Continuing antiplatelets during hip fracture surgery may be safe for older adults, while early surgery after discontinuation reduces hospital stay without adverse outcomes. The safety of continuing antiplatelets or direct oral anticoagulants (DOACs) before surgery in older patients with hip fractures remains uncertain. The feasibility of timely surgery after discontinuation also warrants further investigation. We included studies of hip fracture patients aged ≥ 65 years taking antiplatelets or DOACs, comparing continuation versus discontinuation, or early versus delayed surgery. MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched to November 2024. Risk of bias was assessed using the Newcastle–Ottawa Scale. Meta-analyses were conducted using a random-effects model to pool effect estimates. This study was registered with PROSPERO (CRD42022378334). Thirteen observational studies from nine countries involving 885 patients were included. There were no significant differences in transfusion rates in patients who continued the medication (Odds Ratio [OR] = 0.87; 95

Objective:To compare the outcomes of isolated Mason type Ⅱ radial head fracture between operative and non-operative treatments.Methods:A retrospective study was conducted to analyze the data of patients who had been treated for isolated Mason type Ⅱ radial head fracture either operatively or nonoperatively at Department of Trauma and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University from January 2017 to October 2020. The patients were divided into a non-operative group and an operative group according to their treatment method. After 1:1 propensity score matching method was used to match the patients in the 2 groups, a total of 58 pairs of patients were successfully matched. In the operative group, there were 24 males and 34 females with a mean age of (40±14) years and a body mass index of (23.7±3.4) kg/m 2; in the non-operative group, there were 22 males and 36 females with a mean age of (42±13) years and a body mass index of (23.5±3.9) kg/m 2. Elbow flexion-extension, forearm rotation, Mayo elbow performance score (MEPS), Quick-disabilities of the arm, shoulder and hand (q-DASH) score and complications were compared between the 2 groups. Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). All the patients were followed up for (24±9) months. At the last follow up in the operative and the non-operative groups, respectively, the elbow flexion-extension was 134° (132°, 136°) and 134°(131°, 136°), the forearm rotation 176° (174°, 179°) and 178° (175°, 179°), the MEPS 100 (100, 100) and 100 (100, 100), the q-DASH score 0 (0, 0) and 0 (0, 0), showing no significant differences between the 2 groups in the above items ( P>0.05). Elbow pain was reported respectively in 4 (6.9%) and 6 (10.3%) patients in the operative and non-operative groups, showing no significant difference between the 2 groups ( P>0.05). Conclusion:The outcomes of operative and non-operative treatments of isolated Mason type Ⅱ radial head fracture are comparable.

目的:研究周末入院对老年髋部骨折患者疗效的影响.方法:采用回顾性研究方法,连续纳入2018年11月至2019年11月收治的老年(年龄≥65岁)髋部骨折患者1 009例,根据患者入院时间分为工作日入院组(周一至周四入院)388例和周末入院组(周五至周日入院)621例.收集患者基线资料和治疗相关资料,并于入院后30 d、120 d、1年进行随访,随访患者生存情况和并发症情况.结果:周末入院组与工作日入院组患者基线资料差异均无统计学意义(P＞0.05).与工作日入院组患者相比,周末入院组患者入院48 h内手术率显著降低(64.2％vs.81.6％,P＜0.001),术前等待时间和住院时间均显著增加(P＜0.05),30 d内并发症发生率显著增加(11.9％vs.7.7％,P=0.028).两组患者院内、30 d、120 d和1年死亡率及1年内再次手术率差异均无统计学意义(P＞0.05).结论:周末入院会延长老年髋部骨折患者术前等待时间,增加并发症发生率,应制定相应的流程和路径以降低周末入院对老年髋部骨折患者疗效的影响.

Objective:This retrospective study aims to explore the effect of silver nanoparticles with thermoplastic polyurethane (TPU/NS) on the rehabilitation of diabetic patients with open fracture of lower extremities.Methods:Diabetic patients (n = 98) with open fracture of lower extremities treated in our hospital were analyzed retrospectively from June 2015 to December 2021. TPU/NS nanocomposites were prepared for postoperative treatment of diabetic patients with open fracture of lower extremities. First, the cultured Staphylococcus aureus and Escherichia coli were used to test the antibacterial effect of TPU/NS dressing in vitro. After using TPU/NS dressing (observation group) and traditional dressing (control group), the inflammatory reaction, clinical treatment, functional rehabilitation, and adverse reactions in patients were compared.Results:TPU/NS dressing effectively inhibited the growth of bacteria with a minimum inhibitory concentration of 2 μg/mL. The usage of TPU/NS dressing reduced the inflammatory reaction by reducing positive rate of bacteria after the dressing on the seventh day postoperatively. Besides, the times of dressing, stopping time of wound exudation, wound healing time, length of hospital stay, and VAS score in the observation group were lower than those in the control group; the incidence of adverse reactions after treatment was lower in the observation group as compared with the control group (17.07% vs. 35.09%). Meanwhile, the functional rehabilitation and life quality of patients in the observation group were better TPU/NS dressing treatment.Conclusion:TPU/NS dressing has the function of promoting the postoperative recovery of patients by inhibiting the bacterial infection of the wound, thus improving the limb function and life quality. As a result, there was a tremendous potential to apply the constructed TPU/NS membrane to diabetic patients with open fractures, especially those with soft tissue injury.

