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Risk factors and predictive model of cerebral edema after road traffic accidents-related traumatic brain injury

Chinese Journal of traumatology 2024年第3期27卷 153-162页

作者： Di-You Chen Peng-Fei Wu Xi-Yan Zhu Wen-Bing Zhao Shi-Feng Shao Jing-Ru Xie Dan-Feng Yuan Liang Zhang Kui Li Shu-Nan Wang Hui Zhao Institute for Traffic Medicine Daping HospitalArmy Medical UniversityChongqing400042China department of Radiology Daping HospitalArmy Medical UniversityChongqing400042China Chongqing Key Laboratory of Traffic Injury and Vehicle Ergonomics Chongqing400042China Wound trauma Medical Center State Key Laboratory of TraumaBurns and Combined InjuryInstitute of Surgery ResearchDaping HospitalArmy Medical UniversityChongqing.400042China

Purpose:Cerebral edema(CE)is the main secondary injury following traumatic brain injury(TBI)caused by road traffic accidents(RTAs).It is challenging to be predicted *** this study,we aimed to develop a prediction model for CE by identifying its risk factors and comparing the timing of edema occurrence in TBI patients with varying levels of ***:This case-control study included 218 patients with TBI caused by *** cohort was divided into CE and non-CE groups,according to CT results within 7 *** data,imaging data,and clinical data were collected and *** variables that follow normal distribution were presented as mean±standard deviation,those that do not follow normal distribution were presented as median(Q1,Q3).Categorical variables were expressed as *** Chi-square test and logistic regression analysis were used to identify risk factors for *** curve fitting was performed to predict the time to secondary CE in TBI patients with different levels of *** efficacy of the model was evaluated using the receiver operator characteristic ***:According to the study,almost half(47.3%)of the patients were found to have *** risk factors associated with CE were bilateral frontal lobe contusion,unilateral frontal lobe contusion,cerebral contusion,subarachnoid hemorrhage,and abbreviated injury scale(AIS).The odds ratio values for these factors were 7.27(95%confidence interval(CI):2.08-25.42,p=0.002),2.85(95%CI:1.11-7.31,p=0.030),2.62(95%CI:1.12-6.13,p=0.027),2.44(95%CI:1.25-4.76,p=0.009),and 1.5(95%CI:1.10-2.04,p=0.009),*** also observed that patients with mild/moderate TBI(AIS≤3)had a 50%probability of developing CE 19.7 h after injury(χ^(2)=13.82,adjusted R2=0.51),while patients with severe TBI(AIS>3)developed CE after 12.5 h(χ^(2)=18.48,adjusted R2=0.54).Finally,we conducted a receiver operator characteristic curve analysis of CE time,which showed an area under the curve of 0

关键词： Road traffic accident traumatic brain injury Cerebral edema Risk factors Time window

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Pelvic fractures in blunt trauma patients:A comparative study

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World Journal of Orthopedics 2024年第5期15卷 418-434页

作者： Alexander A Fokin Joanna Wycech Knight Madison E Tharp Kyler C Brinton Phoebe K Gallagher Justin Fengyuan Xie Russell D Weisz Ivan Puente trauma and Critical Care Services Delray Medical CenterDelray BeachFL 33484United States Charles E Schmidt College of Medicine Department of SurgeryFlorida Atlantic UniversityBoca RatonFL 33431United States trauma and Critical Care Services Broward Health Medical CenterFort LauderdaleFL 33316United States Charles E Schmidt College of Medicine Florida Atlantic UniversityBoca RatonFL 33431United States Herbert Wertheim College of Medicine Department of SurgeryFlorida International UniversityMiamiFL 33199United States

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy *** of the elderly population with age related comorbidities further complicates the *** organ injuries are kindred with PF due to the proximity to pelvic *** of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is *** To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast *** This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and *** study compared geriatric and non-geriatric patients,patients with and without CB and abdominal *** score matching was implemented in comparison *** PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal *** patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher *** propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric *** of 89 patients with CB,45(51%)were *** propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),hi

关键词： Pelvic fractures Geriatric trauma patients Abdominal co-injuries Contrast blush Contrast extravasation Angioembolization Polytrauma patients Surgical interventions Blunt trauma External and internal fixation for pelvic stabilization

