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To compare the effects of advanced bone flap and no bone flap on the healing of osteotomy gap in open-wedge high tibial osteotomy (OW-HTO) for the treatment of medial compartment osteoarthritis and knee inversion.Methods:A retrospective study was conducted to analyze the 85 patients who had undergone OW-HTO from March 2021 to December 2021 at Trauma Emergency Centre, The Third Hospital of Hebei Medical University for medial compartment osteoarthritis and knee inversion. The patients were divided into 2 groups according to whether bone flap was grafted. In group A of 42 patients who received advanced bone flap intraoperatively, there were 32 females and 10 males with an age of (63.7±6.6) years; in group B of 43 patients who received no advanced bone flap intraoperatively, there were 31 females and 12 males with an age of (63.2±9.4) years. The measures recorded and compared between the 2 groups included: osteotomy gap healing rates at 3, 6, 12, and 18 months postoperatively; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS) for pain, and Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 and 18 months postoperatively; medial proximal tibial angle (MPTA) and femorotibial angle at immediate postoperation and 18 months postoperation; postoperative complications.Results:The differences in preoperative general information between the 2 groups were not statistically significant, showing comparability ( P>0.05). The osteotomy gap healing rates at 3, 6, 12, and 18 months postoperatively in group A were significantly higher than those in group B ( P<0.05). The WOMAC (26.1±5.9), VAS (4.1±1.4), and KOOS (47.0±9.7) scores at 6 months postoperatively in group A were significantly lower than those in group B (31.3±8.3, 4.8±1.6, and 56.1±11.9) ( P<0.05), but the differences in the above indicators between the 2 groups at 18 months postoperatively were not statistically significant ( P>0.05). There was no statistically significant difference in MPTA or femorotibial angle at immediate postoperation between the 2 groups ( P>0.05). At 18 months postoperatively, the MPTA in group A (88.7°±1.1°) was significantly better than that in group B (87.7°±1.5°) ( P<0.05). The total complication rate in group B [27.9% (12/43)] was signifcantly higher than that in group A [2.4% (1/42)]( P<0.05). Conclusions:In the OW-HTO treatment of the patients with medial compartment osteoarthritis and knee inversion, application of an advanced bone flap to fill the osteotomy gap can accelerate the gap healing and reduces occurrence of delayed healing or non-healing of the osteotomy gap.
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Objective:To characterize the biomechanics of distal dynamic locking and distal static locking of proximal femur bionic nails (PFBN) in fixation of intertrochanteric fractures by a finite element analysis.Methods:The CT image data from the hip to the upper tibia from an adult male volunteer were used to establish a three-dimensional model of the femur by Mimics 20.0 and Geomagic 2013 which was processed further into a model of Evans type I intertrochanteric fracture by software NX 12.0. With reference to the internal fixation parameters commonly used, 4 models of PFBN fixation were established: distal single transverse nail dynamic locking (model A), single oblique nail dynamic locking (model B), single nail static locking (model C) and double nail dynamic locking (model D). Abaqus 6.14 software was used to load and analyze the internal fixation stresses and displacements of fracture ends.Results:Under a 2100N loading, the peak stress was located upon the main nail in the 4 models. The smallest peak stress upon the main nail was in Model D (161.9 MPa), decreased by 15.9% compared with model A (192.5 MPa), by 15.6% compared with model B (191.9 MPa), and by 0.9% compared with model C (163.3 MPa). The peak stress upon the fixation screw was the largest in model A (95.3 MPa), the smallest in model B (91.5 MPa), and 91.5 MPa and 92.2 MPa in models C and D, respectively. The overall displacements of the implants, in a descending order, were 10.14 mm in model A, 10.10 mm in model B, 10.09 mm in model C, and 10.05 mm in model D. Similarly, the displacements of fracture ends were 0.125 mm in model A, 0.121 mm in model B, 0.110 mm in model C, and 0.098 mm in model D.Conclusion:Compared with dynamic locking, distal static locking of PFBN provides a better mechanical stability and reduces stress concentration upon internal fixation.
