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Aims: Lower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate. The aim of this systematic review protocol is identifying differences in rates of infection, nonunion, and malunion of extra-articular femoral and tibial shaft fractures in LMICs treated with either internal or external fixation. Methods: This systematic review protocol describes a broad search of multiple databases to identify eligible papers. Studies must be published after 2000, include at least five patients, patients must be aged > 16 years or treated as skeletally mature, and the paper must describe a fracture of interest and at least one of our primary outcomes of interest. We did not place restrictions on language or journal. All abstracts and full texts will be screened and extracted by two independent reviewers. Risk of bias and quality of evidence will be analyzed using standardized appraisal tools. A random-effects meta-analysis followed by a subgroup analysis will be performed, given the anticipated heterogeneity among studies, if sufficient data are available. Conclusion: The lack of easily accessible LMIC outcome data, combined with international clinical guidelines that are often developed by HIC surgeons for use in HIC environments, makes the clinical decision-making process infinitely more difficult for surgeons in LMICs. This protocol will guide research on surgical management, outcomes, and complications of lower limb shaft fractures in LMICs, and can help guide policy development for better surgical intervention delivery and improve global surgical care. Cite this article: Bone Jt Open 2024;5(11):1020–1026.

Older adults (OAs) recovering from lower limb fractures experience social isolation (SI) and functional decline (FD) after they are discharged from inpatient rehabilitation due to reduced physical mobility. Our research used MAISON (Multimodal AI-based Sensor platform for Older iNdividuals), a multimodal sensor system comprising various smart devices collecting acceleration, heart rate, step count, frequency of indoor motion, GPS, and sleep metrics. This study aimed to investigate the correlations between SI and FD with multimodal sensor data from OAs following lower limb fractures. Multimodal sensor data from eight OAs (8 weeks per person) living at home were collected. Five clinical metrics were obtained via biweekly video calls, including three clinical questionnaires (Social Isolation Scale (SIS), Oxford Hip Score, Oxford Knee score) and two physical mobility assessments (Timed Up and Go, 30 s chair stand). From the sensor data collected, 53 statistical and domain features were extracted. Spearman correlation coefficients were calculated between the extracted features and clinical data. The results indicated strong correlations between various items of SIS and sleep metrics in OAs and various items of Oxford Knee Score with GPS and acceleration data. Strong correlations between the questions of the Oxford scores and sensor data highlight the direct impact of physical health status on measurable daily physical activities. [ABSTRACT FROM AUTHOR]

ObjectivesPulmonary thromboembolism is a severe but probably underdiagnosed disorder. Patients with lower limb fractures are at high risk for pulmonary thromboembolism. This study aimed to demonstrate the early identification strategies for occult pulmonary thromboembolism.MethodsFrom January to December 2022, 18 patients diagnosed with pulmonary thromboembolism were reviewed for this study. Data on patients’ demographics, laboratory test results, and radiographic findings were collected. Finally, the data was analyzed.ResultsEighteen patients with lower limb fractures were included in this study. All of them present different symptoms, including 12 cases (12/18, 66%) of unexplained decrease in oxygen saturation; 16 patients had deep vein thrombosis in the lower limbs, with nine cases involving proximal veins and seven involving distal veins. One patient had an antithrombin III level of 35%. Thirteen cases were diagnosed with pulmonary embolism using CT pulmonary angiography. Four patients had pulmonary embolisms incidentally detected during coronary CT angiography, and one patient during aortic CT angiography.ConclusionPatients with lower limb fractures showing chest tightness and unexplained decrease in finger pulse oxygen levels should be assessed for pulmonary thromboembolism. Simultaneously, selecting appropriate diagnostic tools is essential to guaranteeing quick and accurate diagnosis.

Aims: This study aims to estimate economic outcomes associated with 30-day deep surgical site infection (SSI) from closed surgical wounds in patients with lower limb fractures following major trauma. Methods: Data from the Wound Healing in Surgery for Trauma (WHiST) trial, which collected outcomes from 1,547 adult participants using self-completed questionnaires over a six-month period following major trauma, was used as the basis of this empirical investigation. Associations between deep SSI and NHS and personal social services (PSS) costs (£, 2017 to 2018 prices), and between deep SSI and quality-adjusted life years (QALYs), were estimated using descriptive and multivariable analyses. Sensitivity analyses assessed the impact of uncertainty surrounding components of the economic analyses. Results: Compared to participants without deep SSI, those with deep SSI had higher mean adjusted total NHS and PSS costs (adjusted mean difference £1,577 (95% confidence interval (CI) -951 to 4,105); p = 0.222), and lower mean adjusted QALYs (adjusted mean difference -0.015 (95% CI -0.032 to 0.002); p = 0.092) over six months post-injury, but this difference was not statistically significant. The results were robust to the sensitivity analyses performed. Conclusion: This study found worse economic outcomes during the first six months post-injury in participants who experience deep SSI following orthopaedic surgery for major trauma to the lower limb. However, the increase in cost associated with deep SSI was less than previously reported in the orthopaedic trauma literature. Cite this article: Bone Jt Open 2022;3(5):398–403.

