Objective To compare early clinical effects of the femoral neck system (FNS) and three cannulated screws for the treatment of patients with unstable femoral neck fractures. Methods A retrospective analysis with pair matching of 81 patients who received FNS or cannulated screw internal fixation for Pauwels type-3 femoral neck fracture in our hospital from January 2019 to December 2019 was conducted. Patients who received FNS were the test group, and those who received cannulated screws comprised the control group. Matching requirements were as follows: same sex, similar age, and similar body mass index (BMI). A total of 30 pairs were successfully matched at a 1:1 ratio, including 12 males and 18 females. The average age of the patients in the FNS group was 54.53 ± 6.71 years. In the cannulated screw group, the average age of the patients was 53.14 ± 7.19 years. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative visual analog scale (VAS) score, time to walking without crutches, Harris score, femoral head necrosis rate, and complication rate were compared between the groups. Results Postoperative re-examination of radiographs showed satisfactory reduction in all patients, and all patients were followed up for 10-22 months. Those in the FNS group had lower postoperative VAS scores, earlier times to walking without crutches, higher Harris scores at the last follow-up, and lower complication rates (P 0.05). Conclusion For patients with unstable femoral neck fractures, FNS has better clinical efficacy than cannulated screws, though it is also more expensive.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/os.13098

Comparison of Early Clinical Results for Femoral Neck System and Cannulated Screws in the Treatment of Unstable Femoral Neck Fractures.

Access to timely and quality surgical care is limited in low- and middle-income countries (LMICs). Telemedicine, defined as the remote provision of health care using information, communication and telecommunication platforms have the potential to address some of the barriers to surgical care. However, synthesis of evidence on telemedicine use in surgical care in LMICs is lacking. To describe the current state of evidence on the use and distribution of telemedicine for surgical care in LMICs. This was a scoping review of published and relevant grey literature on telemedicine use for surgical care in LMICs, following the PRISMA extension for scoping reviews guideline. PubMed-Medline, Web of Science, Scopus and African Journals Online databases were searched using a comprehensive search strategy from 1 January 2010 to 28 February 2021. A total of 178 articles from 53 (38.7%) LMICs across 11 surgical specialties were included. The number of published articles increased from 2 in 2010 to 44 in 2020. The highest number of studies was from the World Health Organization Western Pacific region (n = 73; 41.0%) and of these, most were from China (n = 69; 94.5%). The most common telemedicine platforms used were telephone call (n = 71, 39.9%), video chat (n = 42, 23.6%) and WhatsApp/WeChat (n = 31, 17.4%). Telemedicine was mostly used for post-operative follow-up (n = 71, 39.9%), patient education (n = 32, 18.0%), provider training (n = 28, 15.7%) and provider-provider consultation (n = 16, 9.0%). Less than a third (n = 51, 29.1%) of the studies used a randomised controlled trial design, and only 23 (12.9%) reported effects on clinical outcomes. Telemedicine use for surgical care is emerging in LMICs, especially for post-operative visits. Basic platforms such as telephone calls and 2-way texting were successfully used for post-operative follow-up and education. In addition, file sharing and video chatting options were added when a physical assessment was required. Telephone calls and 2-way texting platforms should be leveraged to reduce loss to follow-up of surgical patients in LMICs and their use for pre-operative visits should be further explored. Despite these telemedicine potentials, there remains an uneven adoption across several LMICs. Also, up to two-thirds of the studies were of low-to-moderate quality with only a few focusing on clinical effectiveness. There is a need to further adopt, develop, and validate telemedicine use for surgical care in LMICs, particularly its impact on clinical outcomes. 

https://link.springer.com/content/pdf/10.1007/s00268-022-06549-2.pdf

Telemedicine in Surgical Care in Low- and Middle-Income Countries: A Scoping Review

