Impact of the Interaction Model of Client Health Behavior on the Physical and Psychological Health of Patients with Limb Fracture

Background

During rehabilitation, patients with limb fracture should receive physical and psychological nursing. The study aimed to explore the intervention effect of the Interaction Model of Client Health Behavior on the physical and psychological health of patients with limb fracture.

Methods

Convenience sampling was used to recruit patients with limb fracture who underwent orthopedic treatment in three hospitals in Zhejiang Province, China from 2021-2022. In total, 118 volunteers were recruited and randomly divided into intervention (n = 60) and control (n = 58) group. The control group received routine treatment and nursing of limb fracture, whereas the intervention group received nursing intervention under the Interaction Model of Client Health Behavior. The Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Athens Insomnia Scale (AIS), and Visual Analogue Scale (VAS) were used to evaluate the effect of nursing intervention under the Interaction Model of Client Health Behavior.

Results

The intervention group had significantly lower SDS, SAS, AIS, and VAS scores than the control group (P < 0.001) and significantly higher differences before and after treatment than the control group (P < 0.001).

Conclusion

The Interaction Model of Client Health Behavior can effectively improve the physical and psychological health of patients with limb fracture.

Hypercarnivorous teeth and healed injuries to Canis chihliensis from Early Pleistocene Nihewan beds, China, support social hunting for ancestral wolves

Collaborative hunting by complex social groups is a hallmark of large dogs (Mammalia: Carnivora: Canidae), whose teeth also tend to be hypercarnivorous, specialized toward increased cutting edges for meat consumption and robust p4-m1 complex for cracking bone. The deep history of canid pack hunting is, however, obscure because behavioral evidence is rarely preserved in fossils. Dated to the Early Pleistocene (>1.2 Ma), Canis chihliensis from the Nihewan Basin of northern China is one of the earliest canines to feature a large body size and hypercarnivorous dentition. We present the first known record of dental infection in C. chihliensis, likely inflicted by processing hard food, such as bone. Another individual also suffered a displaced fracture of its tibia and, despite such an incapacitating injury, survived the trauma to heal. The long period required for healing the compound fracture is consistent with social hunting and family care (food-sharing) although alternative explanations exist. Comparison with abundant paleopathological records of the putatively pack-hunting Late Pleistocene dire wolf, Canis dirus, at the Rancho La Brea asphalt seeps in southern California, U.S.A., suggests similarity in feeding behavior and sociality between Chinese and American Canis across space and time. Pack hunting in Canis may be traced back to the Early Pleistocene, well before the appearance of modern wolves, but additional evidence is needed for confirmation.

[Clinical efficacy of damage control orthopaedics in treatment of patients with severe traumatic brain injury combined with limb fracture]

Objective: To explore the clinical efficacy of damage control orthopaedics in treatment of patients with severe traumatic brain injury combined with limb fracture. Methods: Total 149 patients with sTBI combined with limb fracture treated in Emergency Surgery Department of Shandong University Qilu Hospital from January, 2011 to December, 2018 were collected. Patients that were treated with immediate definitive fixation before March 31st, 2013 were included into the routine treatment group (group A, 47 cases), and that were treated with damage control orthopaedics (DCO) after April 1st, 2013 were included into the DCO group (group B, 102 cases). The clinical data during hospitalization and prognosis 3 months after injury was analyzed retrospectively. Then according to the risk of postoperative ICP increase, the two groups were divided into low risk subgroup and high risk subgroup. The postoperative ICP, length of stay and GOS score were statistically analyzed. Results: There were no statistically significant differences in sex, age, preoperative GCS score, imaging type of lesion and initial intraoperative ICP between the two groups. The postoperative ICP and incidence of coagulation dysfunction were significantly higher in group A [(17.1±4.6) mmHg, 29.8%] than that in group B[(15.0±4.3) mmHg, 13.7%] separately(P<0.05), and there was no significant difference of length of stay and GOS score between the two groups (P=0.475 and 0.097, respectively). As for the subgroup with low risk of postoperative ICP increase, there was no significant difference in postoperative ICP and GOS score between group A and B, and the length of stay of group B was significantly longer than that of group A (P<0.05). As for the subgroup with high risk of postoperative ICP increase, there was no significant difference in the length of stay between group A and B (P=0.667), and for group A the postoperative ICP was higher and GOS score was lower than that of group B (P<0.05). Conclusions: For patients with sTBI combined with limb fracture, the application of DCO should be based on the severity of traumatic brain injury. For patients with high risk of postoperative ICP increase, DCO can significantly improve the prognosis of patients.

