Royal Thai Air Force Medical Gazette

The risk factors effecting mortality 1 year post operative in elderly patients with neck of femur fracture at Bhumibol adulyadej hospital.

Tanakorn Jirapanuroj — 2023-12-28

The neck femur of femur fracture in elderly patient, Disease that increasing at presence elderly age society, bring the complication and lead the death to the old age patient in Thailand. Treatment at present, Surgery is a good choice to decrease complication and mortality rate but from the previous study there were some number of mortality rate. So far there have been no studies of risk factor, except operative management. The researcher tried to explore risk factor that correlated with mortality of patient neck of femur fracture.

Method: We collected data from the patient in patient formation in vary factor (age, gender, lymphocyte count, hemoglobin levels, mobilization time after surgery, length of stay, comorbidities, American Society of Anesthesiologists (ASA) rating of operative risk, and the time period between injury and surgery, vitamin D level). Then calculated relation between factor and mortality in patient 1 year post operative.

Result: There were 125 neck of femur fracture patients in bhumiphol hospital from July 2017 – June 2018. Divided to male 38 persons (30.4%) and female 87 persons (69.6%) Alive after 1 years 95 persons (76%) Death after 1 years 30 persons (24%) Hemoglobin level ≥ 10 g/dl 114 persons (91.2%) Hemoglobin level < 10 g/dl 11 persons (8.8%) albumin level ≥ 3.5 g/dl 101 persons (80.8%) albumin level < 3.5 g/dl 24 persons (19.2%) white blood cell in urine < 5-10 cell/HPF 72 persons (57.6%) white blood cell in urine ≥ 5-10 cell/HPF 53 persons (42.4% ) vitamin D level ≥ 25 ng/dl 44 persons (35.2%) vitamin D level < 25 ng/dl 81 persons (64.8 %) Age between 60 – 80 years 68 persons (54.4%) Age more than 80 years 57 persons (45.6%) Time before operate less than or equal to 7 days 85 persons (68%) Time before operate more than 7 days 40 persons (32%) Mobilization time after surgery less than or equal to 3 days 68 persons (54.4%) Mobilization time after surgery more than 3 days 57 persons (45.6%) length of stay less than or equal to 14 days 50 persons (40%) length of stay more than 14 days 75 persons (60%) American Society of Anesthesiologists classification ≤ 2 66 persons (52.8%) American Society of Anesthesiologists classification > 2 59 persons (47.2%) comorbidity ≤ 2 diseases 59 persons (47.2%) comorbidity > 2 diseases 66 persons (52.8%) lymphocyte count > 1500 cell/µL 53 persons (42.4%) lymphocyte count ≤ 1500 cell/µL 72 persons (57.6%)

Conclusion: The risk factor that corelate with mortality of patient neck of femur fracture 1 year post operative were albumin level, vitamin D level, mobilization time, length of stay, American Society of Anesthesiologists classification level, comorbidity and sex

Optimal Screw Length in Variable-Angle Locking Plate for Distal Radius Fracture

Chavalit Nakprasert — 2023-12-28

Background : The distal radius fracture is a common fracture in adult patients. Operative treatment with variable-angle volar locking plate is become increasingly popular and has shown good results. After variable-angle volar locking plate fixation, the most important complication is extensor pollicis longus rupture. Screw penetration of the dorsal cortex is most common cause and may result in tendon irritation and rupture. Therefore, we are interested in optimal screw length for distal radius fracture fixation. The aim of study is postoperative complications prevention.

Methods : 10 pairs of fresh-frozen human cadaver wrist were used for this study. The variable-angle locking plates (APTUS Radius 2.5, Medartis, Switzerland) were positioned to the best anatomical fit and proximal from watershed line 3 mm. We labeled variable-angle locking plate holes with number of screw positions. There were number 1-3 in distal row and number 4-5 in proximal row, arranged from lateral to medial. All screw holes were drilled through dorsal cortex with k-wires. Distal row was drilled 90 degrees perpendicular to variable-angle locking plate and proximal row was drilled 15 degrees distally vertical to variable-angle locking plate. A vernier caliper was used to measure screw length between screw head and dorsal cortex for each hole.

Result : 20 specimens were tested successfully, The mean of optimal screw length of No.1 screw was 20.89 ± 1.48 mm, No.2 screw was 22.48 ± 1.38 mm, No.3 screw was 21.51 ± 1.35 mm, No.4 screw was 23.74 ± 1.03 mm and No.5 screw was 24.14 ± 1.03 mm. The most of mean of screw length in distal row was No. 2 screw and in proximal row was No.5 screw. Gender factor and wrist side factor were no statistically significant difference in screw length in all screw holes of variable-angle volar locking plate.

Conclusion : Using variable-angle volar locking plate in distal radius fracture fixation, The most screw length in distal row was No. 2 screw and proximal row was No. 5 because the direction of screws were near the convex dome of Lister tubercle at dorsal cortex of distal radius. We recommended the placement of optimal screw length wasn’t longer than 24-mm length size both distal row and proximal row. This knowledge could be applied in all patients because gender factor and wrist side factor weren’t correlated with screw length.

