Abstract:[Objective] To compare the clinical results of posterior hemivertebrotomy for treatment of spinal deformities due to single hemivertebra in different ages. [Methods] A retrospective study was performed on 80 children who underwent posterior hemivertebrotomy for spinal deformities due to single hemivertebra in our department from January 2013 to December 2020. Based on the age at operation, 43 children who aged 3 to 6 years were fall into the young group, while 37 children who aged more than 6 to 10 years were enrolled into the old group. The perioperative, follow- up and radiographic documents were compared between the two groups. [Results] All children in both groups had the surgical procedures completed smoothly without complications, such as nerve and vascular injury. The young group con- sumed significantly shorter operative time, associated with significantly less intraoperative blood loss and segments fixed than the old group (P＜0.05) . Patients in both groups were followed up for 10~12 months, with an average of (11.05±0.84) months. The sitting height and stand- ing height significantly increased in both groups over time (P＜0.05) , while there were no significant differences in the time to resume walk- ing and full weight-bearing activity, the variation rate of sitting height and the incidence of complications between the 2 groups (P＞0.05) . Radiographically, kyphotic Cobb angle, scoliotic Cobb angle, and C₇PL-CSVL were significantly reduced in both groups immediately after surgery and at the last follow-up compared with those preoperatively (P＜0.05) . At corresponding time points, they young group had signifi- cantly less kyphotic Cobb angle, scoliotic Cobb angle and C7PL-CSVL than the old group (P＜0.05) . There was no statistical significance in the correction rate of kyphotic and scoliotic Cobb angles and the correction rate of C₇PL-CSVL between the two groups immediately after surgery and at the last follow-up (P＞0.05) . Pearson correlation analysis found that age was positively correlated with operating time and blood loss (P＜0.001) , but not correlated with sitting height change rate, kyphotic Cobb angle, scoliotic Cobb angle, and C₇PL correction rate (P＞0.05) . [Conclusion] Early posterior hemivertebrotomy for spinal deformities due to single hemivertebra might be conducive to shorten the operation time, reduce intraoperative blood loss and fixed segments.

Abstract:[Objective] To compare the clinical outcomes of microendoscopic discectomy system (MED) assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for spinal canal stenosis accompanied with lumbar instability (LI) versus lumbar spon- dylolisthesis (LS) . [Methods] From May 2005 to May 2018, a total of 935 patients received MED assisted MIS-TLIF for spinal canal steno- sis in our hospital. According to preoperative radiographs, 462 patients were diagnosed of LI accompanied, while the remaining 473 pa- tients had LS. The perioperative, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups were operated on successfully without serious complications. There were no significant differences between the two groups in terms of operative time, total incision length, intraoperative blood loss, postoperative drainage, walking time, incision healing and hospital stay (P＞ 0.05) . The VAS and ODI scores decreased significantly over time in both groups (P＜0.05) , which in the LI group were significantly better than those in the LS group at 1 and 6 months postoperatively (P＜0.05) , but became not significantly different between the two groups at 12 and 48 months after surgery (P＞0.05) . Radiographically, there was no significant difference in term of Gertzbein-Robbins scales for the ac- curacy of pedicle placement between the two groups (P＞0.05) . Compared with that 6 months postoperatively, BSF fusion classification sig- nificantly upgraded in both groups at 48 months after surgery (P＜0.05) , however, there were no statistically significant differences in BSF classification between the two groups at the any corresponding time points (P＞0.05) . [Conclusion] The MED assisted MIS- TLIF does achieve satisfactory clinical outcomes for spinal stenosis accompanied with both lumbar instability and lumbar spondylolisthesis, and has the advantages of accurate operation under clear vision.

