Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture

BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.

Bone Density and Mechanical Properties in Femoral Bone of Swim Loaded Aged Mice

Effects of swirnming on bone density and mechanical properties of femur were investigated in aged male and female mice. R/1 strain of senescence accelerated mouse (SAM) at eleven months old was used. Two groups of males and two groups of females each consisting of 7 mice were used. One male and one female groups were loaded with a swim regiment of 40 min a day, 5 days a week for 6 consecutive weeks. The remaining groups were used as the controls. All mice were fed with the standard diet and water ad libitum during the experiments.The results of this study indicated that (i) the hady weight was significantly (P<0.05) lower in the swimming groups than in the control groups in boh sexes. (ii) The bone density was significantly higher (P <0.05) in the swimming groups than in the control groups in boh sexes. However, there was no sighficant difference in cortical thickness index. (iii) In the mechanical properties of bone, there were no significant differences in the level of the maximum breaking force, the ultimate stress and the deformation between the swimndng and the contro groups in beth sexes. However, the elasticity of the bone of the female hoce in the swimming group was significantly higher (P<0.05) than that of the control group.These results suggest that regimented swimming for the aged mice might suppress age-associated bone loss, and the effect of exercise in the females is greater that in the males.

Clinical Outcomes of Artificial Total Hip Arthroplasty for Proximal Femoral Bone Tumors

Objective:To investigate the clinical outcome of artificial hip replacement for proximal femoral bone tumors.Methods:One hundred patients with proximal femur bone tumors admitted to the hospital for treatment from June 2018 to May 2020 were selected and divided into a control group and an experimental group of 50 patients each using central randomization.The control group received conventional treatment and the experimental group underwent artificial total hip arthroplasty,and the results of treatment were compared between the two groups.Results:The operative time and hospitalization time of the experimental group were shorter than that of the control group,and the blood loss was less than that of the control group;after the replacement surgery,the range of flexion and extension,internal and external rotation activity and abduction activity scores were better than those of the control group;and the total incidence of adverse reactions in the experimental group was 6.0%,which was significantly lower than that of the control group(14.0%).By comparing the treatment effects of the two groups,the differentiation was significant,and P<0.05 was statistically significant.Conclusion:Artificial hip arthroplasty can effectively treat proximal femoral tumors,shorten operative time,hospitalization time and intraoperative bleeding,and alleviate patients’therapeutic pain,which has good promotion value in clinical practice.

Usage of buttress plate internal fixation associated with autografting of fibula and iliac bone for the treatment of distal femoral C_3 type fracture

To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture using buttress plate associated with antografting of fibula and iliac bone were analyzed retrospectively.Results All cases were followed up for an average of 24 months（8～55 months）.The average time of octets bridge forming were 4 months（3～5 months） while the average time for bone union were 8 months （6～14 months）.According to Shelbourne rating system,result of all 18 cases were excellent and no malunion,infection were found.Conclusion Buttress plate associated with antografting of fibula and iliac bone is an effective alternative for the treatment of distal femoral C3 type fracture.It can provide more stable fixation to the bone and earlier functional exercises can be achieved.5 refs,3 figs,1 tab.

Tissue level microstructure and mechanical properties of the femoral head in the proximal femur of fracture patients

This study aims to investigate the regional variations of trabecular morphological parameters and mechanical parameters of the femoral head,as well as to determine the relationship between trabecular morphological and mechanical parameters.Seven femoral heads from patients with fractured proximal femur were scanned using a micro-CT system.Each femoral head was divided into 12 sub-regions according to the trabecular orientation.One 125 mm^3 trabecular cubic model was reconstructed from each sub-region.A total of 81 trabecular models were reconstructed,except three destroyed sub-regions from two femoral heads during the surgery.Trabecular morphological parameters,i.e.trabecular separation（Tb.Sp）,trabecular thickness（Tb.Th）,specific bone surface（BS/B V）,bone volume fraction（BV/TV）,structural model index（SMI）,and degree of anisotropy（DA） were measured.Micro-finite element analyses were performed for each cube to obtain the apparent Young＇s modulus and tissue level von Mises stress distribution under 1%compressive strain along three orthogonal directions,respectively.Results revealed significant regional variations in the morphological parameters（P〈0.05）.Young＇s moduli along the trabecular orientation were significantly higher than those along the other two directions.In general,trabecular mechanical properties in the medial region were lower than those in the lateral region.Trabecular mechanical parameters along the trabecular orientation were significantly correlated with BS/BV,BV/TV,Tb.Th,and DA.In this study,regional variations of microstructural features and mechanical properties in the femoral head of patients with proximal femur fracture were thoroughly investigated at the tissue level.The results of this study will help to elucidate the mechanism of femoral head fracture for reducing fracture risk and developing treatment strategies for the elderly.

