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INTRODUCCION Las fracturas de fémur distal (FFD) son un problema importante de salud pública. Con el envejecimiento de la población, se espera un incremento de esta lesión en los próximos años. Objetivo Describir las complicaciones y la mortalidad de las FFD en un grupo de pacientes geriátricos. MATERIALES Y METODOS Estudio descriptivo y retrospectivo de pacientes mayores de 60 años operados por FFD, todos tratados en un mismo centro, entre 2011 y 2015, con al menos 1 año de seguimiento. Se excluyeron pacientes con ficha incompleta. Se analizaron los datos demográficos y radiológicos, las complicaciones locales y sistémicas, la estadía hospitalaria y la mortalidad. RESULTADOS En total, 16 pacientes cumplieron con los criterios de selección; tenían una mediana de edad de 73 (rango: 61 a 93) años, y 14 (87,5%) eran mujeres. La clasificación de la Asociación para el Estudio de la Fijación Interna (Arbeitsgemeinschaft für Osteosynthesefragen, AO, en alemán) de las fracturas fue: A 12 (75%); B 2 (12,5%); y C 2 (12,5%). No hubo casos de fractura expuesta. Un total de 9 (56,3%) pacientes fueron operados con placa condilar dinámica, 4 (25%), con placa bloqueada, y 3 (19%), con clavo retrógrado. La mediana de latencia quirúrgica fue de 10 (rango: 3 a 27) días, con una mediana de hospitalización de 14 (rango: 5 a 47) días. Complicaciones fueran presentadas por 6 (37,5%) pacientes: 2 (12,5%) casos de tromboembolismo pulmonar y 4 (25%) casos que requirieron reintervención (2 fallos de osteosíntesis, 1 artrofibrosis y 1 no unión aséptica). No hubo complicaciones infecciosas. La mortalidad a 12 meses fue de 0%. CONCLUSIONES Los pacientes con FFD en esta cohorte geriátrica presentaron una larga estadía hospitalaria, con una alta tasa de complicaciones, que incluye un 25% de reintervenciones. Pese a esto, la mortalidad a 12 meses fue de 0%
INTRODUCTION Distal femoral fractures (DFF) are a relevant problem for public health worldwide. As the population ages, an increase in the rate of these lesions is expected in the next few years. Objective To describe the complications and mortality from DFF in geriatric patients. MATERIALS AND METHODS A descriptive and retrospective study with patients aged 60 years or older who underwent surgery due to DFF. All subjects received treatment in the same trauma center from 2011 to 2015 and underwent a minimum follow-up of 1 year. Patients with incomplete medical records were excluded. We analyzed demographics, radiological findings, local and systemic complications, length of stay, and mortality rates. RESULTS In total, 16 patients met the inclusion criteria; their median age was of 72 (range: 61 to 93) years, and 14 subjects (87,5%) were female. The classification of the Association for the Study of Internal Fixation (Arbeitsgemeinschaft für Osteosynthesefragen, AO, in German) was as follows: A 12 patients (75%); B 2 patients (12.5%); and C 2 patients (12.5%). There were no open fractures. The devices used in the operations included dynamic condylar screw (DCS) plates (9 subjects; 56%), distal femur locking compression plates (LCPs) (4 subjects; 25%), and retrograde distal femoral nails (DFNs) (3 subjects; 19%). The median time until surgery was of 10 (range: 3 to 27) days, with a median length of stay of 14 (range: 5 to 47) days. Complications were presented by 6 (37.5%) patients: 2 (12.5%) cases of pulmonary thromboembolism and 4 (25%) cases which required reintervention (2 due to hardware failure, 1 because of arthrofibrosis, and 1 due to aseptic nonunion); there were no cases of infection. The mortality rate at 12 months was of 0%. CONCLUSION The patients with DFF in this geriatric cohort presented a long length of stay, with a high rate of complications, including a rate of 25% of reintervention. Nevertheless, the 1-year mortality rate was of 0%
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Femoral Fractures/complications , Femoral Fractures/mortality , Epidemiology, Descriptive , Aftercare , Femoral Fractures/surgery , Fracture Fixation, Internal/methods , Length of StayABSTRACT
BACKGROUND:Digital three-dimensional reconstruction technology is gradually applied to orthopedic diseases with the advantages of visualization,accuracy and non-invasiveness,but there is less evidence-based support for its use in artificial hip hemiarthroplasty for intertrochanteric fractures of the femur in the elderly. OBJECTIVE:To investigate the application value and economic effects of digital three-dimensional reconstruction techniques in artificial hip hemiarthroplasty of intertrochanteric fractures of the femur in the elderly. METHODS:One hundred and thirty elderly patients with intertrochanteric femur fractures admitted to Zunyi First People's Hospital from January 2019 to December 2022 were selected and randomly divided into a control group(n=65)and an observation group(n=65).Artificial hip hemiarthroplasty was performed in both groups.The control group adopted the film template measurement method for manual preoperative planning while the observation group adopted a digital three-dimensional reconstruction technique.Preoperative planning and intraoperative actual application of prosthesis compliance rate,fibrinogen,D-dimer,bilateral femoral eccentric distance difference,bilateral lower limb length difference,Harris hip function score,visual analog scale score,excellent and good rate of hip function,complications,and hospitalization cost were observed in both groups. RESULTS AND CONCLUSION:(1)The proportion of acetabular side and femoral side prosthesis in grade 0(fully compliant)was higher in the observation group than that in the control group(P<0.05).(2)Fibrinogen and D-dimer levels in the observation group were lower than those in the control group 3 days after surgery(P<0.05).(3)The difference in bilateral femoral eccentric distance and the difference in bilateral lower limb length in the observation group were smaller than those in the control group immediately after surgery(P<0.05).The differences in Harris and visual analog scale scores were not significantly different between the two groups preoperatively,6 and 12 months postoperatively(P>0.05).There was no significant difference in excellent and good rate of hip function between the two groups 12 months postoperatively(P>0.05).(4)There was no significant difference in the complication rate between the two groups(P>0.05).The hospitalization cost of the observation group was higher than that of the control group(P<0.05).(5)It is indicated that digital three-dimensional reconstruction technology applied in artificial hip hemiarthroplasty of intertrochanteric femoral fracture in the elderly can not only accurately determine the prosthesis type before surgery,but also accurately reconstruct the bilateral lower limbs offline,but its hospitalization cost is high.
