Objective The incidence of surgical site infection (SSI) after femoral neck fracture is significantly higher in immunocompromised patients. This study was performed to explore the temporal changes of blood-related parameters in immunocompromised patients after femoral neck fracture repair and to determine the correlation between the platelet (PLT) count and SSI. Methods This study involved 101 immunocompromised patients who underwent repair of a femoral neck fracture from April 2018 to August 2019. SSI was confirmed by postoperative observation of the incision and B-mode ultrasound imaging examination. Blood parameter measurements and dynamic observation were performed 1, 3, 5, 7, and 14 days postoperatively. Results The procalcitonin concentration, D-dimer concentration, and PLT count were strongly correlated with temporal changes. The PLT count changes crossed between patients with and without SSI 3 to 5 days after surgery, and the PLT count increased in patients with SSI 3 to 5 days after surgery. The PLT count had high specificity and sensitivity for predicting SSI with a cut-off value of 167.5 × 109/L. Conclusion The temporal changes of the PLT count in immunocompromised patients who have undergone femoral neck fracture repair can serve as an early warning of SSI.
BackgroundScrew internal fixation is one of the main surgical procedures for femoral neck fractures. Routine intraoperative fluoroscopy is hard to identify screw penetration, which becomes one of the important factors of postoperative hip pain and postoperative complications.MethodsCollect and analyze the intraoperative and postoperative imaging data of patients with internal fixation. Using geometric methods and analysis of anatomical characteristics, we explored the best imaging angle where the screw penetration was not found in the conventional 2D images of the anterior and lateral view during the operation, so that it can be determined whether there is screw penetration by taking a certain angle during the operation.ResultsThe unrecognized screw penetration rate during the operation was 25%, 5% penetrated from the back of the femoral head, and 20% penetrated the femoral neck part and then entered the head. The unrecognized screw of the femoral head is caused by the intersection of the anterior and lateral projection to form the Steinmetz solid. The study found that the special photographic orientation θ=90°—arctan (M1O′/M2O′). For the screw penetration of the femoral neck, the probability of occurrence in different areas of the femoral neck is 10.5% of the front superior part, 44.2% of the front inferior part, 28.6% of the back superior part, and 16.8% of the back inferior part. The best shooting directions of the front superior,front inferior, back superior, and back inferior through which the detection screw passes are the positive position ,35.8° to the tail side, 70° to the head side, 46.3° to the head side, and 40.5° to the tail side.ConclusionIt is important to avoid unrecognized screw penetration during the operation. In this study, it was concluded that a certain angle was taken during the operation to determine whether there was screw penetration, which significantly reduced the incidence of screw penetration of the femoral head and femoral neck.
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