Blood Calcium as a Protective Factor against Traumatic Fracture

Purpose: This study aims to investigate the predictive value of blood calcium in the prognosis of traumatic fracture. Methods: A retrospective experimental design was employed, 112 cases (52 non-fracture and 60 traumatic fracture) were randomly selected. The type of fracture complies with WHO-recommended (2019) diagnostic criteria for osteoporosis combined with fracture. The blood pressure (BP) was measured by OMRON’s HEM-7136 model electronic blood pressure monitor. Blood calcium (Ca2+), and blood phosphorus (P) values were measured using Colorimetric Roche kits on a Roche/Hitachi fully automated biochemical analyzer. Data collection and analysis followed. Results: Higher levels of age, systolic and diastolic blood pressures were found in the traumatic fracture group compared to the control group, whereas weight, height, and blood phosphorus did not differ significantly (P adjusting for age, systolic blood pressure, diastolic blood pressure, and blood phosphorus, binary logistic regression analysis revealed that blood calcium was a protective factor against traumatic fracture (β = -26.85, OR = 0.00, 95% CI = 0.00 -0.02, P = 0.022). Conclusion: The findings suggest that high and low blood calcium levels may serve as useful indicators in predicting the prognosis of fractures resulting from trauma.

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.

Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture:Three case reports

BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis.This article retrospectively analyzed the imaging and clinical data of three patients,to explore the imaging characteristics and treatment strategies for carotid artery occlusion,combined with severe skull base fractures.CASE SUMMARY This case included three patients,all male,aged 21,63,and 16 years.They underwent plain film skull computed tomography(CT)examination at the onset of their illnesses,which revealed fractures at the bases of their skulls.Ultimately,these cases were definitively diagnosed through CT angiography(CTA)examinations.The first patient did not receive surgical treatment,only anticoagulation therapy,and recovered smoothly with no residual limb dysfunction(Case 1).The other two patients both developed intracranial hypertension and underwent decompressive craniectomy.One of these patients had high intracranial pressure and significant brain swelling postoperatively,leading the family to choose to take him home(Case 2).The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction(Case 3).We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.CONCLUSION For patients with cranial trauma combined with skull base fractures,it is essential to complete a CTA examination as soon as possible,to screen for blunt cerebrovascular injury.

Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture

The internal carotid artery occlusion caused by head and neck trauma,also known as traumatic intracranial artery occlusion,is relatively rare clinically.Traumatic skull base fracture is a common complication of traumatic brain injury.Traumatic skull base fracture is one of the causes of traumatic internal carotid artery occlusion.If not detected early and treated in time,the prognosis of patients is poor.This editorial makes a relevant analysis of this disease.

Timing theory continuous nursing,resistance training:Rehabilitation and mental health of caregivers and stroke patients with traumatic fractures

BACKGROUND Stroke is the leading cause of adult lifelong disability worldwide.A stroke is an acute cerebrovascular disease with a variety of causes and corresponding clinical symptoms.Around 75%of surviving stroke patients experience impaired nerve function,and some suffer from traumatic fractures,which can lead to special care needs.AIM To determine the effect of timing theory continuous care,with resistance training,on the rehabilitation and mental health of caregivers and stroke patients with traumatic fractures.METHODS Between January 2017 to March 2021,we selected 100 hospital admissions with post-stroke hemiplegia complicated with a traumatic fracture.Two participant groups were created:(1)Control group:given resistance training;and(2)Observation group:given timing theory continuous care combined with resistance training.The degree of satisfaction and differences in bone and phosphorus metabolism indexes between the two groups were compared.The self-perceived burden scale(SPBS)and caregiver burden questionnaire were used to evaluate the psychological health of patients and caregivers.The Harris hip function score,ability of daily living(ADL)scale,and global quality of life questionnaire(GQOL-74)were used to evaluate hip function,ability of daily living,and quality of life.RESULTS Data were collected prior to and after intervention.Alkaline phosphatase(ALP),osteocalcin,and vitamin D3 in the observation group and control group increased after intervention(P<0.05),and carboxy-terminal peptide of type I collagenβSpecial sequence(β-CTX)decreased(P<0.05).ALP and osteocalcin in the observation group were higher than in the control group(P<0.05).There was no significant difference inβ-CTX and vitamin D3 between the two groups(P>0.05).The SPBS score of the observation group was lower and the ADL score was higher than the control group.The burden score was lower and the Harris hip function and GQOL-74 scores were higher than that of the control group(P<0.05).The observation group’s satisfaction rating was 94.00%,which was higher than the rating from the control group(P<0.05).CONCLUSION Timing theory continuous nursing with resistance training can reduce hip dysfunction in stroke patients with a traumatic fracture and enhance quality of life and mental health of patients and caregivers.

