The study aimed to explore the epidemiology and clinical characteristics of chronic osteomyelitis observed in a northern China hospital. Clinical data of 255 patients with chronic osteomyelitis from January 2007 to January 2014 were collected and analyzed, including general information, disease data, treatment and follow-up data. Chronic osteomyelitis is more common in males and in the age group from 41–50 years of age. Common infection sites are the femur, tibiofibular, and hip joint. More g+ than g- bacterial infections were observed, with S. aureus the most commonly observed pathogenic organism. The positive detection rate from debridement bacterial culture is 75.6%. The detection rate when five samples are sent for bacterial culture is 90.6%, with pathogenic bacteria identified in 82.8% of cases. The two-stage debridement method (87.0%) has higher first curative rate than the one-stage debridement method (71.2%). To improve detection rate using bacterial culture, at least five samples are recommended. Treatment of chronic osteomyelitis with two-stage debridement, plus antibiotic-loaded polymethylmethacrylate (PMMA) beads provided good clinical results in this study and is therefore recommended.

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5The study aimed to explore the epidemiology and clinical characteristics of chronic 6 osteomyelitis observed in a northern China hospital. Clinical data of 255 patients with 7 chronic osteomyelitis from January 2007 to January 2014 were collected and analyzed, 8including general information, disease data, treatment and follow-up data. Chronic 9 osteomyelitis is more common in males and in the age group from 41-50 years of age. 10Common infection sites are the femur, tibiofibular, and hip joint. More g+ than g-bacterial 11infections were observed, with S. aureus the most commonly observed pathogenic organism. 12The positive detection rate from debridement bacterial culture is 75.6%. was not peer-reviewed) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint (which . http://dx.doi.org/10.1101/316836 doi: bioRxiv preprint first posted online May. 9, 2018; 2 Chronic osteomyelitis is a common clinical disease and a challenging disorder, characterized 21 by its long disease course, difficult early diagnosis and high disability rate. The clinical 22 characteristics of chronic osteomyelitis are varied, and may be affected by geography, time, 23 and pathogenetic differences. Geographically, developing countries have a higher incidence 24 of the disease than developed ones, likely caused by differences in economic foundation, 25 lifestyle and healthcare level [1][2]. Over time, a shift has occurred from predominately 26 hematogenous osteomyelitis several decades ago, to a predominance of chronic osteomyelitis 27 that results from trauma, implant infection, and diabetes [3][4][5][6]. 28In recent years, the number of patients with open wounds and multiple fractures from road 29 and industrial accidents has sharply increased in China, as the Chinese economy undergoes 30 rapid development. Multiple injuries are difficult to treat and frequently lead to infection; 31 thus, treatment exerts great pressures on patients, both economically and psychologically. It 32 also poses great challenges for orthopedists [7]. Wang [8] and Jiang et al. [9] provide recent 33 data on the epidemiology of chronic osteomyelitis in southwest and southern China, which 34 can be used by local government policy-makers and by clinicians. However, China is a 35 country of great diversity in its population, climate and culture. Currently, data and relevant 36 research are lacking for northern China on the epidemiology of chronic osteomyelitis. To 37 address this, we conduct an epidemiological statistical analysis on 255 patients at a 38 prominent hospital and explore the clinical characteristics of chronic osteomyelitis in 39 . CC-BY 4.0 International license It is made available under a was not peer-reviewed) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint (which . http://dx.doi.org/10.1101/316836 doi: bioRxiv preprint first posted online May. 9, 2018; (1) acute osteomyelitis ...

Objective: To compare the perioperative hidden blood loss (HBL) and analyze its risk factors in elderly patients undergoing intramedullary fixation after intertrochanteric fractures at different altitudes. Materials and methods: This prospective study collected the perioperative clinical data of 120 elderly femoral intertrochanteric fractures from February 2020 to February 2021 at different altitudes. Twenty-nine cases were from Nanjing, where an average altitude is 10 m (group A); 73 patients were from Xining, where an average altitude is 2300 m (group B); and 20 cases were from Yushu where an average altitude is 3600 m (group C). Demographic data of the included patients, preoperative and postoperative hemoglobin, hematocrit, prothrombin time (PT), activated partial thromboplastin time (APTT), preoperative and postoperative HBL, intraoperative visible blood loss, and perioperative blood transfusion rate, and other relevant indicators were recorded and the clinical data of the 3 groups were summarized. Results: The total HBL, preoperative HBL, and postoperative HBL of group C were greater than those of groups A and B, that is, total HBL: 740±380 mL in group A versus 850±530 mL in group B versus 1090±180 mL in group C, F=3.551, P=0.032; preoperative HBL: 460±320 mL in group A versus 410±300 mL in group B versus 590±120 mL in group C, F=9.086, P=0.011; Postoperative HBL: 270±220 mL in group A versus 440±420 mL in group B versus 500±140 mL in group C, F=13.138, P=0.001. Multiple linear regression analysis found that admission PT and APTT, fracture classification AO/OTA 31-A2.2–A3.3, male, body mass index, intraoperative blood transfusion, injury to operation time >5 days, longer operation time, and high altitude all were independent risk factors for perioperative HBL increase. There was a negative correlation between low altitude and hemoglobin on the first postoperative day and HBL. Conclusion: Elderly patients undergoing intramedullary fixation after intertrochanteric fractures develop massive HBL during the perioperative period, especially in patients in high altitude areas. Regular blood tests, PT, APTT during the perioperative period are vital to avoid perioperative anemia. Shortening the perioperative period and operation time will significantly reduce HBL.