Early complications of preoperative external traction fixation in the staged treatment of tibial fractures:A series of 402 cases

BACKGROUND Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment.However,the early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed.AIM To analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.METHODS A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a Level 1 trauma center from 2014 to 2018 were enrolled in this retrospective study.Data regarding the demographic information,Tscherne soft tissue injury,fracture site,entry point placement,and duration of traction were recorded.Procedure-related complications such as movement and sensation disorder,vessel injury,discharge,infection,loosening,and iatrogenic fractures were analyzed.RESULTS The mean patient age was 42.5(18-71)years,and the mean duration of traction was 7.5(0-26)d.In total,19(4.7%)patients presented with procedure-related complications,including technique-associated complications in 6 patients and nursing-associated complications in 13.Differences in the incidence of complications with respect to sex,affected side,soft tissue injury classification,and fracture sites were not observed.However,the number of complications due to hammer insertion was significantly reduced than those due to drill insertions(2.9%vs 7.4%).CONCLUSION We found a low incidence of early complications related to the fixation.Furthermore,the complications were not significantly associated with the severity of the soft tissue injury and fracture site.Although relatively rough and more likely to cause pain,the number of complications associated with hammer insertion was significantly smaller than that of complications associated with drill insertion.

Association Study of a Proliferation-inducing Ligand, Spermatogenesis Associated 8, Platelet-derived Growth Factor Receptor-alpha, and POLB Polymorphisms with Systemic Lupus Erythematosus in Chinese Han Population

Background： Systemic lupus eiLythenaatosus （SLE） is a prototypic autoimmune disease wida complex genetic inheritance. This study was conducted to examine whether the association ofa proliferation-inducing ligand （APRIL）, spermatogenesis associated 8 （SPATA8）, platelet-derived growth lhctor receptor-alpha （PDGFRA）, and DNA polymerase beta （POLB） with SLE can be replicated in a Chinese Han population. Methods： Chinese SLE patients （n = 1247） and ethnically and geographically matched healthy controls （n 1440） were genotyped for the APRI L, SPATAS. PDGFRA, and POLB single-nucleotide polymorphisms （SN Ps）, rs3803800 rs8023715, rs1364089 and rsl2678588 using the Sequenom MassARRAY System. Results： The Chinese Hart SLE patients and controls had statistically similar liequencies of alleles and genotypes of four gene polynlorphisms. Moreover, no association signal was detected on different genetic models （additive, dominant, and recessive, all, P〉 0.05） or in SLE subgroups stratified by various clinical nlanifestations （all, P 〉 0.05）. Conclusions： Different genetic backgrounds from different ancestries and various populations may result in different genetic risk litctors for SLE. We did not detect any significant association with SNPs of APRIL SPATAS, PDGFRA, and POLB.

Anatomical Risk Factors of Anterior Cruciate Ligament Injury

Background:Nowadays,the anterior cruciate ligament (ACL)injury has been one of the most common diseases of the knee joint.The relationships between the ACL injury and the anatomical structures are still controversial.This study aimed to identify the anatomical risk factors of ACL injury by magnetic resonance imaging (MRI)of the knee. Methods:This was a retrospective study of 125 patients undergoing primary ACL reconstruction between July 2013 and May 2017. Another 125 patients without any organic knee joint injury were served as controls.The shape of intercondylar notch,the intercondylar notch width index,the intercondylar notch height index,the a angle,the β angle,and the medial and lateral tibial plateau slope were measured with MRI and compared.The data were compared by binary logistic regression to find the risk factors. Results:The two groups differed in the proportion of male patients (70.4% vs.52.0%,x^2 =8.911,P =0.003),but gender was excluded as a risk factor for ACL injury with regression analysis (odds ratio =1.476,95%confidence interval [CI]:0.689-3.160,P =0.317). The injured group was found to have a smaller notch width index (95%CI =7.960E-23-2.154E-9,P <0.001),a larger β angle (95% CI =1.311-1.785,P <0.001),and a larger lateral tibial plateau slope (95%CI =1.201-1.683,P <0.001).The cutoff values of notch width index,β angle,and the lateral tibial plateau slope were 0.252,38.5°,and 7.5°,respectively. Conclusions:In this study,a narrow intercondylar notch (intercondylar notch width index <0.252),a larger lateral tibial slope ( >7.5°), and larger β angle ( >38.5°)might be the factors associated with ACL injury.