Intervention effect of injury control orthopedic strategy on fat embolism syndrome associated with long shaft fracture of lower limb / 中国骨伤

OBJECTIVE@#To observe the intervention effect of damage control orthopaedic(DCO) strategy on fat embolism syndrome(FES) associated with long shaft fracture of lower limbs.@*METHODS@#Retrospective analysis was made on the clinical data of 163 patients with FES associated with lower limb long shaft fractures admitted from January 2015 to May 2021. They were divided into two groups based on the time point of implementing DCO strategy in January 2018. Total of 92 patients were admitted from January 2015 to December 2017 as the control group, and other 71 patients were admitted from January 2018 to May 2021 as the intervention group. The hospital mortality, arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2) and oxygenation index (OI), hemoglobin (Hb), platelet count(PLT), Harris score of hip joint, HSS score of knee joint, AOFAS score of ankle joint, clinical efficacy and complications were observed and compared between two groups.@*RESULTS@#Total of 163 patients were followed up for 12 to 18 months with an average of (16.91±1.22) months. The in-hospital mortality rate in the intervention group was 2.82% (2/71), and that in the control group was 16.30% (15/92), the difference between two groups was statistically significant(χ2=6.455, P<0.05). After the intervention, SaO2, PaO2 and OI in two groups were higher than those before the intervention(P<0.05), and after the intervention, SaO2, PaO2 and OI in two groups were statistically significant(P<0.05). Hb and PLT in two groups after intervention were higher than those before intervention (P<0.001), and there was statistically significant difference in Hb and PLT between two groups after intervention (P<0.05). The Harris score of hip joint, HSS score of knee joint and AOFAS score of ankle joint in both groups after 3 months of treatment were better than those before treatment (P<0.05). The total clinical effective rate of the intervention group was higher than that of the control group(χ2=4.194, P<0.05). The total incidence of complications in the intervention group was lower than that in the control group(χ2=4.747, P<0.05).@*CONCLUSION@#DCO strategy is helpful to reduce the in-hospital mortality of patients with FES associated with long shaft fracture of lower extremities, eliminate FES symptoms and stabilize vital signs, gain time advantage for phase Ⅱ definitive surgery, and has significant clinical intervention effect, which is worth popularizing.

A case of life-threatening intraoperative diffuse alveolar hemorrhage during a femur fracture operation with suspected fat embolism: A case report

Diffuse alveolar hemorrhage (DAH) is a rare manifestation of trauma or long bone fracture. A relationship between fat embolism and DAH has been reported. A 73-year-old female developed sudden cardiac arrest during a femur fracture operation. Cardiopulmonary resuscitation (CPR) was repeated for about 130 minutes. During CPR, blood was detected in the endotracheal tube. Diffuse patch ground glass opacity appearance and increased pulmonary artery with bulging of interventricular septum toward the left ventricle were detected on a chest computed tomography scan. After full supportive care including ventilator therapy, the patient's condition became stabilized and she was extubated after 7 days. We report a case of DAH in the course of a suspected fat embolism during femur fracture operation. Although DAH is a rare manifestation of fat embolism, early diagnosis and aggressive treatment likely can decrease morbidity and mortality.

Re-evaluation of the effect of autologous fibula plate in treatment of old nonunion of long bone fracture / 中国矫形外科杂志

[Objective]To discuss the technique and outcome in the treatment of old nonunion of long bone fracture by using autologous fibula plate alone or combination with internal fixator plates.[Method]Fifty-seven patients(41 males and 16 females;average age of 41.6 years)with nonunion of long bone fracture were recruited.Of them 18 had short deformity(average 2.6 cm)and 12 had angled deformity(average 15?).Average time was 12 months(6-36 months).The sclerosed cortex was removed at both ends of the nonunion long bone.A suitable length of fibula plate were transplanted by screw with or without internal fixator plates.[Result]The follow-up average time was 3 years(ranged,1 to 6 years).At 1,3,6,12,24 months after operation,the outcome was analyzed by radiography.Bone healing was found in all 57 patients,with an average of 15 weeks(8-24 weeks).All the patients exhibited a good function in walking and burdening.No nonunion occurred.[Conclusion]Autologous fibula plate with or without internal fixator plates for nonunion of long bone fracture can facilitate healing and early functional recovery.This therapeutic method is an ideal technique in treating patients with nonunion of long bone fracture.

Navigation in intramedullary nailing of long bone fracture / 中华创伤骨科杂志

Objective This paper illustrates the application of fluoronavigation in intramedullary nailing in long bone fractures (femur and tibia), especially during the procedure of distal locking. We also explore the possibility of distal locking with an image bank of intramedullary nails and under navigation. Furthermore medical robots are being developed to further improve the precision of the procedure. Methods In our hospital, distal locking in 55 cases of femoral nailing and 36 cases of tibial nailing were performed under navigation. Another 13 cases of distal locking were performed with the image bank. Result The overall successful rate of distal locking was 97%. Conclusions Fluoronavigation in distal locking of intramedullary nailing of long bone fractures has achieved a high successful rate. Development of an image bank could further decrease the X-ray exposure suffered by the patient and operation theater staffs.

