Analgesic Effect of Combined Spinal-Epidural Anesthesia and its Effect on TNF-α and CRP Levels in Elderly Patients with Hip Fracture During Surgical Treatment

Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.

Hemiarthroplasty for irreparable distal radius fractures in the elderly:A comprehensive review

BACKGROUND Elderly patients maintaining functional independence can now be candidates for primary wrist hemiarthroplasty to manage acute irreparable distal radius fractures(DRFs).However,further investigation with long-term follow-up is required to validate these initial findings.AIM To review the literature on the outcomes of distal radius hemiarthroplasty with available implants to assess its viability as a treatment option.METHODS A comprehensive review of the literature was conducted using electronic databases,including PubMed,Medline,and Scopus.The search terms employed were"distal radius fracture","hemiarthroplasty","wrist arthroplasty",and related terminology.The search was restricted to articles published in English from 1980 until June 2023.Inclusion criteria encompassed cases or case series of DRF treated with hemiarthroplasty,providing clinical or radiographic outcomes,and published in peer-reviewed journals.RESULTS A total of 2508 articles from PubMed and 883 from Scopus were identified initially.Following screening and removal of duplicates,13 articles met the inclusion criteria.These articles,predominantly clinical retrospective studies,provided insights into hemiarthroplasty outcomes,including functional improvements and complications.Hemiarthroplasty was a treatment option for complex DRF,particularly those cases with severe comminution,intraarticular involvement,or severe osteoporosis.Functional outcomes demonstrated improvements in pain relief,wrist mobility,and grip strength,with variability across studies.Complications included implant loosening,infection,nerve injury,and stiffness,with varying incidence rates influenced by surgical techniques and implant choice.Long-term outcomes were inadequately documented,warranting further research.CONCLUSION Hemiarthroplasty is a promising treatment for irreparable DRF in the elderly.Long-term outcomes and complications require further study.

Results of Open Surgical Treatment of Humeral Paddle Fractures about 63 Cases

Fractures of the humeral paddle, common to young adults, are most often complex, linked to violence and an increase in road accidents. The objective of our work is to evaluate our functional results, in the medium term, correlated with a review of the literature. This is a retrospective study of 63 patients, carried out in the traumatology-orthopedics department 1 of the IBN EL JAZZAR hospital in KAIROUAN, over a period of 7 years from January 2015 to December 2021. The average age of patients was 39 years (17 - 68 years). Predominantly male. The etiologies are dominated by falls and accidents on public roads. Fractures are classified according to the Müller and Allgöwer classification where type C is found in 51% of cases. All our patients undergo an olecranon osteotomy in 71% of cases. Osteosynthesis using a Lecestre plate combined with screwing or plugging is used in 84% of cases. The evolution is marked by complications observed in eight patients (16%), including two cases of sepsis, four cases of elbow stiffness (8%), one case of joint callus and one case of pseudarthrosis. Our results are evaluated according to the Mayo Elbow Performance Score, they are excellent and good in 71% of cases, average in 18% of cases and poor in 11% of cases. Fractures of the humeral paddle are fractures with a satisfactory functional prognosis, requiring ad integrum anatomical restoration and solid osteosynthesis allowing early rehabilitation of the elbow. One case of joint callus and one case of pseudarthrosis.

Long-Term Clinical and Radiological Outcome in Primary Hemiarthroplasty for Comminuted Humeral Head Fractures in the Elderly: A 5 - 10 Years Follow-Up Prospective Study

