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Kim JW, Park JW, Kim HJ, Kim TY, Yoo JI, Lee YK, Jang BW. Comparison of the Surgical Outcome between the Multiple Screw Fixation and Fixed Angle Devices for the Basicervical Femoral Neck Fractures. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:680. [PMID: 38792863 PMCID: PMC11123322 DOI: 10.3390/medicina60050680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024]
Abstract
Introduction: Basicervical femoral neck fracture (FNF) is an uncommon type of femoral neck fracture and is associated with an increased risk of fixation failure due to its inherent instability. The purpose of this study was to compare the surgical parameters and reoperation rate between the use of a multiple cannulated screw (MCS) and fixed angle device (FAD) in treating basicervical FNFs. Methods: We retrospectively reviewed the records of 885 patients who underwent internal fixation between May 2004 and August 2019 to determine basicervical FNF with at least 12 months of follow-up. Among the identified 77 patients with basicervical FNF, 17 patients who underwent multiple cannulated screw (MCS) fixation and 36 patients who underwent fixed angle device (FAD) fixation were included. We compared the rates of fracture-site collapse and reoperations according to the fixation device. Results: Among the 53 patients with basicervical FNF, 13 patients (24.5%) sustained surgical complications (8 collapses of fracture site and 5 reoperations). The reoperation rate in the MCS group was significantly higher than that in the FAD group (23.5% vs. 2.8%, p = 0.016), without any significant difference in the collapse of the fracture site (11.8% vs. 16.7%, p = 0.642). Conclusions: Although basicervical FNF was rare among hip fractures, fracture site collapse was prevalent and prone to fixation failure. Surgeons should keep this in mind, and consider FAD for basicervical FNF.
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Affiliation(s)
- Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Seoul 01830, Republic of Korea; (J.-W.K.); (H.-J.K.)
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National Bundang Hospital, Seongnam-si 13620, Republic of Korea; (J.-W.P.); (Y.-K.L.)
| | - Hyo-Jung Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Seoul 01830, Republic of Korea; (J.-W.K.); (H.-J.K.)
| | - Tae-Young Kim
- Department of Orthopaedic Surgery, Konkuk University Hospital, Seoul 05030, Republic of Korea;
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea;
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National Bundang Hospital, Seongnam-si 13620, Republic of Korea; (J.-W.P.); (Y.-K.L.)
| | - Byung-Woong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
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Wen H, Wang N, Hou R. Correlation analysis between D-dimer-to-fibrinogen-ratio and carotid plaque in young patients aged 18-45 with acute cerebral infarction. Clin Neurol Neurosurg 2022; 222:107427. [PMID: 36108464 DOI: 10.1016/j.clineuro.2022.107427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND D-Dimer and fibrinogen were commonly used to detect the coagulation and fibrinolytic function, but D-dimer to fibrinogen ratio (DFR) in carotid plaque in young patients aged 18-45 with acute cerebral infarction (ACI) has not been used clinically. In this work, we focused on the evaluation of the DFR value of this group of patients and analyzed its possible correlation. METHODS A total of 164 patients with ACI patients aged 18-45 were selected as research subjects after their first admission. They had undergone carotid plaque contrast-enhanced ultrasound (CEUS) and were divided into two groups with carotid plaque (n = 97) and with no carotid plaque (n = 67). According to NIHSS score and carotid plaque grade, the clinical symptoms of patients were judged. Univariate and multivariate analyses were conducted to compare the risk factors of carotid plaque in ACI patients. RESULTS The DFR value of patients in the carotid plaque group (103.41 ± 20.81) was significantly higher than that of the no carotid plaque control group (88.9 ± 26.51). We also identified DFR X103 was the only independent risk factor (β = 0.53; 95% CI, 0.914-0.984; P = 0.05). DFR X103 was increased with the severity of the disorder and with the CEUS grades. The area under the DFR curve was 0.673 (95% CI 0.584~0.762). CONCLUSION The value of the DFR is positively correlated with CEUS carotid plaque grading and NIHSS score, which can predict the severity of carotid plaque in ACI patients aged 18-45. Therefore it is worthy of clinical application.
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Affiliation(s)
- Huijun Wen
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, PR China
| | - Ning Wang
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, PR China
| | - Ruihua Hou
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, PR China.