BackgroundPrevention of deep vein thrombosis (DVT) is indispensable in the treatment of lower limb fractures during the perioperative period. This study aimed to develop and validate a novel model for predicting the risk of DVT in elderly patients after orthopedic surgeries for lower limb fractures.MethodsThis observational study included 576 elderly patients with lower limb fractures who were surgically treated from January 2016 to December 2018. Eleven items affecting DVT were optimized by least absolute shrinkage and selection operator regression analysis. Multivariable logistic regression analysis was performed to construct a predictive model incorporating the selected features. C-index was applied to evaluate the discrimination. Decision curve analysis was employed to determine the clinical effectiveness of this model and calibration plot was applied to evaluate the calibration of this nomogram. The internal validation of this model was assessed by bootstrapping validation.ResultsPredictive factors that affected the rate of DVT in this model included smoking, time from injury to surgery, operation time, blood transfusion, hip replacement arthroplasty, and D-dimer level after operation. The nomogram showed significant discrimination with a C-index of 0.919 (95% confidence interval: 0.893–0.946) and good calibration. Acceptable C-index value could still be reached in the interval validation. Decision curve analysis indicated that the DVT risk nomogram was useful within all possibility threshold.ConclusionThis newly developed nomogram could be used to predict the risk of DVT in elderly patients with lower limb fractures during the perioperative period.

• The number of undocumented migrants has increased drastically in the past decade, while during COVID-19 the amount has seen further exponential increase. Between the Hungarian–Serbian border near the Southern City of Szeged, 4 meter high walls were created in 2018 aiming to better control the influx of undocumented migrants. • The number of patients has exponentially increased. In 2018 there were a total of 21 patients whereas in 2022 a total of 711 patients were admitted. With a direct relation to the migrant number, the financial costs have also shown an exponential increase and will continue to do so in this fashion. • While assessing the fracture patterns, we saw a constant ratio of calcaneal (AO82) and ankle (AO44) fractures as expected, but increased numbers in more proximal fractures in consecutive years, with 2022 having the highest proportion of proximal fractures as well as open and bilateral fractures which had also increased in the same noticeable fashion. • In 2020 and 2021, the ratio of costs allocated to surgery (52 % and 50 % respectively) was almost the same but this ratio drastically increased in 2022; more surgeries were required due to more complex injuries. The Traumatology Clinic of the University of Szeged is a level one Trauma center situated near the Hungarian - Serbian border, where a 4 m tall fence constructed in 2018 serves as a barricade leading to numerous trauma cases. The objective of this study is to characterize the epidemiology of injuries, challenges, and recent trends whilst treating these undocumented migrants in Hungary. A national retrospective mono-centrical study was performed, examining 982 patients who were admitted to the emergency trauma center in the University of Szeged between January 2018 and December 2022, using data from our electronic administrative system (eMedSol). Factors such as basic epidemiology, country of origin, fractures- according to the AO classification- and its respective treatments, mechanism of injury, duration of stay, and costs were assessed to set as a basis for prediction using a regression model. A total of 982 patients from 2018 to 2022 were included in the study. Patterns of injury included calcaneal fractures in 2018 and 2019 whereas in 2021 and 2022 along with the exponential increase in patient number, bilateral calcaneal fractures, open and multi-fragmentary tibial fractures were also observed. Additionally, seasonal variations, favoring the months of September through November were observed. Treatment cost ratios, especially surgeries, have also been consistent with the pattern of proximalizing injuries; more proximal surgeries indicate higher surgical costs which is evidently visible in the significantly higher cost ratio dedicated to surgery in 2022. While migration seems to be a global problem affecting governments and citizens alike, rarely do we understand the direct consequences of illegal migration affecting healthcare services. Hungary in particular created a 4 m tall wall between Serbia in 2019 with means of preventing illegal migration, which in turn led to gradual and later an exponential increase in the number of injured patients particularly in the years 2021 and 2022. Undocumented migrant cases have increased exponentially between 2018 and 2022, with certain patterns seen not only in the injury types but also in seasonal variations and cost expectations. Injuries have been showing a trend of proximalization and have been of more serious quality, including bilateral and/or open injuries. Revisions after surgery were virtually impossible due to the discharging of patients back to border control after their definitive treatment. The need for adequate quality surgical care, manpower and financial aid should be considered. [ABSTRACT FROM AUTHOR]

