Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.

Epidemiological and Clinical Pattern of Open Fractures of Long Bones of the Lower Limbs in the South-West Region of Cameroon: A 5-Year Review

Background: An open fracture is an injury in which the fracture site and/or hematoma communicates with the external environment. It is associated with significant morbidity and disability and is a challenge to the surgical team. The lower extremities are the most often exposed to traumatic injuries compared to other anatomical parts of the body. Patterns of open fractures differ with different mechanisms of injury and the segment of the long bone affected. The correct and timely management of open fractures is beneficial to the patients and leads to a more favorable outcome. This study aimed at describing the pattern of open fractures of long bones of the lower limb treated in 3 major hospitals of the south west region, Cameroon. Methodology: This was a hospital-based retrospective review of files of patients with open fractures of long bones of the lower limb managed at the surgical units of three secondary health facilities in the South-West region of Cameroon from the 1st of January 2015 to the 31st of December 2019. The socio-demographic characteristics, clinical presentation, treatment modalities, and outcomes were recorded. The data was stored and analyzed using Epi info version 7.0 and SPSS version 23.0 respectively. Results: A total of 195 files of patients aged 8 to 80 years were studied. The main age group affected was between 20 - 40 years. There were 147 (75.4%) males and 48 (24.6%) females giving a sex-ratio of 3.1:1. The most common cause was road traffic crashes 142 (72.8%). In 98 cases (50.3%), the left side was more involved. The tibia was the most common long bone affected in 75 (38.5%) cases. Comminuted fracture was the most common fracture pattern encountered in 126 cases (64.6%). A total of 76 (39%) fractures were graded Gustilo-Anderson IIIA. External fixator was used in 112 cases (57.1%) and internal fixator in 86 cases (42.9%). We recorded 127 (65.1%) cases of wound infection and 143 (73.3%) cases of limb shortening as the most common complications. Other complications include: 20 cases (17.1%) of mal-union, 27 cases (22.5%) of delayed union, 18 cases (15.1%) of non-union and 50 cases (38.5%) chronic osteomyelitis. We recorded a mortality of 2.1%. Gustilo IIIB and IIIC were associated to chronic osteomyelitis (P = 0.02). Conclusion: Open fractures of long bones of the lower limb affect the active age group of the population and road traffic crashes are the most common causes. It tends to affect the left side and the tibia being the most fractured long bone. A reasonable proportion of these fractures subsequently get infected. Comminuted fracture is the common fracture pattern.

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.

Surgical treatment of metastatic bone disease of the distal extremities

Metastatic bone disease of the distal extremities,also known as acrometastasis,is very rare.Thus,there is very limited information regarding the clinical manifestations and methods of surgical treatment.The current available literature shows that acrometastases are often encountered in the context of advanced disease and are thus associated with poor patient survival.As metastatic bone disease is generally uncurable,the goal of surgical treatment is to provide the patient with good function with as few complications as possible.In this article,we discuss the clinical manifestation of acrometastases,the methods of surgical intervention,and the expected clinical outcome.Non-surgically managed pathological fractures generally remain ununited;therefore,conservative treatment is reserved for patients with poor general condition or dismal prognosis.The current evidence suggests that in lesions of the lower arm and leg,osteosynthesis(plate and screw fixation or intramedullary nail)is the most common method of reconstruction,whereas local excision or amputation are more commonly used in cases of more distal lesions(such as ankle,foot and hand).Following surgery most patients receive adjuvant radiotherapy,even though its role is poorly documented.Close collaboration between orthopedic surgeons and medical oncologists is necessary to improve patient care and treatment outcome.Further studies are needed in order to provide stronger clinical evidence and improve decision-making,in an effort to optimize the patients’quality of life and avoid the need for revision surgery.

