Background: There remain limited data on the epidemiological characteristics and related predictors of surgical site infection (SSI) after open reduction and internal fixation (ORIF) for distal femur fractures (DFFs). We designed this single-centre prospective study to explore and forecast these clinical problems. Methods:From October 2014 to December 2018, 364 patients with DFFs were treated with ORIF and followed for complete data within one year. Receiver operating characteristic (ROC) analyses, univariate Chi-square analyses, and multiple logistic regression analyses were used to screen the adjusted predictors of SSI. Results: The incidence of SSI was 6.0% (22/364): 2.4% (9/364) for superficial SSIs and 3.6% (13/364) for deep SSIs. Staphylococcus aureus (methicillin-resistant S. aureus in 2 cases) was the most common pathogenic bacteria (36.8%,7/19). In multivariate analysis, parameters independently associated with SSI were: Open fracture (OR: 7.3, p = 0.003), drain use (OR: 4.1, p = 0.037), and incision cleanliness (OR: 3.5, p = 0.002). An albumin/globulin (A/G) level ≥ 1.35 (OR: 0.2, p = 0.042) was an adjusted protective factor for SSI. Conclusions: The SSI after ORIF affected approximately one in 15 patients with DFFs. The open fracture, drain use, high grade of intraoperative incision cleanliness, and preoperative A/G levels lower than 1.35 were significantly related to increasing the risk of post-operative SSI after DFFs. We recommended that more attentions should be paid to these risk factors during hospitalization.Trial registration: NO 2014-015-1, October /15/2014, prospectively registered.We registered our trial prospectively in October 15, 2014 before the first participant was enrolled. This study protocol was conducted according to the Declaration of Helsinki and approved by the Institutional Review Board. The ethics committee approved the Surgical Site Infection in Orthopaedic Surgery (NO 2014-015-1). Data used in this study were obtained from the patients who underwent orthopaedic surgeries between October 2014 to December 2018.
Background To investigate the effect of residual varus and valgus deformity on the stress distribution of knee joint after distal femoral fracture malunion. Methods Fourteen adult cadaver specimens with formalin were selected to establish the femoral fractures models, which were fixed subsequently at neutral position (anatomical reduction) and malunion positions (at 3 degrees, 7 degrees, 10 degrees valgus positions and 3 degrees, 7 degrees, and 10 degrees varus positions). The stress distribution on the medial and lateral plateau of the femur was quantitatively measured using ultra-low pressure sensitive film technology. The change of stress distribution of knee joint after femoral fracture malunion and the relationship between stress value and residual varus varus or valgus deformity were analyzed. Results Under 400 N vertical load, the stress values on the medial and lateral plateau of the femur at the neutral position were 1.162 ± 0.114 MPa and 1.103 ± 0.144 MPa, respectively. When compared with the stress values measured at the neutral position, the stress on the medial plateau of femur were significantly higher at varus deformities and lower at valgus deformities, and the stress on the lateral plateau was significantly higher at valgus deformity and lower at varus deformities (all P < 0.05). The stress values on the medial plateau of tibia were significantly higher than the corresponding data on the lateral plateau at neutral and 3 degrees, 7 degrees, 10 degrees varus deformities, respectively (all P < 0.05), and significantly lower than the corresponding data on the lateral plateau at 3 degrees, 7 degrees, 10 degrees valgus deformities, respectively (all P < 0.05). Conclusions Residual varus and valgus deformity after femoral fracture malunion can cause obvious changes of the stress distribution of knee joint. Therefore, the distal femoral fracture should be anatomically reduced and rigidly fixed to avoid residual varus-valgus deformity and malalignment of lower limbs.
