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Background The timing of post-operative full weight-bearing in patients of isolated displaced lateral malleolar fractures remains controversial. The aim of this study was to evaluate the outcomes of early full weight-bearing after rigid internal fixation of such fractures with locking plates. Methods From 2012 to 2018, 46 patients who had closed isolated displaced lateral malleolar fractures were included in the study. All fractures were managed with open reduction and internal fixation with locking plates. The patients were allowed to walk bearing their full weight 2 weeks after the operation. The follow-up period was 41.5 months on average (range: 12-70 months). The patients were available to evaluate union conditions, functional results, and complications. Results The fractures united smoothly with an average union time of 10.5 weeks (range: 8-16). At the final follow-up, the average American Orthopaedic Foot and Ankle Score Ankle-Hindfoot Score was 91 (range: 85-98). No complications were observed. Conclusion For patients with isolated displaced lateral malleolar fractures, full weight-bearing is safe and effective, without an increase in the rate of complications, 2 weeks after open reduction and rigid fixation with locking plates.

Background We elucidated the effect of open reduction and internal fixation with locking plate for acute isolated displaced greater tuberosity fractures of humerus in elder adults (aged >60 years). Methods From 2009 to 2015, data from 32 patients, aged between 60 and 88 years, who had acute unilaterally displaced greater tuberosity fractures of humerus were collected and evaluated retrospectively. All the fractures were managed with open reduction and internal fixation with locking plate. The follow-up period was 50.8 months on an average (range 22-80 months). Finally, 25 patients were available for final evaluation of radiographic and functional results. Results All the 32 fractures had union with the average union time of 14 weeks (range 10-18 weeks) and with no complications. The average of preoperative Visual Analogue Scale (VAS) was 6.2 (range 4-8), ASES was 30.4 (range 13-45), and Constant score was 30.4 (range 20-45). At the last follow-up, the mean VAS was 1.3 (range 0-2.5), the mean ASES score was 90.1 (range 72-100), and the mean Constant score was 90.3 (range 80-100). There were statistically significant differences between preoperative and final follow-up in VAS, ASES, and Constant score. Hundred percent of patients had good or excellent results by Constant score, with excellent results (86-100) in 17 (68%) patients and good result (71-85) in 8 (32%). Conclusion In conclusion, open reduction and internal fixation with locking plate is an effective treatment for acute displaced greater tuberosity fractures of humerus in elder adults.

Patients with lumbar spondylolisthesis typically suffer from symptom discomfort and various degrees of disability for months or years prior to receiving surgical treatments. Knowing the factors that influence the disability status of these patients will help healthcare providers develop effective preventive measures.To explore preoperative disability and its important predictive factors in patients with lumbar spondylolisthesis.A predictive correlational design was used and a convenience sample of eighty-six lumbar spondylolisthesis preoperative patients were recruited from a medical center in northern Taiwan. Data were collected using a study questionnaire, which included the Oswestry disability index, the revised geriatric depression scale-short form, and a pain numeric rating scale.The average disability index of the participants was 48.52 (SD = 16.14). The multiple linear regression analyses identified lower back pain, depression, age, and gender as significant predictors of preoperative disability, collectively explaining 40.9% of the variation in disability severity. Being female, being older, having a higher degree of lower back pain, and having depression were significantly associated with preoperative disability.The results of the present study indicate that lumbar spondylolisthesis patients who are older in age, female, currently experiencing lower back pain, and suffering from depression face a higher risk of preoperative disability. Patients in these at-risk categories should be assessed actively and provided with appropriate patient education in order to enhance their quality of life.腰椎滑脫病人術前失能情形及其影響因素探討.腰椎滑脫的病人在接受手術治療前，大多經歷長達數月至數年的不適症狀，且有不同程度的失能情形，探討失能情形之影響因素，有助於發展有效之預防措施。.探討腰椎滑脫病人術前失能情形的重要預測因子。.本研究採預測相關性研究設計，以方便取樣，於臺灣北部某醫學中心招募86位腰椎滑脫術前病人。以問卷進行資料收集，內容包括疼痛數字等級量表、修正版簡式老年憂鬱量表及歐氏失能量表。.研究對象平均失能指數為48.52（SD = 16.14）分。多元線性迴歸分析結果顯示下背痛、憂鬱、年齡和性別為失能嚴重程度之重要預測因子，共可解釋40.9%之變異量。女性、年長、下背疼痛及憂鬱程度高的腰椎滑脫病人有較高的失能嚴重度。.女性、高齡、下背疼痛和憂鬱情緒的腰椎滑脫術前病人為失能的高危險群，應積極評估並給予適當的護理指導，以期得到較佳的生活品質。.