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Objective:To determine the relationship between tibial plateau stresses and malunion by exploring the changes in mechanical conduction in the knee joint after malunion of Hoffa fracture of the tibial plateau.Methods:This study selected 28 knee joint specimens treated with formalin for preservation, half of which were from male and half from female individuals with an age of (51.4±9.5) years. Their structures were intact, and flexion-extension activities normal. X-ray examinations excluded osteoporosis, tuberculosis, and diseases that could have potentially affected bone quality. The knee specimens were divided into a control group (intact tibia) ( n=4) and 6 groups of tibial plateau Hoffa fracture malunion model: 3 vertical malunion groups (groups V1, V2, and V3, with a vertical displacement of 1, 2, and 3 mm, respectively, n=4) and 3 separation malunion groups (groups S3, S5, and S7, with a separation displacement of 3, 5, and 7 mm, respectively), with half males and half females in each group. After a 600N vertical load was applied at passive knee flexions at 0°, 30°, 60°, 90°, and 120°, the stress levels in the medial and lateral compartments of the knee joint were measured using pressure-sensitive films. Results:Under a vertical load of 600 N, when the knee joint was in a neutral position (flexion of 0°), the differences in the medial and lateral tibial plateau stress values were not statistically significant between the malunion models groups and the control group ( P>0.05). When the knee flexion increased to 30°, the medial tibial plateau stress in the V3 and S7 groups was significantly greater than that in the control group ( P<0.05). At a knee flexion of 60°, the medial plateau stress was significantly greater in the V3, S5 and S7 groups than that in the control group, and the differences were significantly greater than the comparisons at a knee flexion of 30° (all P<0.05). When the knee flexion was 90°, the medial plateau stress in the V2, V3, S5 and S7 groups was significantly greater than that in the control group ( P<0.05), but the lateral tibial plateau stress in the V3 group was significantly smaller than that in the control group ( P<0.05). When the knee flexion was further increased to 120°, the differences in the medial and lateral plateau stress values were statistically significant between all the malunion groups and the control group ( P<0.05), and the differences significantly greater than the comparisons at a knee flexion of 90° (all P<0.05). Under a vertical load of 600 N, the differences in the stresses on the medial and lateral plateaus were not statistically significant between the control group and all the malunion groups at a knee flexion of 0° ( P>0.05). When the knee flexion increased to 30°, the difference between the medial and lateral stresses was not statistically significant in the control group ( P>0.05), but was statistically significant in the V3 and S7 groups ( P<0.05). When the knee flexion reached 60°, 90°, and 120°, the differences between the medial and lateral tibial plateau stresses in all the groups were statistically significant ( P<0.05). Conclusions:The peak knee stresses after malunion of Hoffa fracture of the tibial plateau correlate with the severity of malunion and knee flexion angles. The mechanical properties are not significantly different between a mild malunion knee and a normal knee, but a significant displacement (vertical displacement >2 mm and separation displacement ≥5 mm) may increase the peak knee stresses to increase the risk of knee osteoarthritis. When the severity of malunion is certain, an increase in knee flexion angle increases the difference in the peak stress between the medial and lateral tibial plateaus, thus increasing the risk of knee osteoarthritis.
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The neutrophil-to-lymphocyte ratio (NLR), the ratio of inflammatory cell counts in the blood, reflects the changes of neutrophils and lymphocytes in the inflammatory system in the peripheral blood. More and more scholars have found that NLR increases in patients with bone and joint injury, which can be used to predict postoperative mortality, infection, deep vein thrombosis, pain and other complications. This article is intended to review the application of NLR in bone and joint injury and related complications, providing reference for clinical application of NLR.