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Therapeutic Effectiveness of Leukocyte-and Platelet-rich Fibrin for Diabetic Foot Ulcers:A Retrospective Study

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Current Medical Science 2024年第3期44卷 568-577页

作者： Fen WANG Xiao-ling ZHANG Jing ZHANG Song GONG Jing TAO Hui XIANG Xiao-qing FU Xu-na BIAN Xue-feng YU An-hui XU Cheng-la YI Shi-ying SHAO department of Endocrinology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China Branch of National Clinical Research Center for Metabolic Diseases Wuhan430030China department of Radiology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China department of trauma surgery Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China

Objective Diabetic foot ulcer(DFU)is one of the most serious complications of ***-and platelet-rich fibrin(L-PRF)is a second-generation autologous platelet-rich *** study aims to investigate the clinical effects of L-PRF in patients with diabetes in real clinical *** Patients with DFU who received L-PRF treatment and standard of care(SOC)from 2018 to 2019 in Tongji Hospital were *** clinical information including patient characteristics,wound evaluation(area,severity,infection,blood supply),SOC of DFU,and images of ulcers was retrospectively extracted and analyzed.L-PRF treatment was performed every 7±2 days until the ulcer exhibited complete epithelialization or an overall percent volume reduction(PVR)greater than 80%.Therapeutic effectiveness,including overall PVR and the overall and weekly healing rates,was *** Totally,26 patients with DFU were enrolled,and they had an ulcer duration of 47.0(35.0,72.3)*** severity and infection of ulcers varied,as indicated by the Site,Ischemia,Neuropathy,Bacterial Infection,and Depth(SINBAD)scores of 2–6,Wagner grades of 1–4,and the Perfusion,Extent,Depth,Infection and Sensation(PEDIS)scores of 2–*** initial ulcer volume before L-PRF treatment was 4.94(1.50,13.83)cm3,and the final ulcer volume was 0.35(0.03,1.76)*** median number of L-PRF doses was 3(2,5).A total of 11 patients achieved complete epithelialization after the fifth week of treatment,and 19 patients achieved at least an 80%volume reduction after the seventh *** overall wound-healing rate was 1.47(0.63,3.29)cm3/week,and the healing rate was faster in the first 2 weeks than in the remaining *** treatment did not change the percentage of complete epithelialization or healing *** Adding L-PRF to SOC significantly improved wound healing in patients with DFU independent of the ankle brachial index,SINBAD score,or Wagner grade,indicating that this method is appropriate for D

关键词： diabetic foot ulcer autologous platelet-rich plasma leukocyte-and platelet-rich fibrin standard of care percentage volume reduction

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Bromocriptine protects perilesional spinal cord neurons from lipotoxicity after spinal cord injury

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Neural Regeneration Research 2024年第5期19卷 1142-1149页

作者： Ying Peng Zhuoxuan Li Zhiyang Zhang Yinglun Chen Renyuan Wang Nixi Xu Yuanwu Cao Chang Jiang Zixian Chen Haodong Lin trauma Center Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina department of Orthopedics Zhongshan HospitalFudan UniversityShanghaiChina department of Rehabilitation Medicine Shanghai Geriatric Medical CenterShanghaiChina

Recent studies have revealed that lipid droplets accumulate in neurons after brain injury and evoke lipotoxicity,damaging the ***,how lipids are metabolized by spinal cord neurons after spinal cord injury remains ***,we investigated lipid metabolism by spinal cord neurons after spinal cord injury and identified lipid-lowering compounds to treat spinal cord *** found that lipid droplets accumulated in perilesional spinal cord neurons after spinal cord injury in *** droplet accumulation could be induced by myelin debris in HT22 *** debris degradation by phospholipase led to massive free fatty acid production,which increased lipid droplet synthesis,β-oxidation,and oxidative *** oxidative phosphorylation increased reactive oxygen species generation,which led to increased lipid peroxidation and HT22 cell *** was identified as a lipid-lowering compound that inhibited phosphorylation of cytosolic phospholipase A2 by reducing the phosphorylation of extracellular signal-regulated kinases 1/2 in the mitogen-activated protein kinase pathway,thereby inhibiting myelin debris degradation by cytosolic phospholipase A2 and alleviating lipid droplet accumulation in myelin debris-treated HT22 *** function,lipid droplet accumulation in spinal cord neurons and neuronal survival were all improved in bromocriptine-treated mice after spinal cord *** results suggest that bromocriptine can protect neurons from lipotoxic damage after spinal cord injury via the extracellular signal-regulated kinases 1/2-cytosolic phospholipase A2 pathway.