Purpose The effects of cerclage wiring in the open reduction and internal fixation of displaced associated anterior column and posterior hemi-transverse acetabular fractures were evaluated. Methods This is a retrospectively clinical study of such cases where the main surgical strategy was open reduction and internal fixation with cerclage wire and reconstruction plates. Data on 12 cases treated between 1992 and 2011 were collected. The mean follow-up period was 32 (12–132) months. Results Reduction with a fracture gap of less than 2 mm without articular stepping and solid union was achieved in all 12 cases. Postoperative complication developed in one case of symptomatic arthritis. Excluding the case with symptomatic arthritis, the other cases had good to excellent final D’Aubigne and Postel functional results. Conclusions Cerclage wiring is very useful and effective in the reduction and fixation of displaced associated anterior column and posterior hemi-transverse acetabular fractures, and supplemental fixation with reconstruction plates and screws is necessary.

Elastic (Esmarch) bandage exsanguination is widely used in lower limb surgery to provide a bloodless operating field. Nevertheless, it is still not known exactly how exsanguination through Esmarch bandage usage contributes to venous pressure physiology following TKA. We wished to determine whether exsanguination with Esmarch bandage affects the venous hemodynamics of the lower limb in the first few weeks following TKA, so a prospectively randomized study was set. We prospectively collected consecutive 38 male patients with unilateral advanced osteoarthritis of the knee. All of the subjects were randomly assigned to one of two TKA procedures: TKA with (Group A) or without (Group B) Esmarch bandage exsanguination. No pharmacologic thromboembolic prophylaxis was used in this study. The venous hemodynamics of each operated leg was assessed by strain-gage plethysmography, firstly before the operation, then postoperatively on days 2, 6, 14 and 28. The postoperative results revealed significant falls in venous outflow 2, 6 and 14 days following TKA in Group A; and 2 and 6 days following TKA in Group B. Twenty-eight days after TKA, venous outflow in both groups had returned to baseline level. Over the 28 days following the operation, Group A venous outflow tended to fall more significantly than in Group B. As with venous outflow, venous capacitance in both groups showed significant falls 2 and 6 days following TKA, with recovery to baseline levels 28 days postoperation. More significant falls in arterial filling index were recorded in Group A 6 days following TKA, returning to their baseline level 14 days postoperation. It appears that better leg venous hemodynamic changes are attained during the first month after TKA in Group B. We therefore question the need for exsanguination with Esmarch bandage before knee arthroplasty.

We evaluated the effect of revision with dynamic compression plate and cancellous bone graft for aseptic nonunion after intramedullary nailing of femoral shaft fracture. Fifty patients with aseptic nonunion of femoral shaft fracture after intramedullary nailing were reviewed and analyzed retrospectively between 1996 and 2007. There were 40 men and 10 women with an average age of 44 years (range, 19–76 years). Thirty-five were diaphyseal fractures, 8 were distal fractures, and 7 were proximal fractures. Twenty-eight fractures were defined as atrophic nonunion, 13 fractures were hypertrophic nonunion, and 9 fractures could not be defined clearly. All fractures were managed by retaining previous implants, open reduction and internal fixation with dynamic compression plate, and supplementation by cancellous bone graft. The average follow-up period was 76 months (range, 24–128 months). Functional evaluations were done by Harris Hip score and Hospital for Special Surgery knee score. All nonunions united on average at 24 weeks (range, 18–32 weeks). One superficial wound infection occurred. At follow-up, each patient was evaluated to have satisfactory function results, with near normal hip/knee functions without noticeable pain, and full return to preinjury activities/work without pain. Augmentative dynamic compression plate with cancellous bone graft is a reliable and effective treatment for revision of aseptic nonunion of femoral shaft fracture after intramedullary nailing.

