[Analyzing risk factors for surgical site infection following Pilon fracture surgery].

OBJECTIVE: To study the related risk factors for surgical site infection following Pilon fracture surgery. METH ODS: The data of 561 patients with Pilon fractures treated with open reduction plate osteosynthesis at our institution's trauma centre were collected from January 2006 to December 2012. All the patients were divided into two groups: infection group and non-infection group. In the infection group, there were 23 males and 10 females, ranging in age from 21 to 69 years old, with an average of (45.50±4.40) years old. In the non-infection group, there were 296 males and 232 females, ranging in age from 16 to 76 years old, with an average of (43.50±7.19) years old. The possible risk factors such as age, gender, smoking, diabetes, alcohol abuse, open fractures, compartment syndrome and operative time were studied. The multivariate Logistic regression model was used to analyze the risk, factors. RESULTS: The infection rate of surgical site after Pilon fracture surgery was 5.88%. There were significant statistical differences between infection group and non-infection group in operative time, open fractures and compartment syndrome. However, multivariate Logistic regression analysis revealed that only operative time was significantly associated with surgical site infection (P=0.005, OR=44.92). CONCLUSION: Operation time is an independent predictor for post-operative surgical site infection of Pilon fracture treated with open reduction plate osteosynthesis. Though open fracture and compartment syndrome could increase the surgical site infection rate, they could not not be considered as independent predictors.

[Locking compression plate (LCP) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of Pilon fracture].

OBJECTIVE: To summarize clinical outcomes of locking compression plate (LCP) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of Pilon fracture. METHODS: From January 2009 to December 2012, Pilon fracture patients treated by LCP with MIPPO were retrospectively analyzed. All open fractures, pathologic fractures and those who had limb vascular disease or nerve injury were excluded. Thirty-eight patients were enrolled, including 29 males and 9 females aged from 21 to 78 years old with an average of 48 years old. According to AO classification, 20 cases were type B, 18 cases were type C. Operative time, blood loss, reduction quality, time of fracture healing complications and postoperative ankle joint function were applied for evaluating clinical outcomes, AOFAS scoring were used for assessing postoperative clinical effects. RESULTS: All patients were followed up from 13 to 24 months (averaged 18 months). All patients obtained bone union without any plate failures or loss of fixation/reduction. One patient occurred superficial wound infection, and resolved with antibiotics and local wound care. Postoperative average AOFAS score was 81 (ranged 65 to 97). CONCLUSION: LCP with MIPPO for Pilon fratcure has advantages of less invasion, fewer complications and satisfactory ankle function.

[Screen and identification of the relative protein expressed in the acute tractive spinal cord injury in rats].

OBJECTIVE: To screen and identify the relative protein expressed in the acute tractive spinal cord injury (TSCI) in rats. METHODS: Ten adult Sprague Dawley rats were randomly divided into Sham group and TSCI group, 5 rats in each group. Rats from Sham group and TSCI group at 1 day after surgery were sacrificed for harvesting T13-L2 spinal tissue specimens. The extraction and quantitation of protein in the spinal tissue was finished firstly. Proteins from spinal tissue were separated by two-dimensional electrophoresis (2-DE) and identified by mass spectrometry (MS). The different expression map was established in each group, and proteins express differently was determined by comparing the level of each spot with gel imaging software and manually. Proteins were identified by High performance liquid chromatography-electrospray tandem (NanoUPLC-ESI-MS/MS) and peptide sequence tag with tandem MS combining with database respectively. After that, the function of these identified proteins was known and classified. RESULTS: There were 22 differential protein expression spots were found between Sham group and TSCI group. Among them, 18 spots were up-regulated and 4 were down-regulated. 4 differential protein expression spots were newly found in TSCI group. Sixteen significant proteins were identified by NanoUPLC-ESI-MS/MS. Four kind of proteins were related to apoptosis, 3 in nerve signal transduction and 6 in metabolism, respectively. Unnamed proteins were 3. CONCLUSIONS: The differential expression proteins were found between Sham group and TSCI group. These identified proteins may play important role in the process of injury and recovery through transduction nerve signal, regulating nerve cells apoptosis and metabolism.