Abstract Background Older people who are non-weight-bearing after a lower limb fracture are at risk of poor outcomes but there are no clinical guidelines for this group of patients. Given the paucity of the research evidence base, we conducted a consensus exercise to ascertain expert opinion about the management of this group. Methods A three-round e-Delphi technique was planned to use the online JISC survey tool with a multidisciplinary panel of health professionals. Panellists were invited by email via professional organisations and UK NHS Trusts. The initial statements for this study were prepared by the authors based upon the findings of their scoping review. Consensus required >/= 70% agreement with statements. Results Only 2 survey rounds were required. Ninety panellists, representing seven clinical disciplines, reached consensus for 24 statements about general issues (osteoporosis detection and management, falls risk reduction and nutrition) and specific non-weight bearing issues (such as the need for activity to be promoted during this period). Conclusions These findings can be used in the generation of a clinical guideline for this group of patients.

Purpose: To describe the pattern and distribution of lower extremity injuries in victims of intimate partner violence (IPV).Materials and Methods: A retrospective radiological review of 688 patients reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 88 patients with 154 lower extremity injuries. All lower extremity injuries visible on radiological studies were analyzed. Concomitant, recurrent, and associated injuries were also collected, in addition to the demographic data.Results: The injuries consisted of 103 fractures, 46 soft tissue injuries, and 5 dislocations. The foot was the most common site of injury representing 39% (60/154) of total injuries, 48% (49/103) of fractures, 17% (8/46) of soft tissue injuries, and 3 dislocations. The ankle was the second most common site of injury representing 30% (47/154) of total injuries, 20% (21/103) of fractures, and 57% (26/46) of soft tissue injuries. Recurrent injuries of the lower extremity were seen in 30% (26/88) of victims who had 74 recurrent injuries. The most common sites of recurrent injury were the foot and ankle, representing 72% (53/74) of recurrent injuries.Conclusion: Recurrent injuries of the foot and ankle, synchronous craniofacial injuries, and upper extremity injuries in young women (<35 years) should prompt radiologists to consider IPV. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of preoperative management on blood glucose level, hemodynamics and stress factors in elderly patients undergoing general anesthesia for lower limb fractures. Methods: From June 2017 to June 2019, 120 elderly patients with lower limb fractures who were admitted to the department of orthopedics of our hospital for general anesthesia operation were randomly divided into two groups. The observation group（60 cases） was given preoperative reasonable management, while the control group（60 cases） was given traditional preoperative management. The differences of blood glucose level, hemodynamics and stress factors were compared. Results: There were statistically significant differences between the two groups in mean arterial pressure（MAP),cardiac output（CO), systemic vascular resistance（SVR), thoracic fluid content（TFC), blood glucose, glucagon, insulin, C-peptide, cortisol（Cor), renin（Rn） and adrenocorticotrophic hormone（ACTH）（P<0.05). After anesthesia or surgery, MAP, CO, TFC, insulin and C-peptide were higher in the observation group than in the control group, while SVR, blood glucose, glucagon, Cor, Rn and ACTH were lower in the control group. The first postoperative exhaust time, first postoperative out-of-bed activity time and postoperative hospitalization time in the observation group were shorter than those in the control group（P<0.05). In the observation group, the first time to exhaust, the first time to get out of bed, the first time to stay in hospital were shorter than those in the control group（P<0.05), and the incidence of thirst, hunger and postoperative infection was lower than that in the control group（P<0.05). Conclusion: Preoperative reasonable management can stabilize perioperative hemodynamics and blood glucose level of elderly patients undergoing general anesthesia for lower limb fractures, reduce stress factor level and risk of postoperative complications, and promote rapid postoperative recovery. [ABSTRACT FROM AUTHOR]

Background: Older people who are non-weight-bearing after a lower limb fracture are at risk of poor outcomes but there are no clinical guidelines for this group of patients. Given the paucity of the research evidence base, we conducted a consensus exercise to ascertain expert opinion about the management of this group.Methods: A three-round e-Delphi technique was planned to use the online JISC survey tool with a multidisciplinary panel of health professionals. Panellists were invited by email via professional organisations and UK NHS Trusts. The initial statements for this study were prepared by the authors based upon the findings of their scoping review. Consensus required >/= 70% agreement with statements.Results: Only 2 survey rounds were required. Ninety panellists, representing seven clinical disciplines, reached consensus for 24 statements about general issues (osteoporosis detection and management, falls risk reduction and nutrition) and specific non-weight bearing issues (such as the need for activity to be promoted during this period).Conclusions: These findings can be used in the generation of a clinical guideline for this group of patients. [ABSTRACT FROM AUTHOR]

