Background The existence of a “bare area” at the anterior plateau has been observed in cases where anteromedial and/or anterolateral proximal tibial locking plates are used for fixation in the treatment of hyperextension tibial plateau fractures (HTPF). The objective of this study is to introduce the rim plate fixation technique and evaluate its clinical efficacy. Methods A retrospective analysis was conducted on HTPF patients who underwent treatment with a combination of rim plate and proximal tibial locking plate at our hospital between April 2015 and December 2019. All patients were followed up for a minimum of one year. Open reduction and internal fixation were performed using anteromedial/posteromedial and/or anterolateral approaches for all cases. The surgical strategies employed for rim plate fixation were introduced, and both radiographic and clinical outcomes were assessed. Results Thirteen patients were enrolled in the study, with an average follow-up time of 4.3 years. Satisfactory reduction was achieved and radiographically maintained in all cases. Additionally, all patients exhibited satisfactory clinical functions, as evidenced by a mean hospital for special surgery (HSS) knee score of 96.2 ± 2.0 (range: 90–98). Furthermore, no wound complications or implant breakage were observed in this series. Conclusion The combination of the rim plate and proximal tibial plate proved to be an effective fixation configuration, resulting in satisfactory clinical outcomes.

In order to provide more practicable and convenient continuing medical education for orthopedic surgeons in primary hospitals and expand the academic influence of expert lecturers and host hospitals in the region, our department hosted nine short-term training courses of orthopedic surgery jointly with primary hospitals, which lasted for 1 to 1.5 days on weekends from June 2001 to October 2017, with expert lectures as the main form. Traumatic orthopedics was the main topic, and most expert lecturers were orthopedic experts from famous hospitals within the province and the whole country, as well as the experts from the host hospital. More than 1200 orthopedic and surgical physicians in local districts and counties participated in the training, and excellent social effect has been achieved. For short-term orthopedic training jointly held with hospitals in prefecture-level cities, the topic of training should be carefully selected, and duration of the training and number of lecturers should be controlled, so as to achieve satisfactory social effects under the premise of low cost of administrative resources.

Objective To analyze the effects of external fixation for emergency treatment of pilon fracture on deep venous thrombosis (DVT),plasma D-Dimer and Fib.Methods Enrolled in this study were 117 patients with simple closed pilon fracture who received B-mode ultrasonic diagnosis and venography.They were grouped according to whether external fixation was applied or not during emergency treatment.Incidence of DVT and concentrations of plasma D-Dimer and Fib were compared between the 2 groups.Results Altogether DVT occurred in 12 cases,giving an incidence of 10.3％.All the cases of DVT were found in the non-external fixation group,giving an incidence of 12.1％,while the DVT incidence was zero in the external fixation group.The D-Dimer concentration was (620.6 ± 228.7) μg/L in the non-external group,insignificantly higher than that in the external group (331.5 ±39.7) μg/L (t =0.533,P =0.597).The Fib concentration in the non-external group was (378.6 ± 16.6) mg/dL,insignificantly higher than that in the external group (290.2 ±64.4) mg/dL (t =1.882,P =0.068).Conclusion External fixation for emergency treatment of pilon fracture may have an effect on the incidence of DVT but not on the concentrations of plasma D-Dimer and Fib.

