Hip trauma has been a leading cause of death in senile patients for more than a centenary.Although the mortality decreased due to the advanced technique in medication,surgery and nursing,the increasing mortality shoul...Hip trauma has been a leading cause of death in senile patients for more than a centenary.Although the mortality decreased due to the advanced technique in medication,surgery and nursing,the increasing mortality should not be neglected in elders after orthopedic operation nowadays.Many factors are considered to influence the causes of death after trauma,such as age,gender,personal customs,comorbidities,types of fracture,timing of surgery,procedure,anesthesia,complications,medical treatment,activity of daily living,or even marriage status.This article reviews these causes from the aspects of patient＇s own factors,iatrogenic factors,medical treatment and other factors and provides some clues for further clinical application according to the recent foreign and domestic researches.According to the present research,it is essential for surgeons to perform a comprehensive estimation for patients suffering from hip trauma.展开更多
Objective： The anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures. For complex fracture patterns a com- bined anterolateral/anteromedial approach is suitable but a h...Objective： The anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures. For complex fracture patterns a com- bined anterolateral/anteromedial approach is suitable but a high rate of complication has been reported. In our retro- spective study a two-choice strategy adopting a medial tibial approach was proposed for the treatment of pilon fractures with anterior or posterior fragmentation. Methods： Based on an anatomic study oftibial pilon fractures, we retrospectively analyzed the fractures with primary posterior, posterior-lateral or anterior, anterior-lat- eral （Tillaux-Chaput） involvement of the distal tibia. This retrospective study consisted of 18 patients with a closed tibial plafond fracture. The inclusion criteria were： （1） pre- sence of an anterior/anterolateral type fragment or a poste- rior （Volkmann） type fragment involving 〉25% of the articu- lar surface, （2） a minimum follow-up of 12 months, （3） a fibula fracture associated with a medial colunm fracture of the distal tibia, and （4） soft tissue conditions at the time of opera- tion that did not compromise the choice of surgical access （Tscheme classification for closed fractures： grade 0 and grade 1）. Tibial plafond fractures were classified into two groups： one presenting anterior and the other with poste- rior rim （Volkmann） fragments. Results： Most patients achieved a good clinical re- covery in terms of range of motion and Olerud-Molander scale scores. Only three patients presented a grade 2 os- teoarthritis at the 12 month follow-up. Conclusion： Our two-choice strategy highlights con- cepts which have been previously debated and described in the literature. But a new extended protocol for surgical approach to the distal tibia, including more fracture pat- terns and their association should be further investigated.展开更多
文摘Hip trauma has been a leading cause of death in senile patients for more than a centenary.Although the mortality decreased due to the advanced technique in medication,surgery and nursing,the increasing mortality should not be neglected in elders after orthopedic operation nowadays.Many factors are considered to influence the causes of death after trauma,such as age,gender,personal customs,comorbidities,types of fracture,timing of surgery,procedure,anesthesia,complications,medical treatment,activity of daily living,or even marriage status.This article reviews these causes from the aspects of patient＇s own factors,iatrogenic factors,medical treatment and other factors and provides some clues for further clinical application according to the recent foreign and domestic researches.According to the present research,it is essential for surgeons to perform a comprehensive estimation for patients suffering from hip trauma.
文摘Objective： The anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures. For complex fracture patterns a com- bined anterolateral/anteromedial approach is suitable but a high rate of complication has been reported. In our retro- spective study a two-choice strategy adopting a medial tibial approach was proposed for the treatment of pilon fractures with anterior or posterior fragmentation. Methods： Based on an anatomic study oftibial pilon fractures, we retrospectively analyzed the fractures with primary posterior, posterior-lateral or anterior, anterior-lat- eral （Tillaux-Chaput） involvement of the distal tibia. This retrospective study consisted of 18 patients with a closed tibial plafond fracture. The inclusion criteria were： （1） pre- sence of an anterior/anterolateral type fragment or a poste- rior （Volkmann） type fragment involving 〉25% of the articu- lar surface, （2） a minimum follow-up of 12 months, （3） a fibula fracture associated with a medial colunm fracture of the distal tibia, and （4） soft tissue conditions at the time of opera- tion that did not compromise the choice of surgical access （Tscheme classification for closed fractures： grade 0 and grade 1）. Tibial plafond fractures were classified into two groups： one presenting anterior and the other with poste- rior rim （Volkmann） fragments. Results： Most patients achieved a good clinical re- covery in terms of range of motion and Olerud-Molander scale scores. Only three patients presented a grade 2 os- teoarthritis at the 12 month follow-up. Conclusion： Our two-choice strategy highlights con- cepts which have been previously debated and described in the literature. But a new extended protocol for surgical approach to the distal tibia, including more fracture pat- terns and their association should be further investigated.
