Abstract:[Objective] To compare the clinical outcomes of hexapod external fixator (HEF) versus unilateral external fixator (UEF) for open tibial shaft fractures. [Methods] A retrospective study was performed on 123 patients who had open tibial shaft fractures treated in our hospital from June 2017 to September 2019. According to the results of doctor-patient communication, 72 patients received HEF, while the remaining 51 patients were used UEF. The perioperative period, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation finished successfully. The HEF group proved significantly superior to the UEF in terms of the number of postoperative frame adjustment and time to resume postoperative weight-bearing activity (P＜0.05), but the former costed significantly more than the latter (P＜0.05). There were no significant differences in operation time, intraoperative fluoroscopy times, time to stand on ground and hospital stay between the two groups (P＞0.05). All the patients were followed up for (26.5±1.3) months on an average, and the HEF group had the external fixator removed significantly earlier than the UEF group (P＜0.05). The knee and ankle flexion- exten- sion ROM significantly improved over time in both groups (P＜0.05), whereas which were not significant different between the two groups at any corresponding time points (P＞0.05). In addition, there was no significant difference in Johner-Wruhs grade, as well as claudication and squatting scales between the two groups at the latest follow-up (P＜0.05). Radiographically, fracture alignment and tibial shortening were significantly improved in both groups with postoperative time (P＜0.05). The HEF group proved significantly superior to the UEF in terms of fracture healing time on images, as well as the fracture alignment and tibial shortening at the latest follow-up (P＜0.05). [Conclusion] The HEF for open tibial shaft fractures does improve the quality of fracture reduction, and shorten the time of frame bearing and fracture healing compared with the traditional UEF.

Abstract:[Objective] To compare the clinical outcomes of mixed bone autografting (MBAG) versus granular bone autografting (GBAG) in the treatment of postoperative nonunion of middle and lower tibial shaft fractures. [Methods] A retrospective study was conduct- ed on 48 patients who received bone autografting for aseptic bone nonunion of the middle and lower tibial shaft secondary to previous surgi- cal treatment in our hospital from May 2013 to May 2020. According to the results of preoperative doctor-patient communication, 28 pa- tients received MBAG, while the other 20 patients received GBAG. The documents regarding perioperative period, follow-up and imaging were compared between the two groups. [Results] All patients in both groups were operated on successfully without important vascular and nerve injuries during the operation. The MBAG group consumed significantly longer operative time with a significantly longer total incision length than the GBAG group (P＜0.05), however, the former resumed postoperative walking significantly earlier than the latter (P＜0.05). There were no significant differences in terms of intraoperative blood loss, intraoperative fluoroscopy times, postoperative drainage volume, incision healing grade and total hospital stay between the two groups (P＞0.05). All patients in both groups were followed up for (15.9±2.6) months on an average, and the MBAG group returned to full weight-bearing activity significantly earlier than the GBAG group (P＜0.05). The AOFAS score and dorsal extension-plantar flexion range of motion (ROM) increased significantly in both groups over time (P＜ 0.05), which were not significantly different before operation between the two groups (P＜0.05), whereas the MBAG group proved significantly su- perior to the GBAG group in terms of AOFAS score and ROM 3 months postoperatively (P＜0.05), and AOFAS score at the latest follow-up (P＜0.05). In addition, the MBAG group was significantly superior to the GBAG in term of Johner-Wruh criteria at the latest follow-up (P＜ 0.05). Radiographically, the MBAG group got healing of the nonunion significantly earlier than the GBAG group (P＜0.05). [Conclusion] Both bone autografting techniques do effectively treat nonunion of the middle and lower shaft of the tibia. In contrast, the clinical efficacy of mixed bone autografting is superior to granular bone autografting.