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Jiahao L, Kun Z, Binfei Z, Yan Z, Hanzhong X, Shuangwei Q, Chen F, Na Y, Ding T, Pengfei W. Relationship Between the Incidence of Deep Vein Thrombosis During Hospitalization and the Energy of Injury in Tibial Plateau Fractures. Clin Appl Thromb Hemost 2021; 26:1076029620913948. [PMID: 32988241 PMCID: PMC7545747 DOI: 10.1177/1076029620913948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to investigate the relationship between the incidence of deep vein thrombosis (DVT) during hospitalization and the energy of injury in tibial plateau fractures (TPFs). One hundred and forty patients were enrolled between September 1, 2014, and October 1, 2017. According to Schatzker's classification, they were classified into the low-energy (type I-III) and high-energy (type IV-VI) groups. For DVT evaluation, duplex ultrasonography was performed in the lower extremities preoperatively and postoperatively. The location and changes of DVT were recorded. All patients underwent mechanical and chemical thromboprophylaxis. The incidence of DVT in TPFs was 36.43% and 46.43% preoperatively and postoperatively, respectively. The DVT incidence was 31.75% (20/63) in the low-energy group and 40.26% (31/77) in the high-energy group preoperatively, and 44.44% (28/63) in the low-energy group and 48.05% (37/77) in the high-energy group postoperatively. There was no significant difference between the 2 groups preoperatively (P = .298) and postoperatively (P = .785). The days between operation and discharge (P = .016), blood loss during surgery (P = .016), and preoperative d-dimer level (P = .02) showed differences between the 2 groups. Additionally, 29 new thrombi (14 [48.28%] in the high-energy group and 15 [51.72%] in the low-energy group) appeared and 16 preoperative thrombi disappeared postoperatively. Despite mechanical and chemical thromboprophylaxis, the DVT risk in patients with TPFs remains high. Although the DVT incidence is not significantly different between high-energy and low-energy injuries, the occurrence of DVT should be carefully monitored.
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Affiliation(s)
- Li Jiahao
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
- Department of Hand and Foot Microsurgery, Baoji Hospital of Traditional Chinese Medicine, Shaanxi, China
| | - Zhang Kun
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Zhang Binfei
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Zhuang Yan
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Xue Hanzhong
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Qu Shuangwei
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Fei Chen
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Yang Na
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Tian Ding
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Wang Pengfei
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
- Wang Pengfei, Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China.
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Yan M, Pan XT, Cheng X, Lu Y. Characteristics and significance of changes of thrombomodulin and plasma protein C in patients with cancer before and after PICC. Indian J Cancer 2019; 57:27-30. [PMID: 31736467 DOI: 10.4103/ijc.ijc_252_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective This study aimed to evaluate the changes and clinical significance of thrombomodulin (TM) and plasma protein C (PC) in patients with cancer before and after peripherally inserted central catheter placement (PICC). Materials and Methods The levels of plasma TM and PC in 35 patients with cancer before and after PICC were measured by enzyme-linked immunosorbent assay, and the significance of the differences was analyzed. Results TM was 3.57 ± 1.01 μg/L at 1 day after catheterization, which was significantly lower than the value of 4.41 ± 1.26 μg/L before catheterization; these values were 4.30 ± 1.81 and 4.73 ± 0.97 μg/L at 30 and 90 days after catheterization, respectively (F = 4.14,P < 0.05). PC was 3.32 ± 1.35 μg/L at 1 day after catheterization, which was significantly lower than the value of 5.32 ± 2.12 μg/L before catheterization; these values were 4.64 ± 2.44 and 5.83 ± 3.14 μg/L at 30 and 90 days after catheterization, respectively (F = 6.28,P < 0.01). There were no significant differences in platelet (PLT) counts, plasma D-D, and coagulation parameters among the four time points before and after catheterization. There was a positive correlation between TM and PC (r = 0.5420,P < 0.01) on day 1 after PICC line insertion. The levels of TM and PC were not related to PLT, plasma D-dimer, or various coagulation parameters. Conclusions The levels of TM and PC in the patients 1 day after PICC were significantly decreased and showed a positive correlation, but were not related to PLT, plasma D-dimer, or coagulation function.
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Affiliation(s)
- Min Yan
- Department of Hematology and Oncology, Taicang Hospital Affiliated to Suzhou University, Taicang, China
| | - Xiang-Tao Pan
- Department of Hematology and Oncology, Taicang Hospital Affiliated to Suzhou University, Taicang, China
| | - Xu Cheng
- Department of Hematology and Oncology, Taicang Hospital Affiliated to Suzhou University, Taicang, China
| | - Ye Lu
- Department of Hematology and Oncology, Taicang Hospital Affiliated to Suzhou University, Taicang, China
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Sheehan KJ, Williamson L, Alexander J, Filliter C, Sobolev B, Guy P, Bearne LM, Sackley C. Prognostic factors of functional outcome after hip fracture surgery: a systematic review. Age Ageing 2018; 47:661-670. [PMID: 29668839 DOI: 10.1093/ageing/afy057] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Indexed: 11/13/2022] Open
Abstract
Objective this systematic review aimed to identify immutable and modifiable prognostic factors of functional outcomes and their proposed mechanism after hip fracture surgery. Design systematic search of MEDLINE, Embase, CINAHL, PEDRO, OpenGrey and ClinicalTrials.gov for observational studies of prognostic factors of functional outcome after hip fracture among surgically treated adults with mean age of 65 years and older. Study selection, quality assessment, and data extraction were completed independently by two reviewers. The Quality in Prognosis Studies Tool was used for quality assessment and assigning a level of evidence to factors. Proposed mechanisms for reported associations were extracted from discussion sections. Results from 33 studies of 9,552 patients, we identified 25 prognostic factors of functional outcome after hip fracture surgery. We organised factors into groups: demographics, injury and comorbidities, body composition, complications, and acute care. We assigned two factors a weak evidence level-anaemia and cognition. We assigned Parkinson's disease an inconclusive evidence level. We could not assign an evidence level to the remaining 22 factors due to the high risk of bias across studies. Frailty was the proposed mechanism for the association between anaemia and functional outcome. Medication management, perceived potential, complications and time to mobility were proposed as mechanisms for the association between cognition and functional outcome. Conclusion we identified one modifiable and one immutable prognostic factor for functional outcomes after hip fracture surgery. Future research may target patients with anaemia or cognitive impairment by intervening on the prognostic factor or the underlying mechanisms.