Is traumatic meniscal lesion associated with acute fracture morphology changes of tibia plateau? A series of arthroscopic analysis of 67 patients

BACKGROUND Computed tomography(CT)has become a routine preoperative examination for tibial plateau fractures(TPFs).Assessing the location of the fragment and intercondylar eminence fracture can provide clinicians with valuable information;however,the evaluation of traumatic meniscal lesion(TML)and arthroscopic management are controversial.AIM To predict TML by three-dimensional skeletal anatomy changes in unilateral TPF and bilateral TPF on preoperative thin layer CT.METHODS Acute fracture of tibial plateau patients undergoing arthroscopic surgery between December 2017 and December 2019 were included in this retrospective study.The type,zone,and location of TMLs were diagnosed based on the operation records and/or arthroscopic videos.Measurement of three-dimensional fracture morphology included the following:Frontal fragment width of plateau,sagittal fragment subsiding distance(FSD),sagittal fracture line distance,sagittal posterior tibial slope,and transversal area ratio of fragment area)on preoperative CT three-dimensional plane.The correlation of TML with skeletal values was calculated according to unicondylar TPFs and bicondylar TPFs.RESULTS A total of 67 patients were enrolled in this study,among which 30 patients had TMLs,lateral/medial(23/7).FSD was a particularly positive factor to predict TML,with odds ratio of 2.31(1.26-5.63).On sagittal view of CT,FSD degree of 8 mm and posterior tibial slope exceeding 11.74°implied enhanced risk of TML in bicondylar TPFs.On coronal view,once fragment width of plateau surpassed 3 cm,incidence of TML reached 100%.On transverse view,area ratio of fragment as enhanced risk of 5.5%and FSD>4.3 mm for predicting TML were observed in unicondylar TPFs.CONCLUSION TML can be predicted by different parameters on preoperative CT views according to unicondylar fractures and bicondylar TPFs.

Early reoccurrence of traumatic posterior atlantoaxial dislocation without fracture:A case report

BACKGROUND In general,atlantoaxial dislocation is rare due to the stability of the C1-C2 complex.Traumatic atlantoaxial dislocations are usually anterior and accompanied by odontoid fractures.Posterior atlantoaxial dislocations are rare,and complete posterior dislocation without associated fracture is even more rare.A case of early recurrence of posterior atlantoaxial dislocation without fracture being in therapy of first closed reduction and then open reduction has not been previously reported.CASE SUMMARY A 45-year-old female presented with traumatic posterior atlantoaxial dislocation(TPAD)of C1-C2 without associated fractures,and Frankel Grade B spinal cord function.She was successfully managed by immediate closed reduction under skull traction.Unexpectedly,17 d later,re-dislocation was discovered.On day 28,closed reduction was performed as before but failed.Then,open reduction and posterior internal fixation with autologous iliac bone grafts was performed.By 6 mo after surgery,atlantoaxial joint fusion was achieved,and neurological function had recovered to Frankel Grade E.At 12 mo follow-up,she had lost only 15°of cervical rotation,and atlantoaxial complex instability in joint flexing and extending were no longer observed under fluoroscopy.CONCLUSION Early assessment of transverse ligament is critical for TPAD without fracture avoiding re-dislocation after closed reduction.