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Abstract Atypical fractures are well elucidated when they occur in the femur and are related to the use of bisphosphonates. Prolonged therapy with this drug leads to excessive suppression of bone remodeling, which makes the bone more brittle. In general, they are caused by minimal trauma or are atraumatic. This type of fracture is also reported in other bony sites, such as the metatarsus. Some reports and studies on atypical metatarsal fractures have been published, but further investigations are required to better understand this type of fracture and establish the proper diagnosis, treatment and conduct. The present study is a report of five cases of patients who presented metatarsal fractures during therapy with bisphosphonates. All patients were female, had osteoporosis as a preexisting disease, were taking bisphosphonates, presented fractures that were either atraumatic or caused by minimal trauma, and the imaging examination showed a transverse meta-diaphyseal fracture of the fifth metatarsal shaft with thickening of the lateral cortex, image characteristics similar to the criteria used by the American Society for Bone and Mineral Research (ASMBR) to define atypical femur fractures.
Resumo Fraturas atípicas são bem elucidadas quando ocorrem no fêmur e tem relação com o uso de bifosfonatos. A terapia prolongada com esse medicamento leva a uma supressão excessiva do remodelamento ósseo, o que torna o osso mais quebradiço. Em geral, são fraturas atraumáticas ou causadas por trauma mínimo. Este tipo de fratura é também relatada em outros sítios ósseos, como o metatarso. Alguns relatos e estudos referentes às fraturas atípicas de metatarso já foram publicados, mas outras investigações são necessárias para que essa fraturas sejam mais bem compreendidas e recebam o devido diagnóstico, tratamento e conduta. No presente trabalho, relatam-se cinco casos de pacientes que apresentaram fratura de metatarso durante terapia com bifosfonatos. Todos os pacientes eram do sexo feminino, tinham osteoporose como doença pré-existente, faziam uso de bifosfonatos, apresentaram fraturas atraumáticas ou causadas por trauma mínimo, e o exame de imagem revelou fratura metadiafisária transversa de eixo de quinto metatarso com espessamento do córtex lateral, características de imagem semelhantes aos critérios utilizados pela American Society for Bone and Mineral Research (ASMBR) para definir fraturas atípicas de fêmur.
Subject(s)
Humans , Female , Middle Aged , Aged , Osteoporosis , Metatarsus/diagnostic imaging , Femoral Fractures/drug therapyABSTRACT
ABSTRACT Introduction: Proximal femoral nailing for intertrochanteric femur fracture is sometimes a challenging procedure without a traction table, especially if complicated fracture pattern. We aimed to overcome this difficulty with the hook. Materials and Methods: A retrospective study of 60 patients. 28 of the patients reduction was necessitated with a hook (group 1). The other patients did not need to use this technique (group 2, n=32). The collo-diaphyseal angle, lag screw placement, and tip-apex distance were measured using radiographs. Results: There were statistically significant differences between the two groups regarding the Garden Alignment Index, postoperative collo-diaphyseal angle measurements, and tip-apex distance. The Garden Alignment Index was found as 163.92 degrees (dg.) In the frontal plane in group 1, and 154.78 dg in group 2, respectively. In group 1, the tip-apex distance was 16.05 cm, whereas it was 25.32 cm in group 2. The collo-diaphyseal angle was 133.1º in group 1, and 128.65º in group 2. Conclusions: The hook-assisted reduction is beneficial when operating without a traction table; however, it can also be a part of the surgeons' equipment even when operating on a traction table. When difficulties in obtaining an ideal anatomical reduction in displaced intertrochanteric femoral fractures, we suggest using the hook-assisted reduction technique. Level of Evidence III; Case-control Study.
RESUMO Introdução: Frequentemente, a fixação do fêmur proximal para fratura intertrocantérica do fêmur sem uma mesa de tração é um procedimento desafiador, especialmente se o padrão da fratura for complicado. O objetivo foi superar essa dificuldade utilizando um gancho. Materiais e métodos: Trata-se de um estudo retrospectivo de 60 pacientes. Em 28 desses, a redução foi necessária com um gancho (grupo 1). Os outros pacientes não precisaram usar essa técnica (grupo 2, n=32). O ângulo colo-diafisário, a colocação do parafuso lag e a distância ponta-ápice foram medidos por meio de radiografias. Resultados: Houve diferenças estatisticamente significativas entre os dois grupos com relação ao Índice de Alinhamento de Garden, às medidas do ângulo colo-diafisário pós--operatório e à distância ponta-ápice. O índice de alinhamento de Garden foi de 163,92 graus (dg.) No plano frontal no grupo 1 e 154,78 dg no grupo 2, respectivamente. No grupo 1, a distância ponta-ápice foi de 16,05 cm, enquanto no grupo 2 foi de 25,32 cm. O ângulo colo-diafisário foi de 133,1 graus no grupo 1 e 128,65 graus no grupo 2. Conclusão: A redução assistida por gancho é benéfica quando se opera sem uma mesa de tração; no entanto, ela também pode fazer parte do equipamento do cirurgião mesmo quando se opera em uma mesa de tração. Quando houver dificuldades em obter uma redução anatômica ideal em fraturas femorais intertrocantéricas deslocadas, sugerimos o uso da técnica de redução assistida por gancho. Nível de Evidência III; Estudo de Caso-controle.
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ABSTRACT Objective: Assess complications and risks in staged femoral shaft fracture treatment using external fixation and intramedullary nailing (DCO). Methods: Analysis involved 37 patients with 40 fractures, mostly male (87.5%), average age 32.9 years. Data included ASA score, AO/OTA and Gustilo classifications, Glasgow Coma Score, Injury Severity Score, times to external fixation and conversion, ICU duration, nail type, and reaming status. Complications tracked were mortality, deep infection, and non-union. Results: Predominant fracture type was AO/OTA A (45%), with 40% open (Gustilo A, 93.8%). Average ISS was 21; GCS was 12.7. Median ICU stay was 3 days; average time to conversion was 10.2 days. Retrograde nails were used in 50% of cases, with reaming in 67.5%. Complications included deep infections in 5% and non-union in 2.5%. Conclusion: DCO strategy resulted in low infection and non-union rates, associated with lower GCS and longer ICU stays. Level of Evidence III; Retrospective Cohort Study.
