Value of negative pressure sealing drainage on wound healing of Gustilo IIIB and IIIC open fractures

BACKGROUND Gustilo III fractures have a high incidence and are difficult to treat.Patients often experience difficulty in wound healing.Negative pressure drainage technology can help shorten wound healing time and has positive value in improving patient prognosis.AIM To explore the clinical value of the negative pressure sealing drainage technique in wound healing of Gustilo IIIB and IIIC open fractures.METHODS Eighty patients with Gustilo IIIB and IIIC open fractures with skin and soft tissue injuries who were treated in the Second People’s Hospital of Dalian from March 2019 to December 2021 were selected as the research subjects.They were divided into a study group(n=40,healed with negative pressure closed drainage)and a control group(n=40,healed with conventional dressing changes)according to the variation in the healing they received.The efficacy of the clinical interventions,the variations in the regression indicators(time to wound healing,time to fracture healing,time to hospitalization),and the conversion and healing of bacterial wounds were compared 1-3 mo after the intervention.RESULTS The total effective rate of patients among the study group was 95.00%(38/40),which was notably higher than 75.00%(30/40)among the control group(P<0.05).The wound healing time,fracture healing time,and hospital stay of the patients in the study group was shorter than the control group(P<0.05).After the intervention,the negative bacterial culture at the wound site rate and wound healing rate of the patients among the study group increased compared to the control group(P<0.05).CONCLUSION Negative pressure sealing and drainage technology has a good therapeutic effect on patients with Gustilo IIIB and IIIC open fracture wounds with skin and soft tissue injury.It can notably enhance the wound healing rate and the negative rate of bacteria on the wound surface and help to speed up the recovery process of patients.

Stent fracture after transjugular intrahepatic portosystemic shunt placement using the bare metal stent/stent-graft combination technique

BACKGROUND A transjugular intrahepatic portosystemic shunt(TIPS)is widely placed to treat portal hypertension.Because the Viatorr®stent(W.L.Gore and Associates,Flagstaff,AZ,United States)is not available in all hospitals in China,the bare metal stent(BMS)/stent-graft combination technique is still popular for TIPS construction.Stent fracture is a complication after TIPS placement using this technique,with limited available literature focusing on it.AIM To assess the incidence of stent fracture after TIPS placement using the BMS/stent-graft combination technique and to identify the risk factors for stent fracture.We proposed technique modifications to improve the clinical results of TIPS placement with the BMS/stent-graft combination technique.METHODS We retrospectively analyzed the computed tomography(CT)data of all patients with portal hypertension who underwent the TIPS procedure between June 2011 and December 2021 in a single center.Patients implanted with the BMS/stent graft and had follow-up imaging data available were included.We identified patients with stent fracture and analyzed their characteristics.Multivariable logistic regression was applied to identify the potential predictors of stent fracture.RESULTS Of the 68 included patients,stent fracture occurred in seven(10.3%)patients.Based on CT images,the stent fractures were categorized into three types.Our study consisted of four(57.1%)type I fractures,one(14.3%)type II fracture,one(14.3%)type IIIa fracture,and one(14.3%)type IIIb fracture.After adjusting for covariates,multivariable logistic regression revealed that the risk factors for stent fracture were the implantation of a greater number of stents[adjusted odds ratio(aOR)=22.2,95%confidence interval(CI):1.2-415.4,P=0.038]and a larger proximal sagittal stent bending angle(aOR=1.1,95%CI:1.0-1.3,P=0.020).CONCLUSION Stent fracture occurred in approximately 10%of patients with portal hypertension who underwent TIPS with the BMS/stent-graft combination technique.The number of implanted stents and stent bending angle at the inferior vena cava end were predictors of stent fracture,which suggests that the incidence of stent fracture could potentially be reduced by procedural modifications.

Assessing the readability of online information about jones fracture

BACKGROUND Hand in hand with technological advancements,treatment modalities continue to grow.With the turn of the century,the internet has become the number one source of information for almost every topic.Thus,many patients look toward the internet as their primary source of information to learn about their respective medical conditions.The American Medical Association and National Institute of Health strongly recommend that online medical information be written at the 6th to 8th-grade level to aid comprehension by patients of all literacy backgrounds.AIM To assess the readability of online information regarding Jones fracture.Our hypothesis is that the reading level of medical information published on websites far exceeds the recommended reading level of 6th-8th grade as proposed by the American Medical Associate and National Institute of Health.The result of this study can help us formulate improved recommendations for publishing more comprehensible material and,thus,eventually improve patient compliance and clinical outcomes.METHODS The exact phrase“Jones fracture”was queried on the three most common search engines,Google,Yahoo!,and Bing,on December 28,2022.As of December 2022,Google held 84%,Bing held 9%,and Yahoo!held 2%of the worldwide search engine market share.Web pages uniform resource locator from the first three pages of search results were recorded from each search engine.These web pages were classified according to academic,physician-sponsored,governmental and non-government organizations(NGO),commercial,and unspecified as per formally defined categories.Websites associated with an educational institution or medical organization were classified as academic.Websites with products for sale,corporate sponsorship,or advertisements were classified as commercial.Governmental websites or NGOs comprised those that received government subsidies or grants.Webpages that were independently owned by physicians or physician groups were respectively classed as physician sponsored.The remainder of websites that did not fall under the above categories were classified as unspecified.RESULTS A total of 93 websites were analyzed for reading assessment.A whopping 44%of websites were commercial,followed by 22%of physician-sponsored websites.Third place belonged to non-government organization websites holding a 15%share.The academic website held a meager 9%portion,while unspecified sites were 3%.The table illustrates mean readability scores,along with average cumulative grade level.The average grade level was 10.95±2.28 for all websites,with a range of 6.18 to 18.90.Since P values were more than 0.05,there was not a significant statistical difference between the first page results and the results of all pages.Thus,we can rationalize that readability scores are consistent throughout all pages of a website.CONCLUSION Hand in hand with technological advancements,treatment modalities continue to grow.With the turn of the century,the internet has become the number one source of information for almost every topic.Thus,many patients look towards the internet as the primary source of information to learn about their respective medical conditions.Our study demonstrates that current online medical information regarding Jones fracture is written at an extraordinarily high-grade level,with an average grade level of all websites at 10.95,nearly an 10th-grade educational level.The American Medical Association and National Institute of Health strongly recommend that online medical information should be written at the 6th to 8th-grade level to aid comprehension by patients of all literacy backgrounds.On the contrary,most of the medical information evaluated was at an 10th-grade level,which far exceeds recommendations by AMA and NIH.This is particularly relevant because readability scores are directly proportional to the level of comprehension attained by readers,thus directly impacting patient outcomes.In conclusion,we suggest and encourage that all online reading materials should be re-written at the 6th to 8th-grade level in a public service effort to increase compliance with treatment goals and raise awareness of preventive measures.