Fractures in poliomyelitic limbs are a challenge to surgeons, due to polio's sequelae and morphological disorders, which make conventional osteosynthesis difficult. We present a retrospective study of 62 patients and 73 non-simultaneous fractures in their lower limbs. Average age was 61,7 years and 53,2% were females. We analyzed the preinjury functional level, etiology of the fracture, fracture pattern, treatment used (be conservative or surgical), and implant used in surgical cases. We treated 85,1% of them surgically and 37,9% of them maintained the same functional situation as before the fracture. 55,4% of them experienced the need to add some mechanical aids after the lesion and 6,8% lost the ability to walk. Most of the surgical treatments employed were similar as the ones used in non-poliomyelitic patients, although some cases required atypical implants, such as a Multiloc (® DePuy Synthes) humeral nail for a tibial shaft fracture, due to narrow bone. Mortality along the 1st year was 2.7%. We found similar functional and radiological results as those described in non-poliomyelitic limbs. [ABSTRACT FROM AUTHOR]

Purpose: A traction table is recommended for lower limb fractures, while it is unavailable for amputees to immobilize the ipsilateral foot to remain stationary and reduce the fracture. For these patients, our rapid reductor can be applied to guarantee stable fixation and optimal reduction, allowing satisfactory implant positioning. This study aims to evaluate the prognosis of amputee patients with lower limb fractures treated by minimally invasive techniques that employ a rapid reductor to reduce the fracture.Methods: Between 2013 and 2014, 11 cases of amputees suffering from a lower limb fracture were enrolled in the study, including four transtibial amputees with a tibial plateau fracture, three transtibial amputees with a femoral shaft fracture, and four transfemoral amputees with a femoral neck fracture. All fractures involved the amputated ipsilateral lower limbs, which were all reduced in a closed fashion using a rapid reductor. During the operation, the rapid reductor was connected to the injured limb for skeleton traction to reduce the fracture and then used to maintain the reduction for subsequent minimally invasive fixation. The operation time, reduction time, fluoroscopy time, and intra-operative blood loss were recorded. Follow-ups were conducted to evaluate the union of the fractures and the functional recovery.Results: All 11 cases were treated successfully using this minimally invasive technique, with anatomical or nearly anatomical reduction reached in all fractures. The average operative time, reduction time, fluoroscopy time, and intra-operative blood loss were 60 minutes (range, 46-90 minutes), 13.2 minutes (range, 7-20 minutes), 19.8 seconds (range, 6-65 seconds), and 95 mL (range, 80-170 mL), respectively. No incidents of reductor-induced complications occurred during the operation. Patients were followed up for an average of 20.8 months (range, 18-24 months). All fractures healed well on an average of six months. At the latest follow-up, all 11 cases reported satisfactory functional recovery of the fixed limbs, which were similar to that before the fractures.Conclusions: The rapid reductor can be used to efficiently reduce and maintain ipsilateral fractures of the amputated lower extremity in a closed fashion, which can facilitate minimally invasive fixation of the fractures. The patients can achieve excellent outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The occurrence of orthopedic injuries during pregnancy carries considerable morbidity and mortality for both the mother and fetus. Successful care of lower limb fractures during pregnancy requires a multidisciplinary approach. Both operative and non-operative treatments must be taken into account by the treating orthopedic physician. There is limited literature available on the management of these lower limb fractures in pregnancy, and peri-operative management of this obstetric and orthopedic trauma is largely unclear. Trauma during pregnancy is a common cause of non-obstetrical maternal death, having a significant public health burden to both the mother and child. The aims and objectives of this study were to review the common causes of lower limb long bone trauma during pregnancy and their functional outcome in terms of morbidity and mortality. This study evaluates various operative and conservative methods of treatment to provide a comprehensive management approach to pregnant patients with lower limb trauma., Materials and Methods: A prospective study on functional outcomes of 30 pregnant females who were admitted with lower limb long bone fractures from 2017 to 2021 was done. The patients were randomly selected intra-operatively for various procedures based on the surgeon's preference. All patients were followed for two years or till union occurred, and the radiographic union score for tibial (RUST) and modified radiographic union score for tibial (mRUST) fracture criteria were used to assess bony union clinico-radiologically.  Results: During this study, the mean age of patients was 27 years (range 19-38), having right-side (53.33%) predominance with road traffic accidents (n=22) and falls (n=6) as the most common causes of injury. Two cases of domestic violence were also reported. In our study, the maximum number of cases was 17-25 weeks of their gestation; 12 (40%) patients had tibial fractures, and 18 (60%) had femoral fractures. Six tibial fractures were handled conservatively, while all femoral fractures required surgical intervention. Out of 18 femoral fractures, which were treated surgically, dynamic compression plating was done in 15 (83.33%) patients, while interlock nailing was done in three patients. Six tibial fractures have been operated upon, two (66.66%) with dynamic compression plating and four (33.33%) with an interlocking nail., Conclusion: A multidisciplinary approach in terms of both operative and non-operative methods must be taken into account for treating pregnant mothers by the orthopedic physician while carefully weighing the benefits and risks of both procedures. Based on the pattern and displacement of the fracture, many prenatal fractures can be treated conservatively. Another alternative that is frequently safe is to postpone the surgical procedure until childbirth. The physiologic changes associated with pregnancy and any potential dangers to the fetus must be taken into account by the orthopedic surgeon when fractures necessitate surgical intervention. The surgeon is responsible for the patient's correct placement, the C-arm's use, the radiation dose, and the intra-operative fetal monitoring, as well as the danger brought on by anesthetics, antibiotics, analgesics, and anticoagulants., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Pal et al.)

