Progress in The Application of Nursing Care Based on ERAS Concept after Thoracolumbar Fracture Surgery

Thoracic spine fracture is a common orthopedic injury that is usually caused by external forces acting directly on or transmitted to the thoracic spine through other parts of the spine.Thoracic spine fractures can be divided into two types:stable and unstable.An unstable fracture means that the relationship between the vertebral bodies is no longer stable,which may cause serious consequences such as spinal compression,nerve root compression,or spinal cord injury.Surgical treatment is often needed for patients with unstable fractures,nerve root compression,or spinal cord injury to restore stability and function to the thoracic spine.The probability of complications after thoracolumbar fracture surgery is high,which affects the outcome of surgical treatment.To improve postoperative rehabilitation outcomes,this article analyzed the value of nursing care based on the enhanced recovery after surgery(ERAS)concept for patients undergoing thoracolumbar fracture surgery.

Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

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.

Application of the Modality of Multiple Disciplinary Team for a Perioperative Patient with Suspected Novel Coronavirus Pneumonia and Cervical Spine Fracture in Nursing

With the explosive spread of novel coronavirus pneumonia, a major public major public health emergency has been declared around the world. Our country has come to a crucial stage of “external defense input, internal defense rebound” and strict quarantine measures are taken in all ports of entry throughout the country. Operations on patients with cervical spine during the quarantine, which not only increases the risk of surgical treatment, but also increases the difficulty of perioperative nursing. The objective is to explore the result of application of the modality of multiple disciplinary team for a perioperative patient with suspected novel coronavirus pneumonia and cervical spine fracture in nursing. The patient’s condition and nursing measures are studied and discussed from various specialist angle through the multidisciplinary team established by the isolation ward, orthopedics department, emergency department, anesthesiology department, operating room, rehabilitation department, psychology department and so on, and the overall and personalized surgical and nursing planning is formed through interdisciplinary advice. The nursing experience is summarized in this paper.

Barriers and facilitators to an outreach rehabilitation program delivered in nursing homes after hip fracture surgical repair

Objective: To identify and understand facilitators and barriers to implementing an Outreach rehabilitation program designed to improve post-operative recovery following hip fracture in long-term care residents. Residents of nursing home facilities are at considerable risk of hip fracture and minimal recovery following a hip fracture. Methods: Data were gathered over June-August, 2012 through semi-structured interviews or focus groups. Fifteen persons (n = 15) who were members of the Outreach rehabilitation team (n = 8) or relevant nursing home staff (n = 7) were interviewed. Data analysis was guided by principles of grounded theory method. Findings: Three major themes that contributed to or hindered the Outreach rehabilitation program emerged, namely, 1) the division, the separate operation and delivery of rehabilitation services;2) building bridges, or negotiating ways to communicate and work together, and 3) strength in the structure, the acceptance of the program and the perceived benefits of the program. One main challenge to program implementation con- cerned coordinating additional rehabilitation with the rehabilitation provided within the nursing homes. Facility staff was largely unaware of the program and were unprepared to work with Outreach team members. As the program progressed, the facility staff and Outreach team were able to collaborate to overcome resident health issues impeding recovery such as cognitive impairment, language barriers and post-surgical pain control needs. Facilitators included the consistency of Outreach team members and accessible facility staff, which contributed to effective communication and trust between the Outreach team and facility staff. Facilitators also included support for the program by the Outreach team and facility staff, as well as the potential benefits of improved mobility and functional status among some program recipients. Conclusion: Although planning, implementation, and delivery of an Outreach rehabilitation program present some challenges, this study suggests that it is possible to deliver rehabilitation to older residents who fracture their hips in nursing homes.

Evidence-based Care for Rehabilitation Nursing Effect of Patients with Patellar Fracture

Objective.To analyze the effect of applying evidence-based care in rehabilitation nursing effect of patients with patellar fractures.Methods.A total of 54 patients with patellar fractures were randomly selected from the hospital.The diagnosis and treatment time were from the beginning of July 2018 to end of June 2019.The digital table grouping was adopted to divide patients into two groups with each group consists of 27 patients with this disease.Both groups underwent routine nursing and the experimental group with increased evidence-based care.Results.Compared with the control group,the knee function evaluation,complications and nursing satisfaction of the experimental group were more ideal,and the difference was statistically significant(P<0.05).Conclusion.Evidence-based care in rehabilitation nursing of patients with patellar fracture can obtain ideal nursing effect.

Application Value of Evidence-Based Nursing in the Perioperative Care of Ankle Fracture Patients

Objective:To analyze the value of applying evidence-based nursing in the perioperative care of patients with ankle fractures and propose corresponding measures to improve the quality of patient care.Methods:The study started in May 2022 and was terminated in March 2023.During this period,50 patients with ankle fractures treated by our hospital were selected as research subjects.They were divided into a control group and a research group.The control group had 25 patients who received routine care,and the research group had 25 who received evidence-based care.The nursing effects of the two groups were observed and compared.Results:The pain scores,quality of life,incidence of adverse reactions,and nursing satisfaction of patients in the research group were all significantly better than those in the control group(P<0.05).Conclusion:Evidence-based nursing can effectively improve the quality of care,reduce the risk of adverse reactions,and promote patient recovery,so it is suitable for clinical implementation.