Abstract:[Objective] To compare the long-term clinical outcomes of femoral neck system (FNS) versus four cannulate compression screws (CS) for femoral neck fracture. [Methods] From September 2018 to June 2021, a total of 45 patients with femoral neck fracture were included in this study. According to doctor-patient communication, 22 patients received FNS internal fixation, while the remaining 23 pa- tients underwent CS internal fixation. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had corresponding surgical procedures performed successfully. The FNS group was significantly less than the CS group in terms of operative time [(54.6±18.0)min vs (84.3±33.3)min, P=0.001] and intraoperative fluoroscopy times [(17.3±4.2)times vs (24.3±6.3)times, P＜0.001], whereas the former was significantly greater than the latter in terms of incision length [(5.4±0.6)cm vs (4.6±0.7) cm, P＜0.001] and intraoperative blood loss [(132.4±50.9)ml vs (47.0±15.7)ml, P＜0.001]. All patients were followed up for 15~46 months, with a mean of (29.5±15.2)months. The FNS group returned to full weight-bearing activity significantly earlier than the CS group [(5.5±1.2) months vs (7.7±4.2)months, P=0.029]. The Harris score, hip extension-flexion ROM and hip internal-rotation ROM were significantly in- creased in both groups over time (P＜0.05). By the latest follow-up, the FNS group had significantly lower incidence of late adverse events, including internal fixation displacement, femoral neck shortening, fracture nonunion, and femoral head necrosis, than the CS group [7/22 (31.8%) vs 15/23 (65.2%), P=0.027]. The former had low rate of total hip replacement revision than the latter, despite of that the difference was not statistically significant [4/22 (18.2%) vs 8/23 (34.8%), P=0.563]. In terms of imaging, Garden index was significantly improved in both groups at the last follow-up compared with the preoperative period (P＜0.05). At the last follow-up, the FNS group got significantly low- er incidence of adverse imaging changes than the CS group (P＜0.05). The Tonnis grade of hip degeneration tended to increase over time in both groups, but the difference was not statistically significant (P＞0.05). [Conclusion] The FNS used as internal fixation for femoral neck fracture in young and middle-aged does considerably be superior to the CS regarding fracture healing and late adverse events.

Abstract:[Objective] To compare the clinical outcomes of arthroscopic double-bundle coracoclavicular reconstruction with 3 button plates (DB), arthroscopic single- bundle reconstruction with 2 button plates (SB) and traditional open hook plate fixation (HP) for acute Rockwood type III acromioclavicular dislocation. [Methods] A retrospective study was conducted on 49 patients who received surgical treatment for Rockwood type III acromioclavicular dislocation in our hospital from October 2016 to December 2020. According to preopera- tive doctor-patient communication, 15 patients underwent DB, 17 were treated with SB, while the remaining 17 received HP. The periopera- tive period, follow-up and imaging data were compared among the three groups. [Results] All the three groups were successfully operated on without serious complications. The DB and SB groups proved significantly superior to the HP group in terms of incision length, intraoper- ative blood loss and postoperative hospital stay (P＜0.05). The VAS score for pain decreased significantly over time during the early stage in all three groups (P＜0.05), which in DB and SB groups were significantly less than that in the HP group 4 and 14 days after surgery (P＜ 0.05). All patients were followed up for more than 12 months, the DB group and SB group resumed full weight-bearing activities significant- ly earlier than the HP group (P＜0.05). The Constant-Murley scores, abduction range of motion (ROM), forward flexion ROM, and internal-external rotation ROM significantly increased over time in all the three groups (P＜0.05). Although there was no significant differences in the abovesaid parameters among the three groups before surgery (P＞0.05), the DB group were significantly better in those than the SB group and HP group at 3 months and the latest follow-up (P＜0.05). As for imaging, the acromioclavicular distance (ACD) and coracoclavicular dis- tance (CCD) significantly reduced postoperatively in all the three groups compared with those preoperatively (P＜0.05). There was no signifi- cant difference in ACD among all groups at time points accordingly (P＞0.05), but the DB group and SB group proved significantly superior to the HP group in term of CCD at 2 weeks postoperatively and the latest follow-up (P＜0.05). [Conclusion] The arthroscopic DB coracocla- vicular reconstruction with 3 button plates does achieve better clinical outcomes than the SB reconstruction and traditional open HP fixa- tion for acute Rockwood type III acromioclavicular dislocation in this study.