OBJECTIVE:To establish a preoperative deep venous thrombosis predictor score for patients with fresh lower extremity fractures by statistical analysis.METHODS:From January 2011 to December 2012, 1 705 patients with fresh lower extremity fractures were admitted to department of orthopaedic trauma, Beijing Jishuitan Hospital. They were randomly divided into two groups, the group 1 (n = 879) was used to screen risk factors and derived a predictive models based on logistic regression, the group 2 (n = 826) validated the models.RESULTS:Among the patients, there were 1 106 male and 599 female patients, with an average age of (50 ± 18) years.Variables related to preoperative deep venous thrombosis were age, length of time before surgery, cause of injury, low/high-energy injury, location of injury, history of cardiovascular and cerebrovascular diseases, and D-Dimer. The scores based on OR were: age ≤ 35 years: 1 point, > 35- < 65 years: 4 points, ≥ 65 years: 6 points; length of time before surgery, < 8 days:1 point, ≥ 8 days:2 points;low-energy injury:1 point, high energy injury:3 points;location of injury, foot and ankle:1 point, calf:3 points, around the knee: 5 points, femoral diaphysis and proximal femur:7 points, pelvis and acetabulum:4 points, ≥ 2 sites:6 point;history of cardiovascular and cerebrovascular diseases, yes:2 points, no:1 point. D-Dimer < 600 µg/L:1 point, ≥ 600 µg/L:3 points. Area under receiver operating characteristic curve was 0.79, critical point 15.5 points, sensitivity was 77.00%, specificity was 68.17%.CONCLUSION:The score can predict the preoperative deep venous thrombosis for patients with fresh lower extremity fractures, but limited.

股骨粗隆间骨折好发于老年患者，且患者往往合并多种内科疾病，体质较差。对于这类骨折，手术治疗已经被骨科医生及患者所接受，手术方法有髓外的钉板系统及髓内固定装置，如股骨近端髓内钉（ PFN）、股骨近端防旋髓内钉（ PFNA）、Gam－ma钉、亚洲髋螺钉（ IMHS）及新一代髓内钉InterTan系统〔1〕，本文回顾性分析使用InterTan治疗老年股骨粗隆间骨折患者的疗效。

Objective To introduce a new CT classification system we designed for Hoffa fractures and compare the interrater reliability between the CT and X-ray classification systems.Methods A total of 20 isolated Hoffa fractures from January 2008 to December 2011 were randomly selected for the present analysis of their imaging data (anteroposterior and lateral X-ray films of the knee joint and three-dimensional CT reconstruction of the femoral condyle).At the same time,a total of 20 independent observers (clinicians with junior,intermediate and senior professional qualifications) were selected for classification of the Hoffa fractures in the same manner respectively according to the Letenneur's X-ray system and our self-designed CT system.We used Kappa statistics to evaluate the interrater reliability among the clinicians between the 2 classification systems for Hoffa fractures.Results According to the CT classification of the 20 Hoffa fractures by the 20 clinicians,type Ⅰ,Ⅱ and Ⅲ fractures accounted for 66.0％,30.5％ and 3.5％ respectively.In type Ⅰ fractures,type Ⅰb involving zone b accounted for the most (50.0％),next by type Ⅰc(31.0％) and type Ⅰa (19.0％).In type Ⅱ comminuted fractures,fracture fragments were mostly seen in zone b.The overall incidence of fractures involving zone b by CT classification was 67％.According to the X-ray classification,type Ⅰ,Ⅱ,Ⅲ and Ⅳ fractures accounted for 31.4％,14.3％,28.0％ and 26.3％,respectively.The interrater reliability for CT classification agreement (Kappa =0.681) among clinicians was higher than that for X-ray agreement (Kappa =0.261).Conclusion For Hoffa fractures,communicated ones in particular,our CT classification system may be better than the X-ray classification system.

锁骨骨折是最普通的一种骨折,约占全身骨折的2.6％～5％[1].粉碎性、移位性、短缩的高能量锁骨骨折发生率也正在增长.传统上锁骨骨折都是使用闭合复位进行治疗.大多数早期的报道评定锁骨骨折的疗效时,把医生主观经验或者影像学的结论等同于成功的愈合[2-5];很少有文献是以患者角度来客观评定临床疗效的.近来的研究发现保守治疗效果并不总是很理想的,特别在高能量的锁骨骨折上.因此,多少年来传统的保守治疗受到空前的挑战.随着现代内固定技术的发展,相应的治疗理念也在发生改变.

