Treatment Of Lower Limb Fractures Research Articles

Correlation analysis of serum MMP-1 and MMP-2 levels with lower extremity deep venous thrombosis after operation for lower limb fracture

To investigate the relationship between serum matrix metalloproteinase-1(MMP-1) and matrix metalloproteinase-2(MMP-2) and the formation of deep venous thrombosis(LDVT) in lower extremity patients after surgery for lower extremity fracture, and to analyze the value of MMP-1 and MMP-2 in predicting the occurrence of LDVT after lower extremity fracture. From June 2018 to December 2021, 352 patients who planned to receive surgical treatment of lower limb fracture in our hospital were selected as the research objects. Venous blood was collected at 1, 2 and 3 days after surgery, respectively, and serum MMP-1 and MMP-2 levels were detected. The incidence of LDVT during hospitalization was analyzed, and the risk factors of postoperative LDVT in patients with lower limb fracture surgery and the predictive value of MMP-1 and MMP-2 for LDVT were analyzed. LDVT occurred in 40 patients (LDVT group), the incidence of LDVT was 11.36%, and 312 patients did not occurred(no occurred group). The serum levels of MMP-1 and MMP-2 in LDVT group increased gradually after surgery; the serum levels of MMP-1 and MMP-2 in the no occurred group increased slightly after surgery at 2 days and then decreased at 3 days after surgery (P<0.01);the serum levels of MMP-1 and MMP-2 in LDVT group were higher than those in the no occurred group at 2 days and 3 days after surgery (P<0.05). Serum levels of MMP-1 and MMP-2 were positively correlated with serum levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor -α (TNF-α) in LDVT patients at 2 days and 3 days postoperatively (P<0.05). Operative time, MMP-1 and MMP-2 postoperative 3 days were related to the occurrence of LDVT after lower limb fracture (P<0.01). The area under the curve(AUC) predicted by MMP-1 and MMP-2 postoperative 3 days for LDVT after lower limb fracture was 0.738 and 0.744 respectively, and the AUC predicted by combined MMP-1 and MMP-2 was 0.910, which was higher than that predicted by single indicator(Z=2.819 and 2.025, P<0.05). High levels of MMP-1 and MMP-2 after lower extremity fracture are closely related to the occurrence of LDVT, and 3 d mMP-1 and MMP-2 after surgery maybe used as evaluation indexes for LDVT risk prediction.

Effect of application of short-form video health education on the health knowledge and satisfaction with nursing care of patients with lower extremity fractures

BackgroundVideo health education has been increasingly adopted in the clinic to expand patient guidance and improve perioperative outcomes. To date, however, it is unclear whether the use of short-form videos and web-based clinician-created forums actually improve the perioperative experience of patients.ObjectiveTo evaluate the effect of application of short-form video health education on the health knowledge and satisfaction with nursing care of patients with lower extremity fractures.MethodsThis study is a quasi experimental study, using convenient sampling method and grouping according to historical control., one hundred and twenty-two patients admitted with lower limb fractures to the orthopedic ward of a tertiary first-class general hospital in Fujian, China were enrolled in this study. Based on their admission order, patients admitted from September 2021 to November 2021 were enrolled into the control group (n = 61) and patients admitted from December 2021 to March 2022 were enrolled in the intervention group (n = 61). Both groups received identical admission-based patient education, perioperative care, and discharge rehabilitation instructions. The control group received the traditional education method while the intervention group received a short-form educational video in addition to the traditional education method. Patient perioperative health knowledge and patient satisfaction with nursing care during treatment of lower limb fractures were compared across the two groups.ResultsPreoperative health knowledge in the intervention group was 95.1%, compared to 82.0% in the control group (χ2 = 3.954, P<0.05). The Newcastle satisfaction with nursing scales score in the intervention group was (80.902 ± 7.016) points, compared to (78.131 ± 8.213) points in the control group. These group differences were statistically significant (P < 0.05).ConclusionThe application of a short-form educational video during the perioperative care of patients with lower limb fractures may improve patients’ understanding of perioperative health and increase satisfaction with nursing care.

