Publications by authors named "Yanbin Zhu"

113 Publications

Treatment of tibial plateau fractures: A comparison of two different operation strategies with medium-term follow up.

J Orthop Translat 2022 Sep 9;36:1-7. Epub 2022 Jul 9.

Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.

Background: The objective of this study was to compare the clinical and radiological outcomes of two surgical methods for tibial plateau fractures (TPFs): minimally invasive surgery (MIS) using a double reverse traction repositor and traditional open reduction internal fixation (ORIF).

Methods: From our prospectively collated database, 187 consecutive adult patients with 189 operatively treated TPFs in our level I trauma center were included from January 2015 to March 2018 who had a minimum of three years' follow-up. All cases were performed by the senior surgeon using either MIS (group 1, 84 patients with 84 TPFs) or ORIF (group 2, 103 patients with 105 TPFs). Details of the demographics, injury mechanism, pre- and postoperative follow-up imaging, operative procedures and complications were collected. The final results from the 36-Item Short-Form Health Survey (SF-36), Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Hospital for Special Surgery (HSS) were obtained at the final follow-up.

Results: Clinically, significant differences were observed in the WOMAC (pain,  ​= ​0.001; stiffness,  ​< ​0.001), HSS ( ​= ​0.003) and SF-36 ( ​= ​0.001). Radiologically, significant intergroup differences were observed in the loss of immediate postoperative reduction rates, secondary loss of reduction rates and signs of osteoarthritis (Kellgren-Lawrence). Two and ten superficial infections in group 1 (2.4%) and group 2 (9.5%), respectively, and 6 lateral popliteal nerve palsy cases occurred (0 MIS, 6 ORIF), with significant intergroup differences.

Conclusion: Our study shows that the MIS using a double reverse traction repositor is promising and safe technique for the TPFs when used for the correct indications.

The Translational Potential Of This Article: The current status of using a minimally invasive surgery for the treatment of TPFs have been analyzed and a new method of using a double reverse traction repositor for the treatment of TPFs have been proposed in this study, which updated treatment concept of TPFs.
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http://dx.doi.org/10.1016/j.jot.2022.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9284320PMC
September 2022

Identification and Regulatory Network Analysis of Genes Related to Reproductive Performance in the Hypothalamus and Pituitary of Angus Cattle.

Genes (Basel) 2022 May 27;13(6). Epub 2022 May 27.

Jilin Provincial Key Laboratory of Animal Embryo Engineering, College of Animal Science and Veterinary Medicine, Jilin University, 5333 Xi'an Avenue, Changchun 130062, China.

In this study, we explored the gene expression patterns of the pituitary gland and hypothalamus of Angus cows at different growth and developmental stages by deep sequencing and we identified genes that affect bovine reproductive performance to provide new ideas for improving bovine fertility in production practice. We selected three 6-month-old (weaning period), three 18-month-old (first mating period), and three 30-month-old (early postpartum) Angus cattle. The physiological status of the cows in each group was the same, and their body conformations were similar. After quality control of the sequencing, the transcriptome analyses of 18 samples yielded 129.18 GB of clean data. We detected 13,280 and 13,318 expressed genes in the pituitary gland and hypothalamus, respectively, and screened 35 and 50 differentially expressed genes (DEGs) for each, respectively. The differentially expressed genes in both tissues were mainly engaged in metabolism, lipid synthesis, and immune-related pathways in the 18-month-old cows as compared with the 6-month-old cows. The 30-month-old cows presented more regulated reproductive behavior, and pituitary CAMK4 was the main factor regulating the reproductive behavior during this period via the pathways for calcium signaling, longevity, oxytocin, and aldosterone synthesis and secretion. A variant calling analysis also was performed. The SNP inversions and conversions in each sample were counted according to the different base substitution methods. In all samples, most base substitutions were represented by substitutions between bases A and G, and the probability of base conversion exceeded 70%, far exceeding the transversion. Heterozygous SNP sites exceeded 37.68%.
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http://dx.doi.org/10.3390/genes13060965DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9222274PMC
May 2022

Incidence and Risk Factors for Surgical Site Infection after Femoral Neck Fracture Surgery: An Observational Cohort Study of 2218 Patients.

Biomed Res Int 2022 6;2022:5456616. Epub 2022 Jun 6.

Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei, China.

Background: Surgical site infection (SSI) was a formidable challenge for surgical management of femoral neck fractures; however, there was a lack of studies with comprehensive variables. We conducted this study to investigate the incidence and risk factors of SSI in elderly patients with femoral neck fractures.

Methods: This was a retrospective study of patients who presented with femoral neck fractures and underwent surgery in our institution between January 2016 and April 2020. All data were collected from a previously validated database. Patients were divided into SSI and non-SSI groups. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for SSI.

Results: A total of 2218 patients with femoral neck fractures were enrolled in the study, of whom 22 (1%) developed SSI, including 15 (0.7%) superficial and 7 (0.3%) deep SSIs. After multivariable adjustment for confounding factors, patients with and without SSI significantly differ in terms of gender, prolonged time to surgery, CHE < 5 U/L, and injury mechanism.

Conclusions: Our results were helpful for stratification of SSI risk and improved management of hip fracture. Clinicians should be alert to patients with these factors and improve modifiable factors such as preoperative waiting time.
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http://dx.doi.org/10.1155/2022/5456616DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9192207PMC
June 2022

A comparative Study of Novel Extramedullary Fixation and Dynamic Hip Screw in the Fixation of Intertrochanteric Fracture: A Finite-Element Analysis.

Front Surg 2022 25;9:911141. Epub 2022 May 25.

Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, China.

Background: Dynamic hip screw (DHS) is one of the most widely internal fixations for stabilizing intertrochanteric fracture, however, with a high risk of postoperative complications. The triangle support fixation plate (TSFP) is developed to reduce the postoperative complications. The purpose of study is to evaluate the biomechanical performance of the DHS and TSFP and demonstrate the rationality of triangular internal fixation for stabilizing intertrochanteric fractures.

Methods: The CT data of the proximal femur were used to establish finite-element models. Evans type I and IV intertrochanteric fracture were constructed and stabilized with the DHS and TSFP. The Von-Mises stress, maximum principal stress, minimum principal stress, and displacement were used to evaluate the biomechanical effect of two implants on intertrochanteric fracture.

Results: Under a 600N axial load, the maximum stress and displacement of an intact proximal femur were 13.78 MPa and 1.33 mm, respectively. The peak stresses of the bone in the TSFP were 35.41 MPa and 68.97 MPa for treating Evans type I and IV intertrochanteric fractures, respectively, which were lower than those in the DHS. The maximum overall displacement and relative distance of the fracture surface in the DHS fixation model were 1.66 mm and 0.10 mm for treating Evans type I intertrochanteric fracture, which was 29.59% and 150% higher than that in the TSFP, and were 2.24 mm and 0.75 mm for treating Evans type IV intertrochanteric fracture, which was 42.58% and 650% higher than that in the TSFP.