Objective To introduce a type of anatomical locking plate (Synthes(R) LISS DF) in the less invasive stabilization system (LISS) which can have an effect of indirect reduction and fixation on comminuted fractures of the femur.Methods From December 2002 through December 2006,13 male patients with complicated fresh fracture of the distal femur were treated with Synthes LISS DF.Their ages ranged from 18 through 58 years,with an average of 37.1 years.First,a specially shaped LISS DF was placedat the femoral external condyle to fixate the distal femur.The distal locking screws at the holes D and F of the LISS DF plate were paralleled to the knee joint surface in the anteriorposterior view and the line between the screw holes D and F was kept as long as the axis of the femoral lateral condyle in the lateral view.Next the proximal end of the LISS DF was placed at the lateral femur to fixate the femur shaft after traction to restore the length of the femur.After the fixation like this,the femoral fractures were reduced automatically in a functional reduction.The femoral axis orientation and the Blumensaat line were used for evaluation of the reduc-tion.Results All the patients were followed up for an average of 18 months (from 13 to 36 months).The fracture united in 61.5％ (8/13) of the patients at 3 months postoperation and in all at 12 months postoperation.The average distal femoral axis orientation was 81.7°±3.5° and the average angle between the Blumensaat line and the long axis of the femoral shaft was 38.7° + 6.0°.The last follow-up found no secondarydisplacement of the fracture or no implant failure.By the evaluation system of The Hospital for Special Surgery (HSS),the patients scored 76 on average (from 42 to 96).Three cases were rated as excellent,6 as fine,3 as fair and one as poor,with a good to excellent rate of 69.2％.Conclusions LISS DF can be used as a template to fix and reduce simultaneously the comminuted fractures of the distal femur,especially in cases who have lost the reduction marks on X-ray.In this way,the surgical procedures can be simplified to achieve a functional reduction of the femur in a minimally invasive plate osteosynthesis.

BACKGROUND:The correlation between the plasma D-dimer level and deep vein thrombosis has not been conclusive in various studies. The aim of this research was to study the relationship between plasma D-dimer levels and the severity of orthopedic trauma by retrospective examination of orthopedic trauma cases.METHODS:Clinically acute trauma and non-acute trauma patients were selected and their plasma D-dimer levels were measured. Plasma D-dimer levels in patients of these two groups were compared. The relationship between the plasma D-dimer level and the severity of the trauma was also studied.RESULTS:There were 548 cases in the acute trauma group and 501 cases in the non-acute trauma group. The levels of plasma D-dimer were significantly higher in the acute trauma group than in the non-acute trauma group (P < 0.01). In the acute trauma group, the correlation between the D-dimer level and the number of fractures was a positive linear correlation (r = 0.9532).CONCLUSIONS:Elevated plasma D-dimer is common in trauma patients. The D-dimer level and the number of fractures in the trauma patients are closely correlated. D-dimer is not only an indicator for the diagnosis of deep vein thrombosis and pulmonary embolus, but also an indicator of the severity of trauma in acute trauma patients.

踝关节骨折是一种常见创伤,发病率占各个关节内骨折的首位.其致伤原因一部分源于直接暴力,而更常见的原因来自于扭转等间接暴力[1-3].国家十一五科技支撑计划支持的课题共在全国5家大学附属医院收集到完整随访资料的骨折患者2338例,其中踝关节骨折235例,占10.1%。

目的 探讨下尺桡脱位合并桡骨头脱位的的诊断和治疗.方法 本文报道的2个典型病例,一例是下尺桡背侧脱位同时合并桡骨头后脱位,另一例是下尺桡掌侧脱位合并桡骨头前脱位,均不合并尺桡骨干的骨折.用单纯桡骨头脱位或下尺桡脱位的机制不能很好地解释.对于急性损伤,应先在麻醉下试行闭合复位,如不成功可考虑切开复位.结果 根据目前研究,"绞锁损伤"的机制能比较好得解释这种损伤,骨间膜在前臂两骨之间起到一个"枢轴"的作用.早期诊断和治疗能达到良好的效果.结论 早期诊断和早期复位固定非常重要,需要和孟氏骨折、盖氏骨折或Essex-lopresti损伤等相鉴别.

