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Objective:To investigate the prevention and risk factors of deep vein thrombosis (DVT) in the lower extremity after medial open wedge high tibial osteotomy (HTO).Methods:A total of 128 patients who underwent medial open wedge HTO in the Third Hospital of Hebei Medical University from January 2020 to October 2022 were retrospectively analyzed, including 45 males and 83 females, aged 59.3±6.8 years (range, 44-87 years). Postoperative anticoagulation with enoxaparin sodium was applied at a randomized dose of 4,000 AXaIU/d or 6,000 AXaIU/d. Gender, age, history of chronic diseases (hypertension, diabetes), smoking history, body mass index, and body fat percentage were collected. On admission, the risk of DVT was assessed using the Caprini scale and calf circumference was measured. Hemoglobin, D-dimer, antithrombin III, activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), fibrinogen degradation products (FDP), glutathione, glutathione, urea, creatinine, uric acid were recorded. Patients were divided into DVT group and non-DVT group according to whether DVT occurred after operation. Binary logistic regression was used to analyze the independent risk factors of DVT after HTO. The receiver operating characteristic (ROC) curve was plotted, and the area under curve (AUC) was calculated to analyze the predictive value of the postoperative Caprini scale in the occurrence of DVT after HTO.Results:A total of 128 patients were enrolled, 83 patients were treated with enoxaparin sodium 4 000 AXaIU/d and 45 patients were treated with enoxaparin sodium 6 000 AXaIU/d. According to the results of color Doppler examination of bilateral lower extremity veins on the third day after operation, DVT occurred in 39% (50/128) of patients, including 39 cases of calf intermuscular thrombosis, 6 cases of peroneal vein thrombosis, 4 cases of posterior tibial vein thrombosis, and 1 case of popliteal vein thrombosis. DVT occurred in 36% (30/83) of patients receiving 4 000 AXaIU/d enoxaparin sodium and 44% (20/45) of patients receiving 6 000 AXaIU/d enoxaparin sodium, with no statistically significant difference (χ 2=0.84, P=0.358). Univariate analysis showed that smoking history, postoperative Caprini scale≥8, and female may be associated with the development of DVT after HTO ( P<0.05). They were included in the binary logistic regression, and the results showed that postoperative Caprini scale≥8 was an independent risk factor for DVT after HTO. The ROC curve of postoperative Caprini scale for predicting DVT after HTO was drawn, and the AUC was 0.847 (95% CI: 0.73, 0.96), the optimal cut-off value was 8, and the sensitivity and specificity were 84.2% and 77.6%, respectively. Conclusion:Caprini scale≥8 is an independent risk factor for DVT after medial open wedge HTO. Caprini scale has a good value in predicting the occurrence of DVT after HTO. The recommended dose of enoxaparin sodium is 4 000 AXaIU/d for the prevention of postoperative DVT, and increasing the dose is not associated with a decreased risk of DVT.
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Objective:To analyze the factors influencing functional recovery after surgery of calcaneal fracture.Methods:A retrospective analysis was performed in 1,080 eligible patients with calcaneal fracture who had been admitted to The Third Hospital of Hebei Medical University from January 1, 2018 to December 31, 2020. They were 931 males and 149 females with a mean age of 43.0 years. By the Sanders classification, there were 107 cases of type Ⅰ, 343 cases of type Ⅱ, 471 cases of type Ⅲ and 159 cases of type Ⅳ. Multiple linear regression model was used to screen out the main relevant factors affecting the postoperative functional recovery by analyzing the 18 factors which might influence the postoperative functional recovery like gender, age, Sanders type, occupation, body mass index, season, cause, hospital stay, operation method, internal fixation, preoperative combined injury, preoperative complication, anesthesia, attendance to rehabilitation institution, incision selection, waiting time, preoperative blister and reduction quality.Results:All the 1,080 patients were followed up for 17.5 months on average. The mean Creighton-Nebraska score at the last follow-up was 88.4. The univariate analyses showed statistically significant differences in the Creighton-Nebraska score among patients with different gender, age group, Sanders type, occupation, injury cause, surgical method, preoperative combined injury, incision selection and reduction quality ( P<0.05). Multiple linear regression model analysis resulted in the following regression equation: Y=107.408-4.013×gender-7.101×age-1.214×Sanders type-1.606×incision selection. Conclusions:The factors which influence the functional recovery after surgery of calcaneal fracture may be gender, age, fracture type and incision selection; the functional recovery score after surgery of calcaneal fracture may be low for female senior patients with type Ⅳ fracture and a large L-shaped incision.