Background Surgical site infection (SSI) was the most common complication of tibial plateau fracture after open reduction and internal fixation (ORIF). Severe infections even required repeat surgeries, which would cause serious psychological harm to patients and increased the economic burden of treatment. In order to identify the characteristics of the SSI and to avoid the occurrence of SSI, we conducted a prospective study to investigate the incidence and independent risk factors of SSI after ORIF for closed tibial plateau fractures in adults. Methods This study was performed at a first-level trauma center. From October 2014 to December 2018, the study subjects were adult patients with closed fractures of the tibial plateau, all of whom underwent open reduction and internal fixation (ORIF) treatment. Finally, a total of 1108 patients were followed up. We collected patient demographics information, surgery-related variables and indexes from pre-operative laboratory examinations. Univariate and multivariate logistic analysis models were used to investigate the potential risk factors. Results Twenty-five patients (2.3%, 25/1108) developed SSI. A total of 15 of 25 infections (60.0%) were due to Staphylococcus aureus and 3 (12.0%) were due to MRSA. Independent risk factors of SSI identified by multivariate logistic analysis model were bone grafting: autograft (OR, 6.38; 95% CI, 2.155–18.886; p = 0.001) and allograft (OR, 3.215; 95% CI, 1.009–10.247; p = 0.048), fracture type (Schartzker Ⅴ-Ⅵ) (OR, 8.129; 95% CI, 2.961–22.319; p < 0.001), aspartate aminotransferase (> 40 U/L) (OR, 5.500; 95% CI, 2.191–13.807; p < 0.001), white blood cell (> 10*109/L) (OR, 2.498; 95% CI, 1.025–6.092; p = 0.044), and anion gap (> 16 mmol/L) (OR, 8.194; 95% CI, 1.101–60.980). Conclusions We should pay enough attention to patients who carried one or more of these factors at admission and adopt more reasonable treatment strategies to reduce or avoid the occurrence of SSI.
Objectives: This study aims to determine whether the dynamic change of lumbar anatomy parameters is associated with bone mineral density.Methods: This retrospective study included participants who did lumbar computed tomography (CT) scanning from October 2018 to December 2021. The established and recorded CT scanning images were used for analysis. Bone mineral density (BMD) was determined by the qCT value. CT scanning was also used to measure angle between upper and lower endplate on median sagittal view, and that between pedicle center and horizontal alignment on median sagittal view and transverse section angle on the axial view. Results: 476 participants were included. Angle between upper and lower endplate on median sagittal view in lumbar 1 (5.72±3.60), lumbar 2 (4.03±3.14), lumbar 3 (2.60 ±3.08) was positively associated with BMD, while that in lumbar 4 (2.07±4.66) was negatively associated (All P<0.05). Furthermore, angle between pedicle center and horizontal alignment on median sagittal view in lumbar 1 (-1.89±6.49), lumbar 2 (-2.10±6.96), and lumbar 3 (-0.75±5.61) was positively associated with BMD (P<0.001 for them all). However, this angle in lumbar 4 (2.99±4.78) showed no correlation with BMD (P=0.961). However, no significant correlation was observed between transverse section angle on the axial view and BMD. Conclusion: The dynamic change of lumbar anatomy parameters is associated with BMD and thus orthopadic surgeons should pay attention to these changes in the internal fixation operation.
Background: Limited information exists on the incidence of postoperative deep venous thromboembolism (DVT) in patients with isolated patella fractures. The objective of this study was to investigate the postoperative incidence and locations of deep venous thrombosis (DVT) of the lower extremity in patients underwent isolated patella fractures and to identify the associated risk factors.Methods: We collected the medical data of 716 hospitalized patients with acute isolated patella fracture who presented at the 3rd Hospital of Hebei Medical University between January 1, 2016, and February 31, 2019 and all patients met the inclusion criteria. Medical data were collected using the inpatient record system, including the patient demographics, patient’s bad hobbies, comorbidities, past medical history, fracture and surgery-related factors, and hematological biomarkers, total hospital stay, preoperative stay. Doppler examination was conducted for the diagnosis of DVT, Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors.Results: Among the 716 patients, DVT was confirmed in 29 cases, indicating an incidence of 4.1%. DVT involved bilateral limbs (injured and uninjured) in one patient (3.4%). DVT involved superficial femoral common vein in 1 case (3.4%), popliteal vein in 6 cases (20.7%), posterior tibial vein in 11 cases (37.9%), and peroneal vein in 11 cases (37.9%). The median of the interval between surgery and diagnosis of DVT was 4.0 days (range: 1.0 to 8.0 days). Six variables were identified to be independent risk factors for DVT, including age category (>65 years old), OR, 4.44 (1.34 - 14.71), arrhythmia, OR, 4.41(1.20 - 16.15), intra-operative blood loss, OR, 1.01 (1.00 - 1.02), preoperative stay (delay of each day), OR, 1.43 (1.15 - 1.78). Surgical duration, OR, 1.04 (1.03 - 1.06), LDL-C (> 3.37 mmol/L), OR, 2.98 (1.14 - 7.76).Conclusion: Incidence of postoperative DVT in patients with isolated patella fractures is not low. More attentions should be paid on postoperative DVT prophylaxis in patients with isolated patella fractures. Identification of associated risk factors can help clinicians recognize the risk population, assess the risk of DVT and develop personalized prophylaxis strategies.
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