Conclusions: In conclusion, the TSFP has obvious advantages in stress distribution and stability than the DHS, providing a promising option for the treatment of intertrochanteric fractures.
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http://dx.doi.org/10.3389/fsurg.2022.911141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9174929PMC
May 2022

Relative Prevalence and Associated Factors of Complex Regional Pain Syndrome Type I in Patients with Radial Head Fractures Treated with Open Reduction and Internal Fixation: A Cross-Sectional Study.

Pain Res Manag 2022 19;2022:9214404. Epub 2022 May 19.

Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, China.

Objective: This study aimed to examine the incidence and associated factors of complex regional pain syndrome type I (CRPS I) in patients who underwent open reduction and internal fixation (ORIF) for radial head fractures.

Methods: The study enrolled 601 radial head fracture patients treated with ORIF, 523 of which completed the 1-year follow-up. The incidence of CRPS I in those patients was assessed using the Budapest criteria. Patients were then divided into 2 groups: patients with CRPS I ( = 28) and patients without CRPS I ( = 495). The patients' demographic and clinical data before the operation were prospectively collected by our team. Independent -tests and tests were used as univariate analyses to compare the demographic and clinical data between the two groups. Meanwhile, multivariate regression analysis was conducted to identify the associated risk factors for CRPS I.

Results: The incidence of CRPS I in patients with radial head fractures treated with ORIF was 5.5% during the first year following surgery. Significant differences were observed in age, gender, type of trauma, modified Mason Classification, and depressive personality disorders. The logistic regression analysis revealed that the female gender, modified Mason type III fractures, and depressive patients were significantly more likely to develop CRPS I (=0.021, 0.023, and 0.025, respectively).

Conclusions: The incidence of CRPS I among radial head fracture patients undergoing ORIF was 5.5%. In addition, early detection of CRPS I and providing adequate intervention will likely result in greater benefits for those patients.
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http://dx.doi.org/10.1155/2022/9214404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9135570PMC
May 2022

Surgeon volume and risk of deep surgical site infection following open reduction and internal fixation of closed ankle fracture.

Int Wound J 2022 May 31. Epub 2022 May 31.

Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, China.

Increasing evidences have shown that surgeon volume was associated with postoperative complications or outcomes in a variety of orthopaedics surgeries, but few were focused on ankle fractures. This study aimed to investigate the deep surgical site infection (DSSI) in association with the surgeon volume following open reduction and internal fixation (ORIF) of ankle fractures. This was a retrospective analysis of the prospectively collected data on patients who underwent ORIF for acute closed ankle fractures between October 2014 and June 2020. Surgeon volume was defined as the number of ORIF procedures performed within 12 months preceding the index operation. The receiver operating characteristic (ROC) curve was constructed to determine the optimal cut-off value, whereby surgeon volume was dichotomized as high or low. The outcome was DSSI within 1 year postoperatively. Multivariate logistics analysis was performed to examine the DSSI in association with surgeon volume and multiple sensitivity/subgroup analyses were performed to refine the findings. Among 1562 patients, 33 (2.1%) developed a DSSI. The optimal cut-off value was 7/year. Low-volume (<7/year) was significantly associated with a 5.0-fold increased risk of DSSI (95%CI, 2.2-11.3; P < .001). Sensitivity/subgroup analyses restricted to patients aged <65 years, with or without concurrent fractures, with unimalleolar fractures, bi- or trimalleolar fractures, receiving ORIF within 14 days and those operated by ≥10-year experience surgeons showed the consistently significant results (ORs, 2.7-6.8, all P < .05). The surgeon volume of <7 cases/year is associated with an increased risk of DSSI. It is more feasible that patients with complex fractures or conditions (eg, bi- and trimalleolar or presence of concurrent fractures) are preferentially directed to high-volume and experienced surgeons.
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http://dx.doi.org/10.1111/iwj.13819DOI Listing
May 2022

Relationship Between Preoperative Hypoalbuminemia and Postoperative Pneumonia Following Geriatric Hip Fracture Surgery: A Propensity-Score Matched and Conditional Logistic Regression Analysis.

Clin Interv Aging 2022 13;17:495-503. Epub 2022 Apr 13.

Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.

Background: Pneumonia is a devastating complication following geriatric hip fracture surgery, and preoperative hypoalbuminemia may be a potentially modifiable factor leading to improved outcome. This study aimed to quantify the relationship between preoperative hypoalbuminemia and postoperative pneumonia.

Methods: We retrospectively reviewed the medical records of elderly patients (≥60 years) who underwent surgeries for hip fracture in a tertiary referral center between 2016 and 2020. According to the preoperative serum albumin level, they were divided into two groups: <35 g/ L and ≥35 g/ L. To reduce potential confounding, propensity score matching (PSM) in a 1:1 ratio was performed, with the caliper value set as 0.002; and further conditional logistic regression analysis was used to control the other potential confounders to determine the association strength.

Results: Among 3,147 eligible patients included, PSM yielded 1,318 matched patients, with 659 in each respective group, suggesting significantly improved balance in most variables (standardized mean deviation improvement range, 20.7% to 99.1%), except for basophil count. The conditional logistic regression analysis, adjusted for PS and other intra- or post-operative variables, showed 6.18-fold (relative ratio, 6.18; 95% CI, 3.15-11.98; P<0.001) increased risk of postoperative pneumonia associated with preoperative hypoalbuminemia.

Conclusion: Preoperative hypoalbuminemia was identified to be independently and highly associated with development of postoperative pneumonia in elderly patients undergoing hip fracture surgeries. However, whether the patients who had such condition may benefit from preoperative targeted nutritional support needs to be clarified by more prospective studies.
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http://dx.doi.org/10.2147/CIA.S352736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9013674PMC
April 2022

Development and validation of a predictive nomogram for preoperative deep vein thrombosis (DVT) in isolated calcaneal fracture.

Sci Rep 2022 04 8;12(1):5923. Epub 2022 Apr 8.

Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.

The fact that most of the patients with preoperative DVTs after calcaneal fractures are asymptomatic brought challenges to the early intervention, and periodic imaging examinations aggravated the financial burden of the patients in preoperative detumescence period. This study aimed to use routine clinical data, obtained from the database of Surgical Site Infection in Orthopaedic Surgery (SSIOS), to construct and validate a nomogram for predicting preoperative DVT risk in patients with isolated calcaneal fracture. The nomogram was established base on 7 predictors independently related to preoperative DVT. The performance of the model was tested by concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), and the results were furtherly verified internally and externally. 952 patients were enrolled in this study, of which 711 were used as the training set. The AUC of the nomogram was 0.870 in the training set and 0.905 in the validation set. After internal verification, the modified C-index was 0.846. Calibration curve and decision curve analysis both performed well in the training set and validation set. In short, we constructed a nomogram for predicting preoperative DVT risk in patients with isolated calcaneal fracture and verified its accuracy and clinical practicability.
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http://dx.doi.org/10.1038/s41598-022-10002-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8993928PMC
April 2022

Triangular support intramedullary nail: A new internal fixation innovation for treating intertrochanteric fracture and its finite element analysis.

