Application of Wire-Assisted Reduction Guided by Minimally Invasive Wire Introducer in the Treatment of Irreducible Femoral Intertrochanteric Fractures

Abstract Background: Open reduction was often required in the treatment of irreducible femoral intertrochanteric fractures. A minimally invasive wire introducer was designed to assist the reduction of such fractures. The aim of our study was to investigate the clinical outcomes of this technique.Methods: Between 2013 and 2018, 92 femoral intertrochanteric fracture patients who were treated with intramedullary nail fixation and difficult reduction using the traction beds were retrospectively reviewed. Decision for surgery was based on the displacement of the fracture. The patients was divided into two groups, 31 in the control group and 61 in the observation group. The control group were received open reduction operation. And the observation group still received the closed reduction operation, using minimally invasive wire introducer to guide the wire and assist the fracture reduction. The operation time, blood loss, VAS scores, angulation, reduction, neck-shaft angle, redisplacement, limb length discrepancy, and union time were recorded.Results: All patients of two groups were successfully operated and were followed up for an average of 23.8 months. There was no statistical difference in baseline data between the two groups. The observation group had shorter operation time, lower VAS score and less intraoperative bleeding. And the datas are statistically different.Conclusion: Minimally invasive wire introducer is a good technology to guide the wire for irreduciblr femoral intertrochanteric fracture reduction. Using this technique, irreduciblr femoral intertrochanteric fractures could be restored and good clinical outcome was achieved.Level of evidence: Level IV; Case Series; Treatment Study

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Application value of minimally invasive percutaneous dilational tracheostomy for ICU critical patients

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.2.594 ◽

2019 ◽

Vol 36 (2) ◽

Author(s):

Hongmei Gan ◽

Aihong Dong ◽

Haiyan Xu

Keyword(s):

Heart Rate ◽

Minimally Invasive ◽

Operation Time ◽

Healing Time ◽

Control Group ◽

Observation Group ◽

Percutaneous Dilational Tracheostomy ◽

Intraoperative Bleeding ◽

Incision Length ◽

Critical Patients

Objective: To find out the application value of minimally invasive percutaneous dilational tracheostomy in critically ill patients in intensive care unit (ICU). Methods: One hundred and forty critically ill patients who underwent tracheostomy in ICU of our hospital were included in the study from August 2016 to December 2017. They were divided into an observation group and a control group by random number table method, 70 in each group. The control group received conventional tracheotomy, while the observation group received percutaneous dilational tracheostomy. The operation time, incision length, amount of intraoperative bleeding and healing time of incision were compared between the two groups, and the changes of vital signs and complications after operation were recorded. The family members of the patients signed the informed consent. Results: The operation time, healing time and incision length of the observation group were (9.92±4.13) min, (1.31±0.21) cm and (6.91±0.72) respectively, shorter than (24.09±6.82) min, (3.40±0.65) cm and (67.48±0.61) d in the control group, and the differences were statistically significant (P<0.05). The amount of intraoperative bleeding of the observation group was (7.81±1.83) mL, less than (16.34±2.83) mL in the control group; the difference was statistically significant (P<0.05). The heart rate and oxygen saturation of the observation group before and during the operation were not significantly different (P>0.05). The heart rate of the control group during the operation was significantly higher than that before the operation (P<0.05); the oxygen saturation of the control group before and during the operation had no significant difference (P>0.05). The incidence of complications in the observation group was 24.3%, which was significantly lower than that in the control group (55.7%, X2=8.279, P=0.014). Conclusion: Minimally invasive percutaneous dilational tracheostomy has advantages of small trauma, less infection and beautiful incision, and it will not increase postoperative complications. It is of great value in the treatment of ICU critical patients. doi: https://doi.org/10.12669/pjms.36.2.594 How to cite this:Gan H, Dong A, Xu H. Application value of minimally invasive percutaneous dilational tracheostomy for ICU critical patients. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.594 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Intracortical Screw Insertion Plus Limited Open Reduction in Treating Type 31A3 Irreducible Intertrochanteric Fractures in the Elderly

10.21203/rs.3.rs-271287/v1 ◽

2021 ◽

Author(s):

Xiao-wen Huang ◽

Gu-qi Hong ◽

Qiang Zuo ◽

Chen Qun

Keyword(s):

