Abstract:[Objective] To compare the clinical efficacy of proximal femoral nail anti-rotation (PFNA) versus InterTAN intramedullary nail combined with anti-osteoporosis therapy for osteoporotic intertrochanteric fractures of the femur. [Methods] A total of 102 elderly pa- tients who underwent surgical treatment for osteoporotic intertrochanteric fracture of the femur in our hospital from January 2016 to January 2019 were included in this study. According to the results of preoperative doctor-patient communication, 53 patients received PFNA fixa- tion, while the other 49 patients received InterTAN fixation. The Perioperative, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups had surgical procedures performed successfully. The InterTAN group proved signifi- cantly superior to the PFNA group in terms of operation time, incision length and intraoperative blood loss (P＜0.05) . All patients were fol- lowed up for 12~32 months, with an average of (22.52±6.41) months. InterTAN group resumed walking and full weight bearing activity sig- nificantly earlier than PFNA group (P＜0.05) . The hip extension-flexion range of motion (ROM) , internal-external rotation ROM, and Har- ris score significantly increased postoperatively compared with those preoperatively in both groups (P＜0.05) , which in the InterTAN group were significantly better than those in the PFNA group at 6 months and the latest follow-up (P＜0.05) . With respect to imaging evaluation, the Inter TAN group got significantly higher rate of proper fracture reduction than the PFNA group (P＜0.05) . By the time of the latest fol- low-up, the fracture healing was achieved in all patients of both groups without nonunion. At the latest follow-up, the InterTAN group was significantly superior to the PFNA group in terms of femoral shortening and femoral neck-shaft angle (P＜0.05) . [Conclusion] For osteopo- rotic intertrochanteric fractures of the femur, the InterTAN used as internal fixation is considerably better than the PFNA.

Abstract:[Objective] To compare the clinical efficacy of hemiarthroplasty (HA) versus total hip arthroplasty (THA) for femoral neck fracture accompanied with left heart failure in the elderly. [Methods] A retrospective study was conducted on 45 elderly patients who re- ceived surgical treatment for displaced femoral neck fracture complicated with left heart failure in our hospital from 2017 to 2019. Accord- ing to preoperative doctor-patient communication and cardiac function status, 30 patients underwent HA, while the remaining 15 patients underwent THA. The documents regarding to clinical conditions, cardiac function and radiographs were compared between the two groups. [Results] The HA group proved significantly superior to the THA group in terms of operation time, intraoperative blood loss, postoperative drainage, decline of hemoglobin and hospital stay (P＜0.05) . The Harris scores increased significantly over time postoperatively in both groups (P＜0.05) . Although there were no significant differences in Harris score between the two groups at 3 and 6 months after surgery (P＞ 0.05) , the THA group was significantly better than HA group in Harris score at 12 months after operation (P＜0.05) . In terms of cardiac function, the ejection fraction remained unchanged before and after surgery in both groups (P＞0.05) , whereas which in the HA group were significantly inferior to those in the THA group at any corresponding time point (P＜0.05) . Postoperative radiographs showed that the pros- thesis in both groups was in good position, without clear band around the prosthesis, osteolysis, infection, subsidence and other adverse man- ifestations. [Conclusion] Hemiarthroplasty is safe and effective for the patients with heart failure and abnormal ejection fraction, whereas to- tal hip arthroplasty should be considered for those with heart failure but normal ejection fraction to achieve better long-term hip function.