Injury 2022 Jun 20;53(6):1796-1804. Epub 2022 Mar 20.

Trauma Emergency Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei 050051, PR China; Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei 050051, PR China. Electronic address:

Background: Proximal femoral nail anti-rotation (PFNA) and Gamma nail were recommended for intertrochanteric fracture, however, with high rate of post-operation complications. The triangular support intramedullary nail (TSIN) was designed to reduce the risk of postoperative complications related to Gamma nail and PFNA, and the aim is to compare the biomechanical characters of Gamma nail, PFNA and TSIN for fixation of intertrochanteric fracture and prove the rationality of the concept of triangle fixation in the treatment of intertrochanteric fractures.

Methods: The finite element model of proximal femur was constructed according to the CT data of femur. Intertrochanteric fracture models with Evans type Ⅰ and Ⅳ were established and fixed with Gamma nail, PFNA and TSIN by UG-NX 12.0. The finite element analysis software was used to compare the stress distribution and displacement of three implants fixation models.

Results: Under axial loading of 600 N, the peak stress and maximum displacement of intact proximal femur was 13.78 MPa and 1.33 mm, respectively. The maximum stress of TSIN for fixation of Evans type Ⅰ and Ⅳ intertrochanteric fractures was 86.23 MPa and 160.63 MPa which was significantly lower than that of Gamma nail and PFNA. The maximum relative displacement of fracture section in Gamma nail and PFNA fixation models was 0.18 mm and 0.19 mm which has 135% and 148% higher than in TSIN fixation models for fixing Evans type Ⅰ intertrochanteric fracture, and 0.47 mm and 0.59 mm which has 91% and 140% higher than in TSIN fixation models for stabilization of Evans type Ⅳ intertrochanteric fracture.

Conclusion: Compared with Gamma nail and PFNA fixation, TSIN has superior advantages in stress distribution and construct stability. We believe that triangle fixation concept help to reduce the risk of post-operative complications associated with PFNA and Gamma nail and improve the clinical effect of intertrochanteric fracture.
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http://dx.doi.org/10.1016/j.injury.2022.03.032DOI Listing
June 2022

Incidence and risk factors for postoperative pneumonia following surgically treated hip fracture in geriatric patients: a retrospective cohort study.

J Orthop Surg Res 2022 Mar 24;17(1):179. Epub 2022 Mar 24.

Department of Orthopaedic Surgery, The Third Hospital, Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.

Objective: Large sample investigations for risk factors for pneumonia in elderly patients after hip fracture surgeries are lacking. The purpose of this study is to determine the incidence and risk factors for postoperative pneumonia in geriatric patients following hip fracture operations.

Methods: A retrospective study of incidence and risk factors in a tertiary referral center between 2016 and 2020 was conducted. Geriatric patients who developed postoperative pneumonia after surgeries of hip fracture during hospitalization stay were defined as cases and those without as controls. Multivariate logistic regression model was used to evaluate risk factors for postoperative pneumonia.

Results: This study included 3147 patients, and 182 developed postoperative pneumonia, denoting the rate of 5.8%. In the multivariate analyses, age (OR 1.04; 95% CI 1.02-1.06), sex (males) (OR 2.27; 95% CI 1.64-3.13), respiratory disease (OR 3.74; 95% CI 2.32-6.04), heart disease (OR 1.68; 95% CI 1.14-2.47), cerebrovascular disease (OR 1.58; 95% CI 1.11-2.27), liver disease (OR 2.61; 95% CI 1.33-5.15), preoperative stay (OR 1.08; 95% CI 1.05-1.11) and general anesthesia (OR 1.61; 95% CI 1.15-2.27) were identified as independent risk factors for postoperative pneumonia.

Conclusions: This study identified several risk factors for pneumonia in geriatric patients after hip fracture operations, providing a viable preventive strategy for optimizing clinical conditions for reduction of postoperative pneumonia.
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http://dx.doi.org/10.1186/s13018-022-03071-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8944015PMC
March 2022

Preoperative incidence and risk factors of deep venous thrombosis in patients with isolated femoral shaft fracture.

BMC Surg 2022 Mar 4;22(1):83. Epub 2022 Mar 4.

Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University; Orthopaedic Institution of Hebei Province; Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.

Background: Preoperative deep vein thrombosis (DVT) of the lower extremities delays surgery in patients with femoral shaft fractures and impairs functional recovery. However, studies on preoperative DVT in patients with femoral shaft fractures are still rare. This study was aimed to retrospectively analyze the preoperative incidence, location and risk factors associated with DVT in patients with femoral shaft fractures.

Methods: Data of patients with femoral shaft fractures and treated with surgery at the Third Hospital of Hebei Medical University were retrospectively collected from January 2013 to December 2019. The information collected included demographic data, comorbidities, injury-related data and laboratory tests. Patients were divided into DVT and non-DVT groups. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors.

Results: A total of 432 patients were included in this study, of whom 114 (26.4%) patients were diagnosed with preoperative DVT (all asymptomatic) and injured extremities of 78.1% (89/114) were investigated. Multivariate analysis showed that older age (increase in each 10 years), delay time from injury to operation (in each day), FIB > 4 g/L were independent risk factors for preoperative DVT.

Conclusion: Patients with femoral shaft fractures (especially the elderly and patients with the above-mentioned conditions) are at the risk of DVT right from admission to surgery hence should be intensively monitored and provided with prompt treatment to prevent DVT.
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http://dx.doi.org/10.1186/s12893-022-01534-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8896081PMC
March 2022

Preoperative incidence and risk factors of deep vein thrombosis in patients with an isolated patellar fracture.

BMC Musculoskelet Disord 2022 Mar 3;23(1):204. Epub 2022 Mar 3.

Trauma Emergency Center, Key Laboratory of Biomechanics of Hebei Province, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, PR China.

Purpose: This study aimed to investigate the incidence, location, and related factors of preoperative deep venous thrombosis (DVT) in patients with isolated patellar fractures.

Methods: Patients with an isolated patellar fracture, admitted between January 2013 and December 2019 at our institution, were retrospectively analyzed. Upon admission, patients underwent routine Doppler ultrasound scanning (DUS) of the bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patients in both groups did not perform preoperative off-bed weight-bearing exercises. Data on demographics, comorbidities, and laboratory test results upon admission were extracted. Variables were evaluated between the two groups using univariate analyses, and independent risk factors associated with DVT were identified by logistic regression analysis.

Results: During the study period, 827 patients were included, of whom 5.8% (48/827) were found to have preoperative DVT. In DVT patients, 85.4%(41/48) were injured, 8.3%(4/48) were not injured, and 6.3%(3/48) were lower limbs. Multivariate analysis showed that male (male vs. female, odds ratio, OR = 2.25), delayed from injury to DUS (in each day, OR = 1.29), and elevated plasma D-dimer level (> 0.5 µg/mL, OR = 2.47) were independent risk factors associated with DVT.