Objective:To evaluate the effectiveness of perioperative fasting abbreviation in traumatic patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery.Methods:The patients were selected for this prospective nonrandomized controlled study who had undergone selective surgery from June 2019 to June 2021 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. They were divided into an intervention group and a control group according to the wards where they stayed. The intervention group was fasted for solids from 0 o'clock on the surgery day and received oral solution with 6.25% maltodextrin which had been prepared by the nutritional department 3 hours prior to surgery. The control group was fasted for either liquids or solids from the midnight before surgery. All patients were evaluated according to the wake-up score and defensive reflex score after surgery. Once they were awakened, they were allowed slag-free drinks. Normal food was allowed if there was no discomfort after 2 hours. The 2 groups were compared in terms of basic information, actual preoperative fasting time, total amount of preoperative drinking, and postoperative time for initial drinking and eating. The perioperative subjective feelings (anxiety, thirst, hunger, nausea, fatigue, dizziness, sweating, stomach discomfort, etc.), grip strength and blood glucose were observed and compared between the 2 groups. Adverse reactions in the 2 groups were also observed.Results:A total of 135 patients were included, including 52 in the intervention group and 83 in the control group. The intervention group consisted of 22 males and 30 females aged from 30 to 84 years; the control group consisted of 39 males and 44 females aged from 29 to 81 years. There was no significant difference in the basic information between the 2 groups, showing comparability ( P>0.05). The intervention group had significantly shorter preoperative fasting time [3.5 (2.5, 6.3) h versus 12.0 (9.0, 16.0) h], significantly higher water intake before surgery [300 (200, 300) mL versus 100 (100, 200) mL], significantly shorter postoperative fasting time [0.08 (0, 1.25) h versus 2.00(0, 6.00) h], and significantly reduced time to return to normal diet [2.0 (2.0, 2.3) h versus 3.0(2.0, 6.0) h] than the control group (all P<0.05). The symptoms of anxiety, fatigue, sweating, and stomach discomfort in the intervention group were significantly fewer than those in the control group throughout the evaluation period. The thirst in the intervention group was significantly alleviated than that in the control group immediately after returning to the ward after surgery, and the dizziness and hunger were significantly alleviated than those in the control group when the patients left the ward to the operation room before surgery and immediately after returning to the ward. The symptom of nausea after returning to normal diet in the intervention group was significantly relieved compared with the control group. All the comparisons above showed statistically significant differences ( P<0.05). The blood glucose in the intervention group 2 hours after taking slag-free drinks was significantly higher than that in the control group ( Z=-2.108, P=0.035). There was no significant difference in the blood glucose between the 2 groups during other measurement periods ( P>0.05). There were no serious adverse reactions in either of the 2 groups. Conclusion:The protocol of perioperative fasting abbreviation may be safe and feasible for the patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery, because it shows benefits of improving the patients' subjective feelings and stabilizing the blood glucose perioperatively.