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Objective:To explore the epidemiological characteristics of inpatients with tibial pilon fracture in The Third Hospital of Hebei Medical University from 2016 to 2019.Methods:The data of all the patients who had been hospitalized for pilon fracture from January 2016 to December 2019 in The Third Hospital of Hebei Medical University were collected using the medical image computer archiving and transmission system and the medical record query system. The patients' age, gender, occupation, residence, season, cause of injury, Rüedi-Allg?wer classification, and AO classification were analyzed.Results:A total of 234 inpatients with tibial pilon fracture were collected, including 179 males and 55 females, with a ratio of male to female of 3.3∶ 1. The prevalence age ranged from 41 to 50 years in male patients (31.3%, 56/179) and from 51 to 60 years in female patients (25.5%, 14/55). In the 234 patients, farmers (101 cases, 43.2%), rural area (166 cases, 70.9%) and spring season (77 cases, 32.9%) accounted for a higher proportion. The proportions of high-altitude falling (41.0%, 96/234) and high-energy injury (61.5%, 144/234) were the highest. Of the 234 patients by the Rüedi-Allg?wer classification, 23 (9.8%) had type Ⅰ fracture, 90 (38.5%) type Ⅱ fracture, and 121 (51.7%) type Ⅲ fracture, with type Ⅲ fracture prevalent in males (58.1%, 104/179) and type Ⅱ fracture prevalent in females (16.4%, 9/55). Of the 234 patients by the AO classification, 131 (56.0%) had type 43B fracture and 103 (44.0%) type 43C fracture, with a higher proportion of type 43B fractures in women (67.3%, 37/55) than in men (52.5%, 94/179). In type 43B fractures, type 43B3 (43.5%, 57/131) and type 43B3.3 (75.4%, 43/57) were the most common; in type 43C fractures, type 43C3 (74.8%, 77/103) and type 43C3.3 (51.9%, 40/77) were the most common.Conclusions:In the recent 4 years in The Third Hospital of Hebei Medical University, pilon fractures increased year by year and occurred more frequently in spring. They were more common in farmers and in the rural areas. They prevailed in the patients aged from 41 to 50 years. The Rüedi-Allg?wer type Ⅲ fractures and the AO type 43B fractures were the most common.
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Objective:To explore the factors related to functional recovery of the knee in patients with tibial plateau fracture complicated with intercondylar ridge fracture.Methods:Included in this retrospective study were 63 patients who had been treated at Emergency Center of Trauma, The Third Hospital of Hebei Medical University from January to June 2019 for tibial plateau fracture complicated with intercondylar ridge fracture. They were 43 males and 20 females, aged from 18 to 66 years (average, 43.9 years). According to our comprehensive classification of tibial plateau fractures, there were 27 simple ones (20 cases of type Ⅰ and 7 cases of type Ⅱ) and 36 complicated ones (16 cases of type Ⅲ, 17 cases of type Ⅳ, one of type Ⅴ and 2 cases of type Ⅵ). To screen out major influencing factors, a multiple linear regression model was used to analyze the 12 factors that might affect functional recovery of the knee by the Hospital for Special Surgery (HSS) scoring: age, gender, occupation, fracture type, way of medical payment, cause of injury, operation method, starting time for rehabilitation, postoperative brace installation, time from injury to operation, length of hospital stay, and presence or absence of a free intercondylar ridge fracture fragment.Results:The 63 patients were followed up for 6.0 to 7.1 months (average, 6.1 months). The HSS knee scores ranged from 45 to 100 points (average, 92.4 points). The HSS knee scores were significantly different between different fracture types ( P<0.05). The HSS scores were significantly higher for the patients without a free intercondylar ridge fracture fragment than for those with ( P<0.05). Multiple linear regression model analysis of the 5 variables with P<0.02 in the single factor analysis (age, fracture type, way of medical payment, hospital stay and presence or absence of a free intercondylar ridge fracture fragment) and HSS scores showed that only fracture type and presence or absence of a free intercondylar ridge fracture fragment had a significant impact on the knee function. Their regression equation was Y=125.591-7.790a-17.277b (Y indicates HSS score, a indicates fracture type and b indicates presence or absence of a free intercondylar ridge fracture fragment). Conclusions:The short-term prognosis for tibial plateau fractures of comprehensive types Ⅰ&Ⅱ (simple ones) may be better than that for tibial plateau fractures of comprehensive types Ⅲ, Ⅳ, Ⅴ&Ⅵ (complicated ones). For patients with a free intercondylar ridge fracture fragment on their lateral knee X-ray film, effective reduction and fixation is indicated but is not for those without.