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Objective:To evaluate the biomechanical stability of our slot-designed compression bolt (SCB) combined with bilateral locking compression plates (LCPs) in the treatment of intra-articular distal femur fracture.Methods:In 24 adult male knee specimens treated with formalin, the femoral bony part was preserved to establish standard models of intra-articular distal femur fracture (AO type 33-C1). According to the random number table, the fracture models were divided into 2 equal groups: an experimental group ( n=12) subjected to fixation with one SCB combined with bilateral LCPs with 10 locking screws and a control group ( n=12) subjected to fixation with bilateral LCPs with 12 locking screws. In each model, a vertical ballast test was conducted to record the maximum axial displacement of the system and a horizontal torsion test to calculate the torsional stiffness of the system. When the loading pressure was 0-1,000 N in the biomechanical machine, structural abnormalities were observed in the 2 groups of models and the system maximum axial displacement and system torsional stiffness were compared between the 2 groups. Results:When the vertical ballast pressure was 400 N, 600 N, 800 N and 1,000 N, the maximum axial displacement of the system was, respectively, (0.14±0.01) mm, (0.25±0.01) mm, (0.41±0.02) mm and (0.63 ± 0.02) mm in the experimental group, and (0.15 ± 0.01) mm, (0.26 ± 0.01) mm, (0.46 ± 0.03) mm, and (0.67 ± 0.04) mm in the control group. Compared with the control group, the average maximum axial displacement in the experimental group decreased significantly under the axial pressure of 600-1,000 N ( P<0.05). When the horizontal torsion reached 5°, the torsional stiffness was, respectively, (2.00±0.12) Nm/° and (2.02±0.07) Nm/° in the experimental group and the control group, showing no significant difference between the 2 groups ( P>0.05). Conclusions:In the treatment of intra-articular distal femur fracture, compared with simple bilateral LCPs, our SCB combined with bilateral LCPs demonstrate similar torsional stability but better axial biomechanical stability. As our SCB has advantages of bilateral compression and minimal invasion in operation, it may be a new option for the reduction and compression treatment of intra-articular fractures.
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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 investigate the associations of articular depression depth (ADD) and tibial plateau widening (TPW) by pre-operative CT measurement with incidence of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture.Methods:Included in this retrospective study were 131 patients who had been admitted to Emergency Center of Trauma, The Third Hospital Affiliated to Hebei Medical University from January 2016 to January 2020 for Schatzker type Ⅱtibial plateau fractures. They were 88 males and 51 females, aged from 18 to 60 years (average, 41.5 years), with 74 right and 57 left sides injured. All patients were treated with closed reduction and internal fixation assisted by bidirectional traction. Arthroscopy was used to detect the status of lateral meniscus immediately after closed reduction and internal fixation of the fracture fragments. Furthermore, patients were divided into 2 groups according to the integrity of lateral meniscus: meniscal tear group ( n=70) and tear-free group ( n=61). The 2 groups were compared in terms of age, gender, body mass index(BMI), injury side, time interval from injury to surgery, TPW and ADD. The receiver operating curve (ROC) was drafted to calculate the cut-off values of TPW and ADD in complication of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture. Results:The overall incidence of lateral meniscal tear in this cohort was 53.4% (70/131). There was no statistically significant difference in terms of age, gender, injury side, BMI or time interval from injury to surgery between the 2 groups ( P>0.05); TPW and ADD were significantly higher in the meniscal tear group than in the tear-free group ( P<0.05). To predict lateral meniscal tear in patients with Schatzker type Ⅱtibial plateau fracture, the area under ROC was 0.656 (95% CI: 0.562 to 0.750, P=0.002) for TPW and 0.709 (95% CI: 0.619 to 0.800, P<0.001) for ADD, respectively; the cut-off values of TPW and ADD were 4.3 mm and 6.1 mm. Conclusion:TPW and ADD may be effective predictors for prediction of lateral meniscal tear in patients with Schatzker type Ⅱ tibial plateau fracture.