The Effects of Bone Screw Configurations on the Interfragmentary Movement in a Long Bone Fixed by a Limited Contact Locking Compression Plate

The locking compression plates (LCP) are efficient tools in open reduction and internal fixation (ORIF), especially in osteoporotic bones. Two important factors of screw density and screw position can affect the functionality of the bone plate. Several studies have assessed the influence of the screw configurations on the bone-plate stiffness, but the effects of screw positions on the interfragmentary strain, εIF of LCP construct have not been investigated yet. In this study, finite element method was used to investigate the influence of screws number and position on the interfragmentary strain of LCP-femur system for a mid-shaft fracture. Results of this study showed that by insertion of screws closer to the fracture site, εIF decreases by 2nd degree polynomial function versus screw position, but by adding the screws from the ends of the plate, or by moving and placing the screws towards the fracture site, the reduction of εIF will be linear. Results of this study were compared and are in agreement with some studies in the literature, even though their scope was mostly stability of the bone-implant system, whereas our scope was focused on the interfragmentary strain.

Virtual Reconstruction of Long Bone Fracture in Car-to-pedestrian Collisions Using Multi-body System and Finite Element Method

Lower limb injures are frequently observed in passenger car traffic accidents.Previous studies of the injuries focus on long bone fractures by using either cadaver component tests or simulations of the long bone kinematics,which lack in-depth study on the fractures in stress analysis.This paper aims to investigate lower limb impact biomechanics in real-world car to pedestrian accidents and to predict fractures of long bones in term of stress parameter for femur,tibia,and fibula.For the above purposes,a 3D finite element(FE) model of human body lower limb(HBM-LL) is developed based on human anatomy.The model consists of the pelvis,femur,tibia,fibula,patella,foot bones,primary tendons,knee joint capsule,meniscus,and ligaments.The FE model is validated by comparing the results from a lateral impact between simulations and tests with cadaver lower limb specimens.Two real-world accidents are selected from an in-depth accident database with detailed information about the accident scene,car impact speed,damage to the car,and pedestrian injuries.Multi-body system(MBS) models are used to reconstruct the kinematics of the pedestrians in the two accidents and the impact conditions are calculated for initial impact velocity and orientations of the car and pedestrian during the collision.The FE model is used to perform injury reconstructions and predict the fractures by using physical parameters,such as von Mises stress of long bones.The calculated failure level of the long bones is correlated with the injury outcomes observed from the two accident cases.The reconstruction result shows that the HBM-LL FE model has acceptable biofidelity and can be applied to predict the risk of long bone fractures.This study provides an efficient methodology to investigate the long bone fracture suffered from vehicle traffic collisions.

Waders(Scolopacidae)surviving despite malaligned leg fractures in the wild:kinematics of bipedal locomotion

Background: Bone fracture frequencies and survival rates are essential parameters in skeleton evolution, but information on the functional consequences of naturally healed fractures is scarce. No leg bone fracture healing in the wild has been reported so far from long-legged Charadriiformes(waders), which depend on bipedal locomotion for feeding.Methods: We documented a healed but malaligned tarsometatarsus fracture in a wild Willet(Tringa [Catoptrophorus]semipalmata), and a malaligned tibiotarsus fracture in a Curlew(Numenius arquata) skeleton from a museum collection. Functional consequences of the malalignments were evaluated by kinematic analyses of videos(Willet) and in silico 3D modeling(Curlew).Results: The Willet's left tarsometatarsus exhibited an angular malalignment of 70°, resulting in a limping gait that was less pronounced at high than at low walking speed. The bird seemed unable to club the toes of the left foot together, apparently a secondary effect of the deformity. The Curlew's tibiotarsus showed an angular and an axial malalignment, causing the foot to rotate outwards when the intertarsal joint was flexed. Despite the severe effects of their injuries, the birds had survived at least long enough for the fractures to heal completely.Conclusions: Somewhat unexpectedly, leg fractures are not necessarily fatal in long-legged waders, even if deformities occur in the healing process. Bipedal locomotion on vegetated grounds must have been impeded due to the bone malalignments in both analyzed cases. The birds probably alleviated the impact of their handicaps by shifting a larger proportion of their activities to vegetation-free habitats.

