The clinical effectiveness of multidisciplinary co-managed care for hip fracture patients in China has been demonstrated in a multicenter non-randomized controlled study. This study aims to estimate the cost-effectiveness of the co-managed care.

Backgroud Psychological disorders, including depression, fear of falling, and cognitive disorders, are common among elderly patients with hip fractures. The effectiveness of a co-management care model in elderly hip fracture patients has been established, but its impact on those with psychological disorders remains unclear. Objective This study aims to investigate the effects of a co-management care model on elderly hip fracture patients with psychological disorders. Methods This study conducted a post-hoc analysis of a quasi-experiemental trial. The intervention group received collaborative care from orthopedic and geriatric departments in Beijing hospital, while the control group received standard orthopedic-led management in five other hospitals. The primary outcomes included three follow-up assessments within one year, focusing on changes in quality of life from admission. Repeated measurement linear regression models were used to compare differences between the groups, adjusting for potential confounding factors. Results The study included 2,071 patients with hip fractures: 1,110 in the intervention group and 961 in the control group. Over half of the patients experienced one or more psychological disorders, primarily fear of falling and cognitive disorders. The intervention had no significant effect on patients with depressive states. Patients with cognitive disorder can benefit from a co-management care model. The co-management care model may have a unfavorable effect on patients with high fear of falling. Additionally, it did not impact the quality of life in patients with concurrent depression, higher fear of falling, and cognitive disorder. Conclusion The co-management care model can improve quality of life for elderly hip fracture patients with cognitive disorder. Long-term health education for elderly hip patients should be strengthened, especially those with high fear of falling.

Background The clinical effectiveness of multidisciplinary co-managed care for hip fracture patients in China has been demonstrated in a multicenter non-randomized controlled study. This study aims to estimate the cost-effectiveness of the co-managed care. Methods The study is based on a multicenter clinical trial (n = 2071) in China. We developed a state transition microsimulation model to estimate the cost-effectiveness of the co-managed care compared with usual care for hip fracture patients from healthcare system perspective. The costs incorporated into the model included hospitalization costs, post-discharge expenses, and secondary fracture therapy costs. Effectiveness was measured using quality-adjusted life years (QALYs). Costs and effects were discounted at 5% annually. A simulation cycle length of 1-year and a lifetime horizon were employed. The cost-effectiveness threshold was established at USD 37,118. To address uncertainties, one-way deterministic sensitivity analysis and probabilistic sensitivity analysis were conducted. Findings In the base case analysis, the co-managed care group had a lifetime cost of USD 31,571 and achieved an effectiveness of 3.22 QALYs, whereas the usual care group incurred a cost of USD 27,878 and gained 2.85 QALYs. The incremental cost-effectiveness ratio was USD 9981 per QALY gained; thus the co-managed care model was cost-effective. The cost-effectiveness was sensitive to the age of having hip fractures and hospitalization costs in the intervention group. Interpretation The co-managed care in hip fracture patients represents value for money, and should be scaled up and prioritized for funding in China. Funding The study is supported by Capital's Funds for Health Improvement and Research (2022-1-2071, 2018-1-2071).

Background There is well-established evidence to understand the characteristics of falls among the older patients with hip fracture in many countries, but very little knowledge existed in China. This study described the characteristics of falls in older patients with hip fractures from six Chinese hospitals. Methods This cross-sectional study is a post-hoc descriptive analysis of a recently completed trial. Eligible patients were aged 65 years and older, with confirmed hip fractures due to falls, and were admitted to the hospital within 21 days of the fracture. All patients were consecutively enrolled and screened within one year (November 15, 2018, to November 14, 2019). The collected data included patient demographics and fall-related information. Results A total of 1,892 patients’ fall-related information were described. Most patients with hip fractures caused by falls were in the oldest old age group (60.4% in age group ≥ 80), with an overall average age of 80.7 (7.6) years. There were more females (n = 1,325, 70.0%) than males (n = 567, 30.0%). The majority lived in urban (n = 1,409, 74.5%). Most falls (n = 1,237, 67.3%) occurred during the daytime (6:01–18:00). There were 1,451 patients had their falls occurring at home (76.7%). Lost balance (n = 1,031, 54.5%) was reported as the primary reason to cause falls. The most common activity during a fall was walking (n = 1,079, 57.0%). Conclusions Although the incidence of fall-related hip fractures in China is unclear, preventing falls and fall-related hip fractures in older people remains an urgent health concern as the ageing society increases. Studies with larger sample size and diverse population are needed to robustly understand this growing epidemic.