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Objective:To evaluate our self-designed easily-breaking compression bone bolt plus bone plate in the treatment of tibial plateau fracture.Methods:From July 2018 to December 2018, 12 patients with tibial plateau fracture were treated at Emergency Center of Trauma, The Third Hospital of Hebei Medical University using our self-designed easily-breaking compression bone bolt plus bone plate. They were 8 males and 4 females, aged from 20 to 65 years (average, 45.6 years), with 6 left sides and 6 right sides injured. According to Schatzker classification, there were one case of type I, 3 cases of type Ⅱ, 3 cases of type Ⅲ, 2 cases of type Ⅳ, one case of type Ⅴ and 2 cases of type Ⅵ. The width of tibial plateau was measured and compared before and after operation on X-ray films. Operation time, blood loss and fracture union time were recorded. Loss of reduction and postoperative complications were followed up. Knee function was evaluated at the final follow-up by Rasmussen scoring.Results:For this cohort, operation time averaged 54.6 min, blood loss 25 mL, and fracture union time 17.2 weeks. No nonunion or delayed union was observed. The postoperative width of tibial plateau was (78.9±7.2) mm, significantly narrower than the preoperative value [(87.4±6.1) mm] ( P < 0.05). No loss of reduction or surgical complications occurred postoperation. Deep venous thrombosis of the lower extremity developed in 2 patients but recovered after treatment. The Rasmussen scoring for knee joint function at the final follow-up yielded 9 excellent, 2 good and one poor. Conclusion:In treatment of tibial plateau fractures, our self-designed easily-breaking compression bone bolt plus bone plate can restore width of tibial plateau, compress fracture fragments tightly and allow for early exercise, leading to fine functional recovery of the knee joint.
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Fracture of the tibial spine, insertion of the anterior cruciate ligament, is one of the most common concomitant injuries seen in tibial plateau fractures. Anatomical reduction and healing of the tibial spine fragments are essential to the stability and function of the knee. Clinical management of the tibial spine fractures associated with tibial plateau fracture should be based on their classification after comprehensive assessment of intra-articular injuries, in order to restore tension of the cruciate ligament and articular congruity. The purpose of this review is to briefly summarize the research updates in recent 5 years regarding the classification, operation methods and fixation options for these complex fractures.
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Objective:To analyze the short-term efficacy of pushing reduction via a pretibial bone tunnel for treatment of tibial plateau fracture.Methods:From March 2019 to June 2019, 9 patients were treated at Trauma Emergency Center, Third Hospital of Hebei Medical University for tibial plateau fractures by pushing reduction through a pretibial bone tunnel. They were 7 males and 2 females, aged from 26 to 63 years (average, 38 years). Involved were 5 left sides and 4 right sides. According to the Schatzker classification, there were 7 cases of type Ⅱ and 2 ones of type Ⅲ. According to the Zhang's comprehensive classification of tibial fractures, they were all type Ⅰ. The patients were operated on under general anesthesia or intraspinal anesthesia. According to the length of fracture line, a circular drill was used to establish a bone tunnel which was 1 to 2 cm away from the distal fracture line. The collapsed fracture was reduced by the bar through the bone tunnel. A bicortical autogenous iliac bone or artificial bone bar was selected for bone grafting. The plate was placed through small incisions. Arthroscopic examination was used to measure the fracture displacement. The operation time, incision length, number of fluoroscopy, intraoperative blood loss and postoperative complications were recorded.Results:For the 9 patients, operation time ranged from 40 to 60 minutes (average, 48.3 minutes), intraoperative blood loss from 35 to 60 mL (average, 46.1 mL), number of fluoroscopy from 12 to 21 times (average, 17.4 times), length of reduction incision from 1.6 to 3.0 cm (average, 2.3 cm), fracture displacement after fixation from 0 to 2.0 mm (average, 0.8 mm), and maximum mobility of the knee joint from 125° to 140° (average, 128.9°) 15 days after operation. All incisions healed well by the first intention. Fibular vein thrombosis occurred in one case after operation. There were no infections or related complications.Conclusion:The short-term efficacy of pushing reduction through a pretibial bone tunnel for treatment of tibial plateau fracture is positive, but more reliable results should be waited for when much more surgical cases are available.