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Affiliation(s)
- K J Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - L Williamson
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - J Alexander
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - C Filliter
- Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - P Guy
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
| | - L M Bearne
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
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Lee YK, Yoon BH, Hwang JS, Cha YH, Kim KC, Koo KH. Risk factors of fixation failure in basicervical femoral neck fracture: Which device is optimal for fixation? Injury 2018; 49:691-696. [PMID: 29433801 DOI: 10.1016/j.injury.2018.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/31/2018] [Accepted: 02/07/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Basicervical femur neck fracture (FNF) is a rare type of fracture, and is associated with increased risk of fixation failure due to its inherent instability. The purpose of this study was (1) to investigate the incidence of fixation failure and (2) to determine risk factors for fixation failure in basicervical FNF after internal fixation. METHODS To identify basicervical FNF with a minimum of 12 months follow-up, we retrospectively reviewed records of 3217 patients who underwent hip fracture surgery from May 2003 to March 2016. Among the identified 77 patients with basicervical FNF, 69 patients were followed up for at least 12 months. We evaluated the rate of collapse of fracture site and reoperation due to fixation failure. We performed a multivariable analysis to determine risk factors associated with fracture site collapse and fixation failure. RESULTS Among the 69 patients with basicervical FNF, 17 (24.6%) showed collapse of fracture site, and 6 (8.6%) underwent conversion to arthroplasty because of fixation failure. In the multivariable analysis, use of extramedullary plating with a sliding hip screw was an independent significant risk factor for both collapse of fracture site (odds ratio 6.84; 95% confidence interval 1.91-24.5, p = 0.003) and fixation failure (odds ratio 12.2; 95% confidence interval 1.08-137.7, p = 0.042). CONCLUSIONS Basicervical FNF treated with extramedullary plate with a sliding hip screw is more likely to fail than that treated with intramedullary nail with a helical blade. Our results suggested that intramedullary nail with a helical blade is more recommended for basicervical FNF compared with extramedullary plate with a sliding hip screw. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea.
| | - Ji Sup Hwang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Yong-Han Cha
- Department of Orthopedic Surgery, Eulji University Hospital, 95, Dunsanseo-ro, Seo-gu 35233, South Korea.
| | - Ki-Choul Kim
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Dongnam-gu, Cheonan-si, Chungcheongnam-do, South Korea.
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Venous Thromboembolism as Predictor of Acute Care Hospital Transfer and Inpatient Rehabilitation Length of Stay. Am J Phys Med Rehabil 2017; 96:367-373. [PMID: 27779488 DOI: 10.1097/phm.0000000000000643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of venous thromboembolism (VTE) on rate of acute care hospital transfer, inpatient rehabilitation (IPR) length of stay (LOS), and functional outcomes. DESIGN This was a retrospective cohort study of 2312 consecutive patient discharges from a single IPR facility over an 18-month period. RESULTS When age, sex, reason for admission, and admission Functional Independence Measure (FIM) scores were controlled for, those with VTE had nearly 2 times greater odds for transfer to acute care hospital than did those without a diagnosis of VTE. Inpatient rehabilitation LOS was 4.700 days (95% confidence interval [CI], 2.956-6.445 days) longer for those with a diagnosis of VTE prior to IPR admission and 2.287 days (95% CI, 1.026-3.547 days) longer for those with a diagnosis of VTE during IPR admission compared with those without a diagnosis of VTE. There was no difference in FIM change based on VTE diagnosis. Venous thromboembolism diagnosis during IPR was associated with a significant decrease in FIM efficiency (-0.358; 95% CI, -0.654 to -0.062) if diagnosed during IPR admission, but there was no difference in FIM efficiency if VTE was diagnosed prior to IPR. CONCLUSIONS Patients with a diagnosis of VTE were more likely to be transferred to the acute care hospital and have longer IPR LOS independent of admission FIM scores. It is important to prevent development of VTE. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) understand the association of venous thromboembolism (VTE) diagnosis with acute hospital transfer and inpatient rehabilitation length of stay; (2) identify reasons for acute hospital transfer in patients diagnosed with VTE; and (3) understand the relationship between VTE diagnosis and functional outcomes during inpatient rehabilitation. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Re: "Predictors of poor clinical outcome following hip fracture in middle-aged patients". Injury 2015; 46:1695-6. [PMID: 25604156 DOI: 10.1016/j.injury.2014.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/25/2014] [Indexed: 02/02/2023]
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