Abstract:[Objective] To compare the clinical outcomes of locking proximal humeral plate (LPHP) versus humeral hemiarthroplasty (HHA) for complex proximal humeral fractures in the elderly. [Methods] A retrospective study was done on 78 elderly patients (≥80 years old) who underwent surgical treatment for complex proximal humeral fractures (Neer type III and IV fractures) from January 2015 to Janu- ary 2018. According to the results of preoperative doctor-patient communication, 46 patients received LPHP for open reduction and inter- nal fixation, while the remaining 32 patients had HHA performed. Clinical documents, such as complications, Neer, ASES and ConstantMurley scores, as well as radiographic data were compared between the two groups. [Results] All the patients in both groups were success- fully operated on without serious intraoperative complications. The HHA group had significantly less intraoperative blood loss and operation time than the LPHP group (P＜0.05) , although there were no statistically significant differences in terms of number of fluoroscopy, postoper- ative blood transfusion, hospital stay and perioperative complications between the two groups (P＞0.05) . All patients in both groups were fol- lowed up for 12~18 months, with an average of (13.87±2.84) months. Adverse events were of 14/46 (30.43%) in the LPHP group, 5/32 (15.63%) in the HHA group, which was not statistically significant (P=0.134) . There were no significant differences in terms of time to re- sume active motion and time to recover full weight-bearing activity between the two groups (P＞0.05) . At corresponding postoperative time points, HHA group had less forward extension ROM, while higher Neer, ASES and Constant-Murley scores than LPHP group, despite of the fact that no statistically significant differences were noticed in the abovementioned items between the two groups (P＞0.05) . Radiographical- ly, the acromiohumeral interval (AHI) and humeral neck-shaft angle (HNSA) remained unchanged significantly in the two groups at the lat-est follow-up compared with those immediately after surgery (P＞0.05) , and there was no statistical significance in AHI and HNSA between the two groups at corresponding time points (P＞0.05) . By the time of the latest follow-up, 9 patients presented loosening or perforation of screws, 5 cases had ischemic necrosis of the humeral head, and 11 cases had poor fracture union, including nonunion and delayed fracture union in the LPHP group, whereas 3 patients had periprosthetic fractures and 2 had poor healing of humeral greater trochanter in the HHA group. [Conclusion] Both LPHP and HHA do achieve reasonable clinical outcomes for complex proximal humeral fractures in the elderly. By comparison, the HHA is more conducive to early rehabilitation exercise and improvement of shoulder joint function.

Abstract:[Objective] To compare the clinical outcomes of four versus three cannulated screws for internal fixation of Pauwels type III femoral neck fractures. [Methods] From January 2014 to November 2018, 70 patients with Pauwels type III femoral neck fracture were en- rolled in this study and randomly divided into two groups by lottery. Among them, 35 patients had fractures fixed with 4 cannulated screws (the four-screw group) , while the remaining 35 patients were treated with 3 cannulated screws (the three-screw group). Perioperative condi- tions, follow-up consequences and imaging data were compared between the two groups. [Results] All the patients in both groups had inter- nal fixations performed successfully with no vascular and nerve injury. The four-screw group consumed significantly longer operative time, associated with significantly more intraoperative bleeding, total incision length and intraoperative fluoroscopy frequency than the threescrew group (P＜0.05) . However, there were no significant differences in hospital stay and the time to resume walking between the two groups (P＞0.05) . The follow-up period lasted for 18 to 48 months with a mean of (26.41±5.02) months. To the latest follow-up, total hip ar- throplasty due to femoral head necrosis or nonunion was performed 5/35 (14.26%) in the four-screw group, whereas 7/35 (20.00%) in the three- screw group. The hip range of motion (ROM) in all directions and the Harris score was significantly increased over time in both groups (P＜0.05) . At all the corresponding time points, the four-screw group proved significantly superior to the three-screw group in terms of ROMs and Harris scores (P＜0.05) . With respect to radiographic evaluation, there was no significant difference in fracture reduction qual- ity in term of Garden's alignment index between the two groups (P＞0.05) . However, the four-screw group was significantly superior to the three- screw group in terms of femoral head and neck shortening and neck- shaft angle (P＜0.05) . [Conclusion] The four cannulated screws used in internal fixation of Pauwels type III femoral neck fracture does achieve better clinical outcomes than the three canulated screws.

Abstract:[Objective] To explore the value of surgical planning by digital virtual reality and 3D printing for open reduction and inter- nal fixation of complex tibial plateau fractures. [Methods] A total of 60 patients who were admitted into our hospital from June 2018 to June 2019 for complex tibial plateau fractures were randomly divided into two groups. Of them, 30 patients underwent open reduction and inter- nal fixation based on preoperative surgical planning by digital virtual reality and 3D printing, while another 30 patients underwent opera- tions by using conventional techniques. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation completed successfully. The 3D group proved significantly superior to the conventional group in terms of operation time, incision length, intraoperative blood loss, intraoperative fluoroscopy times, plate placement times, incidence of postoperative tension blister and hospital stay (P＜0.05) . The follow- up period lasted for18~28 months, with a mean of (22.36 ± 10.28) months. The 3D group resumed walking and full weight bearing activity significantly earlier than the conventional group (P＜0.05) . The VAS scores decreased significantly (P＜0.05) , whereas the HSS score and knee extension-flexion range of motion (ROM) significantly in- creased in both groups over time postoperatively (P＜0.05) . At the corresponding postoperative time point, the 3D group was significantly su- perior to the conventional group in abovementioned items (P＜0.05) . Regarding to radiographic assessment, the 3D group got significantly better quality of fracture reduction postoperatively, and more proper medial proximal tibial angle (MPTA) and posterior tibial slope (PTS) at the latest follow up than the conventional group (P＜0.05) . [Conclusion] The digital virtual reality and 3D printing used for preoperative sur- gical planning do considerably improve the precision of open reduction and internal fixation, and improve the clinical outcome for complex tibial plateau fractures.

