Limbs Fracture Research Articles

Epidemiology of complications after non-compulsory planned hardware-removal after limbs fracture

IntroductionRemoval of hardware (HR) following a fracture is a frequent question from patients. The incidence of this kind of intervention remains very variable depending on the healthcare systems and its interest is debated in view of the benefits and associated risks that remain poorly defined. Mandatory preoperative information cannot be given optimally in this context. ObjectiveTo determine the rate of complications (major and minor) after non-compulsory planned hardware-removal following a limb fracture. HypothesisThe rate of major complications was greater than 1%. MethodsA 10-year retrospective single-center study included 1990 patients who had undergone routine HR. Analysis of medical records, with a minimum of one year of follow-up, allowed us to collect: patient data, the type and anatomical location of the osteosynthesis material, as well as the occurrence of a postoperative complication, categorized as a major complication (resulting in either a new surgical procedure, re-hospitalization, or lasting functional impairment) or a minor complication. ResultsOverall, 4.1% (79/1990) of patients experienced postoperative complications, including 1.56% (31/1990) major complications and 21 surgical revisions (1.06%). The time to onset of complications was 9.1 +/- 8.4 days. The most common complications were deep infections and impaired skin healing with superficial infection (55/79, 69.6%). Locations "around the knee" and "around the ankle" were at higher risk of complications (p < 0.01). Smoking was identified as a significant risk factor for complications, particularly deep infection (p = 0.004, OR = 8.7 [1.98; 38.11]). DiscussionNon-mandatory routine RH has a significant complication rate even in a healthy population. Preoperative information of the patient and the assessment of the benefit/risk balance are essential in this indication. This study also raises the question of mandatory smoking cessation preoperatively. Level of evidenceIV; retrospective study.

COVID-19 in Elderly Patients Surgically Treated for Lower Limbs Fracture.

Background: The coronavirus disease 2019 (COVID-19) pandemic outbreak has posed new problems in the context of patients suffering from other diseases. In particular, musculoskeletal sequelae related to the state of debilitation associated with COVID-19 are important to consider in elderly patients undergoing surgery after lower limbs fracture, especially in the post-operative period. The objective of this study was to evaluate whether COVID-19 influenced biochemical parameter, recovery and mortality of surgically treated patients suffering from lower extremity fractures. Methods: Laboratory and clinical data of 30 patients were extrapolated and analyzed in the pre-operative and post-operative periods. Among these patients, 13 had COVID-19 infection (COVID-19 +), whereas 17 had no signs of COVID-19 infections (COVID-19 −). Long-term clinical and functional outcomes were also analyzed. Results: Lower calcium, slightly higher values of CRP and much higher values of CPK and AST were observed pre-operatively in COVID-19 + patients, who also showed higher prevalence of long-term sequelae than COVID-19 − patients. Conclusions: COVID-19 affects long-term outcome of elderly patients with lower limb fractures in a multifactorial way. First, the virus directly damages the muscle tissue. Secondly, the lung function impairment worsens the overall performance, making rehabilitation more challenging.

Effect of Intervenous Magnesium Sulfate on Decreasing Opioid Requirement after Surgery of the Lower Limb Fracture by Spinal Anesthesia.

Background:Magnesium is the calcium natural physiological antagonist; it also antagonizes N-Methyl-D-aspartate receptors, therefore, providing antinociceptive properties. The reason for effective role of treatment with magnesium on decreasing opioid usage, less dissatisfaction, and good sleep quality is proposed theoretically yet. This study aimed to evaluate the effect of magnesium sulfate on decreasing opioids requirement after surgery of the lower limbs fracture by spinal anesthesia.Methods:A total of 60 patients aged from 45 to 75 years with the lower limb fractures (femur and hip) candidate for surgery by spinal anesthesia. In a randomized double-blind method, patients were divided into two groups as Magnesium Group (M) and Control Group (C). Group M received a bolus of 5 mg/kg magnesium sulfate plus (250 CC) normal saline and Group C received (250 CC) normal saline in the same condition.Results:Pain score and the physical dissatisfaction were reduced at 12, 24, and 48 h after surgery in Group M as compared with Group C (P = 0.000). Total opioid requirement at the end of 48 h and at the first 24 h after surgery were reduced in Group M as compared with Group C (P = 0.001). The endurance of spinal block was increased in Group M as compared with Group C (P = 0.000).Conclusions:A low dose of magnesium sulfate reduced the pain score, opioid requirement, and physical dissatisfaction while increased endurance of spinal block.

