ObjectiveTo investigate the clinical features of elderly hip fracture in Leshan area in China. MethodsThe clinical data of patients with hip fractures from June 2006 to January 2013 were retrospectively analyzed. Gender, age, fracture type, injury causes, activities before injury and treatment were analyzed. ResultsThe mean age of patients with a hip fracture was 76.5 years. The overall male to female ratio with hip fracture was 1:1.44. There were 154 patients (50.0%) with femoral neck fracture, 138 patients (44.8%) with intertrochanteric fracture, and 16 patients (5.2%) with subrtrochanteric fracture. A total of 248 patients (77.3%) were poorly educated, and 210 patients (68.2%) had basic medical insurance. The mean time between being injured and hospitalized after injury was 3 days. There were 257 patients (83.4%) with fall damage. ConclusionFemale patients with hip fracture are more than male patients. Fall damage is the main injure type. The features of elderly hip fracture in Leshan include retardation to consult a doctor, poor education of the patients, dependence primarily on basic medical insurance and under-emphasis of anti-osteoporosis therapy.
ObjectiveTo introduce the clinical pathway for geriatric hip fracture regulated by our hospital and report the five-year outcomes after the implementation of the pathway. MethodsThe geriatric hip fracture patients treated between September 2003 and August 2012 were followed up. We did not implement the clinical pathway until January 2007. Statistical analysis was done to evaluate the effect of the clinical pathway on patient outcomes by comparing rate of complication, mortality, and length of hospital stay before and after the implementation of the clinical pathway. ResultsAfter the implementation of the pathway, the in-hospital mortality, one-year mortality and the rate of complication were significantly lower. Besides, the time from admission to operation and the total length of stay in hospital were obviously shortened. ConclusionThe use of clinical pathway for geriatric hip fracture can reduce the rate of complication and mortality, and shorten hospital stay, and the five-year outcomes after the implementation of the pathway are satisfying.
ObjectiveTo investigate the clinical outcome of arthroscopic synovectomy for inpatients with rheumatoid knee. MethodsArthroscopic synovectomy was performed on 32 rheumatoid knees in 31 patients, including 10 males and 21 females with an average age of (35.5±8.7) years (23 to 51 years) between January 2009 and March 2013. The patients' mean morbidity duration was (12.0±5.5) years (5 to 21 years). X-ray examination results were observed before the operation, 1 year and 2 years after the operation, and then Larsen method was used for assessment. Pain alleviation, C-reactive protein (CRP), rheumatoid factors (RF), and erythrocyte sedimentation rate (ESR) were compared before and after operation. ResultsThe follow-up averaged 1.7 years, and the average pain score decreased from 4.23±0.96 before surgery to 2.21±0.87 one year after surgery; RF decreased from (265.3±120.1) U/mL to (89.2±12.1) U/mL; CRP decreased from (89.36±32.12) mg/L to (20.12±10.21) mg/L; and ESR decreased from (86.56±12.32) mm/h to (45.23±11.12) mm/h. ConclusionArthroscopic synovectomy can effectively relieve pain and delay radiologic progression in patients with rheumatoid knees.
ObjectiveTo compare the early clinical outcome of GenesisⅡ high-flexion versus standard prostheses in total knee arthroplasty (TKA), and evaluate whether high-flexion prostheses can improve the postoperative range of motion (ROM). MethodsBetween September 2007 and December 2011, 80 patients (85 knees) consecutively underwent posterior cruciate-sacrificing TKA with GenesisⅡ systems. Finally, we reviewed 60 patients (60 knees) including 32 knees in high-flexion group and 28 knees in standard group. The follow-up time was 2.7 years in average. The postoperative knee ROM and the rate of complication of the two groups were evaluated. ResultsThe mean postoperative knee ROM of 32 knees was 112.8° in the high-flexion group and was 108.9° in the standard group. The mean postoperative HSS score was 86.6 and 84.2, respectively. The postoperative knee ROM, hospital for special surgery (HSS) score and the rate of complication did not show significant difference between the two groups. ConclusionThe high-flexion prosthesis is no better than the ordinary prosthesis in terms of the range of motion. We need more mid to long-term studies to do further research.