Abstract:[Objective] To compare clinical outcomes of open reduction and internal fixation (ORIF) of fractures with or without del- toid repair for ankle fractures accompanied with deltoid ligament tear. [Methods] A retrospective study was conducted on 82 patients who received surgical treatment for ankle fractures accompanied with the syndesmosis injury and deltoid ligament tear from January 2018 to June 2019. Based on the results of preoperative doctor-patient communication, the patients were divided into two groups. Among them, 41 patients underwent ORIF for fractures combined with deltoid ligment repaired, while the remaining 41 patients had ORIF only without del- toid ligament repaired. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the 82 patients had operation completed successfully without serious complications. The repaired group was significantly greater than the unrepaired group in term of operation time, total incision length, and intraoperative blood loss (P＜0.05) . All patients were followed up for 12-18 months, with an average of (14.39±2.17) months. The patients in the repair group recovered to full weight bearing significantly earlier than those in the unrepaired group (P＜0.05) . The VAS score decreased significantly (P＜0.05) , while the AOFAS score and ankle dorsiflexion-plantar flexion ROM and ankle and foot varus-valgus ROM increased significantly over time postoperatively in both groups (P＜0.05) . However, the repaired group proved significantly superior to the unrepaired group at the corresponding time point in the VAS and AOFAS scores (P＜ 0.05) , despite of the fact that the repaired group had significantly less ankle foot varus-valgus ROM than the unrepaired group (P＜0.05) . Regarding to radiographic assessment, there was no statistically significant difference in MCS, TFCS and TFO between the two groups at the corresponding time points (P＞0.05) . The repaired group got fracture healing significantly earlier than the unrepaired group (P＜0.05) . [Conclusion] The deltoid ligament repairing is beneficial to improve the clinical outcomes of surgical treatment for ankle fracture accompanied with deltoid ligament tear.

Abstract:[Objective] To compare the clinical outcomes of pedicle screw placement at the injured vertebra after and before fracture reduction in posterior short-segment fixation for Magerl type A3 thoracolumbar fractures. [Methods] From December 2018 to June 2020, 59 patients who were undergoing surgical treatment for Magerl type A3 thoracolumbar fractures were randomly divided into two groups. All the patients received posterior short-segment fixation with the intermediate screws. Of them, 32 patients had the screws at injured vertebra placed after fracture reduction by using self-developed reducing rods with the upper and lower pedicle screws (the reduced group), while the remaining 27 patients had the screws placed before fracture reduction as usual (the conventional group). The documents regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All patients in both groups had surgical procedures completed successfully without serious intraoperative complications. There was no statistically significant difference between the two groups in terms of operation time, intraoperative blood loss, incision length, hospital stay, the time to return walking and the time to resume full-weight bearing activity (P＞0.05) . All the 59 patients were followed up for 12-21 months with an average of (14.42±2.04) months. Both the VAS score and the ODI score decreased significantly in both groups over time (P＜0.05) , however, no significant differ- ence was noted in the two scores at any corresponding time point between the two groups (P＞0.05) . Regarding to radiographic assessment， the relative anterior vertebral height, kyphotic Cobb angle and spinal canal occupation ratio significantly improved postoperatively com- pared with those before operation in both groups (P＜0.05) . Although there was no statistically significant difference in the relative anterior vertebral height and kyphotic Cobb angle at any matching time point (P＞0.05) , the reduced group proved significantly superior to the con- ventional group in term of spinal canal occupation ratio at 3 days after operation and the latest follow- up (P＜0.05) . [Conclusion] Both short-segment pedicle screw fixation with screws placement at the injured vertebra after or before fracture reduction achieve satisfactory and comparable clinical outcomes for Magerl type A3 thoracolumbar fractures. However, the screws placed after fracture reduction does im- prove spinal canal occupation better.