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

The analysis of relevant risk factors of traumatic arthritis resulting from the surgery of acetabular fractures

Objective To explore the relevant risk factors of tramatic arthritis resulting from the surgery of acetabular fractures. Methods From January 2000 to January 2009,88 patients aged from 20 to 60 years old with acetabular fractures

Serum EGF and NGF levels of patients with brain injury and limb fracture

Objective:To explore the expression and significance of human epidermal growth factor(EOF) and nerve growth factor(NGF) in patients with knee osteoarthritis. Methods:RT-PCR and enzyme-linked immunosorbent assay were used to measure the serum EOF and NGF expression levels of patients with limb fracture and brain trauma injurry after 1 d,3 d,7 d,14 d and the relationship between them was analyzed.The level was compared among the simple fracture group,traumatic brain injury group and the normal control group,with 40 cases in each group.Results:The serum NGF levels were significantly different among three groups. Senun NGF,EGF mKNA and protein levels gradually decreased with the increasing injury time in the limb fracture combined with brain injury gnmp,traumatic brain injury group,the simple fracture group and the health control group(P【0.05).Conclusions:The serum of NGF.EGF levels significandy increased when limb fracture combined with brain injury,so EGF and NGF may be involved in the process of fracture healing.

Traumatic optic neuropathy:a review of 24 patients

AIMTo evaluate the clinical presentations of traumatic optic neuropathy and to assess the visual outcome of three groups of patients managed differently (conservative, intravenous corticosteroids only and combination of intravenous and oral corticosteroids) at an academic tertiary care referral centre.

Total knee arthroplasty for treatment of post-traumatic arthritis: Systematic review

AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for Englishlanguage clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles.We extracted data on patients' demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text.RESULTS Sixteen studies, four prospective and ten retrospective,examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion(ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear.CONCLUSION Although associated with higher complication rates,TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes.

Surgical Management of Traumatic Facial Paralysis:A Case Review Study

Objective To evaluate efficacy of surgical treatment in traumatic facial paralysis.Methods:Thirty-three cases were reviewed,including temporal bone fracture and iatrogenic facial nerve injury.All the patients were treated with various surgical methods according to their pathogeny.Results The mean percentage facial function improvement (House-Brackmann GradeⅠ-Ⅱ) was 86% in temporal bone fracture and function was improved after proper operation to iatrogenic facial nerve injury.Conclusions Patients with traumatic facial paralysis receive proved outcomes itreaed with proper surgical methods according to their particular condition of nerve injury.

Bilateral Multi-Level Pedicle Fractures in the Lumbar Spine Secondary to Trauma: A Case Report and Literature Review

Pedicle fractures are among the least common;those involving bilateral pedicle fractures are rare. To our knowledge, there are no previous reports of bilateral multi-level pedicle fractures in the lumbar spine secondary to trauma concerning adolescents. We report a 14-year-old male with bilateral multi-level traumatic pedicle fractures (BMTPF) of lumbar spine (LS) three and five (L3, L5) and spondylolisthesis of L3 on L4 (classified Meyerding grade II). Posterior lumbar instrumentation from L1 to S1 was performed. Postoperative recovery was uneventful. The aims of the study were to provide the first documentation of this pattern of injury in adolescents LS secondary to trauma and to review literature. The patient’s parents were informed that non-identifying information from the case would be submitted for publication, and they provided consent.

Ankle Arthroscopy: A Complimentary Adjunct in the Diagnosis and Management of Ankle Fractures

Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the Lauge-Hansen fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, versus ORIF plus arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/- arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the Lauge-Hansen ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with an SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes.

