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Objective To explore the effects of enhanced recovery nutritional management on the perioperative comfort and nutritional status of the patients with fractures. Methods A total of 100 patients with traumatic fractures admitted to the department of trauma orthopedics of the hospital from March to September 2023 were selected and randomly divided into the study group and the control group, with 50 patients in each group. The control group received conventional perioperative management, while the study group received enhanced recovery nutritional management, including reduced preoperative fasting and perioperative oral nutritional supplementation. The preoperative discomfort, postoperative adverse reactions, and nutrition-related indicators were compared between the two groups. Results The incidence of moderate to severe preoperative thirst [34.00% (17/50)vs. 10.00% (5/50)], hunger [44.00% (22/50) vs. 16,00%(8/50)].and irritability [26.00% (13/50) vs. 8.00%(4/50)], as well as postoperative nausea/vomiting [16.00% (8/50) vs. 4.00(2/50), was significantly lower in the study group compared to the control group. The levels of plasma albumin on postoperative days 1.7, and 14. as well as hemoglobin levels on postoperative day 14, were significantly higher in the study group than in the control group, with all differences being statistically significant (P< 0.05). Conclusion Enhanced recovery nutritional management can improve perioperative comfort and nutritional status, contributing to early recovery in patients. [ABSTRACT FROM AUTHOR]

Abstract Deep vein thrombosis (DVT) is one of the important factors leading to death in patients undergoing fracture surgery. This study aims to investigating the predictive value of the Caprini score combined with thrombus molecular markers for the risk of DVT in patients after traumatic fracture surgery. A total of 342 patients who underwent surgery for traumatic fractures were included in the study. The patients were divided into two groups based on the occurrence of DVT after surgery: the DVT group (n = 57) and the non-DVT group (n = 285). A univariate analysis and logistic regression analysis were conducted on clinical factors and laboratory indicators that might be associated with DVT in patients with traumatic fractures. A predictive model for DVT risk was then constructed by combining thrombus molecular markers with the Caprini score. The median age of all patients was 65 years (54–75 years), the postoperative Caprini score was 9 (6–11), and the length of hospital stay was 11 days (8–16 days). In univariate analysis, age (P = 0.029), postoperative Caprini score (P

Abstract Background Deep vein thrombosis (DVT) is an obstructive disease with a hindering venous reflux mechanism. The aim of this study was to identify independent risk factors for deep vein thrombosis (DVT) in patients with traumatic lower extremity fractures and assess the diagnostic value of thromboelastogram (TEG) and thrombus molecular markers. Methods Reviewed patients with lower extremity fractures were admitted from October 2022 to September 2023. DVT was screened using color Doppler ultrasonography postoperation. Patients were categorized into two groups: those with DVT (n = 61) and those without (n = 191). Logistic regression was utilized to analyze DVT risk factors in these patients, and the diagnostic effectiveness of each marker was determined using the receiver operating characteristic curve (ROC curve). Results Significant differences were found in the incidence of hip (44.8%), and tibia (16.4%) fractures in the DVT groups (P

Background: Simultaneous bilateral femoral neck fractures are rare and often underdiagnosed, typically affecting patients with significant comorbidities. Although these fractures are rarely reported in the literature, they can occur in cases of severe skeletal trauma, such as motor vehicle accidents or electrical injuries. Prompt recognition and early intervention are essential, as delayed diagnosis can significantly increase morbidity and mortality.Case Presentation: We report the case of a 79-year-old Caucasian male with multiple medical comorbidities, who developed bronchopneumonia complicated by sepsis. Following treatment and discharge, the patient returned one week later with bilateral hip pain. Physical examination revealed functional disability and external rotation of both lower limbs, and radiographs of the hips and pelvis identified bilateral femoral neck fractures. The fractures were successfully managed with hip arthroplasty.Conclusion: This case underscores the importance of vigilance for such injuries in patients with complex medical conditions and highlights the need for timely diagnosis and intervention to prevent further complications.

Objectives To investigate the clinical epidemiological characteristics and occurrence of post-traumatic stress symptoms (PTSS) in patients with traumatic fractures, we sought to analyze the factors that influence the prognosis of a length of hospital stay (LOS) and provide valuable insights to prevent PTSS in fracture patients and improve their prognosis. Methods Inpatients with traumatic fractures were recruited from a third-class comprehensive general hospital in southwest China between November 2019 and October 2020. Case data of traumatic fracture patients were collected, and a questionnaire that included general information and basic fracture details was completed. The post-traumatic stress disorder Self-rating Scale was used to assess PTSS among the fracture inpatients. Results A total of 204 inpatients who experienced traumatic fractures were included in this study. Falls accounted for the largest proportion of traumatic fractures. A Cox's regression analysis revealed that serious injury [Hazard Ratio (HR) = 2.44, 95% Confidence Interval (CI): 1.33–4.46], critical illness during hospitalization (HR = 1.70, 95% CI: 1.13–2.54), and undergoing two surgeries (HR = 1.87, 95% CI: 1.20–2.93) were risk factors for longer LOS. Among the fracture patients, 30.39% exhibited positive PTSD symptoms, and physical activity during the fracture [Odds Ratio (OR) = 0.63, 95% CI: 0.45–0.88] and increased pain (OR = 3.34, 95% CI: 1.82–6.11) were identified as influencing factors. Conclusions Given the high detection rate of PTSS following traumatic fractures, it is crucial for relevant departments to implement targeted measures to protect high risk individuals. Furthermore, strengthening the care provided to the patients' physical and mental health is urgently needed to reduce the incidence of PTSS.