Abstract:[Objective] To explore whether body mass index (BMI) is associated with adverse events after shoulder arthroplasty. [Methods] The published papers about the relationship between obesity and shoulder arthroplasty were searched from databases, such as PubMed, EMBASE, Web of Science and Cochrane in English, as well as Wanfang, CNKI and VIP in Chinese. The quality of the literatures was evaluated by Newcastle Ottawa scale (NOS) , and the data of the included literatures were extracted. Revman 5.3 software provided by Cochrane Collaboration Network was used for a meta-analysis. [Results] A total of 10 literatures were included, with sample size in each study ranged from 76 to 144139. All the studies were enrolled as observational studies, including 3 prospective studies and 7 retrospective studies, which all proved of high-quality. As results of the meta-analysis, the obesity (BMI＞30 kg/m2 ) had significantly higher postoperative infection rate [OR=3.83, 95% CI (2.72~5.41) , I 2 =64% ] , significantly higher incidence of venous thrombosis [OR=3.93, 95% CI (3.61~ 4.29) ] , while the overweight (BMI＞25kg/m2 ) consumed significantly longer operation time [MD=6.90, 95%CI (3.79~10.00) , I 2 =0%] . How- ever, there were no significant differences between the overweight patients and the normal weight patients in terms of postoperative compli- cations [OR=0.87, 95%CI (0.71~1.08) , I 2 =38%] , postoperative revision rates [OR=1.48, 95%CI (1.39~1.57) , I2 =71%] , hospitalization time [MD=0.03, 95%CI (-0.03~0.09) , I 2 =1%] and American Shoulder and Elbow Surgeon (ASE) scores [MD=0.36, 95%CI (-7.38~8.11) , I 2 =0%] . [Conclusion] The obesity has considerably higher risk of infection and takes significantly longer operation time, However, all pa- tients do get benefit from shoulder arthroplasty.

Abstract:Secondary lesions of spinal cord injury (SCI) , such as oxidative stress and apoptosis, further aggravate the neurological im- pairment. The microRNAs (miRNAs) are a novel class of small non-coding RNAs that regulate protein production and cell function by si- lencing translation or interfering with the expression of target mRNAs. SCI alters the expression of miRNAs associated with many secondary injuries such as oxidative stress, inflammation and apoptosis. This review aims to clarify the latest research progress of miRNAs in apopto- sis and oxidative stress secondary to spinal cord injury, and to provide a reference for further research of miRNAs in spinal cord injury.

Abstract:Ligamentum flavum hematoma is a rare spinal epidural hematoma with unclear pathogenesis, which may be caused by the rupture and bleeding of small blood vessels hyperplasia in degenerative ligamentum flavum caused by slight trauma. This disorder was first reported by Sweasey in 1992, and is mostly seen in lumbar spine, with progressive aggravation of clinical symptoms similar to disc hernia- tion and synovial cyst, and mainly manifested as symptoms of nerve and dural sac compression. Here, we report a case of lumbar ligamen- tum flavum hematoma and give a review of the published literature.

Abstract:Nonunion of femoral intertrochanteric fractures secondary to surgical treatment is a rare but serious complication. Revision surgical treatment is the main clinical option, involving femoral head preservation and hip arthroplasty. The former includes valgus osteoto- my and replacement of internal fixation, and the latter includes total hip arthroplasty and hemiarthroplasty. Many factors must be consid- ered in the choice of treatment, especially the failure of the previous internal fixation with proximal femur loss in some extent, which in- creases the difficulty of the revision surgery. This paper summarized the treatment strategies, techniques and indications for postoperative nonunion of femoral intertrochanteric fractures at home and abroad in recent years, providing reference for the diagnosis and treatment of this dilemma in clinical setting.