Objective: In the constantly growing population of people beyond the age of 60 years, the incidence of complex comminuted humeral head fractures increases, thus increasing the need for prosthetic replacement. The purpose of this study was to determine the long-term results after primary hemiarthroplasty in patients older than 60 years. Methods: From 08/2010 to 12/2015 a prospective study of 54 patients (mean age 75 years) with complex humeral head fracture was performed at the University Hospital Rostock. 24 patients were available for follow-up after 5 - 10 years. Pain, the Karnofsky-index, and the range of motion were obtained as well as radiographs in two planes. The Constant-Murley score and the UCLA rating system were evaluated for functional assessment. Results: 15 patients were painfree. The Karnofsky index deteriorated from 94 preoperatively to 70. The Constant-Murley score of the operated extremity reached 47 points out of possible 100, the uninjured side scored 82 points. The age-specific Constant-Murley score showed more favorable results. The UCLA rating system values leveled up to 22 out of 35 points for the replaced shoulder and 33 points for the other arm. Radiologically, more than 50% of the implants were classified as non-centered and the acromio-humeral space diminished significantly. Conclusions: Primary hemiarthroplasty helps to restore a situation of little or no pain whereas functional and radiological outcome remains limited. Revision surgery or conversion to reverse shoulder arthroplasty was not indicated in any case supporting the clinical value of hemiarthroplasty.

Fracture of the Humeral Palette in Adult Patient: Therapeutic and Evolutive Aspect at Gabriel Touré Hospital: About 35 Cases

Introduction: Fractures of the humeral pallet occur between the distal insertion of the anterior brachial muscle and the joint space of the elbow. It represents 2% of all elbow fractures. These lower humeral fractures present a therapeutic challenge to trauma. These fractures are in the majority of joint cases and can be accompanied by loss of substance, which makes their functional prognosis random despite the application of the main therapeutic principles: exact reduction with possible bone graft;stable osteosynthesis, usually allowing early rehabilitation. This work focused on identifying therapeutic aspects and assessing treatment outcomes. Material and Methods: This was a descriptive cross-sectional study of patients with a fracture of the humeral palette from January 2015 to December 2019 at the Orthopaedic Trauma Department CHU Gabriel Touré Bamako. Results: We collected 35 cases of fractures of the humeral palette. The average age was 39.25 years with extremes of 22 and 74 years. The male gender predominated (71.4%) with a sex ratio of 2.5. Etiologies were dominated by falls with 19 cases (54.3%) and stroke with 13 cases (37.1%). The standard X-ray of the face and profile of the elbow was performed in all our patients. The most frequent types of anatomoradiology were supra condylar fractures type A in 16 cases (45.7%), supra and inter condylar fractures type C in 15 cases (42.9%);4 cases of uni condylar fractures type B (11.4%). Associated lesions were observed in 42.85%. Surgical treatment was performed in 80% of cases. Complications were dominated by elbow stiffness in 18 cases (51.42%), secondary displacement in 5 cases (14.28%), ossifications in 4 cases (11.42%). At an average decrease of 3.2 years our results were considered good in 45.7%. Conclusion: Fractures of the humeral palette are relatively common with associated lesions. The complexity of the fracture with associated lesions makes treatment difficult with unpredictable evolution.

Low risk of postoperative ulnar nerve affection in surgically treated distal humeral fractures when the nerve is released in situ

BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided.

Effects of surgical treatment modalities on postoperative cognitive function and delirium in elderly patients with extremely unstable hip fractures

BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.AIM To determine the influence of two surgical treatment modalities on postoperative cognitive function(CF)and delirium in elderly patients with EUHFs.METHODS A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included.Of them,30 patients received conventional treatment(control group;general consultation+fracture type-guided internal fixation),and the other 30 received novel treatment(research group;perioperative multidisciplinary treatment diagnosis and treatment+individualized surgical plan+risk prediction).Information on hip function[Harris hip score(HHS)],perioperative risk of orthopedic surgery[Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)],CF[Montreal cognitive assessment scale(MoCA)],postoperative delirium[mini-cognitive(Mini-Cog)],adverse events(AEs;internal fixation failure,infection,nonunion,malunion,and postoperative delirium),and clinical indicators[operation time(OT),postoperative hospital length of stay(HLOS),ambulation time,and intraoperative blood loss(IBL)]were collected from both groups for comparative analyses.RESULTS The HHS scores were similar between both groups.The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group,and MoCA and Mini-Cog scores were statistically higher.In addition,the overall postoperative complication rate was significantly lower in the research than in the control group,including reduced OT,postoperative HLOS,ambulation time,and IBL.CONCLUSION The new treatment modality has more clinical advantages over the conventional treatment,such as less IBL,faster functional recovery,more effectively optimized perioperative quality control,improved postoperative CF,mitigated postoperative delirium,and reduced operation-related AEs.