Abstract Background Traumatic fractures occur frequently worldwide. However, research remains limited on the association between short-term exposure to temperature and traumatic fractures. This study aims to explore the impact of apparent temperature (AT) on emergency visits (EVs) due to traumatic fractures. Methods Based on EVs data for traumatic fractures and the contemporary meteorological data, a generalized Poisson regression model along with a distributed lag nonlinear model (DLNM) were undertaken to determine the impact of AT on traumatic fracture EVs. Subgroup analysis by gender and age and sensitivity analysis were also performed. Results A total of 25,094 EVs for traumatic fractures were included in the study. We observed a wide “J”-shaped relationship between AT and risk of traumatic fractures, with AT above 9.5 °C positively associated with EVs due to traumatic fractures. The heat effects became significant at cumulative lag 0–11 days, and the relative risk (RR) for moderate heat (95th percentile, 35.7 °C) and extreme heat (99.5th percentile, 38.8 °C) effect was 1.311 (95% CI: 1.132–1.518) and 1.418 (95% CI: 1.191–1.688) at cumulative lag 0–14 days, respectively. The cold effects were consistently non-significant on single or cumulative lag days across 0–14 days. The heat effects were higher among male and those aged 18–65 years old. The sensitivity analysis results remained robust. Conclusion Higher AT is associated with cumulative and delayed higher traumatic fracture EVs. The male and those aged 18–65 years are more susceptible to higher AT.

Background: Traumatic fractures occur frequently worldwide. However, research remains limited on the association between short-term exposure to temperature and traumatic fractures. This study aims to explore the impact of apparent temperature (AT) on emergency visits (EVs) due to traumatic fractures. Methods: Based on EVs data for traumatic fractures and the contemporary meteorological data, a generalized Poisson regression model along with a distributed lag nonlinear model (DLNM) were undertaken to determine the impact of AT on traumatic fracture EVs. Subgroup analysis by gender and age and sensitivity analysis were also performed. Results: A total of 25,094 EVs for traumatic fractures were included in the study. We observed a wide "J"-shaped relationship between AT and risk of traumatic fractures, with AT above 9.5 °C positively associated with EVs due to traumatic fractures. The heat effects became significant at cumulative lag 0–11 days, and the relative risk (RR) for moderate heat (95th percentile, 35.7 °C) and extreme heat (99.5th percentile, 38.8 °C) effect was 1.311 (95% CI: 1.132–1.518) and 1.418 (95% CI: 1.191–1.688) at cumulative lag 0–14 days, respectively. The cold effects were consistently non-significant on single or cumulative lag days across 0–14 days. The heat effects were higher among male and those aged 18–65 years old. The sensitivity analysis results remained robust. Conclusion: Higher AT is associated with cumulative and delayed higher traumatic fracture EVs. The male and those aged 18–65 years are more susceptible to higher AT. [ABSTRACT FROM AUTHOR]

Obejective: To explore the predictive value of Caprini thrombosis risk score and serum D-dimer (D-D), vascular endothelial growth factor (VEGF), platelet-derived growth factor B (PDGF-B) for postoperative deep vein thrombosis (DVT) in patients with traumatic fracture, and to construct risk prediction model. Methods: 216 hospitalized patients with traumatic fracture admitted to The Affiliated Hospital of Xuzhou Medical University from June 2019 to May 2022 were selected as the research objects. According to the occurrence of postoperative DVT, they were divided into DVT group (62 cases) and non-DVT group (154 cases). The differences of Caprini thrombosis risk score, serum D-D, VEGF, PDGF-B and clinical data between the two groups were compared. Multivariate Logistic regression analysis was used to identify the risk factors of DVT, the prediction model was established, and the model was validated, and the receiver operating characteristic (ROC) curve was drawn for efficacy evaluation. Results: The occurrence rate of postoperative DVT in patients with traumatic fracture was 28.70%. The proportion of patients in the DVT group with the time from fracture to admission greater than 24 hours were more than those in the non-DVT group, and the prothrombin time (PT), activated partial thromboplastin time (APTT), D-D, VEGF, PDGF-B and Caprini thrombosis risk score were higher than those in the non-DVT group (P<0.05). Multivariate Logistic regression analysis showed that the time from fracture to admission greater than 24 hours, high levels of serum D-D, VEGF, PDGF-B and increased Caprini thrombosis risk score were independent risk factors for the occurrence of postoperative DVT in patients with traumatic fracture (P<0.05). Logistic regression analysis was used to analyze the 5 independent risk factors of the occurrence of postoperative DVT in patients with traumatic fracture, and the prediction model equation was established as follows: Logit (P) =-0.171 +1.170×time from fracture to admission +1.041×serum D-D +0.046×serum VEGF +0.100×serum PDGF-B +0. 080×Caprini thrombosis risk score, the internal verification results showed that the C-index count was 0.825 (95%CI: 0.740~0.892), and the Calibration curve showed that the Calibration curve was close to the ideal curve (P>0.05). External validation used this study sample: the area under curve (AUC) was 0.901, the sensitivity was 0.887, and the specificity was 0.870, which showed that the model had high predictive efficiency, it was significantly higher than the predictive efficacy of D-D, VEGF, PDGF-B and caprini thrombus risk score alone. Conclusion: The time from fracture to admission, serum D-D, VEGF, PDG and Caprini thrombosis risk score were the influencing factors of the occurrence of postoperative DVT in patients with traumatic fracture, the constructed prediction model had good predictive efficiency for the occurrence of DVT. [ABSTRACT FROM AUTHOR]

Introduction: The photodynamic bone stabilization system (PBSS) was was developed in 2010, and in 2018 gained FDA approval in the United States. Given its relative novelty, our analysis sought to analyze the available literature exploring the indications, outcomes, and complications of the PBSS. Methods: We performed a systematic review (PROSPERO registration of study protocol: CRD42022363065, October 8th, 2022). PubMed, EBSCOHost, and Google Scholar electronic databases were queried to identify articles evaluating PBSS in the treatment of pathologic or traumatic fractures between January 1 2010 and 15 October 2022. The quality of the included studies was assessed using the Methodological Index for Nonrandomized Studies tool. Results: Our initial search yielded 326 publications, which were then screened for appropriate studies that aligned with the purpose of our review. A total of thirteen studies, comprising seven case series, four case reports, and two cohort studies. The total sample size of the included studies consisted of 345 patients, with 242 females (70%) and 103 males (30%). The implants were most commonly utilized in the humerus (41%), radius (12%), and metacarpal (12%). The most common complications were related to broken implants (5%) and dislocation (1%). Most studies reported complete fracture healing and return of full strength and range of motion. Conclusion: Despite being a relatively novel technology, PBSS appears to be a viable option for fracture stabilization. Most studies included in our analysis reported complete fracture healing and return of function with minimal complications. [ABSTRACT FROM AUTHOR]