Bilateral Long Bone Fractures in a Patient with Sarcoid: A Case Report

Although there have been many reports of small bone and vertebral involvement in sarcoidosis, long bone pathology is rare. We report a case of almost identical bilateral fractures of the proximal femoral diaphysis during separated in time through a low-energy mode of injury, and explore the difficulties encountered when seeking radiological and tissue diagnosis.

Fat Embolism Syndrome in a Patient with Bilateral Tibial Fractures: Report of the Case and Review of the Literature

Background: Although the original clinical description of fat embolism syndrome (FES) dates from 1873, the condition remains a diagnostic challenge for modern clinicians. The syndrome is described as a serious consequence of fat emboli producing a distinct pattern of clinical symptoms and signs. It is mainly associated with fractures of the long-bones and the pelvis. The present paper describes the case of a trauma patient with bilateral tibial fractures that present the syndrome and highlights the importance of early identification and aggressive treatment of FES which is obligatory for the patient’s survival. Case Description: A 32 year-old man reached the hospital as a trauma call after a road traffic accident. Clinical examination was unremarkable with the only finding that the patient was unable to straight leg raise and weight bear. Both shins were painful and swollen at their middle third, while the left one was in varus and posterior displacement. Neurovascular status of both lower extremities was normal. Plain radiographic control (X-Rays) revealed an oblique right tibial fracture of the mid-shaft with a distal third fibular fracture and a comminuted fracture of the left tibia with a fracture of the fibula at the same level. The legs were immobilised on a splint and the decision was to treat the patient surgically. Within a few post admission hours the haemoglobin dropped by 2.9 mg/dL, however a source of active bleeding could not be allocated. The abdomen was soft and not tender in palpation and the central nervous system did not present any abnormalities. The following day the haemoglobin dropped but the new ultrasonography control did not reveal any free abdominal fluid. Both lower limbs were not compromised. The second post-injury day the patient went to theatre and the right tibia was stabilised with an antegrade nail (T2-Stryker) while the left one with an external fixation. During the reaming process the haemoglobin dropped to 7.1 gr/dL, so he was transfused with 3 blood units. Immediately after extubation, the patient desaturated on air and ABG values forced the anaesthetists to intubate him in recovery and place him in mechanical ventilation with high levels of positive end expiratory pressure (PEEP). Symptoms subsided rapidly and he was transferred to the IMU. Clinical image and CT scan were in favour of fat embolism syndrome. On the fifth post-operative day the patient was transferred back to ward and a week later he was discharged being completely free of symptoms. Clinical Relevance: Fat embolism syndrome is typically presented with the following triad: a) respiratory changes;b) neurologic abnormalities;c) petechial rash. These three constitute the major criteria described by Gurd and are pathognomonic for the condition. The patient—described in the present case report—developed progressively all those symptoms within the expected period of time. The FES is a well-known pathological condition that is well described in literature and should be familiar to those clinicians that manage trauma patients. Diagnosing the condition can be highly demanding since there are no laboratory investigations or radiographic imaging techniques specific for FES. Suspicion and diagnosis can be mainly placed based on the criteria described by Gurd, in 1970.

Vitamin D and Number of Falls in a Long-Term Care Facility

Falls represent a significant contribution to the morbidity and mortality of the elderly population. Because vitamin D is important in bone physiology, the use of vitamin D to restore deficient bone and ameliorate the effects of bone fractures due to falls has become a common practice in recent years. Following introduction of widespread use, reports began to emerge that vitamin D not only aided in repair of fall-induced bone fractures, but that it also reduced the occurrence of falls. Vitamin D now has become a routine intervention as a fall-prevention measure. Early analyses found evidence of prevention efficacy (reduced falls), but recent analyses are more equivocal. We retrospectively examined the records of 350 patients in a long-term care facility in which vitamin D administration and the number of falls were recorded as part of a comprehensive database of care. We found a dramatic rise in vitamin D use over the period covered (2006 – 2011) and a corresponding dramatic decrease in the number of falls. However, the number of falls continued to decline after 2008, despite a plateau in number of patients on vitamin D, particularly females. It appears that other factors contribute to the overall decline.

