Fractures In China Research Articles

A survey of outcomes and management of patients post fragility fractures in China

We found that the fragility hip and vertebral fractures caused excess mortality rates in this Chinese female population, which was unexpectedly lower than those in western countries and other Asian countries. This was the first nationwide survey relating to post-fracture outcomes conducted among Chinese population in Mainland China. This study aimed to investigate the mortality, self-care ability, diagnosis, and medication treatment of osteoporosis following fragility hip and vertebral fractures through a nationwide survey among female patients aged over 50 in Mainland China. This was a multicenter, retrospective cohort study based on medical chart review and patient questionnaire. Female patients aged 50 or older admitted for low-trauma hip or vertebral fractures and discharged from Jan 1, 2008 to Dec 31, 2012 were followed. Total of 1151 subjects of hip fracture and 842 subjects of vertebral fracture were included. The mean age was 73.4 ± 10.0, and the median of duration from index fracture to interview was 2.6 years. The overall 1-year, 2-year, 3-year, 4-year, and 5-year cumulative mortality rates were 3.5, 7.0, 11.2, 13.1, and 16.9 %, respectively. The first year mortality rates in hip (3.8 %, 95% CI 3.3-4.4 %) and vertebral fracture (3.1 %, 95% CI 2.5-3.7 %) were significantly higher than that in the general population (1.6 %). Impaired self-care ability was observed in 33.2, 40.6, and 23.8 % of overall, hip fracture, and vertebral fracture group, respectively. The overall diagnosis rate of osteoporosis was 56.8 %, and bone mineral density (BMD) measurement had never been conducted in 42.0 % among these women. After the index fracture, 69.6 % of them received supplements and/or anti-osteoporotic medications, among which 39.6 % only received calcium with/without vitamin D supplementation. The osteoporotic hip and vertebral fractures caused excess mortality rates in this population of Mainland China. The current diagnosis and medical treatment following the fragility fractures is still insufficient in Mainland China.

The economic burden of fracture patients with osteoporosis in western China

To study the cost of osteoporotic fracture in China, we performed a prospective study and compared the costs of the disease in referral patients with fractures in three of the most common sites. Our results indicated that the economic burden of osteoporotic fracture to both Chinese patients and the nation is heavy. This paper aims to study the cost of osteoporotic fracture in China and thus to provide essential information about the burden of this disease to individuals and society. This prospective observational data collection study assessed the cost related to hip, vertebral, and wrist fracture 1year after the fracture based on a patient sample consisting of 938 men and women. Information was collected using patient records, registry sources, and patient interviews. Both direct medical, direct non-medical, and indirect non-medical costs were considered. The annual total costs were highest in hip fracture patients (renminbi, RMB 27,283 or USD 4,330, with confidence interval (RMB 25715, 28851)), followed by patients with vertebral fracture (RMB 21,474 or USD 3,409, with confidence interval (RMB 20082, 22866)) and wrist fracture (RMB 8,828 or USD 1,401, with confidence interval (RMB 7829, 9827)). The direct medical care costs averaged approximately RMB 17,007 per year per patient, of which inpatient costs, drugs, and investigations accounted for the majority of the costs. Nonmedical direct costs were much less compared to direct healthcare costs and averaged approximately RMB 1,846. These results indicate that the economic burden of osteoporotic fracture to both Chinese patients and China was heavy, and the proportion of the costs in China demonstrated many similar features and some significant differences compared to other countries.

PMS38 - Outpatient Medical Costs, Indirect Costs, and Family Burden of Osteoporosis Fracture in China

PMS38 - Outpatient Medical Costs, Indirect Costs, and Family Burden of Osteoporosis Fracture in China

Artificial neural network models for predicting 1-year mortality in elderly patients with intertrochanteric fractures in China