Development and validation of a newly developed nomogram for predicting the risk of deep vein thrombosis after surgery for lower limb fractures in elderly patients.

Prevention of deep vein thrombosis (DVT) is indispensable in the treatment of lower limb fractures during the perioperative period. This study aimed to develop and validate a novel model for predicting the risk of DVT in elderly patients after orthopedic surgeries for lower limb fractures. This observational study included 576 elderly patients with lower limb fractures who were surgically treated from January 2016 to December 2018. Eleven items affecting DVT were optimized by least absolute shrinkage and selection operator regression analysis. Multivariable logistic regression analysis was performed to construct a predictive model incorporating the selected features. C-index was applied to evaluate the discrimination. Decision curve analysis was employed to determine the clinical effectiveness of this model and calibration plot was applied to evaluate the calibration of this nomogram. The internal validation of this model was assessed by bootstrapping validation. Predictive factors that affected the rate of DVT in this model included smoking, time from injury to surgery, operation time, blood transfusion, hip replacement arthroplasty, and D-dimer level after operation. The nomogram showed significant discrimination with a C-index of 0.919 (95% confidence interval: 0.893-0.946) and good calibration. Acceptable C-index value could still be reached in the interval validation. Decision curve analysis indicated that the DVT risk nomogram was useful within all possibility threshold. This newly developed nomogram could be used to predict the risk of DVT in elderly patients with lower limb fractures during the perioperative period.

Clinical and Radiological Outcomes After Surgical Treatment of Lower Limb Fractures in Patients With Spinal Cord Injury.

Study Design:Retrospective observational study.Objectives:To analyze the clinical and radiological outcomes of lower limb fractures following surgical treatment in patients with chronic spinal cord injury (SCI).Methods:Between January 2003 and December 2015, 102 chronic SCI patients with a lower limb fracture were surgically treated at our hospital. A total of 58 patients met the inclusion criteria and were recruited for final analysis. Patients with 2-stage procedure or incomplete clinical records with lost-to-follow-up were excluded from the study. Patients were divided into 2 groups (group 1= internal fixation; group 2 = external fixation). Primary outcome measures were to identify the number of nonunions via Kaplan-Meier analysis and the time to bone consolidation. The diagnosis of a pseudarthrosis was made after more than 180 days of consolidation time. Considering the Kaplan-Meier analysis, pseudarthrosis was interpreted as treatment failure. Secondary outcome measure was to evaluate the complication rate with special focus on heterotopic ossification.Results:A total of 58 chronic SCI patients with closed bone fractures were included in this study. Fifty-two fractures (88%) were simple and 7 (12%) were complex (type C) fractures according to AO classification. The majority of patients (34 cases, 59%) developed femur fractures followed by 24 tibial fractures (41%). Seventeen patients received an external (29%) and 41 an internal fixation (71%). Bone consolidation was reported in 31 patients (53%) with a mean time interval of bone consolidation after 97 days (range from 45 to 160 days; SD = 30). The reported nonunion (pseudarthrosis) rate was 47%. Comparing the internal group (n = 15 patients) versus the external group (n = 14), we could not find any significant difference (P = .939) concerning the bone consolidation time. The Kaplan-Meier analysis showed a 75% cumulative survivorship at 120 days (internal group) versus 111 days (external group). Most common postoperative complications occurred in the internal fixation group with Wound infections being predominantly observed (10%), followed by heterotopic ossifications (8%).Conclusions:Our results show that surgical treatment of lower limb fractures in chronic SCI patients is a challenging treatment with a high pseudarthrosis rate in both groups. The complication rate seems to be lower in the patients treated with external fixation. As a clinical recommendation, longer implants should be used for a stable osteosynthesis since SCI patients seem to have a higher load on the osteosynthesis material due to missing sensomotoric feedback.