Objective: To explore the risk factors for inferior vena cava filter (IVCF) thrombus in orthopedic trauma patients who underwent filter placement with ongoing anticoagulation in clinical settings. Methods: We retrospectively analyzed clinical data from fracture patients with lower extremity acute deep vein thrombosis (DVT) implanted with an IVCF admitted to Tianjin Hospital from January 2017 to December 2019. Potential risk factors, such as gender, age, diabetes, hypertension, fracture sites, thrombus location, free-floating thrombus, filter type, Injury Severity Score (ISS), and postoperative D-dimer values, were analyzed by the Chi-square test, t-test, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: A total of 662 patients were included in our study, and filter-related thrombosis was present in 67 (10.1%) patients. No significant differences were observed in age, gender, hypertension, diabetes, fracture site, free-floating thrombus, filter type, indwelling time, and postoperative D-dimer level. Thrombus location and ISS were significantly different (p < 0.05). Popliteal DVT (P-DVT) (odds ratio [OR]: 2.130, p = 0.018) and ISS (OR: 1.135, p = 0.000) were associated with filter thrombus. Patients with P-DVT were prone to a small filter thrombus (OR: 3.231, p = 0.037). From the ROC curve analysis, the diagnostic value of ISS was 24.5 and 26.5 for patients with filter and massive filter thrombus, respectively. Conclusion: Thrombus location and ISS were independent risk factors for filter thrombus in patients with traumatic fractures. P-DVT had a higher potential to result in a small filter thrombus and an ISS value >26.5, which was considered a significant massive filter thrombus predictor. [ABSTRACT FROM AUTHOR]

Background: The goal was to investigate the relationship between serum vascular endothelial growth factor (VEGF), P-selectin, high-density lipoprotein cholesterol (HDL-C), platelet parameters, and coagulation function indexes and postoperative deep vein thrombosis (DVT) in patients with traumatic fracture. Methods: A total of 150 patients with traumatic fractures after DVT were selected as the DVT group, and 150 patients with traumatic fractures without DVT during the same period were selected as the non-DVT group. Serum VEGF, P-selectin, HDL-C, platelet parameters including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), platelet large cell ratio (P-LCR), and plasma coagulation function indexes including thrombin time (TT), prothrombin time (PT), activated partial thrombin time (APTT), fibrinogen (FIB), and D-dimer (D-D) were measured. Pearson's correlation was performed to analyze the correlation between serum VEGF, P-selectin, and coagulation function indexes, and binary logistic regression was used to analyze the risk factors of DVT. Results: Serum VEGF and P-selectin in the DVT group were higher while HDL-C was lower than those in the non-DVT group (p < 0.05). Serum VEGF and P-selectin were negatively correlated with plasma D-D and FIB (p < 0.05), and serum HDL-C was negatively correlated (p < 0.05). Compared with the non-DVT group, MPV, PDW, and P-LCR in the DVT group were decreased (p < 0.05). Multivariate logistic regression analysis showed that PLCR was a risk factor for postoperative DVT in patients with traumatic fractures (p < 0.05). Conclusions: Serum VEGF and P-selectin are higher and HDL-C is lower in patients with DVT after postoperative traumatic fracture than in patients without DVT. Combined detection of serum VEGF, P-selectin, HDL-C, and coagulation function indexes may help to reduce the risk of DVT. Platelet parameters (MPV, PDW, P-LCR) have certain reference values for the clinical diagnosis and disease evaluation of DVT. [ABSTRACT FROM AUTHOR]

Objective: To investigate the correlation between the expression of serum alkaline phosphatase (ALP), osteoprotegerin (OPG) and the balance of helper T cell 1 (Th1)/helper T cell 2 (Th2) in traumatic fracture. 80 patients with traumatic fracture admitted to our hospital from February 2019 to December 2022 were selected as the study subjects and divided into observation group, and 80 healthy volunteers who came to our hospital for physical examination at the same time were selected as the control group. The fasting venous blood of the patients in the observation group and the control group in the morning after admission were taken to detect the expression levels of ALP, OPG, Th1 and Th2, and to analyze the correlation between the expression of serum ALP, OPG and Th1/Th2 balance. Eighty patients in the observation group were followed up 12 months after the operation. They were divided into fracture healing group (n=54) and delayed healing group (n=26) according to the degree of fracture healing. The clinical general situation and the expression level of ALP, OPG, Th1/Th2 in the two groups were compared, and the multiple factors affecting the fracture healing of traumatic fracture patients were analyzed. There were differences in the expression of ALP, OPG and helper T cells between the observation group and the control group. The levels of ALP, OPG and Th2 in the observation group were higher than those in the control group, and the levels of Th1 and Th1/Th2 were lower than those in the control group (P<0.05); Spearman correlation analysis showed that serum ALP and OPG were negatively correlated with Th1/Th2 balance (P<0.05); There was no difference in sex, age, cause of injury and Th2 between the fracture healing group and the delayed healing group (P>0.05). There was difference in BMI, ALP, OPG, Th1 and Th1/Th2 levels between the two groups (P<0.05); The above univariate analysis has statistical difference indicators to assign values. The multi-factor analysis results show that ALP, OPG, Th2, Th1/Th2 are independent influencing factors affecting the fracture healing of traumatic fracture patients (P<0.05). The occurrence of traumatic fracture will lead to the increase of ALP and OPG levels and the change of Th1/Th2 balance. There is a significant correlation between the serum ALP and OPG levels of patients and Th1/Th2 balance. In addition, changes in the levels of ALP, OPG, Th1, Th1/Th2 can affect the level of postoperative fracture healing in patients with traumatic fracture. Therefore, clinically, patients with elevated ALP and OPG levels and Th1/Th2 imbalance should be alert to the occurrence of poor fracture healing. [ABSTRACT FROM AUTHOR]