Introduction: This study aims to analyze clinical effects between far cortical locking (FCL) system and standard plating techniques in the treatment of lower limb fractures and identify potential preoperative risk factors for complications in patients treated with FCL system.Method: We retrospectively analyzed 76 patients treated with FCL system (the study group) and 68 patients treated with standard plating techniques (the control group) between January 2014 and January 2017. Patients were followed up for a minimum of one year. Surgery-related complications, fixation features, fracture healing rates, the radiographic union scores, and knee functions (Kolment scores) were analyzed between the two groups in the study. Besides, we analyzed eight preoperative characteristics for surgery-related complications, including age, gender, presence of risk factors affecting bone healing, cause of injury, AO/OTA fracture classifications, facture sites, presence of open fractures, and presence of bone losses.Results: The distributions of baseline date were similar between the two groups (P＞0.05). The average number of FCL screws was 4.5 (range: 3-9) in the study group. The average time to union was 2.8 ± 0.9 months in the study group and 3.6 ± 1.0 months in the control group (P＜0.001), and average time to whole weight bearing was 2.3 ± 0.8 months and 2.8 ± 1.2 months, respectively (P = 0.004). Regarding radiographic union score, the study group scores were significantly higher than the control group scores at 1 and 3 months after surgery (P＜0.001), while it becomes insignificant between the two groups at 6 and 12 months after surgery (P = 0.19 and P = 0.15).The working lengths, fracture healing rates, complication rates, and Kolment scores were similar between the two groups (P＞0.05). In the multivariate analysis, fracture sites (OR = 5.34; 95% CI, 1.11-25.75; P = 0.03) and presence of open fractures (OR = 6.19; 95% CI, 1.05-36.38; P = 0.04) were significant associated with complications, whereas other variables were not included.Discussion: FCL system can truly accelerating bone healing and allow earlier whole weight bearing. Fracture healing rates and complication rates were similar between patients treated with FCL implants or conventional plating techniques. Patients with shaft fractures and open fractures trended to have higher complication rates.Conclusions: FCL system is superior to standard plating technique in terms of early callus formation, but standard plating technique is not inferior to FCL system in terms of final fracture healing, surgery-related complication, and function outcome. Fracture site and presence of open fracture are the independent factors for complications in patients treated with FCL system. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of two dimensional echocardiography on time of surgery, post-operative ambulation and hospital stay among patients with lower limb fractures. Study Design: Descriptive cross sectional study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Sep 2015 to Dec 2015. Patients and Methods: A total of 123 patients were included in study based on non-probability convenient sampling who presented with lower limb fractures. The patients were divided into two groups, group A included those who underwent only electrocardiogram (ECG) for assessment and group B included those patients who were further assessed by echocardiography. Results: There was significant delay in group B patients from time of admission to surgery (p=0.0001) as well as post-operative ambulation (p=0.0001) and mean hospital stay was also longer (p=0.0005). However the postoperative complications were similar in two groups. Conclusion: Pre-operative cardiac evaluation by echocardiography is associated with delay in surgery and increases overall hospital stay. The implementation of the American College of Cardiology/American Heart Association guidelines may prevent unnecessary cardiac consultations which can minimize use of preoperative resources, delay in time of surgery and early post-operative recovery. [ABSTRACT FROM AUTHOR]