Abstract:[Objective] To compare the clinical outcomes of zero-profile stand-alone cervical cage (ROI-C) versus conventional cage and plate (CP) used in anterior cervical decompression and fusion (ACDF) for traumatic disc herniation accompanied with spinal cord inju- ry. [Methods] A retrospective study was performed on 44 patients who received ACDF for traumatic disc herniation with spinal cord injury in our department from September 2015 to September 2020. According to doctor-patient communication, 21 patients received ACDF with ROI-C, while the remaining 23 patients had conventional CP used. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation performed successfully without serious intraoperative complications. The ROI-C group proved significantly superior to the CP group in terms of operation time, incision length, intraoperative fluoroscopy times, in- traoperative blood loss, postoperative walking time and hospital stay (P＜0.05). All of them were followed up for (16.8±3.2) months on an av- erage, and the ROI-C group resumed full weight-bearing activities significantly earlier than the CP group (P＜0.05). The ASIA grade for neurological function, JOA and NDI scores and pyramidal signs improved significantly over time in both groups (P＜0.05). Although there were no statistically significant differences in the abovesaid items between the two groups before surgery (P＞0.05), the ROI-C group proved significantly superior to the CP group in term of ASIA grade 1 and 3 months after operation (P＜0.05). Regarding imaging, postoperative C_2~7 Cobb angle and intervertebral height significantly improved in both groups compared with those before surgery (P＜0.05), which was not sta- tistically significant between the two groups before surgery (P＞0.05), the ROI-C group got significantly higher intervertebral space height than the CP group at all time points postoperatively (P＜0.05). In addition, the ROI-C group had significantly better intervertebral fusion than the CP group three months after surgery (P＜0.05). [Conclusion] Both procedures do improve neurological function, improve cervical physiological curvature, and maintain intervertebral height for traumatic disc herniation with spinal cord injury. Compared with traditional CP, the ROI-C has the advantages of less trauma and shorter operation time, and more obvious effect of restoring the height of cervical inter- vertebral space.

Abstract:[Objective] To compare the clinical outcomes of total hip arthroplasty (THA) through the Orthopadische Chirurgie Munchen (OCM) approach versus the direct lateral approach (DLA). [Methods] A retrospective study was performed on 53 patients who received THA in our hospital from January 2018 to January 2022. According to the results of preoperative doctor-patient communication, 18 patients had THA performed through OCM approach,while the other 35 patients took DLA approach. The perioperative period, follow-up and imaging da- ta were compared between the two groups. [Results] All patients in both groups had THA completed successfully without nerve or vascular injury and other serious complications. Although the OCM group spend significantly longer operation time than the DLA group (P＜0.05), the former proved significantly superior to the latter in terms of incision length, intraoperative blood loss, blood transfusion rate, postoperative time of getting out of bed and hospital stay (P＜0.05). As time went during follow-up lasted for (15.0±3.2) months on an average, the Harris score and hip extension-flexion range of motion (ROM) significantly increased in both groups (P＜0.05). There were no significant differences in preoperative Harris score and ROM between the two groups (P＞0.05), which in the OCM group were significantly superior to those in the DLA group one month after surgery (P＜0.05), whereas became not statistically significant between the two groups 3 months after surgery and at the latest follow-up (P＞0.05). Radiographically, the acetabular abduction angle, anteversion angle and bilateral leg length discrepancy were not statistically significant between the two groups postoperatively (P＞0.05). [Conclusion] Compared with the traditional DLA, the OCM approach used in THA has the advantages of less injury, less bleeding and faster postoperative recovery.