Blood Loss ◽

Elderly Patients ◽

Open Reduction ◽

Operation Time ◽

The Elderly ◽

Fracture Reduction ◽

Intertrochanteric Fractures ◽

X Rays ◽

Intraoperative Blood Loss ◽

Screw Insertion

Abstract Objective: To discuss the clinical efficacy of intracortical screw insertion plus limited open reduction in treating type 31A3 irreducible intertrochanteric fractures in the elderly. Methods: A retrospective analysis was performed for 23 elderly patients with type 31A3 irreducible intertrochanteric fractures (12 males and 11 females, aged 65-89 years old, with an average of 75.6±5.1 years old) who received treatment at the orthopedics department of our hospital from September 2017 to August 2019. After type 31A3 irreducible intertrochanteric fractures were confirmed by intraoperative C-arm, all of these cases received intracortical screw insertion plus limited open reduction in the broken end with intramedullary screw internal fixation. The basic information of surgery, reduction effects, and FRS scores of the hip joint were assessed. Results: All patients were followed up for an average of 13.8 months. The operation time was 53.8±13.6min (40-95min). The intraoperative blood loss was 218.5±28.6ml (170-320ml). The average number of intraoperative X-rays was 22.8±4.6 (18-33). The average time to fracture union was 4.8±0.7 months. The reduction effect was assessed using Kim's fracture reduction evaluation. 20 cases achieved grade I fracture reduction and 3 cases grade II fracture reduction. All of them achieved excellent or good fracture reduction. Upon the last follow-up, the FRS score was 83.6±9.8, which was not significantly different from the FRS score (84.8±10.7) before the fracture (t= 0.397, P= 0.694). Conclusion: With careful preoperative preparation, intracortical screw insertion plus limited open reduction could achieve high-quality fracture reduction and fixation in elderly patients with type 31A3 irreducible intertrochanteric fractures. Good clinical outcomes were achieved without increasing operation time and intraoperative blood loss.

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Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2793-8 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 4

Author(s):

Shenghu Zhou ◽

Jun Liu ◽

Ping Zhen ◽

Weiwei Shen ◽

Yanfeng Chang ◽

...

Keyword(s):

Postoperative Complications ◽

Elderly Patients ◽

Intertrochanteric Fracture ◽

Operation Time ◽

The Elderly ◽

Proximal Femoral Nail ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Intraoperative Bleeding ◽

Femoral Intertrochanteric Fracture

Abstract Background The treatment for unstable intertrochanteric fractures in the elderly has always been a controversial issue. The aim in this study was to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (CPH) on femoral intertrochanteric fracture in the elderly. Methods From March 2008 to December 2012, 108 elderly patients with femoral intertrochanteric fractures were treated by PFNA or CPH. There were 63 males and 45 females, aged 75.3–99.1 years [(83.7 ± 5.6) years]. The patients’ bone mineral density was routinely measured, and the fractures were classified according to Evans-Jensen. The patients were divided into CPH group and PFNA group. The differences in operation time, intraoperative bleeding, immobilization duration, hospitalization time, Harris scores and postoperative complications including deep venous thrombosis, lung and urinary infection were analyzed. Results All patients were followed for 12.5–36.2 months [(28.0 ± 6.3) months)]. The operation time was (53.7 ± 15.2) min and (77.5 ± 16.8) min in PFNA group and CPH group, respectively (P < 0.05); intraoperative bleeding was (132.5 ± 33.2) mL and (286.3 ± 43.2) mL, respectively (P < 0.05); immobilization duration was (28.2 ± 3.7) days and (3.1 ± 1.2) days, respectively (P < 0.05); hospitalization time was (7.6 ± 1.8) days and (6.9 ± 2.2) days, respectively (P > 0.05); and the Harris scores after 1 year were (87.7 ± 7.9) points and (88.3 ± 9.2) points, respectively (P > 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion Both PFNA and CPH are safe and effective treatments for femoral intertrochanteric fracture in elderly patients. Nonetheless, CPH allows faster mobilization and recovery. Trial registration Registration Number: ChiCTR1900022846. Reg Date:2019-04-26 00:27:33 Retrospective registration

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A Comparative Study on the Efficacy between Minimally Invasive Caries Removal Technique involving Carisolv and Traditional Mechanical Caries Removal in Treating Dental Caries in Children

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v4i3.1228 ◽

2020 ◽

Vol 4 (3) ◽

Author(s):

Jiaying Song

Keyword(s):