Abstract Background In Ethiopia, little is known about postoperative pain trajectories and possible predictive factors associated with them in patients undergoing surgery following traumatic fractures. Methods This multi-center prospective observational cohort study included surgical candidates for traumatic fractures (n = 218). Worst pain intensity was measured with an 11-point numeric rating scale on the first 4 postoperative days and day of hospital discharge. Growth mixture modeling was used to identify subgroups of patients based on their pain trajectories, and logistic regression models to quantify associations between pain trajectories and demographic, clinical, psychological, and life style factors. Results Two postoperative pain trajectory subgroups were identified: rapid pain relief (48% of included individuals) and consistently high pain (52% of included individuals). Sub-analysis stratified by cause of injury demonstrated that higher preoperative pain was an independent risk factor for consistently high postoperative pain regardless of the patient’s injury type: traffic accident (OR = 1.48, 95% CI 1.23–1.79), machine/tool injury or conflict (OR = 1.58, 95% CI 1.11–2.26), or fall (OR = 1.47, 95% CI 1.08–1.99). Moreover, longer surgical time was a risk factor for consistently high postoperative pain among patients who had a fall-related injury (OR = 1.02, 95% CI 1.00–1.03). In contrast, among patients with a traffic-related injury, receiving a nerve block was a protective factor (OR = 0.19, 95% CI 0.04–0.87) compared with general anesthesia. Conclusion Higher preoperative pain and longer surgical time were associated with a consistently high acute postoperative pain trajectory. Clinicians may use these potentially modifiable factors to identify patients at risk for consistently high pain during the early postoperative period.

Abstract Aim To evaluate the potential influencing factors of acute stress disorder (ASD) in patients with accidental traumatic fractures to provide evidence for clinical nursing care. Design A retrospective study. Methods Patients with traumatic fractures treated in our hospital from 1 January 2020 to 30 November 2021 were included. The characteristics of ASD and no ASD patients were assessed. Results A total of 468 patients with traumatic fractures were included, the incidence of ASD was 28.20%. Logistic regression analysis showed that age ≤50 years (OR2.918, 95% CI1.994 ~ 3.421), female (OR2.074, 95% CI1.489 ~ 3.375), AIS‐ISS at admission ≥20 (OR3.981, 95% CI2.188 ~ 5.091), VAS at admission≥7 (OR2.804, 95% CI2.027 ~ 3.467), introverted personality (OR1.722, 95%CI1.314 ~ 2.432) and CD‐RISC at admission≤60 (OR3.026, 95% CI2.338 ~ 4.769) were the risk factors of ASD in patients with traumatic fractures (all p

Background: In Ethiopia, little is known about postoperative pain trajectories and possible predictive factors associated with them in patients undergoing surgery following traumatic fractures. Methods: This multi-center prospective observational cohort study included surgical candidates for traumatic fractures (n = 218). Worst pain intensity was measured with an 11-point numeric rating scale on the first 4 postoperative days and day of hospital discharge. Growth mixture modeling was used to identify subgroups of patients based on their pain trajectories, and logistic regression models to quantify associations between pain trajectories and demographic, clinical, psychological, and life style factors. Results: Two postoperative pain trajectory subgroups were identified: rapid pain relief (48% of included individuals) and consistently high pain (52% of included individuals). Sub-analysis stratified by cause of injury demonstrated that higher preoperative pain was an independent risk factor for consistently high postoperative pain regardless of the patient's injury type: traffic accident (OR = 1.48, 95% CI 1.23–1.79), machine/tool injury or conflict (OR = 1.58, 95% CI 1.11–2.26), or fall (OR = 1.47, 95% CI 1.08–1.99). Moreover, longer surgical time was a risk factor for consistently high postoperative pain among patients who had a fall-related injury (OR = 1.02, 95% CI 1.00–1.03). In contrast, among patients with a traffic-related injury, receiving a nerve block was a protective factor (OR = 0.19, 95% CI 0.04–0.87) compared with general anesthesia. Conclusion: Higher preoperative pain and longer surgical time were associated with a consistently high acute postoperative pain trajectory. Clinicians may use these potentially modifiable factors to identify patients at risk for consistently high pain during the early postoperative period. [ABSTRACT FROM AUTHOR]

Objectives: To assess and compare the diagnostic performance of CT-like images based on a three- dimensional (3D) T1-weighted spoiled gradient-echo sequence (3D T1 GRE) with CT in patients with acute traumatic fractures of the mandible. Materials and methods: Subjects with acute mandibular fractures diagnosed on conventional CT were prospectively recruited and received an additional 3 T MRI with a CT-like 3D T1 GRE sequence. The images were assessed by two radiologists with regard to fracture localization, degree of dislocation, and number of fragments. Bone to soft tissue contrast, diagnostic confidence, artifacts, and overall image quality were rated using a five-point Likert-scale. Agreement of measurements was assessed using an independent t-test. Results: Fourteen subjects and 22 fracture sites were included (26 ± 3.9 years; 4 females, 10 males). All traumatic fractures were accurately detected on CT-like MRI (n = 22, κ 1.00 (95% CI 1.00–1.00)). There was no statistically significant difference in the assessment of the fracture dislocation (axial mean difference (MD) 0.06 mm, p = 0.93, coronal MD, 0.08 mm, p = 0.89 and sagittal MD, 0.04 mm, p = 0.96). The agreement for the fracture classification as well as the inter- and intra-rater agreement was excellent (range κ 0.92–0.98 (95% CI 0.96–0.99)). Conclusion: Assessment of mandibular fractures was feasible and accurate using CT-like MRI based on a 3D T1 GRE sequence and is comparable to conventional CT. Clinical relevance: For the assessment of acute mandibular fractures, CT-like MRI might become a useful alternative to CT in order to reduce radiation exposure particularly in young patients. [ABSTRACT FROM AUTHOR]