Abstract:[Objective] To compare the clinical outcomes of coracoclavicular ligament reconstruction with modified Y-shaped Tight- Rope system (TR) versus internal fixation with hook plate for acromioclavicular dislocation. [Methods] A retrospective study was conducted on 30 patients who received surgical treatment for acromioclavicular dislocation in our hospital from January 2017 to November 2020. Ac- cording to the preoperative doctor-patient communication results, 9 patients underwent coracoclavicular ligament reconstruction with modi- fied TR (TR group) , while the other 21 patients had fixation with hook plate (hook plate group). The perioperative, follow-up and imaging results of the two groups were compared. [Results] Both groups of patients successfully completed the operation, and there were no compli- cations such as vascular and nerve injury and fracture. There was no significant difference in operation time, incision length, intraoperative bleeding, fluoroscopy times, incision healing and hospital stay between the two groups (P＞0.05) . All patients were followed up for an aver- age of (15.34±3.26) months. There was no significant difference in the recovery time of complete weight-bearing activities between the two groups (P＞0.05) . The VAS scores decreased significantly (P＜0.05) , while Constant-Murley score and ROM of shoulder lift were signifi- cantly increased over time in both groups (P＜0.05) . At 3 months and the latest follow-up, the TR group proved significantly superior to the hook plate group in terms of VAS score, Constant-Murley score and ROM (P＜0.05) . Radiographically, the coracoclavicular distance (CCD) and acromioclavicular distance (ACD) significantly reduced in both groups at the latest follow-up compared with those preoperatively (P＜ 0.05) , whereas there was no significant difference in CCD and ACD between the two groups at any corresponding time points (P＞0.05) . [Conclusion] The coracoclavicular ligament reconstruction with modified Y-shaped TightRope is superior to the internal fixation with hook plate for Rockwood type III~V acromioclavicular dislocation in term of clinical outcomes.

Abstract:[Objective] To compare the clinical outcomes of Masquelet technique versus Ilizarov technique for treatment of infectious tibial bone defects. [Methods] A retrospective study was conducted on 60 patients who received surgical treatment for infectious tibial bone defect in our hospital from August 2017 to August 2020. According to the results of preoperative doctor-patient communication, 35 patients received Masquelet treatment, the induced membrane technique, while the other 25 patients received Ilizarov therapy, the bone transporta- tion. The perioperative, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups had operations completed smoothly. The Masquelet group proved significantly superior to the Illizarov group in terms of total number of intraop- erative fluoroscopy and incision healing grade (P＜0.05) . The early complications were of 3/35 (8.57%) in the Masquelet group, whereas 9/ 25 (36.00%) in the Ilizarov group, which was statistically significant between the two groups (P＜0.05) . During follow-up period lasted for (24.54±5.86) months on an average, the Masquelet group resumed walking and full weight-bearing activity significantly earlier than the Ilizarov group (P＜0.05) . The VAS score significantly decreased (P＜0.05) , while Iowa knee score, Iowa ankle score and SF-36 score signifi- cantly increased in both groups over time (P＜0.05) . VAS score in Masquelet group was significantly better than those of Ilizarov group at 6 months after surgery and the latest follow-up (P＜0.05) , although there were no significant differences in Iowa knee score, Iowa ankle score and SF-36 score between the two groups at any corresponding time points (P＞0.05) . Radiographically, the Masquelet group got healing of the bone defect significantly earlier than the Ilizarov group (P＜0.05) . [Conclusion] Both Masquelet technique and Ilizarov technique are ef- fective for treatment of infectious tibial bone defects, by contrast, the Masquelet technique does achieve considerably better clinical results than the Ilizarov technique in this study.