The objective of this study was to understand the following: (1) the specific care needs of geriatric hip fracture patients; (2) the level of care difficulty during the transition period following discharge; and (3) the correlation amongst demographics, the physical function status of the elderly, and care needs. Purposive sampling was used, and a total of 71 hip fracture cases and their caregivers were selected. A survey was carried out to collect data just before discharge and one week following discharge. Statistical methods included descriptive statistics, correlation analysis, one-way ANOVA, and a paired t-test. Results were as follows: Most geriatric patients depended upon care from family members before discharge, with an average physical function status score of 6.99 (0 to 18) that improved significantly after one week to 10.27; paired t = -7.956 (p < .000). The mean age of primary caregivers was 51.72 years old (SD = 14.05). Most caregivers (47, or 66.2%) were female. The relationship between elderly participants and their primary caregiver was predominantly that of husband and wife (22 people; 31.0%). Participant care needs identified included return visit assistance, awareness of safety at all times, assistance with cleaning and maintaining living quarters, and so on. Caring tasks that were identified as more difficult for the primary caregivers includes providing stair climbing assistance, emotional problems management assistance, walking training assistance, rehabilitation assistance, and emergency disease management assistance. The care needs of the elderly in this study and level of execution difficulty for caregivers was found to be negatively related to the physical function status of the elderly. The study results suggest that providing patient-related home care knowledge to primary caregivers prior to discharge from the hospital and enhancement of the social support system are both needed.

This study was conducted to identify the factors influencing mechanical failure of cementless acetabular reconstruction for arthropathy after operative treatment of acetabular fractures. Fifty-six patients (56 hips) undergoing cementless total hip arthroplasty were enrolled and followed for a mean of 120 months (range, 60–180 months). The 10-year survival rate, with mechanical failure (radiographic loosening or revision due to aseptic loosening) as the endpoint, was analyzed with respect to sex, age, body mass index (BMI), acetabular bone deficiency, sclerotic changes to the acetabulum, and use of the Trabecular Metal (TM) cup (Zimmer, Inc, Warsaw, Indiana). Mean 10-year survival rates of the acetabular component were as follows: 80% (range, 65%–96%) in males and 100% in females ( P =.032); 77% (range, 60%–95%) in patients younger than 50 years and 91% (range, 82%–100%) in older patients ( P =.027); 88% (range, 78%–98%) in patients with a BMI less than 30 kg/m 2 and 81% (range, 74%–89%) in patients with a BMI of 30 kg/m 2 or higher ( P =.068); 54% (range, 32%–76%) in patients manifesting large acetabular deficiency and 90% (range, 78%–100%) in the remaining patients ( P P =.022); and 82% (range, 73%–100%) in patients who received a conventional shell and 100% in patients who received the TM cup ( P =.039). Male sex, age younger than 50 years, large acetabular deficiency, and sclerotic changes of the acetabulum were significant factors contributing to the mechanical failure of cementless acetabular reconstruction performed for old acetabular fractures treated with open reduction and internal fixation. Use of the TM cup seemed able to prolong the endurance of the acetabular component in the subsequent reconstruction. [ Orthopedics. 2015; 38(10):e934–e939.]

