initial load time after operation was a risk factor of internal fixation failure. Generally, the older, the more osteoporosis and the less effect of internal fixation. According to our experience, the more complex fracture, the more time before operation, the more difficult the reduction and the higher the rate of device failure. CONCLUSION: The initial load time after operation is crucial to the destiny of internal fixation. We should keep patients from early loading after operation and make a time table for the individual according to the patient's own condition.

Adaptive process monitoring via online dictionary learning and its industrial application.

For industrial processes, one common drawback of conventional process monitoring methods is that they would make an increasing number of false alarms in cases of various factors such as catalyst deactivation, seasonal fluctuation and so forth. To address this issue, the present work proposes an online dictionary learning method, which can fulfill the process monitoring and fault diagnosis task adaptively. The proposed method would incorporate currently available information to update the dictionary and control limit, instead of keeping a fixed monitoring model. The online dictionary learning method are more superior than conventional methods. Firstly, compared with some traditional offline methods based on small amounts of historical data, the proposed method can augment train data with online dictionary updating, thus it copes with time-varying processes well. Secondly, the proposed method enjoys a lower computational complexity than the offline learning method with mass data, which is appealing in the era of industrial big data. Thirdly, the proposed method performs more reliably than the existing recursive principal component analysis-based methods because it can resolve the anomaly of principal component or non-orthogonality of eigenvectors problem which was often confronted in the recursive principal component analysis-based methods. Finally, some experiments were designed and carried out to demonstrate the advantage of the online dictionary learning.

The Efficacy of Multidisciplinary Team Co-Management Program for Elderly Patients With Intertrochanteric Fractures: A Retrospective Study.

Background: Intertrochanteric fractures increased quickly in past decades owing to the increasing number of aging population. Recently, geriatric co-management was rapidly emerging as a favored clinical care model for older patients with hip fractures. The purpose of this study was to assess the efficacy of a multidisciplinary team (MDT) co-management program in elderly patients with intertrochanteric fractures. Methods: In this retrospective study, patients were divided into MDT group and traditional orthopedic care (TOC) group according to the healthcare model applied. 249 patients were included in the TOC group from January 2014 to December 2016 and 241 patients were included in the MDT group from January 2017 to December 2019. Baseline data, peri-operative data, and postoperative complications were collected and analyzed using SPSS 21.0. Results: No significant differences were observed between the two groups in terms of patient baseline characteristics. Patients in the MDT group had significantly lower time from admission to surgery and length-of-stay (LOS) compared with those in the TOC group. Furthermore, the proportion of patients receiving surgery within 24 h (61.4 vs. 34.9%, p < 0.001) and 48 h (80.9 vs. 63.5%, p < 0.001) after admission to the ward was significantly higher in the MDT group compared with those in the TOC group. In addition, patients in the MDT group had significantly lower proportion of postoperative complications (25.3 vs. 44.2%, p < 0.001), deep vein thrombosis (7.9 vs. 12.9%, p = 0.049), pneumonia (3.8 vs. 8.0%, p = 0.045) and delirium (4.1 vs. 9.2%, p = 0.025) compared with those in the TOC group. However, no significant changes were found for in-hospital and 30-day mortality. Conclusion: The MDT co-management could significantly shorten the time from admission to surgery, LOS, and reduce the postoperative complications for elderly patients with intertrochanteric fractures. Further research was needed to evaluate the impact of this model on patient health outcomes.

Risk factors for implant failure of intertrochanteric fractures with lateral femoral wall fracture after intramedullary nail fixation.

INTRODUCTION: Few studies have specifically evaluated the comminution extent of lateral femoral wall (LFW) fracture and risk factors of implant failure in intertrochanteric fractures with LFW fracture. The aim of present study was to evaluate the influence of comminution extent of LFW fracture on implant failure and identify risk factors of implant failure in cases with LFW fracture after intramedullary fixation. METHODS: This retrospective study included 130 intertrochanteric fracture with LFW fracture treated with intramedullary fixation at a teaching hospital over a 13-year period from January 2006 to December 2018. Demographic information, cortical thickness index, the reduction quality, status of medial support, position of the screw/blade and status of lateral femoral wall were collected and compared. The logistic regression analyzes was performed to evaluate risk factors of implant failure in intertrochanteric fractures with LFW fracture after intramedullary nail fixation. RESULTS: 10 patients (7.69%) suffered from mechanical failure after intramedullary fixation. Univariate analyzes showed that comminuted LFW fracture (OR, 7.625; 95%CI, 1.437~40.446; p = 0.017), poor reduction quality (OR, 49.375; 95%CI, 7.217~337.804; p < 0.001) and loss of medial support (OR, 17.818; 95%CI, 3.537~89.768; p < 0.001) were associated with implant failure. After adjustment for confounding variables, the multivariable logistic regression analyzes showed that poor reduction quality (OR, 11.318; 95%CI, 1.126~113.755; p = 0.039) and loss of medial support (OR, 7.734; 95%CI, 1.062~56.327; p = 0.043) were independent risk factors for implant failure. Whereas, comminuted LFW fracture was not associated with implant failure (p = 0.429). CONCLUSIONS: The comminution extent of the LFW fracture might influence the stability of intertrochanteric fractures; and intramedullary fixation might be an effective treatment method. Furthermore, poor reduction quality and loss of medial support could increaze the risk of implant failure in intertrochanteric fractures with LFW fractures after intramedullary fixation. Therefore, we should pay great emphasis on fracture reduction quality in future.

Surgical Treatment for Cervical Spine Fracture in Patients With Ankylosing Spondylitis: Single Posterior Approach or Combined Anterior-posterior Approach?

STUDY DESIGN: A retrospective single-center study. OBJECTIVE: We aimed to compare the clinical outcomes of cervical spine fracture accompanied with ankylosing spondylitis (ASCSF) treated by single posterior approach (PA) and combined anterior-posterior approach (CA) for patients who were followed up for >1 year. SUMMARY OF BACKGROUND DATA: For ASCSF patients, surgical treatment has been widely accepted as a recommendable therapeutic option. But the optimal surgical approach is still under controversy, and few studies have focused on the comparison between PA and CA. MATERIALS AND METHODS: From February 2007 to March 2019, 53 patients were enrolled and divided into the PA group (34 cases) and CA group (19 cases). Their general characteristics and clinical materials were recorded. From the aspects of reduction distance, bone fusion, neurological functional restoration, and postoperative complications, patients' surgical outcomes were evaluated qualitatively and quantitatively. RESULTS: The reduction degree of dislocation (mean PA=2.05 mm, mean CA=2.36 mm, P=0.94) was close between the 2 groups. Besides, with a similar follow-up period (P=0.10), the rate of bone fusion (both 100%) and neurological functional restoration (PA=31.03%, CA=35.29%, P=0.77) were also without significant difference. The occurrence rate of postoperative complications tended to be higher in the CA group (31.58% vs. 23.53%) but with no significant difference (P=0.52). Nevertheless, the surgical duration time (mean=209.15 min) and blood loss (average=388.91 mL) of PA group were significantly less than CA group (mean duration time=285.34 min, mean blood loss=579.27 mL) (P<0.01). CONCLUSIONS: Compared with to the CA approach and with the equally significant outcome, surgery by single PA was feasible and should be positively recommended for ASCSF patients, especially for those accompanying with a severe chin-on-chest deformity or poor physical conditions which restrain patients from tolerating a long surgery or major surgical trauma.