Abstract:[Objective] To investigate the clinical outcomes of syndesmotic screw combined with platelet rich plasma (PRP) for treat- ment of distal tibiofibular syndesmosis injury. [Methods] From June 2018 to July 2019, a total of 96 patients with ankle fracture and distal tibiofibular syndesmosis injury were enrolled in this study, and were divided into two groups by random number table method. Of them, 48 patients received tibiofibular screw fixation combined with local PRP injection (the PRP group) , while the other 48 patients received tibio- fibular screw fixation only (the non-PRP group) . The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation done successfully without serious complications. Although there were no significant dif- ferences in operative time, incision length and preoperative VAS score between 2 groups (P＞0.05) , the PRP group proved significantly su- perior to the non-PRP group in terms of intraoperative blood loss, postoperative drainage volume, swelling and petechial grades 3 days post- operatively, as well as incision healing, VAS score from 24 hours postoperatively to discharge, time to return walking postoperatively and hospital stay (P＜0.05) . The follow up period lasted for more than 12 months. The PRP group resumed full weight-bearing activity signifi- cantly earlier than the non-PRP group (P＜0.05) . The VAS scores significantly decreased (P＜0.05) , whereas the AOFAS score and plantar flexion-dorsal extension range of motion (ROM) significantly increased in both groups at the latest follow up compared to those preopera- tively (P＜0.05) . The PRP group was significantly superior to the non-PRP group in aforesaid items at the latest follow up (P＜0.05) . Radio- graphically, the tibiofibular clear space (TFCS) and medial clear space (MCS) significantly reduced (P＜0.05) , while the tibiofibular overlap (TFO) increased significantly in both groups at the latest follow-up compared with those preoperatively (P＜0.05) , which in PRP group were significantly better than those in non-PRP group at the latest follow up (P＜0.05) . [Conclusion] Tibiofibular screw fixation combined with PRP for distal tibiofibular syndesmosis injury does alleviate early postoperative injury reaction, accelerate ligament healing, and benefit functional recovery.

Abstract:[Objective] To explore the factors related to the outcomes of radial extracorporeal shock wave (rESW) for long bone non- union. [Methods] From September 2014 to June 2019, 54 patients received rESW therapy for long bone nonunion, involving 13 femurs, 22 tibias, 2 fibulas, 6 humerus, 7 radius, and 4 ulnas. The rESW was applied once a week for 30 minutes without anesthesia for 4 weeks. All patients were followed for at least 12 months to assess outcomes by using clinical and radiographic fracture healing criteria and VAS scores. Univariate comparison and binary multi-factor logistic regression were conducted to search the factors related to treatment outcome. [Results] Fracture healing achieved in 35 patients (64.81%) at 3 months after treatment, 39 cases (72.22%) at 6 months and 40 cases (74.07%) at 12 months after treatment. Regarding to univariate comparison, the union group had significantly higher ratio of hypertrophic bone non- union than the nonunion group (P＜0.05) , whereas, the union group was significantly less than the nonunion group in terms of interval be- tween fracture and rESW treatment, the number of previous surgical operations, fracture gap and the number of rESW treatment cycles (P＜ 0.05). As results of logistic regression, interval between fracture and rESW treatment (OR=1.080, P=0.036) , the number of previous opera- tion (OR=4.900, P=0.015) , fracture gap (OR=1.418, P=0.010) , the type of nonunion (OR=31.054, P＜0.001) and the number of rESW treat- ment cycle (OR=2.401, P＜0.001) were significantly related to the outcomes of rESW therapy. [Conclusion] The rESW is safe and effective in the treatment of long bone nonunion, and its outcomes is related to the type of nonunion, interval between fracture and rESW treatment, the number of previous surgery, fracture gap. In addition, rESW therapy greater than 8 cycles might be meaningless.

Abstract:Osteoarticular infections (OAIs) are still serious diseases in clinical practice. Accurate and early detection of the pathogens that cause osteoarticular infections remains important for administering clinical treatment, however, the traditional detection methods is time consuming with lower positive rate. Therefore, it is necessary to develop better methods or techniques for determining the pathogens re- sponsible for OAIs. In recent years, an increasing number of studies have reported that metagenomic next-generation sequencing (mNGS) is a fast approach with high specificity and sensitivity, and has potential to be used as an effective diagnostic tool. This article summarizes the application of major traditional techniques in the diagnosis of OAIs, and discuss the prospects of mNGS in the diagnosis of OAIs.