To identify risk factors of admission deep vein thrombosis (DVT) in patients with traumatic fractures. Medical records of 1596 patients with traumatic fractures were reviewed. According to the ultrasound reports of the lower extremity veins, patients were assigned to the DVT or non-DVT group. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors of DVT, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of the D-dimer level for DVT. DVT admission incidence was 20.67%. Statistically significant differences were revealed between the 2 groups in terms of age, sex, fracture site, presence of hypertension, coronary heart disease, stroke, smoking status, time from injury to admission, and levels of fasting blood glucose, hemoglobin, fibrinogen, D-dimer, and hematocrit. Multivariate analysis results showed that age above 50 years, female, above-knee fracture, cigarette smoking, injury-to-admission delay beyond 48 h, low hemoglobin levels, high fasting blood glucose levels, and high D-dimer levels were independent risk factors for admission DVT. ROC analysis showed that the D-dimer level was effective for the prediction of admission DVT in patients with peri-knee and below-knee fractures (area under the curve [AUC] = 0.7296, cutoff point = 1.21 mg/L). An age over 50 years, female, above-knee fracture, smoking, injury-to-admission delay beyond 48 h, decreased hemoglobin level, and increased fasting blood glucose and D-dimer levels were found to be potential independent risk factors for admission DVT. In patients with peri-knee and below-knee fractures, the plasma D-dimer level was effective in predicting admission DVT. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the potential influencing factors of acute stress disorder (ASD) in patients with accidental traumatic fractures to provide evidence for clinical nursing care. Design: A retrospective study. Methods: Patients with traumatic fractures treated in our hospital from 1 January 2020 to 30 November 2021 were included. The characteristics of ASD and no ASD patients were assessed. Results: A total of 468 patients with traumatic fractures were included, the incidence of ASD was 28.20%. Logistic regression analysis showed that age ≤50 years (OR2.918, 95% CI1.994 ~ 3.421), female (OR2.074, 95% CI1.489 ~ 3.375), AIS‐ISS at admission ≥20 (OR3.981, 95% CI2.188 ~ 5.091), VAS at admission≥7 (OR2.804, 95% CI2.027 ~ 3.467), introverted personality (OR1.722, 95%CI1.314 ~ 2.432) and CD‐RISC at admission≤60 (OR3.026, 95% CI2.338 ~ 4.769) were the risk factors of ASD in patients with traumatic fractures (all p <.05). Conclusions: The development of ASD in patients with traumatic fractures is affected by multiple factors. Medical workers should take early and timely management and nursing measures for related risk factors to reduce the occurrence of ASD. [ABSTRACT FROM AUTHOR]

Objective: To investigate the influencing factors of psychological resilience in patients with traumatic fractures, and to analyze its influence on post-traumatic growth. Methods: A total of 197 patients with traumatic fractures admitted to Changsha Fourth Hospital from April 2019 to March 2021 were selected as the research subjects. The mental toughness of all the subjects was evaluated by the resilience scale (CD-RISC), and they were divided into group A (CD-RISC score ≥ 60 points), 76 cases and group B (CD-RISC score) according to the evaluation results. <60 points) 121 cases. Multiple stepwise regression analysis was used to analyze the influencing factors of mental toughness in patients with traumatic fractures. In addition, the post-traumatic growth rating scale (C-PTGI) was used to assess the post-traumatic growth status of all subjects, and the differences between groups A and B were compared. The relationship between mental toughness and posttraumatic growth was analyzed by Pearson correlation. Results: The univariate analysis showed that the psychological toughness of patients with traumatic fractures was related to age, gender, trauma severity and personality (all P<0.05). The results of multiple stepwise regression analysis showed that gender, age, trauma severity and personality were all influencing factors of CD-RISC score in patients with traumatic fractures (all P<0.05). The C-PTGI scores and total scores of patients in group A were higher than those in group B (all P<0.05). The Pearson correlation analysis showed that the CD-RISC score of patients with traumatic fracture was positively correlated with the scores of each dimension of C-PTGI and the total score of C-PTGI (all P<0.05). Conclusion: The influencing factors of psychological resilience in patients with traumatic fractures include age, gender, trauma severity and personality, and psychological resilience is closely related to post-traumatic growth. [ABSTRACT FROM AUTHOR]

Summary: Bone material properties were assessed using impact microindentation in patients with high-energy trauma fractures. Compared to patients with low-energy trauma fractures, bone material strength index was significantly higher in patients with high-energy trauma fractures, and did not differ between patients with osteopenia and those with osteoporosis within each trauma group. Introduction: Impact microindentation (IMI) is a technique to assess tissue-level properties of bone at the tibia. Bone material strength index (BMSi), measured by IMI, is decreased in patients with low-energy trauma fractures, independently of areal bone mineral density (aBMD), but there is no information about BMSi in patients with high-energy trauma fractures. In the present study, we evaluated tissue-level properties of bone with IMI in patients with high-energy trauma fractures. Methods: BMSi was measured 3.0 months (IQR 2.0–5.8) after the fracture in 40 patients with high-energy trauma and 40 age- and gender-matched controls with low-energy trauma fractures using the OsteoProbe® device. Results: Mean age of high- and low-energy trauma patients was 57.7 ± 9.1 and 57.2 ± 7.7 years, respectively (p = 0.78). Fracture types were comparable in high- vs low-energy trauma patients. Lumbar spine (LS)-aBMD, but not femoral neck (FN)-aBMD, was higher in high- than in low-energy trauma patients (LS 0.96 ± 0.13 vs 0.89 ± 0.13 g/cm2, p = 0.02; FN 0.75 ± 0.09 vs 0.72 ± 0.09 g/cm2, p = 0.09). BMSi was significantly higher in high- than in low-energy trauma patients (84.4 ± 5.0 vs 78.0 ± 4.6, p = 0.001), also after adjusting for aBMD (p = 0.003). In addition, BMSi did not differ between patients with osteopenia and those with osteoporosis within each trauma group. Conclusion: Our data demonstrate that BMSi and LS-aBMD, but not FN-aBMD, are significantly higher in high-energy trauma patients compared to matched controls with similar fractures from low-energy trauma. Further studies of non-osteoporotic patients with high-energy trauma fracture with measurements of BMSi are warranted to determine whether IMI might help in identifying those with reduced bone strength. [ABSTRACT FROM AUTHOR]

