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Objective:To report our experience in the admission and perioperative management of 88 patients with lower extremity fracture in a mildly affected area in the epidemic of COVID-19.Methods:A retrospective analysis was conducted of the 88 patients with 97 lower extremity fractures who had been admitted to Department of Orthopedic Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine from 23rd January, 2020 to 22nd February, 2020. They were 43 males and 45 females, aged from 15 to 95 years (average, 65.5 years). The patients underwent screening for COVID-19 infection before admission. Their fractures were located at the femoral neck in 33 cases and at the femoral trochanter in 26. Open reduction and internal fixation was performed for 29 cases, internal fixation with proximal femoral nail anti-rotation (PFNA) for 25 and hip replacement for 28. The time from injury to admission, time from admission to surgery, operation time, fracture reduction, hospital stay, and perioperative deep venous thrombosis (DVT) of lower limbs were recorded. COVID-19 infection was observed in the medical staff and patients as well.Results:All the 88 patients were COVID-19 negative in the screening before admission. The time from injury to admission averaged 4.5 days, the time from admission to surgery 3.7 days and hospital stay 6.6 days. The prostheses were all well located in the 28 patients undergoing hip replacement. The rate of functional and anatomic reduction was 94.2%(65/69) in the 69 patients undergoing internal fixation. Peri-operatively, DVT occurred in 25 cases (28.4%). High temperature was observed in 7 patients within 3 days after operation, which was diagnosed as absorption fever. No medical staff or patients were infected by COVID-19.Conclusion:In the epidemic of COVID-19, orthopedic surgeons in a medical institute in a mildly affected area can still provide effective and safe medical services for fracture patients and reduce nosocomial infection, as long as they comprehend the diagnosis and treatment guidelines for the epidemic, strictly screen the patients accordingly, stick to operative indications, protect against possible infection cautiously, and carry out the procedures in a standard manner.
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Objective To explore the application of 3D-printing rapid prototyping in classification of acetabular fractures and education of young surgeons.Methods The data of 20 patients with acetabular fracture were reviewed in this study who had been treated between January and June 2016.Three junior orthopedic surgeons and 3 senior ones were chosen as observers.The conventional radiographs (X-ray films of the pelvis and acetabulum,CT scans and 3D reconstruction images of the pelvis) and 3D-printing rapid prototyping models of the 20 patients(1∶ 1) were randomly numbered.All the observers were asked to make Letournel-Judet classification of each radiograph and 3D-printing model independently in the first assessment.Four weeks later in the second assessment,all the observers were asked to make the same classifications after all the conventional radiographs and 3D-printing models were randomly numbered again.The kappa statistics was used to evaluate inter-and intra-observer agreements among the recorded results.Results At the first assessment,the inter-observer agreement was 0.887 and 0.962 respectively for conventional radiographs and 3D-printing models in senior surgeons while 0.659 and 0.849 in junior surgeons.The second assessment showed the intra-observer agreement was 0.906 for radiographs and 0.925 for 3D-printing models in senior surgeons while 0.696 and 0.849 in the junior ones.Conclusions Compared with conventional radiographs,since 3D-printing models can effectively enhance the reliability of acetabular fracture classification,they may be more helpful for young surgeons in understanding acetabular fractures.
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Objective To explore how to make a rapid judgment of distal inward or outward rotation during closed reduction and intramedullary nailing for complex tibial fractures so as to avoid bad reduction of the distal rotation.Methods Twenty-one patients with complex tibial fracture underwent closed reduction and intramedullary nailing from January 2014 to January 2016.They were 16 males and 5 females,aged from 22 to 53 years (average,34.6 years).By AO/OTA classification,6 cases were type 42-C1,2 type 42-C2,and 13 type 42-C3.During surgery,the relationship between the connecting rod of the front pressure lever of intramedullary nail in the tibia and the second metatarsal bone was used to judge the rotation.After surgery CT plane scanning was used to assess reliability of the intraoperative judgment of the rotation.Validity of the rotation judgment was finally evaluated by comparing Functional Index Questionnaire (FIQ) scores,Olerud Molander ankle scores (OMAS) and Health Status Questionnaire (SF-36) scores between pre-injury and final follow-up.Results The 21 patients were followed up for 12 to 24 months (average,18.3 months).Bony union was achieved from 3 to 7 months after surgery (average,4.5 months) without nonunion or refracture.There was no significant difference in the tangent angle between the proximal and distal tibiae on CT scan between the healthy side (47.1° ± 2.9°) and the affected side (44.8° ± 5.6°) (P ＞ 0.05).There were no significant differences either in FIQ scores,OMAS or SF-36 scores between pre-injury and final follow-up (P ＞ 0.05).Conclusion In the course of closed reduction and intramedullary nailing for complex tibial fractures,it is simple and effective to judge the distal inward or outward rotation by pointing the connecting rod of the front pressure lever of intramedullary nail in the tibia to the second metatarsal bone.
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Objective To investigate the surgical method and clinical curative results of acetabulum top compression fractures with sea gull sign. Methods Data of 14 patients who had acetabulum top compression fractures with sea gull sign were retrospectively analyzed and were accepted surgical therapy and followed up. There were 5 females and 9 males, aged from 28 to 71 years (average, 49.9 years). The pre-operative time was from 4 to 14 days (average, 9 days). Letournel-Judet fracture classifica-tion:eight cases for the anterior column+posterior semi-transverse, six cases for a simple anterior column. Three patients with lum-bar compression fracture, two patients with tibial plateau fracture, one patient with multiple rib fractures. All patients were accept-ed open reduction and bone graft and internal fixation through ilioinguinal approach or ilioinguinal approach+Kocher-Langenbeck approach. The quality of fracture reduction was assessed according to the Matta reduction criterion after operation. The hip func-tion was evaluated according to Matta. Results 14 patients were followed up from 6 to 60 months (average, 36 months). All pa-tients reached bone healing;healing time was from 3 months to 4 months (average, 3.4 months). According to the Matta reset stan-dard after operation, there were 6 excellent cases, 5 good cases, 2 fair cases, 1 poor case, the excellent and good rate was 78.5%(11/14). The Matta was from 10 to 18 scores (average, 16.4 scores), 5 excellent cases, 5 good cases, 3 fair cases, 1 poor case, the ex-cellent and good rate was 71.4%(10/14). Traumatic arthritis occurred in 3 patients. Pain was serious in two patients and disap-peared after total hip joint replacement. Pain was mild for one patient and disappeared after accepted non steroidal painkiller. One patient had heterotopic ossification after operation, which was not treatmented because of no obvious symptom. Conclusion The appropriate operation time of acetabular roof compression fracture with sea gull sign was from 5 to 10 days after fracture, which was no more than two weeks had best. Through ilioinguinal approach or ilioinguinal approach+Kocher-Langenbeck approach, the articular surface could be reduced excellent and got sufficient bone graft. The clinical efficacy was satisfactory after operation.