In this study, we examined the lower limb fracture healing time in children using random forest (RF) and Self Organizing feature Maps (SOM) methods. The study sample was obtained from the pediatric orthopedic unit in University Malaya Medical Centre. Radiographs of long bones of lower limb fractures involving the femur, tibia and fibula from children ages 0–12 years, with ages recorded from the date and time of initial injury. Inputs assessment extracted from radiographic images included the following features: type of fracture, angulation of the fracture, contact area percentage of the fracture, age, gender, bone type, type of fracture, and number of bone involved. RF is initially used to rank the most important variables that effecting bone healing time. Then, SOM was applied for analysis of the relationship between the selected variables with fracture healing time. Due to the limitation of available dataset, leave one out technique was applied to enhance the reliability of RF. Results showed that age and contact area percentage of fracture were identified as the most important variables in explaining the fracture healing time. RF and SOM applications have not been reported in the field of pediatric orthopedics. We concluded that the combination of RF and SOM techniques can be used to assist in the analysis of pediatric fracture healing time efficiently. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of predictive nursing in the operating room on the stress response and risk events of elderly patients with lower limb fractures., Methods: The medical records of 114 elderly patients with lower limb fractures who underwent surgical reduction from August 2020 to May 2022 in Baiyin First People's Hospital were collected for this retrospective analysis. Among them, 54 patients who received routine nursing during the perioperative period were the control group, and 60 patients who received predictive nursing in operating room during the perioperative period were the observation group. The two groups were compared in terms of the changes of intraoperative stress response indexes and the occurrence of risk events, general data, postoperative complications, nursing satisfaction and changes in anxiety and depression. Logistic regression was used to analyze the risk factors affecting the occurrence of risk events in patients., Results: After nursing, the observation group showed significantly lower levels of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), noradrenaline (NE), and adrenaline (AD) than the control group (P<0.05). After nursing, the observation group got significantly lower self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores than the control group (P<0.05). A lower incidence of risk events was found in the observation group than in the control group (P=0.037). Additionally, the observation group experienced less intraoperative blood loss and shorter operation time than the control group (P<0.05). The observation group presented a lower incidence of complications after operation than the control group (P=0.009), and greatly higher nursing satisfaction than the control group (P=0.001). According to multivariate logistic regression analysis, age and nursing plan were independent risk factors affecting the risk events in patients (P<0.05)., Conclusion: Predictive nursing in the operating room can substantially improve the intraoperative nursing quality of elderly patients with lower limb fractures, which can reduce intraoperative stress reaction, negative emotions, and surgical risk events and complications, and improve postoperative rehabilitation., Competing Interests: None., (AJTR Copyright © 2023.)

We report a case of fatal pulmonary embolism (PE) following exsanguinations of lower limb in orthopedic surgery. A 30-year-old man was posted for fixation of a tibial plateau fracture on the seventh day after injury. Subarchnoid block was performed. Esmarch bandage was used for exsanguination of the limb and tourniquet was inflated. Within three minutes after tourniquet inflation, the patient became unconscious hypotensive, and collapsed. Resuscitation was instituted and spontaneous circulation restored. Right ventricular strain pattern on transthoracic echocardiography, increased levels of D-dimer, and Doppler examination of the lowerlimb confirmed deep venous thrombosis of right femoral vessels and PE. In spite of thrombolytic therapy with streptokinase and heparin, the patient died on the ninth day after the event. Cases of PE secondary to the use of Esmarch bandage and tourniquet are reviewed here to identify the risk groups and management of PE.

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Objective: For the present study, the authors hypothesized that the d-dimer levels would be systematically raised in a postoperative population of patients younger than 50 with lower limb fractures and to define a feasible cutoff value for identification of venous thromboembolism (VTE). Methods: Doppler ultrasonography of lower limbs was performed pre- and postoperatively to evaluate for deep vein thrombosis in 150 patients who underwent open reduction and internal fixation (ORIF). Plasma d-dimer levels were assessed 2 days before surgery and on the 3rd, 7th, and 10th days after surgery. Statistical analysis was carried out to define a feasible threshold for the d-dimer levels. Results: Plasma d-dimer levels were found to be systematically raised postoperatively, and they differed between patients with and without VTE significantly. On the third day after surgery, d-dimer levels of more than 3 mg/L indicated VTE with a sensitivity of 88.37% and a specificity of 96.96%, allowing for the definition of a feasible cutoff value. Duration of surgery, duration of tourniquet, ventilation time, and time of postoperative immobility of lower limbs were identified as highly significant risk factors for the development of VTE. Conclusion: Using a threshold of 3 mg/L, the d-dimer levels will screen out VTE with a high degree of sensitivity and specificity in younger patients who have undergone ORIF for lower limb fractures. [ABSTRACT FROM AUTHOR]