关键词： bromocriptine central nervous system cytosolic phospholipase A2 high-content screening lipid droplet lipid metabolism lipotoxicity mitogen-activated protein kinase spinal cord injury spinal cord neurons

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Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis:A comparison of clinical and radiological outcomes

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World Journal of Orthopedics 2024年第5期15卷 444-456页

作者： Frederick William Wyatt Oday Al-Dadah Translational and Clinical Research Institute Faculty of Medical SciencesNewcastle UniversityNewcastle Upon Tyne NE24HHUnited Kingdom department of trauma and Orthopaedic surgery South Tyneside District HospitalSouth Shields NE340PLUnited Kingdom

BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee ***,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much ***,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or *** To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to *** This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee ***-reported outcome measures(PROMs)were collected to evaluate clinical *** included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)*** radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz *** Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both *** were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO *** significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA *** UKAs and HTOs are both efficacious operations that provide a comp

关键词： Arthroplasty Osteotomy Medial compartment Osteoarthritis Knee alignment Patient reported outcome measures

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Incidence and prognosis of olfactory and gustatory dysfunctions related to SARS-CoV-2 Omicron strain infection in China:A national multicenter survey of 35,566 individuals

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World Journal of Otorhinolaryngology-Head and Neck surgery 2024年第2期10卷 113-120页

作者： Meng-Fan Liu Rui-Xia Ma Xian-Bao Cao Hua Zhang Shui-Hong Zhou Wei-Hong Jiang Yan Jiang Jing-Wu Sun Qin-Tai Yang Xue-Zhong Li Ya-Nan Sun Li Shi Min Wang Xi-Cheng Song Fu-Quan Chen Xiao-Shu Zhang Hong-Quan Wei Shao-Qing Yu Dong-Dong Zhu Luo Ba Zhi-Wei Cao Xu-Ping Xiao Xin Wei Zhi-Hong Lin Feng-Hong Chen Chun-Guang Shan Guang-Ke Wang Jing Ye Shen-Hong Qu Chang-Qing Zhao Zhen-Lin Wang Hua-Bin Li Feng Liu Xiao-Bo Cui Sheng-Nan Ye Zheng Liu Yu Xu Xiao Cai Wei Huang Ru-Xin Zhang Yu-Lin Zhao Guo-Dong Yu Guang-Gang Shi Mei-Ping Lu Yang Shen Yu-Tong Zhao Jia-Hong Pei Shao-Bing Xie Long-Gang Yu Ye-Hai Liu Shao-Wei Gu Yu-Cheng Yang Lei Cheng Jian-Feng liu Graduate School of Beijing University of Chinese Medicine BeijingChina department of Otorhinolaryngology Head and Neck surgery China-Japan Friendship HospitalBeijingChina department of Otorhinolaryngology Head and Neck surgery The First People's Hospital of YinchuanYinchuanChina department of Otorhinolaryngology The First People's Hospital of Yunnan ProvinceKunmingChina department of Otorhinolaryngology The First Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina department of Otorhinolaryngology Head and Neck surgery The First Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina department of Otorhinolaryngology Head and Neck surgery Xiangya Hospital Central South UniversityChangshaChina department of Otorhinolaryngology Head and Neck surgery The Affiliated Hospital of Qingdao UniversityQingdaoChina department of Otorhinolaryngology Head and Neck surgery The First Affiliated Hospital of USTCHefeiChina department of Otorhinolaryngology Head and Neck surgery The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina department of Otorhinolaryngology Head and Neck surgery Qilu Hospital of Shandong UniversityJinanChina department of Otorhinolaryngology Head and Neck surgery The Second Affiliated Hospital of Harbin Medical UniversityHarbinChina department of Otolaryngology The Second Hospital of Shandong UniversityShandong UniversityJinanChina department of Otorhinolaryngology Head and Neck surgery Peking University People's HospitalBeijingChina department of Otorhinolaryngology Head and Neck surgery Yantai Yuhuangding HospitalQingdao UniversityYantaiChina department of Otorhinolaryngology Head and Neck surgery Xijing HospitalThe Fourth Military Medical UniversityXi'anChina Gansu Provincial Center for Disease Control and Prevention LanzhouChina department of Otorhinolaryngology Head and Neck surgery The First Affiliated Hospital of China Medical UniversityShenyangChina department of Otorhinolaryngology Head and Neck surgery Tongji Hospit