Clinical effects and risk factors of far cortical locking system in the treatment of lower limb fractures

IntroductionThis study aims to analyze clinical effects between far cortical locking (FCL) system and standard plating techniques in the treatment of lower limb fractures and identify potential preoperative risk factors for complications in patients treated with FCL system. MethodWe retrospectively analyzed 76 patients treated with FCL system (the study group) and 68 patients treated with standard plating techniques (the control group) between January 2014 and January 2017. Patients were followed up for a minimum of one year. Surgery-related complications, fixation features, fracture healing rates, the radiographic union scores, and knee functions (Kolment scores) were analyzed between the two groups in the study. Besides, we analyzed eight preoperative characteristics for surgery-related complications, including age, gender, presence of risk factors affecting bone healing, cause of injury, AO/OTA fracture classifications, facture sites, presence of open fractures, and presence of bone losses. ResultsThe distributions of baseline date were similar between the two groups (P＞0.05). The average number of FCL screws was 4.5 (range: 3–9) in the study group. The average time to union was 2.8 ± 0.9 months in the study group and 3.6 ± 1.0 months in the control group (P＜0.001), and average time to whole weight bearing was 2.3 ± 0.8 months and 2.8 ± 1.2 months, respectively (P = 0.004). Regarding radiographic union score, the study group scores were significantly higher than the control group scores at 1 and 3 months after surgery (P＜0.001), while it becomes insignificant between the two groups at 6 and 12 months after surgery (P = 0.19 and P = 0.15).The working lengths, fracture healing rates, complication rates, and Kolment scores were similar between the two groups (P＞0.05). In the multivariate analysis, fracture sites (OR = 5.34; 95% CI, 1.11–25.75; P = 0.03) and presence of open fractures (OR = 6.19; 95% CI, 1.05–36.38; P = 0.04) were significant associated with complications, whereas other variables were not included. DiscussionFCL system can truly accelerating bone healing and allow earlier whole weight bearing. Fracture healing rates and complication rates were similar between patients treated with FCL implants or conventional plating techniques. Patients with shaft fractures and open fractures trended to have higher complication rates. ConclusionsFCL system is superior to standard plating technique in terms of early callus formation, but standard plating technique is not inferior to FCL system in terms of final fracture healing, surgery-related complication, and function outcome. Fracture site and presence of open fracture are the independent factors for complications in patients treated with FCL system.

Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre

ObjectiveTo report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. Material and methodA total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. ResultsPatients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. DiscussionThere is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. ConclusionsChronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients.

¿Se deben tratar quirúrgicamente las fracturas de extremidad inferior en pacientes con lesiones medulares crónicas? Experiencia en un centro de referencia

ObjectiveTo report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. Material and methodA total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. ResultsPatients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. DiscussionThere is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. ConclusionsChronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients.

History of traction for treatment of lower limb fractures

The last two hundred years have seen the development of different systems of traction with effective methods of applying traction to the foot or to the leg for the treatment of fractures of the femur. The success of these methods has been tested during many wars by clinical evaluations but also by means of x-rays since the beginning of the twentieth century. Because of their advantages, these methods of traction were very frequent during the first part of the twentieth century. Crosby, Smith, Buck, Hodgen, Steinmann, Codivilla, Kirschner, and Pearson are names recurring daily on our fracture wards. Their concern for the welfare of their patients led to substantial improvements in the treatment of all patients with fractures.

Treatment of Lower Limb Fractures in Children with Multiple and Concomitant Injuries

Treatment results for 306 children (1-17 years) with lower limb fractures accompanied by multiple and concomitant injuries were studied during 2005 - 2014. Comparative assessment of conservative treatment, transcutaneous osteosynthesis with external fixation devices and internal fixation was performed. The number of complications, duration and number of hospitalizations, total duration of treatment, long-term results and quality of life at terms from 1 to 3 years after injury were evaluated. Indications to the application of every osteosynthesis technique were determined.