Timing of internal fixation and effect on Schatzker IV-VI tibial plateau fractures.

OBJECTIVE: To study the effect of internal fixation performed at different times on therapeutic outcomes of Schatzker IV-VI tibial plateau fractures. METHODS: The clinical data of 42 cases of Schatzker IV-VI tibial plateau fractures treated in our department were analyzed retrospectively. Among these 42 patients, 21 received surgical treatment within 12 h after injury (Group I), the other 21 were first treated by traction or plaster fixation followed by a delayed internal fixation after soft tissue swelling subsided (Group II). The surgical time, complications, length of hospital stay, cost of hospitalization, and time for fracture union, as well as functional recovery were analyzed and compared between the two groups. RESULTS: After 10-28 months follow-up (mean 16.5 months), except 5 cases who lost to follow-up, no differences were found between the two groups regarding surgical time, preoperative and postoperative complications, healing time or the Hospital for Special Surgery (HSS) score at the end of follow-up, but significant differences were found in the length of hospital stay, cost of hospitalization and HSS score at 3 months after operation (P less than 0.05). CONCLUSION: Under certain conditions, early internal fixation for Schatzker IV-VI tibial plateau fracture is feasible, which can shorten the length of hospital stay, decrease the cost of hospitalization and promote early functional rehabilitation.

A comparative study of ipsilateral intertrochanteric and femoral shaft fractures treated with long proximal femoral nail antirotation or plate combinations.

OBJECTIVE: To compare the results of long proximal femoral nail antirotation (PFNA-long) and plate combinations in the treatment of ipsilateral intertrochanteric and femoral shaft fractures. METHODS: Between March 2004 and April 2009, 23 patients with ipsilateral intertrochanteric and femoral shaft fractures were treated with PFNA-long or plate combinations. The patients were divided into two groups. Group I contained 13 patients who were treated with dynamic hip screws (DHS) combined with compression plate fixation. The 10 patients in Group II were treated with PFNA-long. RESULTS: The average follow-up was 17.8 and 16.8 months for Groups I and II, respectively. The average union time for intertrochanteric fractures was 17.4 and 16.6 weeks in Groups I and II, respectively, and for femoral shaft fracture 22.2 and 21.5 weeks, respectively. There were nine good, two fair, and two poor functional results in Group I, and eight good, one fair, and one poor in Group II. There was nonunion of two femoral shaft fractures in Group I and one in Group II. There were no significant differences between the two groups in functional outcomes or major complications. CONCLUSION: Both treatment methods achieve satisfactory functional outcomes in patients with ipsilateral intertrochanteric and femoral shaft fractures. PFNA-long is the better choice for the treatment of complex fractures, having the advantages of minimal exposure, reduced perioperative blood loss, and achievement of biological fixation of both fractures with a single implant.

Traumatic asymmetrical bilateral hip dislocation: a case report and literature review.

Traumatic asymmetrical bilateral dislocation of the hip joint is a rare occurrence. Herein we report a case of traumatic asymmetrical bilateral dislocation of the hip caused by a falling object. A 31-year-old healthy male was injured by a falling wall of weighing approximately 100 kg from behind in the lumbosacral area. The patient sustained a pelvic fracture, posterior dislocation of the right hip joint associated with a comminuted fracture of the right acetabulum, and anterior dislocation of the left hip joint. Manual reduction of both hip dislocations was performed in the Emergency Department. The posterior wall fracture of the right acetabulum was treated with open reduction and internal fixation by plate and screw. Reduction of both hips was successful and no femur necrosis or arthrosis was found during the four-year follow-up. Heterotopic ossification was found but it did not affect joint function. Prompt reduction of hip dislocations in the Emergency Department can reduce the incidence of avascular necrosis of the femoral head.

[Case-control study on therapeutic effects of surgery for the treatment of complex acetabular fractures and effect of waiting time for surgery on clinical results].

