RESUMEN

The incidence of open femoral fractures is relatively low, primarily caused by high-energy trauma and often associated with multiple injuries. The management of open femoral fractures is considered one of the most challenging lower limb injuries due to their serious nature, multiple traumas, high disability rate, high infection rate, and high amputation rate. Most scholars currently recommend that open grade I and grade II fractures of the femur be treated with thorough debridement and open reduction, and internal fixation at the initial stage when the patients are in good condition. However, for open grade III femur fractures, many studies still show that staged treatment strategies are preferred, but the fixation method at the initial stage is still controversial. For patients with severe open femoral fractures, the medical team should create an individualized treatment plan, taking into account the patient's and family's preferences, the medical team's experience, and available resources, rather than simply relying on the salvage or amputation scoring system to make the final decision. This review discusses the epidemiology, classification, surgical management options, and strategies for limb salvage and amputation in the treatment of open femur fractures, providing practical guidance for healthcare professionals who manage these patients.

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Fertilizer nitrogen (N) is a main pollutant in the agricultural ecosystem, while the fate of fertilizer N influenced by different irrigation modes is not well comparatively investigated. In this study, the distribution of fertilizer N in soil layers and tomato organs as well as its loss under drip, spray and flood irrigation with different quotas of 140, 180 and 220 m3 ha-1 were evaluated quantitatively by using nitrogen-15 (15N) labeled urea (abundance of 19.6%) as fertilizer source. The results showed that the plant 15N, soil 15N and 15N loss accounted for 27.9-47.8%, 38.8-54.0% and 10.3-21.9% of the total applied 15N, respectively. The amount of 15N absorbed by plants was significantly (p < 0.05) higher under drip and spray irrigation in comparison to flood irrigation with the same irrigation quota. The maximum 15N use efficiency and the minimum 15N residual were detected under drip irrigation with quota of 180 m3 ha-1, indicating that the supply and demand of urea-15N was more synchronized under such an irrigation mode. The 15N loss increased obviously as irrigation quota increased. Moreover, the correlation analysis between 15N loss and the possible impact factors indicated that the soil mineral 15N content after irrigation was one important factor influencing the 15N loss. Among the three irrigation modes, spray irrigation caused the lowest 15N loss of 10.3-13.1% when using the same irrigation quota. It was concluded that the irrigation modes have profound impacts on the fate of urea-15N. Irrigation could be used as a regulation pathway of plant N absorption and agricultural N output.

RESUMEN

OBJECTIVE: Whether external or plating fixation is more appropriate for high-energy tibial plateau fractures is still being disputed, our aim was to test the hypothesis whether external fixation can provide a fair outcome with fewer complications, when compared to the results with previously reported data of plating fixation for high-energy tibial plateau fractures. METHODS: An Ovid of Medline, Embase, and Cochrane Library search was conducted for the relevant English orthopedic journals, and eligible studies, including twenty-four case series and one comparative study containing 885 patients associated with 892 fractures, were enrolled. RESULTS: The results showed there were a higher proportion of men, open fractures, malunion, knee instability, and posttraumatic arthritis occurred in external fixation group than those in plating group (P=0.007, P=0.000, P=0.024, P=0.006, P=0.000, respectively), while valgus deformity happened at a significantly higher rate in plate group (P=0.014). No significant differences were found between the two groups in terms of age, Schatzker type, follow-up, mean time to union, mean range of knee motion, and rate of reoperation. With regard to the functional and radiological outcome assessment, despite what assessment tools were used, most of these studies presented less than 90% good/excellent results in their high-energy fracture series. Besides, there was a trend for patients in plating group to have a higher risk than those in external fixation group in terms of heterotopic ossification and local irritation (1.23 vs 0.17%, 4 vs 1.94%, accordingly). CONCLUSIONS: Although lack of good quality randomized control trials, there are rather enough samples supporting the current available results. Meanwhile, future multicentered, randomized, controlled studies should be implemented to test these outcomes.

Asunto(s)

Fijadores Externos , Fijación Interna de Fracturas , Fracturas Intraarticulares/cirugía , Fracturas de la Tibia/cirugía , Artritis/etiología , Placas Óseas/efectos adversos , Epífisis/lesiones , Epífisis/cirugía , Fijadores Externos/efectos adversos , Fijación Interna de Fracturas/efectos adversos , Fracturas Mal Unidas/etiología , Genu Valgum/etiología , Humanos , Inestabilidad de la Articulación/etiología , Articulación de la Rodilla

RESUMEN

[Objective]To explore the surgical management and its results of intercondylar fracture of humerus through approach of osteotomy of olecranon(AOO) with dual anatomical steel plate DASP.[Method]From July 2002 to March 2006,26 patients of intercondylar fracture of humerus were treated surgically through AOO,and the fracture was reduced and fixed with DASP.The patients were 19 males and 7 females with a mean age of 35 years (range 15～46 years),According to Riseborough and Radin classification,type Ⅱ fracture was found in 6 cases,type Ⅲ in 18,type Ⅳ in 2.Early rehabilitation exercises was taken.[Result]Twenty-five fractures were satisfactory reduced but one not too good,none had incision infection,injuries of the ulnar nerve.Twenty-two patients were followed up from 6 months to 19 months(average 13.5 months),of these 22 patients,all the osteotomies healed in 17 weeks averagely(range 14～24 weeks) and the injuried ulnar nerve recovered completely.The function of the elbow(according to Cassbaum scale) showed excellent in 5 cases,good in 13,fair in 3 and poor in 1.the good-excellent rate was 81.8%.[Conclusion]The technique of DASP for the treatment intercondylar fracture of humerus through transolecranon approach offers many advantages,such as sufficient exposure easy to get anatomical reduction,stable fixation and earlier exercise.

RESUMEN

Objective To discuss difficulties and techniques of standard video-assisted thoracoscopic or laparoscopic surgery(SVATS or SVALS) for spine internal fixation.Methods Between July 2004 and September 2005,6 cases of vertebral lesions located in the T_5～L_1 segment(including 2 cases of vertebral tuberculosis) were given SVATS under single-lung ventilation for resection of diseased vertebral body,reconstruction with autograft or titanium mesh cage,and fixation with the Z-plate system or the CD-Horizon system.Other 2 cases of vertebral tuberculosis located in the L_2～L_3 segment underwent retroperitoneal gasless SVALS for lesion debridement,reconstruction with autograft,and fixation with the Z-plate system.For cases of vertebral tuberculosis,(anti-tuberculosis) drugs were administrated preoperatively for 3 weeks and postoperatively for 6 months.Results The lesion debridement and anterior decompression was completed in all the 8 cases,including internal fixation with the Z-Plate system in 7 cases and with the CD-Horizon system in 1 case.There were 5 cases of iliac autografting and 3 cases of titanium mesh cage reconstruction.The operative time was 6.5~12.6 h(mean,8.7 h) and the blood loss during surgery was 250~1 800 ml(mean,950 ml).The correction of the Cobb angle was 5?~18?(mean,12?).During a follow-up period for 2~13 months(mean,7.4 months) in the 8 cases,nerve functions recovered by 1~2 Frankel grade in 5 cases,and the Cobb angle lost by 4? at 6 months postoperatively in 1 case of metastatic adenocarcinoma at the T_7 segment.Conclusions Spine internal fixation of T_5～L_3 segment can be conducted successfully with SVATS or SVALS.The key to the question is accurate orientation of the port site,proper hemostasis of the segment blood vessel,and careful resection of the anterior wall of the vertebral canal.