Abstract:Autophagy is a highly conserved catabolic process induced under cellular stress, which prevents cell damage and promotes survival. Autophagy dysfunction is associated with aging and a variety of degenerative diseases, including osteoarthritis (OA). Therefore, it is very important to maintain autophagy homeostasis and function. OA is a degenerative disease that causes irreversible and progressive de- struction of articular cartilage. However, there is no effective method to delay the progression of OA. In the past decade, more and more evi- dence has shown that autophagy plays important roles in the pathogenesis of OA, and regulating autophagy activity can prevent articular car- tilage degeneration. In view of the important role of autophagy in OA, this paper reviews the relationship between autophagy and OA, the key autophagy molecules and related signaling pathways that regulate the progression of OA, as well as related drugs targeting autophagy pathways for the treatment of OA.

Abstract:Low back pain is a common clinical disease, which in number of cases has been increasing in recent years with the aging of the population. Many studies have found that intervertebral disc degeneration is one of the main causes of low back pain. The mesenchymal stem cells with capacity of pluripotent differentiation, homing, and paracrine properties plays important roles in intervertebral homeostasis, involving regulation of internal inflammation, and repair of injuries in intervertebral disc degeneration, which has great significances for treatment of low back pain. In recent years, the clinical application of MSC in the treatment of intervertebral disc degeneration has achieved good results in some extent. The development of tissue engineering has further improved the effect and application scope of MSC treatment. This article summarizes the latest literature about mechanism of MSCs in repairing intervertebral disc, the progress in clinical and tissue en- gineering research and clinical application to provide new ideas for the treatment of low back pain.

Abstract:Ribosome biogenesis (RiBi) plays an important role in the growth and proliferation of cell. Currently, RiBi is considered a close relationship with malignant tumor, on other hand, interfering the process of RiBi will inhibit tumor cells, which in some respects have been convinced that could be potential therapy targets. In addition, some RNA Pol I inhibitors have been developed and tested clinically. The research of RiBi may provide new therapeutic approaches for malignant therapy.

Abstract:Steroid-induced avascular necrosis of the femoral head (SANFH) is a metabolic disease that occurs due to improper clinical use of glucocorticoid. The blood supply system inside the femoral head is impaired and the tissue components of bone cells and bone mar- row die, which may lead to structural changes of the femoral head, collapse of the femoral head and joint dysfunction. SANFH in adults is a challenging orthopedic disorder due to collapse of the femoral head in the end-stage with hip dysfunction eventually, which seriously com- promises the patient's quality of daily life, and will need total hip replacement, however, the pathogenesis of the disease remains unclear. In recent years, exact pathogenesis of SANFH and more new treatments for it are conducting with the further development of precision medi- cine and extensive and in- depth research on stem cells and molecular biology. This review discusses several leading theories about the pathogenesis of SANFH.