Abstract:[Objective] To compare the clinical results of closed reduction and fixation in human position with above-knee hip spica cast versus standard hip spica cast for developmental dysplasia of the hip in infants. [Methods] A retrospective study was performed on 6~18 month-age 121 children who received closed reduction and external fixation in human position with hip spica cast in our department from January 2010 to December 2018. According to the results of communication with the parents of the infant, 58 infant (76 hips) were fixed with above-knee cast (AK group), while the other 63 cases (80 hips) had standard hip spica cast used (SD group). The clinical and imaging data of the two groups were compared. [Results] The early redislocation rate was 11.8% (9/76) in the AK group, whereas 2.5% (2/80) in the SD group, which proved statistically significant between them (P＜0.05). All children with redislocation were changed to open reduction, and were excluded from further evaluation of this study. There were no significant differences in fluoroscopy times, time in plaster, and incidence of pressure sores between the two groups (P＞0.05). All the children were followed up for (5.3±2.0) years on an average, and there was no sig- nificant difference in the time to start standing and to walking after the plaster removed between the two groups (P＜0.05). Radiographically children in both groups got significant improvement in T?nnis grades at the latest follow-up compared with those pre-treatment (P＜0.05). In addition, the Severin grade and center-edge angle (CE) in both groups remained unchanged at the latst follow-up compared with those just after cast removal (P＞0.05), whereas acetabular index (AI) increased significantly over time in both groups (P＜0.05). At any corresponding time points, there were no significant differences in T?nnis grade, Severin grade, CE and AI between the two groups (P＜0.05). At the latest follow-up, the femoral head necrosis rate was 14.9% (10/67) in the AK group, while 16.7% (13/78) in the SD group, which was not statistical-ly significant (P＞0.05). [Conclusion] Closed reduction and fixation with hip spica cast is an effective treatment for DDH in 6~18 monthage infant, the above-knee hip spica cast has higher risk of early redislocation than the standard hip spica cast. Key words: developmental dysplasia of the hip, closed reduction plaster fixation, human position, above-k

Abstract:Medial meniscal posterior root performed an important biomechanical function of the meniscus. As an important anatomical structure for maintaining annular tension of the medial meniscus of the knee joint, the posterior root has also received increasing attention. Several works have summarized the indications, surgical methods and clinical outcomes of medial meniscal posterior root tears. The litera- tures regarding to above issues are reviewed in this article.

Abstract:Intervertebral disc degeneration (IDD), one of the most common clinical spinal degenerative diseases, is the main cause of low back pain, which could affect the quality of life of the population, and bring a huge economic burden to the family and society. In recent year, a large number of studies found that dysregulation of mitochondrial homeostatic system could be observed in degenerated nucleus pulposus cells. The mitochondrial homeostasis system can regulate the proliferation and apoptosis of nucleus pulposus cell, thereby affect- ing the pathophysiological process of IDD. This article reviews the regulatory roles of mitochondrial homeostasis in the development of IDD, involving mitochondrial antioxidant system, mitochondrial protein homeostasis, mitochondrial dynamics, mitochondrial biogenesis and mi- tophagy to provide new ideas for exploring the early prevention and treatment of IDD.

Abstract:The femoral shaft fractures (FSF) are common fractures in clinical orthopedics, usually caused by high energy. As a result of its special anatomy, most fractures occur with obvious displacement, and accompanied with complications, such as fat embolism and acute respiratory distress syndrome that may threaten life in severe cases, as well as malunion and bone nonunion if treated improperly. There- fore, FSF should be treated timely and effectively to restore the continuity, normal alignment and length of the bone. However, the most com- monly used internal fixation methods, such as intramedullary nail and bone plate all have their own advantages and disadvantages. This arti- cle mainly introduces the research progress in internal fixation of femoral shaft fracture in adults, in order to provide reference for clinical practice.

Abstract:Tibial torsion (TT) refers to the twisting of the tibia itself around its longitudinal axis, which may cause clinical symptoms such as abnormal gait, knee pain, and patellofemoral joint disorder in about 1% of adults, despite of the fact that TT is prone to be ignored in clinical setting. The current research on tibial torsion in China mainly focuses on the relationship between the angle of tibial torsion and clini- cal symptoms. In this paper, we reported a case of tibial torsion deformity treated by surgery, additionally reviewed the literatures about the clinical symptoms, surgical indications and surgical methods for tibial torsion to provide a reference for the diagnosis and treatment of clini- cal tibial torsion.

Abstract:Posterior shoulder dislocation (PSD), also known as posterior glenohumeral dislocation, refers to that the humeral head is displaced out the posterior margin of posterior glenoid fossa under direct backward forces in extreme adduction and internal rotation posi- tion. Compared with anterior glenohumeral dislocation, PSD is considerably rare, while with significantly higher rate of missed diagnosis and misdiagnosis. Clinically, PSD is frequently accompanied with obvious bone defects of the anterior humerus head, namely reverse HillSacks lesion. In this paper, we reported one case of acute posterior glenohumeral dislocation with reverse Hill- Sacks lesion was treated non-operatively, additionally the relative literatures were reviewed in order to provide reference for the clinical management of PSD.

