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.

Extreme massive hydraulic fracturing in deep coalbed methane horizontal wells:A case study of the Linxing Block,eastern Ordos Basin,NW China

Deep coal seams show low permeability,low elastic modulus,high Poisson’s ratio,strong plasticity,high fracture initiation pressure,difficulty in fracture extension,and difficulty in proppants addition.We proposed the concept of large-scale stimulation by fracture network,balanced propagation and effective support of fracture network in fracturing design and developed the extreme massive hydraulic fracturing technique for deep coalbed methane(CBM)horizontal wells.This technique involves massive injection with high pumping rate+high-intensity proppant injection+perforation with equal apertures and limited flow+temporary plugging and diverting fractures+slick water with integrated variable viscosity+graded proppants with multiple sizes.The technique was applied in the pioneering test of a multi-stage fracturing horizontal well in deep CBM of Linxing Block,eastern margin of the Ordos Basin.The injection flow rate is 18 m^(3)/min,proppant intensity is 2.1 m^(3)/m,and fracturing fluid intensity is 16.5 m^(3)/m.After fracturing,a complex fracture network was formed,with an average fracture length of 205 m.The stimulated reservoir volume was 1987×10^(4)m^(3),and the peak gas production rate reached 6.0×10^(4)m^(3)/d,which achieved efficient development of deep CBM.

Clinical effect of ultrasound-guided nerve block and dexmedetomidine anesthesia on lower extremity operative fracture reduction

BACKGROUND Lower extremity fractures are mainly treated by surgical reduction,but this operation is often affected by the patient’s level of agitation and the type of anesthesia used.The main treatment for lower-extremity fractures is operative reduction.However,operations can often be affected by both agitation and the degree of anesthesia.Therefore,it is of great importance to develop an effective anesthesia program to effectively ensure the progress of surgery.AIM To discuss the effect of ultrasound-guided nerve block combined with dexmedetomidine anesthesia in lower extremity fracture surgery.METHODS A total of 120 hospital patients with lower extremity fractures were selected for this retrospective study and divided into an observation group(n=60)and a control group(n=60)according to the anesthesia scheme;the control group received ultrasound-guided nerve block;the observation group was treated with dextromethomidine on the basis of the control group,and the mean arterial pressure,heart rate(HR),and blood oxygen saturation were observed in the two groups.RESULTS The mean arterial pressure of T1,T2 and T3 in the observation group were 94.40±7.10,90.84±7.21 and 91.03±6.84 mmHg,significantly higher than that of the control group(P<0.05).The observation group’s HR at T1 was 76.60±7.52 times/min,significantly lower than that of the control group(P<0.05);The observation group’s HR at T2 and T3 was 75.40±8.03 times/min and 76.64±7.11 times/min,significantly higher than that of the control group(P<0.05).The observation group’s visual analog score at 2 h,6 h and 12 h after operation was 3.55±0.87,2.84±0.65 and 2.05±0.40.the recovery time was 15.51±4.21 min,significantly lower than that of the control group(P<0.05).Six hours post-anesthesia,epinephrine and norepinephrine in the observation group were 81.10±21.19 pg/mL and 510.20±98.27 pg/mL,significantly lower than that of the control group(P<0.05),and the mini-mental state exam score of the observation group was 25.51±1.15,significantly higher than that in the control group(P<0.05).CONCLUSION Ultrasound-guided nerve block combined with dexmedetomidine has a good anesthetic effect in the operation of lower limb fractures and has little effect on the hemodynamics of patients.

The Effects of Absorbable Materials in the Treatment for Non-Weight-Bearing Bone Fractures of Extremities

Objective:To study the effects of absorbable materials in non-weight-bearing bone fractures of extremities.Methods:After 66 patients with nonweight-bearing bone fractures of extremities were selected,absorbable materials were used in the observation group and metal materials were used in the control group.Results:After treatment,the bone healing in the observation group was significantly improved(P<0.05).Conclusion:the application of absorbable materials in non-weight-bearing bone fractures of extremities is effective.

Expression of transforming growth factor-β in local bony callus in traumatic brain injury combined with extremity fracture in rats

Objective To investigate gene expression of transforming growth factor-β(TGF-β)in local bony callus in tracumatic brain in jury combined with extremity long bone fracture in rats.Methods Eighty male SD rats were randomized into 2 even

Scarf-related injuries at a major trauma center in northern India

Purpose： Scarf is a long loose piece of cloth worn around the neck and shoulder. Despite cultural asso- ciation of this apparel, it is part of numerous injury episodes of varying enormity. Entanglement of loose scarf in spoke wheels of bike, tricycle, belt driven machines like sugarcane juice machine, thresher, grinding machines, etc is observed both in social and industrial milieu. This study aims to investigate the scarf-related injuries at a major trauma center in northern India. Methods： From June 2013 to May 2015, a hospital-based prospective observational study was done in patients who presented to a level 1 trauma center in northern India with the mode of injury involving scarf around the neck. Demographic profile, mode of trauma, contributing factors, injury pattern, and the early management as well as early complications were recorded. Results： There were 76 injuries directly related from scarf with the mean age of patients being 32.4 years. The most common primary factor involved was rotating wheel of motorbike/tricycle （46.1%）, followed by belt driven machines （28.970）. The spectrum of injuries was diverse, including minor abrasions or lac- erations （53.9%）, large lacerations （15.8%）, fractures and spine trauma （18.4%）, mangled extremity and amputations （7.9%） and death （3.9%）. More severe injury patterns were noted with belt driven machines. Conclusion： Scarf-related injuries constitute a sizable proportion of trauma, with varying degrees of severity. Devastating consequences in significant proportion of cases dictate the call for a prevention plan comprising both educational and legislative measures. Urgent preventive measures targeting scarf- related injuries will help reduce mortality and morbidity.

Pattern of bony injuries among civilian gunshot victims at tertiary care hospital in Karachi, Pakistan

Purpose： Firearm injuries impose a continuous economic burden on society and hospital resources. The aim of this study was to assess the pattern of bony injuries among victims of gunshots. Methods： A retrospective study was conducted in the Department of Orthopedics, Dow University of Health Sciences and Civil Hospital l〈arachi from January 2011 to December 2012. Patients with isolated bony injuries were included while patients with other systemic injuries were excluded. Results： There were 90 cases and the majority of them were male （84.4%）. Mean age was （32.52 ± 10.27） years. Most of the patients （72.2%） belong to the younger age group. A low velocity weapon was used in 61 （67.8%） cases and a high velocity weapon was used in 29 （32.2%） cases. Armed robbery （64.4%） was the cause of conflict in more than half of the cases. Lower limb was involved in 72.2%. Fifty eight （64.4%） patients remained hospitalized for 15-20 days and others for more than 20 days. Internal fixation with intramedullary nailing was done in 35 patients while K-wire was used in 5 patients. Fifty patients were managed with external fixation, either uniplanar or multiplanar ilizarov. Deep wound infection and nonunion were observed more often in high velocity injuries. Conclusion： Armed robbery was the leading cause of gunshot bony injuries in our hospital. Young males were victimized in a majority of cases. High velocity injuries were associated with more complications.