Dental Caries ◽

Minimally Invasive ◽

Recovery Time ◽

Control Group ◽

Observation Group ◽

Research Subjects ◽

Removal Method ◽

Caries Removal ◽

The Difference ◽

Removal Technique

Objective: To explore the curative effect of Carisolv, a minimally invasive caries removal technique and traditional mechanical caries removal treatment on children's dental caries. Methods: A total of 97 children with dental caries who were treated in the Department of Stomatology in Affiliated Hospital of Chifeng University, Chifeng from September 2017 to May 2019 were selected and recruited as the research subjects. They were divided into two groups by random number table method. Forty-nine individuals were assigned in the control group while the remaining 48 individuals in the observation group. The control group was treated with traditional mechanical caries removal method, and the observation group was treated with minimally invasive caries removal technique, i.e. Carisolv. Both groups were followed up for six months. The degree of pain, recovery time of dental function and complications after six months of treatment were observed in the two groups of children. Results: During the treatment, compared with the control group, the children in the observation group experienced lower degree of pain and had shorter recovery time of dental function. After six months of treatment, the incidence of complications in the observation group was lower than that in the control group. The difference was statistically significant (P<0.05). Conclusion: Compared with traditional mechanical caries removal method, Carisolv, a minimally invasive caries removal technique could reduce the pain of children during the treatment process, shorten the time to restore dental function, reduce the occurrence of complications, and had a better therapeutic effect in treating children’s dental caries.

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Efficacy of carprostol tromethamine combined with mifepristone in the treatment of uterine fibroids

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v3i1.697 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Jun Wang ◽

Xian Zhang

Keyword(s):

Estrogen Receptor ◽

Progesterone Receptor ◽

Treatment Effect ◽

Uterine Fibroids ◽

Operation Time ◽

Clinical Treatment ◽

Control Group ◽

Observation Group ◽

Significant Difference ◽

Better Than

ã€Abstractã€‘Objective: To investigate the clinical efficacy of carboprost tromethamine combined with mifepristone in the treatment of uterine fibroids. METHODS: A total of 66 patients with uterine fibroids admitted to our hospital between April 2018 and January 2019 were selected as subjects. According to the two different treatment methods, patients were divided equally. The observation group and the control group, each group of 33 people. The oxytocin drug treatment was medicated to the control group, and the prostaglandin tromethamine combined with mifepristone was medicated to the observation group. The treatment effect, adverse reaction, operation, and uterine muscle before and after surgery were observed in these two groups. Tumor tissue progesterone receptor and estrogen receptor levels. Results: The clinical treatment effect of the observation group was 93.94%, and the clinical treatment effect of the control group was 60.61%. The clinical treatment effect of the observation group was significantly higher than that of the control group; also the incidence of adverse reactions in the observation group in terms of rash, fatigue, nausea and vomiting was much lower than the control group, and could observe a significant difference. Finally in observation group, the amount of intraoperative blood loss, operation time and hospitalization time were better than those of the control group. The progesterone receptor and estrogen receptor levels in the uterine fibroid tissue after surgery should also be better than the control group, it is worth to make further comparison. Conclusion: Carprostol tromethamine combined with mifepristone is effective in the treatment of uterine fibroids and can be further developed.

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Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures

BioMed Research International ◽

10.1155/2020/1896935 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Chun-Wei Fu ◽

Ji-Ying Chen ◽

Yueh-Ching Liu ◽

Kuang-Wen Liao ◽

Yung-Chang Lu

Keyword(s):

Intertrochanteric Fracture ◽

Operation Time ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Intertrochanteric Fractures ◽

Residual Pain ◽

Unstable Intertrochanteric Fracture ◽

Hip Screw ◽

Proximal Femoral Nail Antirotation ◽

Im Nailing

Background. The dynamic hip screw (DHS) with the addition of an angular stable trochanter-stabilizing plate (TSP) has been considered the ideal treatment for the unstable intertrochanteric fracture type. However, there have been few comparisons between DHS+TSP augmentation with intramedullary (IM) nailing. The aim of this retrospectively registered study was to compare the clinical outcomes of patients with the unstable type of intertrochanteric fractures treated with DHS+TSP or IM nailing (proximal femoral nail antirotation (PFNA)). Methods. From June 2013 to April 2018, 358 patients with proximal femur fracture AO/OTA type 31A2 and 31A3 treated with PFNA or DHS+TSP and followed for ≥10 months postoperatively were included. The surgical-dependent outcome evaluation included the operation time, intraoperative blood loss, postoperative decrease in hemoglobin, and blood transfusion amount. Functional status was also measured. Radiographic findings and postoperative complications were recorded and analyzed. Result. The operation time was significantly shorter in the DHS+TSP group than that in the PFNA group for both A2 and A3 fractures (A2 type: 84.0 vs.96.4 min; p<0.05; A3 type: 102.4 vs.116.1 min; p<0.05). Postoperative decrease in hemoglobin was more significant in the PFNA group than that in the DHS+TSP group for both fracture types (A2 type: −1.88 vs. −1.29 (mg/dL); p<0.05; A3 type: −1.63 vs. −1.04 (mg/dL); p<0.05). However, the patients treated with DHS+TSP had significantly more residual pain than those treated with PFNA during the final follow-up (Visual Analog Scale score, A2 type: 28.4 vs.23.2; p<0.05; A3 type: 27.5 vs.23.6; p<0.05) and complained of greater implant irritation. Conclusion. We found that DHS+TSP was associated with less operation time and less postoperative decrease in hemoglobin but more residual pain and implant irritation than those of PFNA. As a treatment for unstable intertrochanteric fracture, DHS+TSP provided ideal surgical outcomes which were not inferior to the PFNA.