股骨近端防旋髓内钉(PFNA)与骨水泥加长柄人工股骨头置换治疗IFOF的疗效

目的分析在治疗股骨粗隆间骨折(IFOF)中应用股骨近端防旋髓内钉(PFNA)与骨水泥加长柄人工股骨头置换治疗的效果。方法本次研究选取2017年1月—2018年12月期间收治的60例股骨粗隆间骨折患者作为本次研究对象,根据治疗方法的不同分为两组,各30例,其中对照组给予骨水泥加长柄人工股骨头置换治疗,观察组给予PFNA治疗,比较两组效果。结果两组患者手术情况对比,观察组患者在手术时间、术中出血量、切口长度方面对比,均优于对照组;而对照组患者在住院时间、下地负重行走时间方面对比,均优于观察组,两组患者手术情况比较差异有统计学意义(P<0.05)。组间并发症发生情况比较,两组并发症发生率分别为16.7%、6.7%,其中观察组并发症发生率明显更低,差异有统计学意义(P<0.05)。组间术后各时间段髋关节功能评分对比,两组患者术后1个月、术后12个月这两个时间段的髋关节评分比较差异无统计学意义(P>0.05);而两组患者术后3个月、术后6个月这两个时间段髋关节评分对比,对照组评分明显更高,比较差异有统计学意义(P<0.05)。组间术后半年生活质量评分对比,对照组在躯体功能、心理功能、社会功能、物质生活状态四个维度方面的评分均比对照组高,比较差异有统计学意义(P<0.05)。结论在治疗股骨粗隆间骨折中,股骨近端防旋髓内钉与骨水泥加长柄人工股骨头置换治疗都发挥着重要的作用,其中股骨近端防旋髓内钉治疗具有手术时间短、创伤小、出血少的特点,而骨水泥加长柄人工股骨头置换治疗具有住院时间短、恢复快的特点。两种手术方法各有优势,所以在选择方面应该根据患者实际病情合理选择。

Impact of the fracture on low-order guided waves in long bone

Using ultrasonic guided waves to assess long bone fractures and fracture healing has become a promising diagnostic issue. But the multimode overlap of the guided waves challenges the quantitative evaluation and clinical application. In the preformed study, in order to simplify the signal interpretation, the low-frequency sinusoidial signals were used to only excite SO and A0 modes in fractured long bones. The amplitudes of SO and A0 modes were numerically analyzed with variation in crack width and fracture angle. Numerical simulation, based on the two-dimension finite-difference time-domain （2D-FDTD） reveals that both SO and A0 amplitudes decrease with the fracture widening. However, the increase in fracture angle gradually enhances the A0 amplitude, while with respect to the SO mode, its amplitude shows a non-monotonic trend to the variation in fracture angle with a turning point around 45°. The amplitude ratio between S0 and A0 can reflect the variations in crack width and fracture angles. The simulation illustrates that ultrasonic guided SO and A0 modes are sensitive to the degree of both vertical and oblique fractures in the long cortical bone. These findings may be helpful for fractures diagnosis and healing evaluation of the long bone.