RESUMO Objetivo: Analisar taxa de complicações e riscos no tratamento estagiado de fraturas diafisárias do fêmur com fixador externo e conversão para haste intramedular (DCO). Métodos: Estudo com 37 pacientes, 35 masculinos, idade média de 32,9 anos, abordando escores ASA, classificação AO/OTA, Gustilo, Glasgow e ISS, tempo até a fixação externa, na UTI e tipo de haste. Complicações como mortalidade, infecção profunda e não união foram registradas. Resultados: Fraturas tipo AO/OTA A foram as mais comuns (45%), com 40% expostas (Gustilo A, 93,8%). ISS médio de 21 e ECG de 12,7. Média de 3 dias na UTI e 10,2 dias até a conversão. Uso de haste retrógrada em 50% dos casos e fresagem em 67,5%. As complicações incluíram infecção profunda em 5% e não união em 2,5%. A não união correlacionou-se com baixo ECG e tempo prolongado na UTI. Conclusão: A estratégia de DCO mostrou-se eficaz com baixas taxas de infecção e não união, associada a baixo ECG e tempo na UTI. Nível de Evidência III; Estudo de Coorte Retrospectivo.
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ABSTRACT Objectives: Evaluate the prevalence of hospital mortality in older adult patients with femoral fracture undergoing surgical treatment during the COVID-19 pandemic period, and to evaluate whether COVID-19 infection, clinical, and orthopedic factors interfered with mortality. Material and Methods: A retrospective study was conducted by reviewing medical records. Patients over 60 years of age with proximal femoral fracture undergoing surgical treatment were included. Overall mortality was calculated, as well as mortality whose primary or secondary cause was COVID-19 infection, to determine if infection influenced patient mortality. Clinical and orthopedic factors that interfered with mortality were evaluated. Categorical variables were compared using the Chi-square test or Fisher's exact test. Both unpaired t-test (parametric variables) and Mann-Whitney test (non-parametric variables) were used. The Kaplan-Meier mortality curve was constructed. Conclusion: The mortality of older adult patients with femoral fracture undergoing surgical treatment during the COVID-19 pandemic was 4.2%. Male sex, older age, and those who underwent blood transfusion had higher mortality rates. COVID-infected patients had ten times more chance of death and died twice as fast as the non-infected population. Level of Evidence II, Retrospective Study.
RESUMO Objetivos: Avaliar a mortalidade hospitalar de pacientes idosos com fratura de fêmur submetidos ao tratamento cirúrgico durante o período pandêmico de covid-19. Avaliar se a infecção pelo vírus do covid-19 e os fatores clínicos e ortopédicos interferiram na mortalidade. Material e Métodos: Realizou-se um estudo retrospectivo por levantamento de prontuários. Foram incluídos pacientes acima de 60 anos associados a fratura da extremidade proximal do fêmur e que submetidos a tratamento cirúrgico. Calculou-se a mortalidade geral e também aquela cuja causa principal ou secundária foi a infeção pelo covid-19 para determinar se essa influenciou na mortalidade dos pacientes. Foram avaliados se os fatores clínicos e ortopédicos interferiram na mortalidade e variáveis categóricas foram comparadas pelo teste de Qui-quadrado ou exato de Fisher, utilizando tanto o teste t não pareado (variáveis paramétricas) como o teste de Teste Mann-Whitney (variáveis não paramétricas). Por fim, construiu-se a curva de mortalidade de Kaplan-Meier. Conclusão: A taxa de mortalidade de pacientes idosos com fratura de fêmur submetidos ao tratamento cirúrgico durante a pandemia de Covid foi de 4,2%. Pacientes do sexo masculino, idosos e os que foram submetidos à transfusão sanguínea evoluíram com maior mortalidade. Pacientes infectados pelo Covid tiveram dez vezes mais chance de evoluir para óbito e de forma duas vezes mais rápida que a população não infectada. Nível de Evidência II, Estudo Retrospectivo.
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ABSTRACT Objectives: To describe the historical series of admissions to the Intensive Care Unit of older adults with femoral fractures, and verify the association between age and injury characteristics and treatment, nursing workload, severity, and clinical evolution in the unit. Method: Retrospective cohort of 295 older adults (age ≥60 years) admitted to the Intensive Care Unit of a hospital in São Paulo, between 2013 and 2019, and who presented with a femur fracture as the main cause of hospitalization. Variables regarding demographic characteristics, cause, and type of fracture, treatment provided, severity, nursing workload, and medical outcome of patients were analyzed. The Shapiro-Wilk, Wilcoxon-Mann-Whitney, Kruskal-Wallis tests and Pearson correlation were applied. Results: There was an increase in older adults admission to the Intensive Care Unit from 2017 on. Female patients with distal femur fractures who died in the Intensive Care Unit had significantly (p < 0.05) higher median age than men, patients with shaft or proximal femur fractures, and survivors. Conclusion: The study findings highlight essential information for structuring care for older adults with femoral fractures who require intensive care.
RESUMEN Objetivo: Describir la serie histórica de internaciones, en la Unidad de Cuidados Intensivos, de ancianos con fractura de fémur, y verificar la asociación entre la edad y las características y tratamiento de la lesión, carga de trabajo de enfermería, gravedad y evolución clínica en la unidad. Método: Cohorte retrospectiva de 295 ancianos (edad ≥60 años) ingresados en la Unidad de Cuidados Intensivos de un hospital de São Paulo, entre 2013 y 2019, y que presentaron fractura de fémur como principal causa de hospitalización. Se analizaron variables relativas a características demográficas, causa y tipo de fractura, tratamiento realizado, gravedad, carga de trabajo de enfermería y evolución clínica de los pacientes. Se aplicaron las pruebas de Shapiro-Wilk, Wilcoxon-Mann-Whitney, Kruskal-Wallis y correlación de Pearson. Resultados: Hubo aumento de hospitalizaciones de ancianos en Unidad de Cuidados Intensivos desde 2017. Las pacientes del sexo femenino con fracturas de fémur distal que murieron en la Unidad de Cuidados Intensivos tuvieron mediana de edad significativamente (p < 0,05) más alta que los hombres, los pacientes con fracturas de diáfisis o de fémur proximal y los supervivientes. Conclusión: Los hallazgos del estudio resaltan información esencial para estructurar la atención de los ancianos con fracturas femorales que requieren tratamiento intensivo.