Objective:This cross-sectional study aimed to determine the epidemiology of olfactory and gustatory dysfunctions related to COVID-19 in ***:This study was conducted by 45 tertiary Grade-A hospitals in *** and offline questionnaire data were obtained from patients infected with COVID-19 between December 28,2022,and February 21,*** collected information included basic demographics,medical history,smoking and drinking history,vaccination history,changes in olfactory and gustatory functions before and after infection,and other postinfection symptoms,as well as the duration and improvement status of olfactory and gustatory ***:Complete questionnaires were obtained from 35,566 *** overall incidence of olfactory and taste dysfunction was 67.75%.Being female or being a cigarette smoker increased the likelihood of developing olfactory and taste *** received four doses of the vaccine or having good oral health or being a alcohol drinker decreased the risk of such *** infection,the average olfactory and taste VAS scores were 8.41 and 8.51,respectively;after infection,they decreased to 3.69 and 4.29 and recovered to 5.83 and 6.55 by the time of the *** median duration of dysosmia and dysgeusia was 15 and 12 days,respectively,with 0.5%of patients having symptoms lasting for more than 28 *** overall self-reported improvement rate was 59.16%.Recovery was higher in males,never smokers,those who received two or three vaccine doses,and those that had never experienced dental health issues,or chronic accompanying ***:The incidence of dysosmia and dysgeusia following infection with the SARS-CoV-2 virus is high in *** and prognosis are influenced by several factors,including sex,SARS-CoV-2 vaccination,history of head-facial trauma,nasal and oral health status,smoking and drinking history,and the persistence of accompanying symptoms.

关键词： epidemiologic studies incidence olfactory disorders prognosis SARS-CoV-2 taste disorders

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Biliary complications associated with weight loss,cholelithiasis and choledocholithiasis

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2024年第4期15卷 1-8页

作者： Marcelo A Ribeiro Jr Gabriela K Tebar Helena B Niero Leticia S Pacheco department of surgery Division of TraumaCritical Care and Acute Care SurgerySheikh Shakhbout Medical CityAbu Dhabi 11001United Arab Emirates department of surgery Pontifical Catholic University of São Paulo-Campus SorocabaSorocaba 18030070SPBrazil

Biliary complications like cholelithiasis and choledocholithiasis are more common in bariatric surgery patients due to obesity and rapid weight *** with a body mass index>40 face an eightfold risk of developing *** surgery,especially after laparoscopic Roux-en-Y gastric bypass(LRYGB),30%of patients develop biliary disease due to rapid weight *** aim of this review is to analyze the main biliary complications that occur after bariatric surgery and its management.A review of the literature was conducted mainly from 2010 up to 2023 with regard to biliary complications associated with bariatric patients in SciELO,PubMed,and *** undergoing LRYGB have a higher incidence(14.5%)of symptomatic calculi post-surgery compared to those undergoing laparoscopic sleeve gastrectomy at 4.1%.Key biliary complications within 6 to 12 months post-surgery include:Cholelithiasis:36%;Biliary colic/dyskinesia:3.86%;Acute cholecystitis:0.98%-18.1%;Chronic cholecystitis:70.2%;Choledocholithiasis:0.2%-5.7%and Pancreatitis:0.46%-9.4%.Surgeons need to be aware of these complications and consider surgical treatments based on patient symptoms to enhance their quality of life.