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.

目的 探讨滑雪运动损伤的临床特点及分类情况.方法 采用横断面调查方法调查2017年1月至2019年1月在北京积水潭医院急诊就诊的滑雪运动损伤患者,分析损伤的部位、类型及严重程度.结果 共有216例患者纳入本调查,其中男130例,女86例,年龄9～65岁,平均(38.78±14.12)岁.滑雪运动损伤部位以下肢占比最高,为51.4％,其中膝、踝关节及小腿损伤最为多见,分别占总数的22.2％、12.0％和8.8％;躯干损伤次之,以腰部损伤为主,占12.0％;上肢损伤最少,以肩关节损伤较为常见,占11.1％.常见的损伤类型依次为韧带损伤、擦伤、挫伤和骨折,分别占损伤总数的32.4％、17.6％、13.9％和11.6％.在创伤严重程度分级中,轻伤患者最多,占83.33％,随着损伤严重程度的增加,患者比例逐渐降低,分别为重伤13.43％、严重伤2.31％、存活概率低0.93％.结论 滑雪运动损伤中下肢损伤占比最高,且以韧带损伤最为常见,因此在滑雪运动中需加强对下肢的保护,以减少相关损伤的发生.

Objective:To summarize our experience in prevention of COVID-19 infection in emergency and confined operations during the first 3 weeks after Spring Festival in 2020.Methods:From February 3rd to 23rd, 2020, 151 patients were admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for emergency and confined operations. In this cohort, 125 patients were admitted to ordinary wards. They were 70 males and 55 females with an age of 51.1 years ± 14.9 years. Of them, 2 were subjected to emergency operation and 123 to confined operation. The mean time from injury to operation was 9.9 days ± 6.1 days. There were 26 cases in the senile wards, 7 males and 19 females with an age of 80.8 years ± 7.0 years all of whom underwent confined operations. The mean time from injury to operation was 8.4 days ± 6.3 days. The protocols for emergency diagnosis, admission, emergency and confined operations, postoperative rehabilitation and management of suspects with COVID-19 during the epidemic of COVID-19 were optimized according to Diagnosis and Treatment Protocols for Novel Coronavirus Pneumonia (Trial version 5), emergency responding pre-plans of our hospital, and our experience in Enhanced Recovery After Surgery (ERAS) as well.Results:The patients in the ordinary wards had a hospital stay of 6.8 days ± 4.6 days while those in the senile wards 5.1 days ± 2.0 days. Abnormal temperature (≥37.3 ℃) was observed perioperatively in 17 cases in the ordinary wards. It was absorption fever in all and appeared in 4 cases upon admission. Fever appeared in 11 patients in the senile wards and upon admission in 3 of them. One senile patient who had been diagnosed of normal pneumonia returned to normal temperature and remained stable conditions after antibiotic therapy. The other patients were free of complications related to COVID-19 during their hospital stay.Conclusion:The first-line medical staff working at emergency department, wards and surgical theaters must heighten their vigilance against COVID-19 infection and rigorously follow protocols for prevention of COVID-19 infection in their daily clinical practice.