The Efficacy of Ultrasound-guided Hydrodissection at Kager’s fat pad to reduce symptom in Achilles tendinopathy patients

Tharit Saiklangdee — 2023-12-28

Background : Achilles tendinopathy is one of the most common cause of foot and ankle disability. Conservative treatment is recommended as many patient’s pain and function will improve such as stretching, orthotics, medication etc. However, there were many patients poorly responsive to standard management. Recently, case series study, ultrasound-guided hydrodissection at Kager’s fat-pad can produce pain relief in the Achilles tendinopathy patients. Therefore, we interested in this technique may reduce symptoms in our Achilles tendinopathy patients.

Methods : The study-enrolled patients showed persistent pain for more than 3 months after to all conservative treatment in the Achilles tendon. All patients were accessed for plain film of the affected heels and document the presence or absence of calcaneal spur and other information about foot deformity). VAS and FFI-TH data were performed by patient before treatment. Evaluated complication for 1 week after ultrasound-guided hydrodissection at out patient department, VAS and FFI-TH were accessed again at this visit. Finally, 2 weeks and 4 weeks after treatment, we review VAS and FFI-TH by telephone visited.

Result : Enroll of thirteen suitable candidates, 6 male (46%) and 7 female (54%) patients, the median of age was 45 years (range : 34-62). 9 patients was insertional Achilles tendinopathy (69%). Initial median VAS and FFI-TH were 5.98 and 160.77 respectively. At 1 week follow-up, the median of VAS was 5.45 that significant improvement in pain score (P-value = 0.02) but not significantly different from 2 and 4 weeks after Hydrodissetion. The median FFI-TH before intervention comparing with 1,2 and 4 weeks follow-up were significantly different (P-value = 0.03, 0.01, 0.01 in the same order). There were no adverse effect or complication event along in this study.

Conclusion : From the research, we found that Ultrasound-guided Hydrodissection at Kager’s fat pad can reduce symptoms in both insertional and non-insertional Achilles tendinopathy patients at a short time period, but in 4 weeks follow-up, the outcome of foot functional score was improved.

Open reduction and internal fixation with Calcaneal anatomical plate via Subtalar arthroscopic assisted minimal incision approach for displaced intra-articular calcaneal fractures

Suchol Luangrachaphan — 2023-12-28

Objective : The open reduction and internal fixation with Calcaneal anatomical plate via Subtalar arthroscopic assisted minimal incision approach for displaced intra-articular calcaneal fractures is to verify if the method can achieve the operation standard without any wound complication. Since the current standard operation method (ELA) for intra-articular calcaneal fractures can achieve a good result but not without noticeable wound complication. Furthermore, the minimal invasive operation (STA) still has some limitations of joint reduction.

Method : The radiologic data of Böhler’s angle, Calcaneal length, height, and width, and posterior facet residual stepping/gapping data were labeled to display the injury conditions. We collected and compared the data of the pre-operation, post-operation, and uninjured calcaneal bone. We collected the Thai FAAM clinical data three and six months after the operation. We collected the wound complication, time to operation, length of the operation, and length of the hospital stay period data. All the data are collected from the patients diagnosed with displaced intra-articular calcaneal fractures Sander classification IIA, IIB, III at Bhumibol Adulyadej hospital from April 1st, 2019 to December 31st, 2021

Result : From the post-operation data of twelve suitable candidates, the median (min, max) of Böhler’s angle, Calcaneal height, width, Stepping, and Gapping data in order are at 21.34 (16.64, 39.43), 39.78 (34.91, 50.3), 36.41 (29.09, 42.51), 0 (0, 2.36), 1.62 (1.39, 3.32). Which were significantly different from the pre-operation data with P = 0.002, 0.034, 0.003, 0.004, 0.002 in the same order. By comparing them with the data from the uninjured one, the Böhler’s angle was still significantly different from the post-operation with P =0.01, The Calcaneal length, height, and width were insignificantly different from the post-operation data. This method can achieve 66.67% anatomical reduction, 25% nearly anatomical reduction, and 8.33% approximately anatomical reduction. The Thai FAAM clinical data after three and six months did have a significant difference only in the point of daily activity. There was no reported serious wound complication. The average day to surgery was 18±6.34 days, the average length of the operation was 199.92±81.26 minutes and the average length of the hospital stay was 22.42±12.61 days.

Conclusion : From the research, we found that the operation performed well in terms of radiological and clinical outcomes without any severe wound complication. This can be applied on operations for patients diagnosed with Displaced intra-articular calcaneal fractures (DIACF) type Sander IIA, IIB, III. Still, the length of operation has to be reduced to be closer to the current method. With the constraints of small sample size, length of the follow-up period, and that we need to compare to more operational methods, more experimental studies are needed to get a more accurate and reliable conclusion for future applications.

Editorial Notic

Gp.Capt.Pongsathorn Gojaseni — 2023-12-28