ObjectiveTo investigate the method to measure the tip-apex distance (TAD) in treatment of femoral intertrochanteric fracture with proximal femoral nail antirotation (PFNA). MethodsBetween March 2008 and March 2011, 35 patients with femoral intertrochanteric fracture underwent closed reduction and internal fixation with PFNA, which were all closed fractures. There were 14 males and 21 females with an average age of 72.3 years (range, 48-88 years). According to Evans classification, 1 case belonged to type III, 27 cases to type IV, and 7 cases to type V. The time between injury and operation was 2-7 days (mean, 4.3 days). The TAD was measured according to relationship between tip of helical blade and the center point of femoral head radius during operation, and according to X-ray films after operation. ResultsPrimary healing of incision was obtained in all cases, and no infection or deep venous thrombosis occurred. At 2 days after operation, the X-ray films showed TAD was 18-24 mm (mean, 22.6 mm). Thirty-two cases were followed up 10-22 months (mean, 16 months). All fractures healed, with a mean healing time of 7.6 months (range, 6-10 months). The patients could walk without stick at 11-16 weeks (mean, 13 weeks). Pulmonary infection occurred in 1 case at 5 days after operation; no breakage of femoral nail or cut-out helical blade from femoral head was observed. At 10 months after operation, the Parker hip scores were 9 in 23 cases, 8 in 4 cases, 7 in 3 cases, and 5 in 2 cases, with a mean score of 8.44. ConclusionIt is easy to control the TAD in treatment of femoral intertrochanteric fracture with PFNA with an simple method and important to prevent breakage and cut-out helical blade from the femoral head.
ObjectiveTo compare the knee flexion degree after high-flexion versus standard total knee arthroplasty (TKA). MethodRelevant randomized controlled trials on comparison of knee flexion degree after high-flexion versus standard TKA were identified from Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure from the establishment of these databases until October 2015. A systematic review was performed to compare knee flexion degree, knee function score and complications between the two types of prostheses. Analyses were conducted using RevMan version 5.2.0 software. ResultsTwenty-one studies were included in this Meta-analysis. The results showed that the knee flexion degree was higher in high-flexion group than that in the standard group[WMD=2.71°, 95%CI (0.96, 4.46)°, P=0.002]; while the difference was not significant leaving out six low-quality literatures[WMD=0.72°, 95%CI (-0.15, 1.60)°, P=0.10]. There was no significant difference in knee function score between the two groups[WMD=-0.54, 95%CI (-1.34, 0.25), P=0.18]. There was no significant difference in complications between the two groups[OR=0.99, 95%CI (0.53, 1.84), P=0.98]. ConclusionsThe important finding from the current study is that there is no evidence to support that the use of high-flexion prostheses is superior to the standard prostheses during total knee arthroplasty.
ObjectiveTo analyze the clinical outcomes of 3D-printing assisting minimally invasive fixation of calcaneal fractures. MethodsThe study included 12 patients who were diagnosed with calcaneal fractures between October 2014 and May 2015. Using a real-size 3D-printed calcaneus model, the calcaneal locking plate could be preshaped before the operation and used with a minimally invasive approach to achieve rigid plate fixation just as with the lateral approach. Complications and surgery time were recorded and functional results were evaluated using the American Orthopaedic Foot Society ankle-metapedes score (AOFAS). The reduction of fracture was evaluated using the Bohler angle and Gissane angle. ResultsThere was no relevant postoperative complications. All fractures got bone union. The mean postoperative Bohler angle was (29.4±6.1) ° and the mean postoperative Gissane angle was (121.4±12.6) °. The difference in Bohler angle and calcaneal Gissane angle before and after the surgery was significant (P ＜ 0.01) . The mean postoperative AOFAS score was 75.2±5.4, and the fine/excellent rate was 83.3%. ConclusionWe believe this novel technique can be useful for the operative treatment of displaced intra-articular calcaneal fractures.