Epidemiological, Clinical and Microbiological Characteristics of Patients with Post-Traumatic Osteomyelitis of Limb Fractures in Southwest China: A Hospital-Based Study

Objective To determine the epidemiological, clinical and microbiological characteristics, of patients with post-traumatic osteomyelitis of extremity fractures, and provide evidence-based guidelines for early diagnosis and treatment, including empiric antibiotic therapy. Methods Human subject research was performed using institutional review board approved protocols. A retrospective chart review was conducted on 5,368 patients diagnosed with extremity traumatic fractures from January 1, 2012 to December 31, 2015, to identify osteomyelitis patients. Records from the Microbiology Department were reviewed, and patients with a positive wound culture, or bone biopsy culture, were selected for the study. Microbial suceptability was determined by the M-100-S22 protocol (Clinical & Laboratory Standards Institute® (CLSI) 2012 USA). Additional clinical information, including data on patients' baseline epidemiological, clinical, and microbiological records was collected from all available charts, and reviewed using a designed protocol. Results 84 (1.56%) patients were diagnosed with osteomyelitis based on a positive culture result. The most prevalent comorbidities in these patients were compartment syndrome, diabetes and hypertension. The most commonly involved infected site was the tibia-fibula (47.62%). 66 (78.57%) of these cases were monomicrobial, and 18 cases (21.43%) were polymicrobial. The infections were predominantly caused by Gram-positive bacteria (56, 53.85%). The most common Gram-positive bacteria were Staphylococcus aureus (39 cases, 37.50%) and S. epidermidis (6 cases, 5.77%), which were sensitive to ampicillin, synercid/ dalfopristin, linezolid, tigecycline, macrodantin, and vancomycin. S. aureus was the most common pathogen in both monomicrobial and polymicrobial cases. All 17 cases of MRSA infection were sensitive to Imezolid, ampicillin, synercid/ dalfopristin, linezolid, tigecycline, furadantin, piperacillin/yaz, rifampicin, and vancomycin, respectively. The most common Gram-negative bacteria were E. coli (16 cases, 15.38%) and Enterobacter cloacae (11 cases, 10.58%), which were sensitive to thienamycin. Conclusions In this study, the overall rate of post-traumatic osteomyelitis of limb fractures (1.56%) is lower than the national average rate (2.6-7.8%), for major medical centers in China. The main medical comorbidities were compartment syndrome, diabetes mellitus and hypertension. The most common infection was monomicrobial in lower extremities. S. aureus was the most common pathogen, which presented in 39 (37.50%) cases, and 17 of these (43.59%) were caused by MRSA. These findings can guide empiric antibiotic therapy in Southwest China for osteomyelitis in patients with traumatic limb fractures.

Minimally invasive plate internal fixation in limb fracture patients complicated with stress ulcer: Efficacy and impact on quality of life

AIM

To observe the clinical effect of minimally invasive bone plate fixation in patients with limb fracture complicated with stress ulcer and its effect on quality of life.

METHODS

Ninety limb fracture patients complicated with stress ulcer treated from August 2015 to December 2016 were selected and randomly divided into a control group (n = 45) and an observation group (n = 45). Both groups of patients were given aluminium magnesium carbonate plus lansoprazole for treatment of stress ulcer. The control group adopted traditional internal fixation, and the observation group was treated by minimally invasive plate internal fixation. Physical function, psychological function, social function and quality of life were assessed using the World Health Organization quality of life questionnaire. Clinical curative effect and quality of life were compared between the two groups.

RESULTS

Operative time and wound healing time were significantly shorter in the observation group than in the control group (P < 0.05). Blood loss and incision length of the observation group were significantly less than those of the control group (P < 0.05). The scores of physical function, psychological function, social function and quality of life were significantly better in the observation group than in the control group (P < 0.05). The incidence of postoperative complications was 4.44% in the observation group and 13.33% in the control group, and there was a significant between the two groups (P < 0.05).

CONCLUSION

Minimally invasive plate internal fixation combined with routine treatment has good efficacy and can improve quality of life in limb fracture patients complicated with stress ulcer.