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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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Objective:To evaluate the clinical efficacy of minimally invasive treatment of Fraser type Ⅱ floating knee by homeopathic reduction.Methods:From November 2016 to July 2018, 7 patients with Fraser type Ⅱ floating knee were treated by homeopathic reduction and minimally invasive surgery at Trauma Emergency Center, The Third Hospital of Hebei Medical University. They were 5 males and 2 females, aged from 30 to 82 years (average, 52 years). They all suffered from tibial plateau fracture complicated with floating knee, with 5 cases of Fraser type ⅡA (tibial plateau fracture complicated with femoral shaft fracture) and 2 cases of Fraser type ⅡC (tibial plateau fracture complicated with femoral condyle fracture). The femoral and tibial plateau fractures were reduced with a bidirectional traction reduction device, followed by minimally invasive implantation of internal fixators. The operation time, length of a single incision, blood loss and fluoroscopic frequency were recorded. The anteroposterior and lateral X-ray films of the lower limb were taken and fracture healing time was recorded during follow-up. The function of knee joint was evaluated by Hospital for Special Surgery (HSS) scoring system at the last follow-up.Results:For the 7 patients, operation time averaged 87.2 min, length of a single incision 2.8 cm, blood loss 471 mL, and fluoroscopy frequency 37 times. The postoperative X-ray films showed fine alignment and force line and smooth articular surface in all patients. All the incisions healed by grade A. The follow-up time for 7 patients ranged from 12 to 21 months (average, 15.6 months). All the fractures healed after an average time of 12.8 weeks. The HSS scores at the last follow-up showed that 6 cases were excellent and one was good.Conclusion:The fractures of the femur side and of the tibia side can be treated separately by closed reduction and internal fixation using a homeopathic bidirectional traction reduction device so as to obtain better knee joint function.
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Tibial plateau fracture is a common acute trauma of the knee joint. At present, there are many studies on its classification and treatment, and minimally invasive treatment has become a research hotspot and mainstream direction of tibial plateau fracture. We summarized the clinical results of minimally invasive treatment of more than 300 cases of tibial plateau fractures, and proposed the concept of core weight-bearing area on tibial plateau, that is, the core weight-bearing area of the tibial plateau of the knee joint under normal motion statuswhile walking and moderate-intensity running. We performed thinsection CT scanning of the knee joint in a male volunteer for three-dimension finite element modeling.The results showed that during the walking state (the load was twice that of gravity), the core weight-bearing area of the medial and lateral plateaus was 389 mm 2 and 363 mm 2, accounting for 33.2% and 42.9% of tibial plateau, respectively;during the moderate-intensity running state (the load was four times that of gravity), the core weight-bearing area of the medial and lateral plateaus was 418 mm 2 and 406 mm 2, accounting for 35.6% and 48.0%of tibial plateau, respectively. Accordingly, tibial plateau fractures are supposed to be divided into core weight-bearing fracture and non-core weight-bearing fracture, and there are significant differences in the treatment ofthese twokinds of fractures: reduction is more demanding for core weight-bearing fracture,and the fracture involves the core area closely, the anatomical reduction is sought; for non-core weight-bearing area, the reduction requirements can be appropriately low demanded, and even in some cases , for example simple avulsion fracture, marginal fracture, some tibial plateau Hoffa fractures,can be treated conservatively. In summary, during clinical diagnosis and treatmentpractice, orthopedic surgeons should take the core weight-bearing area fracture as the core of diagnosis and treatment, strictly evaluate the extent of fracture involvement, select targeted internal fixation materials, and target to promote more accurate, minimally invasive, and individualized treatment of tibial plateau fractures.
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Objective:To compare the biomechanical properties between triangular supporting fixation and conventional dynamic hip screw (DHS) fixation in the treatment of femoral intertrochanteric fractures.Methods:Eight pairs of 16 femoral specimens with an average death age of 51.9 years were used in this study. After thawing, they were randomly divided into an experimental group ( n=8) and a control group ( n=8) according to the left or right laterality. They were made models of femoral intertrochanteric fracture of AO 31-A1 type with strain gauges pasted. The experimental group was subjected to fixation with double triangu-lar supporting and the control group conventional DHS fixation to achieve anatomical reduction. The specimens were then mounted onto a biomechanical testing machine and subjected to loading till 400 N at a rate of 10 N/s. The values of overall deformation of the specimens and strain at 16 selected sites were recorded and compared between the 2 model groups. Results:Under the load of 400 N, the overall deformation was (0.31±0.13) mm for the experimental group and (0.49±0.21) mm for the control group, showing a significant difference ( t=-2.456, P=0.023). The strain values in front of femoral neck, upon front fracture line, at inferior-lateral, inferior-median and inferior-interior sites of front fracture line, at the root of anterior fixation screw, below medial femoral neck fracture line, behind femoral neck, at superior-lateral, superior-median and superior-interior sites of posterior fracture line, below posterior fracture line, at superior and inferior roots of posterior fixation screw, at points parallel to the fixation screw in front of and behind femoral shaft were, respectively, -244.90, 13.16, -71.77, -124.38, -366.89,121.62, -10.94, -166.00, -54.93, -367.38, -608.93, -69.09, 326.50, 133.14, 52.97, and -185.82 in the experimental group and -24.62, -40.39, -36.99, -120.97, -486.38, 99.20, 35.36, -205.67, -74.30, -566.01, -1, 085.40, -77.41, 334.34, 114.08, 38.50, and -235.74 in the control group. Internal fixation failure occurred in one specimen in the control group after 1,759 cycles of loading but in none in the experimental group. Conclusion:For femoral intertrochanteric fractures, double triangular supporting fixation may result in less overall deformation and is more consistent with the normal biomechanical conduction of the femur than conventional DHS fixation.
