Development and validation of a newly developed nomogram for predicting the risk of deep vein thrombosis after surgery for lower limb fractures in elderly patients.

Background: Prevention of deep vein thrombosis (DVT) is indispensable in the treatment of lower limb fractures during the perioperative period. This study aimed to develop and validate a novel model for predicting the risk of DVT in elderly patients after orthopedic surgeries for lower limb fractures. Methods: This observational study included 576 elderly patients with lower limb fractures who were surgically treated from January 2016 to December 2018. Eleven items affecting DVT were optimized by least absolute shrinkage and selection operator regression analysis. Multivariable logistic regression analysis was performed to construct a predictive model incorporating the selected features. C-index was applied to evaluate the discrimination. Decision curve analysis was employed to determine the clinical effectiveness of this model and calibration plot was applied to evaluate the calibration of this nomogram. The internal validation of this model was assessed by bootstrapping validation. Results: Predictive factors that affected the rate of DVT in this model included smoking, time from injury to surgery, operation time, blood transfusion, hip replacement arthroplasty, and D-dimer level after operation. The nomogram showed significant discrimination with a C-index of 0.919 (95% confidence interval: 0.893-0.946) and good calibration. Acceptable C-index value could still be reached in the interval validation. Decision curve analysis indicated that the DVT risk nomogram was useful within all possibility threshold. Conclusion: This newly developed nomogram could be used to predict the risk of DVT in elderly patients with lower limb fractures during the perioperative period.

[Treatment of type c fractures of the distal radius with volar locking compression plate and radial styloid process plate].

OBJECTIVE: To analyze the effectiveness ofvolar locking compression plate (LCP) and radial styloid process plate for the treatment of type C fractures of the distal radius. METHODS: Between May 2010 and May 2011, 24 cases of type C fractures of the distal radius were treated, including 8 males and 16 females with an average age of 52 years (range, 23-73 years). Injury was caused by falling in 20 cases and by traffic accident in 4 cases. All were fresh closed fractures. The locations were the left side in 15 cases and the right side in 9 cases. According to AO typing, there were 16 cases of type C2 and 8 cases of type C3. The preoperative palmar tilt angle ranged from 60 to 25 degrees (mean, -45.3 degrees); the preoperative ulnar inclination angle ranged from 16 to 13 degrees (mean, 8.2 degrees); and the preoperative radial length shortening was 8-18 mm (mean, 12 mm). The time from injury to operation was 3-10 days (mean, 5.2 days). RESULTS: All operation incisions healed primarily. All patients were followed up 9-16 months (mean, 13.5 months). The healing time of fracture was 8-12 weeks (mean, 10.2 weeks). The articular surface was smooth and the radial length was recovered. The postoperative palmar tilt angle ranged from 8 to 15 degrees (mean, 12.3 degrees); the postoperative ulnar inclination angle ranged from 18 to 26 degrees (mean, 22.3 degrees). No loss of reduction, refracture, or carpal tunnel syndrome occurred during follow-up. The average range of motion of the wrist was 45.3 degrees (range, 30-70 degrees) in dorsal extension, was 50.2 degrees (range, 26-78 degrees) in palmar flexion, was 13.5 degrees (range, 8-25 degrees) in radial inclination, was 23.6 degrees (range, 15-32 degrees) in ulnar inclination, was 65.7 degrees (range, 35-90 degrees) in pronation, and was 72.5 degrees (range, 20-90 degrees) in supination at last follow-up. According to the wrist function by Gartland-Werley scoring, the results were excellent in 12 cases, good in 8 cases, and fair in 4 cases; and the excellent and good rate was 83.3%. CONCLUSION: Treatment of type C fractures of the distal radius with volar LCP and radial styloid process plate can reconstruct normal anatomic structures and get good functional recovery.

A randomized trial to compare 24 h versus 12 h double dose regimen of levonorgestrel for emergency contraception.

BACKGROUND: Levonorgestrel (0.75 mg given for two doses 12 h apart) has been proven to be an effective regimen for emergency contraception when the first dose is given within 72 h of unprotected coitus. However, the dosing interval is inconvenient for those taking the first dose in the afternoon. We conducted a randomized study to evaluate two levonorgestrel dosing regimens for emergency contraception. Two doses of levonorgestrel 0.75 mg were administered with the first dose given up to 120 h after unprotected intercourse. The second dose was given 12 h later in the first regimen and 24 h later in the second regimen. METHODS: We conducted a double-blind, randomized trial between 1997 and 2003 at five centres in China. A total of 2071 women requesting emergency contraception within 120 h of unprotected intercourse were recruited. They were randomized to receive two doses of 0.75 mg of levonorgestrel, given either 24 h apart or 12 h apart. RESULTS: Outcome was unknown for 53 women (24 in the 24 h group and 29 in the 12 h group). Among the remaining 2018 women, the crude pregnancy rate was 1.9% in the 24 h group [95% confidence interval (CI) 1.17-2.94] and 2.0% in the 12 h group (95% CI 1.19-2.99). The proportion of pregnancies prevented was estimated to be 72% in the 24 h group and 75% in the 12 h group. Side-effects were mild in both groups. The efficacy of the 12 h regimen declined significantly when there were further acts of intercourse after treatment (5.0 versus 1.0%, P<0.01). This was not observed in the 24 h group. CONCLUSIONS: Two doses of 0.75 mg levonorgestrel given either 24 or 12 h apart are effective for emergency contraception up to 120 h after unprotected intercourse. Further research to investigative more effective methods of emergency contraception is warranted.

Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial.

BACKGROUND: A single 10 mg dose of mifepristone, and two 0.75 mg doses of levonorgestrel 12 h apart, are effective for emergency contraception. Because no studies had compared the efficacies of both compounds, or investigated a single dose of 1.5 mg levonorgestrel, we undertook this three-arm trial. METHODS: We did a randomised, double-blind trial in 15 family-planning clinics in 10 countries. We randomly assigned 4136 healthy women with regular menstrual cycles, who requested emergency contraception within 120 h of one unprotected coitus, to one of three regimens: 10 mg single-dose mifepristone; 1.5 mg single-dose levonorgestrel; or two doses of 0.75 mg levonorgestrel given 12 h apart. The primary outcome was unintended pregnancy; other outcomes were side-effects and timing of next menstruation. Analysis was by intention to treat, but we did exclude some patients from the final analyses. FINDINGS: Of 4071 women with known outcome, pregnancy rates were 1.5% (21/1359) in those given mifepristone, 1.5% (20/1356) in those assigned single-dose levonorgestrel, and 1.8% (24/1356) in women assigned two-dose levonorgestrel. These proportions did not differ significantly (p=0.83). The relative risk of pregnancy for single-dose levonorgestrel compared with two-dose levonorgestrel was 0.83 (95% CI 0.46-1.50), and that for levonorgestrel (the two regimens combined) compared with mifepristone, 1.05 (0.63-1.76). Side-effects were mild and did not differ greatly between groups, and most women menstruated within 2 days of the expected date. Women who took levonorgestrel had earlier menses than did those who took mifepristone. INTERPRETATION: The three regimens studied are very efficacious for emergency contraception and prevent a high proportion of pregnancies if taken within 5 days of unprotected coitus. Mifepristone and levonorgestrel do not differ in efficacy. A 1.5 mg single levonorgestrel dose can substitute two 0.75 mg doses 12 h apart.