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Jia Q, Peng Z, Huang A, Jiang S, Zhao W, Xie Z, Ma C. Is fracture management merely a physical process? Exploring the psychological effects of internal and external fixation. J Orthop Surg Res 2024; 19:231. [PMID: 38589910 PMCID: PMC11000308 DOI: 10.1186/s13018-024-04655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/02/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Internal and external fixation are common surgical procedures for treating fractures. However, the impact of different surgical approaches (including internal and external fixations) on patients' psychological status and Quality of Life (QoL) is rarely examined. Herein, we aimed to investigate the effects of internal and external fixation on anxiety, depression, insomnia, and overall mental and physical health in Distal Radius Fractures (DRF) patients. METHODS We performed a retrospective study on 96 fracture patients who underwent internal fixation (57 patients) or external fixation (39 patients). The Visual Analog Scale (VAS), the Hospital Anxiety and Depression Scale (HADS), the Athens Insomnia Scale (AIS), and the Medical Outcomes Study Short Form 36 (SF-36) questionnaire were used to assess the patients' pain, anxiety, depression, sleep, and QoL before surgery and at seven days, one month, and three months post-surgery. RESULTS The VAS scores were significantly lower in the Internal Fixation Group (IFG) than in the External Fixation Group (EFG) on the seventh day and one month postoperatively (P < 0.05). Although both groups showed no significant anxiety, depression, or insomnia before surgery (P > 0.05), the EFG showed significantly higher HADS-A, HADS-D, and AIS scores than the IFG at seven days and one and three months postoperatively (P < 0.05). Additionally, changes in HADS-A, HADS-D, and AIS scores were most significant at day seven post-surgery in the EFG (P < 0.05). Furthermore, no significant difference was found between the two groups in the average Physical Component Summary (PCS) and Mental Component Summary (MCS) scores before surgery (P > 0.05). However, both groups showed positive changes in PCS and MCS scores at postoperative day seven and one and three months postoperatively, with the IFG having significantly higher average PCS and MCS scores compared to the EFG (P < 0.05). CONCLUSION Compared to external fixation, internal fixation did not significantly impact patients' emotions regarding anxiety and depression in the early postoperative period, and physical and mental health recovery was better during the postoperative rehabilitation period. Furthermore, when there are no absolute indications, the impact on patients' psychological well-being should be considered as one of the key factors in the treatment plan during surgical approach selection.
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Affiliation(s)
- Qiyu Jia
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenlei Peng
- Xinjiang Clinical Research Center for Mental Health, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Anqi Huang
- Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Child Mental Health Research Center, Nanjing University, Nanjing, China
| | - Shijie Jiang
- Xinjiang Clinical Research Center for Mental Health, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wen Zhao
- Department of Orthopedics, Beijing Aerospace General Hospital, Beijing, China.
- Department of Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Zengru Xie
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Chuang Ma
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Song W, Wang Y, Chen W, Zhang Z, Liu X, Ou G, Cheng B, Lin H. The comparison of the Effect of double reverse traction repositor (DRTR) and traction table assisted Anterograde Intramedullary nail in treatment of femoral shaft fractures. BMC Musculoskelet Disord 2023; 24:303. [PMID: 37072713 PMCID: PMC10111643 DOI: 10.1186/s12891-023-06421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/12/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE The objective of this study was to compare the clinical efficacy of DRTR (Double Reverse Traction Repositor, DRTR)and traction table in the treatment of femoral shaft fractures with the aid of AN-IMN (Antegrade intramedullary nailing). PATIENTS AND METHODS In this study, patients with femoral shaft fractures admitted to the Department of Orthopedics at Zhaoqing First People's Hospital from May 2018 to October 2022 were recruited. All patients were treated with anterograde intramedullary nailing, with 23 patients in the DRTR-assisted group and 21 patients in the traction table-assisted group. The demographic characteristics, fracture classification, intraoperative data, postoperative data, and prognostic indicators of the two groups were recorded and analyzed retrospectively. All procedures were performed by the same team of experienced physicians. RESULTS All the patients in the two groups were followed up for more than 12 months. Both traction methods could provide stable traction for the operator during AN-IMN, and there was no significant difference in demographic characteristics and fracture classification. The intraoperative fluoroscopy times and opening reduction rate of the DRTR group were lower than those of the traction table group (P < 0.05), and the postoperative Harris Hip Score, as well as the Lyshol Lysholm knee function Score of the DRTR group, were significantly higher than the traction table group members (P < 0.05). Postoperative complications such as perineal soft tissue injury and lateral femoral cutaneous nerve injury occurred in the traction table group, but not in the DRTR group. CONCLUSION DRTR can safely and effectively provide continuous and stable traction in the femoral shaft fractures surgery, and outperforms the traction table in the number of intraoperative fluoroscopy, opening reduction rate, reduction of complications, and postoperative joint function score.