Abstract:Lumbar disc herniation (LDH) is a highly prevalent disease and a common cause of sensory-motor disorders of the lower ex- tremities in adults. Most of the current research on LDH is traditional, however, with the advance of artificial intelligence, machine learning (ML) is gradually taking the historical stage. The ML use computers to learn complex relationships from big data and generate models that link a large number of covariates to the target variable of interest, including but not limited to lesion detection and classification, automatic image segmentation, data analysis, radiological feature extraction, priority reporting and study classification, and image reconstruction. The ML has reached a considerable level of ability to process data. This paper reviews current ML researches in LDH.

Abstract:[Objective] To introduce the techniques and preliminary clinical results of surgical treatment and rapid rehabilitation of Hoffa fracture accompanied with medial collateral ligament avulsion fracture. [Methods] From May 2016 to March 2021, 3 patients re- ceived abovementioned treatment for the medial Hoffa fracture complicated with avulsion fracture at the origin of the medial collateral liga- ment. All the patients underwent open reduction and internal fixation with full-thread cannulated screws and medial plate through the medi- al incision. In addition, lag cannulated screws was used to fix the insertion of the medial collateral ligament with reinforcement by Ethicon suture. After operation, the knee was placed at 110°~120° of flexion, while analgesic pump used for pain relief and ankle pump exercise and quadriceps isometric contraction training were performed. Twenty-four hours later, knee extension-flexion exercise was performed 3 times a day with 30 minutes each time. After exercise, the knee joint was fixed at 110°~120° for a total of 3 days. After 3 days, the knee po- sition was determined according to the knee extension-flexion function. [Results] All the 3 patients had operation performed successfully without serious complications, such as vascular and nerve injury, and got incisions healed well. The knee extension-flexion range of motion (ROM) was of (142.3±8.7)° at 2 months after operation, whereas the HSS score was of (85.4±5.1) at the latest follow-up. All the patients had knee function recovered well without knee stiffness, while got fractures healed well on the radiographs with healing time of 3~6 months., whereas no adverse imaging changes such as internal fixation loosening and displacement, refracture of the repaired ligament occurred. [Conclusion] After open reduction and internal fixation of Hoffa fracture complicated with avulsion fracture of medial collateral ligament, maintaining 110°~120° knee flexion fixation and early functional exercise do accelerate the rehabilitation of knee function and reduce the occurrence of complications.

Abstract:[Objective] To investigate the clinical outcomes of posterior unilateral door- open decompression combined with pedicle screw fixation for multilevel discoligamentous complex injuries secondary to cervical hyperextension injury. [Methods] From January 2016 to June 2021, 36 patients underwent abovementioned surgical procedures for multilevel discoligamentous complex injuries secondary to cer- vical hyperextension injury. The clinical and imaging data were evaluated. [Results] All the 36 patients had operation performed successful- ly without serious complications. With time of the follow-up period lasted for more than 8 months (before surgery, 3 months after surgery and at the latest follow-up), the ASIA neurological function scale [A/B/C/D/E, (4/10/16/6/0), (0/4/6/12/14), (0/0/4/8/24), P<0.001], JOA cer- vical score [(7.8±2.4), (11.6±2.2), (14.2±1.4), P<0.001] and neck-pain VAS score [(5.2±1.6), (2.9±1.4), (1.6±1.1), P<0.001] significantly improved. However, the cervical curvature measured by imaging showed a decreasing trend over time, but the difference was not statistical- ly significant (P>0.05). Until the last follow- up, all patients had no adverse imaging manifestations such as loosening or fracture of the screws and rods. [Conclusion] The posterior decompression and fixation for multilevel discoligamentous complex injuries leaded by cervi- cal hyperextension have the advantages of sufficient decompression, good recovery of nerve function and strong spinal stability remained, avoiding the complications of long-segment anterior cervical surgery.