To analyze cervical spine injuries resulting from recreational activity in shallow ocean water amid high-energy breaking waves. Single-center 10-year review of patients who sustained cervical injuries at the beach in Long Island, New York, USA. A systematic review following the PRISMA guidelines was also performed. Nineteen patients (age 17–79 years) sustained cervical injury from high-energy breaking waves while in shallow beach water. Six patients dived into a wave; 6 patients were struck by a large wave while standing upright; and 7 tumbled in the waves while engaged in nonspecified recreational activity. All 7 patients with subaxial cervical AO Spine Injury Score (AO-SIS) >10 had cervical spine injury with cord signal change and required operative management. Diving mechanism, AO-SIS >10, and cord signal change all predicted significant disability or death at 12 months (P < 0.01). The present study and 7 additional studies reporting on 534 patients (mean age, 45.4 years) were analyzed. Within the reported literature, most patients (94.2%) sustained a spinal cord injury. On long-term follow-up, an estimated 64.8% of patients had permanent neurologic injury and 12.5% had permanent quadriplegia. We offer the first description of cervical injuries sustained in water-related recreational activity using the AO-SIS. The morphology of injuries varied significantly and seemed to depend on body position and wave kinetic energy. Patients presenting with cervical injury in this setting and yielding AO-SIS >10 are likely to have poor functional recovery. [ABSTRACT FROM AUTHOR]

Introduction. Symptoms of psychological trauma are known to be seen at varying rates in children following extremity trauma. The treatment methods for paediatric fractures may affect the psychological symptoms experienced after trauma. The aim of this study was to determine post-traumatic stress disorder (PTSD) developing after fracture in paediatric patients and to investigate the fracture-related factors that could affect PTSD. Materials and Methods. The study included a total of 30 patients who presented at the Emergency Department and were diagnosed with an isolated, displaced fracture of any extremity. The patients were grouped according to the fracture localization and the treatment method. At the 1-month follow-up examination, the patients were evaluated by an orthopaedic surgeon and a child psychiatrist. A psychiatric interview was conducted and the PTSD Reaction Index (CPTSD-RI) for children and adolescents was applied. Results. The CPTSD-RI score at the end of one month was determined to be higher for children with a lower extremity fracture compared to those with an upper extremity fracture (p=0.151). No significant difference was determined between the general anaesthesia group and the sedation group (p=0.543). Conclusions. Psychological trauma symptoms generally start immediately after the traumatic event, may last for years if the treatment approach is not suitable and an increase in symptoms may be observed during follow-up. It can be recommended that attention is paid to children and adolescents with fractures, particularly of the lower extremity, in respect of PTSD symptoms.

Objective: To investigate the relationship between serum thrombomodulin (TM), P-selectin, high density lipoprotein (HDL-C) and coagulation function and postoperative deep vein thrombosis (DVT) in patients with traumatic fracture. Methods: 100 cases of traumatic fracture patients with postoperative occurrence DVT from January 2018 to January 2020 in our hospital were selected as the DVT group, at the same time, and 100 cases of traumatic fracture patients without DVT as the non DVT group. The serum TM, P-selectin, HDL-C, plasma coagulation function index [thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-Dimer (D-D)] were compared between the two groups. Ultivariate logistic regression was used to analyze the influencing factors of DVT in patients with traumatic fracture. Results: The serum TM, P-selectin, plasma D-D, FIB levels and proportion of age ≥ 60 years in the DVT group were higher than those in the non DVT group, and the serum HDL-C levels were lower than those in the non DVT group (P＜0.05). In DVT group, serum TM and P-selectin were positively correlated with plasma D-D and FIB (P＜0.05), while serum HDL-C was negatively correlated with plasma D-Dand FIB (P＜0.05), and there were no significant correlation with other plasma coagulation function indexes (P>0.05). Multivariate Logistic regression analysis showed that age ≥ 60 years, serum TM≥ 9.50 IU/mL, P-selectin ≥ 70.00 ng/ml, HDL-C<1.00 mmol/L, plasma D-D≥ 700.00 g/L and FIB≥ 4.00 g/L were the risk factors of postoperative DVT in patients with traumatic fractures (P＜0.05). Conclusion: In patients with traumatic fractures, the serum TM and P-selectin are higher than those without DVT, and HDL-C is lower than those without DVT, Combined detection of serum TM, P-selectin, HDL-C and coagulation function indicators may help to reduce the risk of DVT. [ABSTRACT FROM AUTHOR]

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Summary: The China National Fracture Study has been conducted to provide a national dataset of traumatic fractures across China. A national representative sample of 512,187 individuals was selected. The population-weighted incidence rates, distribution, injury mechanisms, and risk factors for traumatic fractures were identified for various groups of individuals. Introduction: The China National Fracture Study (CNFS) has been conducted to provide a comprehensive and up-to-date national dataset of traumatic fractures across China. This study aims to report the national incidences and distributions of traumatic fractures that occurred in 2012, 2013, and 2014 and to analyze the risk factors. Methods: A national representative sample of individuals was selected from 24 rural counties and 24 urban cities of 8 provinces using stratified random sampling and the probability proportional to size (PPS) methodology. Participants were interviewed to identify whether they sustained traumatic fractures of the trunk and/or four extremities that had occurred in 2012, 2013, and 2014. The main risk factors associated with traumatic fractures were analyzed by multiple logistic regression models. Results: A total of 512,187 individuals, including 259,649 males and 252,538 females, participated in the CNFS. The population-weighted incidence rates of traumatic fractures in China were calculated to be 2.5 (95% CI, 2.2–2.8) per 1000 population in 2012, 2.8 (95% CI, 2.5–3.3) in 2013, and 3.2% (95% CI, 2.8–3.6) in 2014. The population-weighted incidence rates of fragility fractures among participants aged 65 years and older were calculated to be 27.4 (95% CI, 21.4–33.4) per 1000 population in 2012, 36.0 (95% CI, 28.6–43.5) in 2013, and 42.4 (95% CI, 34.9–49.9) in 2014. The most common cause of fracture was low-energy injuries, followed by traffic accidents. For all age groups, sleeping less than 7 h was a risk factor for traumatic fractures. Alcohol consumption and previous fracture history were identified as risk factors for adults aged 15 years and over. Cigarette smoking was found to be a risk factor for males aged 15–64 years old. For individuals aged 15–64 years old, underweight incurred a risk effect for males and overweight for females. Alcohol consumption, sleeping less than 7 h per day, living in the central and eastern regions, a body mass index less of than 18.5, and having a previous fracture history were identified as strong risk factors for fragility fractures. Conclusion: The national incidence, distribution, and injury mechanisms for traumatic fractures were revealed in the CNFS. Risk factors were identified for various groups of individuals. [ABSTRACT FROM AUTHOR]