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Objective:To compare clinical characteristics of orthopedic trauma patients between the patients during pandemic of corona virus disease 2019 (COVID-19) and those beyond the pandemic period and analyze the factors influencing fracture site changes during pandemic of COVID-19.Methods:A retrospective case-control study was made on data of 1 048 patients with fractures hospitalized in Third Hospital of Hebei Medical University treated from January 20, 2020 to February 25, 2020 (pandemic period group) and from January 31, 2019 to March 9, 2019 (beyond pandemic period group). There were 232 patients in pandemic period group, including 121 males (52.2%) and 111 females (47.8%), with age range of 1-100 years [(47.9±26.3)years]. There were 816 patients in beyond pandemic period group, including 454 males (55.6%) and 363 females (44.5%), with age range of 1-96 years [(47.3±23.9)years]. Fracture sites were compared between the two groups. Age, sex, occupation, cause of injury, history of basic medical diseases, location of fracture, residence, marital status and other factors among the patients with low limb fractures and other fractures in pandemic period group were analyzed using the Logistic regression analysis.Results:Incidence of limb fractures in pandemic period group (69.4%, 161/232) was significantly higher than that in beyond pandemic period group (59.8%, 488/816) ( P<0.05), while the incidence of whole-body multiple fractures in pandemic period group (8.2%, 19/232) was significantly lower than that in beyond pandemic period group (13.6%, 111/816) ( P<0.05). Univariate analysis showed that female, middle or older age, farmers, low-energy injury, basic medical disease, staying at home were risk factors for limb fracture during pandemic ( P<0.05). Multivariate Logistic regression analysis showed low-energy injury ( OR=8.264, P<0.01) was an independent risk factor for limb fracture during pandemic. Conclusions:Compared with the beyond pandemic period, some location of fracture is changed and incidence of limb fracture is increased during pandemic. Low energy injury is an independent risk factor of limb fracture during the pandemic.
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Objective To analyze the epidemiological characteristics of all the patients with tibial plateau fracture admitted to the Third Hospital of Hebei Medical University in the past 10 years.Methods The picture achieving and communication system was used to collect the general information and disease-related information from the hospitalized patients with tibial plateau fracture who met the inclusion and exclusion criteria from January 1,2009 to December 31,2018.The patients from January 1,2009 to December 31,2013 were assigned into group A while those from January 1,2014 to December 31,2018 into group B.The 2 groups were compared to find out the epidemiological characteristics and trends of tibial plateau fractures in the past 10 years in gender,age,occupation,injury cause and Schatzker classification.Results A total of 1,936 patients with tibial plateau fracture were included in the study,including 1,352 males and 584 femaleswith a male to female ratio of 2.32∶ 1.The peak age ranged from 50 to 59 years,with 40 to 49 years for males and 50 to 59 for females.There were 793 cases in group A (a male to female ratio of 1.89∶1) and 1,143 ones in group B (2.69∶1),showing a significant difference between the 2 groups in the male to female ratio (P ＜ 0.05).The peak age ranged from 40 to 49 years (25.09％,199/793) in group A and from 50 to 59 years (23.27％,266/1,143)in group B.There were significant differences between the 2 groups in the constituent ratios of age groups from ≥50 years (P ＜ 0.05).Physical workers accounted for the highest proportion in group A (57.12％,453/793) and group B (52.58％,601/1,143).There were significant differences between the 2 groups in the constituent ratios of occupations (P ＜ 0.05).In all the 1,837 patients with a definite injury cause,the fall and indoor activity accounted for the highest proportion(41.92％,770/1,837),the traffic accident(33.25％,248/769) in group A did and the fall and indoor activity(48.88％,522/1,068) in group B did too.There were significant differences between the 2 groups in the injury causes (P ＜ 0.05).Of all the 1,658 patients with X-ray films available,by the Schatzker classification,types Ⅱ and Ⅵ were the most common.Type Ⅵ accounted for the highest proportion in group A (33.25％,248/769) while type Ⅱ did in group B (48.88％,522/1,068).There were significant differences between the 2 groups in the proportions of Schatzker types (P ＜ 0.05).Conclusions The tibial plateau fractures admitted to the Third Hospital of Hebei Medical University in the past 10 years were more common in males than in females,and predominant in physical workers.Fall and indoor activity was the most common injury cause.Schatzker types Ⅱ and Ⅵ prevailed.The fractures showed an aging trend by comparing the former 5 years and the latter 5 years.