RESUMO Objetivos: Descrever a série histórica das internações, na Unidade de Terapia Intensiva, de idosos com fratura de fêmur, e verificar a associação entre idade e as características e tratamento da lesão, carga de trabalho de enfermagem, gravidade e evolução clínica na unidade. Método: Coorte retrospectiva de 295 idosos (idade ≥60 anos) admitidos na Unidade de Terapia Intensiva de hospital em São Paulo, entre 2013 e 2019, e que apresentaram fratura de fêmur como causa principal da internação. Variáveis sobre características demográficas, causa e tipo da fratura, tratamento realizado, gravidade, carga de trabalho de enfermagem e desfecho clínico dos pacientes foram analisadas. Os testes de Shapiro-Wilk, Wilcoxon-Mann-Whitney, Kruskal-Wallis e correlação de Pearson foram aplicados. Resultados: Houve aumento das internações de idosos na Unidade de Terapia Intensiva a partir de 2017. Pacientes do sexo feminino, com fratura distal de fêmur e que morreram na Unidade de Terapia Intensiva apresentaram significativamente (p < 0,05) maior mediana de idade do que homens, pacientes com fratura de diáfise ou proximal do fêmur e sobreviventes. Conclusão: Os achados do estudo evidenciam informações essenciais para estruturação dos cuidados ao idoso com fratura de fêmur que necessita de tratamento intensivo.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aged , Nursing , Femoral Fractures , Mortality , Workload , Intensive Care UnitsABSTRACT
Abstract Objective To evaluate the stability of osteotomies created in the subtrochanteric and trochanteric regions in a pediatric femur model fixed by flexible intramedullary rods. Methods Tomographic sections were obtained from a pediatric femur model with two elastic titanium rods and converted to a three-dimensional model. This model created a mesh with tetrahedral elements according to the finite element method. Three virtual models were obtained, and osteotomies were performed in different regions: mediodiaphyseal, subtrochanteric, and trochanteric. A vertical load of 85N was applied to the top of the femoral head, obtaining the displacements, the maximum and minimum main stress, and the equivalent Von Mises stress on the implant. Results With the applied load, displacements were observed at the osteotomy site of 0.04 mm in the diaphyseal group, 0.5 mm in the subtrochanteric group, and 0.06 mm in the trochanteric group. The maximum stress in the diaphyseal, subtrochanteric, and trochanteric groups was 10.4 Pa, 7.52 Pa, and 26.4 Pa, respectively. That is around 40% higher in the trochanteric group in regards to the diaphyseal (control). The minimum stress of the bone was located in the inner cortical of the femur. The equivalent Von Mises stress on the implants occurred at osteotomy, with a maximum value of 27.6 Pa in the trochanteric group. Conclusion In both trochanteric and subtrochanteric osteotomies, fixation stability was often lower than in the diaphyseal model, suggesting that flexible intramedullary nails are not suitable implants for proximal femoral fixations.
Resumo Objetivo Avaliar a estabilidade de osteotomias criadas nas regiões subtrocantérica e trocantérica em modelo de fêmur pediátrico, fixadas por hastes intramedulares flexíveis. Método A partir de um modelo de fêmur pediátrico com duas hastes elásticas de titânio, foram obtidos cortes tomográficos que foram convertidos para um modelo tridimensional. Neste modelo foi criado uma malha com elementos tetraédricos, de acordo com o método dos elementos finitos. Foram obtidos três modelos virtuais, e realizadas osteotomias em regiões diferentes: mediodiafisária, subtrocantérica e trocantérica. Foi aplicado um carregamento vertical de 85N no topo da cabeça do fêmur, obtidos os deslocamentos, a tensão máxima e mínima principal e tensão equivalente de Von Mises no implante. Resultados Com o carregamento aplicado foram observados deslocamentos no local da osteotomia de 0,04mm no grupo diafisário, 0,5mm no subtrocantérico e 0,06mm no trocantérico. A tensão máxima principal foi 10,4Pa, 7,52Pa e 26,4Pa nos grupos diafisário, subtrocantérico e trocantérico, respectivamente. Ou seja, a tensão máxima foi em torno de 40% maior no grupo trocantérico, em relação ao diafisário (controle). A face de tensão mínima do osso localizou-se na cortical interna do fêmur. A tensão equivalente de Von Mises nos implantes ocorreu na osteotomia, com valor máximo de 27,6Pa no grupo trocantérico. Conclusão Tanto nas osteotomias no nível trocantérico, quanto subtrocantérico, a estabilidade da fixação foi muitas vezes menor que no modelo diafisário, sugerindo que as hastes intramedulares flexíveis não são implantes adequados para as fixações proximais do fêmur.
Subject(s)
Humans , Child , Osteotomy , Finite Element Analysis , Femoral Fractures/surgery , Fracture Fixation, Intramedullary , Models, AnatomicABSTRACT
Resumen: Introducción: los bifosfonatos se usan para el manejo de osteoporosis postmenopáusica con riesgo elevado de fractura, osteoporosis inducida por glucocorticoides, enfermedad de Paget e hipercalcemia; así como coadyuvante para manejo del hiperparatiroidismo. Los bifosfonatos se han asociado a efectos adversos previamente desconocidos dentro de los que se encuentran fracturas de fémur de trazo atípico. Objetivo: analizar la relación del antecedente de uso de bifosfonatos (BF) como factor de riesgo para presentar fracturas atípicas de fémur (FAF). Material y métodos: se incluyeron pacientes de 40 años o más de dos centros hospitalarios atendidos desde 2009 a 2018 por fractura de fémur. Se revisaron los estudios radiográficos de 441 registros, de los cuales se definió el sitio de fractura. Se analizaron las fracturas de fémur subtrocantéricas (FS) y diafisarias (FD) aplicando los criterios del segundo reporte de la American Society for Bone and Mineral Research para la definición de caso de FAF. Finalmente, se indagó el consumo de bifosfonatos en estos grupos para para estimar una medida de asociación. Resultados: de los 441 registros clínicos, 98 (22.2%) fueron del sexo masculino y 343 (77.7%) del femenino, con edad promedio de 77.8 (40-103) años. Se identificaron 59 FS/FD, de las cuales 53% (31 registros) fueron catalogadas FAF. El consumo de BF se determinó en 80.6% de pacientes con FAF y en 3.57% con FS/FD. El uso de BF se asoció significativamente con la presencia de FAF (OR: 112, p ≤ 0.000, IC 95%: 12.6-1001). Conclusiones: el uso de BF aumenta significativamente el riesgo de presentar FAF. Las FAF en pacientes que usaron BF se presentó tras un consumo mínimo de 24 meses.