Conclusions: Despite the low prevalence of DVT after an isolated patellar fracture, this study underscores the importance of identifying those with a high risk of DVT, especially those with multiple identifiable factors, and encourage the early targeted use of anti-thromboembolic agents to reduce DVT occurrence.
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http://dx.doi.org/10.1186/s12891-022-05163-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8895776PMC
March 2022

The Hoffa-like fracture of the tibial plateau: a clinical study.

Int Orthop 2022 06 18;46(6):1387-1393. Epub 2022 Feb 18.

Department of Orthopaedic Surgery, the 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.

Background: Given the contrapositive link between the posterior tibial plateau and the femoral condyle and the similar injury cause, the fracture type should be the same as the well-known Hoffa fracture of the femoral condyle. This study aims to report a case series with Hoffa-like tibial plateau fractures to improve understanding.

Methods: We analysed six consecutive patients presented with Hoffa-like tibial plateau fractures in our hospital between October 2014 and December 2020, a period in which 1924 tibial plateau fractures were treated. Patients' data on demographics, radiographs, surgical therapy, and assessment at a 12-month follow-up were retrieved.

Results: The incidence of Hoffa-like tibial plateau fractures was 0.31% (6/1924). This study included three men and three women, with a mean age of 45.8 years. The injury mechanism was either a fall from a great height or a vehicle accident. On average, 7.5 days after the injury, patients were surgically treated with open reduction and internal fixation (ORIF) with place/screws via a lateral or posteromedial approach. At 10 to 15 weeks, all instances had osseous union on radiography. At 12-month follow-up, the HSS score of the operated knee ranged from 93 to 98 points (mean: 94.8), and Rasmussen radiograph score was from 15 to 18 (mean: 15.8). There were no intra-operative or post-operative problems.

Conclusion: This Hoffa-like fracture of the tibial plateau is a rare condition; however, it can occur. Orthopaedic surgeons should pay attention to this neglected but actually familiar fracture type.
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http://dx.doi.org/10.1007/s00264-022-05345-wDOI Listing
June 2022

2-Methyl Nonyl Ketone From Alleviates LPS-Induced Inflammatory Response and Oxidative Stress in Bovine Mammary Epithelial Cells.

Front Chem 2021 31;9:793475. Epub 2022 Jan 31.

College of Animal Sciences, Jilin University, Changchun, China.

Mastitis is one of the most common diseases in dairy cows, causing huge economic losses to the dairy industry every year. ( ) is a traditional Chinese herbal medicine that is widely used in clinical treatment. However, the therapeutic effect of 2-methyl nonyl ketone (), the main volatile oil component in the aqueous vapor extract of , on mastitis has been less studied. The purpose of this study was to investigate the protective effect and mechanism of MNK against lipopolysaccharide ()-induced mastitis . The results showed that MNK pretreatment of the bovine mammary epithelial cell line () enhanced cell viability and inhibited LPS-induced reactive oxygen species () production and inflammatory response. MNK reduced the production of pro-inflammatory cytokines such as interleukin () and tumor necrosis factor-α () by repressing LPS-induced activation of Toll-like receptor 4-nuclear factor-κB () signaling pathway. In addition, MNK protected cells from inflammatory responses by blocking the downstream signaling of inflammatory factors. MNK also induced ( ) production by Nuclear factor erythroid 2-related factor 2 () pathway through AKT and extracellular signal-regulated kinase () pathways, thereby reducing LPS-induced oxidative damage for MAC-T cells. In conclusion, MNK played a protective role against LPS-induced cell injury. This provides a theoretical basis for the research and development of MNK as a novel therapeutic agent for mastitis.
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http://dx.doi.org/10.3389/fchem.2021.793475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8842123PMC
January 2022

Unilateral locking plate versus unilateral locking plate combined with compression bolt for Schatzker I-IV tibial plateau fractures: a comparative study.

Int Orthop 2022 05 2;46(5):1133-1143. Epub 2022 Feb 2.

Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.

Background: The quality and durability of fracture reduction play an important role in the functional prognosis of articulation. The purpose of this study was to investigate the radiological and clinical effects of compression bolts in the treatment of Schatzker I-IV tibial plateau fractures (TPFs).

Methods: Between May 2015 and April 2018, a total of 96 consecutive adult patients with operatively treated Schatzker I-IV TPFs were included and divided into two groups according to the internal fixations: Group 1 (unilateral locking plate) and Group 2 (unilateral locking plate combined with compression bolt). Data on demographic and fracture characteristics, postoperative follow-up imaging, intraoperative indicators, postoperative reduction quality and durability, clinical outcomes, and complications were retrospectively collected and compared between the two groups.

Results: There were no significant intergroup differences in preoperative baseline data, duration of operation, intra-operative blood loss, days in hospital, rate of immediate post-operative reduction loss, or complications. The time of fracture healing, the rate of secondary reduction loss, and the mean WOMAC score were significantly reduced compared with those in Group 1 (P = 0.024, 0.015, and 0.024, respectively). There were significant intergroup differences in the mean HSS score (89.0 ± 11.4 vs. 94.4 ± 6.7, P = 0.042), the mean Lysholm score (83.8 ± 9.6 vs. 88.4 ± 5.2, P = 0.027), and the mean SF-36 score (82.8 ± 12.5 vs. 90.5 ± 7.6, P = 0.001). Additionally, there were similar significant differences in subgroup analysis (only included patients with Schatzker II-III), except for WOMAC score.

Conclusion: Compared with unilateral locking plate fixation, unilateral locking plate combined with compressing bolt fixation can reduce the rate of secondary reduction loss, accelerate fracture healing, and show better clinical outcomes for patients with Schatzker I-IV TPFs.
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http://dx.doi.org/10.1007/s00264-022-05324-1DOI Listing
May 2022

Incidence and risk factors associated with preoperative deep venous thrombosis in the young and middle-aged patients after hip fracture.

J Orthop Surg Res 2022 Jan 11;17(1):15. Epub 2022 Jan 11.

Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.

Objective: This study aims to investigate the incidence, occurrence timing and locations of preoperative DVT and identify the associated factors in this group.

Methods: A retrospective analysis of collected data in young and middle-aged (18-59 years) patients who presented with hip fracture between October 2015 and December 2018 was conducted. Before operation, patients were routinely examined for DVT by Duplex ultrasonography (DUS). Electronic medical records were retrieved to collect the data, involving demographics, comorbidities, injury and laboratory biomarkers after admission. Multivariate logistic regression analysis was performed to identify factors that were independently associated with DVT.