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Objective To investigate the epidemiological characteristics of the in-patients with femoral supracondylar fracture in the Third Hospital of Hebei Medical University from 2009 through 2018.Methods The medical imaging computer archiving and transmission system and the medical record inquiry system were used to collect the data of all the in-patients with femoral supracondylar fracture who had been treated from January 2009 through December 2018 in The Third Hospital of Hebei Medical University.Their gender and age distribution,basic sociological data and cause of injury were characterized.The in-patients from January 2009 to December 2013 were assigned into group A while those from January 2004 to December 2018 into group B.The 2 groups were compared to find out the epidemiological characteristics and trends of the in-patients with femoral supracondylar fracture in the 10 years.Results Of the 508 in-patients with femoral supracondylar fracture,279 (54.9％) were male and 229 (45.1％) female.Their age ranged from 1 to 94 years,averaging 44.3 years.The age group from 41 to 50 years accounted for the largest proportion (104 cases,23.9％).In males,the age group from 41 to 50 years accounted for the largest proportion (33.3％,80/279);in females,the age group from 51 to 60 years the largest proportion (30.3 ％,59/229).The proportion of females in the in-patients under 50 years of age (37.1％) was significantly lower than that (62.9％) in the in-patients over 50 years of age (P ＜ 0.05).According to the AO classification,there were 193 cases (38％) of type 33-A1,117 ones (23％) of type 33-A2 and 198 ones (39％) of type 33-A3.There were 270 farmers (53.1％),164 workers (32.4％) and 74 students (14.5％).Most injuries were caused by high energy (56.5％).The age of in-patients with low-energy injury (50.5 ±20.7 years) was significantly higher than that of in-patients with high-energy injury (39.5 ± 19.6 years) (P ＜0.05).The proportions of urban residents (30.0％),patients with low energy injury (37.9％) and type 33-A1 fractures (23.9％) in group A were significantly lower than in group B (43.3％,46.9％ and 32.3％,respectively) (P ＜ 0.05);the age of group A (41.9 ± 21.8 years) was significantly younger than that of group B (45.9 ± 19.9 years) (P ＜0.05);type 33-A3 fractures in group A (46.5％) were significantly more than in group B (36.3％) (P ＜0.05).Conclusions Femoral supracondylar fractures were more common in farmers.Most of the fractures were type 33-A3.The fractures were common in males from 41 to 50 years old and in females from 51 to 60 years old.There were more males than females in the junior patients but more females than males in senior patients.There were more young patients in complex fractures but there were more old patients in simple fractures and there were more very old patients in low-energy injuries.In the past 10 years,the patients with femoral supracondylar fracture increased year by year.Compared with the first 5 years,the late 5 years witnessed significant increases in age of patients and proportions of low-energy injury and simple fracture.
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Objective To evaluate the factors contributing to medial compartment knee osteoarthritis and the possible correlations between them.Methods Radiographic images were collected for analysis of 840 patients who had sought medical attention from January to July 2017 for 1,422 sides of knees varus at Department of Orthopedic Surgery,The Third Hospital of Hebei Medical University.They were aged from 17 to 87 years(average,61.0 years),involving 323 knees in males and 1,099 knees in females.The alignments and parameters of lower extremity were measured,including hip-knee-ankle angle (HKA),mechanical medial distal femoral angle (mMDFA),medial proximal tibial angle (MPTA) and joint line convergence angle (JLCA).The measurements were compared between HKA values and genders for correlation analysis.Results HKA,mMDFA,MPTA and JLCA were respectively 172.85° ± 4.27°,90.99° ± 2.59°,84.78° ± 2.82° and 2.83° ±2.33 ° for males,and 172.13 ° ± 4.63°,91.11 ° ± 2.74°,84.58 ° ± 3.30° and 3.48 ° ± 2.58 ° for females.The females had significantly smaller HKA and significantly larger JLCA than males (P ＜ 0.05),but there was no significant difference in mMDFA or MPTA between genders(P ＞ 0.05).Pearson correlation test showed that there were significant correlations between HKA and mMDFA,MPTA and JLCA (rmale1 =0.526,rmale2 =0.545,rmale3 =-0.562;rfemale1=0.547,rmale2=0.610,rmale3=-0.485;P ＜0.01).mMDFA (βmale=0.491,βfemale=0.464,P ＜0.01) and MPTA (βmale=0.487,βfemale=0.560,P ＜0.01) had significantly positive influences on HKA;the influence of JLCA was negative (βmale =-0.463,βfemale =-0.450,P ＜0.01).Conclusions Femoral mechanical axis varus,increased JLCA and collapse of medial tibial plateau all significantly contribute to the varus gonarthrosis.The effects of mMDFA,MPTA and JLCA on HKA may be almost the same.