Fixation of Calcaneal Tuberosity Beavis II Fracture in Elderly Patients Using Locking Plate Combined with Tension Screw

Background:Calcaneus is the largest bone of foot and the main load-bearing structure of heel.The incidence of simple calcaneal tubercle avulsion fracture is low,accounting for about 1%to 3%of all calcaneal fractures.Beavis II fracture has large bone fracture,obvious displacement,obvious soft tissue irritation,and often leads to skin necrosis.It needs surgical treatment,reduction and fixation as soon as possible.Although open reduction and tension screw internal fixation is used for Beavis II calcaneal tubercle fracture,but the failure rate is more common.Methods:This study retrospectively analyzed the surgical treatment of calcaneal tubercle Beavis II fracture over 55 years old in our hospital from January 2013 to January 2019.The patients were treated with tension screw combined with locking plate,and followed up and analyzed.Results:12 patients in this group were followed up for 12 to 36 months(mean 20 months).After operation,the fracture healed smoothly in all patients,the healing time was 8 to 12 weeks(mean 10.7 weeks),and there were no complications such as poor incision healing,fracture displacement,internal fixation loosening,fracture and so on.When the patients were followed up 18 weeks after operation,the AOFAS score was 47 to 100,with an average of 91.1,of which 8 cases were excellent,3 good and 1 poor,with an excellent and good rate of 91.7%.Conclusion:Our hospital has been treated with tension screw combined with locking plate,fixed firmly,can early functional exercise,achieved good results.

Optimization of transdisciplinary management of elderly with femur proximal extremity fracture:A patient-tailored plan from orthopaedics to rehabilitation

Fractures of femur proximal extremity(FFPE)are the most common fragility fractures requiring hospitalization,with a high risk of mortality,low independence in the activities of daily living and severe consequences on healthrelated quality of life.Timing for surgery has a key role in the management of elderly patients with FFPE as recommended by the Australian and New Zealand guidelines and the National Institute for Health and Care Excellence guidelines.Early surgery(within 48 h from hospital admission)allows significant benefits in terms of lower rates of postoperative complications and risk of death and can provide better functional outcomes.Therefore,time for surgery could be considered as a comorbidity marker.The choice between conservative or surgical approach surprisingly seems to be still not strongly supported by available literature,but it seems that both 30 d and 1 year risk of mortality is higher with the conservative treatment rather than with surgery.In light of these considerations,the optimization of FFPE management care is mandatory to improve functional outcomes and to reduce sanitary costs.Albeit it is widely accepted that transdisciplinary approach to patients suffering from FFPE is mandatory to optimize both short-term and long-term outcomes,the feasibility of a comprehensive approach in clinical practice is still a challenge.In particular,the large variability of figures involved could be considered both a resource and an additional disadvantage taking into account the difficulty to coordinate multidisciplinary approach covering care in all settings.Therefore,the aim of the present article was to summarize current evidence supporting transdisciplinary management of patients with FFPE,highlighting the benefits,feasibility and limitations of this approach.

External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.

Preventing Lower Extremity Deep Vein Thrombosis After Hip Fracture Surgery in Elderly Patients by Acupoint Application Combined with Pneumatic Compression Therapy

Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.

The Radial Nerve Entrapment in Pediatric Extension-Type Supracondylar Humeral Fractures. About Two Cases Reports

Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.