Results: Eight hundred and fifty-seven patients were included, and 51 (6.0%) were diagnosed with preoperative DVT, with 2.5% for proximal DVT. The average age of patients with DVT is 48.7 ± 9.4 year, while that of patients without DVT is 45.0 ± 10.9 year. The mean time from injury to diagnosis of DVT was 6.8 ± 5.5 days, 43.1% cases occurring at day 2-4 after injury. Among 51 patients with DVT, 97 thrombi were found. Most patients had thrombi at injured extremity (72.5%), 19.6% at uninjured and 7.8% at bilateral extremities. There are significantly difference between patients with DVT and patients without DVT in term of prevalence of total protein (41.2% vs 24.4%, P = 0.008), albumin (54.9% vs 25.6%, P = 0.001), low lactate dehydrogenase (51.0% vs 30.3%, P = 0.002), lower serum sodium concentration (60.8% vs 29.9%, P = 0.001), lower RBC count (68.6% vs 37.0%, P = 0.001), lower HGB (51.0% vs 35.1%, P = 0.022), higher HCT (86.3% vs 35.1%, P = 0.022) and higher platelet count (37.3% vs 11.3%, P = 0.001). The multivariate analyses showed increasing age in year (OR 1.04, 95% CI; P = 0.020), delay to DUS (OR, 1.26; P = 0.001), abnormal LDH (OR, 1.45; P = 0.026), lower serum sodium concentration (OR, 2.56; P = 0.007), and higher HCT level (OR, 4.11; P = 0.003) were independently associated with DVT.

Conclusion: These findings could be beneficial in informed preventive of DVT and optimized management of hip fracture in specific group of young and mid-aged patients.
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http://dx.doi.org/10.1186/s13018-021-02902-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8753898PMC
January 2022

Time-resolved fluorescence immunoassay (TRFIA) for the simultaneous detection of hs-CRP and lipoprotein(a) in serum.

Biotechnol Appl Biochem 2022 Jan 4. Epub 2022 Jan 4.

Guangzhou Youdi Biotechnology Co., Ltd., Guangzhou, China.

Elevated serum high-sensitivity C-reactive protein (hs-CRP) and lipoprotein(a) (Lp(a)) levels are associated with the development of native coronary atherosclerosis. We aimed to establish a new method for the simultaneous detection of hs-CRP and Lp(a) to predict the development of atherosclerosis. A one-step time-resolved fluorescence immunoassay (TRFIA) with europium(III) (Eu ) or samarium(III) (Sm ) labels was established, and the performance of this TRFIA (in terms of sensitivity, specificity, accuracy, and cutoff values) was evaluated using clinical serum samples and compared with those of registered kits. The sensitivity was 0.052 μg/ml for hs-CRP and 0.64 μg/ml for Lp(a). The intra-assay and inter-assay cross-reactivities (CVs) were very low, ranging from 2.05% to 4.67% for hs-CRP and from 2.42% to 6.43% for Lp(a). The CVs were very low (<0.34% and <2.65%, respectively) with five interferents. Additionally, there was a high Pearson coefficient between the present TRFIA method and the registered kits (R = 0.9967 and 0.9906, respectively). These data indicate that this study developed a TRFIA method that can be used for the quantitative detection of hs-CRP and Lp(a) in serum with high sensitivity, specificity, and accuracy. This TRFIA provides a new method for predicting the development of atherosclerosis.
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http://dx.doi.org/10.1002/bab.2310DOI Listing
January 2022

Roles of Nitric Oxide in the Regulation of Reproduction: A Review.

Front Endocrinol (Lausanne) 2021 19;12:752410. Epub 2021 Nov 19.

College of Animal Science, Jilin University, Changchun, China.

Nitric oxide (NO) has attracted significant attention as a stellar molecule. Presently, the study of NO has penetrated every field of life science, and NO is widely distributed in various tissues and organs. This review demonstrates the importance of NO in both male and female reproductive processes in numerous ways, such as in neuromodulation, follicular and oocyte maturation, ovulation, corpus luteum degeneration, fertilization, implantation, pregnancy maintenance, labor and menstrual cycle regulation, spermatogenesis, sperm maturation, and reproduction. However, the mechanism of action of some NO is still unknown, and understanding its mechanism may contribute to the clinical treatment of some reproductive diseases.
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http://dx.doi.org/10.3389/fendo.2021.752410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640491PMC
February 2022

Epigenetic modifications potentially controlling the allelic expression of imprinted genes in sunflower endosperm.

BMC Plant Biol 2021 Dec 4;21(1):570. Epub 2021 Dec 4.

College of Bioscience and Biotechnology, Shenyang Agricultural University, Shenyang, 110866, Liaoning, China.

Background: Genomic imprinting is an epigenetic phenomenon mainly occurs in endosperm of flowering plants. Genome-wide identification of imprinted genes have been completed in several dicot Cruciferous plant and monocot crops.

Results: Here, we analyzed global patterns of allelic gene expression in developing endosperm of sunflower which belongs to the composite family. Totally, 691 imprinted loci candidates were identified in 12 day-after-pollination sunflower endosperm including 79 maternally expressed genes (MEG) and 596 paternally expressed genes (PEG), 6 maternally expressed noncoding RNAs (MNC) and 10 paternally expressed noncoding RNAs (PNC). And a clear clustering of imprinted genes throughout the rapeseed genome was identified. Generally, imprinting in sunflower is conserved within a species, but intraspecific variation also was detected. Limited loci in sunflower are imprinted in other several different species. The DNA methylation pattern around imprinted genes were investigated in embryo and endosperm tissues. In CG context, the imprinted genes were significantly associated with differential methylated regions exhibiting hypomethylation in endosperm and hypermethylation in embryo, which indicated that the maternal demethylation in CG context potentially induce the genomic imprinting in endosperm.

Conclusion: Our study would be helpful for understanding of genomic imprinting in plants and provide potential basis for further research in imprinting in sunflower.
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http://dx.doi.org/10.1186/s12870-021-03344-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8642925PMC
December 2021

Incidence and risk factors associated with surgical site infection after surgically treated hip fractures in older adults: a retrospective cohort study.

Aging Clin Exp Res 2022 May 29;34(5):1139-1148. Epub 2021 Nov 29.

Department of Infection Control and Prevention, The Third Hospital of Hebei Medical University, Shijiazhuang, China.

Background: Surgical site infection (SSI) is one of the most common complications in the traumatic orthopedics field, but remains not adequately studied after hip fractures.

Aims: This study aims to investigate the incidence and risk factors associated with SSI after surgically treated hip fractures in older adults.

Methods: A retrospective cohort study including 2932 older adult patients (1416 with femoral neck fracture and 1516 with intertrochanteric fracture) surgically treated from Jan 2015 to Dec 2019 due to hip fractures was performed. Their data on demographics, injury-related data, surgery-related data, and preoperative laboratory test results were collected from hospitalization medical records. Univariate analyses were used to compare between the patients with and without SSI, and multivariate logistic regression analyses were used to identify the risk factors.