High Resolution Computerized Tomographic and Pathologic Findings of Pulmonary Fat Embolism after Long Bone Fracture of Rabbit / 대한정형외과학회잡지

PURPOSE: Fat embolism syndrome is caused by traumatic and nontraumatic conditions, and most commonly associated with fractures of long bones of the lower extremity. Clinical manifestation of the fat embolism syndrome occurs in a minority of patients with fat emboli. The incidence of fat emboilsm has been reported 5-10%. The pulmonary symptoms of fat embolism are clinically important but hard to diagnose, so treatment was often delayed. The purpose of this study is to search for the development of fat embolism after long bone fracture of rabbit, and to demonstrate pulmonary fat embolism by high resolution computerized tomograhy (HRCT) and pathologic findings. MATERIALS AND METHODS: Twelve rabbits (Newzealand, 2.5-3 Kg) were divided into 2, 24, 72 hours and control groups after closed tibiofibular fracture. The presence of involvement was classified by high resolution computerized tomography with ground glass opacity, consolidation and focal hyperlucency. The extent was measured by 10% grading scale. Gross inspection, histologic examination and histochemistry (Oil red 0) were performed in removed lungs. RESULTS: Ground glass opacity was found in 100% of test subjects, consolidation was found in 89%, bronchovascular bundle thickening was found in 78% and focal hyperlucency was found in 33%. Fat embolism was developed in all groups with the 24-hour group showing maximal changes. Microscopically the vessel was occluded with fat globule which was stained with Oil red 0 stain. CONCLUSIONS: The abnormal density lesion on HRCT was correlated with pathologic finding and was induced by fat emboli after long bone fracture of the rabbit

Bone Density and Mechanical Property after Locked Intramedullary Nailing of the Long Bone Fractures: Preliminary Study of QCT & Lunar of 15 Long Bone Fractures / 대한정형외과학회잡지

The decrease of bone density after fracture is a well-known phenomenon. Several studies of the changes of bone density after fracture demonstrated bone density decreased not only at the fracture site, b ut also along the whole fractured bone. Being treated with locked intramedullary (IM) nailing, 15 patients with the long bone fractures of lower limbs were examined by Quantitative Computed Tomography (QCT) or Dual-Energy X-ray Bone Densitometer (Lunar DPX-L) a few days after nail removal. In the cases of QCT (5 patients of the tibia shaft fracture), cortical bone density, cortical thickness and geometrical shape (i.e. external antero-posterior and medio-lateral diameters) of the fracture site were compared to those of the contralateral side. On the other hand, in the case of Lunar' (5 patients of the tibia shaft fracture & 5 patients of the femur shaft fracture), only cortical bone density was compared to that of the contralateral side. The results of this study were as follows: 1. When treated by the locked intramedullary nailing of the long bone fractures, the bone density of the tibia & femur shaft fractures measured from the fracture site, proximal and distal sites to mid-fracture decreased. 2. There was a difference in the bone density of the uninjured long bone diaphysis of the tibia & femur shaft fractures. That is, in the case of the tibia shaft fracture, the bone density of the ipsilateral femur diaphysis measured by QCT increased 2 %, and increased 7 % when measured by Lunar. But, in the case of the femur shaft fracture, the bone density of the ipsilateral tibia diaphysis measured by Lunar decreased 4%. 3. In the case of the tibia shaft fracture, the cortical thickness in the fracture site measured by QCT increased 72 %, and external antero-posterior and medio-lateral diameters increased 7 % and 63 %. It seemed to be the formation of peripheral callus due to medullary reaming preceding intramedullary nail insertion. Therefore, this clinical study demonstrated that the mechanical property of the long bone fractures was restored and restricted weight bearing hardly needs to recommended when the nail was removed after the fracture union. 4. The bone densities of the tibia shaft fratures measured by QCT were not different with those measured by Lunar.

Complication in Learning Process of Surgeon after Interlocking Intramedullary Nailing for Long Bone Fracture / 대한정형외과학회잡지

There are many advantages in treating long bone fractures with interlocking intramedullary nail and its advantages are well known. Although it is used widely, many major and minor complication can develop in spite of meticulous operation techniques. Frist fifty consecutive interlooking intramedullary nail of two different surgeon, total of 100 cases that were operated in Seoul Paik Hospital from January, 1991 to July, 1994, were reviewed and the complications were analyzed with various factors. 1. Among the 100 cases, a total of 30(30%) major and minor complications had developed. But only 4 major complications which needed reoperation or poor result occurred. 2. Among the complications that had developed, angulation and rotation deformity being 10 cases were the most common, other complications were delayed union in 5 cases, nonunion in 2 cases, problem of screw in 4 cases, metal failure in 2 cases, misentry point in 2 cases and others in 5 cases. 3. There were no remarkable difference between surgeon A and surgeon B. The complications decreased abruptly after 30th case for each surgeon and only a few complications, probably due to complex fracture pattern, occurred. In conclusion, complications after interlocking intramedullary nailing can be reduced by meticulous preoperative planning and learning process of surgeon.

Fat Embolism / 대한정형외과학회잡지

Fat Embolism is a rare complication of multiple long bone fracture or extensive soft tissue injury. The pathogenesis of fat embolism has been poorly understood and still its definite pathogenesis, diagnosis and treatment were not fully established. Recently fat embolism considered as a post traumatic respiratory failure. Monitoring of blood gas is required for early diagnosis and respiratory supportive treatment with continued minitoring is necessary until resolution. Fifteen cases of fat embolism treated at from September 1979 to October 1981 Eul Ji General Hospital were clinically analized. Among the fifteen cases, fourteen were recovered without sequalae and one was expired ten days after trauma.