Abstract:Impairment of the extensor mechanism secondary to total knee arthroplasty is a rare but devastating complication. Transfem- oral amputation is considered to be the last choice for failed knee arthroplasty, which seriously affects the quality of patient's life. At pres- ent, there is a variety of treatment methods, which has not been systematically evaluated. Therefore, this article summarizes the related origi- nal articles on the treatment of extensor mechanism disruption after total knee arthroplasty, involving the current researches on the injury mechanism, concrete treatment plan, and related complications, to provide a reference for clinicians who will deal with knee extensor dis- ruption.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of a modified anterolateral approach for Pi- lon fracture accompanied with Weber C fibula fracture. [Methods] A total of 16 patients received open reduction and internal fixation through the modified anterolateral approach for Pilon fracture accompanied with Weber C-type fibula fracture from January 2018 to Octo- ber 2019. This approach was gone between the anterior edges of tibia and fibula, extending downward to about 1cm below the ankle joint, forming a 110° arc and to the medial of the ankle midline. The fibula fracture ends were exposed between the peroneus and the extensor digitorum longus, and then a locking plate or 1/3 tubular plate was placed for fixation of the fibula. Subsequently, the medial column, mid- dle column and lateral column of the distal tibia were exposed inside and outside of tibialis anterior tendon, and the medial and anterolater- al anatomical plates were placed for fixation of the tibia. [Results] All patients had operation performed successfully, and followed up for (13.44±3.43) months. No complications such as infection and flap necrosis occurred except 2 patients. During the follow-up, all patients had no complications, such as internal fixation loosening and loss of fracture reduction. Clinical fracture healing time was of (13.75±1.75) weeks on average. The AOFAS score at the latest follow-up was of (82.94±7.39) , with excellent outcomes in 4 cases, good in 10 cases and fair in 2 cases. [Conclusion] This improved anterolateral approach for Pilon fracture accompanied with Weber C fibula fracture has the ad- vantages of full exposure and fewer complications, and is beneficial to the recovery of ankle function.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of anchor suture with figure of 8 stitch for fixation of patellar lower pole fractures. [Methods] From June 2017 to December 2019, 38 patients had patella lower pole fractures fixed with the above techniques. An anterior midline incision was made on the knee to expose the fracture ends. A 5.0 mm wire anchor was placed on the proximal fracture end of the patella. Two bone tunnels were created by using Kirschner wire 2-0 in diameter from the front on both sides to patellar articular surface posteriorly emerging 0.1 mm above the fracture end. The sutures were introduced through the tunnels by using epidural needle and stitched with the distal patellar end and tendon in woven, tightened and knotted. Then, two sutures were con- tinuously sutured back to the starting point on the proximal patellar end, and was tightened and tied. [Results] All 38 patients had operation completed successfully. At 12 months after the operation, the clinical outcomes were graded as excellent in 30 cases and good in 7 cases based on Bostman's criteria for patella fracture, with excellent and good rate of 100%. The knee joint stability was good. [Conclusion] This suture anchor technique for treatment of patellar lower pole fractures is simple and safe in surgical operation, get well knee functional recov- ery without the need of second operation to remove the implant.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic crowbar reduction com- bined with bone grafting for treatment of Schatzke type III tibial plateau fractures. [Methods] From January 2017 to January 2018, a total of 16 patients with Schatzke III tibial plateau fracture were treated with arthroscopic crowbar reduction, bone allografting and autologous bone plug fixation As standard anteromedial and anterolateral portals for knee arthroscopy was established, the concave center of tibial plateau collapse was positioned with a ACL guider, and a guide wire was inserted following the ACL guider in a proper angle. Using the bone extrac- tor of the osteochondral transplantation system, a cylindrical bone plug with a length of about 1.5 cm was removed under the guidance of the guide wire. Subsequently, the tibial plateau collapse was reduced to the normal level by slowly pry the roof with a crowbar under arthroscop- ic monitoring. The bone allografts were inserted into the bone tunnel and packed firmly to the upper part of the tunnel just under subchon- dral bone to maintaining the fracture reduction. Finally, the autologous bone plug harvested previously was inserted back. [Results] All pa- tients had surgical procedures performed successfully without serious complications, and were followed up for 24~40 months. The knee flex- ion- extension range of motion (ROM) , VAS and IKDC scores significantly improved at the latest follow up compared with those before op- eration (P＜0.05) . [Conclusion] This arthroscopic crowbar reduction combined with bone grafting has advantages of reduction under direct vision and minimally invasive operation, does achieve satisfactory clinical outcomes for Schatzke type III tibial plateau fractures.

Abstract:[Objective] To introduce the surgical techniques and preliminary results of arthroscopic figure “8” suture in figure "4" position for posterior cruciate ligament (PCL) tibial avulsion fractures. [Methods] From March 2019 to March 2021, 28 patients underwent abovementioned surgical treatment for PCL tibial avulsion fracture. Three portals were established: including anterolateral, anteromedial, and posteromedial portals. Sutures were introduced under the arthroscope and knotted around the PCL. Two bone tunnels were created on both sides of the fracture fragments, and then the sutures were introduced to the anterior aspect of the tibia through the bone tunnels. As the suture ends were pull out at anterior drawer position, the fracture was reduced firmly. Finally, the fractures were fastened by the sutures as them tied on anteriorly. [Results] All the 28 patients had operation performed successfully without serious complications, such as vascular and nerve injury. Lysholm score increased significantly from (33.14±9.60) before surgery to (84.07±5.43) at the latest follow-up (P＜0.05) , while IKDC score significantly increased from (32.39±84.79) preoperatively to (84.79±4.42) at the latest follow-up (P＜0.05) . At the last fol- low-up, clinical examination showed that none of the 28 patients had knee joint relaxation or instability, with affected knee range of motion symmetrical with the healthy side. Radiographically, all the 28 fractures got fracture healing without displacement. [Conclusion] The tech- nique is simple and reliable, does achieve satisfactory clinical outcomes for PCL tibial avulsion fractures.