The mortality rate of older patients with intertrochanteric fractures has been increasing with the aging of populations in China. The purpose of this study was: 1) to develop an artificial neural network (ANN) using clinical information to predict the 1-year mortality of elderly patients with intertrochanteric fractures, and 2) to compare the ANN's predictive ability with that of logistic regression models. The ANN model was tested against actual outcomes of an intertrochanteric femoral fracture database in China. The ANN model was generated with eight clinical inputs and a single output. ANN's performance was compared with a logistic regression model created with the same inputs in terms of accuracy, sensitivity, specificity, and discriminability. The study population was composed of 2150 patients (679 males and 1471 females): 1432 in the training group and 718 new patients in the testing group. The ANN model that had eight neurons in the hidden layer had the highest accuracies among the four ANN models: 92.46 and 85.79% in both training and testing datasets, respectively. The areas under the receiver operating characteristic curves of the automatically selected ANN model for both datasets were 0.901 (95%CI=0.814-0.988) and 0.869 (95%CI=0.748-0.990), higher than the 0.745 (95%CI=0.612-0.879) and 0.728 (95%CI=0.595-0.862) of the logistic regression model. The ANN model can be used for predicting 1-year mortality in elderly patients with intertrochanteric fractures. It outperformed a logistic regression on multiple performance measures when given the same variables.

Epidemiological analysis of maxillofacial fractures treated at a university hospital, Xinjiang, China: A 5-year retrospective study

PurposeTo investigate the epidemiological characteristics of maxillofacial fractures treated at a university hospital, Xinjiang, China over a 5-year period. Patients and methodsBetween 2006 and 2010, a total of 1350 patients with maxillofacial fractures were reviewed retrospectively. The data collected included demographics, aetiology, site of fracture, time regarding injuries, presence of associated injuries, treatment modalities, and complications. ResultsA total of 1860 maxillofacial fractures were seen in 1350 patients with a male to female ratio of 4.9:1. The most common aetiology of the fractures was motor vehicle accident, followed by interpersonal violence. The age group 21–30 years accounted for the largest subgroup in both sexes. The mandible was the most common site of fracture followed by the zygoma. Associated injuries were found in 48.3% of patients, with a prevalence of intracranial injuries (37.0%). Majority of fractures were treated with open reduction (62.4%), and 7.2% of patients presented post-operative complications. ConclusionRoad traffic accident is the most common cause of maxillofacial fractures in China, which is characterized by an increasing prevalence and resulting in more associated injuries. Thus, more attention should be paid on the prevention and treatment of these injuries caused by road traffic accidents in our country.

Clinical characteristics and treatment of multiple site comminuted mandible fractures

Multiple site comminuted mandibular fractures are the result a concentrated and prolonged force on a region of the mandible. The purpose of this retrospective study was to investigate the clinical characteristics of these fractures in China, as well as review our experience with these types of fractures. Twenty-one patients treated for multiple site comminuted mandibular fractures were included in the study. The case records were reviewed, with particular attention to the patient’s gender, age, aetiology of injury, area and extent of comminution, concomitant injuries and treatment methods. Sixteen of the 21 patients were males. Ages ranged between 18 and 48 years, with a mean of 34.81 years. Traffic accidents were responsible for the majority (42.86%) of the fractures. Concomitant injuries were uncommon. Treatment was with open reduction with rigid internal fixation and maxillo-mandibular fixation. We recommend that fixation and reconstruction of the mandible with reconstruction plates should be the treatment of choice and MMF should be used as an adjunct.

Characteristic Changes of Pediatric Maxillofacial Fractures in China During the Past 20 Years

The changes in the characteristics of maxillofacial fractures in pediatric patients during the past 20 years in China were investigated in an attempt to find valuable insight into the future prevention of such fractures. In this retrospective study, all pediatric patients age 0 to 12 years treated for maxillofacial fractures at our hospital between January 1987 and December 2006 were included. The epidemiologic information, including patient's gender, age, etiology, fracture type, and fracture site were divided chronologically into two 10-year periods: period 1 (January 1987 to December 1996) and period 2 (January 1997 to December 2006). Both periods were compared and analyzed. The characteristics of pediatric maxillofacial fractures in our data remained relatively consistent during the past 20 years. The only confirmed significant difference was the change in proportion of maxillofacial fractures in patients 0 to 2 years of age. The characteristics of maxillofacial fractures can be influenced by social and economic factors; however, they are also associated with the subjects' social role in each particular age group. In China, the key to reducing occurrences of pediatric facial fractures is to prevent accidental falls in children as much as possible.