Objective:To investigate the current situation of perioperative fasting management in patients with orthopaedic trauma waiting for elective surgery (those combined with diabetes mellitus included) and the surgeons' awareness in China.Methods:From November 1st to December 31st, 2021, the questionnaire forms were distributed through WeChat in the exchange group of National Enhanced Recovery Surgery (ERAS) and the exchange group of national training orthopaedists in Beijing Jishuitan Hospital. The survey contents included: time for preoperative water deprivation and for postoperative recovery of drinking in patients without diabetes mellitus, the rationales for orthopaedists to choose perioperative dietary management, the orthopaedists＇understanding of the existing guidelines, time for preoperative water deprivation and postoperative recovery of drinking and diabetes-related issues in patients with diabetes mellitus, and the time for postoperative recovery in all the patients (For the postoperative recovery of eating, there is no difference between patients with and without diabetes mellitus). The relationships were analyzed between some professional data of the orthopaedists and their rationales for choice of management strategies and their understanding of the guidelines.Results:A total of 565 valid questionnaires were collected. 12.92% (73/565) of orthopaedists required their patients without diabetes mellitus not to drink for at least 2 hours. In fact, the proportion of water prohibition from 0 o'clock on the day of operation was still the highest [24.07% (136/565)]. Respectively, 22.83% (129/565) and 42.12% (238/565) of the orthopaedists chose "water intake is allowed once awakened" and "water intake after at least 6 hours after operation" for their patients without diabetes mellitus. 33.98% (192/565) of the orthopaedists required all the patients fasted for at least 6 hours before surgery, and 44.25% (250/565) of the orthopaedists chose "eating can be resumed if there is no discomfort for 2 hours after water intake" .21.06% (119/565) of the orthopaedists demonstrated that they were quite familiar with the guidelines and carried out perioperative dietary management according to the guidelines. The management of water deprivation was more inconsistent for patients with diabetes mellitus, and more hospitals followed the traditional principles for water deprivation. The proportions of water deprivation starting at 0 o'clock on the day of operation, 8 hours before operation, 6 hours before operation and 4 hours before operation accounted respectively for 22.83% (129/565), 19.12% (108/565), 21.95% (124/565), and 18.94%% (107/565). The level of an orthopaedist's hospital and the professional rank of an orthopaedist were the factors related to the orthopaedist's understanding of the guidelines ( P<0.05). Conclusions:The current perioperative dietary management guidelines are not widely implemented or well known in Chinese faculties of orthopaedic trauma. The process of perioperative dietary management needs to be optimized for the patients combined with diabetes mellitus.

Objective:To investigate the safety of early hip fracture surgery for elderly patients on clopidogrel.Methods:This retrospective study included 242 consecutive elderly patients (≥65 years) with acute hip fracture who had undergone surgery at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital between November 2016 and April 2017. Of them, 20 were assigned into the study group who had taken clopidogrel before injury but discontinued its use within 4 days before surgery. They were 6 males and 14 females, with a median age of 80 years (77, 81). Their operation procedures for hip fracture included internal fixation with cannulated screws for femoral neck fracture in 2 cases, hemiarthroplasty for displaced femoral neck fracture in 11 cases, and internal fixation for intertrochanteric fracture in 7 cases. The control group included 222 patients who had undergone the same operative procedures but not taken any antiplatelet or anticoagulant drugs. The 2 groups were compared in terms of time between admission and operation, operation duration, intraoperative blood loss, perioperative transfusion and complications related to bleeding to analyze the safety of early surgery.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There was no significant difference between the 2 groups in the time between admission and operation [42.5 (36.3, 48.0) h for the study group versus 43.0 (28.0, 61.0) h for the control group] ( P=0.870). The median time between the last use of clopidogrel and operation was 55.0 (30.5, 71.0) h. There were no significant differences between the 2 groups in preoperative hemoglobin, operation duration, intraoperative blood loss, rate or amount of perioperative blood transfusion, or rate or amount of wound drainage ( P>0.05). The rate of general anesthesia was significantly higher for the study group (45.0%, 9/20) than for the control group (18.5%,41/222) ( P=0.012). No complications related to spinal hematoma occurred in the patients receiving spinal anesthesia from the study group. Wound hematoma and subsequent infection occurred in 2 patients from the control group. Conclusion:Early hip fracture surgery is safe for elderly patients on clopidogrel.

在加速康复外科的研究中,围术期饮食管理是重要的一环.以往的加速康复外科研究通常将糖尿病视为相对禁忌证,但糖尿病患者更加需要科学的围术期饮食管理.本文通过文献综述,总结了糖尿病患者胃轻瘫的危险因素,胃排空的定性及定量测量方法,以及糖尿病患者围术期饮食研究方面的进展.目前认为合并糖尿病的骨折患者可以参照加速康复外科围术期禁食水流程处理,缩短术前禁食水时间,但对于高风险患者需警惕糖尿病性胃轻瘫.快速床旁B超检查是术前评估胃内容物的有效方式,可以通过定性及定量测量的方法评估患者的误吸风险.术前3h饮用总量小于400ml的碳水化合物饮品不会造成糖尿病患者术前及术中血糖升高,还可减轻胰岛素抵抗,提高患者主观舒适度.