Abstract:[Objective] To compare the general bone mineral density (BMD) and local bone structure around the lesion between spinal tuberculosis (STB) and pyogenic spondylitis (PS) . [Methods] A total of 36 patients who received surgical treatment for spinal bone destruc- tion secondary to infection in the Department of Spine Surgery, Xiangya Hospital, Central South University were enrolled into this study, and divided into spinal tuberculosis (STB) group and pyrogenic spondylitis (PS) group based on the consequence of microbiologic assays. The two groups were paired according to gender, and were compared in terms of the preoperative general BMD, CT grayscales of affected vertebra and adjacent vertebra. In addition, the bone volume/tissue volume (BV/TV) , thickness of trabecular bone (Tb.Th) and sparse densi- ty of trabecular (Tb.Sp) measured on the trabecular bone around the lesion taken out during the operation by micro-CT were compared be- tween the two group. [Results] There were no significant differences between STB group and PS group in terms of the BMDs of the total lum- bar, cervical vertebra, femoral intertrochanteric area and the Ward triangle (P＞0.05) , neither in BMDs of aforesaid areas between the Gram-positive subgroup and Gram-negative subgroup of the PS patients (P＞0.05) . The STB group had significantly higher CT grayscales than the PS group (P＜0.05) . The CT grayscales of sclerosed bone around lesions in both groups significantly increased (P＜0.05) , which in STB group was significantly higher than the PS group (P＜0.05) . In term of micro-CT, the STB group got significantly higher BV/TV and TB. Th, whereas significantly lower Tb.Sp than the PS group (P＜0.05) . [Conclusion] The STB has more vigorous pathological osteogenesis around lesions than the PS, with increase of density and thickness of local bone trabeculae, however, there was no significant difference in general BMD between the two groups.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of a modified arthroscopic technique for lateral meniscus cyst of the knee. [Methods] A retrospective study was conducted on 120 patients who underwent arthroscopic surgery for lateral meniscus cyst from January 2017 to December 2018. All the patients received a modified arthroscopic therapy, involving resection of the lower part of the teared meniscus, drainage of cyst fluid, and complete resection of synovial cyst wall, meniscus repaired if necessary. Lysholm and Tegner scores were used for evaluation of clinical outcomes, while MRI at 3 days after surgery and the latest follow-up was taken to evaluate the resection and recurrence of cysts. [Results] All the 120 patients underwent the arthroscopic procedures smoothly with- out serious complications, such as injuries to blood vessels and nerves. The Lysholm score [ (56.21±7.51) versus (88.82±3.46) ] and Tegner score [ (3.74 ±0.64) versus (5.92±0.72) ] significantly improved at the latest follow-up compared with those preoperatively (P＜0.05) . Radio- graphically, the MRI 3 days postoperatively showed that cyst had been completely resected in 115 cases (95.8%) except partial remnants in other 5 cases, while the MRI at the latest follow-up revealed that no cyst recurred in all patients including the 5 cases who had cyst existed partially. [Conclusion] This modified arthroscopic technique does maximize resection of cyst and cyst wall tissue, with advantages of good recovery of postoperative knee joint function, and lower postoperative recurrence rate for lateral meniscus cyst of the knee.

Abstract:[Objective] To explore the surgical techniques and clinical efficacy of reduction with a distractor and intramedullary nail- ing by small incisions for femoral subtrochanteric fractures. [Methods] From January 2018 to June 2019, 34 patients underwent closed re- duction with a distractor and intramedullary nailing by small incisions for Seinsheimer type Ⅱ~Ⅳfemoral subtrochanteric fractures. The perioperative, follow-up and imaging data were summarized. [Results] All patients were successfully operated on without vascular or nerve injury, and followed up for (20.00±3.16) months. The Harris score and range of motions (ROMs) including hip extension-flexion, and inter- nal-external rotations at the last follow-up significantly improved compared with those at 3 months postoperatively (P＜0.05) . At the last fol- low-up, all patients had achieved clinical fracture union with proper lower limb alignment. In terms of imaging, the reduction quality of frac- ture was excellent in 8 cases, good in 24 cases and poor in 2 cases, with an excellent and good rate of 94.12%. Radiographs revealed bony healing in 23.53% at 3 months after the operation, whereas 100% at latest follow-up, without loosening or fracture of the internal implants. [Conclusion] The reduction with a distractor and intramedullary nailing by small incisions for Seinsheimer type II ~ IV femoral subtrochan- teric fractures has an advantage of high surgical efficiency.

Abstract:[Objective] To compare the clinical outcomes of arthroscopic versus open repairs for recurrent anterior shoulder dislocation in the elderly. [Methods] A retrospective study was conducted on 88 elderly patients, including 35 males and 53 females, aged (65.21± 5.64) years, who underwent surgical treatment for traumatic recurrent anterior dislocation of the shoulder in our hospital from May 2015 to April 2019. According to the results of preoperative doctor-patient communication, 22 patients had the Bankart lesion and rotator cuff tear repaired arthroscopically, while the other 66 patients underwent traditional open repair surgery. [Results] The patients in both groups had operations completed successfully. The arthroscopic group proved significantly superior to the open group in term of operation time, intraop- erative blood loss, postoperative drainage and hospital stay (P＜0.05) . During the follow-up, no further dislocation of shoulder happened in anyone in both groups. The arthroscopic group resumed full weight-bearing activity significantly earlier than the open group (P＜0.05) . The VAS scores decreased significantly (P＜0.05) , while the Neer and Constant-Murley scores increased significantly over time postoperatively in both groups (P＜0.05) . At 6 months after operation and the latest follow-up, the arthroscopic group was significantly superior to the open group regarding VAS, Neer, and Constant-Murley scores (P＜0.05) . [Conclusion] For recurrent anterior shoulder dislocation in the elderly, the arthroscopic technique is better than the open counterpart in term of the clinical results of simultaneous repair of Bankart injury and ro- tator cuff tear.