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A NEW MIXED SURGICAL TREATMENT FOR GRADES III AND IV HEMORRHOIDS: MODIFIED SELECTIVE HEMORRHOIDECTOMY COMBINED WITH COMPLETE ANAL EPITHELIAL RETENTION

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020210002e1594 ◽

2021 ◽

Vol 34 (2) ◽

Author(s):

Hua HUANG ◽

Yunfei GU ◽

Lijiang JI ◽

Youran LI ◽

Shanshan XU ◽

...

Keyword(s):

Anal Canal ◽

Anal Incontinence ◽

Treatment Satisfaction ◽

Operation Time ◽

Controlled Study ◽

Anal Stenosis ◽

Control Group ◽

Observation Group ◽

Canal Diameter ◽

Significant Difference

ABSTRACT Background: Varicose veins appear above and below the dentate line in mixed hemorrhoids, which seriously affects anal function and quality of life. Aim: To propose an improvement in tissue-selecting therapy repair of anal pad combined with complete anal canal epithelial retention comparing with Milligan-Morgan surgery. Methods: A prospective randomized controlled study was designed enrolling 200 patients with grade III and IV hemorrhoids. They were divided into control and observation groups. The control received Milligan-Morgan surgery, and the observation the modified tissue-selecting therapy stapler combined with complete anal canal preservation surgery. All patients were followed for six months to evaluate the treatment differences. Results: In final, control group included 82 and observation 87. The average operation time of the control group was significantly lower than that of the observation, while the bleeding volume was significantly lower in control group. The control group VAS score was 3 (1, 4), and observation 4 (2, 5). There was no significant difference in the incidence of urinary retention, bleeding and wound margin edema after surgery at one month postoperatively. Digital incidence of anal stenosis in the observation group was significantly lower than in control; the same occurred with residual anal margins. The postoperative anal canal diameter was significantly larger than the control group. Wexner anal incontinence score showed that no anal incontinence occurred in both groups, and the control group scored was significantly higher than observation. In final six months follow-up, the observation group did not experience any relapse and four cases were found among controls. The treatment satisfaction of the observation group was better. Conclusions: In grades III and IV hemorrhoids, modified tissue-selecting therapy combined with complete anal canal preservation had better prognosis and treatment satisfaction than Milligan-Morgan procedure, and it is a new surgical method for patients with advanced mixed hemorrhoids.

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The Effect of Prospective Nursing to Lower Deep Vein Thrombosis after the Internal Fixation of Femoral Intertrochanteric Fracture

Journal of Nursing ◽

10.18686/jn.v2i1.3 ◽

2013 ◽

Vol 2 ◽

pp. 11

Author(s):

Yapei Sui

Keyword(s):

Deep Vein Thrombosis ◽

Internal Fixation ◽

Intertrochanteric Fracture ◽

Test Group ◽

Control Group ◽

Vein Thrombosis ◽

Femoral Intertrochanteric Fracture ◽

Deep Vein ◽

Better Than

Objective: The effect of prospective nursing to lower deep vein thrombosis afer the internal fixation of femoral intertrochanteric fracture was studied. Method: 80 patients, who treated with the internal fixation of femoral intertrochanteric fracture in the orthopedics department of our hospital between January 2012 and June 2013 were selected, the patients were randomly allocated to control group and test group, 40 cases per group, the control group were treated by conventional nursing measures, while the test group used the prospective nursing measures. Compared the living quality and the lower deep vein thrombosis of two groups. Results: For the living quality, the scores of all items in prospective nursing group were better than conventional nursing group. The number of lower deep vein thrombosis in the prospective nursing group was 2 cases and the conventional nursing group was 8 cases, with statistical difference. Conclusion: The prospective nursing could reduce the incidence of lower deep vein thrombosis after the internal fixation of femoral intertrochanteric fracture, improved the living quality of such patients after surgery, worth clinical promotion.