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Objective:To compare the biomechanical properties of triangular supporting fixation and Gamma nail fixation for intertrochanteric fractures of the femur.Methods:The femoral CT imaging data provided by a healthy adult male volunteer aged 40 years, height 172 cm, and weight 75 kg were used to reconstruct the femur model using Mimics 21.0 software and Geomagics 2013 software. Evans type I intertrochanteric fracture models were established using UG12.0 software, and Gamma nail and triangular supporting intramedullary nail models were reconstructed to simulate intertrochanteric fracture internal fixation, respectively. In Abaqus software, two internal fixation models of Gamma nail and triangular supporting intramedullary nail in standing state are simulated, and the stress peaks of the main nail, fixation screw and bone substance were collected, also the stress peak of supporting screw of the triangular supporting intramedullary nail is obtained. Additionally, the maximum displacement of the fracture model fixed by Gamma nail and triangular supporting intramedullary nail is measured.Results:Under the load of 1 200 N, the peak stress of the two fracture internal fixation models was located in the main nail, in which the peak stress of the triangular supporting intramedullary nail was 233.73 MPa, which was 11.9% lower than that of the Gamma nail (265.21 MPa); the peak stress of the fixation screw was located in the contact area between the pressure screw and the main nail, which was 23.2% lower in triangular supporting intramedullary nail than that of the Gamma nail (138.86 MPa vs. 180.75 MPa); the peak stress of the bone model was located in the medial cortex of the femur, which was 61.67 MPa and 32.38 MPa, respectively, 47.5% lower in the triangular supporting intramedullary nail than that of the Gamma nail; the peak stress of the supporting screw in the triangular supporting intramedullary nail was 92.04 MPa. The maximum displacement of the fracture model fixed with triangular supporting intramedullary nail was 17.34 mm, which was 10.5% less than the maximum displacement of the fracture model fixed with Gamma nail (19.37 mm). Conclusion:Compared with Gamma nail, triangular supporting intramedullary nail fixation can significantly improve the stability of intertrochanteric fractures and stress distribution as well as reduce stress peak and stress concentration area, which is helpful to improve the efficacy of intertrochanteric fractures.
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In December 2019, the corona virus disease 2019 (COVID-19) broke out in Wuhan, Hubei Province. Although the number of newly confirmed COVID-19 cases in provinces outside of Hubei Province has declined continuously since February 4, the epidemic of COVID-19 remains serious. As companies resume work, it is still inevitable that some high-energy orthopedic trauma patients and elderly patients with low-energy fractures will need surgical treatment. The operating room, as a place for close contact between doctors, patients and nurses, increases the risk of infection and transmission. Based on the current needs of orthopedic trauma patients and the situation of the country's resistance to the epidemic of COVID-19, the authors expound the operating room management, preparation of medical materials, transfer of patients needing surgery, intraoperative protection and post-operative end disinfection in Third Hospital of Hebei Medical University so as to provide reference for prevention and control management of the operating room during the epidemic period.