OBJECTIVE: To discuss the operative effects and evaluate how the waiting time before surgery influence the outcome of complex acetabular fractures. METHODS: From January 2006 to December 2008, 33 patients, 28 males and 5 females, with complex acetabular fractures were operated in our hospital. All of them were followed up for an average 24 months (ranged, 14 to 47 months). The average age was 42 years (ranged,27 to 57 years). According to the waiting time before surgery, all patients were divided into two groups, namely preoperative waiting time of more than 14 days group and preoperative waiting time of less than 14 days group. Postoperative reduction quality and long-term radiographic results were evaluated according to the Matta radiological systems. The modified Merle d' Aubigne-postel hip scoring system was used for evaluating the functional outcomes. The Mos SF-36 was used to evaluate the quality of life. RESULTS: Anatomical reduction in 28 cases, good in 4 cases, and poor in 1 case. According to the mean Merle d'Aubigne and Postel Score, 22 patients got excellent result, 4 good, 4 fair and 3 bad. Average score of the Mos SF-36 was (70.63 +/- 17.03). When time was measured as a categorical variable, an anatomical reduction and an excellent or good functional outcome were more likely if surgery was performed within 14 days. Postoperative complications: iatrogenic injuries of sciatic nerve in 2 cases, heterotopic ossification in 6 cases,traumatic osteoarthritis in 3 cases, and femoral head necrosis in 1 case. CONCLUSION: Good image evaluation,correct approaches, appropriate time before surgery and approach, early functional rehabilitation are essential for better outcomes in the treatment of complex acetabular fractures, of which, time to surgery is a crucial and controllable prognostic factor.

Ipsilateral basicervical femoral neck and shaft fractures treated with long proximal femoral nail antirotation or various plate combinations: comparative study.

BACKGROUND: Although many treatment methods have been developed, controversy exists regarding the optimal management of ipsilateral femoral neck and shaft fractures. The purpose of this retrospective study was to compare the results of long proximal femoral nail antirotation (PFNA-long) and various plate combinations in the treatment of ipsilateral basicervical femoral neck and shaft fractures. METHODS: Between January 2004 and May 2008, a total of 21 patients with ipsilateral basicervical femoral neck and shaft fractures were treated with PFNA-long or various plate combinations. We divided patients into two groups. Group I included 11 patients who underwent surgery with cancellous lag screws or dynamic hip screws (DHS) combined with compression plate fixation. Group II included 10 patients who underwent surgery with PFNA-long. RESULTS: The average follow-up periods were 22.2 and 20.8 months for groups I and II, respectively. The average union times for femoral neck fractures in groups I and II were 15.6 and 16.0 weeks, respectively; and the average union times for shaft fractures were 21.1 and 20.3 weeks, respectively. There were eight good, two fair, and one poor functional result in group I and eight good, one fair, and one poor in group II. One case of implant failure and nonunion of the femoral shaft fracture occurred in group I. There were no significant differences in the functional outcomes or major complications between the two groups. CONCLUSIONS: Both treatment methods achieved satisfactory functional outcomes in patients with ipsilateral basicervical femoral neck and shaft fractures. PFNA-long was a good option for the treatment of complex fractures, with the advantages of closed antegrade nailing with minimal exposure, reduced perioperative blood loss, and biological fixation of both fractures with a single implant.

Minimally invasive technique versus conventional technique of dynamic hip screws for intertrochanteric femoral fractures.

INTRODUCTION: Intertrochanteric fractures of femur are common in elderly patients. The compression hip screw has become the predominant method for osteosynthesis of intertrochanteric fractures. However, the conventional dynamic hip screws (CDHS) technique has some disadvantages. Recently, we have used a minimally invasive dynamic hip screws (MIDHS) technique to reduce these disadvantages. This prospective study is to compare curative effect of MIDHS with that of CDHS with open reduction on Evans type 1 intertrochanteric fractures. MATERIALS AND METHODS: All 97 fractures were classified according to the Evans systems. The MIDHS group included 47 patients with an average age of 68.7 years, and the CDHS group included 50 patients with an average age of 68.7 years. The Singh index was used as a measure of osteoporosis. RESULTS: Both groups were similar in injury mechanism, fracture types, mean Singh index and medical diseases (all P > 0.50). All fractures were healed within 4 months in both groups except three cases who were implant failure and nonunion in the CDHS group. The MIDHS group had significantly smaller wound size, shorter surgery time, less blood loss, lower blood transfusion rate, earlier active mobilization of fractured hip joint, shorter hospital stay, lower serious complication rate and higher Harris hip score than the CDHS group (all P < 0.05). The satisfactory reduction, adequate screw position, healing time and union rate was not significantly difference between two groups (all P > 0.05). CONCLUSION: When the fractures are treated adequately, either the MIDHS or the CDHS with open reduction is an effective and safe method, but the MIDHS is superior to the CDHS with open reduction for the treatment of Evans type 1 intertrochanteric fractures of femur.