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Affiliation(s)
- Wei Song
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China.
- Department of Orthopaedics, The First people's Hospital of Zhaoqing, Zhaoqing, China.
| | - Yueying Wang
- Clinical Laboratory of the First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Weihao Chen
- Department of Orthopaedics, The First people's Hospital of Zhaoqing, Zhaoqing, China
| | - Zhenqian Zhang
- Department of Orthopaedics, The First people's Hospital of Zhaoqing, Zhaoqing, China
| | - Xuzhou Liu
- Department of Orthopaedics, The First people's Hospital of Zhaoqing, Zhaoqing, China
| | - Guoji Ou
- Department of Orthopaedics, The First people's Hospital of Zhaoqing, Zhaoqing, China
| | - Benqiang Cheng
- Department of Orthopaedics, The First people's Hospital of Zhaoqing, Zhaoqing, China
| | - Hongsheng Lin
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Lian X, Zhang H, Guo F, Wang Z, Zhao K, Hou Z, Zhang Y. Clinical effect of closed reduction minimally invasive fixation in intra-articular comminuted fractures of the femoral condyle. Front Surg 2023; 10:1085636. [PMID: 36816009 PMCID: PMC9935693 DOI: 10.3389/fsurg.2023.1085636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Objective To evaluate the advantages of double reverse traction closed reduction combined with minimally invasive fixation in treating femoral condylar comminuted fractures. Methods We retrospectively enrolled a total of 24 patients with femoral condylar comminuted fractures (AO = 33C3) admitted to Third Hospital of Hebei Medical University from March 2018 to February 2020. The patients were divided into two groups: experimental group (double reverse traction, n = 12) and control group (conventional surgery, n = 12). Patient demographics, fracture characteristics, operation time, incision length, and postoperative complications were then collected. The Hospital for Special Surgery (HSS) scores were recorded at the last follow-up visit. Results The average surgical time was 52.2 (41-73) min in the experimental group and 71.2 (45-103) min in the control group. In addition, the mean total incision length was 13.8 (11-17) cm in the experimental group and 16.3 (14-19) cm in the control group. The average HHS scores at the final follow-up were 86.3 (78-93) and 82.7 (76-90) in the experimental group and control group, respectively. Conclusion It was found that double reverse traction closed reduction combined with minimally invasive fixation can provide good repositioning results and functional extremity. Moreover, patients tolerate postoperative functional knee exercises well.
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Affiliation(s)
- Xiaodong Lian
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Heng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Fan Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Zhongzheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China,Correspondence: Yingze Zhang ; Zhiyong Hou
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China,Chinese Academy of Engineering, Beijing, China,Correspondence: Yingze Zhang ; Zhiyong Hou
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Essomba T, Nguyen Phu S. Kinematic Analysis and Design of a Six-Degrees of Freedom 3-RRPS Mechanism for Bone Reduction Surgery. J Med Device 2020. [DOI: 10.1115/1.4049057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Robot-assisted bone reduction surgery consists in using robots to reposition the bone fragments into their original place prior to fracture healing. This study presents the application of a 3-RRPS augmented tripod mechanism with six degrees-of-freedom for longitudinal bone reduction surgery. First, the inverse and forward kinematic models of the mechanism are investigated. Particularly, the forward kinematic is solved by applying Sylvester's dialytic method. Second, the velocity model is studied and its singular configurations are identified. The workspace of the 3-RRPS mechanism is then outlined and compared with the Stewart platform, which is a classical mechanism for the targeted application. The results show that this mechanism provides a larger workspace, especially its rotation angle about the vertical axis, which is an important aspect in the bone reduction. A series of simulations on the numerical and graphic software is performed to verify the entire analysis of the parallel mechanism. A physiguide and mscadams software are used to carry out a simulation of a real case of femur fracture reduction using the proposed mechanism to validate its suitability. Finally, a robotic prototype based on the mechanism is manufactured and experimented using an artificial bone model to evaluate the feasibility of the mechanism.