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Although the epidemic outbreak of Corona Virus Disease 2019 (COVID-19) restricted freecoming and going of people, it was inevitable that fracture patients, elderly ones with low-energy fracture in part ICU lar, sought medical attention. In this special situation, itwas crucial for trauma orthopaedists to do well in prevention and control of COVID-19 infection and in perioperative management of their patients as well while they went on with routine diagnosis and treatment. It was also of great significance for prognosis of the patients and prevention and control of the epidemic that orthopaedic surgeons chose proper surgical and anesthesia methods. In the process of diagnosis, treatment, nursing and rehabilitation, medical staff too was challenged by how to prevent themselves from infection and how to eliminate cluster COVID-19 transmission. This paper, from the perspectives of orthopedic surgeons, nurses and patients, expounds briefly on the management of patients with orthopedic trauma during the epidemic period of COVID-19 in a mode of multidisciplinary comprehensive interventions.
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In December 2019, the corona virus disease 2019 (COVID-19) broke out in Wuhan, Hubei Province. Although the number of newly confirmed COVID-19 cases in provinces outside of Hubei Province has declined continuously since February 4, the epidemic of COVID-19 remains serious. As companies resume work, it is still inevitable that some high-energy orthopedic trauma patients and elderly patients with low-energy fractures will need surgical treatment. The operating room, as a place for close contact between doctors, patients and nurses, increases the risk of infection and transmission. Based on the current needs of orthopedic trauma patients and the situation of the country's resistance to the epidemic of COVID-19, the authors expound the operating room management, preparation of medical materials, transfer of patients needing surgery, intraoperative protection and post-operative end disinfection in Third Hospital of Hebei Medical University so as to provide reference for prevention and control management of the operating room during the epidemic period.
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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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Hoffa fracture of tibial plateau is a special type of coronal fracture of tibial plateau, among which occult fracture accounts for a large proportion, resulting in missing diagnosis and delayed treatment. The current studies are all case reports, and the incidence, diagnostic protocol, injury characteristics and injury mechanism of Hoffa fracture have not been systematically studied. The commonly used classifications such as AO type, Schatzker type, three-column classification and comprehensive classification of tibial plateau cannot cover this type. In this study, a retrospective case series study was performed for the clinical data of 3 086 patients with tibial plateau fractures. There were 13 patients with Hoffa fracture of tibial plateau, and 23% of them were occult ones. The injury mechanism of this fracture was as follows: under the state of knee joint flexion, axial violence through femur concentrated on the posterior half of tibial plateau, with the knee joint in transient varus and pronation position, leading to the posteromedial coronal splitting fracture. According to the position and degree of fracture displacement involving the joint, the fracture was divided into three type: type I involving the articular surface of tibial plateau fracture less than 1/4, type II involving the articular surface of tibial plateau equal to or more than 1/4 and less than 1/2, type III involving the joint face equal to or more than 1/2. Each fracture type was divided into three subtypes, of which subtype A was non-displaced fracture, subtype B had articular surface displacement<2 mm, and subtype C had articular surface displacement≥2 mm. According to the classification characteristics, the treatment principles were proposed. The authors systematically summarized the Hoffa fracture of tibial plateau for the first time in aspects of the incidence, injury characteristics, injury mechanism, fracture classification and treatment principles, which is helpful to avoid missed diagnosis and improve treatment efficacy.
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Although the epidemic outbreak of Corona Virus Disease 2019(COVID-19) restricted free coming and going of people, it was inevitable that fracture patients, elderly ones with low-energy fracture in particular, sought medical attention. In this special situation, it was crucial for trauma orthopaedists to do well in prevention and control of COVID-19 infection and in perioperative management of their patients as well while they went on with routine diagnosis and treatment. It was also of great significance for prognosis of the patients and prevention and control of the epidemic that orthopaedic surgeons chose proper surgical and anesthesia methods. In the process of diagnosis, treatment, nursing and rehabilitation, medical staff too was challenged by how to prevent themselves from infection and how to eliminate cluster COVID-19 transmission. This paper, from the perspectives of orthopedic surgeons, nurses and patients, expounds briefly on the management of patients with orthopedic trauma during the epidemic period of COVID-19 in a mode of multidisciplinary comprehensive interventions.
