| Part 1 Epidemiological analysis of the incidence and risk factors for ankle fractures in ChinaObjective:Ankle fractures are common clinical injuries,and the incidence is increasing year by year.The literature lacks population-based epidemiologic studies on the incidence and risk factors for traumatic ankle fractures.This study aimed to investigate the population-based incidence rate of ankle fracture and associated risk factors in China.Methods:All the data on ankle fractures were available from the China National Fracture Survey(CNFS)conducted between January and May in2015.The CNFS retrospectively analyzed the incidence and risk factors of traumatic fractures in China in 2014.The entire sampling process of CNFS was completed with combined use of optimum allocation and random stratifed and probability proportionate to size sampling method.Eight provinces and municipalities were initially selected from three regions(east,central,and west),using stratified random sampling and the probability proportional to size method.A total of 24 cities,41 streets,112 neighborhood committees and24 counties,67 towns and 223 villages were selected from 8 provinces and municipalities.Only members of eligible families living in their current residence for 6 months or longer were invited for face-to-face interview with our trained research team members.The detailed information included age,sex,height,weight,Chinese ethnic nationality,education,occupation,smoking,alcohol drinking,dietary habits,sleeping time per day,previous history of fracture and others.The fracture site,injury mechanism and other information of the individuals who had ankle fractures between Jan 1,and Dec31,2014,were determined by X-ray and medical records.After extracting the relevant data of ankle fracture from the database,we analyzed the incidence and risk factors of ankle fracture in China in 2014.Results:A total of 512187 valid questionnaires were collected in the CNFS.Of them,there were 190 patients with 193 ankle fractures in 2014,indicating that the incidence rate of traumatic ankle fracture in China was 37.1/100000 person-year.There were 94 female and 96 male patients,and their average age was 46.7 years(standard deviation,17.6;range,4–87).Fall was the most common cause for ankle factures,and resulted in 76.8%(146/190)of the overall injuries.Home and the road were the most common places where ankle fractures occurred.Stratified by occupation,students had the highest incidence rate either in males or females and that was 62.1 and 90.9/100,000person-year,respectively.Results of univariate analysis using Chi-square test for adults showed that Han ethnic origin,cigarette smoking,alcohol consumption,living alone,average sleep time<7 h/d and previous history of fracture were significant risk factors for ankle fractures;and living house facing the sun was identified to be a protective factor for males.For females,age,Han ethnic origin,occupation,alcohol consumption,living alone,average sleep time<7 h/d,previous history of fracture,earlier age of menopause and more births were identified to have significant effect on the occurrence of ankle fractures.Multivariate analysis showed that,for males,alcohol consumption,living alone and average sleep time<7 h/d increased the risk of ankle fracture by 1.86 times,5.05 times and 1.72 times,respectively.For females,alcohol consumption,living alone,previous history of fracture and average sleep time<7 h/d increased the risk of ankle fracture by 3.00 times,5.93 times,3.68 times and 1.63 times,respectively.Conclusions:The incidence of ankle fractures was 37.1 per 100000population in China in 2014.Alcohol consumption,living alone and average sleep time<7 h/d were identifed as independent risk factors for ankle fracture in both males and females.Previous history of fracture was identifed as signifcant risk factor of ankle fracture in females but not in males.Therefore,specifc public health policies focusing on decreasing alcohol consumption and encouraging individuals to obtain sufcient sleep should be implemented.Individuals living alone should focus more on healthcare,especially in those with previous fracture.Part 2 Epidemiological comparison of ankle fractures among the eastern,central and western area of ChinaObjective:The aim of this study was to investigate the epidemiological features of ankle fractures in China and compare the epidemiological characteristics of ankle fractures in different areas.Methods:The data of ankle fractures treated between January 2010 and December 201 1 at 35 east hospitals,20 central hospitals and 28 west ones were analyzed through the PACS system and case reports checking system retrospectively.The patients'gender,age and type of AO classification were documented.The data from the 35 east hospitals,20 central hospitals and 28west ones were classified as group A,group B and group C,respectively.Comparison and analysis was done with analytic items of gender,age and fracture type.Results:A total of 