Treatment of Lower Limb Fractures in Children with Multiple and Concomitant Injuries

Treatment results for 306 children (1-17 years) with lower limb fractures accompanied by multiple and concomitant injuries were studied during 2005 - 2014. Comparative assessment of conservative treatment, transcutaneous osteosynthesis with external fixation devices and internal fixation was performed. The number of complications, duration and number of hospitalizations, total duration of treatment, long-term results and quality of life at terms from 1 to 3 years after injury were evaluated. Indications to the application of every osteosynthesis technique were determined.

Analysis of Centromedullary Nailing with Implant Failure

Centromedullary nailing is the most preferred surgical technique for the treatment of lower limb fractures and sometimes also on the upper extremity. It is a minimal invasive surgical intervention used mainly for long bones fractures that permits treatment without opening the fracture site thus preserving the local vascularization. With the improved knowledge and understanding of the fracture pattern and of the implantation technique good stability and rapid bone healing is obtained.We present a study on 8 patients with long bones fractures (femur, tibia, humerus) that were surgically treated with intramedullary nailing which failed due to non-union. Implant failure usually occured at 6 to 10 months after surgery. In our group of patients the primary causes of non-union was improper fracture reduction, infection and faulty surgical technique. The implant usually failed several months after loading when the nail was not sharing but bearing all the weight. In this cases the metallic implant usually fails due to fatigue in its weakest point. Loss of reduction, inadequate fixation, a need to change implant and breakage of nails were considered as implant failure.Inappropriate usage of intramedullary nailing technique will lead to nonunion or delayed union and after loading the affected limb the metallic implant will bear all the mechanical forces. This will lead to implant failure and a new difficult surgery for the patients.Revision surgery should address both the biological part and the mechanical part of bone union .

Treatment of pediatric femoral and tibial fractures with titanium elastic nails

Objective To investigate the effect of intramedullary stabilization of lower limb fractures with titanium elastic nails (TENs) in children.Methods From June 2004 to October 2010,278 children were stabilized with TENs in our hospital,including 181 boys and 97 girlsat average age of 7.6 years (range,3.0-14 years).There were 162 patients with femoral fractures,of which 35 underwent open reduction and the rest closed reduction.There were 116 patients with tibial fractures,which was treated with closed reduction.Postoperative fixation lasted for 3-4 weeks.The mean hospital stay was seven days.Of all the patients,272 patients received the removal of the TENs six months after operation and 242 received more than one year of follow-up to have a further observation on the limb length,hip and knee mobility and gait condition in children.Results All the patients were followed up for 6-66 months (mean,33 months).All fractures were healed in good alignment without severe complications.There were no intraoperative complications like infections,delayed union,nonunion,TEN broken and femoral or tibial epiphysis injuries.Ten patients suffered from swell and skin irritation in the nail' s position 3-4 months after operation,and the nails were removed in advance.Nineteen patients showed unequal lengths ( within 1 cm) of the lower limbs,with normal function of the lower limb joint but with no obvious limp.According to the Flynn evaluation standard,the excellent and good rate was 100％.Conclusions Characterized by good stability,rapid healing,small incision,anatomic reduction,unimpaired periosteum,short hospital stay and few complications,intramedullary stabilization with titanium elastic nails can achieve effective fixation in the treatment of lower limb fractures in children. Key words: Fracture fixation, internal; Femoral fractures; Tibial fractures; Titanium elastic nails

Haben Kinderchirurgen und Erwachsenenchirurgen unterschiedliche Therapieansätze bei der Behandlung von Wachstumsfugenlösungen?