Treatment of Bilateral Proximal Humeral Fracture in Patients with Parkinson’s Disease: A Case Report

There are only a few reports about upper extremity fractures in patients with Parkinson’s disease (PD). This is a case report of a PD patient with severe tremors who had proximal humeral fracture. We performed surgery for the left side and conservative treatment for the right side. The patient was a 73-year-old woman who had been diagnosed with PD 10 years prior to presentation. Open reduction internal fixation was conducted for the left proximal humeral fracture. 7 months after the left shoulder fracture, she fell resulting in a right proximal humeral fracture for which she underwent conservative treatment. Although bone union was obtained bilaterally, anterior subluxation occurred in the operated side 9 months postoperative. Screw remove was performed because perforation of the screw was observed in the humeral head and was causing pain. Currently, restriction in range of motion and subluxation may be seen on the side that received conservative treatment, although pain is absent and patient satisfaction is high. On the operated side, there is a marked restriction in range of motion, subluxation, and pain. Our experience revealed that conservative treatment was effective for proximal humeral fractures and that optimal bone union might be obtained even in patients with suboptimal PD control.

A comparison of three fixations for intertrochanteric femoral fractures in the elderly

Objective To compare the efficacy of 3 internal fixations,locking proximal femoral plate (LPFP),ASI-AN IMHS and InterTAN,for intertrochanteric femoral fractures in elderly patients.Methods A retrospective study was done to analyse

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients

Clinical analysis of nosocomial infection in 180 elderly patients with hip fractures

Objective To discuss the hip fracture in elderly patients with nosocomial infection,to take effective prevention and control measures. Methods Retrospective analysis of data of the elderly hip fracture combined with nosocomial infection during 2009 - 2010 was performed. Results A total of 180 cases of femoral neck

The impact of operative timing on clinical outcomes in elderly hip fracture

Objective To study the effect of operative timing on clinical outcomes in elderly hip fracture.Methods Two hundred sixty-seven patients with hip fracture were treated from July 2006 to May 2008.The patients who had an operation within

Artificial tiger bone powder for improving the quality of life in elderly patients with fracture

Objective: To investigate the application of artificial tiger bone powder on fracture healing time, wrist functional recovery and quality of life (QOL) in elderly patients with distal radius fracture. Methods: The study was a randomised controlled trials performed from January 2015 to December 2016 in a hospital. Elderly patients with distal radius fracture were divided into the treatment and the control groups by the random sealed envelope method. All patients were given splint or plaster fixation after manipulative reduction, and functional exercise, the treatment group was also given artificial tiger bone powder orally (trade name: Jintiange capsule), the control group was given an oral placebo in their appearance and usage identical with the treatment group. Prior to treatment and 6, 12 months after treatment, the wrist function was assessed by range of motion, including flexion-extension, radial-ulnar and pronation-supination, and the QOL was assessed by the Mos 36-item Short Form Health Survey. Each patient's fracture healing time was recorded. Results: Before treatment, there were no significant differences in wrist function and QOL between the two groups. At 6 and 12 months after treatment, the wrist function and QOL in the treatment group were better than those in the control group, the differences were statistically significant (P < 0.05). The fracture healing time in the treatment group was shorter than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion: The early usage of artificial tiger bone powder for elderly patients with distal radius fracture can promote the healing of fracture, recovery of wrist joint function, and ultimately improve the QOL for elderly patients.

Hidden blood loss after intertrochanteric fractures in elderly patients and its influence on the postoperative function recovery:a random controlled trial

Objective To investigate hidden blood loss after various types of intertrochanteric fractures and to determine whether oral iron supplementations is benefical for the postoperative functional recovery in elderly patients.Methods From

Total hip arthroplastyvs. osteosynthesis in acute complex acetabular fractures in the elderly:Evaluation of surgical management and outcomes

Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. <br> Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification) were treated. The patients were divided into two groups. The total hip arthoplasty (THA) group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12) health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group.P≤ 0.05 was considered statistically significant according to the analytical Student’s t-test. <br> Results: TheP < 0.05 in favor of theTHAgroup was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. <br> Conclusions: Our experience shows that theTHA treatment for acetabular fractures in the elderly is to be preferred.