Objective:To evaluate the clinical outcomes of robot-assisted minimally invasive surgery for acetabular fracture.Methods:From January 2015 to December 2019, 31 patients with acetabular fracture underwent TiRobot-assisted minimally invasive surgery at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. They were 27 males and 4 females, with an average age of 42.3 years (from 17 to 71 years). By the Letournel-Judet classification, there were 5 anterior column fractures, 12 transverse fractures, 2 transverse + posterior wall fractures, 8 T-shaped fractures, 2 anterior + posterior hemitransverse fractures and 2 associated both column fractures. The time from injury to surgery averaged 9.0 d (from 2 to 21 d). Of the 31 patients, 23 underwent robot-assisted percuta neous internal fixation and 8 robot-assisted limited open reduction and internal fixation. Recorded were number of screws, operation time, intraoperative bleeding, blood transfusion, ICU use, hospital stay and related complications.Results:For the 31 patients, on average, screw number was 1.9 (from 1 to 5), operation time 3.3 h (from 1.0 to 8.5 h), intraoperative bleeding 298.7 mL (from 20 to 2,000 mL), allogenic transfusion 77.4 mL (from 0 to 800 mL), autologous transfusion 56.5 mL (from 0 to 800 mL), rate of complications 9.7% (3/31), rate of ICU use 29.0% (9/31), and hospital stay 6.0 d (from 1 to 23 d). In this cohort, 29 patients were followed up for an average time of 34.2 months (from 6 to 65 months) and 2 lost to the follow-up. At the final follow-up, the modified Merle d'Aubigné scores averaged 16.7 points(from 12 to 18 points); the Majeed scores averaged 85.4 points (from 60 to 100 points), giving 18 excellent, 7 good and 4 fair cases and a good to excellent rate of 86.2% (25/29).Conclusion:Orthopaedic robots can help clinicians accurately locate a safe pathway and assist safe placement of acetabular screws to fulfill minimally invasive fixation of acetabular fracture, leading to fine clinical outcomes.

Objective To compare the therapeutic effects between the anesthetic and non-anesthetic closed reduction protocols for distal radius fractures based on the concept of Enhanced Recovery After Surgery (ERAS).Methods A prospective study was conducted in a cohort of 186 patients with distal radius fracture who had been admitted to the Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from September 2018 to January 2019.The patients were divided into 2 groups depending on the choice by themselves.Of them,72 (intervention group) underwent the standardized closed reduction under brachial block anesthesia based on the concept of ERAS while the other 114 (control group) conventional closed reduction under no anesthesia.The 2 groups were compared in terms of emergency reduction times,swelling scores,reoperation rate,splint removal time,functional outcomes by the Patient-Rated Wrist Evaluation (PRWE) and radiographic outcomes by the Lidstr(o)m criteria.Results The patients in both groups were followed up for 6 months.The reduction times were fewer in the intervention group than in the control group (1.1 ± 0.1 versus 1.6 ±0.1,P ＜ 0.05).The reoperation rate was significautly lower in the intervention group than in the control group [2.8％ (2/72) versus 12.3％ (14/114),P ＜0.05].Reduction deteriorated the swelling condition.Compared with the control group,the swelling was significantly less in the intervention group (2.0 ± 0.1 versus 2.6 ±0.1,P ＜ 0.05).The splint removal time for the intervention group (5.3 ±0.2 weeks) was significantly shorter than that for the control group (6.9 ± 0.2 weeks) (P ＜ 0.05).The intervention group had significantly better PWRE scores than the control group (23.4 ± 1.0 versus 30.3 ± 1.1,P ＜ 0.05),but there was no significant difference between groups in the Lidstr(o)m evaluation (P ＞ 0.05).Conclusion Compared with conventional closed reduction,the closed reduction under anesthesia based on the ERAS concept is an effective method for the emergency treatment of distal radius fracture,because it may minimize the patients' pain experience,increase the rate of successful reduction,decrease the rate of reoperation,shorten the splint fixation time and gain better functional outcomes.