[Analysis of patients with bone injury in Wenchuan earthquake].

OBJECTIVE: To evaluate the patients with bone injury in Wenchuan earthquake. METHODS: From May 12th to June 15th 2008 the data of 1410 patients with bone injury in Wenchuan earthquake were analyzed to evaluate clinical intervention and remedy-managing experience. RESULTS: The 1410 patients average age was from 4 to 103 years old. And 744 cases (52.7%) suffered from blunt injuries, 379 cases (26.9%) from buried injuries, 287 cases (20.4%) from falling injuries; And 1317 cases were with fracture, 93 with limbs soft tissue injuries; 261 patients combined with other parts of injuries including 45 cases with paralysis; 66 cases were with crush syndrome, 25 with gas gangrene, 76 with acute kidney failure, 26 with multiple organ failure. And 912 operations were performed including 402 fracture fixation, 224 debridement, 152 debridement and suture, 85 amputation, 29 implant skin, 8 fixation of joint dislocation, 5 surgical flaps transplantation, 4 nerve and tendon suture, 2 arthroscopes, 1 joint replacement. Among the 66 crush syndrome patients, 49 accepted continuous renal replacement therapy, in which 9 cases were bleeding from named arteries and 20 blood vessels were getting embolism. Among the 1410 cases, 1 died from multiple organ failure. CONCLUSIONS: Among the patients with bone injury in Wenchuan earthquake, the elderly patients are more than the youth; The injuries are always combined with other complications; Opened injuries are polluted severely; It is difficult to deal with the crush syndrome; Paraplegia cases are less, but the amputees are more.

[The crush syndrome patients combined with kidney failure after Wenchuan earthquake].

OBJECTIVE: To retrospectively analysis the treatment characteristics of the systemic situation in patients with crush syndrome after Wenchuan earthquake happened in May 12th, 2008. METHODS: Forty-nine patients with crush syndrome and subsequent acute renal failure (ARF) due to the earthquake were treated in West China Hospital. All of patients had been rescued from buildings that collapsed in Wenchuan earthquake. The major associated injuries were in the low extremities and upper extremities. 49 patients developed ARF with increased concentrations of serum creatinine (mean 64 022 U/L) had underwent haemodialysis. Hyperkalaemia was seen in 9 patients and four of them underwent haemodialysis. 49 patients were administered hemodialysis. RESULTS: No patient died. All patients who suffered from the ARF were weaned from hemodialysis after admitted 7 to 35 days. Forty-five extremities underwent amputations and 52 extremities had fasciotomy. CONCLUSIONS: Crush syndrome requires urgent recognition and prompt surgical treatment with simultaneous measures to control hyperkalemia and ARF. The authors believe that immediate intensive care therapy and multi-subjective coordination would have improved the survival rate.

[Basic research and clinical application of cartilage-derived retinoic acid-sensitive protein].

OBJECTIVE: To know the basic research and the clinical application of cartilage-derived retinoic acid-sensitive protein (CD-RAP) in orthopedic and in other clinical fields. METHODS: The literature related to CD-RAP in basic research and clinical application were extensively reviewed. RESULTS: CD-RAP, as a protein, which is cartilage-specific, could be a marker of the joint diseases. It also can be used to monitor metastasis of melanoma. CONCLUSION: CD-RAP test provides a new way to study repair of cartilage and metastasis of melanoma.