We report a case of fatal pulmonary embolism (PE) following exsanguinations of lower limb in orthopedic surgery. A 30-year-old man was posted for fixation of a tibial plateau fracture on the seventh day after injury. Subarchnoid block was performed. Esmarch bandage was used for exsanguination of the limb and tourniquet was inflated. Within three minutes after tourniquet inflation, the patient became unconscious hypotensive, and collapsed. Resuscitation was instituted and spontaneous circulation restored. Right ventricular strain pattern on transthoracic echocardiography, increased levels of D-dimer, and Doppler examination of the lowerlimb confirmed deep venous thrombosis of right femoral vessels and PE. In spite of thrombolytic therapy with streptokinase and heparin, the patient died on the ninth day after the event. Cases of PE secondary to the use of Esmarch bandage and tourniquet are reviewed here to identify the risk groups and management of PE. [ABSTRACT FROM AUTHOR]

Background: Nonunion of long bones in lower limbs is a common complication of orthopedic trauma that can be extremely debilitating. This retrospective study describes our experience using expandable intramedullary nails and autologous bone grafting in treating lower limb long bone nonunion with bone defects. Methods: Nineteen patients (mean age 38.9 years, range 18-61) with lower limb long bone nonunion and defects caused by femoral or tibial fracture types were as follows: A2 (3 femoral, 1 tibial), A3 (1 femoral, 2 tibial), B2 (3 femoral, 4 tibial), and B3 (1 femoral, 4 tibial). Expandable intramedullary nailing and autologous bone (iliac and/or fibular) grafting were used for the treatment. Postoperative bone healing as determined by analysis of standard anteroposterior and lateral X-ray films every 4 weeks. Complications were noted. Results: The average number of previous surgeries was 1.9 (range 1-4). The mean duration from original injury to treatment was 17.6 months (range 9-40 months). Femoral shaft nonunion healed on average of 26.5 weeks (range 16-60 weeks) after surgery, while tibial shaft nonunion healed on average of 23.6 weeks (range 12-40 weeks) after surgery. Class I healing occurred in all but two patients who experienced chronic postoperative osteomyelitis and delayed wound healing, respectively. Two patients complained of postoperative donor site pain. Conclusions: The use of expandable intramedullary nails and autologous bone grafts was an effective method for repair of nonunion of lower limb fractures combining with bone defects with minimal complications. [ABSTRACT FROM AUTHOR]

Abstract: Discrete parameters from ground reaction force (GRF) are been considered in gait analysis studies. However, principal component analysis (PCA) may provide additional insight into gait analysis for considering the complete pattern of GRF. This study aimed at testing the application of PCA to discriminate the vertical GRF pattern between control group (CG) and patients with lower limb fractures (FG), as well as proposing a score to quantify the abnormality of gait. Thirty-eight healthy subjects participated of CG and 13 subjects in FG, five subjects from FG were also evaluated after physiotherapeutic treatment (FGA). The GRF was measured by an instrumented treadmill. Principal component coefficients (PCCs) were obtained by singular value decomposition using GRF of complete stride. Two, four and six PCCs were used to obtain the standard distance (D). The classification between groups was mainly given by the first PC, which indicated higher loading factors during push off of affected side and heel strike of unaffected side. The classification performance achieved 92.2% accuracy with two PCCs, 94.1% with four PCCs and 96.1% with six PCCs. Four subjects reached normal boundary after treatment, with all FGA subjects presenting decreased D. This study demonstrates that PCA is an adequate method for discriminating normal and abnormal gait and D allows an objective evaluation of the progress and effectiveness of rehabilitation treatment. [Copyright &y& Elsevier]