The treatment of paediatric fractures is the concern of several different surgical specialties. There has been no scientific investigation on the different concepts of paediatric (PS) and adult surgeons (AS). 62 paediatric traumatologists were asked concerning their experience with physeal fractures of the leg, including ten cases. Growth disturbances was estimated to be more rare by PS. On evaluation of the examples there were no significant differences in the judgement of degree and direction of the displacement. For displaced fractures, PS rather preferred closed reduction and immobilisation, whereas AS favoured osteosynthesis. There were no basic differences between PS and AS in the treatment of lower limb fractures. AS tend to act more invasively. At the same time they are more concerned about growth disturbances.

Treatment of Lower Limb Fractures by External Skeletal Fixator Preliminary report

Treatment of Lower Limb Fractures by External Skeletal Fixator Preliminary report

Rehabilitation of Fractures in the Aged

In the present paper the aged are defined for convenience sake as those who are over 60 years old. In the authors' hospital 2, 614 in-patients have undergone the orthopedic functional training, and the aged patients among them are 84 in number (3.2%), 61 cases (73%) of which had fractures. Among fractures in the aged those of the femur predominate, and then come the vertebral and the fibula and tibia fractures. The patients at the age of 65 make up the largest number, and the number of male-patients is twice as large as that of female. As the cause of fractures tumbling predominates, then, falling and blow. After they sustained fractures 23% of the patients retired from their jobs, and 7% changed their jobs. In comparison with the younger patients of fracture the aged patients are naturally slower to develop bony union and consequently the period of plaster fixation, hospitalization, and training is likely to be prolonged. Besides, because of the atrophy of soft tissues during this period the adjacent joints tend to develop contractures easily.Since the aged are generally lacking in active motivation for the functional recovery return to the society and very prone to accidents, it is of importance to watch them closely during the orthopedic functional training, and to give them a positive psychological support, while taking the above tendencies into consideration. At the same time it is necessary to direct them with sympathy and kindness to continue the functional training by themselves regularly without undue overstrains. This should also be taken into consideration in cases of the aged patients. Besides, the treatment of the aged patients who suffer from complications requires the utmost caution. However, through above mentioned cautious treatment and training it is possible for the aged patients to recover their function to a level as high as that of the ordinary patients, though it must be admitted that the level of recovery of the aged is slightly lower as expected. But the question remains in the case that the knee joint contracture is apt to stay on even after the treatment of lower limb fracture, as in the cases of general fractures.The questionaire on pain was sent to 37 patients who had undergone the hospital training. Answers were obtained from 77% of them. Generally speaking, among pains numbness predominates, but the incidence of numbness among the aged patients is lower than that among the ordinary patients. And pain occurs most frequently in cold environment and then at the time of fatigue. The cause of pain is the impediment of blood circulation at the affected part. The incidence of pain caused by the impediment of blood circulation is rather high among the aged. And the means of treatment given by the patients are hot spring bath, massage, and hot compress in order. The questionaire indicates that such heat treatments as hot spring bath and others relax muscle tones at the affected part, relieve nervous excitability and improve circulation, and at the sametime, psychologically give them a peaceful rest. The fact acupuncture and moxacautery are resorted to by some patients is considered co be characteristic of the aged.The questionaire on activities of daily living was sent to 23 patients who had undergone the hospital training (16 of them were judged physically handicapped according to the National Annuity Law), and to 6 patients who had received the indoor training. All these patients suffered from fractures of the lower limb and trunk. It is important to notice that the patients of lower limb fracture comlain-ed mainly of difficulty in walking and kneel sitting. By the examination according to the National Annuity Law quite many patients of fractures are judged physically handicapped, because of their inability to do kneel or crosse legged sitting. in sitting upright or cross legged. This kind of impediment becomes serious for the Japanese who spend their home life on tatami matts.

PROPHYLACTIC ANTICOAGULANT THERAPY IN THE TREATMENT OF LOWER LIMB FRACTURES.

(1963). Prophylactic Anticoagulant Therapy in the Treatment of Lower Limb Fractures. Acta Orthopaedica Scandinavica: Vol. 33, No. 1-4, pp. 329-341.