Abstract Background: Geriatric hip fracture patients receiving clopidogrel are a surgical challenge. In China, most of these patients undergo delayed surgical treatment after clopidogrel withdrawal for at least 5 to 7 days. However, delayed surgery is associated with increased complications and mortality in the older adults. This retrospective paralleled comparison study investigated the safety of early surgery for geriatric hip fracture patients within 5 days of clopidogrel withdrawal. Methods: Acute hip fracture patients (≥65 years) who were hospitalized in the orthogeriatric co-management ward of Beijing Jishuitan Hospital between November 2016 and April 2018 were retrospectively reviewed. Sixty patients taking clopidogrel before injury and discontinued <5 days before surgery constituted the clopidogrel group. The control group constituted 60 patients not taking antiplatelet or anticoagulant drugs and matched 1:1 with the clopidogrel group for sex, fracture type, operative procedure, and time from injury to operation (±10 h). The primary outcome was perioperative blood loss and the secondary outcomes were transfusion requirement, complications, and mortality. The Student's t test or Wilcoxon signed rank sum test was used for continuous variables and the Chi-square test was used for categorical variables. Results: Age, body mass index, American Society of Anesthesiologists score, and percentage undergoing general anesthesia were comparable between the groups (P > 0.050). The percentages of patients with coronary heart disease (61.7% vs. 18.3%; P < 0.001) and cerebrovascular disease (45.0% vs. 15.0%; P < 0.010) were significantly higher in the clopidogrel vs. control groups, respectively. The median clopidogrel discontinuation time before operation was 73.0 (range: 3.0–120.0) h. There was no significant difference in the estimated perioperative blood loss between the clopidogrel group (median: 745 mL) and control group (median: 772 mL) (P = 0.866). The intra-operative transfusion rate was higher in the clopidogrel group (22/60, 36.7%) than that in the control group (12/60, 20.0%) (P < 0.050). However, there was no significant difference in the blood transfusion rate during the entire perioperative period (26/60, 43.3% vs. 20/60, 33.3%; clopidogrel group vs. control group, respectively; P > 0.050). There was no significant difference in perioperative complications, and 30-day and 1-year mortality rates between the groups. Conclusions: Early hip fracture surgery is safe for elderly patients within 5 days of clopidogrel withdrawal, without increased perioperative blood loss, transfusion requirement, complications, and mortality compared with patients not taking antiplatelet drugs.

背景:老年髋部骨折患者术前隐性失血与患者结局相关,而临床医师常过多关注术中及术后失血.目的:分析老年髋部骨折不同骨折类型患者术前隐性失血情况.方法:回顾性研究2017年5月至2018年4月于我院手术治疗的老年髋部骨折患者,根据骨折类型将患者分为囊内骨折组和囊外骨折组.收集患者基线数据、术前血液检查结果、术前输血情况,通过公式计算术前隐性失血量,比较不同骨折类型术前隐性失血量的差异.结果:本研究共筛查559例患者,经核查入排标准,共纳入485例患者,其中囊内骨折患者237例,囊外骨折患者248例.囊内骨折患者自急诊至术前血红蛋白变化量(3.0 vs 11.0 g/L)、术前隐性失血量(100 vs 472 ml)及术前输血率(1.3％ vs 16.5％)均小于囊外骨折患者(P＜0.001).无移位股骨颈骨折、有移位股骨颈骨折、转子间骨折31A1、31A2、31A3及转子下骨折各组术前隐性失血量分别为137 ml、47ml、284 ml、485 ml、665 ml,差异有统计学意义(P＜0.001).结论:股骨转子间骨折患者术前隐性失血量大于股骨颈骨折患者,骨折类型越不稳定、粉碎程度越大,术前隐性失血量越多,骨科医师及麻醉医师应予重视.

Hip fractures,with an increasing morbidity in the elderly patients,pose a serious threat to the health of the aged.At the moment,surgery is the preferred treatment for the vast majority of these patients.Early surgical intervention is strongly recommended by most guidelines and articles.It is still controversial,however,whether surgery should be postponed or performed and whether medication therapy should be withdrawn or continued in some of the elderly patients with hip fracture who are taking anticoagulant or antithrombotic drugs before they are injured.Clopidogrel is one of the anti-platelet drugs commonly used clinically.This article reviews the literature regarding the impact of clopidogrel on surgical timing for hip fractures in the aged,hoping to provide useful clues to the clinical study and practice.

There has still been controversy on selection of approapreate treatments for elderly patients with acetabular fracture who are rapidly increasing in number. Although the treatment principle for them is anatomical reduction, effective fixation and early mobilization, choice of a proper treatment has turned to be a new hot spot for clinical research because the physical status, bone quality and fracture type of the elderly population are special. With unceasing achievements in medicine, surgical techniques and implants, the management ideas and strategies for elderly acetabular fractures have become gradually mature and diversified. The current major protocols include conserverative treatment, open reduction and internal fixation and total hip arthroplasty. In order to enhance the surgeons'knowledge of elderly acetabular fractures and summarize the cilinical experiences in management of them, we present this review to illustrate the current achievements and new development trends.