Purpose:To test the hypothesis that lidocaine prolongs the safe period of circulatory arrest during deep hypothermia. Methods: Sixteen dogs were subjected to cooling, first surface cooling to 30~ and then core cooling to 20~ rectal temperature). The circulation was then stopped for 90 rain. In the lidocaine group, 4 mg.kg-' lidocaine was injected into the oxygenator two minutes before circulatory arrest and 2 mg.kg-' at the beginning of reperfusion and rewarming. The control group received equivalent volumes of normal saline. Post-operatively, using a neurological deficit scoring system (maximum deficit score -100; minimum -zero indicating that no scored deficit could be detected). Neurological function was evaluated hourly for six houm and then daily for one week. the pharmacokinetic parameters were calculated using one compartment model. Results: On the seventh day, the neurological deficit score and overall performance were better in the lidocaine (0.83 -+ 2.04) than in the control group (8.33 -+ 4.08 P < 0.05). During the experiment, the base excess values were also better in the lidocaine than in the control group (at 30 min reperfusion:-4.24 _+ 1.30 vs -8.20 _ 2.82 P < 0.01, at 60 min reperfusion was -3.34 _+ 1.87 vs -7.52 _+ 2.40 (P < 0.01). On the eighth day the extent of pathological changes were milder in the lidocaine group than that in the control group. The elimination half life of lidocaine was 40.44 _ 7.99 during hypothermia and 2.01 -+ 4.56 during rewarming. Conclusions:In dogs lidocaine prolongs the safe duration of circulatory arrest during hypothermia.Objectif : V&ifier I'hypoth&e qui veut que la lidoca~ne prolonge la p&iode sans risque d'arr& circulatoire sous hypothermie profonde. M~thode : Seize chiens ont ~t~ soumis ~ un refroidissement, externe d'abord jusqu'~ 30 ~ puis interne jusqu'~ une temp&ature rectale de 20 ~ La circulation a ~t~ arr&& ensuite pendant 90 min. Dans le groupe ayant re~u de la lidoca'ine, 4 mgxkg-' de lidocafne ont ~t~ inject& dans I'oxyg~nateur deux minutes avant I'arr& de la circulation et 2 mgxkg "~ au d~but de la reperfusion et du r&hauffement. Le groupe t~moin a re~u des quantit& ~quivalentes de solution salve. Apt& rintervention, au moyen d'un syst~me de cotation du d~ficit neurologique (d~ficit maximal -100; minimal -z&o, indiquant qu'aucune baisse n'a &~ d&ect~e dans cette &helle de cotation), la fonction neurologique a ~t~ ~valu& ~ toutes les heures pendant six heures et, par la suite, ~ chaque jour pendant une semaine. Les param&res pharmacocin~tiques ont ~te~ calculus avec I'emploi d'un module monocompartimental. K~sultats : Le septi~me jour, la cotation du d~ficit neurologique et le rendement global ont ~t~ meilleurs dans le groupe avec la lidocaine (0,83 -+ 2,04) que dans le groupe t~moin (8,33 -+ 4,08 P < 0,05). Pendant I'exp&ience, les valeum de I'exc~s basique ont aussi ~t~ meilleures dans le groupe avec lidoca'fne que dans le groupe t(~moin (30 min. apr& le d~but de la reperfusion: -4,24 + 1,30 vs -8,20 + 2,82 P < 0,01; ~ 60 min. -3,34 _ 1,87 vs -7,52...
Pauwels type-3 femoral neck fractures are challenging injuries to manage with high rates of complications after internal fixation and no consensus has been reached regarding the optimal fixation construct. The current study aims to evaluate the effect of dynamic limited axial compression in parallel screws combined with medial buttress plate (SMBP) or lateral compression plate (LCP) fixation of Pauwels type-3 femoral neck fractures.Methods: We performed a retrospective analysis of 51 cases of Pauwels type-3 femoral neck fractures who were fixed by SMBP or LCP. Specifically, the screw fixing the femoral head in the buttress plate was omitted. Postoperative complications and functional outcomes were mainly studied.Results: With a mean follow-up of 19.9 months, the rate of neck shortening was higher in the LCP group than that in SMBP group (32.1% vs. 8.7%, p = 0.04). Neither nonunion nor avascular necrosis was observed in both groups. Good-to-excellent Harris hip score accounts for 95.2% in SMBP group and 89.3% in LCP group ( p = 0.40). Moreover, older age, fracture comminution and compression plate fixation predispose to neck shortening. Conclusion:Dynamic limited axial compression by SMBP or LCP fixation was effective to improve the functional outcome of patients with Pauwels type-3 femoral neck fractures.