Abstract: Introduction: bisphosphonates are used for the management of postmenopausal osteoporosis with high risk of fracture, glucocorticoid-induced osteoporosis, Paget's disease and hypercalcemia; as well as an adjuvant for the management of hyperparathyroidism. Bisphosphonates have been associated with previously unknown adverse effects, including atypical femur fractures. Objective: to analyze the relationship of the history of bisphosphonate (BF) use as a risk factor for presenting atypical femur fractures (AFF). Material and methods: patients aged 40 years or older from two hospital centers seen from 2009 to 2018 for femur fracture were included. The radiographic studies of 441 records were reviewed, from which the fracture site was defined. Subtrochanteric (SF) and diaphyseal (DF) femur fractures were analyzed applying the criteria of the second report of the American Society for Bone and Mineral Research for case definition of AFF. Finally, the consumption of bisphosphonates in these groups was investigated to estimate a measure of association. Results: of the 441 clinical records, 98 (22.2%) were male and 343 (77.7%) were female with a mean age of 77.8 (40-103) years. Fifty-nine FS/FD were identified, of which 53% (31 records) were categorized as AFF. BF use was determined in 80.6% of patients with AFF and 3.57% in FS/FD. BF use was significantly associated with the presence of AFF (OR: 112, p ≤ 0.000, CI 95%: 12.6-1001). Conclusions: BF use significantly increases the risk of presenting AFF. AFF in patients who used BF occurred after a minimum consumption of 24 months.
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Abstract Objective To evaluate the factors associated with readmission within 30 days after discharge (R30) and in-hospital mortality (IHM) in elderly patients undergoing proximal femur fracture surgery (PFF). Methods Retrospective cohort with data from 896 medical records of elderly (≥ 60 years) patients submitted to PFF surgery in a Brazilian hospital between November 2014 and December, 2019. The patients included were followed-up from the date of hospitalization for surgery up to 30 days after discharge. As independent variables, we evaluated gender, age, marital status, pre- and postoperative hemoglobin (Hb), international normalized ratio, time of hospitalization related to the surgery, door-surgery time, comorbidities, previous surgeries, use of medications, and the American Society of Anesthesiologists (ASA) score. Results The incidence of R30 was 10.2% (95% confidence interval [CI]: 8.3-12.3%), and the incidence of IHM was 5.7% (95%CI: 4.3-7.4%). Regarding R30, hypertension (odds ratio [OR]: 1.71; 95%CI: 1.03-2.96), and regular use of psychotropic drugs (OR: 1.74; 95%CI: 1.12-2.72) were associated in the adjusted model. In the case of IHM, higher chances were associated with chronic kidney disease (CKD) (OR: 5.80; 95%CI: 2.64-12.31), longer hospitalization time (OR: 1.06; 95%CI: 1.01-1.10), and R30 (OR: 3.60; 95%CI: 1.54-7.96). Higher preoperative Hb values were associated with a lower chance of mortality (OR: 0.73; 95%CI: 0.61-0.87). Conclusion Findings suggest that the occurrence of these outcomes is associated with comorbidities, medications, and Hb.
Resumo Objetivo Avaliar os fatores associados à reinternação em até 30 dias após a alta (R30) e à mortalidade intra-hospitalar (MIH) em idosos submetidos a cirurgia por fratura do fêmur proximal (FFP). Métodos Coorte retrospectiva com dados de 896 prontuários de idosos (≥ 60 anos) submetidos a cirurgia de FFP em hospital brasileiro, no período entre novembro de 2014 a dezembro de 2019. Os pacientes incluídos foram acompanhados desde a data de internação para a cirurgia até 30 dias após a alta. Como variáveis independentes, foram avaliados o sexo, idade, estado civil, hemoglobina (Hb) pré e pós-operatória, razão normalizada internacional, tempo da internação relacionada à cirurgia, tempo porta cirurgia, comorbidades, cirurgias prévias, uso de medicamentos e escore da American Society of Anesthesiologists (ASA). Resultados A incidência de R30 foi de 10,2% (intervalo de confiança [IC] 95%: 8,3-12,3%) e a de MIH foi 5,7% (IC95%: 4,3-7,4%). Referente a R30, no modelo ajustado, associaram-se ter hipertensão (odds ratio [OR]: 1,71; IC95%: 1,03-2,96), uso regular de medicamentos psicotrópicos (OR: 1,74; IC95%: 1,12-2,72). Tratando-se da MIH, maiores chances estiveram associadas à doença renal crônica (DRC) (OR: 5,80; IC95%: 2,64-12,31), maior tempo de internação (OR: 1,06; IC95%: 1,01-1,10) e R30 (OR: 3,60; IC95%: 1,54-7,96). Maiores valores de Hb pré-operatória associaram-se à menor chance de mortalidade (OR: 0,73; IC95%: 0,61-0,87). Conclusão Os achados sugerem que a ocorrência destes desfechos está associada à comorbidades, medicamentos e Hb.
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Humans , Middle Aged , Aged , Patient Readmission , Mortality , Femoral Fractures/surgeryABSTRACT
Objective:To analyze the therapeutic effect of 3D printing technology combined with locking plate fixation on femoral shaft fracture in patients with femoral deformity.Methods:The clinical data of 33 patients with femoral shaft fracture with femoral deformity who met the inclusion criteria and underwent locking plate fixation in the Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University from June 2014 to December 2020 were retrospectively analyzed. The patients were divided into 3D printing group ( n=18) and control group ( n=15) according to whether 3D printing was performed before operation. The 3D printing group including 11 males and 7 females with an age of (46.78±13.76) years.The control group including 9 males and 6 females with an age of (48.20±14.27) years.The operation time, intraoperative blood loss, fracture healing time and complications of the two groups were recorded. Visual analogue scale (VAS) scores of pain were evaluated before and 6, 12, 24, 48 and 72 h after operation. According to the Harris hip score, the Hospital for Special Surgery (HSS) knee score and The MOS 36-item short-from Health Survey (SF-36), the hip and knee function and quality of life of the patients before and 12 months after injury were evaluated. The measurement data were represented as mean±standard deviation( ± s), and the comparison between groups was conducted using the t-test; the comparison of count data between groups was conducted by Chi-square test or Fisher exact probability. Results:The operation time, intraoperative blood loss, and incidence of complications in the 3D printing group were (91.50±9.07) min, (191.11±16.01) mL, and 0(0/18), respectively, and those in the control group were (118.07±14.19) min, (270.27±17.59) mL, and 26.7% (4/15), the differences between the two groups were statistically significant ( P <0.05). The pain VAS scores of the 3D printing group were significantly better than those of the control group at 6, 12, 24, 48, and 72 h after operation ( P<0.05). There were no differences in fracture healing time and preoperative pain VAS between the two groups( P>0.05). There were no significant differences in hip function, knee function and quality of life scores between the two groups before injury and 12 months after injury( P>0.05). Conclusion:In the treatment of femoral shaft fractures in patients with femoral deformity with locking plate fixation, the application of 3D printing technology can be used for preoperative design and plate preshaping, which can shorten the operation time, reduce the amount of intraoperative blood loss, reduce the VAS of pain and the incidence of complications, improve the satisfaction of surgery, and provide a new option for the treatment of femoral shaft fractures in patients with femoral deformity.