Purpose: Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. The toughest issue traumatic orthopaedic surgeons are faced with is how to maintain a balance between adequate COVID-19 screening and timely surgery. In this study, we described our experience with pre-operative COVID-19 screening in patients with traumatic fractures. Furthermore, we analysed the clinical results of fracture patients undergoing confined or emergency surgery during the COVID-19 outbreak. Methods: This was a case series study. Patients with traumatic fractures who were admitted to our hospital for surgery were enrolled in this study during the COVID-19 outbreak from March to April 2020. All patients were enrolled and managed using the standardized clinical pathway we designed for preoperative COVID-19 screening. Clinical, laboratory and outcome data were analysed. Results: The average surgery waiting time from injury to surgery was 8.7 ± 3.4 days. The average waiting time from admission to surgery was 5.3 ± 2.8 days. These average waiting times were increased by 4.1 days and 2.0 days, respectively, compared with 2019 data. Cardiovascular complications, venous thromboembolism and pneumonia occurred in one, two and one patient, respectively. Three and two patients developed pre-operative and postoperative fevers, respectively. Conclusions: We introduced a novel clinical pathway for pre-operatively screening of COVID-19 in traumatic orthopaedic patients. The delay in surgery caused by COVID-19 screening was minimized to a point at which reasonable and acceptable clinical outcomes were achieved. Doctors should pay more attention to perioperative complications, such as cardiovascular complications, venous thromboembolism, pneumonia and fever. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to quantify the incidence of all clinical fractures, including traumatic and fragility fractures, in patients aged 50 years and older, and to describe their distribution by fracture location, sex and age. Methods The incidence of clinical fractures at 10 hospitals in Catalonia, with a reference population of 3 155 000 inhabitants, was studied. For 1 week, from 30 May to 5 June 2016, we reviewed the discharge reports of the Traumatology section of the Emergency Department to identify all fractures diagnosed in patients ≥50 years of age. As a validation technique, data collection was carried out for 1 year at one of the centres, from 1 December 2015 to 30 November 2016. The fracture incidence, including the 95% CI, was estimated for the entire sample and grouped by fracture type, location, sex and age. Results A total of 283 fractures were identified. Seventy per cent were in women, with a mean age of 72 years. The overall fracture incidence was 11.28 per 1000 person-years (95% CI: 11.10, 11.46), with an incidence of traumatic and fragility fractures of 4.15 (95% CI: 4.04, 4.26) and 7.13 per 1000 person-years (95% CI: 6.99, 7.28), respectively. The incidence of fractures observed in the validation sample coincided with that estimated for the whole of Catalonia. The most common fragility fractures were of the hip, forearm, humerus and vertebrae. Conclusion The results of this study are the first to estimate the incidence of clinical fragility fractures in Spain, grouped by location, age and sex. [ABSTRACT FROM AUTHOR]

• Depression (MDD), anxiety (GAD), and post-traumatic stress disorder (PTSD) is prevalent after orthopaedic trauma at mid-term follow-up. • Compared to elective orthopaedic patients, those with extremity fractures are at an increased odds of psychiatric diagnosis post-injury. • History of psychiatric diagnosis appears to be more predictive of post-injury diagnosis of MDD than of GAD and PTSD. • Overall, multiple upper extremity fractures is associated with increased odds of MDD, GAD, and PTSD versus multiple lower extremity fractures. • The exception is multiple lower extremity fractures, which are associated with increased odds of PTSD. Orthopaedic trauma has been linked to major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). Post-injury rates of psychiatric diagnoses and their relationship to various injury characteristics are not well characterized. We aimed to determine the association between orthopaedic trauma and MDD, GAD, and PTSD diagnoses at 5-year follow-up. A national insurance claims database was used to create upper extremity fracture (UEF) and lower extremity fracture (LEF) cohorts, with further stratification by isolated versus multiple fractures. Patient undergoing elective upper or lower extremity orthopaedic procedures served as controls. Rates of post-injury psychiatric diagnoses were calculated. Univariate logistic regression was conducted after matching in a 1:1 ratio based on relevant comorbidities such as psychiatric history. All significant variables were included in multivariate analysis. A total of 308,578 UEF patients and 360,510 LEF patients were identified. Within the UEF cohort, the diagnosis rates following either isolated or multiple fractures were identified: MDD (25% to 30%), GAD (10% to 11%), and PTSD (4%). LEF cohort rates were as follows: MDD (30% to 38%), GAD (11% to 14%), and PTSD (4% to 7%). Compared to non-injured controls, both the UEF and LEF cohorts were associated with higher rates of all psychiatric diagnoses. In comparing UEF and LEF cohorts, isolated UEF was associated with MDD, GAD, and PTSD; however, multiple UEF was associated with MDD and GAD, whereas multiple LEF was associated with PTSD. Psychiatric pathology is prevalent following orthopaedic trauma. Even after controlling for psychiatric history, orthopaedic trauma is independently associated with post-injury psychiatric diagnoses and may be more predictive of PTSD and GAD than of MDD. Upper extremity fractures may portend higher psychiatric risk. With negative stigma surrounding mental health and the early role of orthopaedic surgeons in providing care, it is imperative to normalize psychiatric care with patients and discuss warning symptoms that may indicate the onset of psychiatric disorders. : Prognostic, Level III [ABSTRACT FROM AUTHOR]

Abstract Background Implant breakage after the fixation of traumatic fractures is rare; however, when it occurs, it is debilitating for the patients and a challenge for surgeons. The purpose of this study was to analyze and identify the independent risk factors for implant breakage of traumatic fractures treated with plate osteosynthesis. Methods We reviewed the medical records of patients with a fracture to any part of their four extremities, clavicle, hand or foot, who underwent surgical plate osteosynthesis from January 2005 to January 2015, and who sustained a subsequent implant breakage. Kaplan–Meier univariate and multivariate Cox regressions were performed to identify independent associations of potential risk factors for implant breakage in this cohort. Results We identified 168 patients who underwent plate osteosynthesis surgery and had subsequent internal fixator breakage. The mean patient age was 40.63 ± 16.71 years (range, 3 to 78 years), with 72.0% (121) males and 28.0% (47) females. The average time between surgery and implant breakage was 12.85 ± 12.42 months (range, 1 to 60 months). In the final regression model, we show that inserting screws close to the fracture line is an independent predictive risk factor for implant breakage (HR, 2.165, 95%CI, 1.227 to 3.822; P = 0.008). Conclusions We found that inserting screws close to the fracture line is related to an increased risk of internal fixator breakage in patients treated with plate osteosynthesis after fracture. Plates with additional holes likely lead to an increased risk of implant breakage, presumably because surgeons cannot resist inserting extra screws into the holes adjacent to the fracture line, which reduces the stiffness of the plate. We have addressed this problem by designing a plate without holes adjacent to the fracture line.