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Minimally Invasive Open Reduction by a Modified Suture Bridge with Anchors for Avulsion-type Greater Tuberosity Fracture of the Humerus

10.21203/rs.3.rs-179183/v1 ◽

2021 ◽

Author(s):

Lingpeng Kong ◽

Juanjuan Yang ◽

Yongliang Yang ◽

Fu Wang

Keyword(s):

Los Angeles ◽

Minimally Invasive ◽

Open Reduction ◽

Operation Time ◽

Average Degree ◽

Left Shoulder ◽

Greater Tuberosity ◽

Greater Tuberosity Fracture ◽

Suture Bridge ◽

The Mean

Abstract Background: This study aims to describe a new procedure of minimally invasive open reduction by a modified suture bridge with anchors for avulsion-type greater tuberosity fracture of the humerus and to evaluate its clinical effectiveness.Methods: From January 2015 to January 2018, 16 patients who were diagnosed with an avulsion-type greater tuberosity fracture of the proximal humerus and treated with minimally invasive open reduction by modified suture bridges with anchors were retrospectively studied. Endpoints were assessed preoperatively and postoperatively and included the visual analog scale (VAS), the University of California Los Angeles (UCLA) shoulders score, the American Shoulder and Elbow Surgeons score (ASES), and the range of motion (ROM) for shoulders.Results: There were 7 males and 9 females with an average age of 44.94 years. Six fractures involved the left shoulder, and 10 involved the right shoulder. The time between injury and operation ranged from 1 to 5 days, with an average of 2.32 days. The average length of stay was 6.5 ± 0.85 days; the mean operation time was 103.1 ± 7.23 minutes; and the mean amount of operative blood loss was 51.88 ± 6.40 ml. All patients achieved bone union within 3 months after surgery. The VAS score significantly decreased at 3 weeks postoperatively (p = 0.002), as did the average degree of forward elevation (p = 0.047). The mean degree of abduction increased at 6 weeks after the operation (p = 0.035), and the average degree of external rotation and internal rotation improved at 3 months postoperatively (p = 0.012; p = 0.007). The ASES score and the UCLA score improved at the 6-week follow-up (p = 0.092; p = 0.029). No procedure-related death or incision-related superficial or deep tissue infection was identified in any case. No iatrogenic neurovascular injuries or fractures were found in this study.Conclusion: The fracture block was fixed firmly by minimally invasive open reduction with a modified suture bridge with anchors. Patients were allowed to move their shoulder early after surgery and recovered quickly. It is an efficient method for the treatment of avulsion-type greater tuberosity fractures of the humerus.

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Effect of teriparatide in fracture healing of intertrochanteric fracture: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184386 ◽

2018 ◽

Vol 4 (6) ◽

pp. 918

Author(s):

Sanjeev K. Singhal ◽

Naresh Aggarwal ◽

Ajay Sharma

Keyword(s):

Prospective Study ◽

Fracture Healing ◽

Large Scale ◽

Intertrochanteric Fracture ◽

Calcium Supplementation ◽

Geriatric Trauma ◽

Controlled Study ◽

Control Group ◽

Intertrochanteric Fractures ◽

Early Return

Background: Intertrochanteric fracture is a relatively common and serious medical issue in geriatric trauma result in serious health problems and decrease health related quality of life. Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture-healing. The purpose of the present prospective, randomized, controlled study was to evaluate the effect of teriparatide on the course of intertrochanteric fracture-healing.Methods: Forty patients of intertrochanteric fractures who underwent surgical intervention between June 2016 and May 2017 were enrolled in this prospective study and followed for minimum of six months. Group A included patients who received only calcium supplementation; patients in Group B received teriparatide along with calcium supplementation postoperatively.Results: The mean time to fracture healing was between 8-12 weeks for the treatment group, compared with 12-16 weeks for the control group. There was also significant effectiveness with regards to Parker and Palmer mobility score at 6 months.Conclusions: Postoperative use of teriparatide for 6 months appears to be an effective adjunct therapy in the treatment of patients with intertrochanteric fractures. However, because of the limited power of the study a large-scale cohort study is still required for determining the efficacy of teriparatide.

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