30258 ankle fractures were collected from 83hospitals,including 1979 children(6.54%)and 28279 adults(93.46%)with the median age of 40 years.There were 18165 males(60.03%)and 12093females(39.97%)with a ratio of male to female of 1.50:1.The highest proportion of ankle fractures was observed in patients from 41 to 50 years old(19.13%,5789/30258),while in male patients it was 21–30 years old(21.94%,3985/18165)and in females it was 51–60 years old(22.18%,2682/12093).The youth group had the highest proportion,accounting for 52.15%(15779/30258)of all the ankle fractures.According to AO classification,there were 11252cases(39.79%,11252/28279)of type 44-A,11130 cases(39.36%,11130/28279)of type 44-B and 5897 cases(20.85%,5897/28279)of type 44-C.Group A had15632 cases,a median age of 41 years and a male/female ratio of 1.41:1;Group B had 8585 cases,a median age of 40 years and a male/female ratio of1.45:1;Group C had 15632 cases,a median age of 38 years and a male/female ratio of 1.89:1.There were statistically significant differences in the male/female ratios(?~2=92.367,P<0.001)among the three groups.Compared with group A and group B,group C had a higher male/female ratio(P<0.001)and a higher proportion of youth group.The median age,the proportion of middle-aged group and elderly group decreased progressively among group A,group B and group C.Compared with group A and group C,group B had a higher proportion of children group(P<0.016).The high-risk type was 44-A in group A and group C,while it was 44-B in group B.Compared with group A and group B,group C had a higher proportion of type 44-C and a lower proportion of type 44-B(P<0.016).Compared with group B,group A had a higher proportion of type 44-A and a lower proportion of type 44-C(P<0.016).Conclusions:Ankle fractures were more common in adults,with more males than females.The peak age of ankle fractures was from 41 to 50 years and the high-risk type was 44-A.The ratio of male to female in western regions is higher than that in eastern and central regions.The median age,the proportion of middle-aged group and elderly group decreased progressively among the eastern,central and western area of China.The proportion of youth group was higher in western area than the eastern and central area.The composition ratio type 44-C was highest in western area,while the composition ratio type 44-B was lowest.Part 3 Incidence and risk factors for surgical site infection after adult ankle fractures treated by open reduction and internal fixation:a prospective multicenter studyObjective:Surgical site infection is one of the most serious complications after the open reduction and internal fixation of ankle fracture,which may lead to some severe consequences such as permanent disability and amputation.The purpose of this study was to investigate the incidence and risk factors of surgical site infection in patients with open reduction and internal fixation for adult ankle fractures.Methods:This prospective,multicentre,cohort study involving 25hospitals in Hebei Province of China was performed between 1 July and 15November in 2014.All adult patients with ankle fractures treated by open reduction and internal fixation were included.To analyse risk factors,the most possible information was collected about demographic characteristics,lifestyle,basic diseases,laboratory tests,surgical information,antimicrobial use and postoperative infection of patients.Results:A total of 391 cases of adult ankle fractures treated with open reduction and internal fixation were collected,including 237 males and 154females with a median age of 44 years old(18-96 years).21 patients developed SSI,accounting for 5.37%(21/391).For all the patients,71.43%were caused by high-energy injury,38.10%were open fractures and patients with a BMI?28 accounted for 14.83%.For SSI cases,the three data are 71.43%,38.10%and 33.33%,respectively,showing significant differences between cases with and without SSI(P<0.05).Univariate analysis revealed that the significant risk factors for development of SSI after open reduction and internal fixation of ankle fracture were BMI?28,high-energy injury,open fracture,emergency operation,surgical incision type,prophylactic use of antibiotics during the operation,HGB and TP(P<0.05).The multivariate analysis revealed that emergency operation,high-energy injury and BMI?28were significant risk factors for SSI occurrence,while prophylactic use of antibiotics during the operation was protective factor.Conclusion:The incidence rate after open reduction and internal fixation of adult ankle fracture was 5.37%.Emergency operation,high-energy injury and BMI?28 were significant risk factors for SSI occurrence,while prophylactic use of antibiotics during the operation was protective factor.Preoperative preventative measures should be taken in patients with these conditions to lower the incidence of SSI after open reduction and internal fixation of ankle fracture. |
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