Rehabilitation nursing and follow-up of pelvis fracture in children

Objective To improve the rehabilitation nursing effect of pelvis f racture,physio logical and mental recovery in child ren.Methods22cases of pe lvis fracture in childr en were analyzed retrospectively and followed up(the me an 2.5years).Results The living confidence of all children was rebuilt in s ome extent,and the children could adapt the study and social life when they lef t hospital.Conclusions The better re-habilitation nursing effect was obtained according to the following fou r important factors:observation an d nursing of the complications,reco g-nizing the major and minor nursing problems,adjusti ng relationship between the fracture fixation and functional exercise,paying mo re attenti on to the rehabilitation nursing of child ren having special mental p roblems.

Study on the Value of the Theory of Protection Motivation in the Nursing of Spinal Fracture to the Quality of Life

Objective:To analyze the effect of protection motivation theory on the quality of life of patients with spinal fracture.Methods:From August 2019 to September 2020,72 patients with spinal fracture were selected and randomly divided into two groups.The routine nursing group was the routine nursing group,and the combined nursing with the theory of protective motivation was the dynamic nursing group.Results:The hospitalization time,detumescence time,healing time and muscle strength recovery time of group A were shorter than those of group B(P<0.05).The VAS score and Barthel index score of the dynamic group were better than those of the conventional group(P<0.05);The score of SF-36 in the group A was higher than that in the group B(P<0.05).Conclusions:The application of protection motivation theory in the nursing of patients with spinal fracture can shorten the healing time of fracture,promote the recovery of muscle strength,relieve the pain of fracture,and then improve the ability of daily life and quality of life of patients.

Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures

Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fracture.Navigationguided,percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages,which include less trauma,faster recovery times,and less bleeding.However,due to the complexity of pelvic anatomy,doctors often encounter some problems when using navigation to treat pelvic fractures.This article reviews the indications,contraindications,surgical procedures,and related complications of this procedure for the treatment of sacral fractures,sacroiliac joint injuries,pelvic ring injuries,and acetabular fractures.We also analyze the causes of inaccurate screw placement.Percutaneous screw placement under navigational guidance has the advantages of high accuracy,low incidence of complications and small soft-tissue damage,minimal blood loss,short hospital stays,and quick recovery.There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones.However,computer navigation technology requires extensive training,and attention should be given to avoid complications such as screw misplacement,intestinal injury,and serious blood vessel and nerve injuries caused by navigational drift.

Management of complex and redo cases of pelvic fracture urethral injuries

Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.

Treatment of posterior urethral distractions defects following pelvic fracture

Posterior urethral injuries typically arise in the context of a pelvic fracture.Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected.Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first.Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected.Early diagnosis and proper acute management decrease the associated complications,such as strictures,urinary incontinence and erectile dysfunction.The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury.Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3e6 months continues to be the gold standard of treatment.In this paper,we provide a comprehensive review of the literature with a special emphasis on the various treatments available:Open or endoscopic primary realignment,immediate or delayed urethroplasty after suprapubic cystostomy,and delayed optical urethrotomy.

Multi-slice spiral computed tomography in diagnosing unstable pelvic fractures in elderly and effect of less invasive stabilization

BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.

Progress on the Prevention and Nursing of Urinary Tract Infection Associated with Radical Hysterectomy and Pelvic Lymphadenectomy

Radical hysterectomy(RH) and pelvic lymphadenectomy are the main treatment methods for early cervical cancer and endometrial carcinoma.Effective care measures,however,can decrease the incidence of UTIs and complications associated with RH and pelvic lymphadenectomy,as well as improve the therapeutic effects of administered drugs and patient prognosis.The writer refers to relevant literatures to analyze the reasons for postoperative UTIs and to provide a brief summary of the nursing methods for and progress in UTI prevention.

Progress in nursing methods for chronic pelvic inflammatory disease

Chronic pelvic inflammatory disease is a highly common gynecological disease.It is often caused by the failure to completely treat acute pelvic inflammatory disease or persistent disease due to the poor physique of patients.This paper provides a summary of the recent research studies on chronic pelvic inflammatory disease.

Vaginal Delivery after Pelvic Fracture Fixation with a Subcutaneous Anterior Fixator with Review of Literature of Delivery Mode in Pelvic Injuries

Background: The cesarean section rate following a pelvic fracture is more than double the standard norms. This results from residual deformity and a lack of knowledge among obstetricians regarding the ability to deliver vaginally after a pelvic fracture. Aim: To present a case of pelvic fracture that delivered vaginally indicating vaginal delivery is possible even after pelvic fractures that are stabilized surgically with minimal or no residual displacement. Case presentation: We present a patient that delivered vaginally following internal fixation of an unstable pelvic fracture with a retained orthopedic implant that spanned the lower abdomen with a metallic bar. We also discuss the role of cesarean section in patients with pelvic fractures. Conclusion: Women with pelvic fractures may possibly deliver vaginally however decision regarding mode of delivery in such patients should be on a case by case basis.