Rapid rehabilitation and its application on limb fracture nursing

This paper summarizes the concept of rapid recovery, the its application in trauma orthopeadics of rapid recovery in limb fractures and the future prospect. That rapid rehabilitation is not a pure time acceleration, in patients with perioperative safety and improve the life quality, shorten the hospitalization time and lower cost only its added value, focusing on how to make the patients safe, painless, no cross for perioperative complications. To make the patient with more humanized, individualized, full-dimensional embodiment of professional characteristics of quality care services. It is required that nurses quickly change their ideas, improve their professional knowledge, strengthen communication skills and develop in a more professional direction. Key words: Nursing care; Quick recovery; Limbs fracture

Treatment of the postoperative infection of limbs fracture after internal fixation with vacuum sealing drainage (VSD) combined with continual irrigation

To explore the clinical effects of VSD combined with continual irrigation in treating the infection of limbs fracture after internal fixation. From March 2010 to June 2015, 10 patients with infection of limbs fracture after internal fixation were treated with VSD combined with continual irrigation. There were 7 males and 3 females, aged from 11 to 58 years with an average of 34.4 years. Course of disease was from 1 to 8 months with an average of 4.8 months. Postoperative infection occurred in fractures of ulna and radius of 4 cases, tibiofibular fractures of 3 cases, calcaneal fractures of 2 cases, femoral fractures of 1 case. Eight infections were open fracture and 2 infections were close fracture. In additon to above treatment, antibiotics, dressing changing or skingrafting were used in the patients. Informations of wound surface healing, change dressings, original infection focus were observed. All infections got control, the wound healing after change dressings or skingrafting, and no complications such as osteomyelitis were found. The mean treatment time was 38.4 days(ranged, 29 to 45 days) and replacement times was 2.2 times(ranged, 1 to 4 times). All patients were followed up, no recurrent infections were found at 1 year after fracture healing. VSD combined with continual irrigation can effectively decrease the incidence of complications and promote the wound growth, healing and considerably shorten the healing time. It is an effective method for the treatment of infection of limbs fracture after internal fixation.