Results: A total of 89 patients developed SSI, with an accumulated incidence rate of 3.04% (95%CI 2.41-3.66). Staphylococcus aureus was the most common source of infection. In univariate analysis, 11 items were found to be significant in femoral neck fractures and 5 items were found to be significant in intertrochanteric fracture. In the multivariable logistic regression model, cerebrovascular disease (OR 2.17, 95%CI 1.14-4.15) and hematocrit (HCT) (< Lower limit) (OR 3.46, 95%CI 1.13-10.56) were independent risk factors for SSI in femoral neck fracture. Heart disease (OR 2.13, 95%CI 1.18-3.85) was a risk factor for SSI, while LDH (> 250 U/L) (OR 0.44, 95%CI 0.20-0.95) was a protective factor for SSI in intertrochanteric fracture.

Discussion: We observed 89 cases (3.04%) of SSI in 2932 older adult patients with hip fractures in this study. Cerebrovascular disease and lower HCT were two independent risk factors for SSI in femoral neck fracture, whereas heart disease was a risk factor and LDH was a protective factor for SSI in intertrochanteric fracture.

Conclusions: Targeted preoperative management, such as predicting the probability of SSI and taking appropriate measures accordingly is essential and highly regarded. Future multicentric studies with more patients evaluated are expected to better address the risk factors for SSI in older hip fracture patients.
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http://dx.doi.org/10.1007/s40520-021-02027-2DOI Listing
May 2022

Role of a new age-adjusted D-dimer cutoff value for preoperative deep venous thrombosis exclusion in elderly patients with hip fractures.

J Orthop Surg Res 2021 Oct 30;16(1):649. Epub 2021 Oct 30.

Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.

Objective: This study aimed to describe the characteristics of plasma D-dimer level with increasing age and establish a new age-adjusted D-dimer cutoff value for excluding preoperative lower limb deep vein thrombosis (DVT) in elderly patients with hip fractures.

Methods: This was a retrospective study of elderly patients who presented with acute hip fracture in our institution between June 2016 and June 2019. All patients underwent D-dimer test and duplex ultrasound. Patients were divided into six 5-year-apart age groups. The optimal cutoff value for each group was calculated by using receiver operating characteristic (ROC) curves, whereby the new age-adjusted D-dimer cutoff value was determined. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated and compared when different D-dimer cutoff values were applied, i.e., conventional 0.5 mg/L, previously well-established age-adjusted cutoff value (age × 0.01 mg/L) and the new age-adjusted D-dimer cutoff value herein.

Results: There were 2759 patients included, 887 males and 1872 females, with an average age of 78 years. In total, 280 patients were diagnosed with preoperative DVT. The optimal cutoff values for the six age groups were 0.715 mg/L, 1.17 mg/L, 1.62 mg/L, 1.665 mg/L, 1.69 mg/L and 1.985 mg/L, respectively, and the calculated age-adjusted coefficient was 0.02 mg/L. With this new coefficient applied, the specificity was 61%, clearly higher than those for conventional threshold (0.5 mg/L, 37%) or previously established age-adjusted D-dimer threshold (age × 0.01 mg/L, 22%). In contrast, the sensitivity was lower than that (59% vs 85% or 77%) when D-dimer threshold of 0.5 mg/L or age-adjusted cutoff value (age × 0.01 mg/L) was used. The other indexes as PPV (15%, 11% and 12%) and NPV (93%, 93% and 94%) were comparable when three different D-dimer thresholds were applied.

Conclusions: We developed a new age-adjusted D-dimer cutoff value (age × 0.02 mg/L) for a specified high-risk population of patients aged 65 years or older with hip fractures, and demonstrated the improved utility of the D-dimer test for exclusion of DVT. This formula can be considered for use in elderly hip fracture patients who meet the applicable standards as preoperative DVT screening, after its validity is confirmed by more well-evidenced studies.
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http://dx.doi.org/10.1186/s13018-021-02801-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8557539PMC
October 2021

Biomechanical study on the stability and strain conduction of intertrochanteric fracture fixed with proximal femoral nail antirotation versus triangular supporting intramedullary nail.

Int Orthop 2022 02 26;46(2):341-350. Epub 2021 Oct 26.

Department of Orthopaedic Surgery, The 3Rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.

Objectives: Based on the features of the three-dimensional spatial structure of the proximal femoral trabeculae, we developed a bionic triangular supporting intramedullary nail (TSIN) for the treatment of the femoral intertrochanteric fracture. The current study aimed to compare the mechanical stability and restoration of mechanical conduction between proximal femoral nail antirotation (PFNA) and TSIN to fix the intertrochanteric fractures.

Methods: Firstly, five sets of PFNA and TSIN with the same size were selected and fixed on a biomechanical testing machine, and strain gauges were pasted on the main nail, lag screw, and supporting screw to load to the vertical load to 600 N, and the displacement and strain values were recorded. Secondly, formalin-preserved femurs were selected, and the left and right femurs of the same cadaver were randomly divided into two groups to prepare intertrochanteric femur fractures (AO classification 31-A1), which were fixed with PFNA (n = 15) and TSIN (n = 15), respectively. Sixteen sites around the fracture line were chosen to paste strain gauges and loaded vertically to 600 N, and then, the fracture fragment displacement and strain values were recorded. Finally, a 10,000-cycle test ranging from 10 to 600 N was conducted, and the cycle number and displacement value were recorded.

Results: The overall displacement of PFNA was 2.17 ± 0.18 mm, which was significantly greater than the displacement of the TSIN group (1.66 ± 0.05 mm, P < 0.05) under a vertical load of 600 N. The strain below the PFNA lag screw was 868.29 ± 147.85, which was significantly greater than that of the TSIN (456.02 ± 35.06, P < 0.05); the strain value at the medial side of the PFNA nail was 444.00 ± 34.23, which was significantly less than that of the TSIN (613.57 ± 108.00, P < 0.05). Under the vertical load of 600 N, the displacement of the fracture fragments of the PFNA group was 0.95 ± 0.25 mm, which was significantly greater than that of the TSIN group (0.41 ± 0.09 mm, P < 0.05). The femoral specimens in the PFNA group showed significantly greater strains at the anterior (1, 2, and 4), lateral (7, 9, and 10), posterior (11), and medial (15 and 16) sites than those in the TSIN group (all P < 0.05). In the cyclic compression experiment, the displacements of the PFNA group at 2000, 4000, 6000, 8000, and 10,000 cycles were 1.38 mm, 1.81 mm, 2.07 mm, 2.64 mm, and 3.58 mm, respectively, which were greater than the corresponding displacements of the TSIN group: 1.01 mm, 1.48 mm, 1.82 mm, 2.05 mm, and 2.66 mm (P = 0.012, P = 0.006).

Conclusions: The current study showed that TSIN had apparent advantages in stability and stress conduction. TSIN enhanced the stability of intertrochanteric fractures, particularly in superior fracture fragments, improved stress conduction, reduced the stress in the anterior and medial femur, and restored the biomechanical properties of the femur.
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http://dx.doi.org/10.1007/s00264-021-05250-8DOI Listing
February 2022

Relationship between surgeon volume and the risk of deep surgical site infection (DSSI) following open reduction and internal fixation of displaced intra-articular calcaneal fracture.