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Affiliation(s)
- Terence Essomba
- Department of Mechanical Engineering, National Central University, 300, Jhongda Road, Jhongli City, Taoyuan County 32001, Taiwan
| | - Sinh Nguyen Phu
- The University of Danang – University of Technology and Education, 48, Caothang Street, Danang 550000, Vietnam
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Abd Aziz AU, Abdul Wahab AH, Abdul Rahim RA, Abdul Kadir MR, Ramlee MH. A finite element study: Finding the best configuration between unilateral, hybrid, and ilizarov in terms of biomechanical point of view. Injury 2020; 51:2474-2478. [PMID: 32798038 DOI: 10.1016/j.injury.2020.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023]
Abstract
In an open fracture, the external fixator is one of the definitive treatment options as it could provide the initial stabilisation of the fractured bone. Limited literature discussing on the biomechanical stability between unilateral, hybrid and Ilizarov configurations, principally in treating a femoral fracture. Thus, this study aims to analyse the biomechanical stability of different external fixators via the finite element method (FEM). The present study portrays that different configurations of fixators possess different biomechanical stability, hence leading to different healing rates and complication risks. For the methodology, three-dimensional models of three different external fixators were reconstructed where axial loads were applied on the proximal end of the femur, simulating the stance phase. From the results, the unilateral configuration provides better stability compared to the hybrid and Ilizarov, where it displaced the least with an average percentage difference of 50% for the fixator's frame and 23% for the bone. The unilateral configuration also produced the least interfragmentary movement (0.48 mm) as compared to hybrid (0.62 mm) and Ilizarov (0.61 mm) configurations. Besides, the strain and stress of the unilateral configuration were superior in terms of stability compared to the other two configurations. As a conclusion, the unilateral configuration had the best biomechanical stability as it was able to assist the bone healing process as well as minimising the risk of pin tract infection while treating a femoral fracture.
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Affiliation(s)
- Aishah Umairah Abd Aziz
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Group, School of Biomedical Engineering & Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia; Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia.
| | - Abdul Hadi Abdul Wahab
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
| | - Rabiatul Adibah Abdul Rahim
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia.
| | - Mohammed Rafiq Abdul Kadir
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Group, School of Biomedical Engineering & Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia; Sport Innovation and Technology Centre (SITC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia.
| | - Muhammad Hanif Ramlee
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Group, School of Biomedical Engineering & Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia; Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia.
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Deng XT, Wang ZZ, Zhu J, Tan ZC, Wang YC, Zhu YB, Chen W, Zhang YZ. An Often Easily Missed Injury in the Presence of Orthopaedic Trauma: A Case Series of Derived Injury. Orthop Surg 2020; 12:337-342. [PMID: 31958888 PMCID: PMC7031595 DOI: 10.1111/os.12606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 11/18/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022] Open
Abstract
Derived disaster is a common concept in emergencies such as earthquakes. With the progress of society, the incidence of fractures caused by high-energy trauma has increased year by year. After the first injury, the possibility of derived injury caused by the original injury also increases rapidly. Orthopaedic surgeons, especially trauma orthopaedic surgeons, lack sufficient understanding and recognition of this kind of injury. The purpose of this article is to present a case series of an often missed injury pattern that is associated with an original injury. The diagnosis of derived injury may go unrecognized in a considerable number of cases and delayed treatment decreases the success rate of soft tissue repairing; therefore, a high index of suspicion and a proper early diagnosis is of paramount importance. We also describe the current surgical management used by the authors, and propose the concept of "derived injury", studying its clinical significance in traumatic orthopaedics.
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Affiliation(s)
- Xiang-Tian Deng
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Zhong-Zheng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Jian Zhu
- School of Medicine, Nankai University, Tianjin, China
| | - Zhan-Chao Tan
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yu-Chuan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yan-Bin Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Ying-Ze Zhang
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
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Chen W, Zhang YZ. Concept and Classification of a Derived Injury Resulting from a Primary Injury in Orthopedic Trauma. Chin Med J (Engl) 2017; 130:2632-2634. [PMID: 29067962 PMCID: PMC5678265 DOI: 10.4103/0366-6999.217078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China
| | - Ying-Ze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China
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Mauffrey C, Mauffrey OJ. What's Important: A Personal Perspective on China and Its Rapid Growth: Pearls and Pitfalls for Orthopaedic Care. J Bone Joint Surg Am 2017; 99:1876-1877. [PMID: 29088043 DOI: 10.2106/jbjs.16.01472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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