Objective To evaluate the safety of conversion from external fixation to internal fixation for open tibia fractures. Methods Between January 2010 and December 2014, 94 patients (98 limbs) with open tibia fractures were initially treated with external fixators at the first stage, and the clinical data were retrospectively analyzed. In 29 cases (31 limbs), the external fixators were changed to internal fixation for discomfort, pin tract response, Schantz pin loosening, delayed union or non-union after complete wound healing and normal or close to normal levels of erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and the leucocyte count as well as the neutrophil ratio (trial group); in 65 cases (67 limbs), the external fixators were used as the ultimate treatment in the control group. There was no significant difference in gender, age, side of the limbs, interval from injury to the first debridement, initial pathogenic bacteria, the limbs that skin grafting or flap transferring for skin and soft tissue defect between the two groups ( P>0.05). The incidence of Gustilo type III fractures in the control group was significantly higher than that in the trial group (P=0.000). The overall incidence of infection was calculated respectively in the two groups. The incidence of infection according to different fracture types and whether skin grafting or flap transferring was compared between the two groups. The information of the pathogenic bacteria was recorded in the infected patients, and it was compared with the results of the initial culture. The incidence of infection in the patients of the trial group using different internal fixation instruments was recorded. Results The overall incidences of infection for the trial and control groups were 9.7% (3/31) and 9.0% (6/67) respectively, showing no significant difference (χ2=0.013, P=0.909). No infection occurred in Gustilo type I and type II patients. The incidence of infection for Gustilo type IIIA patients in the trial group and the control group were 14.3% (1/7) and 6.3% (2/32) respectively, showing no significant difference (χ2=0.509, P=0.476); the incidence of infection for type IIIB patients in the two groups were 50.0% (2/4) and 14.3% (2/14) respectively, showing no significant difference (χ2=2.168, P=0.141); and the incidence of infection for type IIIC patients in the two groups were 0 and 16.7% (2/12) respectively, showing no significant difference (χ2=0.361, P=0.548). Of all the infected limbs, only 1 limb in the trial group had the same Staphylococcus Aureus as the result of the initial culture. In the patients who underwent skin grafting or flap transferring, the incidence of infection in the trial and control groups were 33.3% (2/6) and 13.3% (2/15) respectively, showing no significant difference (χ2=1.059, P=0.303). After conversion to internal fixation, no infection occurred in the cases that fixed with nails (11 limbs), and infection occurred in 4 of 20 limbs that fixed with plates, with an incidence of infection of 20%. Conclusion Conversion from external fixation to internal fixation for open tibia fractures is safe in most cases. However, for open tibia fractures with extensive and severe soft tissue injury, especially Gustilo type III patients who achieved wound heal after flap transfer or skin grafting, the choice of secondary conversion to internal fixation should carried out cautiously. Careful pre-operative evaluation of soft tissue status, cautious choice of fixation instrument and meticulous intra-operative soft tissue protection are essential for its safety.
ObjectiveTo investigate the diagnostic value of tuberculosis T cell spot test (T-SPOT.TB) and erythrocyte sedimentation rate (ESR) test in the diagnosis of simple pulmonary nodules in Xinjiang.MethodsA retrospective analysis of 72 patients with asymptomatic simple pulmonary nodules in the Department of Thoracic Surgery, the First Affiliated Hospital of Xinjiang Medical University from October 2017 to July 2019 was performed. According to the pathological results, the patients were divided into a tuberculoma group [n=23, including 14 males and 9 females, aged 37-84 (56.91±12.73) years] and a lung cancer group [n=49, including 31 males and 18 females, aged 34-83 (61.71±10.15) years]. The predictive value of T-SPOT.TB and ESR results for the diagnosis of simple pulmonary nodules was evaluated.ResultsThe positive rate of T-SPOT.TB in the tuberculoma group (69.60%) was higher than that in the lung cancer group (42.90%) (χ2=5.324, P=0.021), with a sensitivity of 69.56% and specificity of 57.14%; the positive ESR was 47.80% in the tuberculoma group and 59.20% in the lung cancer group, and no statistical difference was found between the two groups (χ2=0.981, P=0.322), with a sensitivity of 47.82% and specificity of 40.81%; the area under receiver operating characteristic curve (AUC) was 0.618, the 95% confidence interval of AUC was (0.479, 0.758), and the Youden’s index was 0.267 with a sensitivity of 69.60% and specificity of 57.10%. Difference in the T-SPOT.TB and ESR test results was statistically significant (χ2=4.986, P=0.026), but the correlation between the tests was weak with a Pearson contingency coefficient of 0.199. ESR results in patients with different ages were statistically different (χ2=7.343, P=0.025), but the correlation between age and ESR results was weak with a Pearson contingency coefficient of 0.239; T-SPOT.TB results in patients with different ages were not statistically different (χ2=0.865, P=0.649), and the correlation between age and ESR results was weak with a Pearson contingency coefficient of 0.084.ConclusionThe diagnostic value of T-SPOT.TB and ESR tests is small in the diagnosis of simple pulmonary nodules.