Multi-center clinical study of the prevalence rate of senile osteoporotic fracture in China

Multi-center clinical study of the prevalence rate of senile osteoporotic fracture in China

Epidemiology and Treatment of Fractures of the Zygomatic Complex

Objective: This descriptive analytical study evaluated the epidemiology and treatment of zygomatic fractures in China during a 10-year period, and compared findings with those in the literature.Patients and Methods: 152 patients with comparatively complete records from a total of 428 patients who had zygomatic complex fractures were reviewed, with special focus on epidemiology and treatment. Isolated fractures of the zygomatic arch were excluded. Strict medical follow-up was carried out for sourced patients.Results: There were 84 old fractures and 68 fresh ones in the patient group. Road traffic accidents were the predominant aetiological factor. The majority of patients were male, with age between 20 and 40 years. The most common feature was malar depression. Internal fixation with titanium plate was used in 123 patients, while wire fixation was done for 29 patients. 328 titanium plates were used in the rigid internal fixation group. Plates were distributed at the zygomatic-frontal suture (n = 86), zygomatic-maxillary suture and/or zygomatic crest (n = 105), zygomatic-temporal suture (n = 42), and across the fracture line (n = 95). One-site fixation was done for 21 patients, 2-site fixation for 56 patients, and 3-site fixation or higher for 75 patients.Conclusions: Results confirm that road traffic accidents remain the major cause of zygomatic fractures. Rigid internal fixation for such fractures has become more predominant and reliable with the development of improved fixation strategies.

Socioterritorial Fractures in China: The Unachievable “Harmonious Society”?

This article offers an inventory of the social and territorial fractures in Hu Jintao’s China. It shows the unarguable but ambiguous emergence of a middle class, the successes and failures in the battle against poverty and the spectacular enrichment of a wealthy few. It asks whether the Confucian ideal of a “harmonious society,” which the authorities have been promoting since the early 2000s, is compatible with a market economy. With an eye to the future, it outlines two possible scenarios on how socioterritorial fractures in China may evolve.

Does hip strength analysis explain the lower incidence of hip fracture in the People's Republic of China?

To explore whether there are ethnic differences in calculated hip strength that might explain the low incidence of hip fracture in China, we used Lunar DPX ‘beta’ version of hip strength analysis (HAS) and hip axis length (HAL) programs to compare hip geometry, calculated strength and densitometric values from Chinese subjects in Shenyang to those of Caucasian subjects in Oslo and Leuven participating in the European Prospective Osteoporosis Study (EPOS). Subjects were 210 Chinese and 403 Caucasian men and women aged 53–77 years. Parameters investigated included bone mineral density (BMD), bone mineral content (BMC), bone area (BA), cross-sectional moment of inertia (CSMI) and section modulus (both indicating strength and rigidity of the femoral neck), HAL, neck length (NL), neck diameter, tensile stress (Tstress) and compressive stress (Cstress) (indicating the stress in the femoral neck at its weakest cross section arising from walking or a standard fall, respectively), safety factor (SF, indicating the resistance to fracture for forces generated during walking) and fall index (FI, indicating the resistance to fracture from force generated during a fall in the greater trochanter). The Chinese men and women were significantly shorter and lighter than their Caucasian counterparts ( P < 0.01) and had significantly lower BMD, BMC and BA of the femoral neck ( P < 0.01). After adjusting for BA, weight and height, there was no significant ethnic difference in either gender in BMC. CSMI and section modulus were significantly lower, and HAL, NL and neck diameter were significantly shorter in the Chinese men and women ( P < 0.01). These differences all remained after adjusting for weight and height. There were no significant differences in Tstress, Cstress, SF and FI between ethnic groups in either gender. Most of the parameters of calculated hip strength in the Chinese subjects were similar to or poorer than those in the Caucasian subjects. There was no evidence to indicate that Shenyang Chinese have superior BMD or BMC or better calculated hip strength. The short HAL and NL of the population, however, could be an independent factor contributing to the low incidence of hip fracture.

A review of dynamic fracture mechanics in China

This paper summarizes the recent development of dynamic fracture in China. The review covers analytical and numerical results on elastodynamic crack fields in 3D and layered media; experimental and theoretical research on dynamic mechanical properties of rocks and advanced materials; transient effects on ideally plastic crack-tip fields when the inertia forces are not negligible.