Abstract:[Objective] To investigate the clinical outcomes of free anterolateral thigh perforator flap for repairing large soft tissue de- fect on foot and ankle. [Methods] From January 2011 to December 2019, a total of 22 patients with large soft tissue defects of foot and an- kle were treated with free anterolateral thigh perforator flap, including 10 left feet and 12 right feet. The clinical consequence were ana- lyzed. [Results] All the 22 patients got the flap survived, and were followed up for 12~19 months, with an average of (13.67±4.24) months. The VAS score, ankle planta flexion dorsal extension range of motion (ROM) , AOFAS score, and Highet sensory grade of the flap signifi- cantly improved in all the 22 patients over time postoperatively (P＜0.05) . [Conclusion] Free anterolateral thigh perforator flap has high sur- vival rate for repairing large soft tissue defect on the foot and ankle, and does achieve satisfactory clinical results.

Abstract:[Objective] To evaluate the short-term clinical outcomes of Oxford phase 3 unicompartmental knee arthroplasty (UKA) for medial osteoarthritis of the knee. [Methods] A total of 158 patients underwent unilateral Oxford phase 3 UKA for medial osteoarthritis of the knee from May 2017 to May 2020 in our hospitals. The clinical and imaging results in short term were evaluated. [Results] All patients were successfully operated without serious complications such as nerve and vascular injury, whereas with operative time of (42.42±6.26) min, and intraoperative blood loss of (33.40±9.67) ml. As time went during the follow-up lasted for 12 to 48 months, the AKSS clinical and functional scores as well as OKS score significantly increased (P＜0.05) . Radiographically, hip-knee-ankle angle (HKA) was significantly higher at the latest follow-up than that before surgery (P＜0.05) . None of the patients showed prosthetic dislocation, loosening or subsid- ence, as well as osteoarthritic progression of the lateral compartment of the knee in term of Kellgren-Lawrence grading at the latest followup. [Conclusion] The Oxford phase 3 UKA with advantages of short operation time, less blood loss, short hospital stay and rapid postopera- tive recovery does achieve satisfactory clinical outcomes in short term for medial compartment osteoarthritis of the knee.

Abstract:[Objective] To evaluate the clinical efficacy of spinal fusion hybridized with dynamic fixation for multi-level lumbar degen- erative diseases. [Methods] From August 2017 to March 2019, a total 56 patients underwent spinal fusion hybridized with dynamic fixation for multi-level lumbar degenerative diseases in our department. The clinical and imaging documents were observed and analyzed. [Results] All patients had operation performed successfully with accurate screw placement and no iatrogenic injuries to nerve roots or cauda equina. Of them, 31 patients had lesions from L3 to L5, including 26 patients with L4/5 fusion and 5 patients with L3/4 fusion, while the remaining 25 patients were from L4 to S1, including 21 patients with L4/5 fusion and 4 patients with L5~S1 fusion. At the latest follow-up lasted for (23.23± 7.34) months on an average, the VAS scores for low back pain and leg pain, as well as ODI scores significantly decreased (P＜0.05) , while JOA score significantly increased compared with those preoperatively (P＜0.05) . In term of imaging evaluation, the intervertebral space height in the fused segment significantly increased (P＜0.05) , while the ROM disappeared at the latest follow-up compared with those be- fore operation. By contrast, in the non-fusion segment intervertebral space height remained unchanged (P＞0.05) , with significantly de- creased ROM (P＜0.05) . No loosening and displacement of the implants were noted in anyone of them until the latest follow-up. [Conclusion] The spinal fusion hybridized with dynamic fixation does achieve satisfactory clinical consequences for multi-level lumbar degenera- tive diseases.