Abstract:[Objective] To explore the clinical outcomes of locking plate for internal fixation of Seinsheimer type V femoral subtrochan- teric fractures. [Methods] From September 2014 to January 2019, 16 patients underwent open reduction and internal fixation with locking plate for Seinsheimer type V femoral subtrochanteric fractures. The perioperative status and follow-up results of the patients were recorded. [Results] All the 16 patients had operation performed successfully with incision length of (12.50±1.45) cm, operation time of (133.75± 18.21) min, and blood loss intraoperatively of (493.75±83.42) ml, whereas a patient got incision fat liquefaction after operation. The postop- erative follow-up period lasted for (22.52±5.04) months on average, while clinical fracture healing achieved in (7.88±1.15) months on aver- age. At the latest follow-up, the patients had VAS score of (0.50±0.63) , hip extension-flexion range of motion (ROM) of (135.88±6.30)°, and Harris score of (88.19±6.28) on average. The clinical outcome was marked as excellent in 10 cases, good in 5 cases, fair in 1 case, with an excellent and good rate of 93.75%. [Conclusion] The Seinsheimer type V femoral subtrochanteric fractures is difficult for reduction and fixation, however, locking plating is a safe and effective surgical method with good fracture healings and satisfactory clinical results.

Abstract:[Objective] To explore the clinical outcomes of bone autografting for repairing medial tibial plateau defect in primary total knee arthroplasty (TKA) . [Methods] A retrospective study was conducted on total of 180 patients who underwent primary total knee arthro- plasty from February 2006 to March 2019. Among them, 86 patients remained defect of the medial tibial plateau after tibial osteotomy, and then underwent bone autografting to repair the bone defect. The clinical and radiographic consequences of 86 patients were summarized. [Results] All the 86 patients were operated on successfully, without serious complications such as vascular and nerve injury. The 86 pa- tients were followed up for more than 2 years. All the patients got good function of the knee without revision performed except the first case who received revision TKA for knee pain aggravating 2 years after primary operation, which was caused by tibial prosthetic loosening con- firmed by imaging. The VAS scores were significantly decreased (P＜0.05) , whereas the ROM and HSS scores were significantly increased at the latest follow-up compared with those preoperatively (P＜0.05) . In terms of imaging, the femorotibial angle (FTA) and medial proximal tibial angle (MPTA) significantly improved (P＜0.05) , whereas the posterior tibial slope (PTS) remained unchanged (P＞0.05) at the latest fol- low up compared with those before operation. [Conclusion] Bone autografting has advantages of preserving bone stock maximally, better cost efficiency and achieving satisfactory clinical outcomes for Rand type II and III bone defects of the medial tibial plateau in the primary TKA.

Abstract:[Objective] To evaluate the clinical efficacy of Trimed hook plate for internal fixation of Danis-Weber type A lateral malle- olus fracture. [Methods] From July 2019 to January 2021, a total of 20 patients with Danis-Weber A ankle fracture were divided into two groups based on doctor-patient communication. Of them, 10 patients had the fracture fixed with Trimed hook plate, while the other 10 pa- tients had the fracture treated with conventional non-hook plate. The clinical and imaging data were compared between the two groups. [Results] The patients in both groups were operated on successfully. The hook plate group consumed significantly shorter operation time for lat- eral malleolus fracture management than the non-hook plate group (P＜0.05) . As time went on during the follow-up period lasted for more than 10 months, both AOFAS and Maryland scores increased significantly (P＜0.05) . The hook plate group was significantly superior to the non- hook plate group in abovementioned scores at all matching time points postoperatively (P＜0.05) . Radiographically, the hook plate group got significantly better fracture reduction quality, and significantly earlier fracture healing than the non-hook plate group (P＜0.05) . [Conclusion] This hook plate takes considerable advantages over the conventional non-hook plate in term of early outcomes for internal fix- ation of Danis-Weber type A lateral malleolus fractures.