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Femoral fracture is a common type of fracture in clinical practice, and poor fracture reduction may lead to malunion and dysfunction. At present, traditional reduction with manipulation and intramedullary nailing are the mainstream treatments, but there exist problems such as X-ray exposure or poor reduction. Fracture reduction robots are of positive significance in improving the safety of surgical treatment of femur fracture, avoiding repetitive operations and poor alignment, and shortening the patients′ postoperative recovery time. Navigation algorithm is the key to achieve the function of femoral repositioning. Understanding the advantages and disadvantages that various types of navigation algorithms demonstrated in femoral reduction applications is important for giving full play to the value of fracture reduction robots in femoral reduction. Therefore, the authors reviewed the research progress in existing robot navigation algorithms applied in femoral fracture repositioning from the following four aspects, including image alignment algorithm, algorithm for establishing the target pose of femoral repositioning, algorithm for compensating the mechanical error, and algorithm for path planning, hoping to provide a reference for the application and research of navigation algorithms of fracture reduction robots.
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Objective:To investigate the clinical characteristics and predisposing factors associated with preoperative anemia in adult femoral shaft fractures.Methods:A retrospective analysis of clinical data from 157 patients presenting with femoral shaft fractures admitted to the department of orthopedics at Nanjing Drum Tower Hospital between June 2018 and June 2022 was conducted. The study cohort comprised 106 males and 51 females, with an average age of 45.06 ± 14.32 years (range: 18-65 years). Based on hemoglobin levels measured within 2 days of admission, patients were stratified into two groups: anemia group (Hb<120 g/L in adult males and Hb<110 g/L in adult females) and non-anemia group. General demographic information, AO fracture types, and clinical characteristics, as well as the results of laboratory examinations for both groups were collected. Subsequently, univariate and multivariate logistic regression analyses were conducted.Results:Out of the 157 patients with femoral shaft fractures, 118 (75.2%) exhibited preoperative anemia (the anemia group). Among them, 75 cases were male, and 43 cases were female, with an average age of 45.84±14.23 years (range: 18-65 years). In terms of fracture AO type, 41 cases were classified as 32A, 19 as 32B, and 58 as 32C. Regarding fracture location, 14 were situated in the upper 1/3 of the femoral shaft, 67 in the middle 1/3, and 37 in the lower 1/3. The causes of injury included 63 cases of motor vehicle accidents, 5 cases of blunt trauma, 40 cases of falls, and 10 cases of other falls, with 65 cases involving multiple injuries. Conversely, 39 patients (24.8%) did not exhibit preoperative anemia (the non-anemia group). Of these, 31 were male, and 8 were female, with an average age of 42.72 ± 14.51 years (range: 19-65 years). In terms of fracture AO type, 24 cases were classified as 32A, 5 as 32B, and 10 as 32C. Regarding fracture location, 3 were situated in the upper 1/3 of the femoral shaft, 19 in the middle 1/3, and 17 in the lower 1/3. The causes of injury included 13 cases of motor vehicle accidents, 5 cases of blunt trauma, 20 cases of falls, and 1 other fall, with 8 cases involving multiple injuries. Univariate analysis revealed statistically significant differences between preoperative anemia and AO fracture type, mechanism of injury, multiple injuries, time from injury to hospital admission, albumin levels, and age ( P< 0.05). Multifactorial logistic regression analysis identified AO type 32C ( OR=3.12, P=0.020), blunt trauma injuries ( OR=0.13, P=0.021), reduced albumin levels ( OR=9.90, P=0.037), and multiple injuries ( OR=3.65, P=0.016) as risk factors for preoperative anemia. Multifactorial logistic regression further revealed that multiple injuries ( OR=5.20, P=0.004) and reduced albumin levels ( OR=5.47, P=0.001) were risk factors for the severity of anemia. Conclusion:AO type 32C fractures, blunt trauma injuries, reduced albumin levels, and multiple injuries were identified as potential contributors to the development of preoperative anemia, with multiple injuries and reduced albumin levels exacerbating the severity of anemia. Clinicians should be vigilant for the occurrence of preoperative anemia in adult femoral shaft fracture patients, particularly those with blunt trauma injuries, multiple injuries, hypoalbuminemia, and AO type 32C fractures.