Int Wound J 2022 Aug 15;19(5):1092-1101. Epub 2021 Oct 15.

Department of orthopaedic surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, China.

It is well established that the postoperative results were affected by the surgeon volume in a variety of elective and emergent orthopaedic surgeries; however, by far, no evidences have been available as for surgically treated displaced intra-articular calcaneal fractures (DIACFs). We aimed at investigating the relationship between surgeon volume and deep surgical site infection (DSSI) following open reduction and internal fixation (ORIF) of DIACFs. This was a further analysis of prospectively collected data from a validated database. Patients with DIACFs stabilised by ORIF between 2016 and 2019 were identified. Surgeon volume was defined as the number of surgically treated calcaneal fractures within one calendar year and was dichotomised based on the optimal cut-off value. The outcome measure was DSSI within 1 year postoperatively. Multivariate logistics regression analyses were performed to examine the relationship, adjusting for confounders. Among 883 patients, 19 (2.2%) were found to have a DSSI. The DSSI incidence was 6.5% in surgeons with a low volume (<6/year), 5.5 times as that in those with a high volume (≥6/year) (incidence rate, 1.2%; P < 0.001). The multivariate analyses showed a low volume <6/year was associated with a 5.8-fold increased risk of DSSI (95% confidence interval, 2.2-16.5, P < 0.001). This value slightly increased after multiple sensitivity analyses, with statistical significances still unchanged (OR range, 6.6-6.9; P ≤ 0.001). The inverse relationship indicates a need for at least six cases/year for a surgeon to substantially reduce the DSSIs following the ORIF of DIACFs.
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http://dx.doi.org/10.1111/iwj.13705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9284634PMC
August 2022

Surgeon volume and the risk of deep surgical site infection following open reduction and internal fixation of closed tibial plateau fracture.

Int Orthop 2022 03 22;46(3):605-614. Epub 2021 Sep 22.

Department of Orthopaedic Surgery, the 3Rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.

Background: Emerging evidences supported that the surgeon case volume significantly affected post-operative complications or outcomes following a range of elective or non-elective orthopaedic surgery; no data has been available for surgically treated tibial plateau fractures. We aimed to investigate the relationship between surgeon volume and the risk of deep surgical site infection (DSSI) following open reduction and internal fixation (ORIF) of closed tibial plateau fracture.

Methods: This was a further analysis of the prospectively collected data. Adult patients undergoing ORIF procedure for closed tibial plateau fracture between January 2016 and December 2019 were included. Surgeon volume was defined as the number of surgically treated tibial fractures in the preceding 12 months and dichotomized on the basis of the optimal cut-off value determined by the receiver operating characteristic (ROC) curve. The outcome was DSSI within one year post-operatively. Multiple multivariate logistic models were constructed for "drilling down" adjustment of confounders. Sensitivity and subgroup analyses were performed to assess the robustness of outcome and identify the "optimal" subgroups.

Results: Among 742 patients, 20 (2.7%) had a DSSI and 17 experienced re-operations. The optimal cut-off value for case volume was nine, and the low-volume surgeon was independently associated with 2.9-fold (OR, 2.9; 95%CI, 1.1 to 7.5) increased risk of DSSI in the totally adjusted multivariate model. The sensitivity analyses restricted to patients with original BMI data or those operated within 14 days after injury did not alter the outcomes (OR, 2.937, and 95%CI, 1.133 to 7.615; OR, 2.658, and 95%CI, 1.018 to 7.959, respectively). The subgroup analyses showed a trend to higher risk of DSSI for type I-IV fractures (OR, 4.6; 95%CI, 0.9 to 27.8) classified as Schatzker classification and substantially higher risk in patients with concurrent fractures (OR, 6.1; 95%CI, 1.0 to 36.5).

Conclusion: The surgeon volume is independently associated with the rate of DSSI, and a number of ≥ nine cases/year are necessarily kept for reducing DSSIs; patients with concurrent fractures should be preferentially operated on by high-volume surgeons.
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http://dx.doi.org/10.1007/s00264-021-05221-zDOI Listing
March 2022

Total hip arthroplasty or hemiarthroplasty for femoral neck fractures in elderly patients with neuromuscular imbalance.

Aging Clin Exp Res 2021 Sep 10. Epub 2021 Sep 10.

Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.

Aim: This study aimed at comparing clinical outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in elderly patients with neuromuscular imbalance (stroke, Parkinsonism, etc.).

Methods: A total of 226 elderly patients with neuromuscular imbalance and femoral neck fractures treated with THA or HA were recruited at a single center, and their clinical data retrospectively reviewed. Mean follow-up time was 40.5 months (range 24-78), the primary outcome was secondary hip procedure while secondary outcomes included function, pain, health-related quality of life, complications, and death. Kaplan-Meier survival curves were used to determine the estimated survivorship, with re-operation as the end point. Logistic regression analyses were performed to assess the effects of different surgical procedures on mortality while linear regression analysis was used to evaluate the function, pain and quality of life.

Results: Kaplan-Meier survivorship, with an end point of re-operation for any reason in the THA group, was 90.3% (95% CI 82.3-98.3), which was not significantly different from 95.9% (95% CI 93.0-98.8) for the HA group (p = 0.137). The most common cause of re-operation in both groups was dislocation. There were no significant differences with regards to postoperative complications (including dislocation). Compared to HA, THA exhibited better functional outcomes, quality of life and low pain intensity. Notably, there was no difference in 2 year mortality rates between the groups, however, HA was associated with a higher mortality rate beyond 2 years (OR 0.137; 95% CI 0.030-0.630; p = 0.011).

Conclusion: THA is an effective therapeutic procedure for femoral neck fractures in elderly patients with neuromuscular imbalance.
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http://dx.doi.org/10.1007/s40520-021-01976-yDOI Listing
September 2021

Incidence and risk factors for decreased range of motion of the knee joint after surgery for closed tibial plateau fracture in adults.

J Orthop Surg Res 2021 Sep 7;16(1):549. Epub 2021 Sep 7.

Department of Orthopaedic surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P. R. China.

Purpose: The aim of this study was to quantify the incidence of and identify independent risk factors for decreased range of motion (ROM) of the knee joint after surgery for closed tibial plateau fractures in adults.

Methods: This retrospective study was performed at the trauma centre in our hospital from January 2018 to December 2019. Data from adult patients with tibial plateau fractures treated by surgery were extracted from the electronic medical records. A total of 220 tibial plateau fracture patients were enrolled. We extracted the patients' demographic characteristics, fracture characteristics, and surgery-related variables. Univariate and multivariate logistic regression models were used to investigate the potential independent risk factors.