A retrospective analysis of 374 casualties from the Nepal earthquake

Objective To analyze the feature of victims transported from Nepal Pokhara' s earthquake, and summarized the rescuing experiences got by the Chinese government medical team. Methods A total of 374 casualties from the 2015 Nepal ' s earthquake magnitude 8.1 transported to the Field Hospital of the Chinese government medical team were classified into four groups according to different causes of injury, and then retrospectively analyzed the types of injury, vital signs, severity of injury and causes of injury. Results Of 374 casualties, the average age was (30.1 ±12.4) years, and were divided into group A (n =154) in which casualties trapped under ruined buildings, group B (n =123) in which the victims had crushed injury during escaping with their lives, group C (n =58) in which the wounded had injury resulted from fall on the ground during fleeing for their lives and group D (n =39) in which the injury of casualties was caused by fall from high level. Of them, 273 patients (296 parts of body injured) suffered from fracture including 34 patients with severe multiple trauma. The average age in the group D (22.3 ±7.4 years old) was significant younger compared with the others (all P <0.05). The average age in the group C (48.4 ±13.3 years old) was significant older compared to the others (all P <0.05). The injury probability was higher for male in the group D (14.2% vs. 7.1%, χ2 =5.077, P =0.024) and the injury probability was higher for female in the group C (19.7% vs 10.8%, χ2 =5.635, P =0.018). The incidence of limbs fracture was highest (66.6%) in all 296 parts of body injured. The incidence of skull fracture in the group B (31.6%) was higher compared to the others (all P <0.05), and the incidence of spinal fracture in the group D (40.0%) was higher compared to the others (all P <0.05). There was no significant difference in the severe multiple trauma incidence between the group A and the group D (16.9% vs. 12.8%, χ2=0.381, P =0.537), but both group A and group D had significant higher incidence of severe multiple trauma compared to the rest two groups (all P <0.05). The wound debridement was the leading rate of treatment among variety of treatments (57.5%) and the plaster fixation was the second high rate of treatment (30.9%), and the wound infection was found in 25 patients (17.4%) at the first dressing among 144 patients with soft tissue laceration. After active and regular debridement, 72% patients' wound smear tests were negative 3 days later, and 100% were negative 7 days later. Conclusions The casualties treated by Chinese government medical team had relatively young average age, not very severe critical illness, and quite high rate of wound infection. The treatment of all kinds of fractures and open wound was a matter of critical importance. Although facing the challenge of incomplete set of medical equipment, the lacking of medicine and many other unexpected problems, the Chinese government medical team successfully fulfilled the mission with the prior experience accumulated from several domestic earthquake disaster rescue actions. Key words: Earthquake; Trauma; Mountain; Injury reason; Injury mechanism; Rescue; Nepal; Case-analysis

Expressions of FGF-2 and TGF-β1 during the healing process of limbs fracture

目的 探讨四肢骨折愈合过程中成纤维细胞生长因子2(FGF-2)和转化生长因子-β1(TGF-β1)的表达调控.方法 选择158例四肢骨折患者,检测患者治疗前、治疗后2周和4周血清FGF-2、TGF-β1变化,分析FGF-2,TGF-β1在四肢骨折愈合过程中的表达调控.结果 患者治疗后2周FGF-2与治疗前比较,差异无统计学意义(t=3.187,P>0.05);但治疗后2周的FGF-2水平低于治疗前.患者治疗后4周的FGF-2与治疗前比较,差异有统计学意义(t=8.261,P<0.05),且治疗后4周的FGF-2水平低于治疗前.患者治疗后2周的TGF-β1与治疗前比较,差异有统计学意义(t=4.883,P<0.05),且治疗后2周的TGF-β1水平低于治疗前.患者治疗后4周的TGF-β1与治疗前比较,差异有统计学意义(t=7.732,P<0.05),且治疗后4周的TGF-β1水平低于治疗前.对患者治疗后2周和4周FGF-2与TGF-β1水平进行相关性分析,两者呈正相关(r=0.589,P<0.05).结论 四肢骨折愈合过程中FGF-2与TGF-β1血清含量逐渐降低至正常水平,并具有协同表达,加速组织的修复,促进骨折愈合的作用。

Postoperative nursing of lower limbs fracture in stroke patients

Objective To explore a comprehensive and effective nursing method for stroke patients after surgical treatment of lower limbs fracture.Methods We analyzed 64 cases of stroke patients complicated with lower limbs fracture,made a nursing care plan and carried on medication nursing,psychological nursing according to their situations,then we observed the complications and assessed activities of daily living by Barthel index.Results After treatment,5 cases of bedsores,10 cases of constipation and 1 case of delayed healing presented out of 64 patients were found.No other complications were observed.The patients were hospitalized 14-40 days,the average was 25.2 days.The Barthel index was basically close to the previous level.Conclusion Our results suggest that nursing plays a key role in stroke patients' rehabilitation,which is helpful for improving their quality of life.A comprehensive nursing method combining physical,psychological and social care is recommended. Key words: Stroke; Surgical treatment of lower limbs fracture; Postoperative nursing; Barthel index evalutation

Application of improved tabular orthopedic care table sheet in nursing care for limb fractures patients