关键词： Bariatric surgery Complications Choledocholithiasis Cholelithiasis Acute cholecystitis

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Functional Outcomes of Adult Tibia Shaft Fractures Treated with Solid Intramedullary Nails versus Hollow Nails: A Systematic Review

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Open Journal of Orthopedics 2024年第3期14卷 149-172页

作者： Kwadwo Aning Abu Bernard Hammond Mohammed Issah Suglo Bukari Kizito Kakra Vormawor Ronald Awoonor-Williams David Anyitey-Kokor Paa Kwesi Baidoo Dominic Konadu-Yeboah department of Orthopaedics St. John of God Hospital Duayaw Nkwanta Ghana Directorate of trauma and Orthopaedics Komfo Anokye Teaching Hospital Kumasi Ghana department of surgery Tamale Teaching Hospital Tamale Ghana department of Orthopadics and trauma Seventh Day Adventist Hospital Asamang Ghana

Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.

关键词： Tibia Shaft Fractures Functional Outcome SIGN Nail Hollow Nail

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Piezo1 expression in chondrocytes controls endochondral ossification and osteoarthritis development

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Bone Research 2024年第1期12卷 199-214页

作者： Laura J.Brylka Assil-Ramin Alimy Miriam E.A.Tschaffon-Müller Shan Jiang Tobias Malte Ballhause Anke Baranowsky Simon von Kroge Julian Delsmann Eva Pawlus Kian Eghbalian Klaus Püschel Astrid Schoppa Melanie Haffner-Luntzer David J.Beech Frank Timo Beil Michael Amling Johannes Keller Anita Ignatius Timur A.Yorgan Tim Rolvien Thorsten Schinke department of Osteology and Biomechanics University Medical Center Hamburg-Eppendorf20246 HamburgGermany department of trauma and Orthopedic surgery University Medical Center Hamburg-Eppendorf20246 HamburgGermany Institute of Orthopedic Research and Biomechanics University Medical Center UlmBadenWürttemberg89081 UlmGermany department Legal Medicine University Medical Center Hamburg-Eppendorf20246 HamburgGermany Leeds Institute of Cardiovascular and Metabolic Medicine School of MedicineUniversity of LeedsLS29JT LeedsUK

Piezo proteins are mechanically activated ion channels,which are required for mechanosensing functions in a variety of cell *** we and others have previously demonstrated that the expression of Piezo1 in osteoblast lineage cells is essential for boneanabolic processes,there was only suggestive evidence indicating a role of Piezo1 and/or Piezo2 in *** we addressed the question if and how chondrocyte expression of the mechanosensitive proteins Piezo1 or Piezo2 controls physiological endochondral ossification and pathological osteoarthritis(OA)*** with chondrocyte-specific inactivation of Piezo1(Piezo1^(Col2a1Cre)),but not of Piezo2,developed a near absence of trabecular bone below the chondrogenic growth plate ***,all Piezo1^(Col2a1Cre) animals displayed multiple fractures of rib bones at 7 days of age,which were located close to the growth *** skeletal growth was only mildly affected in these mice,OA pathologies were markedly less pronounced compared to littermate controls at 60 weeks of ***,when OA was induced by anterior cruciate ligament transection,only the chondrocyte inactivation of Piezo1,not of Piezo2,resulted in attenuated articular cartilage ***,osteophyte formation and maturation were also reduced in Piezo1^(Col2a1Cre) *** further observed increased Piezo1 protein abundance in cartilaginous zones of human ***,we identified Ptgs2 and Ccn2 as potentially relevant Piezo1 downstream genes in ***,our data do not only demonstrate that Piezo1 is a critical regulator of physiological and pathological endochondral ossification processes,but also suggest that Piezo1 antagonists may be established as a novel approach to limit osteophyte formation in OA.

关键词： Piezo1 markedly ossification

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Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting

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Open Journal of Orthopedics 2024年第4期14卷 173-186页

作者： Loïc Fonkoue Gaspary Fodjeu Kennedy Olivier Muluem Olivier Ngongang Theophile Nana Marie Ange Ngo Yamben DésiréAkaba Urich Tambekou Daniel Eone Handy department of Orthopaedics and trauma Yaound&#233 General Hospital Yaound&#233 Cameroon. department of surgery and Specialities University of Yaound&#233 1 Yaound&#233 Cameroon department of Orthopaedics and trauma Yaound&#233 Emergency Center Yaound&#233 Cameroon department of Orthopaedics and trauma Yaound&#233 Central Hospital Yaound&#233 Cameroon

Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas o

关键词： Proximal Femoral Fracture Watson-Jones Approach Dynamic Hip Screw Low Resource Setting

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