Background Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt. Methods We retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating from January 2014 to August 2019. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt. Results Age, gender, Garden classification, posterior comminution, and reduction quality showed no significant difference between the groups. Increased posterior tilt was lower in the ALTS group (3.2°, 2.1–4.3°) than that in the NTS group (5.3°, 4.2–8.3°) (p < 0.001), and the percentage of people with > 5° of posterior tilt was also lower in the ALTS group (5, 13.9% vs. 24, 52.2%; p < 0.001). Femoral neck shortening (FNS) was lower in the ALTS group (3.1 (2.1–4.7) mm vs. 4.3 (3.1–6.3) mm, p = 0.003), though not statistically significant when using 5 mm as the cut-off value. Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0, 84.0–90.0 vs. 82.0, 76.0–84.5; p < 0.001). Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups. Multivariable analysis identified posterior comminution (OR 15.9, 95% CI 3.6–70.3, p < 0.001), suboptimal reduction quality (OR 12.0, 95% CI 2.6–56.1, p = 0.002), and NTS configuration (reference: ALTS configuration) (OR 21.9, 95% CI 4.1–116.4, p < 0.001) as risk factors for developing posterior tilt. Conclusions Configuration of anterior positioning screw in proximal femoral plating provides better resistance against posterior tilt in the fixation of retroverted femoral neck fractures. Also, posterior comminution, suboptimal reduction, and NTS configuration (reference: ALTS) are risk factors for developing posterior tilt. Trial registration The trial registration number was ChiCTR2000039482.
Background: Preoperative posterior tilt is a risk factor for fixation failure in femoral neck fractures. This study aimed to evaluate the configuration of anterior positioning screw in proximal femoral plating in the treatment of retroverted femoral neck fractures in terms of resisting posterior tilt.Methods: We retrospectively analyzed patients with retroverted femoral neck fractures who were fixed by proximal femoral plating from January 2014 to August 2019. All patients were divided into two groups according to screw configuration: anterior long-threaded screw (ALTS, n = 36) and normally short-threaded screws (NTS, n = 46). Baseline characteristics were reviewed and radiological and clinical outcomes were analyzed. Logistic regression analysis was used to identify risk factors for developing posterior tilt.Results: Demographic data showed no significant difference. Increased posterior tilt was lower in the ALTS group (3.2°, 2.1 – 4.3°) than that in the NTS group (5.3°, 4.2 – 8.3°) (p < 0.001), and the percentage of people with > 5° of posterior tilt was also lower in the ALTS group (5, 13.9% vs. 24, 52.2%; p < 0.001). Femoral neck shortening (FNS) was lower in the ALTS group (3.1 (2.1 – 4.7) mm vs. 4.3 (3.1 – 6.3) mm, p = 0.003), though not statistically significant when using 5 mm as the cut-off value. Harris Hip Score in the ALTS group was higher than that in the NTS group (87.0, 84.0 – 90.0 vs. 82.0, 76.0 – 84.5; p < 0.001). Postoperative complications including delayed union, nonunion, and avascular necrosis were comparable between the groups. Multivariable analysis identified posterior comminution (OR 15.9, 95% CI 3.6 – 70.3, p < 0.001), suboptimal reduction quality (OR 12.0, 95% CI 2.6 – 56.1, p = 0.002), and NTS configuration (ref: ALTS configuration) (OR 21.9, 95% CI 4.1 – 116.4, p < 0.001) as risk factors for developing posterior tilt.Conclusions: Configuration of anterior positioning screw in proximal femoral plating provides better resistance against posterior tilt in the fixation of retroverted femoral neck fractures. Also, posterior comminution, suboptimal reduction, and NTS configuration (ref: ALTS) are risk factors for developing posterior tilt.Trial registration: Retrospectively registered.
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