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COVID-19 has spread all over the world since December 2019. Although normal work and production have resumed after the epidemic has been preliminarily controlled in China, the situation of prevention and control of the re-spread of COVID-19 in China is still severe and medical institutions are still facing a great pressure in a certain period of future because part of the patients may become re-positive after healing and input cases from abroad are increasing.Based on the 2016 edition of Technical Operating Norms for Cleaning and Disinfection and Sterilization in Hospital Central Sterile Supply Department, the 2012 edition of Technical Standards for Disinfection in Medical Institutions, Prevention and Control Protocols of 2019-nCoV(5 th edition) and Diagnosis and Treatment Protocols of 2019-nCoV (6th trial version), The Central Sterile Supply Department at The Third Hospital of Hebei Medical University has worked out Recycling Procedures for Medical Instruments After 2019-nCoV Infection, Collection Procedures for Medical Instruments After 2019-nCoV Infection, and Vehicle Transport Procedures for Medical Instruments After 2019-nCoV Infection.These contingency plans may be useful references for other Central Sterile Supply Department(CSSD) during the COVID-19 epidemic.
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Objective:To compare the anesthesia methods for patients undergoing orthopaedic surgery between the epidemic period of COVID-19 in 2020 and the same period in 2019.Methods:A retrospective study was conducted of the patients who had undergone orthopedic surgery at The Trauma Emergency Center, The Third Hospital of Hebei Medical University in the epidemic period of COVID-19 from 20 January through 1 March in 2020 and from 4 February through 14 March in 2019 (the same lunar period). Their anesthesia methods were analyzed.The patients in the 2 periods were divided into a group of ≥65 years old and a group of <65 years old.The anesthesia methods and anesthetic operation time were compared between the total cohorts and 2 age groups in the 2 periods.Results:A total of 285 orthopedic operations were completed in the epidemic period in 2020, a decrease by 63.7% than the 784 operations in the same period in 2019; the proportion of elderly fracture patients ≥65 years old in 2020 [29.5%(84/285)] was significantly higher than that [18.1%(142/784)] in 2019. The proportion of non-airway management anesthesia in the epidemic period in 2020 [56.5% (161/285)] was significantly higher than that in the same period in 2019 [38.3%(300/784)]; there was a significant difference in the proportion of non-airway management anesthesia for elderly patients ≥65 years old between the 2 periods [41.6%(59/142) versus 71.4%(60/84)] ( P<0.05). The proportions of intraspinal anesthesia[36.5% (104/285)] and intravenous/+peripheral nerve block anesthesia[4.9%(14/285)] in 2020 were significantly higher than those in 2019 [25.5%(200/784) and 0.3%(2/784)] ( P<0.05); the proportion of laryngeal mask/+peripheral nerve block anesthesia in 2020 [27.7%(79/285)] was significantly lower than that in 2019 [48.9% (383/784)] ( P<0.05). In the group of ≥65 years old, the proportions of intraspinal anesthesia [48.8% (41/84)] and intravenous/+peripheral nerve block anesthesia [10.7%(9/84)]in 2020 were significantly higher than those in 2019 [29.6%(42/142) and 0] ( P<0.05), but the proportion of laryngeal mask/+peripheral nerve block anesthesia in 2020 [21.4% (18/84)] was significantly lower than that in 2019 [47.9%(68/142)] ( P<0.05). Compared with the operation time for intraspinal anesthesia (6.2 min ± 0.4 min) and for intubation/+block anesthesia (7.4 min ± 0.4 min) in 2019, the operation time in 2020 (12.6 min ± 0.4 min and 13.2 min ± 0.3 min, respectively) was significantly increased ( P< 0.05). Conclusions:The anesthesia methods for patients undergoing orthopaedic surgery in the epidemic period in 2020 were featured by non-airway management like peripheral nerve block anesthesia, intraspinal anesthesia, and laryngeal mask/+peripheral nerve block anesthesia because they might have helped to reduce the postoperative complications in respiratory system.The anesthetic operation time in the epidemic period in 2020 was increased than in the same period in 2019.