过表达lncRNA HAGLR促胫骨骨折大鼠骨髓间充质干细胞成骨分化的机制研究

目的研究骨质疏松(OP)-胫骨骨折(TF)大鼠长链非编码RNA同源盒D基因簇反义生长相关长链非编码RNA(lncRNA HAGLR)与其下游靶基因的表达情况,并探讨lncRNA HAGLR对大鼠骨髓间充质干细胞(MSC)成骨分化的作用与机制。方法30只SD雌性大鼠随机分为sham组、OP组、OP-TF组,每组10只。ELISA法检测大鼠血清碱性磷酸酶(ALP)和抗酒石酸酸性磷酸酶(TRAP)的水平。对大鼠MSC细胞系R7500使用成骨分化诱导培养基进行诱导,并分为MSC组和成骨诱导组(Osteogenic-MSC组)。分别转染pcDNA-HAGLR、pcDNA-NC、miR-19a-3p的模拟物(miR-19a-3p mimic)、mimic的阴性对照(NC mimic)、miR-19a-3p的抑制剂(miR-19a-3p inhibitor)、miR-19a-3p inhibitor的阴性对照(NC inhibitor)至R7500后进行相应分组。双荧光素酶报告基因实验验证lncRNA HAGLR和miR-19a-3p以及骨形态发生蛋白2(BMP2)和miR-19a-3p的靶向关系。qRT-PCR检测各组lncRNA HAGLR和miR-19a-3p的表达。Western blot检测BMP2、ALP、胶原蛋白I(COL-I)、骨钙素(OCN)、骨桥蛋白(OPN)的表达。ALP染色和AR染色检测MSC的成骨分化能力。结果OP组和OP-TF组的血清ALP和TRAP水平均高于sham组,差异有统计学意义(P<0.05)。而OP组与sham组胫骨组织中lncRNA HAGLR、miR-19a-3p、BMP2的表达水平比较差异均无统计学意义(P>0.05),而OP-TF组胫骨组织中lncRNA HAGLR、BMP2的表达水平均明显低于sham组和OP组(P<0.05),OP-TF组胫骨组织中miR-19a-3p的表达水平高于sham组和OP组(P<0.05)。与MSC组相比,Osteogenic-MSC组的lncRNA HAGLR表达水平明显升高(P<0.05),而miR-19a-3p的表达降低(P<0.05)。双荧光素酶报告基因实验表明lncRNA HAGLR与miR-19a-3p具有靶向关系,miR-19a-3p与BMP2具有靶向关系。pcDNA-HAGLR组的miR-19a-3p的表达水平低于pcDNA-NC组(P<0.05)。miR-19a-3p mimic组与NC mimic组的lncRNA HAGLR的表达水平比较,差异无统计学意义(P>0.05)。与NC mimic组相比,miR-19a-3p mimic组BMP2的表达水平降低(P<0.05),miR-19a-3p表达水平升高(P<0.05)。pcDNA-HAGLR组细胞较pcDNA-NC组具有更强的成骨分化能力和更高的ALP活性(P<0.05)。miR-19a-3p inhibitor组细胞较NC inhibitor组具有更强的成骨分化能力和更高的ALP活性(P<0.05)。结论胫骨骨折大鼠lncRNA HAGLR和BMP2表达降低,miR-19a-3p表达增高。过表达lncRNA HAGLR通过靶向调控miR-19a-3p/BMP2轴促进大鼠MSC的成骨分化。

四肢创伤骨折病人术后低蛋白血症的危险因素分析及风险预测模型的构建

目的 探讨四肢创伤骨折病人术后低蛋白血症的危险因素,并构建四肢创伤骨折病人术后低蛋白血症的风险预测模型。方法 选取2018年3月至2022年8月池州市人民医院手术治疗的226例四肢创伤骨折病人作为研究对象。应用Lasso分析筛选四肢创伤骨折病人术后低蛋白血症的预测因素,应用logistic回归分析筛选四肢创伤骨折病人术后低蛋白血症的危险因素,应用R软件构建四肢创伤骨折病人术后低蛋白血症的列线图模型,并对四肢创伤骨折病人术后低蛋白血症的列线图模型进行验证。结果 logistic回归分析结果显示,女性、年龄≥65岁、术中出血量≥300 mL、胃肠功能损伤、肺部感染、术前白蛋白<35 g/L、衰弱、输注胶体液及蛋白等是四肢创伤骨折病人术后低蛋白血症的危险因素(P<0.05)。四肢创伤骨折病人术后低蛋白血症的列线图模型的校正曲线显示预测值与实际值的拟合度较好;模型的AUC是0.84[95%CI:(0.80,0.87)];决策曲线显示阈值概率在2%~75%范围内时,应用该列线图预测四肢创伤骨折病人术后低蛋白血症净获益值较高。结论 女性、年龄≥65岁、术中出血量≥300 mL、胃肠功能损伤、肺部感染、术前白蛋白<35 g/L、衰弱、输注胶体液及蛋白等是四肢创伤骨折病人术后低蛋白血症的危险因素,本研究基于以上8项危险因素构建的列线图能够对四肢创伤骨折病人术后低蛋白血症的防治工作起到帮助作用。