Objective To study how to shorten the nurses' recording time,improve work efficiency through the integration of existing different kinds of nursing table sheet from different departments of orthopedics.Methods Five pieces of of orthopedics nursing table sheets commonly used in different departments were integrated into a comprehensive orthopedics nursing table format sheet,applied to record the limbs fracture patients.The observation group was treated with modified form of comprehensive nursing department of orthopedics,control group used the modified anterior nursing records,nursing record writing time,nursing records quality and satisfaction degree of nurses and patients in two groups of were all compared.Results The nurses' nursing documentation time of observation group and the control group were (23.3 ± 2.4) min and (32.5 ± 6.5) min respectively,the difference was statistically significant (P＜0.05),writing quality increased from (87.2 ± 4.1) to (95.1 ± 2.2),satisfaction degree of nurse and patient were improved.Conclusion The modified form of orthopedics department nursing table sheet is simple and convenient to use,and can effectively improve the working efficiency,which is worthy for clinical promotion and application. Key words: Table format; Table sheet; Limb fracture; Nursing care

Effect of two preoperation health education methods on limb fractures patients with PCA after operation

Objective To explore the effect of two preoperation health education methods on limbs fracture patients with PCA after operation. Methods 112cases with PCA after limbs fracture operation were divided into control and experimental groups, each had 56 cases. Control group was given the preoperation health education by the anesthetist including the use of PCA pump at the day before the surgery, and after operation, the duty nurse was in charge of the oral health guidance. The systematic and oral guidance of PCA of experimental group was given by nurse, and was given the health education materials and guided specially by researcher after surgery. The degree of pain at 6, 24, 36, 48 h after operation were evaluated. Results At 6, 24, 36, 48 h after operation, the pain rates of control group were obviously higher than those of experimental group ( P <0. 001) . Conclusions The systematic and oral guidance and the written health education material can efficiently improve the education effect of PCA and also reduce the pain of limbs fracture patients. Key words: Limbs frcture; Postoperation pain; PCA; Health education

Clinical analysis of head injury in Wenchuan earthquake: a survey based on 182 cases

Objective To study the clinical features of head injury after Wenchuan Earthquake. Method From May 12 to June 12, 182 patients of head injuries related to Wenchuan Earthquake were admitted in the department of neurosurgery in West China Hospital. The epidemiology, mechanism, severity,complications, treatments and outcome of head injury were retrospectively studied. Results In this series, 102 cases were men and 80 women. Dilapidated building was the most important reason for head injuries. 88.5% patients were mild or moderated trauma. Open scalp injury was found in 68.7% cases. 46.7% patients were admitted within 72 hours after the earthquake. The data revealed that limbs fracture was the most common complication (16.5%). Only 40 patients received surgical treatment. The Glasgow Outcome Scale upon discharge or transfer were:5 for 121 cases (66.5%),4 for 38 cases(20.8%),3 or less for 23 cases, and 5 cases of death (3.3%). Conclusions The clinical features of head trauma patients after Wenchuan Earthquake included: low salvage treatment rate of severe cases before admission into hospital, high coalescent disease rate and high infective rate. Early standard treatment of multiple departments is important. Key words: Craniocerebral trauma; Earthquake; Therapy

Esophageal perforation complicating with spinal epidural abscess, iatrogenic or secondary to first thoracic spine fracture?

A 49-year-old drunken man was involved in a motorbike crash. He presented with cervical spine injury and multiple limbs fracture. Neuro-imaging demonstrated disruption of the C5-6 anterior longitudinal ligament, herniation of C3-4 and C5-6 discs, and Th1 compression fracture. The neurological deficits improved after anterior cervical decompression, fusion and fixation. One week later, he suffered from fever and severe upper back pain, and he developed paraplegia subsequently. The following image study disclosed esophageal perforation at the level of Th1 and epidural abscess spreading from levels Th1 to Th5. After proper management and rehabilitation, he achieved good recovery one year later at follow-up. We report the unique case of Th1 fracture with esophageal perforation complicated with spinal epidural abscess. The possible mechanism and the controversy concerning therapy for esophageal perforation are discussed.