The aim of this study was to establish and evaluate the effectiveness of a care map for total knee replacement patients.Bureau of National Health Insurance in Taiwan is about to launch a diagnosis-related group. This major reform has seriously affected the running of medical institutions, which are facing unprecedented management pressure.A quasi-experimental control group design was carried out.Eighty-three patients were recruited, with 39 experimental group patients received nursing care based on a care map, while 44 patients who were in control group received routine nursing care. An interdisciplinary team designed the care map, which included items required for patient care from outpatient to postdischarge.(1) The mean age of patients was 72·73 (SD 8·42) years. Mean length of stay was 4·92 (SD 0·77) days for the experimental group and 7·09 (SD = 1·09) for the control group. Difference between groups was significant (t = -10·285, p0·001). The medical cost for the experimental group was less than that for the control group (t = -6·03, p0·001). (2) The self-care efficacy score before discharge for the experimental group was higher than that for the control group (t = 5·90, p0·001). (3) Significant improvements were observed in activities of daily living for both groups with the passage of time after discharge (F = 229·034, p0·001), and the experimental group was better than the control group (F = 40·895, p0·001). The instrumental activities of daily living abilities of both groups were also significant improvements with the passage of time after discharge (F = 46·568, p0·001), and the experimental group was better than the control group (F = 32·163, p0·001).A care map for total knee replacement patient can shorten length of stay, save medical cost and improve patient's functional recovery.Results of this study can be used as a basis for practical implementation of care map in total knee replacement patients.

Background This study was conducted to evaluate the results of treating hypertrophic nonunion of mid-shaft clavicle fracture with a limited contact dynamic compression plate (LC-DCP) without autologous cancellous bone graft. Methods From 1995 to 2008, 51 cases of hypertrophic nonunion of mid-shaft clavicle fracture were managed with open reduction and internal fixation by LC-DCP without bone graft involvement. Of these 51 cases, 30 had nonunion after failure of initial surgical treatment (Group 1), and 21 had nonunion after failure of conservative treatment (Group 2). Preoperative and postoperative case management were the same for both groups, with the average follow-up period being 20.4 months (range 18–36). Our study evaluated the radiographic results and functional outcomes of these cases according to the quick disability of arm, shoulder, and hand score. Results All 51 cases resulted in uneventful unions. There was no statistically significant difference between the two groups regarding patient demography, cause of injury, preoperative and postoperative functional scores, length of operation, union time, and duration of hospitalization (p > 0.05). Conclusion LC-DCP fixation is an effective method for treating hypertrophic nonunion of mid-shaft clavicle fracture. Local bone graft is sufficient to achieve necessary union, and autologous bone graft from other sites of the body appears unnecessary.

Background Concomitant ipsilateral hip and distal radius fractures are uncommon, and little research has been published about these injuries. Our aim was to evaluate the characteristics and results of treatment for these injuries. Methods Between 2006 and 2012, 35 concomitant hip and distal radius fractures were identified, comprising the study group. The characteristics and results of treatment for these injuries were evaluated and analyzed. Another matched control group with isolated hip fractures was collected for comparison of patient characteristics, fall mechanism, fracture pattern, bone density, and functional recovery. Results For the patients with concomitant fractures, the average age was 77.6 years, and the female-to-male ratio was 6:1 (30:5). The majority (91.4%) of patients sustained ipsilateral injuries. Among the controlled pairs, 20 (57.1%) patients in the study group sustained a backward fall, and 25 (71.4%) patients in the control group had a sideways fall. With respect to the pattern of hip fracture, 22 (62.9%) patients in the study group had femoral neck fractures and 20 (57.1%) patients in the control group had pertrochanteric fractures. The average hospital stay was 15.3 days in the study group versus 10.2 days in the control group. Twenty-five (71.4%) patients in the study group and 27 (77.1%) patients in the control group had osteoporosis. The average Barthel index score was 75.1 in the study group and 75.7 in the control group. Conclusion Concomitant hip and distal radius fractures were generally ipsilateral and involved the femoral neck after a backward fall. These patients were younger than and not more osteoporotic than the population with isolated hip fractures; however, the hospital stay was significantly increased. The functional outcome was not influenced by concomitant wrist fracture.