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Objective To investigate the main risk factors of respiratory complications in patients with cervical spinal cord injury so as to provide reference for early nursing assessment and personalized nursing intervention model. Methods A retrospective case series study was conducted on the clinical data of 303 patients with cervical spinal cord injury admitted to the Third Hospital of Hebei Medical University between January 2015 and September 2016. There were 248 males and 55 females, aged (44.9 ±13.8)years (range, 14-70 years). There were 109 cases at fracture site C14 and 194 cases at C5-8. According to ASIA classification, 131 cases were grade A, 26 cases grade B, 42 cases grade C, and 104 cases grade D. The duration from injury to operation was (23.2 ± 69.9) hours (range, 6-48 hours). Univariate analysis was performed on the risk factors of respiratory complications, including gender, age (14-54, 55-65, and 66-70 years old), occupation, hospital stay, smoking history, previous history, ASIA grade (grades A to D), injury cause, complications (abdominal distension, hyponatremia, hypoproteinemia, and anemia). Multivariate logistic regression was used to analyze the significant risk factors in the univariate analysis so as to further identify risk factors associated with respiratory complications. Results Univariate analysis showed that age (55-65 and 66-70 years), ASIA grade A, ASIA grade B, smoking history, injury cause, complications (abdominal distension, hyponatremia, hypoproteinemia, and anaemia) were related to respiratory complication of patients with cervical spinal cord injury (P ＜0.05). The gender, occupation, length of hospital stay, and previous history were not associated with respiratory complications of patients with cervical spinal cord injury (P＞0.05). Logistic regression analysis showed that age between 55 and 65 years (OR = 3.989, P ＜ 0.05), age between 66 and 70 years(OR =0.301, P＜0.05), AISA grade A (OR=30.300, P＜0.05), ASIA grade B (OR =5.784, P ＜0.05), smoking history (OR=5.238, P ＜0.05), abdominal distension (OR = 1.975, P＜0.05), hypoproteinemia (OR =6.212, P ＜ 0.05), and hyponatremia (OR =3.233 ＜0.05) were independent risk factors for respiratory complications in patients with spinal cord injury. Except for ASIA classification, other factors might be easily ignored by doctors and nurses, leading to poor prognosis of patients. Conclusions Age (above 55 years), ASIA grades A and B, smoking history, abdominal distention, hypoproteinemia, and hyponatremia are the risk factors of respiratory complications in patients with cervical spinal cord injury. Based on the results, early nursing assessment can be carried out and personalized nursing measures can be taken to reduce the incidence of respiratory complications. It can also provide reference for constructing standardized nursing intervention model.
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Objective To compare and analyze the epidemiological features of adult patients with distal femoral fracture between the east and west areas in China from 2010 to 2011.Methods The data of adult patients with distal femoral fracture treated from January 2010 through December 2011 in 63 hospitals were collected through the PACS system and case reports checking system.The data from 35 hospitals in the east area were classified as group A and those from 28 hospitals in the west area as group B.The analytic items included gender,age and AO classification.Results A total of 2,523 adult distal femoral fractures were collected,involving i,544 males and 979 females,with a male to female ratio of 1.58:1.The adult femoral fractures predominated in an age range from 41 to 50 years (18.94％) and their high-risk type was 33-A (50.18％).In group A of 1,650 cases,there were 1,027 males and 623 females,with a male to female ratio of 1.65:1 and a median age of 48 years;in group B of 873 cases,there were 517 males and 356 females,with a male to female ratio of 1.45:1 and a median age of 45 years.There were no significant differences in the age distribution and gender proportion between groups A and B (P ＞ 0.05).The age distribution showed that the peak ranges were from 31 to 60 years in both groups.The proportion of type 33-A was the most and that of type 33-B the least in both groups.The proportion of type 33-A in group B (53.49％) was significantly higher than in group A (48.42％) while that of type 33-B in group B (16.84％) was significantly lower than in group A (21.39％) (P ＜ O.05).Conclusions Adult distal femoral fractures were common in middle-aged males and their high-risk type was 33-A.Their peak age was from 31 to 60 years in both east and west areas in China.They were more common in men.The predominant fracture type was 33-A in both areas.The east area witnessed a significant higher proportion of type 33-B and a significant lower proportion of type 33-A than the west area.