Abstract:[Objective] To compare and analyze the difference in the plantar center of pressure (COP) between patients with lumbar spi- nal stenosis (LSS) accompanied with neurogenic intermittent claudication (NIC) and healthy persons, and verify the application value of COP parameter in objectively evaluating the balance function in LSS. [Methods] A total of 32 patients with L4/5 LSS were selected as the LSS group, while the other 32 healthy adults at the same age were selected as the healthy group. Footscan? platform system was used to measure the plantar pressure of these subjects during walking. The balance function of LSS patients was evaluated by comparing the center of pressure (COP) displacement and COP velocity between the two groups. [Results] The COP displacement and velocity of the LSS group during the forefoot contact phase (FFCP) and the foot flat phase (FFP) were significantly higher than those of the control group (P＜0.05) , whereas no significant differences in COP displacement and velocity were observed between the two groups during the initial contact phase (ICP) and forefoot push-off phase (FFPOP) . [Conclusion] The balance function of LSS patients after the occurrences of NIC is significantly damaged. Using the displacement and velocity of COP during the FFCP and FFP might achieve an objective assessment of the dynamic bal- ance function of LSS patients.

Abstract:[Objective] To explore the clinical outcomes of joint replacement combined with plate fixation for intertrochanteric frac- tures in the elderly. [Methods] A retrospective study was done on 18 elderly patients who received hip replacement combined with olecra- non locking plate fixation for femoral intertrochanteric fractures. [Results] All the 18 patients were successfully operated on without serious complications, such as cardiovascular events, pulmonary embolism and death happened in anyone of them during the perioperative period. All patients were followed up for more than 12 months, and resumed full weight-bearing activity in (39.65±2.56) days. The Harris score in- creased from (81.27±2.82) at 6 months after operation to (87.87±3.25) at the latest follow-up, which was statistically significant (P＜0.05) . At the last follow-up, 17 patients returned to their pre-traumatic activity and daily life level, whereas 1 patient did not fully return to the pre-traumatic activity level. During the follow-up period, there were no complications such as prosthesis loosening, dislocation, fracture nonunion, plate screw loosening and refracture. [Conclusion] This hip replacement combined with olecranon locking plate fixation for femo- ral intertrochanteric fractures in the elderly does get satisfactory outcomes, with early postoperative ambulation and fewer complications.

Abstract:[Objective] To evaluate the clinical outcomes of F-shaped cannulated lag screws placement for internal fixation of Pauwels type III femoral neck fracture. [Methods] A total of 96 patients received closed reduction and internal fixation with 3 cannulated lag screws for Pauwels type III femoral neck fracture in our hospital from May 2017 to March 2019. Among them, 50 patients had the screws placed in “F” shape, while the other 46 patients had the lag screws inserted parallelly. The documents regarding to perioperative period, follow-up period and radiographs were compared between the two groups. [Results] All patients in both groups were successfully operated on without serious complications. There were no significant differences in operative time, incision length, intraoperative blood loss and length of hospi- tal stay between the two groups (P＞0.05) . All the patients were followed up for 12~32 months, with an average of (15.52±3.41) months. The VAS score decreased significantly, whereas hip extension-flexion range of motion (ROM) and Harris score increased significantly over time postoperatively in both groups (P＜0.05) , which in the F-shaped group was significantly superior to the parallel group at the latest follow up (P＜0.05) . Radiographically, the F- shaped group proved significantly superior to the parallel group in term of fracture reduction quality measured by Garden alignment index and fracture healing time revealed radiographically (P＜0.05) . [Conclusion] The F-shaped placement of cannulated lag screws for internal fixation of Pauwels type III femoral neck fracture does improve the quality of fracture reduction, in- crease the stability of fixation, and is benefit for functional recovery.