Aims: The purpose of this study was to determine the weightbearing practice of operatively managed fragility fractures in the setting of publically funded health services in the UK and Ireland., Methods: The Fragility Fracture Postoperative Mobilisation (FFPOM) multicentre audit included all patients aged 60 years and older undergoing surgery for a fragility fracture of the lower limb between 1 January 2019 and 30 June 2019, and 1 February 2021 and 14 March 2021. Fractures arising from high-energy transfer trauma, patients with multiple injuries, and those associated with metastatic deposits or infection were excluded. We analyzed this patient cohort to determine adherence to the British Orthopaedic Association Standard, "all surgery in the frail patient should be performed to allow full weight-bearing for activities required for daily living "., Results: A total of 19,557 patients (mean age 82 years (SD 9), 16,241 having a hip fracture) were included. Overall, 16,614 patients (85.0%) were instructed to perform weightbearing where required for daily living immediately postoperatively (15,543 (95.7%) hip fracture and 1,071 (32.3%) non-hip fracture patients). The median length of stay was 12.2 days (interquartile range (IQR) 7.9 to 20.0) (12.6 days (IQR 8.2 to 20.4) for hip fracture and 10.3 days (IQR 5.5 to 18.7) for non-hip fracture patients)., Conclusion: Non-hip fracture patients experienced more postoperative weightbearing restrictions, although they had a shorter hospital stay. Patients sustaining fractures of the shaft and distal femur had a longer median length of stay than demographically similar patients who received hip fracture surgery. We have shown a significant disparity in weightbearing restrictions placed on patients with fragility fractures, despite the publication of a national guideline. Surgeons intentionally restrict postoperative weightbearing in the majority of non-hip fractures, yet are content with unrestricted weightbearing following operations for hip fractures. Cite this article: Bone Joint J  2022;104-B(8):972-979.

OBJECTIVE: To analyze the effects of ropivacaine combined with fentanyl anesthesia on adverse reactions of patients with lower limb fractures. METHODS: 120 patients with lower limb fractures admitted into Foshan Hospital of Traditional Chinese Medicine from Jan. 2013 to Apr. 2015 were selected to be divided into observation group and control group via the random number table, with 60 cases in each. The anesthetic method used in the observation group was ropivacaine combined with fentanyl, while in the control group was simplex ropivacaine combined with physiological saline. The block effects, anesthesia quality, muscle relaxation effects and incidence of adverse reactions were compared between two groups. RESULTS: In the observation group, the improvement time of block and the duration of sensory block were significantly longer than those in the control group, with statistically significant difference (P < 0. 05). The excellent and good rates of anesthesia and muscle relaxation in the observation group were higher than those in the control group, with statistically significant difference (P < 0. 05). The incidence of adverse reactions in the observation group was 56. 7% (34 /60), which was lower than that in the control group 80. 0% (48 /60), besides, the number of patients with pruritus and hypotension in the observation group was smaller than that in the control group, with statistically significant difference (P < 0. 05). CONCLUSIONS: Ropivacaine combined with fentanyl anesthesia in treatment of lower limb fractures is of relatively better anesthetic effects, with few adverse reactions; it is a safe anesthetic regimen. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to develop a core set of outcome domains that should be considered and reported in all future trials of childhood limb fractures., Methods: A four-phase study was conducted to agree a set of core outcome domains. Identification of candidate outcome domains were identified through systematic review of trials, and outcome domains relevant to families were identified through semi-structured interviews with 20 families (parent-child pairing or group). Outcome domains were prioritized using an international three-round Delphi survey with 205 panellists and then condensed into a core outcome set through a consensus workshop with 30 stakeholders., Results: The systematic review and interviews identified 85 outcome domains as relevant to professionals or families. The Delphi survey prioritized 30 upper and 29 lower limb outcome domains at first round, an additional 17 upper and 18 lower limb outcomes at second round, and four additional outcomes for upper and lower limb at the third round as important domains. At the consensus workshop, the core outcome domains were agreed as: 1) pain and discomfort; 2) return to physical and recreational activities; 3) emotional and psychosocial wellbeing; 4) complications from the injury and treatment; 5) rturn to baseline activities daily living; 6) participation in learning; 7) appearance and deformity; and 8) time to union. In addition, 9a) recovery of mobility and 9b) recovery of manual dexterity was recommended as a core outcome for lower and upper limb fractures, respectively., Conclusion: This set of core outcome domains is recommended as a minimum set of outcomes to be reported in all trials. It is not an exhaustive set and further work is required to identify what outcome tools should be used to measure each of these outcomes. Adoption of this outcome set will improve the consistency of research for these children that can be combined for more meaningful meta-analyses and policy development. Cite this article: Bone Joint J  2021;103-B(12):1821-1830.

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Lisfranc injuries are commonly asked about in FRCS Orthopaedic trauma vivas. The term "Lisfranc injury" strictly refers to an injury where one or more of the metatarsals are displaced from the tarsus. The term is more commonly used to describe an injury to the midfoot centred on the 2nd tarsometatarsal joint. The injury is named after Jacques Lisfranc de St. Martin (1790-1847), a French surgeon and gynaecologist who first described the injury in 1815. 'Lisfranc injury' encompasses a broad spectrum of injuries, which can be purely ligamentous or involve the osseous and articular structures. They are often difficult to diagnose and treat, but if not detected and appropriately managed they can cause long-term disability. This review outlines the anatomy, epidemiology, classification, investigation and current evidence on management of this injury., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)