创伤性四肢骨折患儿术后急性中重度疼痛预测模型的构建与验证

目的构建并验证创伤性四肢骨折患儿术后急性中重度疼痛预测模型。方法采用便利抽样法,选取2022年1-6月在苏州大学附属儿童医院骨科进行手术的300例创伤性四肢骨折患儿作为建模组,通过单因素和logistic回归分析确定危险因素并构建预测模型,使用R软件绘制列线图,采用受试者操作特征(receiver operating characteristic,ROC)曲线下面积和Hosmer-Lemeshow检验评价模型的区分度和校准度。将2022年7-12月创伤性四肢骨折手术患儿110例作为验证组,验证模型的临床应用效果。结果logistic回归分析显示,肢体肿胀程度、术前疼痛程度、儿童术前焦虑3项差异具有统计学意义(P<0.05),且纳入其作为预测因子构建预测模型。所构建模型的ROC曲线下面积为0.906(95%CI:0.854~0.957),最大约登指数为0.617时,最佳临界值为0.779,敏感度为69.5%,特异度为92.2%,Hosmer-Lemeshow检验P=0.971。模型验证结果:ROC曲线下面积为0.838(95%CI:0.8~0.875),最大约登指数为0.571时,最佳临界值为0.640,敏感度为61.0%,特异度为96.1%。校准曲线图显示列线图在验证组中发生的风险同实际情况较为一致。结论本研究构建的列线图模型具有较好的区分度和校准度,能较好地预测创伤性四肢骨折患儿术后急性中重度疼痛的发生风险,可为医护人员实施预防性疼痛管理措施提供参考。

“5S”管理法在院前老年创伤性骨折患者与120急救中心联动管理中的应用效果评价

选取2022年1—12月某三级甲等老年综合医院急诊科出诊的50名参加院前老年创伤性骨折患者急救的医护人员作为研究对象,其中2022年1—6月为干预前,2022年7—12月为干预后。干预前运用常规院前老年创伤性骨折患者急救模式;干预后在常规院前老年创伤性骨折患者救治模式的基础上,护理管理者运用“5S”管理法对急诊护理人员进行培训后,分别从接收到120中心指令任务派遣、老年创伤性骨折现场急救处置、安全转运、院前与院内衔接对院前老年创伤性骨折患者的救治流程进行优化和规范化,形成统一标准,以探讨“5S”管理法在老年创伤性骨折患者与120急救中心联动管理中的应用效果评价。

运用CT三维重建技术测量骨质疏松性椎体压缩骨折与中青年创伤性胸腰椎骨折患者椎弓根宽度的临床价值

目的探讨运用CT三维重建技术测量骨质疏松性椎体压缩骨折(OVCF)与中青年创伤性胸腰椎(T_(11)-L_(5))骨折患者椎弓根宽度(PW)的临床价值。方法收集2020年10月—2022年10月我院收治的117例脊柱胸腰段骨折患者资料进行回顾性分析,将65例OVCF患者纳入A组,将52例中青年创伤性胸腰椎(T_(11)-L_(5))骨折患者纳入B组,均采用CT三维重建技术测量T_(11)-L_(5)各对应脊椎PW,比较两组各对应弓根两侧PW及不同性别间的差异,并计算PW<5 mm及<7 mm的百分比。结果A组对应脊椎左右侧PW比较差异无统计学意义(P>0.05)。A组T_(11)-L_(5)各对应脊椎的PW值小于B组(P<0.05)。两组T_(11)-L_(5)各对应脊椎的PW值男性大于女性(P<0.05),A组T_(11)-L_(3)各对应脊椎的男性和女性PW值小于B组(P<0.05),两组的L_(4)、L_(5)脊椎PW值比较差异无统计学意义(P>0.05)。A组共测量655个椎弓根,PW<5 mm者占椎弓根总数的7.48%,主要分布于T_(11)-L_(3)脊椎,<7 mm占比37.25%,T_(11)-L_(4)均有分布;B组共测量359个椎弓根,PW<5 mm者占椎弓根总数的1.67%,T_(12)-L_(2)分别均有分布,<7 mm患者占比13.09%,分布于T_(11)-L_(3)。A组PW<5 mm占比和7 mm占比高于B组(均P<0.05)。结论老年OVCF患者T_(11)-L_(3) PW小于中青年创伤性胸腰椎骨折患者,且女性小于男性,故临床应对胸腰椎骨折患者术前行CT三维重建检查,测量PW,以评估手术治疗的可行性,并降低并发症发生。

