Three-dimensional mapping of intertrochanteric fracture lines

Background:Available research about the anatomic patterns of intertrochanteric fractures is lacking,and fracture mapping has not previously been performed on intertrochanteric fractures.This study aimed to determine the major trajectories of intertrochanteric fracture lines using computed tomography data from a series of surgically treated patients.Methods:In this study,504 patients with intertrochanteric fractures were retrospectively analyzed.Fracture patterns were graded according to Arbeitsgemeinschaft für Osteosynthesefragen(AO)classification.Fracture lines were transcribed onto proximal femoral templates and graphically superimposed to create a compilation of fracture maps that were subsequently divided into anterior,posterior,lateral,and medial fracture maps to create a three-dimensional(3D)pattern by reducing fragments in the 3D models.The fracture maps were then converted into frequency spectra.The major fracture patterns were assessed by focusing on the lateral femoral wall,lesser trochanter,intertrochanteric crest,and inner cortical buttress.Results:Anterior,posterior,lateral,and medial fracture maps were created.The majority of fracture lines(85.9%,433/504)on the anterior maps were along the intertrochanteric line where the iliofemoral ligament was attached.In the medial plane,the majority of fracture lines(49.0%,247/504)shown on the frequency spectrum included the turning point involving the third quadrant.In the posterior plane,the majority of fracture lines(52.0%,262/504)involved the intertrochanteric crest from the greater to the lesser trochanter.In the lateral plane,the majority of fracture lines(62.7%,316/504)involved the greater trochanter at the gluteus medius attachment.Conclusions:The fracture patterns observed in the present study might be used to describe morphologic characteristics and aid with management strategies.Further classifications or modifications that incorporate the fracture patterns identified in this study may be used in future research.

The effects of information platform-based nursing on preventing venous thromboembolism in patients with hip fractures

Purpose:Venous thromboembolism(VTE)is a major health issue among hip fracture patients.This study aimed to develop an information platform based on a mobile application and then evaluate whether information platform-based nursing could improve patient’’s drug compliance and reduce the incidence of VTE in hip fracture patients.Methods:This study retrospectively analyzed hip fracture patients who were treated with conventional prevention and intervention methods for VTE(control group)between January 2008 and November 2012,and prospectively analyzed hip fracture patients who were treated with nursing intervention based on the information platform(study group)between January 2016 and September 2017.All the patients included in the both groups were hip fracture patients who had an age over 50 years,treated with surgery,and hospitalized≥48 h.Patients were excluded if they admitted to hospital due to old fractures,had a severe bleeding after 72 h of admission,diagnosed with any type of VTE,or refused to participate in the study.The information platform was divided into medical,nursing,and patient interface.Based on the information platform,medical practitioners and nurses could perform risk assessments,monitoring management and early warnings,preventions and treatments,health educations,follow-up,and other aspects of nursing interventions for patients.This study compared essential characteristics,drug compliance,VTE occurrence,and mean length of hospitalization between the two groups.Besides,a subgroup analysis was performed in the study group according to different drug compliances.SPSS 18.0 software(IBM Corp.,NY,and USA)was used for statistical analysis.Results:Altogether 1177 patients were included in the control group,and 491 patients in the study group.Regarding baseline data,patients in the study group had more morbidities than those in the control group(p<0.05).The difference of drug compliance between the two groups was statistically significant(p<0.001):761(64.7%)of the patients in the control group and only 30(6.1%)patients in the study group had poor drug compliance.In terms of VTE,10.7%patients(126/1177)in the control group had VTE,and the rate in the study group was 7.1%(35/491),showing a statistically significant difference(p=0.02).Moreover,the average length of hospitalization in the study group was also significantly lower than that in the control group(10.4 daysvs.13.7 days,p<0.001).Subgroup analyses of the study group showed that the incidence of VTE in patients with poor,partial,and good compliances were 56.7%(17/30),5.8%(10/171),and 2.8%(8/290),respectively,revealing a significantly huge difference(p<0.001).Conclusions:Poor drug compliance leads to higher VTE occurrence.The information platform-based nursing can effectively improve the compliance of hip fracture patients and thus considerably reduce the incidence of VTE.The mobile application may be an effective tool to prevent VTE in hip fracture patients.