https://link.springer.com/content/pdf/10.1007/s00402-022-04504-3.pdf

Incidence and treatment of intracapsular femoral neck fractures in Germany

Abstract Proximal femoral fractures are a serious complication, especially for elderly patients. Detailed epidemiological analyzes provide a valuable resource for stakeholders in the health care system in order to foresee future development possibly influenceable by adaption of therapeutic procedures and prevention strategies. This work aimed at answering the following research questions: (1) What are the incidence rates of proximal femoral fractures in the elderly U.S. population? (2) What is the preferred treatment procedure for these fractures? Proximal femoral fractures occurred between January 1, 2009 and December 31, 2019 in patients ≥ 65 years were identified from the Medicare Physician Service Records Data Base. The 5% sample of Medicare beneficiaries, equivalent to the records from approximately 2.5 million enrollees formed the basis of this study. Fractures were grouped into head/neck, intertrochanteric, and subtrochanteric fractures. The overall incidence rate, age and sex specific incidence rates as well as incidence rate ratios were calculated. Common Procedural Terminology (CPT) codes were used to identify procedures and operations. In 2019, a total number of 7982 femoral head/neck fractures was recorded. In comparison to 9588 cases in 2009, the incidence substantially decreased by 26.6% from 666.7/100,000 inhabitants to 489.3/100,000 inhabitants (z = − 5.197, p &lt; 0.001). Also, in intertrochanteric fractures, a significant decline in the incidence by 17.3% was evident over the years from 367.7/100,000 inhabitants in 2009 to 304.0 cases per 100,000 inhabitants in 2019 (z = − 2.454, p = 0.014). A similar picture was observable for subtrochanteric fractures, which decreased by 29.6% (51.0 cases per 100,000 to 35.9 cases per 100,000) over the time period (z = − 1.612, p = 0.107). Head/neck fractures were mainly treated with an arthroplasty (n = 36,301, 40.0%). The majority of intertrochanteric fractures and subtrochanteric fractures received treatment with an intramedullary device (n = 34,630, 65.5% and n = 5870, 77.1%, respectively). The analysis indicated that the incidence of all types of proximal femoral neck fractures decreased for the population of elderly patients in the U.S. within the last decade. Treatment of head and neck fractures was mainly conducted through arthroplasty, while intertrochanteric and subtrochanteric fractures predominantly received an intramedullary nailing. 

Epidemiology and treatment of proximal femoral fractures in the elderly U.S. population

Abstract Objective The majority of individuals with femoral neck fractures opt for total hip replacement to enhance their quality of life. However, this group frequently exhibits perioperative symptoms of pain, anxiety, and sadness, which extends recovery time to some extent. Esketamine, the right-handed monomer of ketamine, is more popular these days due to its sedative, analgesic, and antidepressant properties. There are currently few domestic and international research on the use of esketamine in elderly individuals who have undergone surgery for a femoral neck fracture. In order to further cut the length of the hospital stay and hasten postoperative recovery, this study investigates whether esketamine postoperative analgesia can lessen postoperative pain, anxiety, and depression in older patients having hip replacement. Methods 150 patients, ASA physical status I–II, aged ≥ 60 years, no limitation in gender, BMI 18–25 kg/cm 2 , who underwent selective total hip arthroplasty, according to random number table method, esketamine group (group A) and sufentanil group (group B) were randomized, 75 patients in each group. The two groups received general anesthesia method. At the end of the operation, PCIA was connected for analgesia. In group A, esketamine 2.5 mg/kg was mixed with normal saline to 100 ml. In group B, sufentanil 2.5 ug/kg was mixed with normal saline to 100 ml. Record the VAS scores after operation. Record the first ambulation time, ambulation distance and Patient-controlled Analgesia compression times after operation. The incidence of postoperative adverse reactions such as drowsiness, dizziness, nausea and vomiting, multilingual were recorded. ELISA was used to detect IL-6 and CRP in the morning, 24 h and 72 h after operation. The Hospital Anxiety and Depression Scale (HAD) score and Harris score at 3 days, 1 week and 1 month after operation were followed up. Results There was no significant difference in VAS score and PCA compression times ( P &gt; 0.05), but the incidence of nausea, vomiting and dizziness in group B was higher than that in group A ( P &lt; 0.05). Compared with group B, the levels of IL-6 and CRP in group A at 24 h and 72 h after operation were significantly decreased ( P &lt; 0.05). Postoperative ambulation time and ambulation distance in group A were better than those in group B ( P &lt; 0.05). The HAD score of group A was lower than that of group B at 3 days and 1 week after operation ( P &lt; 0.05). However, there was no significant difference between the two groups at 1 month after operation ( P &gt; 0.05). The Harris score of group A was higher than that of group B at 3 days, 1 week and 1 month after operation ( P &lt; 0.05). Conclusions Esketamine can reduce short-term postoperative anxiety and depression, relieve postoperative pain and stress response, shorten bed rest time after total hip replacement, and accelerate postoperative recovery. 