Results: Fifty-seven patients developed decreased ROM of the knee joint at the 1-year follow-up in this study. The overall incidence was 25.9%. The independent predictors of decreased ROM after surgery, as identified in the multivariate analysis, were orthopedic polytrauma (odds ratio = 3.23; 95% CI = 1.68-6.20; p = 0.000), fracture type (Schatzker V-VI) (odds ratio = 2.52; 95% CI = 1.16-5.47; p = 0.019), and an open reduction and internal fixation approach (odds ratio = 2.10; 95% CI = 1.07-4.12; p = 0.031).

Conclusions: The study confirmed that patients with orthopaedic polytrauma, more complex fractures and those treated with open reduction and internal fixation (ORIF) surgery were more likely to suffer decreased ROM of the knee joint 1 year after surgery.
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http://dx.doi.org/10.1186/s13018-021-02700-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422622PMC
September 2021

Structural Bicortical Autologous Iliac Crest Bone Graft Combined with the Tunnel Bone Tamping Method for the Depressed Tibial Plateau Fractures.

Biomed Res Int 2021 24;2021:1249734. Epub 2021 Aug 24.

Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China 050051.

Background: Clinically, autologous iliac crest bone grafts (ICBG) and bone tamping methods are often applied to manage depressed tibial plateau fractures (DTPFs). The purpose of this study was to describe and evaluate the technique of using structural bicortical autologous ICBG combined with the tunnel bone tamping method (TBTM) for treating DTPFs.

Methods: All patients with DTPFs who underwent structural bicortical autologous ICBG combined with TBTM from January 2016 to February 2018 were prospectively analysed. Demographics, injury, surgery, postoperative complications, and clinical outcomes were recorded. All patients were followed up for more than 30 months. Postoperative radiography and CT were employed to assess fracture healing and the reduction quality.

Results: Forty-three of the included patients completed the follow-up. No malreduction was observed. Based on the immediate postoperative imaging, the intra-articular step-off was significantly reduced (8.19 mm preoperatively vs. 1.30 mm immediate postoperatively, < 0.001). From the immediate operation to the latest follow-up, the reduction was maintained significantly well, with a nonnegligible absolute difference (0.18 mm, = 0.108). A remarkable secondary loss of reduction (intra-articular step off > 3 mm) was found in two elderly patients (2/43, 4.65%). The incidence of complications related to the bone-graft donor and bone-graft site was 2.33% and 4.65%, respectively. At the final follow-up, the mean Hospital for Special Surgery (HSS) score of the knee was 98.19 ± 2.89, and the mean 36-Item Short-Form Health Survey (SF-36) score was 95.65 ± 4.59.

Conclusion: Structural bicortical autologous ICBG combined with TBTM is radiologically effective and stable in terms of complications for the DTPFs.
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http://dx.doi.org/10.1155/2021/1249734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407991PMC
October 2021

Nomogram for predicting reoperation following internal fixation of nondisplaced femoral neck fractures in elderly patients.

J Orthop Surg Res 2021 Sep 1;16(1):544. Epub 2021 Sep 1.

School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.

Objective: We aimed to evaluate risk factors and develop a nomogram for reoperation after internal fixation of nondisplaced femoral neck fractures (FNFs) in elderly patients.

Methods: We conducted a retrospective study involving a total of 255 elderly patients who underwent closed reduction and internal fixation with cannulated screw system for nondisplaced FNFs between January 2016 and January 2019. We collected data on demographics, preoperative radiological parameters, surgery, serum biochemical markers, and postoperative rehabilitation. In addition, we performed univariate and multivariate logistic regression analyses to determine independent risk factors for reoperation, and then developed a nomogram to assess the risks of reoperation. Besides, discriminative ability, calibration, and clinical usefulness of the nomogram were evaluated using the concordance index (C-index), the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA), respectively. We employed bootstrap method to validate the performance of the developed nomogram.

Results: Our analysis showed that among the 255 patients, 28 (11.0%) underwent reoperation due to osteonecrosis of the femoral head (14 cases), mechanical failure (8 cases) or nonunion (6 cases). All of the 28 patients underwent conversion surgery to arthroplasty. The multivariate logistic regression analysis demonstrated that preoperative posterior tilt angle ≥ 20°, Pauwel's III type, younger patients, preoperative elevated levels of alkaline phosphatase (ALP), preoperative hypoalbuminemia, and early postoperative weight-bearing were independent risk factors for reoperation. In addition, the C-index and the bootstrap value of the developed nomogram was 0.850 (95% CI = 0.803-0.913) and 0.811, respectively. Besides, the calibration curve showed good consistency between the actual diagnosed reoperation and the predicted probability, while the DCA indicated that the nomogram was clinically valuable.

Conclusions: Our analysis showed we successfully developed and validated a nomogram for personalized prediction of reoperation after internal fixation of nondisplaced FNFs in elderly patients. This model would help in individualized evaluation of the need for reoperation and inform strategies aimed at eliminating the need for the reoperation.
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http://dx.doi.org/10.1186/s13018-021-02697-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408942PMC
September 2021

Titanium alloy cannulated screws and biodegradable magnesium alloy bionic cannulated screws for treatment of femoral neck fractures: a finite element analysis.

J Orthop Surg Res 2021 Aug 18;16(1):511. Epub 2021 Aug 18.

Trauma Emergency Center, Key Laboratory of Biomechanics and Orthopaedic Research Institute of Hebei Province, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.

Background: Cannulated screws (CS) are one of the most widely used treatments for femoral neck fracture, however, associated with high rate of complications. In this study, we designed a new type of cannulated screws called degradable magnesium alloy bionic cannulated screws (DMBCS) and our aim was to compare the biomechanical properties of DMBCS, the traditionally used titanium alloy bionic cannulated screws (TBCS) and titanium alloy cannulated screws (TTCS).

Methods: A proximal femur model was established based on CT data of a lower extremity from a voluntary healthy man. Garden type III femoral neck fracture was constructed and fixed with DMBCS, TBCS, and TTCS, respectively. Biomechanical effect which three type of CS models have on femoral neck fracture was evaluated and compared using von Mises stress distribution and displacement.

Results: In the normal model, the maximum stress value of cortical bone and cancellous bone was 76.18 and 6.82 MPa, and the maximum displacement was 5.52 mm. Under 3 different fracture healing status, the stress peak value of the cortical bone and cancellous bone in the DMBCS fixation model was lower than that in the TTCS and TBCS fixation, while the maximum displacement of DMBCS fixation model was slightly higher than that of TTCS and TBCS fixation models. As the fracture heals, stress peak value of the screws and cortical bone of intact models are decreasing, while stress peak value of cancellous bone is increasing initially and then decreasing.

Conclusions: The DMBCS exhibits the superior biomechanical performance than TTCS and TBCS, whose fixation model is closest to the normal model in stress distribution. DMBCS is expected to reduce the rates of post-operative complications with traditional internal fixation and provide practical guidance for the structural design of CS for clinical applications.
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http://dx.doi.org/10.1186/s13018-021-02665-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8371795PMC
August 2021
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