Ilizarov external fixators for maluninon of obsolete calcaneal fracture of Stephen Type Ⅲ

Objective To evaluate the clinical effects of Ilizarov external fixator for maluninon of obsolete calcaneal fracture of Stephen Type Ⅲ.Methods From July 2006 to February 2009,25 patients suffering from maluninon of obsolete calcaneal

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.

IMPROVEMENT OF TYPE IV CRACKING RESISTANCE OF 9Cr HEAT RESISTING STEEL WELDMENT BY BORON ADDITION

Creep lives of high Cr ferritic heat resisting steel weldments decrease due to Type Ⅳ fracture, which occurs as a result of formation and growth of creep voids and cracks on grain boundaries in fine-grained heat affected zone (HAZ). Because boron is considered to suppress the coarsening of grain boundary precipitates and growth of creep voids, we have investigated the effect of boron addition on the creep properties of 9Cr steel weldments. Four kinds of 9Cr3WSCoVNb steels with boron content varying from 4.7×10-5 to 1.8×10-4 and with nitrogen as low as 2.0×10-5 were prepared. The steel plates were welded by gas tungsten arc welding and crept at 923K. It was found that the microstructures of HAZ were quite different from those of conventional high Cr steels such as P91 and P92, namely the fine-grained HAZ did not exist in the present steel weldments. Boron addition also has the effect to suppress coarsening of grain boundary carbides in HAZ during creep. As a result of these phenomena, the welded joints of present steels showed no Type Ⅳ fractures and much better creep lives than those of conventional steels.

Bilateral triceps tendon approach is flexible and efficient in the treatment of type C distal humerus fractures

Purpose:The purpose of this study was to assess and compare elbow range of motion,triceps extension strength and functional results of type C(AO/OTA)distal humerus fractures treated with bilateral triceps tendon(BTT)approach and olecranon osteotomy(00).At the same time,we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus,and whether it is convenient to convert to the treatment to total elbow arthroplasty(TEA)or 00.Methods:Patients treated with 00 and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed.Inclusion criteria include:(1)patients'age were more than 18 years old,(2)follow-up was no less than 6 months,and(3)patients were diagnosed with type C fractures(based on the AO/OTA classification).Exclusion criteria include:(1)open fractures(Gustillo type 2 or type 3),(2)treated by other approaches,and(3)presented with combined injuries of ipsilateral upper extremities,such as ulnar nerve.Elbow range of motion and triceps extension strength testing were completely valuated,when the fractures had healed.Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up.The data were compared using the two tailed Student's t-test.All data were presented as mean±standard deviation.Results:Eighty-six patients of type C distal humerus fractures,treated by 00 and BTT approach were retrospectively reviewed between July 2014 and December 2017.Fifty-five distal humerus fractures(23 males and 32 females,mean age 52.7 years)treated by BTT approach or 00 were included in this study.There were 10 fractures of type Cl,16 type C2 and 29 type C3 according to the AO/OTA classification.Patients were divided into two surgical approach groups chosen by the operators:BTT group(28 patients)and 00 group(27 patients).And the mean follow-up time of all patients was 15.6 months(range,6-36 months).Three cases in BTT group were converted to TEA,and one converted to 00.Only one case in BTT group presented poor articular reduction with a step more than 2 mm.There were not significantly different in functional outcomes according to the Mayo elbow performance score,operation time and extension flexion motion are values between BTT group and 00 group(p>0.05).Complications and reoperation rate were also similar in the two groups.Triceps manual muscle testing were no significant difference in the two groups,even subdivided in elder patients(aged>60 years old).Conclusion:BTT is a safe approach to achieve similar functional result comparing with 00.BTT were not suitable for every case with severe comminuted pattern,but it avoids the potential complications related to 00,and has no complications concerning with triceps tendon.It is convenient for open reduction internal fixation and flexible to be converted to 00,as well as available to be converted to TEA in elder patients.