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Objective:To compare treatment effect of the new multi-dimensional cross locking plate-II (MDC-LP-II) and locking compression plate (LCP) as additional plates in the treatment of nonunion after intramedullary nailing treatment of subtrochanteric fractures.Methods:A retrospective analysis was performed on 23 patients with nonunion after subtrochanteric fractures treated with intramedullary nails from January 2019 to January 2021. According to the type of additional plate, it was divided into MDC-LP-II group and LCP group. There were 12 patients in MDC-LP-II group, including 10 males and 2 females, with an age of 36.83±12.61 years, a body mass index (BMI) of 25.09±2.37 kg/m 2, the time from the last operation to this treatment was 12.25±2.93 months, the number of previous operations was 1.33±0.65, 5 cases of hypertrophic nonunion, 7 cases of atrophic nonunion, and the length of bone nonunion defect was 1.19±0.78 cm. In the LCP group, there were 11 cases, 9 males and 2 females, aged 30.55±8.85 years, BMI was 26.74±5.05 kg/m 2, a time of 12.82±4.40 months after the last operation, the number of previous operations was 1.36±0.96, 5 cases of hypertrophic nonunion, 6 cases of atrophic nonunion, and the length of bone nonunion defect was 1.20±0.57 cm. The incision length, additional plate length, number of screws, number of bicortical screws, intraoperative blood loss, blood transfusion, healing time of nonunion, Harris hip score, lower extremity functional scale (LEFS) and the medical outcomes study item short from health survey-36 (SF-36) were compared between the two groups. Results:All 23 patients were followed up. The follow-up time of MDC-LP-II group was 14.17±2.55 months, and that of LCP group was 14.45±3.75 months, with no significant difference ( t=0.22, P=0.834). In MDC-LP-II group, the incision length was 7.25±2.01 cm, the plate length was 9.25±0.62 cm, the number of screws was 7.17±0.94, the number of bicortical screws was 7.17±0.94, the intraoperative blood loss was 279.17±169.84 ml, and the blood transfusion was 166.67±187.05 ml. In LCP group, the incision length was 15.45±4.72 cm, the plate length was 15.51±2.38 cm, the number of screws was 5.09±0.95, the number of bicortical screws was 1.82±1.72, the intraoperative blood loss was 481.82±227.24 ml, and the blood transfusion was 685.45±299.95 ml. There were significant differences in incision length ( P<0.05), plate length ( P<0.05), number of screws ( P<0.05), number of bicortical screws ( P<0.05), intraoperative blood loss ( P<0.05), and blood transfusion volume ( P<0.05) between the two groups. The fracture healing rate was 100% in MDC-LP-II group and 64% in LCP group at 6 months after operation, and the difference was statistically significant ( P<0.05). At 12 months after operation, the healing rate of LCP group was 91%, and the difference was not statistically significant ( P=0.478). The Harris score 92.83±8.04 and LEFS 74.92±6.68 at the last follow-up in MDC-LP-II group and the Harris hip score 83.36±9.89 and LEFS 66.27±7.68 at the last follow-up in LCP group were significantly different between the two groups ( P<0.05). In terms of SF-36, scores of physical function, physical pain, general health status, vital vitality and mental health of MDC-LP-II group were higher than those of LCP group. No complications related to the use of MDC-LP-II or LCP fixation were observed in both groups. Conclusion:On the basis of preserving the original intramedullary nail, MDC-LP-II compared with LCP as additional plates in the rebuilding of nonunion after intramedullary nailing treatment of subtrochanteric fractures, it can effectively enhance the stability of the broken ends in a much smaller operating range, reduce the surgical trauma, protect the local blood supply and accelerate the healing of the broken end of the fracture. The patients who received MDC-LP-II treatment had better lower limb function recovery and quality of life.
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Intertrochanteric femoral fracture occurs frequently in elderly osteoporotic patients, with high disability and mortality, for which surgical treatment is necessary. Common surgical modalities for intertrochanteric femoral fracture include intramedullary and extramedullary internal fixation systems, but neither can avoid the complications like internal fixation cut-out or internal fixation cut-through of the femoral head after surgery. The tip-apex distance theory was once considered to be of great significance in avoiding internal fixation cut-out, with the mainstream view was that screw cut-out could be avoided to the maximum extent when the tip-apex distance was ≤25 mm. However, internal fixation that meets the criteria of the tip-apex distance theory may also show cut-out and "Z-effect" in clinical practice, which lacks a reasonable explanation. Based on the lever balance reconstruction theory and the buttress-stretch effect, the author re-understands the value of the tip-apex distance theory in guiding treatment of intertrochanteric femoral fracture, hoping to propose an enlightenment for the treatment of intertrochanteric femoral fracture.
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Objective:To investigate the short-term efficacy of rotational femoral neck osteotomy with preservation of the round ligament in the treatment of subchondral insufficiency fracture of the femoral head (SIFFH) in young and middle-aged people.Methods:A retrospective case series study was used to analyze the clinical data of 13 patients with SIFFH, who were admitted to 920th Hospital of Joint Logistics Support Force from January 2017 to January 2022. The patients included 10 males and 3 females, aged 22-49 years [(33.5±8.3)years]. There were 6 patients with fracture on the left hip and 7 on the right hip. All the patients were treated by rotational femoral neck osteotomy with preservation of the round ligament. Postoperatively, standardized joint functional training was given. The operative time and intraoperative bleeding were recorded. The modified Harris hip score and visual analogue score (VAS) were compared preoperatively, at 3, 6 months postoperatively and at the final follow-up. Radiological examinations were used to observe the occurrence of any collapse of the femoral head, non-union at osteotomy site or other complications.Results:The patients were followed up for 13-24 months [(17.9±3.1)months]. The operative time was (127.3±9.8)minutes, with the intraoperative bleeding of (393.9±21.9)ml. The values of modified Harris hip score were (61.6±3.3)points, (80.2±4.4)points, and (91.9±4.1)points at 3, 6 months postoperatively and at the final follow-up, respectively, being significantly higher than the preoperative (51.4±3.5)points (all P<0.05), and there were significant differences between different postoperative timepoints (all P<0.05). The values of VAS were (4.9±1.1)points, (3.0±0.9)points, and (1.4±0.5)points at 3, 6 months postoperatively and at the final follow-up, respectively, being significantly lower than preoperative (6.7±0.9)points (all P<0.05), and there were significant differences between different postoperative timepoints (all P<0.05). Imaging examination showed no femoral head collapse, with all the bones healed at the osteotomy site. There were no serious complications such as bone non-union, incision infection or peripheral nerve injury. Conclusion:Rotational femoral neck osteotomy with preservation of the round ligament in treating SIFFH in the young and middle-aged population has the advantages of shortened operative time, less intraoperative bleeding, promoted hip function recovery, attenuated pain and decreased complications, showing a satisfactory early effect.
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Objective:To explore the short-term efficacy of fixation with a 3D printed individualized custom-made plate in the treatment of elderly patients with periprosthetic femoral fracture.Methods:Retrospectively analyzed were the 5 elderly patients with periprosthetic femoral fracture who had been treated by fixation with a 3D printed individualized custom-made plate from January 2022 to July 2022 at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital. There were 3 males and 2 females, aged 81, 86, 77, 91 and 87 years, respectively. One left and 4 right limbs were affected. Vancouver classification: type B1 ( n=3), type B2 ( n=1), and type C ( n=1). The time from operation to injury was 5, 6, 10, 5 and 7 days, respectively. Preoperatively, the femur affected, prosthesis and individualized plate with a greater trochanteric hook, loop cable channel and bone-like trabecular microporous structure were custom-made by 3D printing according to 1:1 models. Virtual operations were simulated to formulate surgical protocols. The operation time, length of surgical incision, intraoperative blood loss and transfusion, hospital stay, hip function and complications at the last follow-up were recorded. Results:The 5 patients were followed up for 12, 7, 10, 3 and 6 months, respectively. There were no events of superficial incision or deep prosthesis infection. Respectively, the operation time was 1.8, 1.7, 2.3, 2.0 and 3.3 h; the length of surgical incision 31, 30, 38, 27 and 30 cm; the intraoperative bleeding volume 400, 300, 300, 500 and 600 mL; the length of hospital stay 8, 9, 15, 14 and 11 d. Four patients received intraoperative blood transfusion of 300, 900, 150 and 1, 050 mL, respectively. One patient died of a heart attack 3 months after discharge; another patient developed dyskinesia at the contralateral limb 3 months after discharge due to cerebral infarction and died of recurrent cerebral infarction 7 months after discharge. At the last follow-up, the Harris hip scores of 3 patients were 86, 77 and 69 points, respectively. None of the patients had complications like breakage or loosening of implants.Conclusion:In the treatment of elderly patients with periprosthetic femoral fracture, fixation with a 3D printed individualized custom-made plate may lead to fine limb function and good short-term curative efficacy.