Kyphoplasty is commonly employed in the treatment of compression fractures in the elderly and is increasingly used in the treatment of adult trauma along with concomitant instrumentation. Although kyphoplasty with instrumentation has been reported in pediatric patients, concerns regarding retardation of spinal growth and iatrogenic spinal deformity have been raised. The utilization of kyphoplasty without instrumentation has yet to be reported in the case of pediatric patients. A 13-year-old male presented to the emergency department with a traumatic L2 burst fracture with 50% loss of height, which continued to cause severe pain after a trial of bracing. He was subsequently treated with a kyphoplasty without instrumentation. He experienced a rapid and excellent recovery and resumed all previous activity. Kyphoplasty alone without instrumentation is a less invasive means to treat these patients and also prevents iatrogenic deformity or retardation of growth in the pediatric spine. [ABSTRACT FROM AUTHOR]

Introduction: Case reports, case series, and case control studies have looked at the incidence of complete nerve transection in the setting of fracture and the need for surgical exploration dating back to the 1920s. We present two cases of nerve laceration accompanying traumatic fracture with a thorough review of the literature.Methods: We used the following search terms: “ulnar nerve” OR “sciatic nerve” AND “laceration” OR “transection” AND “fracture.” Results were reviewed and included for discussion if they specifically reported ulnar or sciatic nerve laceration accompanying traumatic fracture.Results: Our search yielded 15 papers reporting a total of 10 ulnar nerve lacerations and nine sciatic nerve lacerations. We present two additional cases. The first is a patient with a humerus fracture and complete ulnar nerve transection. The second case is a patient who suffered a femur fracture and complete transection of the sciatic nerve.Conclusion: Nerve laceration accompanying traumatic fracture is rare. We review the reported cases of nerve laceration and present two cases treated at our institution. Though uncommon, nerve laceration should be considered in the setting of traumatic fracture with neurological injury, particularly open fractures. [ABSTRACT FROM AUTHOR]

Background: This study aimed to observe the changes of serum procalcitonin (PCT) and C-reactive protein (CRP) concentrations after internal fixation for traumatic fracture and to discuss the diagnostic value of these two indicators in early infection after internal fixation for traumatic fracture. Methods: Patients who received internal fixation for traumatic fracture at our hospital from June 2014 to December 2016 were included. They were divided into infection group (12 cases) and non-infection group (166 cases), depending on whether infection occurred. Venous blood samples were collected from cases in both groups on day 1, day 4, and day 9 after surgery. Changes in PCT and CRP levels were detected at different time points. Results: As compared with the non-infection group, PCT and CRP levels were significantly increased at each time point after surgery in the infection group. The sensitivity of PCT combined with CRP in the detection of early infection after surgery was higher than that of either used alone. Conclusions: The serum PCT level can be used as an early diagnostic indicator of infection after internal fixation for traumatic fracture. The combined use of PCR and CRP levels can increase the sensitivity of detection. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of early dynamic treatment of interlocking intramedullary nail on the healing of traumatic fracture. Methods: 150 cases of tibial fractures were randomly divided into experimental group and control group, with 75 cases in each group. Patients in the control group were treated with routine interlocking intramedullary nailing. Patients in the experimental group were treated with early dynamic method of interlocking intramedullary nail. The treatment method was identical with the control group. According to the patient's recovery, 6-10 weeks after operation, the dynamic treatment of intramedullary nail was carried out. Observation and comparison with human bone protection element (OPG). bone glutamate protein (BGP) level, clinical healing time, bone healing time and the incidence of adverse reactions and complications of the two groups of patients. Results: Compared with before treatment, the OPG. BGP levels of both groups were significantly increased after treatment (P < 0.05). Compared with the control group, the OPG. BGP levels were higher in the experimental group, the clinical healing time, bone healing time were shorter, the incidence of adverse reaction and complication was lower (P<0.05). Conclusion: Early power of interlocking intramedullary nail could increase the level of OPG and BGP of patients with traumatic fracture and accelerate the fracture healing with high safety. [ABSTRACT FROM AUTHOR]

Descrevemos a incidência, causas, manejo e prognóstico das fraturas traumáticas de coluna torácica de T1 a T10. Estudamos retrospectivamente os casos cirúrgicos de fraturas traumáticas da coluna torácica (T1 a T10), durante o período de junho de 1994 a junho de 2003. O tipo de fratura foi determinado segundo a classificação de Gertzbein e o grau de estabilidade através da classificação de Denis. O quadro neurológico à internação e 30 dias após a cirurgia foi avaliado através da classificação de ASIA/IMSOP. O objetivo da cirurgia nos pacientes com lesão medular completa (n=7) foi de estabilização, enquanto nos casos de instabilidade vertebral em que não houve lesão medular ou esta foi incompleta (n=12), optou-se pela descompressão do tecido nervoso, correção do alinhamento da coluna e estabilização da coluna.We describe the incidence, causes, management and prognosis of traumatic fractures of the thoracic spine from T1 to T10 in surgical cases of traumatic fractures of spine during the period from June 1994 to June 2003 studied retrospectively. The type of fracture was determined according to the Gertzbein classification, and the degree of stability using the Denis classification. The neurological picture at admission and 30 days after surgery was evaluated using the ASIA/IMSOP classification. Surgery was performed in patients with complete spinal cord injury (n=7) for the purpose of stabilization using the posterior approach. In cases without spinal cord injury or incomplete injury (n=12), the surgical procedure was performed aiming to decompress the nerve tissue, to correct the alignment of the spine and to stabilize the spine.