肱骨近端骨折属肩关节周围骨折.临床上约占所有骨折的5%,在所有的肱骨骨折中占到将近一半[1].国家"十一五"科技支撑计划支持的课题共在全国5家大学附属医院收集到完整随访资料的关节周围骨折患者2338例,其中肱骨近端骨折315例,占13.5%.其中单纯肱骨近端骨折239例,合并其他部位骨折76例.该损伤发病在年龄上有两个高峰:一个是30岁左右,此类患者骨折多为高能量损伤,常常合并有其他类型的骨折或脏器损伤;另外一个年龄高峰是60岁以上,尤以老年女性为甚[2].最新的研究表明:肱骨近端骨折人群中,60岁以上的患者占70%,且该年龄组的发病率在近30年内增长了近3倍[3].老年肱骨近端骨折发病率高的主要原因是骨质疏松导致骨质强度降低.

Hoffa骨折即股骨髁部冠状面的骨折,治疗原则是解剖复位,坚强内固定,早期功能康复锻炼[1].复习国内文献,骨折的手术方式多数采用单纯螺钉固定,并非坚强内固定,骨折块易向后上方移位[2],导致治疗失败.为拮抗向后上的剪切应力,作者应用拉力螺钉结合抗滑钢板技术.自2006-2009年,采用该手术方式治疗Hoffa骨折共12例,所有患者均获得半年以上的随访,未发生内固定失效及骨折块移位,疗效满意,现报告如下.

Objective To investigate clinical characteristics and treatment of Hoffa fractures.Methods Twenty patients with Hoffa fracture (24 condyles) were treated from January 2002 to April 2009.They were 14 men (18 condyles) and 6 women (6 condyles), aged from 20 to 70 years (average, 43. 3 years).There were 15 fractures of medial femoral condyle and 9 ones of lateral femoral condyle. Two rare cases were fractures of unilateral bi-condyles and one rare case fractures of unilateral bi-condyles plus contralateral single condyle. Four fractured condyles were old due to implant failure and 20 were fresh. According to the modified Letenneur's classification, there were 6 condyles of type Ⅰ, 4 condyles of type Ⅱ and 14 condyles of type Ⅲ.Fifteen condyles were fixed anteroposteriorly with 2 to 4 cancellous or canulated screws, 8 condyles were fixed posteroanteriorly with 2 to 4 screws, and one condyle was fixed with K wires. Five condyles were fixed with screws plus lateral supporting plates, and 3 condyles with screws plus posterior anti-sliding plates. Results All the patients were followed up for an average of 14. 4 months (6 to 84 months) . All the 24 condyles obtained bony union after an average of 18. 6 weeks (from 12 to 44 weeks). There was no infection, implant failure, nonunion or bone necrosis. According to Letenneur's functional assessment system, 16 condyles were excellent, 6 good and 2 poor, with a good-to-excellent rate of 91. 7%. Conclusions All Hoffa fractures should be treated with screws. Screw diameter, fixation direction and surgical incision should depend on facture type and size of fracture block. Unstable Hoffa fractures should be treated with screws combined with lateral supporting plates or posterior anti-sliding plates.

Objective:To explore the indicators of vena cava filters(VCFs) implementation in case of deep venous thrombosis(DVT) secondary to lower extremity trauma and how to select among different types of VCFs.Methods:Based on the previous VCF guideline,DVT patients secondary to lower extremity trauma treated in our hospital in the year of 2010 were categorized into the following subgroups and analyzed separately: implanted temporary VCFs;implanted retrievable VCFs;implanted permanent VCFs.Results:Totally 4 544 subjects were screened and 968 patients were diagnosed with DVT.The DVT incidence is 21.3%.VCFs were implanted in 296 patients.Among them,121 patients received temporary VCFs(40.9%),56 subjects received retrievable VCFs(18.9%) and permanent VCFs were implanted in 119 cases(40.2%).No fatal pulmonary embolism(PE) or significant symptomatic PE were identified while VCFs were implanted.Post surgery,anti-coagulants were administrated and subjects were followed up to three to six month.Two DVT relapses were identified during follow-up.Conclusion:If acute DVT was diagnosed in lower limb trauma patients,VCF implantation before surgery can greatly reduce the incidence of fatal PE.Since the risk of thromboembolism in trauma patients are transient,temporary VCFs are the first choice.Retrievable VCFs are indicated in elderly patients or patients with severe cardiac-pulmonary complications.VCF implantation is not obligatory if thrombus was identified post-surgery or obsolete in nature identified before surgery.