股骨距骨密度变化对老年髋部骨折类型的影响研究

背景:老年髋部骨折主要包括股骨颈骨折及股骨转子间骨折,股骨颈骨折患者的年龄略小于股骨转子间骨折患者,有学者认为这与股骨距的骨密度变化有关。目的:运用螺旋CT扫描及三维重建技术研究股骨距骨密度变化对老年髋部骨折类型的影响。方法:收集自2016年1月至2018年10月老年髋部骨折患者的CT图像,结合图像处理软件重建股骨距及股骨近端三维图像,测量股骨距、压力骨小梁、张力骨小梁、头下骨小梁、大转子骨小梁及次张力骨小梁的平均CT值,并以此CT值代表骨密度,分析股骨距密度变化与老年髋部骨折类型的关系。结果:在相同年龄阶段,不同类型老年髋部骨折患者的股骨距密度比较,差异有统计学意义(P<0.05),其中股骨颈骨折患者的股骨距平均CT值明显大于股骨转子间骨折患者。在老年女性患者中,股骨颈骨折患者的股骨距密度、张力骨小梁和次张力骨小梁密度均大于股骨转子间骨折患者(P<0.05),而男性患者上述指标比较,差异无统计学意义。结论:不同年龄老年人及老年女性股骨距骨密度变化是影响髋部骨折类型的重要因素。

Effects of Modified Qing'e Pill(加味青娥丸) on Expression of Adiponectin,Bone Morphogenetic Protein 2 and Coagulation-Related Factors in Patients with Nontraumatic Osteonecrosis of Femoral Head

Objective： To observe the regulation of Chinese herbal medicine, Modified Qing＇e Pill（加味青娥丸, MQEP）, on the expression of adiponectin, bone morphogenetic protein 2（BMP2）, osteoprotegerin（OPG） and other potentially relevant risk factors in patients with nontraumatic osteonecrosis of the femoral head（ONFH）. Methods： A total of 96 patients with nontraumatic ONFH were unequal randomly divided into treatment group（60 cases） and control group（36 cases）. The treatment group were treated with MQEP while the control group were treated with simulated pills. Both groups were given caltrate D. Six months were taken as a treatment course. Patients were followed up every 2 months. The levels of plasma adiponectin, BMP2, OPG, von Willebrand factor（vWF）, von Willebrand factor cleaving protease（vWF-cp）, plasminogen activator inhibitor 1（PAI-1）, tissue plasminogen activator（tPA）, C-reactive protein（CRP）, blood rheology, bone mineral density（BMD） of the femoral head and Harris Hip Score were measured before and after treatment. Results： After 6 months of treatment, compared with the control group, patients in the treatment group had significantly higher adiponectin and BMP2 levels（P〈0.01 and P=0.013, respectively）, lower vWF, PAI-1 and CRP levels（P=0.019, P〈0.01 and P〈0.01, respectively）, and lower blood rheology parameters. BMD of the femoral neck, triangle area and Harris Hip Score in the treatment group were significantly higher than those in the control group. Moreover, plasma adiponectin showed a positive association with BMP2（r=0.231, P=0.003） and a negative association with PAI-1（r=–0.159, P〈0.05）. Conclusions： MQEP may play a protective role against nontraumatic ONFH by increasing the expression of adiponectin, regulating bone metabolism and improving the hypercoagulation state, which may provide an experimental base for its clinical effects.

Lateral cortex blowout during PFNA blade insertion in a subtrochanteric fracture - Should bone quality determine the type of nail used？

Subtrochanteric fractures pose a therapeutic challenge to the surgeons. With the advent of proximal femoral nails, most of the cases are treated with nailing. Newer nails like proximal femoral nail antirotation （PFNA） require the blade to be directly hammered into the bone compared to older nails where the screws are drilled and tapped before insertion. We report one such case in a middle aged female that had intraoperative lateral cortex blowout during PFNA blade insertion in a sclerotic bone. This occurrence to the best of our knowledge is unreported in literature. It is therefore imperative to consider the quality of bone before a decision is made on the implant chosen.