血清总Ⅰ型前胶原氨基端前肽和β-Ⅰ型胶原交联羧基末端肽联合检测对早期预测四肢长骨骨折延迟愈合的临床价值

目的 探讨血清总Ⅰ型前胶原氨基端前肽(PINP)和β-Ⅰ型胶原交联羧基末端肽(β-CTX)联合检测对早期预测长骨骨折延迟愈合的临床价值。方法 测定156例四肢长骨骨折患者术后1、4、8、12周时的血清PINP和β-CTX水平,根据骨折愈合情况将患者分为延迟愈合组(30例)和正常愈合组(126例),比较两组的血清PINP和β-CTX水平。采用logistic回归分析四肢长骨骨折延迟愈合的影响因素,并采用ROC曲线分析术后血清PINP和β-CTX联合检测对四肢长骨骨折延迟愈合的早期预测效能。结果 两组骨折术后血清PINP和β-CTX水平呈升高趋势,在治疗后8周达高峰,随后下降。骨折术后4、8、12周时,延迟愈合组血清PINP和β-CTX水平均低于正常愈合组,差异有统计学意义(P <0.05)。多因素logistic回归分析结果显示,术后血清PINP和β-CTX水平是四肢长骨骨折延迟愈合的独立危险因素(P <0.05)。ROC曲线显示,术后血清PINP和β-CTX联合检测预测长骨骨折延迟愈合的ROC曲线下面积(AUC)为0.861(P <0.05)。结论 术后血清PINP和β-CTX水平与四肢长骨骨折延迟愈合密切相关,二者联合检测有助于早期预测四肢长骨骨折延迟愈合。

长骨骨不连的发病率及手术治疗研究进展

骨不连是骨折并发症之一,其发病部位及病因多样化,治疗方式也不完全相同。不同因素之间相互作用,使之成为临床骨科医师棘手的难题。多数骨不连发生在长骨骨折后,以锁骨、肱骨、前臂、股骨、胫骨为主。临床治疗中,存在多种手术方式可供选择。笔者就近年来长骨骨不连的发病率及手术治疗现状进行综述,旨在为骨不连手术治疗方法的进一步研究和应用提供参考依据。

Rotary self-locking intramedullary nail for long tubular bone fractures

Background Intramedullary nails had been widely used in the treatment of long-bone fractures because of less interference of fractures and center bearing biomechanical advantage. However, it had been also found many shortcomings such as broken nails, delayed healing and was modified in order to achieve better efficacy and reduce complications. The aim of the present study is to compare the efficacy of rotary self-locking intramedullary nails （RSIN） with that of interlocking intramedullary nails （IIN） in the treatment of long-bone fractures.