目的探讨下肢骨折患者深静脉血栓(DVT)的发生率以及危险因素。方法回顾性分析380例下肢骨折患者资料,所有患者术前行彩色多普勒超声检查以确定是否有DVT形成。结果总的DVT发生率为11.8%,发病率占前三位的骨折种类分别是膝关节骨折、骨盆髋臼骨折以及多发骨折。危险因素包括高龄、高能量创伤、合并高凝状态的疾病、卧床时间大于7 d。结论在下肢骨折患者中,总的DVT发生率为11.8%。高龄、高能量创伤、卧床时间大于7 d是DVT的危险因素。

Objective To analyze factors influencing the incidence of deep venous thrombosis (DVT) and discuss the prevention and treatment of DVT in hip fracture patients. Methods The present study enrolled 531 patients who received surgery between June, 2008 to June, 2010 for hip fractures. They were 242 men with a mean age of 56. 2 years and 289 women with a mean age of 65.2 years. There were 336 femoral neck fractures, 183 femoral intertrochanteric fractures, and 12 femoral subtrochanteric fractures. The associations between DVT incidence and fracture type, plasma D-Dimer, sex, age and preoperative duration of immobilization were statistically analyzed. Inferior yens cava filters were used for patients who suffered DVT while surgery was performed. Results The total incidence of DVT was 10. 4% in this series. DVT occurred in 21 cases of femoral neck fracture, 34 cases of femoral intertrochanteric fracture and 0 case of femoral subtrochanteric fracture. All DVT events happened before surgery. DVT incidence had no significant associations with age or sex (P =0. 347 and 0. 376, respectively), but did with plasma D-Dimer, fracture type and preoperative duration of immobilization (P = 0. 002, 0. 017 and 0. 037, respectively). All the 55 DVT patients underwent a successful surgery. Conclusions The DVT incidence in hip fracture patients may have no significant associations with age or sex, but may do with plasma D-Dimer, fracture type and preoperative duration of immobilization. Inferior vena cava filters can ensure a successful internal fixation of the fracture and an uneventful postoperative rehabilitation.

股骨远端骨折 一、流行病学概述 股骨远端骨折通常指股骨远侧15 cm内的骨折,包括干骺端及关节面骨折,约占股骨骨折的4%～6%[1-2].骨折在不同人群中呈双峰状分布,15～50岁的年轻患者中,以高能量创伤(交通伤、坠落伤和体育运动损伤等)多见,男性为主;而50岁以上的患者,多为低能量创伤(跌倒摔伤等)所致,常合并严重的骨质疏松症,以女性为主[2],股骨远端骨折中年龄50岁以上者占85%以上[1].

Objective To analyze the incidence of deep venous thrombosis(DVT) in trauma patients and its relation with plasma D-Dimer.Methods Patients with simply trauma,such as fracture of femoral neck,intertrochanteric fracture of femur,fracture of femoral shaft and condyloid fracture of femur were involved in this study and detected by using contrast venography.Plasma D-Dimer,a high specific fibrin degradation product,was measured by using NycoCard D-Dimer assay and was analyzed with statistic retrospectively.Results The incidence of DVT in trauma patients was 11.4%.Plasma D-Dimer level was significantly higher in patients with DVT than those without DVT(P0.05).The sensitivity,specificity,positive predictive value and negative predictive value of 500 μg/L were 93.1%,63.6%,24.8% and 98.6%,respectively.Plasma D-Dimer level was affected by length of immobilization before operation.Conclusion Normal plasma D-Dimer concentration has clinic value of exclusion of DVT,while elevated plasma D-Dimer concentration has no value of diagnosis of DVT.Plasma D-Dimer level was affected by length of immobilization before operation.