Abstract:[Objective] To explore the clinical outcomes of percutaneous retrograde pubic rami screw for fixation of fragile fracture of pelvis (FFP) in the elderly. [Methods] A retrospective study was conducted on 25 elderly patients (27 sides of pubic rami) who underwent percutaneous retrograde pubic rami screw for fixation of FFP in our hospital from June 2019 to December 2020. The clinical and imaging consequences were evaluated. [Results] All patients were operated smoothly without complications such as nerve and vascular injuries dur- ing the operation. All patients were followed up for (17.8±0.7) months, with the mean time to return to full weight-bearing activities of (7.8± 0.6) weeks. The Majeed scores significantly increased at the last follow-up compared with 3 months after surgery (P＜0.05), whereas the hip internal-external rotation range of motion (ROM) and extension-flexion ROM remained unchanged (P＞0.05). At the last follow-up, the clin- ical results were marked as excellent 19 sides, good 7 sides and fair 1 side with an excellent and good rate of 96.3% according to Majeed criteria. In terms of imaging, the reduction quality of fracture based on Matta criteria were excellent in 21 sides and good in 6 sides, with ex- cellent and good rate of 100.0%. Of them, 11 sides got fracture healing in 8 weeks, accounted for 40.7%, while the other 16 sides got heal- ing from 8 weeks to 12 weeks, accounted for 59.3%. There was no significant change in term of Tonnis classification for hip degeneration at the latest follow-up compared with those 3 months after surgery (P＞0.05). [Conclusion] The percutaneous retrograde pubic rami screw has the advantages of less trauma, less blood loss, fewer complications and faster functional recovery for treatment of FFP in the elderly.

Abstract:[Objective] To investigate the efficiency of intermittent pneumatic compression (IPC) used for prevention of deep vein thrombosis (DVT) after Achilles tendon repair. [Methods] A total of 114 patients received minimally invasive surgical repair for acute Achilles tendon rupture in our hospital from January 2020 to January 2022. Based on postoperative doctor-patient communication, 59 pa- tients received postoperative routine plaster fixation (the conventional group), while the other 55 patients underwent postoperative routine plaster fixation combined with IPC treatment (IPC group). The incidence of postoperative complications and DVT was compared between the two groups. [Results] All patients in both groups were successfully operated on. Sural nerve injury was found in one case of the IPC group, whereas non in the conventional group, which was considered to be caused by intraoperative pulling and recovered after drug treat- ment, without a statistically significant difference between the two groups (P＜0.05). Poor incision healing and superficial infection were not- ed in 3 patients in the conventional group, while 2 cases in the IPC group, which healed well after dressing change, with no statistically sig- nificant difference in incision healing grade between the two groups (P＞0.05). Ultrasonographically, the incidence of DVT in the IPC group was significantly lower than that in the conventional group 2 weeks after surgery (5.5% vs 13.6%, P=0.042), whereas it became not signifi- cantly different between the two groups 4 weeks after surgery (20.0% vs 25.4%, P=0.737). [Conclusion] The IPC treatment does effectively reduce the incidence of DVT, without significant impact on wound healing and sural nerve.

Abstract:[Objective] To evaluate the clinical efficacy of a novel reductor developed by ourself used for maintaining reduction during percutaneous fixation of humeral supracondylar fractures in children. [Methods] A total of 85 children received percutaneous fixation with Kirschner wire for the extended humeral supracondylar fractures in our hospital from June 2019 to June 2022. According to doctor-patient communication, 43 children received the novel reductor assisted reduction and percutaneous fixation with Kirschner wire (the novel group), while the other 42 patients underwent the traditional closed reduction and percutaneous fixation (the traditional group). The clinical and im- aging consequences were compared between the two groups. [Results] The novel group proved significantly superior to the traditional group in terms of operative time [(36.0±6.6)min vs (55.7±8.5)min, P＜0.001] and intraoperative fluoroscopy [(19.8±3.2)times vs (36.7±6.3)times, P＜ 0.001], although there was no significant difference in the incidence of postoperative complications between the two groups (P＞0.05). At the latest follow-up lasted for (6.7±3.2) months on a mean., there was no significant difference in Flynn grade between the two groups (P＞0.05). The novel group had significantly greater carrying angler than the traditional group [(11.2±1.4)° vs (8.0±1.3)°, P＜0.001], despite of that the Baumann angle was not statistically significant between them at the latest follow-up (P＞0.05). [Conclusion] This novel reduction device is simple in structure, which does shorten the operative time of percutaneous fixation and reduce the number of intraoperative fluoroscopy for humeral supracondylar fractures in children.