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Objective:To compare the biomechanical differences of dynamic condylar screw (DCS), locking compression plate (LCP) combined with DCS and medial anatomic buttress plate (MABP) combined with DCS in the revision of medial defective intertrochanteric fractures by finite element analysis.Methods:The femoral CT imaging data provided by a healthy adult volunteer were used to reconstruct the solid three-dimensional model of femur by Mimics 21.0 and Geomagics Studio 12. Evans-Jensen II B intertrochanteric fracture was established by Ansys Workbench18.0. The three-dimensional models of proximal femoral nail antirotation (PFNA), DCS, LCP and MABP were reconstructed in Solidworks 2015. The PFNA was assembled with the fracture model, and then the PFNA was removed to establish the postoperative failure model of femoral intertrochanteric fracture and then simulated the fixation in the hip-preserving revision surgery of femoral intertrochanteric fractures: non-medial support reconstruction group (DCS); indirect medial support reconstruction group (DCS+LCP) and partial direct medial support reconstruction group (DCS+MABP). Finally, the forces on the hip joint of 70 kg normal people during standing (700 N), slow walking (1,400 N), brisk walking (1,750 N) and going up and down stairs (2,100 N) were simulated in Abaqus 6.14, the relative displacement and stress peak value of fracture end and stress distribution and stress peak value of internal fixation in different models were recorded.Results:At 700 N axial load, the relative displacement of fracture end fixed by DCS, DCS+LCP and DCS+MABP was 0.28, 0.13 and 0.09 mm; the peak stress of the fracture end was 49.01, 15.29 and 1.35 MPa; the peak stress of internal fixation was 230, 220 and 174 MPa, respectively. At 1,400 N axial load, the relative displacement of the fracture end of the three internal fixation methods was 0.56, 0.24 and 0.16 mm; the peak stress of fracture end was 108.49, 28.96 and 3.12 MPa; the peak stress of internal fixation was 469, 352 and 324 MPa, respectively. At 1,750 N axial load, the relative displacement of the fracture end of the three group was 0.70, 0.30 and 0.20 mm; the peak stress of the fracture end was 139.59, 37.57 and 4.17 MPa; the peak stress of internal fixation was 594, 421 and 393 MPa, respectively. At 2,100 N axial load, the relative displacement of the fracture end of the three internal fixation methods was 0.85, 0.35 and 0.23 mm; the peak stress of the fracture end was 170.05, 46.36 and 5.24 MPa; the peak stress of internal fixation was 724, 504 and 460 MPa, respectively.Conclusion:The partial direct reconstruction of medial support under the neck by DCS+MABP may have better biomechanical properties in the revision of medial defective intertrochanteric fractures.
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Objective:To compare the clinical effects robot navigation assisted and conventional proximal femoral nail antirotation (PFNA) implantation and fixation in the treatment of elderly femoral trochanteric fractures.Methods:A total of 86 elderly patients with tuberosity fracture of the femur were admitted as research samples from January to March in 2022 in the Department of Trauma Orthopaedic, Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University, including 37 males and 49 females, who aged from 63 to 92 years, with an average age of (79.6 ± 6.9) years. All patients were treated with intramedullary nails (PFNA), 32 with dimensity robotic-assisted therapy (robot group) and 54 with traditional methods (conventional group). The length of incision, the number of intraoperative fluoroscopy, the amount of intraoperative blood loss, and the operation time were recorded. The occurrence of postoperative complications in the two groups was observed. The rate of excellent hip Harris score at 3 month after surgery was compared between the two groups. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; the comparison of count data were represented as [ n(%)], and was conducted by Chi-square test or Fisher exact probability between groups. Results:All patients were followed up for 9 to 12 months, with an average of (10.6 ± 0.9) months. The incision length and tip apex distance (TAD) of the robot group were (3.40±0.82) cm and (21.85±1.44) mm, which were smaller than (4.82±0.75) cm and (26.83±1.75) mm in the conventional group ( P<0.05 for all). The number of intraoperative fluoroscopy and guide needle adjustment [(14.53±3.26) and 0 times] in the robot group were less than those in the conventional group [(20.67±4.84) and (2.83±1.42)] ( P<0.05). The intraoperative blood loss and drainage rate of the robot group were (87.03±9.41) and (46.40±8.91) mL, which were smaller than that of the conventional group [(110.00±12.52) and (69.62±10.22) mL] ( P<0.05). There was no significant difference in the number of days of hospitalization and operation time between the two groups ( P>0.05). The postoperative complication rate in the robot group was 9.4%, which was lower than that in conventional group (42.6%), and the difference was statistically significant ( χ2=11.88, P=0.036). The excellent rate of postoperative hip joint function in the robot group was 75.0%, and the conventional group was 66.7%, and there was no significant difference between the two groups ( χ2=0.66, P=0.416). Conclusion:Robot-assisted navigation downward PFNA surgery can have good clinical effect in the treatment of femoral tuberosity fracture in the elderly, which can reduce the number of surgical incisions and intraoperative fluoroscopy, and reduce the incidence of postoperative complications, which is helpful to achieve minimally invasive surgery and rapid recovery of elderly patients with femoral tuberosity fracture.
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A 19-year-old man had an accidental fall from the 2nd floor and sustained multiple injuries. On radiological evaluation, the patient had symmetrical quadruple limb involvement with bilateral humerus shaft, bilateral olecranon, bilateral femur shaft, and bilateral patella fractures. The patient was actively managed using damage control orthopaedics, and a sequence of skeletal fixation was planned based on the hemodynamic stability and periodical serum lactate assessment. Symmetrical quadruple limb fractures are very rare, which could be associated with higher mortality. A meticulous clinical evaluation, periodical blood parameter assessment and strict adherence to the principles of damage control orthopaedics can be conducive to prevent life-endangering complications.