/pdf/effect-of-subanesthetic-dose-of-esketamine-on-postoperative-lpmhkc4s.pdf

Effect of subanesthetic dose of esketamine on postoperative rehabilitation in elderly patients undergoing hip arthroplasty

Objective To investigate the biomechanical effects of reduction quality on patients after femoral neck fracture internal fixation. Methods The data of individual patients with femoral neck fractures were reviewed. Data for patients with simple unilateral femoral neck fractures whose reduction quality was evaluated as good by hip X-ray films after internal fixation were collected from January 2013 to January 2017. The CT data of the patients was used to reconstruct 3D models of the femur and the screw. The spatial displacement after the operation of femoral neck fracture was measured, which included the displacement of the deepest portion of the femoral head fovea, the displacement of the center of the femoral head, and the rotational angle. The cases were followed up by telephone consultation and clinical review to determine whether the osteonecrosis of the femoral head occurred. Follow-up time should be more than 18 months after surgery. The cases were grouped according to the results into an osteonecrosis of the femoral head group and a non-osteonecrosis of the femoral head group. Finally, the differences in postoperative spatial displacement between the two groups were compared and analyzed. In addition, a mechanical analysis of femoral force during gait was performed via finite element analysis. Results Data for 241 patients with femoral neck fractures who were treated with closed reduction and internal fixation were collected. 3D measurement showed the average displacement value, including the center of the femoral head (5.90 ± 3.4 mm), the deepest portion of the femoral head fovea (9.32 ± 4.8 mm), and the rotational angle (16.1° ± 9.4°). After telephone consultation and clinical review, osteonecrosis of the femoral head was diagnosed in 28 (11.62%) of the patients. In the osteonecrosis of the femoral head (ONFH) group, the displacement of the deepest portion of the femoral head fovea was 10.92 ± 9.18 mm; the displacement was 8.86 ± 6.29 mm in the non-ONFH group. The displacement of the center of the femoral head in the ONFH group was 7.575 ± 5.69 mm and 5.31 ± 4.05 mm in non-ONFH group. The rotational angle was 20.11° ± 10.27° in the ONFH group and 14.19° ± 11.09° in the non-ONFH group. The statistical analysis showed that the postoperative spatial displacements, including the displacement of the deepest portion of the femoral head fovea, the displacement of the center of the femoral head, and the rotational angle between the two groups, had statistical differences. Finite element analysis showed that as the spatial displacement increased, the stress, the displacement, and the equivalent strain of the proximal femur also increased. Conclusion Poor reduction quality after femoral neck fracture is a risk factor for re-fracture and femoral head necrosis, and the measurement method of this study can be used to predict the occurrence of femoral head necrosis early after femoral neck fracture.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/os.12458

Correlation Between Reduction Quality of Femoral Neck Fracture and Femoral Head Necrosis Based on Biomechanics.

A method for studying muscle fatigue on the basis of static myoelectricity after electrical stimulation includes respectively acquiring static surface myoelectric signals of each subject: selecting the subjects, arranging experimental periods, placing surface myoelectric electrodes and stimulating electrodes on the subjects, and acquiring the static surface myoelectric signals; and respectively analyzing power spectrums of the acquired static surface myoelectric signals: computing the acquired static surface myoelectric signals by a periodic diagram process to acquire the power spectrums, drawing frequency spectrograms according to the power spectrums, computing median frequencies and analyzing the median frequencies. The method has the advantages that change of the surface myoelectric signals after electrical stimulation can be represented, myoelectric response caused by electrical stimulation can be comprehensively evaluated in a frequency domain, an experimental basis is provided for follow-up study, accordingly, an idea is provided for technical standards for evaluating effects of electrical stimulation on human bodies, and development of electrical stimulation is promoted.

Method for studying muscle fatigue on basis of static myoelectricity after electrical stimulation

An electrostimulation induced muscular fatigue evaluation method using approximate entropy for analyzing induced myoelectric M waves includes: respectively acquiring surface electromyogram signals, induced by electrostimulation, of each tester, selecting testers and arranging test time, arranging surface electromyogram electrodes and stimulation electrodes for the testers, and acquiring the surface electromyogram signals induced by electrostimulation; preprocessing the acquired surface electromyogram signals to obtain M wave signals; subjecting approximate entropy results of all testers to normalization processing; and subjecting the normalized approximate entropy results of all testers to statistic analysis. The method overcomes the defects of high static surface electromyogram signal interference and low signal to noise ratio, breaks through limits of the time frequency field on analysis of electromyogram signals with chaotic characteristics, and more effectively represents the dynamic process of electrostimulation induced muscular fatigue. Dynamic changes of electrostimulation induced muscular fatigue can be represented comprehensively and accurately to provide ideas for technical standards of electrostimulation induced muscular fatigue evaluation and promote development of electrostimulation.

Electrostimulation induced muscular fatigue evaluation method using approximate entropy for analyzing induced myoelectric M waves

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Correlation Between Reduction Quality of Femoral Neck Fracture and Femoral Head Necrosis Based on Biomechanics.

Method for studying muscle fatigue on basis of static myoelectricity after electrical stimulation

Electrostimulation induced muscular fatigue evaluation method using approximate entropy for analyzing induced myoelectric M waves