个体化预测老年创伤性四肢骨折患者术后切口感染风险的列线图模型构建

目的探讨老年创伤性四肢骨折患者术后切口感染的影响因素,并构建列线图模型。方法选取2021年5月-2023年9月成都医学院第一附属医院收治的360例接受手术治疗的老年创伤性四肢骨折患者作为研究对象,采用随机数字表法分为建模组252例与验证组108例。采用LASSO回归、logistic回归分析术后切口感染的影响因素,根据影响因素构建列线图,通过ROC曲线、校准曲线评估风险预测模型的预测性能及效果。结果27个研究变量纳入LASSO回归模型中进行筛选,基于最小值与标准化构建2个模型。模型1共纳入12个变量,分别为体质量指数(BMI)、使用钢板、合并糖尿病、引流管放置时间、切口类型、手术时间、切口长度、术后3天外周血C反应蛋白与白蛋白比值(CAR)、血清降钙素原(PCT)/白蛋白(ALB)、白细胞介素-6(IL-6)、中性粒细胞与淋巴细胞比值(NLR)及血清红细胞沉降率(ESR);模型2共纳入7个变量,分别为合并糖尿病、引流管放置时间及术后3天外周血CAR、PCT/ALB、IL-6、NLR及ESR。以术后切口是否发生感染为因变量,模型1与模型2中经LASSO回归筛选出的变量作为自变量,分别构建logistic回归分析模型,模型1结果显示:BMI≥28 kg/m 2、合并糖尿病、切口类型Ⅲ型、手术时间、切口长度、使用钢板、引流管放置时间≥6 d及术后3天外周血CAR、PCT/ALB、IL-6、NLR、ESR均为老年创伤性四肢骨折患者术后切口感染的独立危险因素(P<0.05);模型2结果显示:合并糖尿病、引流管放置时间≥6 d及术后3天外周血CAR、PCT/ALB、IL-6、NLR及ESR均为老年创伤性四肢骨折患者术后切口感染的独立危险因素(P<0.05)。模型1在建模组与验证组中的ROC曲线下面积分别为0.949(95%CI:0.898~1.000)、0.981(95%CI:0.956~1.000),且模型1在建模组与验证组中的Hosmer-Lemeshow检验结果显示该模型未偏离完美拟合,校准曲线一致性良好。模型2在建模组与验证组中的ROC曲线下面积分别为0.882(95%CI:0.787~0.977)、0.921(95%CI:0.843~1.000),且模型2在建模组与验证组中的Hosmer-Lemeshow检验显示该模型偏离完美拟合,校准曲线一致性不佳。结论BMI、合并糖尿病、切口类型、手术时间、切口长度、使用钢板、引流管放置时间及术后3天外周血CAR、PCT/ALB、IL-6、NLR、ESR是引发老年创伤性四肢骨折患者术后切口感染的影响因素。

个体化3D打印技术联合心理干预在下肢创伤骨折手术患者中的应用效果

目的:探讨基于医工结合背景下个体化3D打印技术联合心理干预,在改善下肢创伤骨折手术患者情绪状态的影响效果。方法:选取在唐山市第二医院住院治疗的下肢创伤性骨折手术患者为研究对象。将2022年1-6月住院的患者45例作为对照组,采用传统常规方式进行健康宣教;选取2022年7-12月住院的患者47例为研究组,采用医工结合背景下3D打印技术联合心理干预进行干预,比较两组患者入院时和出院时的焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分差异,比较两组患者存在焦虑状态和抑郁状态差异,比较两组患者依从性(包括健康教育掌握情况、配合治疗护理)和对护理工作满意度的差异。结果:①两组患者入院时焦虑和抑郁情绪没有显著差异,但在出院时研究组的SAS评分和SDS评分与对照组有显著差异(F=111.216,54.172;P<0.01),且实验组的焦虑和抑郁显著低于对照组,差异具有统计学意义(P<0.05);②两组患者的依从性和满意度存在显著性差异,差异均具有统计学意义(χ^(2)=5.520,7.723;P<0.05)。结论:医工结合背景下之3D打印技术联合心理干预可有效减轻下肢创伤骨折患者的焦虑、抑郁情绪,提升患者的依从性和满意度。