ObjectiveTo explore the effectiveness and operative methods to treat first metatarsal diaphysis comminuted fractures with mini-plate via medial approach. MethodsBetween January 2012 and January 2013, 15 patients with first metatarsal shaft comminuted fractures were treated. There were 11 males and 4 females (6 left feet and 9 right feet) with an average age of 38.6 years (range, 27-56 years). The injury causes included falling injury in 6 cases, crash injury of heavy object in 7 cases, and sprain in 2 cases. The left side was involved in 6 cases and the right side in 9 cases. The time from injury to operation was 8.5 days on average (range, 7-10 days). According to AO classification, all cases were rated as 81(T)-C2 type. The surgical treatments included open reduction and internal fixation with mini-plate by medial approach. ResultsPrimary healing of incision was obtained in all cases, and no infection occurred. Twelve patients were followed up 18 months on average (range, 12-24 months). All fractures healed well, and the mean time of bone union was 11.5 weeks (range, 10-14 weeks). No loosening or breakage of internal fixation was observed. At last follow-up, the patients could walk with full weight-bearing, and had no pain. According to American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, the mean score was 85.2 (range, 76-96). ConclusionAnatomic reduction and stable internal fixation are important for first metatarsal comminuted fracture, which is the key point for recovery of foot form and foot arch function. And the medial approach could achieve full exposure and improve the cosmetic results.
Objective To explore the advantage of transection the cervical muscles at sternal end and flip fixed in therapeutic bilateral huge thyroid surgery. Methods The transection of the cervical muscles at sternal end and flip fixed in 53 cases was observation group， 44 cases of the neck white line incision thyroid surgery completed for the control group. The completion of the surgery by the same group of physicians. The operative time， operation field of exposing effect， amount of bleeding in operation， postoperative complications， and postoperative drainage volume were compared between two groups. Results There was no statistically differences of sex， age， disease composition， and tumor size between two groups （P＞0.05）. Operative time， amount of bleeding， and postoperative drainage volume in observation group were shorter （less） than that in control group （P＜0.01）. The postoperative complication rate in observation group was lower than that in control group（P=0.04）. Surgical field exposure in observation group was better than that in control group （P＜0.01）. Conclusions The huge bilateral thyroid surgery with the sternal end approach is feasible and simple. The operation field exposure is better than the white line neck incision， complications after operation is less. It is worthy of clinical application.
ObjectiveTo conclude the effectiveness of arthroscopy combined with Burks and SchaVer's approach in the treatment of posterior cruciate ligament (PCL) avulsion fractures in a floppy lateral position. MethodsBetween May 2010 and March 2014, 21 patients with PCL avulsion fractures were treated. There were 13 males and 8 females, aged 21 to 62 years (mean, 39.1 years). The causes included traffic accident injury in 10 cases, sports injury in 5 cases, and falling injury from height in 6 cases. The time from injury to hospital was 1-6 days (mean, 2.5 days). The results of posterior drawer test were all positive, and the results of anterior drawer test and lateral stress test were all negative. The Lysholm score was 28.0±5.5 before operation. And the American Orthopaedic Foot and Ankle Society (IKDC) score was 46.2±7.6 before operation. According to Meyer standards for fractures classification, 11 cases were rated as type II and 10 cases as type III. Arthroscopy was used to inspect and treat the intra-articular lesions, then avulsion fracture was fixed by Burks and SchaVer's approach in lateral position. Postoperative functional exercises were performed. ResultsPrimary healing of incision was obtained, without nerve and vascular injury or joint infection. All patients were followed up 18-36 months (mean, 27.2 months). The X-ray films of the knee joint showed good fractures reduction and healing at 3 months after operation. The results of posterior drawer test and reverse Lachman test were negative. The knee range of motion was recovered to normal level. At last follow-up, the Lysholm score of the knee joint was significantly improved to 90.9±1.4 from preoperative one (t=54.584, P=0.000), and the IKDC score was significantly increased to 90.5±5.3 from preoperative one (t=15.638, P=0.000), including 19 cases of grade A and 2 cases of grade B. ConclusionA combination of arthroscopy and Burks and SchaVer's approach for the treatment of PCL avulsion fractures in a floppy lateral position has the advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint.
ObjectiveTo improve the comprehensive service ability of the hospital, improve the satisfaction of medical care, implement the requirements of fine management, and enrich the connotation of hospital internal performance improvement.MethodsIn July 2017, based on the concept of approach-deployment-learning-integration, the internal performance improvement model of Children’s Hospital Affiliated to Fudan University was constructed to form a management closed loop.ResultsFrom 2016 to 2019, the average length of hospital stay was reduced from 6.90 d to 6.47 d, the patient satisfaction was elevated from 92.89% to 93.80%, the proportion of drugs was reduced from 35.25% to 30.44%, the proportion of materials was reduced from 23.35% to 18.55%, and the proportion of difficult operations of grade Ⅲ and Ⅳ was elevated from 66.98% to 67.68%.ConclusionThe improvement of key performance indicators depends on the implementation of external policies, the integration of scientific management elements, the cooperation of multiple subjects, and the construction of information system.