Small bowel entrapment and ureteropelvic junction disruption associated with L3 Chance fracture-dislocation

Paediatric Chance fracture are rare lesions but often associated with abdominal injuries. We herein present the case of a seven years old patient who sustained an entrapment of small bowel and an ureteropelvic disruption associated with a Chance fracture and spine dislocation following a traffic accident. Initial X-rays and computed tomographic(CT) scan showed a Chance fracture with dislocation of L3 vertebra, with an incarceration of a small bowel loop in the spinal canal and a complete section of the left lumbar ureter. Paraplegia was noticed on the initial neurological examination. A posterior L2-L4 osteosynthesis was performed firstly. In a second time she underwent a sus umbilical laparotomy to release the incarcerated jejunum loop in the spinal canal. An end-toend anastomosis was performed on a JJ probe to suture the left injured ureter. One month after the traumatism, she started to complain of severe headaches related to a leakage of cerebrospinalis fluid. Three months after the traumatism there was a clear regression of the leakage. One year after the trauma, an anterior intervertebral fusion was done. At final follow-up, no neurologic recovery was noticed. In case of Chance fracture, all physicians should think about abdominal injuries even if the patient is asymptomatic. Initial abdominal CT scan and magnetic resonance imaging provide in such case crucial info for management of the spine and the associated lesions.

Chinese expert consensus on echelons treatment of pelvic fractures in modern war

The characteristics and treatment of pelvic fractures vary between general conditions and modern war. An expert consensus has been reached based on pelvic injury epidemiology and the concepts of battlefield treatment combined with the existing levels of military medical care in modern warfare. According to this consensus, first aid, emergency treatment and early treatment of pelvic fractures are introduced in three separate levels. In Level Ⅰ facilities, simple triage and rapid treatment following the principles of advanced trauma life support are recommended to evaluate combat casualties during the first-aid stage. Re-evaluation, further immobilization and fixation, and hemostasis are recommended at Level Ⅱ facilities. At Level Ⅲ facilities, the main components of damage control surgery are recommended, including comprehensive hemostasis, a proper resuscitation strategy, the treatment of concurrent visceral and blood vessel damage, and battlefield intensive care. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

Pelvic Insufficiency Fractures after Chemoradiation for Gynecologic Malignancies: A Review of Seven Cases

Background: Radiation-induced pelvic insufficiency fracture (PIF) is an important complication associated with pelvic radiation therapy (RT) for patients with gynecologic malignancies. Despite known risk factors and recent reports describing the incidence on the order of 30 percent, there has been a dearth of translational research or consensus statements to guide clinical management. Objective: The aim of this study is to describe seven cases of PIF diagnosed and managed at the Massachusetts General Hospital during a 5-year period and to perform a focused review of the literature to inform several clinical questions that remain unanswered. A secondary aim of this study is to highlight the need for additional research related to screening, prophylaxis, diagnostics, and treatment of PIF in patients with gynecologic malignancy. Methods: In the current retrospective review, we report 10 cases of PIF diagnosed over a 5-year period in 7 patients with vulvar (4), vaginal (2), and cervical (1) cancer following chemoradiation therapy at a single institution. Data were collected from the medical records by a single investigator and all diagnostic imaging was reviewed by a single radiologist to confirm the presence or absence of PIF. Results: All 7 patients were post-menopausal and received concurrent chemoradiation, 3 were over the age of 65 years old (42.8%), 3 had BMI kg/m2 (42.8%), 2 had a history of osteoporosis (28.6%), and 1 had a history of hormone replacement therapy use (14.3%). No patients underwent standard screening for PIF and no patients were started on prophylaxis prior to diagnosis. The plain film was the most common initial imaging performed while MRI was the most common overall study used to diagnose PIF. Median time to the development of fracture was 16 months (range 4-114) with femoral neck fracture being the most common (40%) and sacral fractures trailing close behind (30%). 7 of 10 fractures were initially managed expectantly with 1 ultimately failing expectant management and requiring surgical intervention. 4 of 10 fractures required surgical intervention. All patients had resolution of symptoms by 12 months after diagnosis. Conclusion: Radiation-induced PIF remains an important complication associated with pelvic RT. Significant risk factors have been identified and studies have compared various diagnostic imaging modalities. Future studies are needed to compare screening algorithms and evaluate the comparative effectiveness of prophylactic pharmacotherapies. Future studies are also needed to determine the cost-effectiveness of PET/CT versus MRI and compare the morbidity associated with expectant management versus surgical intervention in patients with symptomatic fractures.

Open pelvic fractures associated with anorectal injuries:emergency management strategies and risk factors for mortality

Objective To investigate emergency management strategies and risk factors for mortality of open pelvic fractures associated with anorectal injuries.Methods Between April 2001 to April 2010,25 patients of openpelvic fractures