Clinical features of neoplastic pathological fracture in long bones

Background Pathological fractures signify a potentially more aggressive subset of the original disease with higher misdiagnosis rates and inferior oncologic results. The purpose of the present study was to explore the clinical features of neoplastic pathological fracture in extremities. Methods From August 2002 to December 2010, a consecutive series of 139 patients suffering neoplastic pathological fracture were recruited, including 79 males and 60 females with a mean age of 31.3 years. Fractures were classified into five groups： tumor-like lesions （55）, benign bone tumors （13）, giant cell tumors （7）, primary malignant bone tumors （28）, and metastatic bone tumors （36）. Based on their inducing forces, pathologic fractures were classified into four grades： spontaneous fracture, functional fracture, minor injury, and traumatic injury. Patients＇ age, fracture site, histological diagnoses, fracture forces, prodromes, and misdiagnosis were well reviewed. Kruskal-Wallis and X2 tests were used to compare forces and prodromes within different types of bone tumors. Results The highest pathologic fracture morbidity was 32.3% （45/139）, which lay in the 11-20 year group, and 86.1% of metastatic tumors occurred in the 50-80 year group. The common sites of fractures were femur, humerus, and tibia. The fracture forces in benign bone tumors and tumor-like lesions are the strongest, followed by metastatic tumors and primary malignant bone tumors （Hc=80.980, P=0.000）. Sixty-seven patients （48.2%） had local prodromes before pathologic fracture. The incidence rates of prodromes between primary malignant tumors and metastatic bone tumors had no significant difference （P=0.146）, but they were all obviously higher than that of benign bone tumors and tumor-like lesions. Twenty patients experienced misdiagnosis. Conclusion Minor injury forces and local prodromes are clinical features of neoplastic pathologic fractures and they are also the critical factor avoiding misdiagnoses.

基于Ⅰ型胶原蛋白和羟基磷灰石的新型仿生人工骨膜修复材料在四肢长骨粉碎性骨折伴游离骨块中的应用

目的观察基于Ⅰ型胶原蛋白和羟基磷灰石的新型仿生人工骨膜修复材料在四肢长骨粉碎性骨折伴游离骨块中的应用效果。方法选取2021年1月—2022年8月临朐县人民医院因外伤致四肢长骨粉碎性骨折伴游离碎骨块的120例患者作为研究对象,所有患者均行骨折切开复位内固定治疗,根据患者是否同意术中使用人工骨膜修复材料进行分组研究,未使用者纳入对照组(n=54),使用骨膜修复材料者纳入观察组(n=66)。观察两组患者手术时间、术中出血量;术后定期复查X线,进行为期1年的持续随访观察,记录并比较两组患者骨折愈合时间。结果120例患者均顺利完成手术,两组患者术中出血量、手术时间比较,差异无统计学意义(P>0.05);对照组平均骨折愈合时间长于观察组,差异有统计学意义(P<0.05)。对照组骨折延迟愈合、骨折不愈合发生率高于对照组,差异有统计学意义(P<0.05)。结论对四肢长骨粉碎性骨折伴游离骨块中的患者应用人工骨膜修复材可促进骨折的修复愈合,减少骨折延迟愈合及不愈合的发生。

交锁髓内钉治疗创伤性下肢长管状骨骨折的临床效果

目的 探究对创伤性下肢长管状骨骨折患者开展交锁髓内钉治疗的效果。方法 选取2021年1月至2022年12月南京市栖霞区医院收治的创伤性下肢长管状骨骨折患者140例,按随机数字表法分为对照组与试验组,两组各70例,对照组采用传统钢板内固定术治疗,试验组采用交锁髓内钉内固定术治疗,对比两组手术重要指标、膝关节功能评分、术后疼痛度评分、关节恢复时间及术后并发症发生情况。结果 试验组手术出血量、手术时长、住院时长及术后关节功能恢复时间均短于对照组(均P <0.05);试验组疼痛、功能、活动度、屈曲畸形、肌力等膝关节功能评分均高于对照组(均P <0.05);两组疼痛度评分和并发症发生率均低于对照组(均P <0.05)。结论 运用交锁髓内钉内固定治疗法治疗创伤性下肢长管状骨骨折安全系数更高,能有效促进患者骨性愈合,减轻术后疼痛,避免关节功能障碍等并发症发生。